1110 - Module 1

PHTA 1110
Introduction to Physical Therapy

Module 1: Introduction to the Profession of Physical
Therapy
Course Materials
 Required Text: Introduction to  Additional Texts and
Physical Therapy, 5th Edition. Publications:
Pagliarulo. The Role of the Physical
 AHA Basic Life Support CPR Therapist Assistant, 2nd
Manual Edition, Clynch
 CPR Pocket Mask The Guide to Physical
Therapist Practice, 3rd
Edition, online at
www.apta.org
Concepts of Evidence Based
Practice for the Physical
Therapist Assistant, Barbara
B. Gresham
 The PTA Exam Complete
Study Guide, Giles
Learning Outcomes
 1.1 Explore and examine the field of physical therapy.

 1.2 Describe the characteristics of the profession.
 1.3 Discuss the history of the profession of physical therapy
and the APTA.
 1.4 Describe the structure and function of the APTA.
 1.5 Describe the benefits of belonging to the APTA and the
rights and privileges of the PTA.
 4.1 Discuss practice issue that impact the PTA.
 4.2 List the constructs and concepts that inform physical
therapy
Define Physical Therapy
• Physical Therapy is a dynamic profession with an established theoretical
and scientific base and widespread clinical applications in the restoration,
maintenance, and promotion of optimal physical function.
• Diagnosis and manage movement dysfunction and enhance physical
and functional abilities
• Restore, maintain, and promote not only optimal physical function but
optimal wellness and fitness and optimal quality of life as it relates to
movement and health
• Prevent the onset, symptoms, and progression of impairments,
functional limitations, and disabilities that may result from disease,
disorders, conditions, and injuries
http://www.apta.org/PTCareers/RoleofaPT/
pp. 4-6 Pagliarulo
Define Physical Therapy
Physical Therapy = Physiotherapy

Physical Therapist=Physiotherapist
http://www.apta.org/PTCareers/RoleofaPT/
er Inc. All rights reserved.
6
Model Definition
 The American Physical Therapy Association (APTA)

constructed a Model Definition of Physical Therapy for State
Practice Acts, which later became known as the Physical
Therapist Scope of Practice. Here are some highlights:
 Physical therapy, which is limited to the care and services
provided by or under the direction and supervision of a
physical therapist, includes:
7
Model Definition (cont’d)
1. Examining (history, systems review, and test and
measures) individuals with impairments, functional
limitations, and disability or other health-related condition
to determine a diagnosis, prognosis, and intervention
2. Alleviating impairment and functional limitation by
designing, implementing, and modifying therapeutic
interventions
3. Preventing injury, impairment, functional limitation, and
disability, including the promotion and maintenance of
health, wellness, fitness, and quality of life in all age
populations
4. Engaging in consultation, education, and research
8
Physical Therapy Is a Health Profession
The APTA adopted a position that defines physical therapy

as a profession:
“Physical therapy is a health profession whose primary
purpose is the promotion of optimum health and function.
This purpose is accomplished through the application of
scientific principles to the processes of examination,
evaluation, diagnosis, prognosis, and intervention to
prevent or remediate impairments, functional limitations
and disabilities as related to movement and health.…”
9
What is a profession?
 Origins in medieval period

 First ones:
 Educators
 Lawyers
 Physicians
 Common characteristics (originally)
 No fee!
 Code of ethics
 Distinguished from guilds by providing service to clients
10
What is a profession? (cont’d)
 Criteria (apply these to the profession of physical

therapy)
 Lifetime commitment
 Representative organization
 Specialized education
 Service to clients
 Autonomy of judgment
11
Physical Therapy in the United States: History and
Development
 What were the initiating factors to the profession of physical

therapy in the United States?
 WWI
 Called reconstruction aides
 Exclusively women who worked under the supervision
of physicians to provide assistance to the individuals
wounded in war
History of the Profession
 Developed as the result of two major events:

 Polio Epidemic of the early 1900s
 World War I
 Group of physicians went to England and France to
learn about PT techniques to better help those
wounded in war
 Development of reconstruction aides (exclusively
women)
pp. 8-13 Pagliarulo

13
Physical Therapy in the United States: History and
Development (cont’d)
 Polio epidemics: provided evaluation and treatment

of individuals with muscle weakness
From American Physical Therapy Association: Historical Photograph Packet.

 Mary McMillan
 Born in US
 Trained in England
 Considered the first PT
 1918 led a group of women
called Reconstruction aides
(early PTs)
 Hydrotherapy
 Exercise
 Pagliaruo, Chapter 1 From American Physical Therapy Association:
Historical Photograph Packet.
 1940s – profession began to discuss the need for formally

trained assistants (PTAs)
 1960s- realized need was increasing
 1967- Medicare system added physical therapy as a
reimbursable skilled service
The Role of the Physical Therapist Assistant: Regulations and

Responsibilities 2nd Ed. Holly M. Clynch
 2000 – APTA House of Delegates endorsed a vision for the profession that
described the hopes for how physical therapy would be practice in 2020 and the
qualifications for those involved with the PT practice.
 Autonomous Practice – practicing independently with self determined
judgment and having he ability to refer patients/clients to other healthcare
providers and professionals.
 Direct Assess – all patients are able to receive services without having to
obtain referral
 Six critical areas that guide the future of the profession (Autonomous Practice,
Direct Access, DPT, Evidence-Based Practice, Practitioner of Choice,
Professionalism)
 2013 – APTA Vision Statement for Physical Therapy
 Redefined Movement – “that anatomic structures and physiologic functions
that interact to move the body or its component parts”
 PT/PTAs will better be able to impact societal health, fitness, and activity.
The Role of the Physical Therapist Assistant: Regulations and Responsibilities
2nd Ed. Holly M. Clynch
Vision 2020
 By 2020, physical therapy will be provided by physical therapists who are doctors
of physical therapy, recognized by consumers and other health care professionals
as practitioners of choice to whom consumers have direct access for the
diagnosis of, interventions for, and prevention of impairments, functional
limitations, and disabilities related to movement, function, and health.
 Source: Professionalism Module Slides (APTA continuing ed course)

The PTA - Definition
“A health care provider whose function is to assist the PT in the

provision of physical therapy services in compliance with laws
and regulations governing physical therapy practice” Which also
means, “under the direction and supervision of a PT”
APTA adopted policy statements since the 1960s to clarify the

preparation and use of PTAs and aides due to the increased
demand for PT services from the 1960s – 1980s
p. 6, box 1-2, Pagliarulo

p. 44, box 3-1 Pagliarulo
Copyright
19 © 2016, Elsevier Inc. All rights reserved.
Definition of the Physical Therapist Assistant
 Technically educated health care provider

 The only providers who deliver physical therapy services
under the direction and supervision of a PT
 Graduates of accredited PTA education programs
 Must pass the National Physical Therapy Examination—
PTA
 Must be licensed or certified in their jurisdiction
Copyright
Origin and History
 Increased need for PT services

 Polio and WWII
 Increased access to PT service
 Hill-Burton Act of 1946
 Medicare and Medicaid legislation in 1965
 APTA concerned about development of training
programs without any consistency
er21Inc. All rights reserved.
Origin and History (cont’d)
 July 5, 1967, the APTA House of Delegates (HOD)

adopted policy statement “Training and Utilization of
the Physical Therapist Assistant”
 Established need for an accredited 2-year
associate’s degree program
 Two PTA education programs were developed in
1967 and graduated 15 PTAs in 1969.
Origin and History (cont’d)
 Education programs proliferated and eventually

exceeded the number of PT education programs.
 In 2009, the HOD adopted a position affirming the PTA
as the sole extender to assist the PT.
Copyright
Education
 All education programs accredited by CAPTE
 Result in associate’s degree
 Curricula include foundational content, basic sciences, clinical

sciences, and clinical education.
 Prepare graduates to assist in data collection and perform physical

therapy interventions under direction and supervision of a PT.
 Many jurisdictions require continuing education units after

graduation to maintain licensure.
 Transition to a baccalaureate degree under consideration
 Pros and cons make this a difficult decision.

Models of Education Programs

 One-plus-one programs
 Foundation courses followed by technical courses
 Integrated 2-year programs
 Foundation and technical courses integrated
throughout the curriculum
 Part-time programs
 Classes scheduled in evenings or weekends to
allow students to continue to work
 Bridging programs
 Students move from the PTA to PT program.
Copyright
Utilization of the PTA
 PTA’s clinical role lies within the intervention section of

the patient/client management model.
 PT remains responsible for the PT services provided.
 Guided by practice act in the specific jurisdiction, APTA
policies, and policies in clinical facility
 APTA policies limit sharp debridement and
peripheral joint mobilization to the PT.
Factors That Influence Direction and Supervision

Levels of Supervision Vary
 General supervision
 PT not required to be on site
 Direct supervision
 PT physically present and immediately available for direction
and supervision
 Telecommunications does not meet this requirement
 Direct personal supervision
 PT or PTA (where allowable by law) physically present and
immediately available for direction and supervision
 Direction and supervision continuous throughout the time the
tasks are performed
 Telecommunications does not meet this requirement.
The Physical Therapy Aide
 Unlicensed support personnel

 Training is on-the-job.
 Must have continuous, on-site supervision of the PT or
PTA
 Tasks must not require clinical decision making (PT) or
clinical problem solving (PTA).
 Applies to PT students who are independently
employed and not conducting clinical education as part
of their program
Copyright
Characteristics of the PTA
 75% are women

 44% younger than 40 years of age
 Associate’s degree most common highest academic
degree
 Most common employment setting is private outpatient
office
APTA Membership and Representation (cont’d)
 Several changes occurred by actions of the HOD in

1998:
 New membership category created: the PTA
 The National Assembly of Physical Therapist
Assistants (RBNA) replaced the Affiliate Assembly
 Voting privileges were removed from the HOD, and
two RBNA delegates were permitted to attend the
HOD to make and debate motions but not vote.
 These changes resulted in the loss of PTA members
in the APTA.
Describe the structure and function of the APTA
 Headquarters are in Alexandria, VA
 Full staff
 House of Delegates
 Board of Directors
 95,000 – 100,000 members nationwide
-www.apta.org/History (accessed 7/18)
Describe the benefits of belonging to the APTA
 Feeling of belonging to a group (this is more important than
you think)
 Professional development
 Easy to access current information, research, and updates
 Legislative engagement
 Networking
 Leadership opportunities
Copyright
APTA Membership and Representation
 Affiliate member category created for the PTA in 1973

 Granted ½ vote at the component level and in the HOD
 Affiliate Special Interest Group (ASIG) created in 1983
 Affiliate Assembly replaced the ASIG in 1989
 In 1992, HOD adopted policy that permitted PTAs to
hold office at the component level, excluding positions
that could succeed to presidency
History of the APTA
 Formed by PTs as the first professional organization (1921)

 Called the American Women’s Physical Therapeutic
Association
 Led by Mary McMillan
 1922 name changed to American Physiotherapy
Association (APA) and added men
 1930 first code of ethics
 1940 name changed to American Physical Therapy
Association (APTA)
- www.apta.org/History (accessed 7/18)

PTA membership in the APTA
 Serve as a conduit for PTA members to be integrated into
chapter activities, including special needs of the chapter.
 Provide opportunities for PT/PTA members to discuss issues
related to PTA education, licensure, practice, governance,
and other professional issues.
 Promote the PT/PTA team in the clinic and within the
Association.
 Provide leadership development opportunity for PTAs.
 Promote PTA membership at the grass roots.
Copyright
APTA Membership and Representation
 Affiliate member category created for the PTA in 1973

 Granted ½ vote at the component level and in the HOD
 Affiliate Special Interest Group (ASIG) created in 1983
 Affiliate Assembly replaced the ASIG in 1989
 In 1992, HOD adopted policy that permitted PTAs to
hold office at the component level, excluding positions
that could succeed to presidency
 Several changes occurred by actions of the HOD in

1998:
 New membership category created: the PTA
 The National Assembly of Physical Therapist
Assistants (RBNA) replaced the Affiliate Assembly
 Voting privileges were removed from the HOD, and
two RBNA delegates were permitted to attend the
HOD to make and debate motions but not vote.
 These changes resulted in the loss of PTA members
in the APTA.
Data from APTA Department of Member Development, Alexandria, VA, 2014.

 In 2005, the RBNA was replaced with the PTA Caucus

and an Advisory Panel of Physical Therapist Assistants
was also created.
 Five members of the PTA Caucus serve as
delegates to the HOD. They can make and debate
motions but cannot vote.
 The Advisory Panel was later dissolved as part of a
comprehensive governance review.
 In 2015, the HOD voted to provide a full vote for the
PTA at the component level at the discretion of the
component.
Organizational Structure
Copyright
Membership
 Voluntary
 Approximately two-thirds of licensed PTs are members.
 Membership provides strength and diversity
 Requirements for membership:
 Graduation from or enrollment in an accredited
education program
 Signed pledge to comply with the Code of
Ethics (PT) or Standards of Ethical Conduct for the
Physical Therapist Assistant (PTA)
 Pay dues
Copyright
Membership (cont’d)
 Categories of membership
 PT
 PTA
 Respective student categories
 Life
 Retired
 Honorary
 Catherine Worthingham Fellow of the APTA
Copyright
Districts
 Most local organizational unit in the APTA

 Exist in highly populated states
 Allow for easy access to meetings and input at the state
(chapter) level
Copyright
Chapters
 State membership
 In 2015, there were 51 chapters
 50 states and Washington, DC
 Chapters can assess dues (districts cannot)
 Provide mechanism for members to participate at the
state level and have proportionate representation at the
national level
American Council of Academic Physical

Therapy (ACAPT)
 Originally the Academic Administrators Special Interest

Group (AASIG) within the Education Section
 In 2010, the AASIG created an Academic Council
approved by the APTA Board of Directors and in 2013
became a component of the APTA, known as ACAPT
 Purpose is to promote excellence in physical therapist
education including clinical and post-professional
education
Physical Therapist Assistant Caucus
 Created in 2005
 Replaced the Representative Body of the Physical
Therapist Assistant
 Consists of delegates from all chapters and the District
of Columbia
 Meets once a year just before the APTA House of
Delegates (HOD)
 Five members serve as nonvoting delegates to the HOD.
Copyright
Board of Directors (BOD)
 Made up of six officers and nine directors

 Officers
 President, vice president, secretary, treasurer, speaker of HOD,
vice speaker of HOD
 Duties
 Carry out mandates and policies established by HOD
 Manage the affairs of the APTA
 Can create ad hoc committees, standing committees,
and task forces as needed
 Can also create advisory groups and councils to
respond to unique service needs of APTA
Copyright
House of Delegates (HOD)
 Highest policy-making body of APTA

 Composed of:
 Voting delegates from all chapters
 Nonvoting delegates from
 Each section
 PTA Caucus
 Student Assembly
 Board of Directors (BOD)
 Formula creates body just over 400 members
 HOD meets for 3 days before the NEXT Conference
and Exposition
 Creates ad hoc committees, standing committees, and
task forces as needed
Copyright
Staff
 Serves APTA at all levels

 Toll-free number: 800-999-APTA (2782)
 More than 180 staff members
 APTA website
 www.apta.org
Copyright
Related Organizations
 American Board of Physical Therapy Residency and Fellowship

Education
 Accredits postprofessional residency and fellowship training
programs
 American Board of Physical Therapy Specialists
 Provides a mechanism to recognize PTs with advanced knowledge
and skills in an area of clinical specialization:
 Cardiovascular and pulmonary
 Clinical electrophysiology
 Geriatrics
 Neurology
 Orthopaedics
 Pediatrics
 Sports
 Women’s health
Related Organizations (cont’d)
 Commission on Accreditation in Physical Therapy

Education (CAPTE)
 Accredits PT and PTA education programs
 Establishes standards for accreditation
 Foundation for Physical Therapy
 Provides funding for research in physical therapy
 Federation of State Boards of Physical Therapy
 Coordinates activities among state boards of physical therapy
 Manages the licensing exams for PTs and PTAs
 Physical Therapy Political Action Committee
 Conducts fundraising to support legislation that addresses the
interests of physical therapists at the federal level
 World Confederation for Physical Therapy
 Represents physical therapy on the global level
Copyright
Benefits of Belonging
 Intangible benefits
 Commitment to high-quality service
 Recognized voice of the physical therapy profession in the
United States
 Representation in a wide variety of public and governmental
areas
 Advocate for best interests of PTs, PTAs, and patients and
clients served
 Tangible benefits
 Legislative efforts and information
 Continuing education
 Professional development
 Research
 Reimbursement and discounts
Copyright
Sections… now called Academies
 Voluntary
 Organized only at the national level
 Made of members with similar interests
 Focus on special areas of practice
 An annual Combined Sections Meeting is held in
February and attracts more than 10,000 participants
 Special Interest Groups (SIGs) are common in sections
Other Opportunities
 Several sections include a special interest group for the

PTA.
 Certain honors and awards pertain to the PTA
exclusively, including:
 Recognition of Advanced Proficiency for the PTA
 Outstanding PTA Award
 Outstanding PT/PTA Team Award
 Mary McMillan Scholarship Award
 F.A. Davis Award for Outstanding PTA Educator
Practice Issues that impact the PTA
 Reimbursement
Constructs and concepts that inform physical therapy
Professional
Evidence Based
The Guide Values/Guiding
Practice
Documents
Quality
Assessment
The Guide to Physical Therapy Practice
Used by
WHO
IFC
Focus on
Ability vs.
Guide Disability
Biophysical
Model
International Classification of Functioning, Disability
and Health (ICF)
 Standardized method to classify health
 Ability vs. disability
 Functioning and the environment
 Biological, psychological, and social domains
Pagliarulo, chapter 2.
Structure of the International Classification of Functioning,
Disability and Health (ICF) model of functioning and disability
Copyright
Levels of Health Care
 Primary: provided by practitioners who are accountable for

majority of needs of patient or client
 Secondary: provided by practitioners by referral
 Tertiary: provided by practitioners in highly specialized
settings
Which is most common for PT and PTAs?

Which do we prefer?
Copyright
Levels of Health Care (cont’d)
 Also provide care in prevention and health promotion:

 Screening: determine need for services
 Prevention: conduct evaluation and prescribe
exercises to avoid pain and dysfunction
Copyright
Description of Practice: Patient or Client Management Model

PHTA 1110
Current Trends in Physical Therapy
#ChoosePT – Campaign to Battle Opioid Epidemic
 National epidemic that has developed since 1999
 Involved opioid drugs including: Vicodin, OxyContin, Opana, and
methodone, and combination drugs like Percocet
 Combined research efforts and a push from the CDC to choose
safe pain modulation, including PT (for non-cancer related pain)
 Opioid use is a top regulatory issue with most state medical boards
 Neonatal Abstinence Syndrome (occurs when an infant is born
having been exposed to opiates such as methadone, subutex,
heroin, and morphine) and expericnes withdrawal symptoms after
birth.
 From 1999-2013 the overall incidence of NAS has increased 300%
 Source: APTA
Mindfulness – the new “buzz” word
 “Mindfulness means paying attention in a particular way; on
purpose in the present moment and nonjudgmentally” – Jon
Kabat-Zinn
 Incorporation of imagery, Pilates, yoga, etc.
 Can assist with pain modulation
 Paradigm shift from “no pain, no gain”
 Holistic approach
 Source: PT in Motion,
Physical Therapy and Nutrition
 Nutrition is part of the scope of practice for Physical

Therapists
 Depends on the state practice act
 A step toward a more holistic model and eating for health
 Source: APTA
 http://www.apta.org/PatientCare/Nutrition/
 PT in Motion, page26 Sept 2017 Nutrition a Portion of PT’s
menu of Services
Women’s Health – Dedicated to the
Improvement of Women’s and Men’s Health
Globally
 Most recent specialty with board certification
 Addresses:
 Bowel/bladder incontinence
 Breast Cancer
 Constipation
 Pediatric Pelvic Health
 Fibromyalgia
 Lymphedema
 Male Pelvic Health
 Orthopedics
 Osteoporosis
 Pelvic Pain
 Urinary Incontinence
 Pregnancy/post partum
 Source: APTA, Section on Women’s Health
Interprofessionalism – a partnership between
healthcare providers
 Collaboration with other healthcare providers
 Collaborative approach that starts in the education setting
 Breaking down preconceived notions and stereotypes
 Empowers the Healthcare Provider & the patient
 Source: Trend Article, Interprofessional collaboration: three
best practice models of interprofessional education. Bridges,
Medical Education online, April 8, 2011.
PT vs. PTA?
 PTA (Physical Therapist Assistant) – works under the
direction and supervision of a PT (Physical Therapist)
 PTA – (2 years) Associate of Science in Physical Therapist
Assistant
 Average cost: 10-15K
 Average wage: 56K
 PT – (7 years) Doctor of Physical Therapy
 Average cost: 80-100K (reported average debt 96K)
 Average starting pay: 85K
 Source: Bureau of Labor Statistics, PT in Motion, February

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PHTA 1110

Introduction to Physical Therapy

 1.1 Explore and examine the field of physical therapy.

Physical Therapy = Physiotherapy

 The American Physical Therapy Association (APTA)

Physical Therapy Is a Health Profession

The APTA adopted a position that defines physical therapy

 Origins in medieval period

 Criteria (apply these to the profession of physical

 What were the initiating factors to the profession of physical

 Developed as the result of two major events:

pp. 8-13 Pagliarulo

 Polio epidemics: provided evaluation and treatment

From American Physical Therapy Association: Historical Photograph Packet.

 1940s – profession began to discuss the need for formally

The Role of the Physical Therapist Assistant: Regulations and

 Source: Professionalism Module Slides (APTA continuing ed course)

“A health care provider whose function is to assist the PT in the

APTA adopted policy statements since the 1960s to clarify the

p. 6, box 1-2, Pagliarulo

Definition of the Physical Therapist Assistant

 Technically educated health care provider

Origin and History

 Increased need for PT services

Origin and History (cont’d)

 July 5, 1967, the APTA House of Delegates (HOD)

Origin and History (cont’d)

 Education programs proliferated and eventually

 Result in associate’s degree

 Curricula include foundational content, basic sciences, clinical

 Prepare graduates to assist in data collection and perform physical

 Many jurisdictions require continuing education units after

 Transition to a baccalaureate degree under consideration

 Pros and cons make this a difficult decision.

Models of Education Programs

Utilization of the PTA

 PTA’s clinical role lies within the intervention section of

Factors That Influence Direction and Supervision

Levels of Supervision Vary

The Physical Therapy Aide

 Unlicensed support personnel

Characteristics of the PTA

 75% are women

APTA Membership and Representation (cont’d)

 Several changes occurred by actions of the HOD in

APTA Membership and Representation

 Affiliate member category created for the PTA in 1973

 Formed by PTs as the first professional organization (1921)

- www.apta.org/History (accessed 7/18)

APTA Membership and Representation

 Affiliate member category created for the PTA in 1973

APTA Membership and Representation (cont’d)

 Several changes occurred by actions of the HOD in

APTA Membership and Representation (cont’d)

Data from APTA Department of Member Development, Alexandria, VA, 2014.

APTA Membership and Representation (cont’d)

 In 2005, the RBNA was replaced with the PTA Caucus

 Most local organizational unit in the APTA

American Council of Academic Physical

 Originally the Academic Administrators Special Interest

Physical Therapist Assistant Caucus

Board of Directors (BOD)

 Made up of six officers and nine directors