Chapter 8 : Therapy and Rehabilitation

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Chapter 8: Therapy and Rehabilitation

Chapter 8: Therapy and Rehabilitation


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


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



• Course Work

– Anatomy

– Cellular biology

– Physiology

– Exercise physiology

– Neuroscience

– Pharmacology

– Applied psychology

– Applied sociology

– Communication

– Clinical reasoning

– Applied statistics



• 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



• 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



• Personal Characteristics

– Care

– Compassion

– Positive attitude

– Ability to work well with others

– Good observation skills

– Good problem-solving skills



• 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



• 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


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


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



• Course Work: General & Technical

– Basic sciences

– Applied physical therapy science

– Physical therapy interventions

– Communication

– Behavior & conduct

– Data collection



• 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




– 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




– Empathy

– Good people skills

– Good communication skills

– Good organizational skills

– Attention to detail

– Good teamwork skills




– 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



• 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


Occupational TherapistsOccupational Therapists


– 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


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



• 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



• 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




– 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



• Professional Characteristics

– Good interpersonal skills

– Empathy

– Patience

– Good observation skills

– Creativity

– Strong organizational skills

– Attention to detail





– Growth of 26% between 2008 & 2018

– Increased opportunities due to:

• Needs of increasing older population

• Medical advances allowing patients w. conditions to survive


• 29% in offices of health practitioners

• 28% in hospitals

• 13% in educational services

• 10% in nursing residential care



• 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


Occupational Therapy AssistantsOccupational Therapy Assistants


– 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


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



• 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



• 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




– 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




– Good people skills

– Empathy

– Patience

– Responsibility

– Willingness to take direction





– 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


• ¾ in hospitals, practitioner offices, & nursing care facilities

• Remainder in community care & home health care



• Professional Organization: AOTA

– Represents OTs & OTAs

– Offers:

• Specialty certifications

• Continuing education

• Online resources


Respiratory TherapistsRespiratory Therapists


– 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


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



• 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



• Licensure

– Required in all states except Alaska & Hawaii

– Must be renewed every 3 years, requiring continuing ed.



• 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)




– 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




– Calm, reassuring manner

– Sensitivity to patients’ needs



– Flexibility

– Willingness to learn




– Growth: 21% between 2008 & 2018


• Increasing # of middle-aged & older adults

• Enhancements in respiratory medications & treatments

• Movement of respiratory therapists into case management


• 81% in hospitals

• Remainder in physicians’ offices & other locations



• 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


Massage TherapistsMassage Therapists


– 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.


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



• Course Work

– Anatomy

– Physiology

– Kinesiology

– Pathology

– Massage theory & application

– Business

– Ethics

– Various modalities



• 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




– 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




– Sociability

– Empathy





– Growth: 19% between 2008 & 2018


• 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



• Professional Organizations

– American Massage Therapy Association (AMTA)

• Founded in 1943

• >58,000 members

– Associated Bodywork & Massage Professionals (ABMP)

• Founded in 1987

• >70,000 members

Chapter 8 : Therapy and Rehabilitation

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