Physical Therapy

1
Physical Therapy

• Who are the preferred providers?

2
Physical TherapistsPhysical Therapist Assistants

• Supported by aides and other office specific
  workers

3
Historical Perspective

• Physical therapist
• 1921 first Womens Physical Therapeutic
  Association
• 1930s admitted men
• 1940s name changed to APTA
• 1950s 39 programs
• 1978 established specialist certification
  program
• Current 210 US programs 21 at MPT/MSPT 189 at
  DPT level (CAPTE April 2008)

• Physical Therapist Assistant
• 1964 Task Force
• 1967 2 programs started
• 1969 first graduation from St Marys in MN
  Miami Dade in FL
• 1971 Nancy Watts article
• 1980-2000 clarifications within House of
  Delegates
• 2005 APTA develops certificate to recognize
  advanced proficiency
• Current gt 233 programs (CAPTE April 2008)

4
Role of PT Assistants

• Technically trained in the skill set needed to
  support the Physical Therapist
• Measurement using standardized techniques
• Direct intervention
• Patient-related instruction
• Onsite assessment of response
• Addressed within the Guide to Physical Therapist
  Practice

5
APTA Education Consensus on Delegation based on
1997 document

• Consider
• PTA education, training, experience, skill
  level
• Patient status (criticality, acuity, stability,
  complexity), predictability of consequences, and
  frequency of re-evaluation that will be needed
• State regulations Potential liability Mission
  for PT services within the setting
• May delegate elements of exam process to PTA - IF
  this will not compromise ability to reach
  diagnosis or decision regarding intervention

6
Quick look at Watts Taxonomy

• Level 1 standardized routine
• Level 2 stable application based on guidelines
• Level 3 variations in treatment occur but not
  rapidly or unexpectedly
• Level 4 rapid modifications needed with
  interpretation ongoing
• Level 5 evaluative, requiring decisions and
  oversight during administration to assess
• Level 6 applications to group patterns
• Level 7 applications to theoretical development

7
CAPTE Position Paper

• Evaluative criteria that address the relationship
  between physical therapists and physical
  therapist assistants
• http//www.apta.org/AM/Template.cfm?SectionGenera
  l_InformationCONTENTID46607TEMPLATE/CM/Content
  Display.cfm

8
From CAPTE Position Paper on PT-PTA preferred
relationship

• The elements of Examination, Evaluation,
  Diagnosis, Prognosis, Plan of Care, and Outcomes
  are the sole responsibility of the physical
  therapist.
• The physical therapist is responsible for
  determining those aspects of intervention that
  may be directed to the physical therapist
  assistant for each individual patient depending
  upon patient acuity, stability, and complexity.
  When interventions require continuous examination
  for safe and effective application ltgt they may
  not be delegated to the physical therapist
  assistant.
• ltgt such as, but not limited to, suctioning, joint
  mobilization, sharp debridement, instrumental
  activities of daily living training, and other
  components of interventions listed in Appendix E
  of the Normative Model of Physical Therapist
  Assistant Education, Version 99

9
Continuing, from CAPTE position paper

• The physical therapist initiates and modifies the
  treatment program the physical therapist
  assistant may modify specific treatment
  procedures in response to patient status.
• The physical therapist assistant may engage in
  specific, limited data collection activities in
  order to assess the patients response to the
  intervention, but for this purpose only.
• At all times the physical therapist assistant
  works under the direction and supervision of the
  physical therapist.

10
State Law

• The PT Practice Act within each state provides
  legal guidelines within the PT Practice Act
• The PT Affiliated Credentialing Board (PTACB) is
  within the Medical Examining Board for State of
  WI
• PT 5.01 Practice and supervision of physical
  therapist assistants and unlicensed personnel
  provided as 1 page handout
• http//www.legis.state.wi.us/rsb/code/pt/pt005.pdf
  

11
Background Training

12
Parallels between PT and PTA

• Normative model for PT Education
• Program Accreditation by CAPTE
• Guide for Professional Conduct (Code of Ethics)
  for PT

• Normative model for PTA Education
• Program Accreditation by CAPTE
• Standards of Ethical Conduct for PTA

13
PT and PTA

• PT Licensure required for Physical Therapists in
  all states in US
• 250 item exam
• Provides supervision consistent with federal
  state requirements - effective for patient care
  status
• Provides supervision consistent with state
  requirements and ethical standards of care

• PTA Licensure exam required in 42 states 45
  require graduation from accredited program some
  dont regulate
• 200 item exam
• Recognizes appropriate inappropriate delegation
  advocates for best practice
• Abides by role supervisory requirements
  consistent with state requirements ethical
  standards

14
Comparison UW-L and Western physical therapy
programs

• Degree conferred
• Clinical Doctorate of Physical Therapy
• Length of program
• 3 years (9 semesters)
• Duration of clinical experiences
• Year 1 2 weeks
• Year 2 4 weeks
• Year 3 36 weeks

• Degree conferred
• Associate Degree as Physical Therapist Assistant
• Length of Program
• 2 years (5 semesters)
• Duration of clinical experiences
• Year 1 1 week
• Year 2 15 weeks

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Prerequisites

• High School Diploma or equivalent
• Courses in High school (Biology, Chemistry)
• Placement testing (ACT, ASSET or COMPASS)
• Background check
• Admitted via wait list
• All admission criteria met (including online
  orientation, immunization record, CPR
  certification)
• Priority admission possible for AP coursework

• Bachelors Degree (or dual degree Senior in
  Biology or Physics at UW-L)
• Courses (Biology, Anat Physiology, Chemistry,
  Physics, Psychology, Sociology, Statistics)
• Graduate Record Exam
• Background check
• Job Shadowing
• Letters of Reference
• Admitted through application process (example, gt
  200 applicants in 2007 for 45 available seats)

16
Sample of Course Topics

• Human Anatomy, Neuroanatomy, Physiology,
  Pathophysiology, Pharmacology, Exercise Science,
  Radiology
• Professionalism Ethos of Care, Clinical
  Teaching, Health Care Admin, Health Wellness
• Biomech Kinesiology, Instrumentation,
  Statistics, Research, EBP
• Examination, Intervention, Physical Agents,
  Cardiopulmonary, Integument, Orthopedics x3 (
  Spine, LE, UE), Neurologic x2 (Adult, Pediatric)
• Fieldwork, Internship x3

• General Anatomy Physiology
• Written Communication, Speech, Psychology,
  Developmental Psychology
• Professional issues, Technical Reporting
• Kinesiology x2
• Therapeutic Exercise, Therapeutic Modalities,
  Neurologic Rehab, Musculoskeletal Rehab, Cardio
  Integument, Lifespan Rehab
• Clinical Practice x3

17
Link to Programs Courses

• www.uwlax.edu
• http//www.uwlax.edu/sah/html/gradprograms.htm
• http//perth.uwlax.edu/pt/pdf/DPT20curriculum20
  outline204-9-08.pdf

• www.westerntc.edu/
• http//www.westerntc.edu/ClassInformation/ClusterD
  etail.aspx?CLUSTER_ID6
• http//www.westerntc.edu/ClassInformation/ProgramI
  nformation.aspx?PROGRAM_NBR105241

18
Plans for Interactive Lab

• Introduction
• Awareness
• Opportunity for interaction
• Preparation for unique shared roles
• Team Members within Health Care

19
Goals for the Interactive Lab

• Students will value the preferred relationship
  between the PT and PTA.
• The PT PTA student will cooperatively discuss
  completion of a treatment session within the plan
  of care as written.
• The PT PTA student will seek clarification on
  any confusing aspects of communication, roles,
  and responsibilities.
• PT and PTA students will recognize the
  educational rigor of each others educational
  background.
• PT PTA students will display mutual respect
  during the communication process.

20
Planned Agenda

• Before the interactive lab session
• Informed consent form
• Pre-Activity Survey
• Lecture-Discussion with these slides
• During the Interactive lab session
• Meet Greet
• Learn about each others program, training,
  expectations, and concerns
• Discuss each patient on your caseload at Healthy
  Sweat Clinic for this date
• Sharing experiences training with each other
• Whole group discussion
• Following the interactive lab session
• Post-Activity Survey

21
References

• APTA CAPTE (Commission on Accreditation of
  Physical Therapy Education) resources at website.
  www.apta.org
• FSBPT (Federation of State Boards of Physical
  Therapy) website. www.fsbpt.org
• Plack MM et al. Collaboration between physical
  therapists and physical therapist assistants
  fostering the development of the preferred
  relationship within a classroom setting. J of
  Phys Therapy Education. 200620(1)3-13.
• Watts NT. Task analysis and division of
  responsibility in physical therapy. Phys Ther.
  19715123-30.