The Art of Physical Therapy By Jennifer Dilger, Bekah Jarosinski, Jake Hillyard, Devin Henry, and Gin Yang

Entry Level Education In order to be a licensed physical therapist, an individual must attend and complete a CAPTE accredited PT program and pass the National Physical Therapy Exam (NPTE). Upon completion of the 3 year PT program, which includes didactic and clinical work, the individual will graduate with a Doctorate of Physical Therapy (DPT). During the 3 years that the student is in school, they will complete the following courses; anatomy, histology, neuroscience, pharmacology, ethics/IPEC, finance, exercise physiology, biomechanics, kinesiology, musculoskeletal, clinical reasoning, communication, evidence-based practice, and the cardiopulmonary system.

Post-entry Level Education Options Students that choose to further their education after graduating with their DPT can do a clinical residency, clinical fellowship or participate in continuing education courses. Clinical residency: A student is mentored and monitored under clinical supervision by a PT in the area that the student is studying. (Such as orthopedic or sports PT) The student will gain more of a theoretical and scientific basis in the specific field they study. Clinical fellowship: The student will study advanced clinical and didactic skills in a subspecialty area of PT under a mentor. The student should come into frequent contact with patients within the subspecialty area they are studying. Continuing education courses: These courses are required in most practices and can consist of a multitude of different practices, theories, techniques, treatments, etc. that will further a PT’s education.

Specialty Certification Options and Process The American Board of Physical Therapy Specialties (ABPTS) offers opportunities for physical therapists to become board-certified clinical specialists. Specialty certification is a voluntary way to develop a greater depth of knowledge and skills for a particular area of practice. The following are areas to become board-certified: cardiovascular and pulmonary, clinical electrophysiology, geriatrics, neurology, orthopaedics, pediatrics, sports physical therapy, women’s health.

Areas of Specialty/niche Practice If a physical therapist chooses to pursue further training and become certified through the ABPTS, this may naturally lead to the development of a niche in which they practice. Examples of this may include: An orthopaedic specialist with vast knowledge of foot/ankle biomechanics and function working mostly with runners. A neurologic specialist with extensive knowledge of dementia or Alzheimer’s disease working primarily with patients affected by these conditions.

Scope of Practice Although different states have laws that vary according to what PT’s can and can’t do, the following slides present a general overview. Physical therapists should always practice within their personal scope of practice. Even if a state law allows a physical therapist to provide a service, the PT should only perform those services in which they personally possess the knowledge, skills, and abilities to perform it competently.

Scope of Practice Patient exam History Systems Review Tests and Measures Including but not limited to: activities of daily living; aerobic capacity/endurance; arousal, attention, and cognition; assistive and adaptive devices; circulation; central and peripheral neurological integrity; environmental, home, and work barriers; ergonomics and body mechanics; gait and balance; integumentary integrity; motor function and muscle performance; neuromotor development; pain; posture; range of motion; respiration. Determine diagnosis, prognosis, and appropriate interventions.

Scope of Practice Alleviating impairments and functional limitations Therapeutic intervention designs that may include: coordination; therapeutic exercise; functional training for activities of daily living, work, and leisure activities; manual therapy - mobilizations; prescription and training for assistive and adaptive equipment; gait training; airway clearance; integumentary repair and protection; and physical agents and mechanical modalities. Preventing injuries, impairments, functional limitations, and disabilities Promoting health and wellness Consultation Education Research

Access to Services Every state allows some sort of direct access to physical therapy services No referral necessary Exact treatments allowed without referral may vary state to state Health care providers that may refer to physical therapy include: Medical Doctors Dentists Podiatrists Physician Assistants Nurse Practitioners Chiropractors

Access to Services Virginia Laws Licensed physical therapists with a DPT or certification of authorization may evaluate and treat a patient for no more than 30 consecutive days after initial evaluation as long as the conditions outlined in the state laws are met. The patient may continue physical therapy after the 30 day period if a referral is submitted by another health care provider. (MD, PA, Dental Surgeon, etc.) Another initial eval shall not be completed within 60 days of the original initial eval for the same condition. Licensed physical therapists without a DPT or certification of authorization may complete and initial evaluation but may not treat without a referral. No restrictions exist in regards to direct access services in workplace settings; school settings (student athletes) and special education students; health and wellness promotion; or prevention of impairments, functional limitations, and disabilities. http://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf

Practice Settings Physical therapists work in a variety of settings and some of them include: Acute care: patients who are admitted to the hospital for short-term Rehab/subacute rehab: physical therapy is given to individuals who can tolerate treatment for several hours Nursing home: typically for elderly patients and provides long-term nursing care and rehab Outpatient clinic: individuals visit a clinic to receive treatment to primarily address musculoskeletal or neuromuscular injuries/impairments Home health: physical therapy is given in the patient’s home Hospice: physical therapy is given during the last phases of an incurable disease to maintain functional abilities for as long as possible and to control pain Local, state and federal gov’t: physical therapy is provided to civilians and military personnel. School: physical therapy is provided in an educational environment

Role of PT A PT’s role is to assess, diagnose, and treat any individual who has difficulty with movement or normal daily activity. Using a variety of tests, measures, and interventions they can assist anyone from a newborn up to the elderly to become more functional and hopefully pain free. In addition to working to help individuals regain function and independence, PT’s also stand as professional advocates for physical activity and other means whereby individuals can maintain the functionality and mobility they currently have.

Examples of Common Patient Profiles Some examples of the patients that a PT works with might include: An elderly man learning how to function following a stroke. A high school gymnast strengthening her ankle following a traumatic accident. A 60 year old woman regaining strength following a total knee replacement. A toddler learning how to mobilize with spina bifida. A chronic smoker with COPD learning how to breath easier and more effectively. A professional football player returning from a surgical knee ligament repair. A middle aged woman learning how to manage her chronic back pain.