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                         OLD DOMINION UNIVERSITY


                          EXERCISE SCIENCE PROGRAM

                                          EXSC 368W


                                  Guidelines and Procedures

Elizabeth A. Dowling, PhD
Associate Professor
Exercise Science Internship Coordinator
Student Recreation Center, 2024
Norfolk, VA 23529-0196
Phone: (757) 683-4514
Fax:    (757) 683-4270
E-mail: (ldowling@odu.edu)

Revised January, 2009

                                            TABLE OF CONTENTS

Topic                                                           Page

Internship Checklist                                            3

Internship Guidelines                                           4

Evaluation Procedures                                           6

Area Internship Sites                                           8

Sample Cover Letter                                             12

Sample Resume’                                                  14

Sample Internship Objectives                                    16

Affiliation Agreement (CONTRACT)                                18

Internship Evaluation                                           22

Case Studies Examples                                           26

Supervisor’s Evaluation Forms                                   36
        (Mid-term and Final)

Roles and Responsibilities of the Internship Coordinator        44

Internship Assessment Form                                      45

                                      INTERNSHIP IN EXERCISE SCIENCE

Approval of the internship site must be obtained from the Program Internship Coordinator Director Elizabeth A.
Dowling, Ph.D.


1.)      Signed Affiliation Agreement
2)       Name of facility, supervisor, address and phone number of internship site, and your personal address, and
         phone number
3.)      Objectives Checklist (turned in the second week of internship)


4.)      Site Assessment Internship Form
5.)      Updated resume
6.)      Exit Interview

The student is responsible for obtaining a signed affiliation agreement internship site prior to the internship
deadline date.


                   SPRING INTERNSHIP                     December 1
                   SUMMER INTERNSHIP                     April 1
                   FALL INTERNSHIP                       August 1


Once the internship has started the student is responsible for maintaining a weekly summary of internship activities
(diary) to be sent via e-mail to the assigned Internship Supervisor.

In addition, the student is responsible for the following prior to the start of the internship.

         1. Completing all major course work
         2. Meeting graduation requirements (GPA=2.0)
         3. Passing the writing proficiency exam

Internship Guidelines


The purpose of the internship program is to provide professional experiences to support academic preparation in the
undergraduate exercise science program. The internship also serves to strengthen your candidacy for entrance into
graduate school and/or the job market.

All internships must be approved by the Internship Coordinator. Internship sites which do not meet the standards
established by these guidelines will not be accepted. The Internship Director also reserves the right to place the
student at a particular internship site or terminate an internship if it is deemed necessary.

You are required to document a minimum of 400 hours (over the FULL 16 week semester) in an approved
internship program. The internship is usually conducted at one site. However, additional internship sites or
departments within an internship organization may be used in order to provide a multidimensional experience.
Consult the Internship Coordinator for specific details concerning selection of intern programs.


The internship is designed to be the culminating experience in the exercise science program and is designed to occur
in the second semester of the senior year. Therefore, ALL core academic courses must be completed prior to
conducting the internship. Exceptions to this prerequisite can only be made by the Undergraduate Program

The student must also have the appropriate grade point average in their major (see coordinator of exercise science
program.) Additionally, the student must realize that the internship is their primary responsibility and that work and
personal matters should not interfere with the internship.


It is the responsibility of the student to identify, contact, and select the internship based on the approval of the
Internship Coordinator, Dr. Dowling. This process should begin at least 4-6 months prior to the start of the
internship. Specific procedures for identifying an internship are as follows:

1.       Identify several institutions in which you would like to conduct your internship. The internship may be
         conducted at local, regional or national approved sites. Since many students obtain employment based on
         their performance in their internship, it is highly suggested that the student do their internship in the field of
         there desired employment. Also, it is to the student’s advantage to conduct their internship at the most
         progressive and multidimensional institution possible. Therefore, it is highly recommended that the student
         perform their internship at regional or national selected sites which provide the greatest learning

         The student may NOT perform their internship in a place of current or prior employment unless the
         internship is conducted in another department of the institution by the approval of the Internship

2.       If necessary, write a letter of inquiry to each institution and ask for details concerning clinical programs and
         opportunities for internships. Your letter should specifically detail your academic preparation and clinical
         skills that you are able to perform.

3.       Once you received information on the potential internship, discuss the potential internship program with the
         Internship Coordinator, Dr. Dowling.

4.       Based on the Internship Coordinator's advice, apply to several internship organizations. Many potential
         internship sites have prepared intern guidelines and procedures which must be adhered to in order to obtain
         the internship. Additionally, many internship sites require an application to be submitted approximately

        three to six months in advance.

        Application for an internship involves sending a resume and cover letter. Some sites may require an
        interview and letters of recommendation.

        Once your internship options have been identified, informally discuss each potential internship opportunity
        with Dr. Dowling.

5.      Based on the Internship Coordinator's advice, make your final selection and inform the organization of your
        acceptance in writing. Send or hand deliver the Internship Affiliation Agreement to the Clinical Facility
        Internship Supervisor.

        You must then submit the original Internship Affiliation Agreement to Dr. Dowling who will obtain
        additional signatures within the university. No internships may begin prior to the receiving signed and
        approved Internship Affiliation Agreement.


As previously stated, the internship should be a multidimensional experience strengthening the academic and
clinical preparation of the exercise science program. The student must understand, however, that the internship
program is not designed to provide all the experiences necessary to obtain certifications and/or entrance into
graduate school. For example: certification at the ACSM exercise specialist level requires 800 documented hours in
phase I-IV cardiopulmonary rehabilitation; and, entrance into graduate physical therapy programs typically requires
80 hours of documented experience in a physical therapy facility. Therefore, we suggest the following format for
conducting your 400 hour internship in the following emphasis areas;

1.      Musculoskeletal and Cardiovascular Assessment.
        This portion of the internship should focus on the musculoskeletal and cardiovascular assessment of
        apparently healthy and high risk patients. The intern should document the conduction of health and fitness
        tests, submaximal exercise tests, and maximal diagnostic stress tests. Interns should also gain experience
        using musculoskeletal assessment modalities used in physical therapy and athletic training if this is the field
        they elect to pursue.

2.      Fitness/Wellness. The student should gain experience in designing and implementing exercise and
        wellness programs for asymptomatic and medically controlled populations. This portion of the internship
        should focus on one on one and group consultation, orientation, and implementation of fitness and wellness
        programs. This component of the internship should focus on appropriate exercise prescription based on
        the ACSM guidelines to exercise. Further, diagnostic orthopedic data from preliminary musculoskeletal
        assessments should be used to assist in the implementation of physical therapy treatment modalities.

3.      Medical Special Populations. This portion of the internship should involve gaining direct experience with
        medical special populations: Orthopedically limited patients, cardiac patients, pulmonary patients and
        diabetic patients.

4.      Administration. In this segment of the internship, the intern should gain insight into the administrative
        management of their internship programs. The student concentrate on staffing and administrative duties
        associated with each program.

The Clinical Facility Internship Supervisor will assist you in planning your internship. In certain cases, your
internship may be designed to meet your specific needs by emphasizing one of these four areas to a greater extent
than another. It is suggested that these decisions be made in consultation with your Clinical Facility Internship
Supervisor PRIOR to the initiation of your internship. However, the student must understand that the internship
will always involve a multidimensional academic experience even though they feel that they are directed towards a
specific area of exercise science.


You are required to perform your 400 hour internship in the semester in which you register for EXSC 368. You
must participate in your internship the full 16 weeks of the semester, unless approved by Dr. Dowling, (NO
LESS)! The reason for this requirement is that you will be assigned an Internship Supervisor for the semester in
which you register only. Your grade will be determined from the quality of the internship program, your internship
manual and evaluation materials, your Clinical Facility Internship Supervisor evaluation, and your University
Internship Supervisor evaluation. Final grade assignments will be the responsibility of your Internship Supervisor.

Evaluation Procedures:

1.      AT THE START of your internship, develop a detailed internship experience goals and objectives
        checklist for approval by the Clinical Facility Internship Supervisor. This checklist should indicate how
        many hours you wish to participate in specific tasks at your internship site(s). For example, you may
        indicate that you want to spend 50 hours in maximal stress testing, 20 hours observing invasive
        cardiovascular tests, etc. Once this checklist is approved by the Clinical Facility Internship Supervisor, this
        checklist should be submitted to Internship Supervisor so it is known exactly which experiences you wish
        to gain in the internship. You are then responsible for obtaining the checklist goals and objectives during
        your internship experience.

2.      Submit your internship work schedule, your work phone number, and your clinical Facility Internship
        Supervisor(s) phone number(s) to your Internship Supervisor.

3.      You are responsible to contact your University Internship Supervisor ONCE PER WEEK BY PHONE
        AND/OR E-MAIL to summarize your progress in the internship. It is your Internship Supervisor's
        responsibility to ensure that you obtain your designed experience. Therefore, the Internship Supervisor
        should serve as a liaison between the student and clinical facility. If you are still experiencing resistance
        towards your involvement in any portion of your internship, the Internship Director will contact the
        appropriate individuals to ensure that you gain the desired experience or find alternative sites to obtain the
        experiences. Your Internship Supervisor will discuss your progress with your Clinical Facility Internship
        Supervisor(s) periodically throughout your internship by phone or in person.

4.      Keep a weekly log of work experiences. Highlight new experiences (i.e., instrumentation, technologies,
        personnel, etc.) and interesting patients or clients that you have been exposed daily. Also, document the
        number of hours worked in each area of your internship for application to your internship checklist

5.      Develop a detailed case study evaluation of approximately one client bimonthly of your internship
        (minimum of 8 case studies). For example, in a wellness, cardiac rehabilitation setting, Highlight: patient
        history; medical treatment employed; exercise prescription used; calculate exercise prescription based on
        ACSM guidelines taught in clinical exercise physiology, cardiac rehabilitation, and any special precautions
        concerning the patient in each case study. In addition, conduct at least one educational program for clients
        or patients (i.e. Hypertension, diet, etc). You will also be required to participate and report on an
        administrative aspect of the internship (i.e. policy and procedures)

6.      Fill out the Site Assessment form, Exit Interview and updated resume at the conclusion of the internship.

7.      Include a professionally prepared and updated resume highlighting your professional preparation,
        professional experiences, technical skills, and related pertinent data at the conclusion of your internship.
        Since this is your culminating experience in our program, this resume should be the resume you will use to
        seek employment and/or entrance into graduate school.

8.      Submit completed internship materials to your Internship Supervisor upon completion of your internship.
        You are expected to perform your internship with professional excellence.

9.   Grading
     Your grade will be based on all materials and evaluations submitted on your behalf as well as your
     University and Clinical Facility Supervisor's evaluation of your performance. Unlike many internship
     programs, you must demonstrate exceptional quality to receive an A in this course. Grades will be
     consistent with the Universities grading scale for undergraduate students with the plus and minus system in


1.   Make sure to submit application from Registrar’s Office for graduation by the appropriate deadline. This
     usually occurs two semesters prior to graduation. Your prior and current course work will be evaluated
     to ensure all academic prerequisites are met. By processing this information at least two semesters in
     advance, it will allow you to take any courses necessary to meet graduation requirements. Be particularly
     attentive to this process if you are a transfer student and are not sure of which courses were accepted.

2.   You are required to pass a University exit Writing Proficiency examination PRIOR to starting your

3.   Be sure to consult your university catalog for other information regarding graduation. It is the student’s
     responsibility to see that all materials, applications, examinations, and interviews are performed in a timely
     manner prior to graduation.

LISTINGS of frequently used internship sites in:



                                           Old Dominion University
                                           Exercise Science Program
                                             Internship Addresses


Virginia Beach General Cardiac Fitness Center             Columbia Retreat Hospital
Contact: Scott VanGeluwe                                  Contact: Sarah Smith
2126 Great Neck Square Shopping Center                    2621 Grove Avenue
Virginia Beach, VA 234541                                 Richmond, VA
481-7656                                                  804 254-5198

Lifestyle Fitness Center                                  Harbor Rehabilitation
Chesapeake General Hospital                               Contact: Maria Desineko
Contact:Rae Silkey                                        5818 D Harbor View Blvd, Suite 150
800 Battlefield Blvd, North                               Sulfolk, VA 23435
P.O. Box 2028                                             757 638-1800
Chesapeake, VA 23320
312-6132; 763-0651

Norfolk General Hospital                                  Chippenham-Johnston Willis Hosital
Contact: Tawnya Reynolds                                  Conact: Pat Cable, RN
600 Gresham Drive                                         7101 Janke Road Glass
Norfolk, VA 23507                                         Richomnd, Va 23225
668-3921                                                  804 327-4058

Bon Secour DePaul Hospital Medical Center                 Bon Secour Maryview hospital
Contact: Twanna Bryant                                    Contact: Brenda Alexander
150 Kingsley Lane                                         3636 high Street
Norfolk, Virginia 23505                                   Portsmouth, VA 23454
889-2126                                                  398-2591

Riverside Rehabilitation                                  Sentara Liegh
Contact: Susan Donston                                    Contact: Evelyn Bogley, RN
500 J. Clyde Morris Blvd.                                 830 Kempsville Road
Newport News, Virginia 23601                              VA Beach, VA
594-2291                                                  910-988-9732

Sentara Careplex Hospital                                Southeastern Regional Medical Center
Contact: Tim Cameron                                     Contact: Donna Gagnon
4895 Fayetteville Rd                                     4000 Colliseum Drive
Lumberton, NC                                            Hampton, Va
261-6826                                                 827-2078

Carolinas Medical Center-Cardiac Rehab
Contact: Jennifer Simmons
PO Box 32861
Charlotte, NC 28232
704 446-1470


Health South Sports Medicine and Rehabilitation Center           Atlantic Physical Therapy
Contact: Lynn Garland                                            Contact: Andy Altman, ATC, PT
4501 N. Witchduck Road                                           7300 Newport Ave
Virginia Beach, VA 23455                                         Norfolk, VA
490-9243                                                         466-4401

Health South Sports Medicine and Rehabilitation Center           Norfolk Physical Therapy Center
1849 Old Donation Parkway                                        839 Poplar Hall Dr
Virginia Beach, VA                                               Norfolk, VA 23517
481-3349                                                         459-2112

Tidewater Physical Therapy Center                                Southeast Physical Therapy
535 Hilltop Plaza Shopping Center                                Contact: Paul Hutchings
Virginia Beach, VA                                               5301 Providence Rd, Suite 80
425-6234                                                         Virginia Beach, VA
425-6234                                                         467-4604

Bayside Sentera Hospital                                         The Therapy Network
Contact: Milton Wilson, RPT                                      Contact: Alex Siyuofy, DPT, ATC
1517 Fuller Lane                                                 1788 Republic Rd
Virginia Beach, VA                                               Virginia Beach, VA
270-2658                                                         437-0412

DePaul OP Rehab                                                  Physical Therapy Center of Ches.
Contact: Travis Jacques, MPT                                     Contact: Ken Loud
7300 Newport Ave                                                 737 Volvo Parkway
Newport News, VA                                                 Chesapeake, VA
217-0333                                                         420-2880


Langley Health and Wellness Center                       YMCA - Reston
223 Elm Street                                           12196 Sunset Hills Road
Hampton, VA 23669                                        Reston, VA 20190
764-5791/5792                                            703 318-5304

                                                         Bayside Wellness and Fitness Center
                                                         Contact: Mark Dana
                                                         1608 Pleasure House Road
                                                         Virginia Beach, VA 23455

Powell Wellness Center                      The Gym Doentown
Contact: Brenna Eck                         Contact: Kevin O’Dea
1005 Gulf Drive                             259 Granby St
Culpepper, VA                               Norfolk, VA
540-529-4741                                321-4963

Depaul Wellness Center                      Cavalier Golf and Yacht Club
Contact: Kimberely Parrish                  Contact:Rodney Hahn
150 Kingsley Lane                           1052 Cardinal Road
Norfolk, Virginia 23505                     Virginia Beach, VA
889-5112                                    406-8431

City of Norfolk-Employee Wellness Program   Mastercard Int’l Health Fitness Center
Contact: Donna Vogel                        Contact: Cynthia Pippin
Department of Human Resources               2200 Mastercard Blvd
100 City Hall Building                      O’Fallen, MO 63368
Norfolk, VA                                 636-722-7500
                                            Greatbridge YMCA
Norfolk Family YMCA                         Contact: Linda Reiske
Contact: Barbara Moore/Beth Armstrong       633 S. Batterfield Blvd
312 West Bute St                            Chesapeake, VA
Norfolk, VA                                 546-9622
                                            Cobb & Douglas Public Health
Greenbrier Country Club                     Contact: Cathy Wendhholt-McDade
Contact: Liliana Crane                      1861 Teasley Dr
1301 Volvo Parkway                          Smyrna, GA 30080
Chesapeake, VA 23320                        770-432-0112

First Colonial Inn                          Naval Amphibious Base – Little Creek
Contact: Matt Towler                        Rockwell Hall Gymnasium
Virginia Beach, VA 23451                    Contact: Paul Knapp
428-2884                                    Bldg #3147
towler@kiscoret.com                         Norfolk, VA

Riverside Wellness and Fitness Center
Contact: Lavonne Joyce
627 Pilot House Drive
Newport News, VA 23606

Old Dominion University
Wellness Institute and Research Center
Norfolk, VA 23503
Contact: Dr. David Swain

Chesapeake General Hospital-Lifestyle Center   Chesapeake General Hospital-Lifestyle
Contact: Beth Reitz                            Contact: Beth Vincent or Page Lile
800 Battlefield Blvd                           Western Branch
Chesapeake, VA 23320                           4626 Taylor Road
312-6132                                       Chesapeake, VA 23321
beth.reitz@chelat.org                          483-8300

Riverside Wellness & Fitness Centers           YMCA MT Trashmore Family YMCA
Contact: LaVonne Joyce                         Contact: Karen Gambill
Lavonne.joyce.rivs.com                         4441 South Blvd
627 Pilot House Drive                          Virginia Beach, VA 23452
Newport News, VA 23606                         456-9622
757 594-2433                                   kgambill@ymcashr.org

Norfolk Yacht and Country Club
Contact: Alex Garland
7001 Hampton Blvd
Norfolk, VA 53505


Beach-Norfolk Chiropractic                     ODU Athletics
Contact: Dr. Scott Niblo                       Contact: Marty Bradley, ATC
953-A W.21st St.                               Powhatan Sports Complex
Norfolk, VA 23517                              Norfolk, VA 23529
622-8777                                       683-3840

The Therapy Network
Contact: Paul Lerner, ATC
637 Kingsborough St
Chesapeake, VA


                                               Contact: Yaw Baidoo
                                               ODU Athletics
                                               Norfolk, VA 23529


http://www.acsm.org (if a member of ACSM)



                                       SAMPLE COVER LETTER FORMAT

Your Address

Employer's Address
(use individual's name, if possible)

Dear                   :

First Paragraph. State the reason why you are writing, explain the type of work you are interested in, and indicate
how you learned about the employer and/or the specific opening.

Second Paragraph. Be specific about why you are interested in the position. Briefly summarize some of your
strongest qualifications to do the work. Remember to consider this from an employer's point of view. Show what
you have to offer the employer; don't merely daydream about what the employer can offer you.

Closing Paragraph(s). Refer the reader to the resume (or application form) you are enclosing. Declare your
interest in an interview and offer to provide further information upon request. Invite a response by asking a question
and/or indicating what follow-up you have in mind.


Signature (4 spaces)

Your name (typed)

Your Name
457 Rockaway Street
Boonton, New Jersey 07005

John S. Smith, Ph.D.
Director, Cardiac Rehab Center
Dover General Hospital
Rt. 46 West
Dover, New Jersey 07801

To Whom It May Concern:

I am currently attending Old Dominion University in Norfolk, Virginia working toward a degree in Exercise
Science. My graduation date is May, 2009. I am writing to request an internship position with_______.

In order to meet my graduation requirements, I must complete a 400 hour internship program between May and
August of this year.

During the past year, I completed a course in Clinical Exercise Physiology, where I was involved in conducting
submaximal stress tests, calculating exercise prescription, ECG recognition, and body composition.

I also completed coursework which included anatomy and physiology, strength and conditioning, prevention and
care of injuries and wellness counseling.

The internship requirements would consist of the full range picture to provide the most exposure. Specific details
include items dealing with administrative procedures, monitoring of clients, participation to some extent in exercise
assessment, exercise prescription, assisting with exercise performance, exposure to case information and evaluation.

It would be required of your facility to advise and explain the proper procedure of your facility during the intern
period, as well as a midterm and final report from the site advisor. Submission of this report would be necessary to
explain responsibilities undertaken, the degree of performance and understanding achieved, and if goals were met.

Please feel free to contact me for any further questions (PHONE NUMBER). Thank you for your consideration of
this opportunity.



                                   FULL NAME

Current Address     Permanent Address
 Address            Address
(Area Code) #        (Area Code) #

Date of Birth        March 31, 1982.

Position Desired     Internship

2004 to present      Old Dominion University (Norfolk, VA).
                     Current Standing: Senior.
                     Major: Sports Medicine.

2000-2004            Henrico High School (Richmond, VA).
                     Graduated with academic degree.

2007 Fall            Student Assistant, Old Dominion University
                     (Norfolk, VA) Wellness Institute and
                     Research Center. Responsibilities
                     included: sub maximal and maximal exercise
                     and stress testing, EKG interpretation,
                     body composition (hydrostatic weighing and
                     skinfolds measurements), flexibility and
                     muscular endurance and strength testing,
                     pulmonary function testing (vital capacity,
                     MVV, & FEV1.O), exercise prescription and
                     administrative procedures.

2002-2004 Summers    Assistant Swim Coach, Glen Allen Swim Club
                     (Glen Allen, VA). Responsibilities
                     included coaching 80-100 children from
                     ages 6 to 18, teaching strokes and race
                     strategy, assisting in direction of meets,
                     and record keeping.

2005 Summer          Fitness Instructor, American Family Health
                     and Fitness Club (Richmond, VA).
                     Responsibilities were instruction in use
                     of weight equipment, the principles of
                     exercise, nutrition, weight loss strategy,
                     blood pressures, heart rate monitoring,
                     cardiovascular fitness test (master step
                     test), body composition (skinfolds),
                     flexibility, and muscular strength and
                     endurance testing.

2007 Spring          Student Assistant, Old Dominion Wellness
                     Institute and Research Center (Norfolk, VA).
                     Responsibilities include maximal and sub-

                                 maximal stress testing, body composition
                                 (hydrostatic weighing and skinfolds method)
                                 blood pressure, heart rate monitoring,
                                 flexibility, and muscular strength and
                                 endurance testing pulmonary function
                                 testing (vital capacity, MVV, & FEV1.O)
                                 and exercise prescription.

Academic Major:          Major emphasis of course work include:

                                 Introduction to Exercise Science
                                 Strength and Conditioning/Leadership
                                 Wellness Programming and Administration
                                 Prevention and Care of Injuries
                                 Exercise Physiology
                                 Exercise Testing-Norm/Special Populations
                                 Cardiac Rehabilitation
                                 Nutrition for fitness and Sport

Certificates:                    Cardiopulmonary Resuscitation--American Red Cross
                                 Advanced First Aid--American Red Cross

Special Interests:               Exercise Science Club
                                 Vice President 2007-present.

References:                      Available upon request

                                 Elizabeth A. Dowing,, PhD
                                 Internship Coordinator
                                 Associate Professor
                                 OLD DOMINION UNIVERSITY
                                 Norfolk, VA 23529-0196
                                 (757) 683-4514

These objectives should be completed with your Clinical Facility Internship Supervisor after receiving

approval for your internship and turned into your University Internship Supervisor at O.D.U. once your
internship has begun

NAME_______________                                                     PHONE NUMBER_______________
                                               SAMPLE OBJECTIVES
                                               PHYSICAL THERAPY

                                          Internship objectives of your site
                                                    Spring 2009

Internship Site: Virginia Beach Physical Therapy Clinic                          Phone Number
                 4501 N. Witchduck Rd. Virginia Beach, VA.

Supervisor:       Daryl Backer P.T.


Starting Date:    See dates in schedule book

Objectives:       Minimum of 400 hrs

Concentration:                                 Hours Wanted    Hours Obtained

Therapeutic Modalities                         200 hrs         Fill in upon
-Ultrasound                                                    completion
-Traction                                                      of internship
-Biodex (Con/Ecc)
Rehabilitation                                 100 hrs
-Orthopedic inserts (foot)
-Home Programs
Consultation                                   50 hrs
Administration                                 50 hrs

Total                                          400 hrs

A minimum of 400 hrs. will be completed, unless otherwise desired by the Hospital/Rehabilitation locations. I am
willing to work as long as possible in order to gain the valuable experience that I need to pursue a vocation in the
medical field. A diary will be kept of my weekly observations, and a weekly case study of patients will also be kept.
One phone call a week will be made to my advisor in order to complete weekly work.

Work completed
Clinical Facility Internship Supervisor

Name_________________                                                           PHONE NUMBER_____
                                            SAMPLE OBJECTIVES
                                          CARDIAC REHABILITATION

                                          Internship objectives of your site
                                                    Spring 2009

Location:         DePaul Hospital (Norfolk, VA)

Supervisor:       Tawanna Bryant                                        Phone Number


Dates:            See dates in schedule book

Objectives:       Minimum of 400 hours

Concentration                                  Hours wanted             Hours Obtained

Cardiac Rehabilitation                         150-175                  Fill in upon
Echocardiography                               50-55                    completion of
Stress Testing                                 50-55                    internship
Administration                                 50-55
Physical Therapy                               20-25
Patient Education                              30-35
Pace Maker Monitoring                          20-25
Doctors Rounds                                  ?

A minimum of 400 hours will be completed, unless otherwise desired by the hospital. I am willing to work as long
as necessary in order to get the most from my internship. A daily log will be kept in order to document my work.
One phone call a week will be made to my advisor in order to complete my weekly work.

Work completed
Clinical Facility Internship Supervisor

Student Name: _______________________________________ SS#: ______________________________

                                     OLD DOMINION UNIVERSITY



This Agreement is made this             day of                , by and between
                 (hereinafter referred to as the "Facility") and Old Dominion University,
an instrumentality of the Commonwealth of Virginia (hereinafter referred to as the

       WHEREAS, the University is an educational institution with an approved
Baccalaureate and Masters Degree programs in Exercise Science which requires
internship experiences of students enrolled therein; and

       WHEREAS, the Facility has the resources in equipment and staff to provide the
internship experiences required by the Exercise Science Program; and

      WHEREAS, it is to the benefit of the University that the resources of the Facility
be made available to its students for the required internship experiences; and

        WHEREAS, it is to the benefit of the Facility to associate with the University, its
faculty and its students; and

       WHEREAS, it is to the benefit of both the University and the Facility to
cooperate in the educational preparation of interns so as to promote excellence in the
management of sports, recreation, or health and physical education to ensure
professional competence, and to provide maximum utilization of community resources;

        NOW THEREFORE, the parties agree as follows:

1.      Purpose

               The purpose of the Agreement is to establish procedures and guidelines
        for the provision of internship experiences within the Facility for students
        enrolled in the Exercise Science Program (hereinafter “Program”) of the

2.      The University's Responsibilities

        The University agrees to:

     a. Present students for internship experiences who have adequate pre-internship
        instruction and who, in the discretion of the faculty of the Program have
        adequately fulfilled the pre-internship requirements of the Program curriculum;

     b. Obtain comprehensive malpractice insurance coverage for students and faculty
        in an amount not less than one million dollars per occurrence and three million
        aggregate per year ($1,000,000/ $3,000,000). Evidence of such insurance shall
        be provided to the Facility prior to student participation in the internship

     c. Inform all students of the rules, regulations, policies, and procedures of the

          Facility, once the University has been provided a copy of the same, and require
          students conformance to such rules, regulations, policies, and procedures to the
          extent they are not inconsistent with law and policy,

     d. No less than two (2) weeks prior to the commencement of the internship
        experiences, advise the Facility of the number of students who will be presented
        for internship experiences and of the dates and hours each such students will
        be assigned to internship experiences as determined by program curricula and
        class schedules;

     e. Provide the services of a faculty member of the Exercise Science Program who

             1) Plan, in conjunction with staff member(s) of the Facility, internship experiences
                and assignments which will fulfill the internship requirements of the Program
                curriculum; and

             2) Meet with staff members(s) of the Facility to discuss the quality of the internship
                experiences and any problems which may have arisen in the provision of those

     f.   Retain responsibility for the education of students in the Department Of Human
          Movement Sciences and for the curriculum of that program, its design, delivery,
          and quality; and

     g. Maintain all educational records and reports relating to the internship
        experiences of its students.

3.        The Facility's Responsibilities

          The Internship Facility agrees to:

     a. Provide a minimum of                internship hours of experience for students;

     b. Provide a minimum of 30 days notice in the event that it is unable to place
        University students;

     c. Provide facilities for internship experiences which may include reasonable
        library, classroom, conference room, and locker room space, and whenever
        possible, office and storage space;

     d. Provide the services of a unit staff member(s) who will:

                         1.      Act as the Facility’s liaison to the University’s supervising
                         faculty member(s) with the planning of the internship experiences
                         and evaluation of students internship experiences; and,

                         2.     Meet with University supervising faculty member(s) to
                         discuss the quality of the internship experience and any problems
                         which may have arisen in the provision of these experiences;

     e. Plan, administer, and retain supervisory responsibility for all aspects of the
        internship experience; and

     f.   All faculty members of the university's Program access to the facilities of the
          Internship Faculty for the purposes of coordinating, observing, and instructing
          students engaged in internship experiences.

4.        Responsibilities of the University and the Internship Facility

          Both parties agree that:

     a. The maximum number of students who may participate in internship
        experiences will be determined by agreement between the parties;

     b. The parties will advise one another of a change in supervising and instructing
        personnel, changes in applicable policies, and changes in the availability of

     c. Emergency treatment of students for any injuries incurred during internship
        activities must be covered through the students' or faculty’s health insurance
        plans (required by the University), or through their own resources;

     d. The Facility may, at any time, summarily relieve a student from a specific
        assignment, or request that a student, or faculty member, leave a patient care
        area for cause related to the quality of patient care;

     e. The Facility may require that a student be withdrawn from participation in the
        internship experience provided that specific reasons for the withdrawal are given
        and that such reasons are not among those prohibited under "f" below; and

     f.   Neither party shall discriminate against any student on the basis of race,
          religion, sex, creed, age, national origin, or handicap;

     g. The University shall be responsible for any and all acts (or omissions) of
        professional negligence on its part, and the Facility shall be responsible for any
        and all acts (or omissions) of professional negligence on its part, or on the part
        of its employees. Nothing herein shall be construed as a waiver of sovereign

     h. Students will be asked to wear nametags identifying them as University

5.        Terms

     a. The term of this Agreement is from                     , to               .

     b. Termination of this Agreement may by effected by either party upon completion
        of performance under the terms of the Agreement.

     c. The terms of this agreement may be modified in writing signed by both parties.

             FACILITY                UNIVERSITY

By:                     By
Signature:              Dr. Elizabeth Dowling
Title                   Internship Coordinator

Date                    By
Site Mailing Address:   Dr. Robert Spina
                        Chair, Exercise Science, Sport, Physical
                        Education, And Recreation
Phone #:
Fax:                    By
                        Dr. J. David Branch, Associate Dean
                        Darden College of Education

                        Dr. Thomas Wunderlich
                        Director of the Center for Career

                                             OLD DOMINION UNIVERSITY

                                          INTERNSHIP EVALUATION

Your grade will be based on the Internship Supervisor evaluation of written assignments, and the Clinical Facility
Internship Supervisors evaluation of your performance.

Clinical Facility Evaluation                                                               20 PTS

The Clinical Facility Internship Supervisor will submit a written evaluation of: quality and quantity of work,
organization punctuality and reliability, communication skills (written and oral), organization, employee and
patient/client relationships, initiative, strengths and weaknesses. This evaluation may be reviewed with the student
by the Clinical Facility Internship Supervisor.

Written Assignments

1.)The student is required to keep a thorough weekly journal of work experiences (i.e., instrumentation,
technologies, personnel, interesting patient pathology, administrative concerns, medical emergencies, etc.)
                                                                                           5 PTS

2.) A detailed case study evaluation of one patient/client per week is also required (Minimum of eight case studies).
The case studies are to vary in pathology. Highlight: a short, well researched description of the pathological disease
or injury, patient history, diagnosis, treatment, rehabilitation, home prescription, and special concerns. The case
studies are to be well-organized, concise, TYPED and should include appendices when appropriate This will also
include the administrative assignment and educational program..
                                                                                              100 PTS

3.) The student will complete the internship site assessment form and turn it in to the program coordinator during
their exit interview. An updated resume must be turned into your ODU supervisor as well.
                                                                                            5 PTS


4.) Maintaining weekly communication.
                                                                                           10 PTS

Internship Supervisor Evaluation                                                           10 PTS

The University Internship Supervisor will evaluate the student’s organization and thoroughness during the search
and development of their internship site. This will include: written assignments required to be completed prior to
starting the internship (i.e. cover letter, resume, goals and objectives).


Written assignments and a clinical facility evaluation are due at mid-term and upon completion of the internship(s).
Immediate feedback will be given so that the student may focus on their weaknesses.


100-93   A    79-77   C+
92-90    A-   76-73   C
89-87    B+   72-70   C-
86-83    B    69-67   D+
82-80    B-   66-63   D
              62-60   D-
              <60     F

NAME_________________________                   UIN#__________________________

Midterm (10pts)     Final (10pts)

JOURNAL/Documented Hours (5pts)

CASE STUDIES and other assignments (10 @ 10 pts. ea.) (100pts)
1.          6.
2.          7.
3.          8.
4.          9.
5.          10.

Internship Assessment/Exit Interview Forms (5pts)
(Updated resume included)


Week Of:



FINAL GRADE__________


                                                    Case Study
                                              (Cardiac Rehabilitation)

This patient is a 68 year old white male recovering from open heart surgery which occurred on March 24, 2082. He
is retired but is currently doing construction work on the side. He is also married. The onset of his cardiac illness
began on March 18, at approximately 8PM. This was a classic episode of angina. This gentleman was then
admitted to the hospital on March 19. Cardiac catherization was then performed on March 22. Results indicated his
dominant Right Coronary Artery had a severe stenosis in its mid portion, followed by a distal stenosis. The Left
Circumflex Coronary Artery had a lesion occluding 50 to 60% of the vessel at its ostium. The LAD had a mild
stenosis proximately occluding 50 to 55% of the vessel. Revascularization is needed but due to this patient's age,
lifestyle, LV function and anatomy, angioplasty was not recommended. This patient required CABG x 4. Surgery
was performed by Dr. Calhoun and Micale. The patient's post operative medications are ASA, Tenormin, HCTZ,
and Amiloride.

Final Diagnosis
         1. Ischemic heart disease with acute myocardial infarction
         2. Cardiogenic shock
         3. Hypertension
         4. Chronic obstructive pulmonary disease
         5. Recent blunt chest trauma

        1.        Tenormin- (Atenolol) is a beta selective beta-adrenergic receptor blocking agent without
                  membrane stabilizing or intrinisc sympathomimetic activities. It also inhibits beta 2-
                  adrenoreceptors found in the bronchial and vascular musculature. Tenormin has been
                  demonstrated to reduce resting and exercise heart rate and cardiac output, reduce reflex orthostatic
                  tachycardia. This patient is taking this medication to relieve hypertension and angina.

         2.       Amiloride- (Midamor) is a potassium conserving (anti-kaliuretic) drug that possesses wide
                  natriuretic, diuretic and antihypertensive activity. It comes in tablet form. Amiloride is used in
                  patients to relieve congestive heart failure or hypertension by restoring normal serum potassium
                  levels in patients who develop hypokalemia on a kaliuretic diuretic. It also prevents development
                  of hypokalemia in patients who would be exposed to particular risk of hypokalemia. This patient
                  requires Amiloride to relieve hypertension.

         3.       HCTZ- (hydrochlorothiazide) it is an antihypertensive. HCTZ effects the distal renal tubular
                  mechanism of electrolyte reabsorption. It also increases excretion of sodium and chloride in
                  approximately equivalent amounts. HCTZ is usually combined with Methyldopa, which is also a
                  antihypertensive, to form aldoril. Once again, this patient takes HCTZ to relieve hypertension.

         4.       ASA- (Lortab) ASA is a combination of hydrocodone Bitartrate and Aspirin tablets.
                  Hydrocodone is believed to relate to the existence of opiate receptors in the central nervous
                  system. Aspirin used for analgesic, anti-inflammatory and antipyretic effects. This effect results
                  from inhibition of the synthesis of certain prostaglandins. Aspirin also interferes with clotting
                  mechanism by diminishing platelet aggregation. ASA is used to relieve moderate to moderately
                  severe pain. This patient requires it for his incisional pain.

Medical History/Risk Factors
To begin with, this patient has an alarmingly positive family history of premature coronary artery disease which
include sudden death, bypass surgery and acute infarctions . In addition, this patient's other risk factors include
systematic arterial hypertension, smoking and is mildly obese. A combination of drugs have been used in order to
control hypertension such as Amiloride and hydrochlorothiazide. Cessation of smoking occurred 15 years ago.
Fortunately, this patient does not consume alcohol excessively and is relatively active.

Diagnostic Testing
        A.       Cholesterol: 213 (3-21-93)
        B.       Persantine Cardiolite: Results can be found on the
                 following pages
        C.       Treadmill:
           1. Pre Cardiac Treadmill
        Test type: Modified Bruce Protocol
        Total exercise time: 3:08 minutes
        Max heart rate: 126 bpm (71% of max predicted 176 bpm
        Max blood pressure: 150/170
        Max work load: 2.0 METs
        Reason for termination: Reached target HR
        1. Resting EKG- ST T segment variation, nonspecific
        2. Post exercise EKG- ST baseline-non sustained ventricular tach (4 beats.

            2. Post Cardiac Rehab Treadmill
                   Test Type: Bruce Protocol
                   Total exercise time: 4:29 minutes
         Max heart rate: 140 bpm (79% of max predicted 176 bpm)
         Max blood pressure: 206/104
         Max work load: 6 METs
         Reason for termination: Severe dyspnea and fatigue
         1. (resting EKG) inferior infarct, ST T segment
                   variation, non specific
                   2. (post exercise) minor EKG changes, infrequent
                   couplets and single ventricular premature beats
         D.        Catheterization: Results can be found on the following pages

Exercise Prescription:
Prior to entering Riverside's Rehab program (Phase II) Dr. Micale requested a treadmill on April 14, 2002 (Results
on this test can be found under Diagnostic Testing). After the patient's completion of the stress test Dr. Micale
authorized admittance of the patient to begin Phase II rehab ASAP. The patient's prescribed exercise heart rate is
114 bpm (90% of 126 bpm). The basic outline for exercise prescription at Riverside Medical Center can be found in
the Phase II section. This prescription may vary for patients depending on each individuals' performance. In
addition, mode of exercise may also vary depending on patient's goals and preference.

Upon meeting this patient in Phase II rehab, this gentleman had an interesting story to share with me. Four days
prior to being admitted to the hospital with angina, this patient was driving in his car and experienced a brief episode
of chest heaviness and pressure. Unfortunately, he experienced a loss of consciousness which caused a head-on
collision with another vehicle. After being taken to the hospital he was examined extensively and was diagnosed
with only a mild contusion to the anterior chest area. There were no indications of any significant internal injuries
or any damage to the cardiac architecture. Afterwards, he was discharged. The following night he experienced a
bout of angina and decided to go Riverside Medical Center at approximately 2:30 AM on March 19, 2002. After
surgery, Dr. Micale suggested this patient attend Phase II cardiac rehab on April 16. His prescribed heart rate was
114 bpm. During his initial session the patient was limited to the bike ergometer. His total time was 12 minutes
and reached a max MET level of 2.4. His max blood pressure was 140/80, and max HR 108 (94% of his target).
After some improvement the patient's target heart rate was increased to 125 bpm on April 26. During each exercise
session, each patient is educated on different subjects concerning their health. These topics bay from sex, diet, signs
an symptoms to medication (For a complete list of all this patient's educational classes, please check the following
pages). The patient supplemented Phase II rehab with his own exercise such as walking, using a stationary bike and
Nordic Track. Upon graduation from Phase II rehab on May 26, 2002, this patient reached a max MET level of 5.5

Unfortunately, I only got a chance to work with this man for a few weeks. He was quiet but a very nice man. He
was enthusiastic about being in the program, all he needed was some support from us. Currently, this gentleman is
continuing his exercise in Phase III at the Riverside Wellness Center, so I still get a chance to visit with him.


                                            SAMPLE CASE STUDY #1
                                         (Physical Therapy/Athletic Training)


SUBJECTIVE: Patient presents status post ACL tear and medial meniscus tear with initial injury occurring to
ACL April 11, 2002
and meniscal tear occurring on May 26, 2008. Surgery was performed on June 24, 2008 and since that time patient
has been utilizing a CPM machine ROM 0 to 75 degrees. Patient is ambulating 40 pounds partial weight bearing left
lower extremity with immobilization brace locked from 10 to 40 degrees. Patient complains of some pain with end
range flexion along anterior knee. She complains of numbness parallel to her incision. Patient's initial injury
occurred while playing softball and secondary injury occurred during "riot training" while working with the Virginia
Beach Police Department. No significant previous medical history is given. Medications include Vicodin.

OBJECTIVE: Active ROM: -5 degrees to 76 degrees.
PROM: -4 degrees to 82 degrees in sitting. -4 degrees to 80 degrees in supine.

Girth:                                                  Right              Left
Superior pole +15cm                                     49.5cm             45.5cm
Superior pole +10cm                                     45.5 cm            43.5cm
Superior pole +5cm                                      40.0cm             39.5cm
Superior pole                                           36.0cm             38.0cm
Inferior pole                                           35.5cm             36.0cm
Inferior pole -5cm                                      33.0cm             34.5cm

Strength: Fair quad contraction is noted with good hamstring concentration. MMT (manual muscle test) deferred at
this time.

Sensation: Mild diminished sensation along incision line distal to patella.

Palpation: Tenderness with palpation to patella as well as to medial joint space.

Patellar mobilization: Limited patellar mob. in all directions; superior, inferior, medial, lateral.

Ligamentous support: Good stability noted with Lachman's, varus and valgus stress. Lachman's is a test done to
determine joint stability. Varus and valgus stress just simply mean stress applied at medial knee and lateral knee to
determine stability.

Edema: Moderate edema is palpated throughout joint capsule.

ASSESSMENT: Patient presents with good ROM considering recent ACL reconstruction. She demonstrates good
extension passively with some restriction noted into flexion. Lack of patellar mobility as well as edema may be
primary limitation of flexion at this time.
Goals: 1. Improve passive ROM to full extension and maximize flexion
         2. Decrease edema throughout joint capsule.
         3. Improve quad contraction and hamstring strength.

PLAN: We will progress Lori with ACL reconstruction program focusing on quad contraction utilizing electric
stim if needed, and progressing with passive ROM and active ROM and limited in protected range. Will be seen
twice a week for 6 weeks.

The procedure involved arthroscopic assisted anterior cruciate ligament reconstruction using bone patella tendon

bone autografting with 10mm strip of autograft and two screw fixations. A partial lateral meniscectomy, left knee
was also performed (partial removal of left meniscus). Only the ACL reconstruction will be discussed here since I
have a case study on meniscal injuries.
The standard medial midline incision was made from the anterior patella to the tibial tubercle. This was done
through skin and subcutaneous tissue to the level of the retinaculum. The patellar synovium was then entered
proximally and distally and the patellar tendon visualized. A central one-third tendon graft was then planned on and
a 10mm double bladed tendon cutter was used to make a strip of 10mm patellar tendon from the patella to the tibial
tubercle. At this point, the patellar tendon was closed after a graft from the tibia was placed in the patella and the
retinaculum closed over this grafting. The closure of the patellar tendons was with 0 Vicryl sutures in a figure 8
fashion. 2-0 Vicryl was used for rectangular closure and the subcutaneous tissues were closed with 2-0 and 3-0
Vicryl. both were described as being as interrupted fashion in layers. The skin closure used 4-0 Vicryl and Steri-
strips and a sterile dressing. A deep Hemovac drain was left in one of the portals and Marcaine 30cc of .5%
Epinephrine was injected into the joint and the joint clamped. Total time for surgery took 2 hours and 20 minutes.
The knee was placed in a brace and the patient returned to recovery room in stable condition.

Lori's therapy consists of moist heat to left knee, heel (for ROM), quad sets, straight leg raises (3 directions: sides,
supine with 2# weight), patellar mob's, active assisted ROM knee extension (she helps her leg), prone knee flex/ext,
bike for 10 minutes for stretching, calf and toe raises, electric stim to left quads for muscle re-education, and follows
ACL Protocol weekly. Lori has progressed to using the multi-hip machine, a lower seat on the bike (and still being
able to make complete revolutions), and partial weight bearing on one crutch. According to the ACL Protocol full
recovery takes about 12 months. The current treatment is early aggressive physical therapy, immediate motion, full
passive extension, early muscular strengthening, immediate weight bearing (as tolerated), and return to sport
activities at 5-6 months (wearing brace/support).

Rehabilitative principles include: never over stress healing tissue, prevent immobilization, patient should achieve
goal-oriented stages (as set by ACL Protocol), and rehab takes team effort and communication between the
Physician, Therapist, and Patient. Although ACL reconstructive surgery is a major procedure that causes great
trauma to the knee and is a long rehabilitative process, it is regarded as a relatively safe and simple procedure with
anticipation of good rehabilitative results.

Lori has a long road ahead of her and she is currently at the Phase II of the ACL Protocol (3-6 weeks post-op). She
ambulates without crutches, wearing a brace, she has reached 120 degrees of flexion, has initiated resistive ROM
exercises (leg raises with weights), and has started hamstring strengthening without resistance to quadriceps (graft is
still weak; if stress is applied too early to patellar tendon, pain and tendinitis may set in). Phase III is 7-9 weeks,
Phase IV is 10-14 weeks (ROM should be at normal limits), Phase V is 15-16 weeks or 4 months, and at Phase VI,
patient is released with a comprehensive and progressive home therapeutic exercise program. Patient returns for
evaluation at 6 months and 12 months which determines if any deficits in hamstring muscle or quad muscle strength.


                                            SAMPLE CASE STUDY #2
                                               (Physical Therapy)

Patient: Paul H.

Diagnosis: L Acromioclavicular repair

The acromioclavicular joint has been repaired so that dislocation of the AC joint will not reoccur. Mr. H. was in a
motorcycle accident and he hit a cow while riding. The AC joint was disrupted and thus causing a severe
separation. If the clavicle had broken the joint would have not separated as severely. However, the clavicle didn't
break and thus a separation occurred. This 57 - year - old male received surgery on 8/31/02 to repair the left
acromioclavicular joint. Mr. H. also sustained a fracture of the 5th metacarpal of the left hand. Currently, he is
taking pain medication and states recent X-rays have been taken. The patient states the pain is reproduced when he
attempts to raise the left arm overhead or the straighten the left elbow. He notes pain when attempting to make a fist
with the left hand. Symptoms increase in the P.M. The patient arrived wearing a sting with the left arm cradled.
There is a fine healed 4" inch surgical incision superior of the left shoulder over the acromioclavicular joint. The
sensation and reflexes of both upper extremities seems to intact.

Range of Motion:

   Active (percent limitations of motion)

    Left Shoulder:

     Flexion:              80% - 95%
     Extension:            60%

     Abduction:            75% - 80%

     Adduction: 80%

     Internal Rotation:    75%

     External Rotation:    90%


     Left shoulder:

     Flexion:              0 - 54 degrees

     Extension:            0 - 40 degrees

     Abduction:            0 - 69 degrees

     Adduction:            0 - 12 degrees

     Internal Rotation:    0 - 18 degrees

     External Rotation:    0 - 4 degrees

Mr. H. was cooperative and tolerated the session well. Significant deficits are noted during active and passive left
upper extremity motions within the involved joint. Strength deficits are also apparent during left upper extremity


   Program consists of:

     1. Active and Passive Range of Motions exercises

     2. Active assistive ROM

     3. Theraband exercises

     4. Pully system

     5. Tricep and Bicep curls

     6. Upper Body Ergometer

     7. ice X 15 min.

 Mr. H (cow man) will be seen 2 - 3 times a week for 3 weeks. Modalities are exercises will be prescribed to reduce
any pain that he may be experiencing and reduce swelling. Therapeutic exercises incorporating passive, active
assistive ROM and functional ROM exercises to enhance the range of motion in the joint. These exercises will be
performed at the clinic and prescribed as a daily home program. His condition will be continually monitored and
updated. Home compliance is very important so that the patient can improve his condition. The large majority of
acromioclavicular separations require no surgical intervention. When circumstances are such that some type of
repair is necessary, this may be accomplished in a manner described by Naviaser of transferring the coracoacromial
ligament to make a new superior acromioclavicular ligament. One of the advantages of this procedure is that the
clavicle is not held down permanently by a screw or wires, thereby limiting the rotation motion of the clavicle,
which in turn would restrict full abduction of the shoulder. The procedures involves the exposure of the anterior
aspect of the shoulder in the area of the coracoacromial ligament and the acromioclavicular joint through a slightly
curved incision over the anterior aspect of the lateral one half of the clavicle extending laterally to the tip of the
acromion process. The deltoid muscle reflected from its attachment on the anterior aspect of the lateral third of the
clavicle. The disrupted acromioclavicular joint is visualized and reduced without disturbing the articular disk that
lies between the clavicle and acromion. While the clavicle is held reduced, one or two Kirschner wires are drilled
successively through skin, acromion process, and into the clavicle in order to adequately maintain the reduction of
the acromioclavicular joint. The lateral end of any such wire is bent slightly outside the posterior aspect of the
acromion process to prevent its inward migration and is left in this position beneath the skin.

Mr. H was first seen at the clinic about 2 weeks after surgery. The patient was limited in abduction of the shoulder
joint. The patient could only to about 100 degrees actively and ll0 degrees passively. When Mr. H first began
coming to therapy he thought that he could get full range of motion in the shoulder. As therapy progressed through
strengthening, stretching, and modalities the patient developed lots of scar tissue in the glenohumeral joint. This
scar tissue did not allow for downward movement of the head of the humerus when the arm was being abducted.
Darrell tried many aggressive stretches to try to prevent the scar tissue from forming. Mr. H continued with therapy
for about a month and half and then went to see the physician. The physician suggested that Mr. H have a
manipulation of the joint. The physician informed him that this may not give him his full range but that it would be
better. The manipulation involved the patient to be administered a anesthetic and then the joint is forced into the
abducted position. The scar tissue is torn and the joint is moved in all ranges of motion to ensure the best possible
post operative prognosis. The patient will then begin therapy and try to obtain that range of motion. Darrell did
many stretches and prescribed various stretches that he could do at home to try to reduce the amount of scar tissue.

At first Mr. H was coming everyday and was a bit discouraged with the manipulation. After weeks of serious
exercises and manual stretching with Darrell, the patient started to improve the range of motion. the doctor told Mr.
H to take pain medication before coming to therapy. Four months after the initial surgery Mr. Heerbrandt was
discharged will full range of motion it the shoulder with a slight flexion at the elbow. Mr. H was pleased and felt
like that all of the pain, aching, suffering and daily visits paid off. Therapy is very affective if the patient is
cooperative and does his part a home. This patient is a prime example of this. Mr.H suffered a severe AC
separation. Through a manipulation, aggressive stretching and exercises, and hard work away from the clinic, the
patient restored almost full function of the involved area.


                                           Strength and Conditioning
                                              (Sample Case Study)
Subject: Harris, J.
Age: 19
Sport: Soccer
Team: Beach F.C. Fyre
Program: D2

Evaluation One:
Pretest Date: 12/13/2005
Height: 72 inches
Weight: 162 pounds

Vertical Reach: 92 inches
Vertical Jump: 28 inches

Broad Jump: 102.5 inches

Pro-Agility Right: 4.67 seconds
Pro-Agility Left: 4.71 seconds

Three Cone Right: 8.30 seconds
Three Cone Left: 8.01 seconds

10-yard: 1.84 seconds
Split: 1.18 seconds
20-yard: 3.02 seconds
Split: 1.05 seconds
30-yard: 4.07 seconds

Subject is already shows a great athletic ability. Harris has good numbers for his power, agility, and speed test. He
had a good start on the thirty, but lost some speed throughout sprint. Main goals are to teach how to recruit more
power from the glutes to increase power output, improve ability to maintain maximum velocity, and work on
movement efficiency.

Set Up and Plan:
Athlete will train two times a week and complete a total of 21 sessions before his post-evaluation.

Evaluation Two:
Post test Date: 02/26/2005
Height: 72inches
Weight: 168 pounds

Vertical Reach: 92 inches
Vertical Jump: 29 inches
Comments: increased 1 inch

Broad Jump: 109 inches
Comments: improved by 6.5 inches

Pro-Agility Right: 4.38 seconds
Pro-Agility Left: 4.48 seconds
Comments: right faster by .29 seconds and left by .29 seconds

Three Cone Right: 7.33 seconds
Three Cone Left: 7.83 seconds
Comments: quicker to the right by .97 seconds and to the left by .18 seconds

10-yard: 1.84 seconds
Split: 1.15 seconds
20-yard: 2.99 seconds
Split: 1.06 seconds
30-yard: 4.05 seconds
Comments: shaved a total of .02 seconds off overall time

Client was in training for a total of ten weeks. The most notable improvements were in his agility test. Coaching the
client in proper body alignment, ankle position, and force application allowed him to develop a more efficient
movement. He was able to synchronize and control the joint movement and muscle action to allow for a minimum
loss of speed while changing direction.

No problems were encountered throughout client’s training. Client was named Boys All Tidewater Player of the
Year and Boys Beach District 1st Team earlier this year. He has attributed his improvements to the training he
received at Velocity Sports. Harris continues to train at Velocity and will soon be given a third post-evaluation.

                                                    Internship EXSC 368

Old Dominion University
Exercise Science                                                                      Date:_____________
Norfolk, VA 23529

                                             Midterm Evaluation 200 Hours

                                     SUPERVISOR'S EVALUATION REPORT

Student's Name


Dates of Internship

Location of Internship

I.         Rate student on the basis of your observations during the
           integration period.

                                       PERFORMANCE VALUE DEFINITIONS
           1 = Consistently exceeds what is expected.         Superior
           2 = Frequently exceeds what is expected.           Above Average
           3 = Consistently achieves what is expected.        Average
           4 = Occasionally fails to achieve what is expected Below Average
           5 = Consistently fails to achieve what is expected Poor

                                                                 Performance Values
                                                                 High         Low
            a.      Quality of Work: Consider                    1 2 3 4 5
                    to the extent to which work
                    is accurate, thorough, well
                    organized, and how often it
                    requires redoing or revision.
                    Consider job knowledge and
                    decision-making ability.

            b.      Volume of Work Produced:                     1 2 3 4 5
                    Consider extent to which
                    the employee produces at a
                    rate consistent with normal

     c.   Work Habits:                     1 2 3 4 5

          Consider how well the
          employee observes
          the following:

          1) Safety                        1   2   3   4   5
          2) Punctuality/Reliability       1   2   3   4   5
          3) Job attitude                  1   2   3   4   5
          4) Acceptance of Suggestions     1   2   3   4   5

     d.   Relationship with People:        1 2 3 4 5
          Consider the extent which
          the employee works coopera-
          tively with supervisors,
          associates, subordinates,
          and the public. Does he/
          she treat them with respect
          and courtesy? Is equal
          employment opportunity
          supported by the employee?

e.        Communication Skills:            1 2 3 4 5
          Consider how well the
          employee is able the express
          thoughts clearly, effectively,
          and concisely orally and in
          writing. \

f.      Initiative: Consider                                    1 2 3 4 5
                  employee's ability to
                  independently complete
                  an assignment without
                  close supervision. Consider
                  employee's ability to come
                  up with new ideas and better
                  ways of accomplishing work.

II. Appraisal of overall performance.

III. How would you rate the performance of this student?
         Superior    Above Average      Average
        Below Average       Poor

IV.     During the period of this internship, the student observed
        and/or worked in the following areas of our organization:

V.      Describe briefly the greatest strength of this student as
        observed by you and your staff:

VI.     Describe briefly the greatest weakness of this students as
        observed by you and your staff:

VII.    Suggestions for improvement and further academic work.

VIII.   Comments. Please add any additional comments you feel may
        be useful to the instructor in evaluating and counseling the

Report completed by:     (Signature)

Telephone Number/Address:

IX.     Student Review. This evaluation has been discussed with
        my supervisor on         . I wish to make the
        following comments:

                Student's Signature

                                                    Internship EXSC 368

Old Dominion University
Exercise Science                                                                      Date:_____________
Norfolk, VA 23529

                                              Final Evaluation 400 Hours

                                     SUPERVISOR'S EVALUATION REPORT

Student's Name


Dates of Internship

Location of Internship

I.         Rate student on the basis of your observations during the
           integration period.

                                       PERFORMANCE VALUE DEFINITIONS
           1 = Consistently exceeds what is expected.         Superior
           2 = Frequently exceeds what is expected.           Above Average
           3 = Consistently achieves what is expected.        Average
           4 = Occasionally fails to achieve what is expected Below Average
           5 = Consistently fails to achieve what is expected Poor

                                                                 Performance Values
                                                                 High         Low
            a.      Quality of Work: Consider                    1 2 3 4 5
                    to the extent to which work
                    is accurate, thorough, well
                    organized, and how often it
                    requires redoing or revision.
                    Consider job knowledge and
                    decision-making ability.

            b.      Volume of Work Produced:                     1 2 3 4 5
                    Consider extent to which
                    the employee produces at a
                    rate consistent with normal

     c.   Work Habits:                     1 2 3 4 5

          Consider how well the
          employee observes
          the following:

          1) Safety                        1   2   3   4   5
          2) Punctuality/Reliability       1   2   3   4   5
          3) Job attitude                  1   2   3   4   5
          4) Acceptance of Suggestions     1   2   3   4   5

     d.   Relationship with People:        1 2 3 4 5
          Consider the extent which
          the employee works coopera-
          tively with supervisors,
          associates, subordinates,
          and the public. Does he/
          she treat them with respect
          and courtesy? Is equal
          employment opportunity
          supported by the employee?

e.        Communication Skills:            1 2 3 4 5
          Consider how well the
          employee is able the express
          thoughts clearly, effectively,
          and concisely orally and in
          writing. \

f.      Initiative: Consider                                    1 2 3 4 5
                  employee's ability to
                  independently complete
                  an assignment without
                  close supervision. Consider
                  employee's ability to come
                  up with new ideas and better
                  ways of accomplishing work.

II. Appraisal of overall performance.

III. How would you rate the performance of this student?
         Superior    Above Average      Average
        Below Average       Poor

IV.     During the period of this internship, the student observed
        and/or worked in the following areas of our organization:

V.      Describe briefly the greatest strength of this student as
        observed by you and your staff:

VI.     Describe briefly the greatest weakness of this students as
        observed by you and your staff:

VII.    Suggestions for improvement and further academic work.

VIII.   Comments. Please add any additional comments you feel may
        be useful to the instructor in evaluating and counseling the

Report completed by:     (Signature)

Telephone Number/Address:

IX.     Student Review. This evaluation has been discussed with
        my supervisor on         . I wish to make the
        following comments:

                Student's Signature

                                 INTERNSHIP COORDINATOR

1.    Assist students in procuring an internship by providing a list of internship sites in the local area, and advise
      on internship possibilities not in the local area.
2.    Review cover letters and resumes.
3.    Answer questions concerning interviewing.
4.    Provide students with the necessary tools, e.g. phone numbers, addresses, names of sites and supervisors
      when available, to allow the student to go out into the community and obtain an internship.
5.    Explain the terms and obligations of the internship at scheduled meetings as outlined in the EXSC 368
      coursepacket. (Students who do not attend these meetings must realize that these meetings are mandatory
      for understanding the internship requirements/process)
6.    Work with the university faculty supervisor when special problems and/or concerns arise regarding the
      student or internship process. This also may include but not be limited to problems associated with the
      university and site supervisors.
7.    Fill in as the student’s university faculty supervisor for university faculty when they are unavailable.
8.    The collection and processing of internship agreements to assure insurance coverage by the university.
9.    Assessment of internship sites for quality and academic excellence.
10.   Make available to exercise science student interns an updated list of internship opportunities that includes
      addresses and when available contact names and phone numbers.

                        Internship Assessment (January 2009)

The purpose of this critique is to directly inform the department chair about your internship experiences.
Provide any good and/or bad comments wherever appropriate. The feedback provided within this critique
will be held in the strictest of confidence as it would be equivalent to a course evaluation.

DIRECTIONS:                Please place an X in the box representing your response to each of the following
                           items. Please note that the internship coordinator is assessed in item 1, your
                           assigned faculty internship supervisor is assessed in items 2, 3, and 4, your
                           internship site staff supervisor is assessed in items 5, 6, and 7, and your
                           internship experience is assessed in items 8, 9, 10, and 11.



NAME OF INTERNSHIP SITE: _________________________________________________________________
                   STATEMENTS                           unacceptable     poor      acceptable     good        very   ex

 Rate the overall effectiveness of the internship
          coordinator in helping you find and/or set
          up an internship placement:

 2.       Rate the overall effectiveness of the
          university faculty internship supervisor:

 3.       Rate the university faculty supervisor=s
          ability to communicate effectively with
          you during your internship:

 4.       Rate the university faculty supervisor=s
          helpfulness, sensitivity, and
          responsiveness to your needs as an intern:

 5.       Rate the overall effectiveness of the
          internship site staff supervisor:

 6.       Rate the internship site staff supervisor=s
          ability to communicate effectively with
          you during your internship:

 7.       Rate the internship site staff supervisor=s
          helpfulness, sensitivity, and
          responsiveness to your needs as an intern:

 8.       Rate the overall quality of the internship

 9.      Rate how much you have learned or
         benefitted from the internship experience:

 1.)     Rate your internship experience on
         organization, structure, and clarity of
         requirements as set forth in the internship

 2.)     Rate the likelihood of recommending this
         internship site to other majors in your

3.)      Identify your program level:           Undergraduate

                                                  OPEN-ENDED COMMENT SECTION

Thank you for your participation! Please return your response upon completion directly by mail or in person
at the exit interview to:
                                              Dr. Liz Dowling
                                          Internship Coordinator
                                                 SRC 2024
                                          Old Dominion University
                                           Department of ESPER
                                          Norfolk, Va. 23529-0196

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