Skills Checklist – PTA Skills Checklist – PTA Name First Last Phone Email SETTING* Rarely Some Experience Proficient Trainer / Preceptor N/A Acute Rehab Inpatient Neck Injuries / Surgeries ADULT – ORTHOPEDIC:* Rarely Some Experience Proficient Trainer / Preceptor N/A Neck Injuries / Surgeries Back Injuries / Surgeries Hip Fractures / Injuries Total Hip Replacement Knee Injuries Total Knee Replacement Upper Extremity Joint Replacements Shoulder Injuries Degenerative Joint Disease / Arthritis Hand Injuries Temporomandibular Joint (TMJ) Post Operative Care Amputations ADULT – NEUROLOGIC:* Rarely Some Experience Proficient Trainer / Preceptor N/A Stroke Rehabilitation Cognitive Disorders Head Trauma Spinal Cord Injury Functional Splinting Adaptive Equipment-Wheelchair Neuromuscular Diseases Multiple Sclerosis ADULT – Prosthetics / Orthotics:* Rarely Some Experience Proficient Trainer / Preceptor N/A Upper Extremity Prosthetics Above Knee Prosthetics Below Knee Prosthetics SPORTS MEDICINE* Rarely Some Experience Proficient Trainer / Preceptor N/A LIDO Machine Nautilus Machine Taping PROCEDURES / TREATMENTS* Rarely Some Experience Proficient Trainer / Preceptor N/A Ankle / Foot Orthosis Slings Splints – Wrist / Hand CPM Machine Hydrotherapy Whirlpool Hubbard Tank Therapeutic Pool TENS Electrical Stimulation Ultrasound Cryotherapy Massage Diathermy Acupressure Spinal Mobilization Extremity Mobilization Myofacial Release Craniosacral Techniques Cervical Traction Lumbar Traction Activities of Daily Living Gait Training Transfers Sports Medicine Athletic Injuries Biodex Cybex Orthotron OTHER* Rarely Some Experience Proficient Trainer / Preceptor N/A Chest PT Cardiac Rehab ICU Procedures CCU Procedures SICU Procedures Burn Management Work Hardening – Work Site Eval Work Capacity Eval Functional Capacity Eval Muscle Energy Techniques Universal Precautions Skilled Nursing Documentation Medicare A Medicare B State Healthcare Skilled Nursing Documentation Electronic Documentation OTHER – TYPES OF ELECTRONIC DOCUMENTATION:(if applicable) Age Group Experience* Rarely Some Experience Proficient Trainer / Preceptor N/A Newborn (birth – 30 days) Infant (30 days – 1 year) Toddler (1 – 3 years) Preschooler (3 – 5 years) School Age (5 – 12 years) Adolescents (12 – 18 years) Young Adults (18 – 39 years) Middle Adults (39-64 years) Older Adults (64+ years) Do you speak any languages other than English?* No If yes, enter languages above, separated by commas. Confirmation* I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education. Signature Date Date Format: MM slash DD slash YYYY