| Application form for an basic course
Orthopedic technician
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| Please fill in all the rubrics
marked with a star *
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| City of the workplace:
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| Personal data
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| *Name surname
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Pole wymagane. |
| *Occupation/specialization
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Pole wymagane. |
| *Date of birth
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Pole wymagane. |
| Home address:
:
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| *Street
:
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Pole wymagane. |
| *City/Zip
:
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Pole wymagane. |
| *Phone:
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Pole wymagane. |
| *Email:
:
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Pole wymagane. |
| Place of employment
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| *Name of the workplace
:
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Pole wymagane. |
| *Street
:
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Pole wymagane. |
| *City/Zip
:
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Pole wymagane. |
| *Phone:
:
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Pole wymagane. |
| *Email:
:
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Pole wymagane |
| *Work experience. Short description
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Pole wymagane. |
| *Member of the medical team treating CP children
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Tak NIE Pole wymagane. |
| Medical team consists of:
MDs physiatrist, neurologist, orthopedic surgeon,
Therapists: PT physiotherapist, OT occupational
therapist and CPO orthopedic technician.
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| *Years of working with CP children
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Pole wymagane. |
| *Amount of hours per week:
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Pole wymagane. |
| Are you familiar with:
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| *central movement disorders with CP
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Tak NIE Pole wymagane. |
| *goal oriented treatment
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Tak NIE Pole wymagane. |
| *gait analysis
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Tak NIE Pole wymagane. |
| *knowledge of gait patterns 1,2.3.4 &5 with CP
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Tak NIE Pole wymagane. |
| *doing fysical examination of gastrocnemius,
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Tak NIE Pole wymagane. |
| *soleus dorsiflexion, pro/supination
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Tak NIE Pole wymagane. |
| *correction of footdeformities using 3 point pressure groundreaction forces and joint torques
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Tak NIE Pole wymagane. |
| *casting & correction of plastermodels:
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Tak NIE Pole wymagane. |
| *working with polypropylene in dorsal afo / hinged:
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Tak NIE Pole wymagane. |
| *AFO fitting , delivering AFO's and tuning AFO/ shoe:
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Tak NIE Pole wymagane. |
| *Knowledge of English
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| Good
:
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Pole wymagane. |
| Sufficient
:
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Pole wymagane. |
| Insufficient
:
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Pole wymagane. |
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