1. Chapter 8: Therapy and Rehabilitation

2. 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

3. 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

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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

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

32. 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

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

34. 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

35. 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

36. 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

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

38. 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)

39. 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

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

41. 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

42. 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

43. 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.

44. 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

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

46. 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

47. 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

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

49. 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

50. 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