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PT	PTA
OT	OTA
SLP	CFY

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1 = No Experience		3 = Experienced
2 = Intermittent Experience		4 = Supervise and Teach

Orthopedic	1	2	3	4
Neck Injuries
Back Syndromes
Hand Injury
Arthritis Programs
Total hip/knee replacement
Total joint replacement/upper extremities
Transmandibular joint dysfunction
Hip Fractures
Mobilization techniques
Neurologic	1	2	3	4
Stroke rehabilitation
Adaptive equipment
Functional splinting
Head Trauma
Neurosurgery
Spinal cord injury
Sports Medicine	1	2	3	4
Bracing/joint immobilization
Biodex
Cybex
LIDO
Orthotron
Nautilus/Eagle
Taping/Strapping
Strength and endurance training
Modalities/Manual Skills	1	2	3	4
Acuscope
Biofeedback
Continuous passive motion machine
Cryotherapy
Diathermy
Craniosacral therapy
Electro-acupuncture
Extremity mobilization
Fluidotherapy
Hot/Cold packs
Hydrotherapy
Hubbard tank
Therapeutic pool
Whirlpool
Massage
Muscle Energy Techniques
Muscle Stimulation
Myofascial release techniques
Neuro probe
Paraffin
Spinal mobilization
Strain/counter strain techniques
TENS
Therapeutic exercise/home programs
Traction
Cervical
Lumbar
Ultrasound
Wound Dressing
Vasopneumatic devices
Prosthetics/Orthotics	1	2	3	4
Above knee prosthetics
Below knee prosthetics
Upper extremity prosthetics
Ankle foot orthosis
Dynamic splints
Static Splints
Gait analysis
Orthoplast/aquaplast
Resting splints
Serial/inhibitory casting
Pediatrics	1	2	3	4
Early intervention
Cerebral Palsy
Equipment assessment
Activities of daily living
Adaptive
Gross motor assessment tools
Learning disabled
Mental retardation
Neurodevelopmental treatment
Orthotics
Spina bifida
Computerized Testing	1	2	3	4
Fatigue-characteristics
Fiber-type
Functional strength
Net muscular torque
ROM
Work-Capacity
Other	1	2	3	4
Burn Management
Chest physiotherapy
Cardiac rehabilitation
Functional capacity evaluation
Geriatrics
Inservice Education
Wheelchair/equipment assessment
Work capacity evaluation

National Specialization Certification	Date Certified
Cardiopulmonary
Clinic Electrophysiology
Geriatrics
NDT
Orthopedics
Pediatrics
Sports Physical Therapy
Athletic Trainer Certified
Other

Education
1. Graduated From
Degree
2. Graduated From
Degree

Licenses
License Number
Expiration
State

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