Chapter 8: Therapy and Rehabilitation

Physical Therapists History of the Profession Began during WWI w. rehabilitation of wounded soldiers 1917: Army training program for reconstruction aides 1921: reconstruction aides form association (APTA) 1940s & 1950s: demand for therapists due to WWII & polio 1950s: state licensing increased 1954: APTA developed competency exam 1960s: therapists began treating other conditions 1968: PT services authorized for Medicare program

Physical Therapists (cont’d) Education Master’s degree programs Minimum requirement 19 accredited programs Take 2 to 2 ½ years Doctoral degree programs Are becoming the entry-level requirement 203 accredited programs Take 3 years More content & longer clinical rotations than master’s

Physical Therapists (cont’d) Course Work Anatomy Cellular biology Physiology Exercise physiology Neuroscience Pharmacology Applied psychology Applied sociology Communication Clinical reasoning Applied statistics

Physical Therapists (cont’d) Licensure Required in all states Requires: Graduation from accredited program Passing exam Other state requirements Specialist Certification Offered by American Board of Physical Therapy Specialties For licensed PTs in practice for at least 10 years Available for 7 specialties Requires 2,000 hours of direct patient care in area

Physical Therapists (cont’d) Work Responsibilities Do a systems review Take patients’ medical history Conduct motor function tests Develop treatment plans Perform gait & locomotion training Assess patients’ progress Educate patients about expected outcomes Coordinate with home care agencies

Physical Therapists (cont’d) Personal Characteristics Care Compassion Positive attitude Ability to work well with others Good observation skills Good problem-solving skills

Physical Therapists (cont’d) Employment Opportunities and Trends 30% growth from 2008 to 2018 Growth due to: Easing of service restrictions by insurers Rising population of older adults Increased survival of trauma victims & infants w. birth defects Increase in treatment of previously untreatable conditions Influence of Individuals with Disabilities Education Act About 35% of jobs in practitioners’ offices About 30% of jobs in hospitals

Physical Therapists (cont’d) Professional Organization: APTA 72,000 members Goal: help advance PT practice, research, & education Monitors legislation & advocates for profession Conducts research on profession Certifies specialists Credentials residency & fellowship programs Offers many member benefits

Physical Therapist Assistants History of the Profession Developed after WWII w. greater need for PT treatments 1950s: first assistants appeared, informally trained 1967: first two PTA education programs approved CAPTE set program accreditation standards APTA developed guidelines for tasks 1970s to 1990s: PTA training programs grew rapidly

Physical Therapist Assistants (cont’d) Education Associate’s degree programs (most) 252 accredited programs 2 years long Includes general education & technical education classes Includes 520 to 720 hours of clinical experience

Physical Therapist Assistants (cont’d) Course Work: General & Technical Basic sciences Applied physical therapy science Physical therapy interventions Communication Behavior & conduct Data collection

Physical Therapist Assistants (cont’d) Licensure, Registration, or Certification Required in most states Requires Associate’s degree from accredited PTA program Passing NPTE exam Passing state exam (in some states) Continuing education for license renewal PTA Recognition Program provides distinction for PTAs with advanced proficiency

Physical Therapist Assistants (cont’d) Work Responsibilities Measure height, weight, length, & girth Use hip & knee flexion techniques Use static stretching techniques Conduct gait training Collect patient data Massage tissues to ease swelling Teach a patient to use a walker Update progress notes after a session

Physical Therapist Assistants (cont’d) Personal Characteristics Empathy Good people skills Good communication skills Good organizational skills Attention to detail Good teamwork skills

Physical Therapist Assistants (cont’d) Employment Opportunities and Trends Rapid growth: 33% between 2008 & 2018 Setting distribution 72% in hospitals or offices of health practitioners Remainder in: Nursing care Home health care Outpatient care

Physical Therapist Assistants (cont’d) Professional Organization: APTA American Physical Therapy Association (APTA) Represents both PTs & PTAs Has organization just for PTAs, National Assembly Offers: Continuing education Special interest groups Awards Online career center

Occupational Therapists History of the Profession Moral treatment: 18th & 19th century approach to mental illness Provided patients w. activities, exercise, & pleasant surroundings Late 19th & early 20th centuries: OT expanded to disabilities 1917: Barton forms professional association (AOTA) WWI: reconstruction aids provided OT for soldiers 1935: AMA joined AOTA in accrediting OT programs WWII: rapid growth, shift in focus to physical rehabilitation 1960s: call for return to occupation-centered roots 2002: AOTA adopted new practice framework

Occupational Therapists (cont’d) Education Master’s degree at minimum 151 accredited master’s degree programs 4 accredited doctoral programs Undergraduate degree can be from variety of majors Programs include: Core & professional courses 24 weeks of supervised fieldwork Doctoral programs offer additional instruction in many subjects

Occupational Therapists (cont’d) Course Work General intro to OT Skills in screening, evaluating, & referring clients Development of an intervention plan Interventions Accommodation to different work settings Management of OT services Research Professional ethics, values, & responsibilities

Occupational Therapists (cont’d) Licensure and Certification Licensure Required in all states Requires graduation from accredited program & passing exam Certification AOTA offers board certification in various areas Requirements: Professional degree Set # of years in practice Set # of hours of OT practice

Occupational Therapists (cont’d) Work Responsibilities Screen for learning disabilities Perform muscle testing Test visual acuity Evaluate home environment Develop intervention plans Select assistive technology Teach patients to dress Instruct in reading strategies Modify classroom equipment

Occupational Therapists (cont’d) Professional Characteristics Good interpersonal skills Empathy Patience Good observation skills Creativity Strong organizational skills Attention to detail Good communication skills

Occupational Therapists (cont’d) Employment Opportunities and Trends Growth of 26% between 2008 & 2018 Increased opportunities due to: Needs of increasing older population Medical advances allowing patients w. conditions to survive Setting distribution 29% in offices of health practitioners 28% in hospitals 13% in educational services 10% in nursing residential care

Occupational Therapists (cont’d) Professional Organization: AOTA 36,000 members Goals Represent interests of members Improve quality of OT services Monitors legislation & regulations affecting profession Advocates for profession Offers board & specialty certifications Provides many benefits to members

Occupational Therapy Assistants History of the Profession 1950s: shortage of OTs after WWII 1958: AOTA began approving ed. programs for assistants Early programs were 3 months long & in hospitals Later moved to community colleges & technical schools, longer time Moved from hospitals to other practice settings

Occupational Therapy Assistants (cont’d) Education 2-year associate’s degree is standard 145 accredited programs Includes: Course work At least 16 hours of supervised fieldwork

Occupational Therapy Assistants (cont’d) Course Work General intro. to OT Skills in screening & evaluation Assistance in development of intervention plan OT skills Accommodation to different work settings Assistance in management of OT services Use of professional literature Professional ethics, values, & responsibilities

Occupational Therapy Assistants (cont’d) Licensure, Registration, or Certification Required in 40 states Optional certification via NBCOT exam: COTA Taking exam requires graduation from accredited program Renewal required every 3 years Specialty certifications available from AOTA

Occupational Therapy Assistants (cont’d) Work Responsibilities Screen for visual perception Test touch awareness Evaluate client data Select therapy activities to fit client’s needs Develop energy-saving strategies for a client with MS Write progress notes

Occupational Therapy Assistants (cont’d) Personal Characteristics Good people skills Empathy Patience Responsibility Willingness to take direction Good teamwork skills

Occupational Therapy Assistants (cont’d) Employment Opportunities and Trends Growth: 30% between 2008 & 2018 Factors prompting growth Cost-control measure Growing school-age population Federal laws requiring funding for ed. for those w. disabilities Setting distribution ¾ in hospitals, practitioner offices, & nursing care facilities Remainder in community care & home health care

Occupational Therapy Assistants (cont’d) Professional Organization: AOTA Represents OTs & OTAs Offers: Specialty certifications Continuing education Online resources

Respiratory Therapists History of the Profession Tech developments in 20th century led to oxygen therapy Nurses initially administered oxygen therapy Post-WWII Equipment became more complex Oxygen orderlies took over 1946: professional organization of oxygen orderlies established 1962: school guidelines approved by AMA 2009: most recent revision of school guidelines

Respiratory Therapists (cont’d) Education Associate’s degree at minimum Bachelor’s or master’s degree may help advancement Programs: Offered at: Colleges & universities Medical schools Vocational-technical institutes & military 378 advanced-level & 27 entry-level accredited programs

Respiratory Therapists (cont’d) Course Work Communication Social & behavioral sciences Math Computer science Cardiopulmonary A&P Chemistry Microbiology Pharmacology Assessment of cardiopulmonary status Airway management Lung inflation therapy Alternate site care

Respiratory Therapists (cont’d) Licensure Required in all states except Alaska & Hawaii Must be renewed every 3 years, requiring continuing ed.

Respiratory Therapists (cont’d) Credentials Awarded by NBRC Certified Registered Therapist (CRT) Registered Respiratory Therapist (RRT) Neonatal/Pediatric Specialist (CRT-NPS or RRT-NPS) Sleep Disorders Testing and Therapeutic Intervention Respiratory Care Specialist (CRT-SDS or RRT-SDS)

Respiratory Therapists (cont’d) Work Responsibilities Do pulmonary function tests Set up mechanical ventilators Monitor arterial blood gases Insert airway tubes Obtain & analyze oxygenation level of arterial blood Administer aerosol medications Perform chest physiotherapy Check lung sounds

Respiratory Therapists (cont’d) Personal Characteristics Calm, reassuring manner Sensitivity to patients’ needs Good communication skills Good teamwork skills Flexibility Willingness to learn

Respiratory Therapists (cont’d) Employment Opportunities and Trends Growth: 21% between 2008 & 2018 Factors prompting growth Increasing # of middle-aged & older adults Enhancements in respiratory medications & treatments Movement of respiratory therapists into case management Setting distribution 81% in hospitals Remainder in physicians’ offices & other locations

Respiratory Therapists (cont’d) Professional Organization: AARC Founded in 1947 Dedicated to professional development & lung health Advocates for profession on legislative & regulatory issues Accredits continuing education programs Offers many member benefits

Massage Therapists History of the Profession Practiced in ancient China, India, Egypt, & other societies Performed on athletes competing in ancient Greek Olympics Per Henrik Ling: developed Swedish massage Mid-1800s: Taylor promoted Swedish massage in U.S. Early 20th century: massage declined in U.S. 1927: first professional massage organization in U.S. 1960s & 1970s: resurgence of massage in U.S.

Massage Therapists (cont’d) Education Most complete formal training program Programs: Combination of course work & hands-on practice May focus on particular modalities Approved by state board & sometimes accredited Take 500 hours or more to complete Require HS diploma or equivalent

Massage Therapists (cont’d) Course Work Anatomy Physiology Kinesiology Pathology Massage theory & application Business Ethics Various modalities

Massage Therapists (cont’d) Licensure or Certification Required by almost all states Requires: Completion of state-approved program Passing an exam Two certification exams administered by NCBTMB Certification renewal requires: 48 hours of continuing education 200 hours of work experience

Massage Therapists (cont’d) Work Responsibilities Schedule client sessions Do client assessments Prepare initial treatment plans Position clients’ body Apply appropriate massage strokes Use various modalities Use proper body mechanics Maintain client records

Massage Therapists (cont’d) Personal Characteristics Sociability Empathy Good communication skills

Massage Therapists (cont’d) Employment Opportunities and Trends Growth: 19% between 2008 & 2018 Factors prompting growth Increased awareness of the benefits of massage Formation of more spas & massage clinic franchises Companies adopting seated massage as a work benefit Increased demands for massage among older & young adults 57% are self-employed Settings: salons, spas, physicians’ & chiropractors’ offices, fitness centers, hotels

Massage Therapists (cont’d) Professional Organizations American Massage Therapy Association (AMTA) Founded in 1943 >58,000 members Associated Bodywork & Massage Professionals (ABMP) Founded in 1987 >70,000 members