Chapter 4 PTA as a Member of the HC Team

Question 1

Physical Therapist Assistant (PTA)

Answer 1

a technically educated health care provider who assists the PT in provision of physical therapy. (APTA)

Question 2

Direction & Supervision of the PTA

Answer 2

1•The PTA is the ONLY individual who can assist the PT in the delivery of selected physical therapy interventions.

2•PTAs have the responsibility to provide physical therapy treatment and assist the PT as directed by their supervising PT.

Question 3

PTA Education Requirements?

Answer 3

1. graduate of a PTA program accredited by CAPTE, the Commission on Accreditation Physical Therapy Education.
2. PTAs and PTs are required to pass the National Physical Therapy Exam (NPTE) as it is developed by the Federation of State Boards of Physical Therapy (FSBPT)

Question 4

Levels of Supervision

Answer 4

MUST KNOW
•PTA supervision is determined by state law (physical therapy practice acts) and insurance requirements. In general, the following rules apply:

1.General Supervision: PT must be available for supervision by telecommunication at all times.
•APTA recommends for PTA supervision

2.Direct Supervision: PT must be physically present, immediately available & will have patient contact during every visit
•Medicare requires that in private practice, PTAs must have direct supervision, recommended for student supervision

3.Direct Personal Supervision: continuously directing and supervising all of the care provided
•Supervision required of aides when used to assist the PT in treatment

Question 5

Roles of the PT & PTA??

Answer 5

1•The PT is ultimately responsible for the patient and the actions of a PTA in patient care management.

2•Even when a PT has passed a patient to a PTAs caseload, he or she is still ultimately responsible

3•The APTA publishes a resource that summarizes the minimum required skills of a PTA graduate at Entry Level.

4•The PTA cannot evaluate, develop, or change the POC or treatment plan

5•The APTA’s position is that the PTA cannot perform joint mobilization techniques and sharp debridement wound therapy because they require evaluation skills to perform them

6•(I disagree with this position; PTAs assess their patients every day and this is within their scope to do so)

7•Some states, including Ohio allow PTAs to perform mobilization, but they must be deemed competent by their supervising PT, who assumes the responsibility of the PTAs competence in these skills

8•PTAs typically learn most of these skills directly from PTs in clinical settings as CAPTE follows APTA recommendations

Question 6

The PT’s Responsibilities in the Clinical Setting

Answer 6

1•PTs are responsible to pass selected interventions to a PTA and are then involved directing and supervising the PT

2•There should be ongoing communication between the PT and PTA regarding the continuing patient care

Question 7

PT’s are solely responsible for

Answer 7

1•Referral Interpretation

2•Initial examination, evaluation, diagnosis and prognosis

3•But PTAs can inform and discuss these with their
patients

4•Development or modification of a POC based on the initial examination and re-examination, including PT goals and outcomes

5•Determining when selected interventions be passes to a PTA

6•Re-examination of the patient and their goals and POC.

7•Establishment of the discharge plan, discharge evaluation & documentation of discharge summary

8•Oversight of all documentation for PT services rendered to that patient

9•Ultimately, the PT remains responsible for the PT services provided when the PTA provides treatment

Question 8

The PT must consider the following when determining whether to pass interventions to a PTA

Answer 8

1•PTA’s education, training, experience, and skill level
2•Patient/client stability, criticality, acuity, & complexity
3•The predictability of the consequences
4•The type of setting
5•Liability & risk concerns
6•Federal and State Practice laws
7•Mission of the PT services for that clinical setting
8•The need frequency of reexamination

Question 9

PT/PTA Communication

Answer 9

1•Supervising PT must be accessible by telecommunications to the PTA at all times (general supervision)
2•There must be regularly scheduled and documented conferences between the supervising PT and PTA regarding patients/clients
3•The PT/PTA relationship is best when the PT & PTA know each others strengths and weaknesses and when there is a trust developed between them.

Question 10

There are many different models of successful PT/PTA teams

Answer 10

1•1 PTA paired with 1 PT
2•1 PTA receiving patients from multiple PTs
3•1 PT giving multiple PTAs patients

Question 11

Supervisory visits by a PT when a patient is being treated by a PTA

Answer 11

1•Upon PTA request for reexamination
2•When change of POC is needed
3•Prior to planned discharge
4•In response to patient’s medical status
5•At least once per month or more when determined necessary

Question 12

Supervisory visit should include the following:

Answer 12

1•On-site re-examination of the patient

2•On-site review of the POC with appropriate revision or termination

3•Evaluation of need and recommendation for use of outside resources

Question 13

PT-PTA Relationship

Answer 13

1•PT-PTA Relationship should be characterized by trust, mutual respect, and values and appreciation for individual and cultural differences
2•Ensures a continuum of care in all settings and educate patients, families, caregivers

Question 14

PTA’s role

Answer 14

offer suggestions, provide feedback, carry out delegated interventions, and freely express concerns

Question 15

PT-PTA Communication

Answer 15

1•Discussion of goals & expectations for patient
2•Frequent & open communication
3•Response to patient care
4•Recommendations for discharge planning
5•Discussion of modifications of POC
6•Recommendations from other disciplines
7•Any problems with precautions, contraindications

Question 16

PTA Supervision Requirements

Answer 16

•PTs are licensed in all states, PTAs are licensed in most (except for Colorado & Hawaii (optional there)

Question 17

The majority of states limit the number of PTAs a PT can supervise

Answer 17

1•Arizona: PT can supervise no more than 3 assistive personnel- PTAs/aides/students
2•Kansas: a PT can supervise no more than 4 PTAs, Iowa, 2 PTAs
3•Ohio: there is no specified limit, but a PT must be able to effectively manage the number supervised
4•Supervision requirements vary by insurance payers
5•Medicare requires “General” supervision for most settings (PTs don’t need to be physically present, but available to contact for questions)
6•But private practice settings require “direct supervision”- PT must be on the premises during PTA treatment

Question 18

The Healthcare Team Members must…

Answer 18

address all the patient’s medical needs & communicate effectively

Question 19

Team members include…

Answer 19

1•patient/client
2•family members/caregivers
3•healthcare professionals involved in the patient’s care
4•insurance companies

Question 20

Three type of healthcare teams:

Answer 20

1•Intradisciplinary- team members from one discipline, e.g. PT & PTA
2•Multidisciplinary- there are members from all disciplines, but they are all working independently of each other
3•Interprofessional- includes members from all disciplines working together to meet patient care needs & goals, they communicate, exchange information

Question 21

Rehab Team includes:

Answer 21

1.PT Director
2.PT
3.PTA
4.OT
5.COTA
6.SLP
7.Orthotist/Prosthetist
8.Physician
9.Nurse
10.Social Worker
11.ATC
12.Kinesiologist
13+ PT aide, volunteers, student clinicians

Question 22

Physical Therapy Director

Answer 22

manager or supervisor over PT services, An experienced PT or PTA who manages all PT personnel, equipment & supplies. Duties include

1•strategic planning & department goals
2•leading department meetings
3•motivating the department
4•communicating with other supervisors
5•impartially evaluating staff & giving feedback
6•educating employees
7•interviewing and developing new employees
8•delegating tasks as needed

Question 23

Physical Therapist

Answer 23

1•Provide services that help restore function, improve mobility, relieve pain, prevent injury/disease, restore/maintain/promote overall fitness and wellness
2•New graduates must have doctoral degree (DPT)- 3 year post graduate degree, current PTs also have Bachelor & Master degrees, Must be licensed by the state
3•Responsibilities include
•Screening, Evaluation, Diagnosis, Prognosis, Intervention/Tx, Education of patients/caregivers/staff members, Prevention of injury/disease, Coordination of care, Referral to other providers, PTA supervision, Modify treatment, Re-examine periodically
•US Dept. of Labor estimates 28% growth through 2026
•Population is living longer, needing additional therapy
•Technology is helping people survive at a greater rate

Question 24

Physical Therapist Assistant (PTA)

Answer 24

1•“Technically educated healthcare provider who assists the PT in the provision of physical therapy”
2•Graduate with an associate degree, typically licensed by the state board of PT, Perform selected interventions under direction of the PT, such as:
•Therapeutic exercise, massage, modalities such as ultrasound, traction, thermo and cryotherapy, patient/family/caregiver ed.
-Document responses and report outcomes
•Can also work as department and program directors, instructors, and clinical instructors
•Dept. of Labor estimates PTA field growth by 30% through 2026, but new Medicare guidelines might decrease that #20

Question 25

Occupational Therapist degree?

Answer 25

OTR/L (registered/licensed), Master or Doctorate degree

Question 26

Occupational Therapy Assistant (COTA)

Answer 26

–certified, Assoc. degree
1•Help people to perform tasks in ADLs.
2-assist patients with mental, physical, developmental, or emotional disabilities
3-improving basic motor function and reasoning abilities
4•Expected to grow 24%-28% through 2026

Question 27

Speech Language Pathologist, CCC-SLP (certification of clinical competence)

Answer 27

–holds a master degree
1•Restore and improve communication of patients with language or speech impairments
2•Assess, diagnose, treat, and help to prevent speech, understanding/improving language, cognitive, attention, memory communication, voice, swallowing, fluency (stuttering) disorders and deficits, select aumentative communication devices
•Work in hospitals, physician offices, nursing homes, home health outpatient centers, child daycare services, schools
•Expected to grow by 18% through 2026

Question 28

Orthotist & Prosthetist

Answer 28

1•Orthotists design, fabricate and fit orthopedic devices (orthoses)- includes braces splints, collars and corsets
2•Prosthetists design fabricate and fit artificial limbs (prosthetics)
3•Complete a master degree
4•Responsible for making modifications once devices are fitted, working closely with the PT/PTA
5•Teach patients how to wear and maintain device
•Work in labs, hospitals

Question 29

Kinesiologist

Answer 29

-Bachelor or Master Degree

1•Works with PT/PTA to help analyze movements and improve exercises/work processes

Question 30

Primary Care Physician (PCP)

Answer 30

1•Medical Doctor (MD) or Osteopractic Doctor (DO) provides primary care services & manages routine healthcare needs
2•Both MD & DOs perform surgery and all medical specialties, DO’s place special emphasis on the musculoskeletal system, preventative medicine & holistic care
3•PCP is the “gatekeeper” for managed care systems
4•Physicians diagnose illnesses, prescribe treatments, examine, perform tests, counsel on diet & health
5•Education: 4 years undergrad, 4 years medical school, 3-8 years of internship & residency (paid training), pass licensing exam
6•Physicians that work most closely with PT: family/general practitioners, physiatrists, orthopedic surgeons, neurologists & pediatricians.

Question 31

Physician Assistant (PA)

Answer 31

: master degree
1•Evaluate and treat patients under the supervision and direction of a physician, must always confer w/ physician
2•Can prescribe medications in most states and refer to professionals, like PT
3•Work in general practices or specialties
4•Expected to grow by 37% by 2026

Question 32

Registered Nurse (RN)

Answer 32

-many roles in medicine, settings
1•Three methods to become RN: BSN – Bachelor of Science, ADN- Associate Degree, and Diploma programs (dying out)
2•Types: hospital nurses, office, nursing home, home health, public health, occupational health, nurse supervisors, nurse practitioners, clinical nurse specialists, nurse anesthesiologists, nurse midwives
3•Nurse practitioners- diagnose and treat, prescribe medications

Question 33

Social Worker

Answer 33

-Bachelor or Master Degree (MSW) – most common in healthcare settings
1•Help people to function optionally in their environments, relationships, personal & family problems
2•Often work with see clients with life-threatening diseases or social problems, like inadequate housing or unemployment, disability, substance abuse
3•. 3 types of Social Workers:
1•child/family school- provide social services to families/children/seniors
2•medical/public- provide support to deal with medical conditions, obtain medical services or supplies, arrange home needs (home health)
3•mental health and substance abuse – therapy, crisis interventions, abuse
4•Expected to grow 16% through 2026

Question 34

Certified Athletic Trainer (ATC)

Answer 34

1-Usually works under the supervision of a physician providing injury prevention and treatment & Rehab to patients after injury
2-Can also work in colleges, schools, hospital clinics, professional sports, physical therapy clinics
3- Expect 23 % growth in field

Question 35

Physical Therapy Aide

Answer 35

1-Non-licensed worker under the direction of the PT/PTA
2-Requires direct personal supervision by the PT/PTA to help treat
3-Duties include patient transportation, equipment cleaning & maintenance, secretarial & housekeeping duties,
4- Aides cannot perform skilled treatment

Question 36

Physical Therapy volunteer

Answer 36

1•Observe, answer phones, light housekeeping duties, transport patients
2•Aides cannot provide direct patient care

Question 37

Physical Therapist or Physical Therapist Assistant Student (SPT, SPTA)

Answer 37

1•Perform duties under the supervision of their clinical instructor (CI) who facilitates clinical learning experiences and assesses student competence

Question 38

Home Health Aide

Answer 38

1•Nonlicensed worker who provides personal care and home management services, be trained by PT/PTA to assist with home exercise program

Question 39

Community Healthcare Worker

Answer 39

1•Assists individuals to access healthcare resources, educate on health concerns, monitor at-risk individuals