The PT/PTA Relationship PTA Professional Issues Presenter: L. Kay Garrison, PT, DPT

Objectives Define the differences in the roles of the PT/PTA Discuss how roles apply in multiple settings Describe ways by which the parameters of your scope of practice may be tested Discuss your relationships with PTs in your clinical experiences

Instructor: L. Kay Garrison, PT, DPT From South Bend, IN Undergrad at Howard University in Washington, DC DPT at Northwestern University Have worked in outpatient orthopedic, acute, subacute, inpatient rehab, wound care, and developmental disabilities Married to Quintin Likes to sing, travel, dance, and read (especially historical fiction)

Methods Discussion Role play Case studies Question and answer

APTA says (In official document HOD P06-01-18-19) The American Physical Therapy Association (APTA) is committed to promoting the physical therapist as the professional practitioner of physical therapy and promoting the physical therapist assistant as the only individual who assists the physical therapist in the provision of selected physical therapy interventions. APTA is further committed to incorporating this concept into all Association policies, positions, and program activities, wherever applicable. Professional: The term “professional,” when used in reference to physical therapy services, denotes the physical therapist.

APTA also says (In official document HOD P06-01-18-19) The physical therapist assistant is an educated individual who works under the direction and supervision of a physical therapist. The physical therapist assistant is the only individual who assists the physical therapist in accordance with APTA’s policies and positions in the delivery of selected physical therapy interventions. The physical therapist assistant is a graduate of a physical therapist assistant education program accredited by the Commission on Accreditation in Physical Therapy Education.

PTA vs. PT PTA PT Successfully complete 2 years or 5 semesters associates degree Pass national exam for license/certification Work under the direction of a PT Measure changes in patient performance Successfully complete 6-7 years of undergrad/graduate coursework Pass national exam for license Evaluate patients in order to establish a plan of care according to MD prescription Periodically re-assess patient progress to advance plan of care

PTA vs. PT PTA PT Instruct patients in exercise and document patient response Utilize procedural interventions, data collection and effective communication to carry out the established plan of care Must communicate with supervising physical therapist that modifications to plan of care are necessary Select and direct interventions to be carried out by PTAs Integrate examination, evaluation, diagnosis, prognosis, and intervention for optimal outcomes May modify plan of care as needed, with MD approval in some cases

PTA vs. PT Must adhere to the APTA PTA Code of Conduct Must adhere to the APTA PT Code of Conduct THESE ARE VIRTUALLY IDENTICAL

Ethical Standard number The difference is…. Ethical Standard number Which says that a PT must make legally and ethically sound decisions, and a PTA must make them in collaboration with a PT.

The PTA is allowed to: Add/modify appropriate interventions Collect data, i.e. objective measures Communicate with the health care team for optimal outcomes

APTA says (In official document Amended HOD P06-00-20-05) The physical therapist’s scope of practice as defined by the American Physical Therapy Association Guide to Physical Therapist Practice includes interventions performed by physical therapists. These interventions include procedures performed exclusively by physical therapists and selected interventions that can be performed by the physical therapist assistant under the direction and supervision of the physical therapist. Interventions that require immediate and continuous examination and evaluation throughout the intervention are performed exclusively by the physical therapist. Such procedural interventions within the scope of physical therapist practice that are performed exclusively by the physical therapist include, but are not limited to, spinal and peripheral joint mobilization/manipulation, which are components of manual therapy, and sharp selective debridement, which is a component of wound management.

Supervision Requirements In order to carry out most selected interventions, the APTA says that GENERAL SUPERVISON is required. WHAT IS THAT???? That means the PT must be available by phone

Where are PTAs working?

Hospital owned outpatient clinic

Physical therapist owned outpatient clinic

Skilled nursing facility/physical therapy clinic

Acute care physical therapy

Home health agency

Case 1: Free-Standing OP PT clinic

Case 1: OP clinic You are working in a free-standing outpatient clinic. You have ten patients to see in your 8 hour work day and you’ve scheduled it out perfectly so that you can head to Chipoltle for lunch. Suddenly, your PT partner has to leave to pick up his daughter from school. Five of your ten patients have Medicare as their primary insurance. How should you adjust your plan?

Possible response: In order to bill Medicare for your services, you must have a licensed physical therapist on-site and available to provide immediate assistance.

Case 2: Home Health Agency

Case 2 HHA You are treating a patient at 21 Jump Street who had a total knee replacement 10 days ago. He had 90 degrees of knee flexion according to the evaluation conducted 2 days ago, he’s been doing LAQs, and he is now ready for more exercise. Can you give him a HEP? What are you going to tell the supervising PT?

Possible response: You can add more exercises for the patient’s home exercise program, as long as the PT plan of care states strengthening and ROM are to be added. Let the PT know how the patient responds to the new exercises in your assessment.

Please READ: Dreeben page 24 Curtis – Chapter 1 “So Close and Yet So Far”- Nancy R. Kirsch, PT, DPT, PhD

Questions? Comments? Concerns?

References Thompson, Terri N. (2007). Guideline for Visits and PTA Supervision [Electronic version]. Advance for Physical Therapy and Rehab Medicine, Vol. 18, Issue 18, page 67. American Physical Therapy Association. (2010, October 05). PT/PTA Teamwork: Models in Delivery of Care, Retrieved December 10, 2010 from http://www.apta.org/.