Chapter 13 Therapy and Rehabilitation Copyright 2012 Wolters

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) – 1940 s & 1950 s: demand for therapists due to WWII & polio – 1950 s: state licensing increased – 1954: APTA developed competency exam – 1960 s: therapists began treating other conditions – 1968: PT services authorized for Medicare program Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Therapists (cont’d) • Course Work – Applied psychology – Anatomy – Applied sociology – Cellular biology – Communication – Physiology – Clinical reasoning – Exercise physiology – Applied statistics – Neuroscience – Pharmacology Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Therapists (cont’d) • Licensure • Specialist Certification – Required in all states – Offered by American Board of Physical Therapy Specialties – Requires: • Graduation from accredited program – For licensed PTs in practice for at least 10 years • Passing exam – Available for 7 specialties • Other state requirements – Requires 2, 000 hours of direct patient care in area Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Therapists (cont’d) • Personal Characteristics – Care – Compassion – Positive attitude – Ability to work well with others – Good observation skills – Good problem-solving skills Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Therapist Assistants • History of the Profession – Developed after WWII w. greater need for PT treatments – 1950 s: first assistants appeared, informally trained – 1967: first two PTA education programs approved – CAPTE set program accreditation standards – APTA developed guidelines for tasks – 1970 s to 1990 s: PTA training programs grew rapidly Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Therapist Assistants (cont’d) • Course Work: General & Technical – Basic sciences – Applied physical therapy science – Physical therapy interventions – Communication – Behavior & conduct – Data collection Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Therapist Assistants (cont’d) • Personal Characteristics – Empathy – Good people skills – Good communication skills – Good organizational skills – Attention to detail – Good teamwork skills Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Occupational Therapists • History of the Profession – Moral treatment: 18 th & 19 th century approach to mental illness – Provided patients w. activities, exercise, & pleasant surroundings – Late 19 th & early 20 th 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 – 1960 s: call for return to occupation-centered roots – 2002: AOTA adopted new practice framework Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Occupational Therapists (cont’d) • Professional Characteristics – Good interpersonal skills – Empathy – Patience – Good observation skills – Creativity – Strong organizational skills – Attention to detail – Good communication skills Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Occupational Therapy Assistants • History of the Profession – 1950 s: 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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Occupational Therapy Assistants (cont’d) • Personal Characteristics – Good people skills – Empathy – Patience – Responsibility – Willingness to take direction – Good teamwork skills Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Occupational Therapy Assistants (cont’d) • Professional Organization: AOTA – Represents OTs & OTAs – Offers: • Specialty certifications • Continuing education • Online resources Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Respiratory Therapists • History of the Profession – Tech developments in 20 th 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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Respiratory Therapists (cont’d) • Course Work – Pharmacology – Communication – – Social & behavioral sciences Assessment of cardiopulmonary status – Airway management – Math – Lung inflation therapy – Computer science – Alternate site care – Cardiopulmonary A&P – Chemistry – Microbiology Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Respiratory Therapists (cont’d) • Licensure – Required in all states except Alaska & Hawaii – Must be renewed every 3 years, requiring continuing ed. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Respiratory Therapists (cont’d) • Personal Characteristics – Calm, reassuring manner – Sensitivity to patients’ needs – Good communication skills – Good teamwork skills – Flexibility – Willingness to learn Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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-1800 s: Taylor promoted Swedish massage in U. S. – Early 20 th century: massage declined in U. S. – 1927: first professional massage organization in U. S. – 1960 s & 1970 s: resurgence of massage in U. S. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage Therapists (cont’d) • Course Work – Anatomy – Physiology – Kinesiology – Pathology – Massage theory & application – Business – Ethics – Various modalities Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage Therapists (cont’d) • Personal Characteristics – Sociability – Empathy – Good communication skills

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins