Exam 1
Roles and Scope of Practice of the PT and PTA
Physical Therapist (PT):
Responsible for the entire Patient/Client Management Model, encompassing:
Examination
Evaluation
Diagnosis
Prognosis
Plan of Care
Intervention
Discharge
Diagnoses and manages movement dysfunction.
Performs the initial evaluation.
Interprets examination findings.
Establishes physical therapy diagnosis.
Determines patient prognosis.
Develops treatment goals.
Creates and modifies the plan of care.
Determines whether referral to another healthcare provider is needed.
Legally responsible for all patient care provided under their supervision.
Performs all patient reassessments.
Directs and supervises Physical Therapist Assistants (PTAs) and support personnel.
Exercises autonomy of judgment, maintaining independent clinical judgment in:
Evaluation
Development of plan of care
Discharge planning
Physical Therapist Assistant (PTA):
Defined as a technically educated individual.
Graduate of a CAPTE-accredited (Commission on Accreditation in Physical Therapy Education) PTA program.
Licensed after passing the NPTE (National Physical Therapy Examination).
Works under the direction and supervision of a PT.
Implements delegated portions of the established plan of care.
Performs selected interventions assigned by the supervising PT.
Collects patient data.
Reports patient responses directly to the PT.
Collaborates with the PT regarding treatment progression and modification of care.
May modify or progress interventions strictly within:
The established plan of care
Delegated authority
Personal competence
PTA Scope Exclusions (PTA does NOT):
Perform evaluations
Establish diagnoses
Create plans of care
Interpret referrals or prescriptions
Determine treatment programs
Make major modifications to treatment programs
Interventions Specifically Outside PTA Scope:
Louisiana State Restrictions:
Sharps debridement
Dry needling
APTA-Identified Exclusions:
Peripheral mobilization
Spinal mobilization
Levels of Supervision and State Regulatory Requirements
APTA Levels of Supervision:
General Supervision:
PT is not required to be on-site.
PT must be available through telecommunication.
Direct Supervision:
PT is physically present.
PT is immediately available.
PT maintains direct patient contact during each visit.
Applies directly to PTA students.
Direct Personal Supervision:
PT (or PTA where law allows) is physically present.
Supervisor is immediately available.
PT remains responsible for patient management.
Louisiana Supervision Requirements:
Licensed PTA:
PT must be readily accessible by telecommunication.
PT must be available by the next scheduled treatment session upon request.
PTA Student:
Requires continuous supervision.
PTA Applicant with Provisional License:
Requires continuous supervision.
Definition of Continuous Supervision:
Supervisor is physically within the same treatment area.
Supervisor is actively observing and supervising the care.
Roles, Responsibilities, and Limits of the Supervising PT of Record
Supervising PT of Record Definition:
The PT who completed the initial evaluation and established the plan of care, OR
The PT who most recently reevaluated or treated the patient.
Responsibilities of the Supervising PT of Record:
Coordinate overall patient care.
Continue patient care.
Progress patient care.
Conduct initial evaluation.
Document the plan of care.
Determine specific PTA responsibilities.
Remain ultimately responsible for all care provided by the PTA.
Be readily accessible by telecommunication.
Actively participate in patient care.
Reassessment Standard: Treat and reassess patients at least every 12th treatment day OR every 30 days, whichever occurs first.
Provide the final treatment session when feasible.
Requirements for Support Personnel / Technicians:
PT determines all assigned responsibilities.
PT remains ultimately responsible for all technician actions.
Must receive continuous in-person supervision.
Documentation of education and training must be formally maintained.
Louisiana Maximum Supervision Ratio: A PT may supervise up to six (6) supportive personnel at any given time.
Patient/Client Management Model and Clinical Scope
Patient/Client Management Model Components:
Examination
Evaluation
Diagnosis
Prognosis and Plan of Care
Intervention
Outcomes
PTA's Role Within the Plan of Care:
Implement delegated interventions.
Collect patient-related data.
Monitor patient progress.
Communicate all clinical findings to the PT.
Progress interventions appropriately within delegated authority.
Modify interventions appropriately within delegated authority.
Explicit PTA Restrictions:
May NOT change goals.
May NOT change frequency of care.
May NOT change duration of care.
May NOT make modifications that alter the plan of care.
Triggers Requiring Direct PT Involvement:
Major modification to treatment program.
Goal changes.
Changes in frequency of care.
Changes in duration of care.
Need for evaluation.
Need for diagnosis.
Need for prognosis determination.
Need for plan of care revision.
Physical Therapy Diagnosis vs. Medical Diagnosis
Physical Therapy Diagnosis:
Performed by physical therapists to diagnose movement dysfunction.
Utilizes examination and evaluation findings.
Identifies specific structural impairments and functional problems.
Medical Diagnosis Referral:
Clinical assessment determines whether referral to another healthcare provider is required.
International Classification of Functioning, Disability and Health (ICF) Model
Background & Developer:
Developed by the World Health Organization (WHO).
Purpose:
Provides a standardized framework describing health and disability.
Focuses on how health conditions impact daily functioning.
Core Components:
Body Functions and Structures: Refers to physical and anatomical functions of body systems.
Activity: Refers to the execution and performance of tasks by an individual.
Participation: Refers to involvement in life situations and societal roles.
Biopsychosocial Model and Social Determinants of Health
Biopsychosocial Model Key Concept:
A patient is more than a medical diagnosis and more than a physical impairment.
Health and recovery are influenced by three interconnected domains:
Biological Factors: Physical health and body systems.
Psychological Factors: Thoughts, mental health, and psychological influences.
Social Factors: Environmental and social influences.
Social Determinants of Health (SDOH):
Definition: Factors that influence the environmental context of movement and health.
Social Risk Factors: Adverse social conditions that contribute to poorer health outcomes.
Examples of Social Determinants:
Economic stability
Access to health services
Education
Social and community support
Home environment
Physical environment
Professional Ethics, Principles, and Core Values
Fundamental Definitions:
Ethics: Moral principles that guide professional behavior and decision-making.
Morals: Personal beliefs and values about right and wrong.
Law: Mandatory requirement to comply with civil, criminal, and administrative laws.
Major Ethical Principles:
Veracity: Telling the truth.
Beneficence: Acting to do good.
Confidentiality: Protecting private patient information.
Duty: Responsibility owed to patients.
Fidelity: Keeping commitments and promises.
Justice: Maintaining fairness in care and resource allocation.
Nonmaleficence: Operating to do no harm.
Autonomy: Respecting patient self-determination and decisions.
Rights: Recognizing legal and moral entitlements.
Paternalism: Restricting patient freedom or autonomy.
APTA Core Values:
Accountability
Altruism
Collaboration
Compassion and Caring
Duty
Excellence
Inclusion
Integrity
Social Responsibility
Code of Ethics and Ethical Commitments
Purpose of Code of Ethics:
Defines ethical behaviors expected within the physical therapy profession.
Communicates expectations to practitioners and the public.
Guides professional decision-making.
Enhances professional identity.
Promotes professional accountability.
Core Ethical Principles in Code of Ethics:
Autonomy
Beneficence
Nonmaleficence
Justice
Veracity
Fidelity
Nine Ethical Commitments:
Respect
Integrity
Accountability
Maintaining Professional Relationships
Compassion and Trust
Responsible Business and Organizational Practices
Direction and Supervision
Professional Expertise
Societal Responsibility
RIPS Model of Ethical Decision-Making
RIPS Acronym Definition:
Realm + Individual Process + Situation
Realm Categories:
Individual: Focuses on the good of the individual patient.
Organizational/Institutional: Focuses on the good of the organization or institution.
Societal: Focuses on the common good of society.
Individual Process Categories:
Moral Sensitivity: Recognizing the presence of an ethical issue.
Moral Judgment: Determining right versus wrong actions.
Moral Motivation: Choosing ethical values over self-interest.
Moral Courage: Taking action to carry out an ethical decision despite barriers.
Situation Categories:
Issue/Problem: Important values are challenged.
Distress: Knowing the right action to take but being unable to act due to barriers.
Temptation: A wrong choice offers personal or organizational benefit.
Silence: Nobody is discussing or addressing an ethical concern.
Dilemma: A conflict between two right choices (right vs. right).
Five Tests for Right vs. Wrong:
Legal Test
Stench Test
Front-Page Test
Mom/Dad Test
Professional Ethics Test
Practice Acts and State Board Regulation
Louisiana Physical Therapy Board:
Official regulatory body governing physical therapy practice in Louisiana.
Louisiana Physical Therapy Practice Act:
Legal statute defining the legal scope of PT practice.
Legal statute defining the legal scope of PTA practice.
Scope of practice is established by both the Practice Act (statute) and Board Rules and Regulations.
Statutory Requirements for PTA Practice:
Assists strictly under PT supervision.
Performs only activities delegated by the PT.
Must work within personal education, training, experience, and clinical competence.
Historical Development of the Physical Therapy Profession
Early Origins:
Ancient China: Integrated Daoyin tu exercises, holistic health concepts, acupuncture, massage, and hydrotherapy.
Hippocrates: Emphasized person-centered care, manual manipulation, and hydrotherapy.
World War I Era:
Created massive rehabilitation needs for wounded soldiers.
Led to the creation of Reconstruction Aides.
Established the foundational infrastructure for physical therapy as a dedicated profession.
Mary McMillan:
Served as Head Reconstruction Aide.
Organized the Walter Reed Physiotherapy Department.
Taught Reconstruction Aides.
Published the text Massage and Therapeutic Exercise.
Served as the founding president of the initial professional physical therapy association.
Polio Era:
Widespread paralysis and disability greatly increased civilian rehabilitation needs.
Facilitated expansion of PT services from military settings into civilian healthcare.
Cemented physical therapy as an independent, distinct healthcare profession.
Professional Organization Evolution:
Initial Association Priorities: Establishing professional standards, scientific standards, higher education requirements, knowledge sharing, qualified practitioners, and interprofessional collaboration.
Association Name History:
American Women's Physical Therapeutic Association
American Physiotherapy Association
American Physical Therapy Association (APTA)
Standardization of Physical Therapy Education:
Development of standardized educational curricula.
The American Medical Association (AMA) evaluated physical therapy educational programs.
Formal requirements for PT education were established.
Educational credentials progressed continuously over time to the Doctor of Physical Therapy (DPT) degree.
World War II Era:
Triggered increased demand for physical therapy services.
Military rehabilitation programs further expanded the professional roles of PTs.
History and Growth of the PTA Profession:
Key Factors Driving PTA Creation:
Rising demand for physical therapy services.
Severe shortage of PTs.
Need for formally educated support personnel.
Milestones in PTA Development:
First PTA educational programs established.
Associate degree established as entry-level education.
PTA licensure expanded across states.
PTA representation and involvement within the APTA increased.
High-Yield Summary Facts
Core PT Management Responsibilities: PT exclusively owns Examination, Evaluation, Diagnosis, Prognosis, and Plan of Care.
Core PTA Functional Scope: Implements delegated interventions and collects patient data; cannot evaluate, diagnose, or create plans of care.
Louisiana PT Reassessment Frequency: PT must treat and reassess patients at least every 12th treatment day OR every 30 days, whichever occurs first.
Continuous Supervision Requirements: PTA students and provisional licensees require continuous supervision (supervisor physically present in the same treatment area observing care).
General Supervision Definition: PT does not need to be physically on-site but must be readily available by telecommunication.
ICF Model Components: Body Functions and Structures, Activity, and Participation.
Biopsychosocial Model Components: Biological, Psychological, and Social factors.
Social Determinants of Health: Economic stability, health services access, education, social and community support, home environment, physical environment.
Fundamental Ethical Principles: Autonomy, beneficence, nonmaleficence, justice, veracity, fidelity.
RIPS Framework Structure: Realm, Individual Process, Situation.
Key Historical Pioneer: Mary McMillan.
Historical Drivers of Profession Growth: World War I, World War II, and the Polio epidemic.