Modalities Help PTAs Help Their Patients
By Bernard J. Colan
Modalities go in and out of fashion, but they're invaluable to many physical therapists who must not only use them, but set parameters so that physical therapist assistants can use them to best effect. And while physical therapist assistants are equipped with specialized knowledge and skills to assist in the provision of physical therapy under the supervision of a PT, the definition of "supervision" varies from state to state.
In Kansas, for instance, which barely fills each of its far-flung square miles with an average of about 30 people, rural areas are vast and some of the smaller hospitals in more remote locations employ PT assistants as PT department directors, according to Mj Meyer, PTA, ACCE.
Meyer, who instructs future PT assistants in the use of modalities at the Colby Community College PTA program in Colby, KS, told ADVANCE that in her state, once a patient has been evaluated by a therapist, an assistant can provide treatment without a PT being present.
SHE INDICATED that her school introduces each PTA student to the utilization of all the modalities that funding and fashion can supply. The instructor noted that once in the field, PT assistants, like anyone else, must be properly schooled in the use of each unfamiliar machine before they can become confident in their proficiency, but are very capable of performing their work independently.
She emphasized, however, that at all times, the PTA is under the guidance of a physical therapist who sets all therapeutic regimens in motion, even though the supervising physical therapist may only come around a couple of times a week to check on patients' progress and adjust treatment orders.
"In the case of ultrasound, for instance, the PT would set the intensity and time limit, but the PTA can then modify the settings as needed. So the PT assistant must be educated about the modality, and the PT must be educated about what the PTA can do with the modality," said Meyer.
She emphasized that individually, PT assistants have their favorite modalities along with those with which they're uncomfortable. Preferences are generally based on experience and are respected by supervising physical therapists, who depend on the PT assistants to help rehabilitate patients in a wide geographic area.
But from Kansas to a state like New Jersey, whose average square mile is bursting with more than a thousand people, the practice guidelines dictate that a PT assistant may not treat a patient unless a physical therapist is in the same building, explained Paul Ogbonna, EdD, PT, who is the director of Pen Physical Therapy and Rehabilitation Services in Ewing Township, NJ, and offers a licensure review course for PTAs.
DR. OGBONNA suggested that the Garden State's interpretation of adequate "supervision" makes it difficult for physical therapists to utilize PT assistants to best advantage. Although the capabilities of PT assistants to work independently while following guidelines set by PTs are respected, in New Jersey, the PTA is prohibited from developing or modifying a treatment.
In nearby Delaware, D. Anne Brown, PTA, CFT, told ADVANCE that PT assistants may work in physical independence, but their work is monitored periodically by PTs, so that close communication has become important. She is able to adjust treatments to meet clients' changing conditions with approval from the PT over the phone, rather than waiting for a PT to make a personal appearance.
Brown, a former bodybuilder who found Forever Fit Inc., to market herself as a personal trainer to finance her education as a physical therapist assistant, works in home health. She advised that therapists should know the particulars of their state practice act so that assistants can be used efficiently. This is especially relevant with cost-containing managed care forcing facilities to increase the use of home care over inpatient care and PTAs over PTs.
"BUT I WISH we could use more modalities in the home because they can be so effective in aiding in the speedy recovery of our patients," she said. "They just aren't as available there as they are in the clinic, and using them under the direction of physical therapists certainly benefits our patients."
But no matter what a state practice act indicates regarding who can use a modality and how, two considerations remain constant: when to use a particular modality and when not to use it, noted Michelle H. Cameron, PT, OCS, of Health Potentials in Oakland, CA. She helps PTs and PTAs keep up with changing technology on ultrasound and electrical stimulation with continuing education courses.
She explained that both the PT and the PTA may have similar information on any given modality, like electrical stimulation, ultrasound, hot and cold packs, compression, traction, whirlpools and fluidotherapy. But since the level of the decision is the difference, they must establish open lines of communication to best serve patients.
THOSE LINES of communication are sometimes weakened in every state by physical therapists who are not adequately informed about the abilities of PT assistants. No wonder, according to Meredith C. Ferraro, PT, CHT, who noted that the APTA is still finding it hard to develop a consensus for the role of physical therapist assistants.
Ferraro, who teaches the modalities course at the physical therapist assistant program at Housatonic Community College in Bridgeport, told ADVANCE that PTAs are competent to use modalities even when the closest a PT can come to the site is with a telephone.
Resia Fedorchuck, MS, PT, who directs Houstatonic's PTA program, echoed those sentiments. "I have total confidence of our graduates to apply modalities. Certainly the therapist should be aware of the skills of the person they're supervising and evaluate a PTA's competency with the equipment specific to the situation.
"They may have to make adjustments, for instance if you have assistants who aren't familiar with a particular brand or model of equipment, you may need to orient them to that specific device, but having done that, they should be able to apply any modality with the same degree of quality of a PT, provided that the PT's plan specifies the parameters within which the modality is to be used."