chapter 8 : therapy and rehabilitation
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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) - PowerPoint PPT PresentationTRANSCRIPT
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 8: Therapy and Rehabilitation
Chapter 8: Therapy and Rehabilitation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical TherapistsPhysical 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
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Physical Therapists (cont’d)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
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Physical Therapists (cont’d)Physical Therapists (cont’d)
• Course Work
– Anatomy
– Cellular biology
– Physiology
– Exercise physiology
– Neuroscience
– Pharmacology
– Applied psychology
– Applied sociology
– Communication
– Clinical reasoning
– Applied statistics
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Physical Therapists (cont’d)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
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Physical Therapists (cont’d)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
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Physical Therapists (cont’d)Physical Therapists (cont’d)
• Personal Characteristics
– Care
– Compassion
– Positive attitude
– Ability to work well with others
– Good observation skills
– Good problem-solving skills
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Physical Therapists (cont’d)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
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Physical Therapists (cont’d)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
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Physical Therapist AssistantsPhysical 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
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Physical Therapist Assistants (cont’d)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
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Physical Therapist Assistants (cont’d)Physical Therapist Assistants (cont’d)
• Course Work: General & Technical
– Basic sciences
– Applied physical therapy science
– Physical therapy interventions
– Communication
– Behavior & conduct
– Data collection
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Physical Therapist Assistants (cont’d)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
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Physical Therapist Assistants (cont’d)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
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Physical Therapist Assistants (cont’d)Physical Therapist Assistants (cont’d)
• Personal Characteristics
– Empathy
– Good people skills
– Good communication skills
– Good organizational skills
– Attention to detail
– Good teamwork skills
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Physical Therapist Assistants (cont’d)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
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Physical Therapist Assistants (cont’d)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
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Occupational TherapistsOccupational 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
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Occupational Therapists (cont’d)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
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Occupational Therapists (cont’d)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
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Occupational Therapists (cont’d)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
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Occupational Therapists (cont’d)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
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Occupational Therapists (cont’d)Occupational Therapists (cont’d)
• Professional Characteristics
– Good interpersonal skills
– Empathy
– Patience
– Good observation skills
– Creativity
– Strong organizational skills
– Attention to detail
– Good communication skills
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Occupational Therapists (cont’d)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
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Occupational Therapists (cont’d)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
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Occupational Therapy AssistantsOccupational 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
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Occupational Therapy Assistants (cont’d)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
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Occupational Therapy Assistants (cont’d)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
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Occupational Therapy Assistants (cont’d)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
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Occupational Therapy Assistants (cont’d)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
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Occupational Therapy Assistants (cont’d)Occupational Therapy Assistants (cont’d)
• Personal Characteristics
– Good people skills
– Empathy
– Patience
– Responsibility
– Willingness to take direction
– Good teamwork skills
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Occupational Therapy Assistants (cont’d)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
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Occupational Therapy Assistants (cont’d)Occupational Therapy Assistants (cont’d)
• Professional Organization: AOTA
– Represents OTs & OTAs
– Offers:
• Specialty certifications
• Continuing education
• Online resources
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Respiratory TherapistsRespiratory 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
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Respiratory Therapists (cont’d)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
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Respiratory Therapists (cont’d)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
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Respiratory Therapists (cont’d)Respiratory Therapists (cont’d)
• Licensure
– Required in all states except Alaska & Hawaii
– Must be renewed every 3 years, requiring continuing ed.
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Respiratory Therapists (cont’d)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)
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Respiratory Therapists (cont’d)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
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Respiratory Therapists (cont’d)Respiratory Therapists (cont’d)
• Personal Characteristics
– Calm, reassuring manner
– Sensitivity to patients’ needs
– Good communication skills
– Good teamwork skills
– Flexibility
– Willingness to learn
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Respiratory Therapists (cont’d)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
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Respiratory Therapists (cont’d)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
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Massage TherapistsMassage 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.
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Massage Therapists (cont’d)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
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Massage Therapists (cont’d)Massage Therapists (cont’d)
• Course Work
– Anatomy
– Physiology
– Kinesiology
– Pathology
– Massage theory & application
– Business
– Ethics
– Various modalities
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Massage Therapists (cont’d)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
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Massage Therapists (cont’d)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
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Massage Therapists (cont’d)Massage Therapists (cont’d)
• Personal Characteristics
– Sociability
– Empathy
– Good communication skills
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Massage Therapists (cont’d)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
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Massage Therapists (cont’d)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