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Chapter 8: Therapy and
Rehabilitation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Therapists
• History of the Profession
–
Began during WWI w. rehabilitation of wounded soldiers
–
1917: Army training program for reconstruction aides
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1921: reconstruction aides form association (APTA)
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1940s & 1950s: demand for therapists due to WWII & polio
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1950s: state licensing increased
–
1954: APTA developed competency exam
–
1960s: therapists began treating other conditions
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1968: PT services authorized for Medicare program
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Therapists (cont’d)
• Course Work
–
Applied psychology
–
Anatomy
–
Applied sociology
–
Cellular biology
–
Communication
–
Physiology
–
Clinical reasoning
–
Exercise physiology
–
Applied statistics
–
Neuroscience
–
Pharmacology
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Therapists (cont’d)
• Licensure
• Specialist Certification
–
Required in all states
–
Offered by American Board
of Physical Therapy
Specialties
–
Requires:
• Graduation from
accredited program
–
For licensed PTs in practice
for at least 10 years
• Passing exam
–
Available for 7 specialties
• Other state
requirements
–
Requires 2,000 hours of
direct patient care in area
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Therapists (cont’d)
• Personal Characteristics
–
Care
–
Compassion
–
Positive attitude
–
Ability to work well with others
–
Good observation skills
–
Good problem-solving skills
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Therapist Assistants (cont’d)
• Course Work: General & Technical
–
Basic sciences
–
Applied physical therapy science
–
Physical therapy interventions
–
Communication
–
Behavior & conduct
–
Data collection
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Therapist Assistants (cont’d)
• Personal Characteristics
–
Empathy
–
Good people skills
–
Good communication skills
–
Good organizational skills
–
Attention to detail
–
Good teamwork skills
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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)
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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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Occupational Therapists (cont’d)
• Professional Characteristics
–
Good interpersonal skills
–
Empathy
–
Patience
–
Good observation skills
–
Creativity
–
Strong organizational skills
–
Attention to detail
–
Good communication skills
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Occupational Therapy Assistants (cont’d)
• Personal Characteristics
–
Good people skills
–
Empathy
–
Patience
–
Responsibility
–
Willingness to take direction
–
Good teamwork skills
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Occupational Therapy Assistants (cont’d)
• Professional Organization: AOTA
–
Represents OTs & OTAs
–
Offers:
• Specialty certifications
• Continuing education
• Online resources
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Respiratory Therapists (cont’d)
• Course Work
–
Pharmacology
–
Communication
–
–
Social & behavioral
sciences
Assessment of
cardiopulmonary status
–
Airway management
–
Math
–
Lung inflation therapy
–
Computer science
–
Alternate site care
–
Cardiopulmonary A&P
–
Chemistry
–
Microbiology
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Respiratory Therapists (cont’d)
• Licensure
–
Required in all states except Alaska & Hawaii
–
Must be renewed every 3 years, requiring continuing ed.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Respiratory Therapists (cont’d)
• Personal Characteristics
–
Calm, reassuring manner
–
Sensitivity to patients’ needs
–
Good communication skills
–
Good teamwork skills
–
Flexibility
–
Willingness to learn
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Massage Therapists (cont’d)
• Course Work
–
Anatomy
–
Physiology
–
Kinesiology
–
Pathology
–
Massage theory & application
–
Business
–
Ethics
–
Various modalities
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Massage Therapists (cont’d)
• Personal Characteristics
–
Sociability
–
Empathy
–
Good communication skills
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins