PTA Scope of Work: Skilled PT Service Providers
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In physical therapy school we have a lot of lab time. Generally, there's a quick demonstration by the professor, then we jump into practicing techniques on each other, sometimes guessing our way through the motions. We get feedback from professors as they walk through the classroom, but with 50 of us in class, it can be difficult to know if you're doing it right at times. One day as I was practicing residual limb bandaging, a classmate offered some very helpful step-by-step instructions. I asked, "How do you know how to do all of this?" She replied, "I learned this in physical therapy assistant school. I spent a lot of time on this and was tested on it."
Prior to that day, I never put much thought into what PTAs are educated and trained to do. This is something that I should know, considering that I will likely work alongside them in the future. Under Medicare rules, PTAs are the only individuals who can provide billable physical therapist services under the direction and supervision of a PT. PTAs provide the treatment that PTs determine appropriate. They collect data, such as goniometric measurements and manual muscle test results, which are important for tracking progress. PTAs are trained to handle emergency situations and to recognize when a patient is not medically stable.
PTAs provide many of the treatments that a PT provides—passive range of motion, electrotherapeutic modalities, mechanical modalities, gait training, functional training, transfer training, wound dressing, airway clearance techniques, and therapeutic exercise for strength, flexibility, and balance. Although PTAs cannot make changes to the overall plan of care, they are trained to make treatment adjustments to accommodate a patient during a session.
PTAs cannot perform selective sharp debridement in wound care management. Depending on state practice acts, PTAs may or may not be able to perform joint mobilizations. Some states do allow PTAs to provide grade V high velocity low-amplitude thrust techniques. Again, the general idea is that a PT can delegate any task to a PTA that they deem appropriate, according to the skill level of that PTA. However, it's important that you refer to your state practice act to determine if there are interventions that a PTA is not permitted to perform in your state. In terms of billing, this can be even trickier. Check out our next blog in this series for more information on billing for PTA services.
PTAs can become skilled in their interested area of practice. APTA's Advanced Proficiency Pathways (APP) program offers PTA members the opportunity to gain advance proficiency knowledge and skill in areas of acute care, cardiopulmonary, geriatrics, oncology, orthopedics, pediatrics, and wound management. To receive APP recognition in a practice area of interest, a PTA must complete an additional 60 hours of continuing education coursework and 2000 clinical hours of work experience. During clinical experience, PTAs are mentored by a PT who is an expert in that practice area, and who will teach, guide, and assess the PTA's skills toward achieving advanced clinical competence.
In summary, PTs must examine, evaluate, screen, diagnose, determine a prognosis, develop plans of care, oversee documentation and care, and discharge patients. PTAs are highly trained in providing treatment interventions for patients and are an asset for patient care, especially when the PT and PTA have a mutually trusting and respectful relationship. If you want more information on PT and PTA scope of work, visit one of the following resources or review your state practice act.
About the PTA Advanced Proficiency Pathway (APP) Program
Leading the Team – A Practical Guide to Working with PTAs: APTA Learning Center Course LMS-353
Katie Kostelecky, SPT, is a member of the APTA Student Assembly Interprofessional Collaboration Project Committee. You can connect with Katie on Twitter at: @katielynnkmarie.