RE: PTA's and joint mobs

[Guest guest]

,

In my clinic we work around a core ideology that insists that the

best interests of the patient must come first and those of the

profession second, profits are third. If we are to truly live by

this core ideology then the following questions must be answered.

Is utilization of the PTA to perform hands on skills with the

patient the best that we can offer that patient regardless of the

effect on profit? I don't know how anyone can answer that it is.

Secondly, is utilization of the PTA to perform hands on skills with

the patient in the best interest of the Physical Therapy

profession? Again, if the patient percieves that what the PTA can

do is truly the best that the Physical Therapy profession has to

offer and this interaction with the PTA frames their perception of

what Physical Therapy is, then I don't see how this can be in the

best interest of the profession.

We perform all of our treatment sessions one on one with our

clients, all of our therapists are highly skilled in manual physical

therapy interventions, a field we have all invested years of work

on. Why would we turn the care of our patient's over to someone with

less expertise? The only answer I can think of would be to increase

profit margin which would certainly be counter to our core ideology.

I hope I have been able to answer your questions without offending.

E. s, PT, DPT, OCS

s Orthopedic & Spine Rehabilitation, Inc

Bonita Springs, Fla

-- In PTManager , <amiller_cpc@y...>

wrote:

> ,

> So you're saying that PTA's shouldn't be hands-on at all? Are we

only able to turn on stim machines, do US, and teach/supervise

patients in the gym? PTA's are far more educated than that. I know

our PTA's didn't just go to school to do modalities only. You must

not know how to utilize your PTA's. Anyone else agree with me? The

PT may not always be the " best person to do the job. " I know of

PTA's who have their own case load and report to the PT any changes

the pt has made, or check with the PT to change anything with the

pt's Rx. The pt. only sees the PT somestimes once a week so he/she

can stay up to date with the pt's progress. Some pts may prefer to

see a particular PTA rather than the PT. I know everyone is

entitled to their opinion, but you need to get off your pedestal and

realize that PTA's can do a lot more than what you lead on. PTA's

are aware of their practice act and know not to do anything to

jeopardize their license (or at least they shouldn't)!!

>

> , CPC-PTA

> Billing Administrator

> lin Physical Therapy, LLC

>

> s <dosrinc@a...> wrote:

> ,

> You can count me in as against as well, simply too much room for

> overutilization. We all come on here and say yes, but only if the

> PTA is trained, ect.. The problem is that there are too many

places

> that utilize far too many PTA's per PT and far too many places that

> don't care how well the PTA is trained, only whether or not they

can

> bill for the PTA's time. My philosophy and that of my clinic is

> that we need to make every effort possible to meet or exceed the

> expectations of the patient when they walk through our door. The

> patient's expectation when they enter a Physical Therapist's

office

> to recieve Physical Therapy is that the person performing their

care

> will be a Physical Therapist. We need to meet that expectation. I

> know some great PTA's and hope I don't offend but this is simply

the

> way I feel I would want to be treated, the best person to do the

> job, the one most qualified and skilled, should be the PT, not the

> PTA; each patient deserves that.

>

> E. s, PT, DPT, OCS

> s Orthopedic & Spine Rehabilitation, Inc.

> Bonita Springs, Fla

>

>

> -- In PTManager , " "

> wrote:

> > Am I the only one against?

> >

> > Simonetti, PT

> > Chestertown, MD

> >

> >

> >

> > >

> > > Group,

> > > How bout an informal survey?

> > >

> > > For or against PTA's performing joint mobs?

> > >

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

> PTManager encourages participation in your professional

association. Join and participate now!

>

[Guest guest]

I'm (PT) doing the joint mobs, the PTA's are doing general ROM

mobilization (ie hamstring stretch) for the following reasons,

1) The PT is liable and assumes the malpractice risk

2) Full comprehension of Joint structure/function as related to joint

mobs, requires PT school level education and post education

3) Patients expect a PT to do the " physical art " aspects of hands on

care

Terry Rose PT, MS

Director of Rehab

Niagara Falls Memorial Medical Center

Re: PTA's and joint mobs

>

> Am I the only one against?

>

> Simonetti, PT

> Chestertown, MD

>

>

>

> >

> > Group,

> > How bout an informal survey?

> >

> > For or against PTA's performing joint mobs?

> >

>

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

> professional workshop or course - call us at 313 884-8920 to arrange

> PTManager encourages participation in your professional association.

> Join and participate now!

>

[Guest guest]

I'm (PT) doing the joint mobs, the PTA's are doing general ROM

mobilization (ie hamstring stretch) for the following reasons,

1) The PT is liable and assumes the malpractice risk

2) Full comprehension of Joint structure/function as related to joint

mobs, requires PT school level education and post education

3) Patients expect a PT to do the " physical art " aspects of hands on

care

Terry Rose PT, MS

Director of Rehab

Niagara Falls Memorial Medical Center

Re: PTA's and joint mobs

>

> Am I the only one against?

>

> Simonetti, PT

> Chestertown, MD

>

>

>

> >

> > Group,

> > How bout an informal survey?

> >

> > For or against PTA's performing joint mobs?

> >

>

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

> professional workshop or course - call us at 313 884-8920 to arrange

> PTManager encourages participation in your professional association.

> Join and participate now!

>

[Guest guest]

I'm (PT) doing the joint mobs, the PTA's are doing general ROM

mobilization (ie hamstring stretch) for the following reasons,

1) The PT is liable and assumes the malpractice risk

2) Full comprehension of Joint structure/function as related to joint

mobs, requires PT school level education and post education

3) Patients expect a PT to do the " physical art " aspects of hands on

care

Terry Rose PT, MS

Director of Rehab

Niagara Falls Memorial Medical Center

Re: PTA's and joint mobs

>

> Am I the only one against?

>

> Simonetti, PT

> Chestertown, MD

>

>

>

> >

> > Group,

> > How bout an informal survey?

> >

> > For or against PTA's performing joint mobs?

> >

>

>

>

>

>

>

>

> Looking to start your own Practice?

> Visit www.InHomeRehab.com.

> Bring PTManager to your organization or State Association with a

> professional workshop or course - call us at 313 884-8920 to arrange

> PTManager encourages participation in your professional association.

> Join and participate now!

>

[Guest guest]

,

Did you mean to state that " The therapy is always overseen by the PT " ? If

not then what are PTA's for?

Re: Re: PTA's and joint mobs

" The therapy is always delivered by the therapist "

, that's an interesting statement. Care to elaborate?

And yes, I absolutely disagree but am wondering where you're coming from

with this.

jeff overstreet pta

delray beach

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

,

Did you mean to state that " The therapy is always overseen by the PT " ? If

not then what are PTA's for?

Re: Re: PTA's and joint mobs

" The therapy is always delivered by the therapist "

, that's an interesting statement. Care to elaborate?

And yes, I absolutely disagree but am wondering where you're coming from

with this.

jeff overstreet pta

delray beach

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

,

Did you mean to state that " The therapy is always overseen by the PT " ? If

not then what are PTA's for?

Re: Re: PTA's and joint mobs

" The therapy is always delivered by the therapist "

, that's an interesting statement. Care to elaborate?

And yes, I absolutely disagree but am wondering where you're coming from

with this.

jeff overstreet pta

delray beach

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

Mobilization and manipulation are synonymous terms and can be used

interchangeably as they are both defined as " the skilled passive movement to a

joint " ( Phys.Ther.,49:8 Aug 1979, Paris,S.V.) The APTA definition is just a bit

more elaborate but essentially the same.

Gervacio M. Laqui,MHScPT, MTC

Sterling Heights,MI

Re: PTA's and joint mobs

Am I the only one against?

Simonetti, PT

Chestertown, MD

>

> Group,

> How bout an informal survey?

>

> For or against PTA's performing joint mobs?

>

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association.

Join

and participate now!

[Guest guest]

I think I have a fortunate perspective at times.

I started in rehab as a Rehab Tech for 2 years.

I enrolled in a program and became a PTA. I practiced for 15 years.

I got my Bachelor's and then went to PT school and got my M.S. I have

been a PT for 14 years. (Yes, add it up...that does make me older

than dirt!)

Everyone agreed I was an extremely bright and skilled PTA. I was

told constantly by " people " that they couldn't tell the difference

between myself and PT's working side by side as we were doing the

same things in much the same ways. I, of course, totally agreed! And

PT's, of course, were counstantly telling me to go to PT school!

I thought being a PTA would give me an edge in PT school. It

did...for the first half hour. There definitely is a difference in

depth (not the same thing as scope) of knowledge, even for the most

experienced PTA's. And the difference is enormously in the sciences.

I thought I was going to PT school to " learn more " but the lightbulb

went on in the first hour - what I was really feeling was wanting to

learn clinical decision-making (and I didn't even know what that was

until then.)

PTA's can have the same and even superior hands-on clinical skills

coompared to individual PT's. But clinical decision-making is the

difference.

PTA education, by purpose, is focused on what to do and how to do it.

PT education, by purpose, is focused on why to do the what and how,

and how did you come to that decision?

Now, I'm shooting from the hip here, to show proportionately the

difference:

PTA's receive a 2 year degree, perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills.

PT's receiving a Master's degree will spend about 4 semesters + (?

about 2000 hours?) learning PT-specific knowledge and skills. (They

got their basic requirements getting a Bachelor's degree - 4 years).

The PT's do not spend 4 semesters learning the same thing 4 times

over, but learn 4 times deeper. (This is not a quantifiable comment -

just food for thought.)

PTA's doing joint mob?

Maybe - does it carry a higher risk factor of damage to patient if

done wrong than, say, hot packs? I don't know. Licensure and

practice act is all about consumer protection.

Here is my guideline - if the PTA can tell and show me not just WHAT

to do and HOW to do it, but WHY to do it in that particular way and

not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

that a word?)then maybe. I have in the past (but no longer) directed

stage I, II, III mobs - but not more than that because knowing when

to stop the movement is a clinical decision falling into EVALUATION

of NEW INFORMATION (because after all you've ventured into new range,

or why are you doing it?)and its implications. PTA's ASSESS status

and response to ALREADY IDENTIFIED INFORMATION(within the known non-

harmful range, what is happening?)

Here is an example from my very recent trip into a clinic covering

for a PT:

a PTA with great intelligence and reputation was very skillfully

applying joint mobs at the proximal tibia to increase knee

extension. The patient had minus 15 degrees of extension. The PTA

was doing the technique correctly and the patient was enthusiastic

about it.

The problem: she was doing it to a brand new Total Knee Replacement -

that the type of prosthesis, cemented or uncemented, etc. was not

known. On examination, I found that the lack of extension was totally

due to the mechanical limitations and insertion of the prosthesis and

was never going to change.

When I directed her to stop, she said " why would they teach us joint

mob if they didn't intend us to use it? And she lacks extension and

this increases extension. " The issue is that she could not visualize

and describe what the movement was doing to the joint surfaces, what

the joint " surfaces " looked like, and how she would know when she was

going as far as she should- that is, the clinical decision-making to

stop at this degree or angle and not another.

I would give a challenge to all PTA's and PT's: Can you do a simple

drawing of what the joint surfaces look like (e.g. concave end

opposed to convex end, etc.) and describe what the mob will do to

that relationship? And how does changing that relationship end up

changing the range? If you can't do that, you should not be doing

jt. mob, even if you are an orthopedic surgeon. It's not enough to

know how to do a movement and that " it increases extension " .

Well, as my staff has always told me: " Lorraine, when all is said and

done...you go on and on, anyways. " :-)

Signing off,

Lorraine , PTTech, PTA, PT, MS

> > >

> > > Group,

> > > How bout an informal survey?

> > >

> > > For or against PTA's performing joint mobs?

> > >

> >

> >

> >

> >

> >

> >

> >

> > Looking to start your own Practice?

> > Visit www.InHomeRehab.com.

> > Bring PTManager to your organization or State Association with a

> > professional workshop or course - call us at 313 884-8920 to

arrange

> > PTManager encourages participation in your professional

association.

> > Join and participate now!

> >

[Guest guest]

I think I have a fortunate perspective at times.

I started in rehab as a Rehab Tech for 2 years.

I enrolled in a program and became a PTA. I practiced for 15 years.

I got my Bachelor's and then went to PT school and got my M.S. I have

been a PT for 14 years. (Yes, add it up...that does make me older

than dirt!)

Everyone agreed I was an extremely bright and skilled PTA. I was

told constantly by " people " that they couldn't tell the difference

between myself and PT's working side by side as we were doing the

same things in much the same ways. I, of course, totally agreed! And

PT's, of course, were counstantly telling me to go to PT school!

I thought being a PTA would give me an edge in PT school. It

did...for the first half hour. There definitely is a difference in

depth (not the same thing as scope) of knowledge, even for the most

experienced PTA's. And the difference is enormously in the sciences.

I thought I was going to PT school to " learn more " but the lightbulb

went on in the first hour - what I was really feeling was wanting to

learn clinical decision-making (and I didn't even know what that was

until then.)

PTA's can have the same and even superior hands-on clinical skills

coompared to individual PT's. But clinical decision-making is the

difference.

PTA education, by purpose, is focused on what to do and how to do it.

PT education, by purpose, is focused on why to do the what and how,

and how did you come to that decision?

Now, I'm shooting from the hip here, to show proportionately the

difference:

PTA's receive a 2 year degree, perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills.

PT's receiving a Master's degree will spend about 4 semesters + (?

about 2000 hours?) learning PT-specific knowledge and skills. (They

got their basic requirements getting a Bachelor's degree - 4 years).

The PT's do not spend 4 semesters learning the same thing 4 times

over, but learn 4 times deeper. (This is not a quantifiable comment -

just food for thought.)

PTA's doing joint mob?

Maybe - does it carry a higher risk factor of damage to patient if

done wrong than, say, hot packs? I don't know. Licensure and

practice act is all about consumer protection.

Here is my guideline - if the PTA can tell and show me not just WHAT

to do and HOW to do it, but WHY to do it in that particular way and

not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

that a word?)then maybe. I have in the past (but no longer) directed

stage I, II, III mobs - but not more than that because knowing when

to stop the movement is a clinical decision falling into EVALUATION

of NEW INFORMATION (because after all you've ventured into new range,

or why are you doing it?)and its implications. PTA's ASSESS status

and response to ALREADY IDENTIFIED INFORMATION(within the known non-

harmful range, what is happening?)

Here is an example from my very recent trip into a clinic covering

for a PT:

a PTA with great intelligence and reputation was very skillfully

applying joint mobs at the proximal tibia to increase knee

extension. The patient had minus 15 degrees of extension. The PTA

was doing the technique correctly and the patient was enthusiastic

about it.

The problem: she was doing it to a brand new Total Knee Replacement -

that the type of prosthesis, cemented or uncemented, etc. was not

known. On examination, I found that the lack of extension was totally

due to the mechanical limitations and insertion of the prosthesis and

was never going to change.

When I directed her to stop, she said " why would they teach us joint

mob if they didn't intend us to use it? And she lacks extension and

this increases extension. " The issue is that she could not visualize

and describe what the movement was doing to the joint surfaces, what

the joint " surfaces " looked like, and how she would know when she was

going as far as she should- that is, the clinical decision-making to

stop at this degree or angle and not another.

I would give a challenge to all PTA's and PT's: Can you do a simple

drawing of what the joint surfaces look like (e.g. concave end

opposed to convex end, etc.) and describe what the mob will do to

that relationship? And how does changing that relationship end up

changing the range? If you can't do that, you should not be doing

jt. mob, even if you are an orthopedic surgeon. It's not enough to

know how to do a movement and that " it increases extension " .

Well, as my staff has always told me: " Lorraine, when all is said and

done...you go on and on, anyways. " :-)

Signing off,

Lorraine , PTTech, PTA, PT, MS

> > >

> > > Group,

> > > How bout an informal survey?

> > >

> > > For or against PTA's performing joint mobs?

> > >

> >

> >

> >

> >

> >

> >

> >

> > Looking to start your own Practice?

> > Visit www.InHomeRehab.com.

> > Bring PTManager to your organization or State Association with a

> > professional workshop or course - call us at 313 884-8920 to

arrange

> > PTManager encourages participation in your professional

association.

> > Join and participate now!

> >

[Guest guest]

I have sat on my hands for a while with regard to responding to the debate of

PTA's & joint mobs. I wasn't going to chime in but I feel the need to offer my

two cents.

How & why did PTA's evolve if the concensus of persons responding to this

argument do not utilize them to their potential? In the thirty plus years they

have been in existence, have we come to a point where PT's want them to evolve

straight out of the profession. It seems silly to say a PTA can do modalities

but not anything else. In my opinion, I think an evaluative process takes place

when you are utilizing modalities. So are we to argue, that since you are

constantly evaluating a patients response to a particular modality or exercise,

that PTA's shouldn't be permitted to perform modalities or supervise exercise. I

think this argument is getting a little out of hand with regard to the scope of

the original topic. It seems to have become an outright attack on PTA's. I

believe it is our duty as PT's to make our own choices with regard to

utilization of PTA's in our clinical practices and keep those degrading opinions

of their particular knowledge levels off of a listserve that includes PTA's!

Connors, MPT

Carrollton, TX

[Guest guest]

I have sat on my hands for a while with regard to responding to the debate of

PTA's & joint mobs. I wasn't going to chime in but I feel the need to offer my

two cents.

How & why did PTA's evolve if the concensus of persons responding to this

argument do not utilize them to their potential? In the thirty plus years they

have been in existence, have we come to a point where PT's want them to evolve

straight out of the profession. It seems silly to say a PTA can do modalities

but not anything else. In my opinion, I think an evaluative process takes place

when you are utilizing modalities. So are we to argue, that since you are

constantly evaluating a patients response to a particular modality or exercise,

that PTA's shouldn't be permitted to perform modalities or supervise exercise. I

think this argument is getting a little out of hand with regard to the scope of

the original topic. It seems to have become an outright attack on PTA's. I

believe it is our duty as PT's to make our own choices with regard to

utilization of PTA's in our clinical practices and keep those degrading opinions

of their particular knowledge levels off of a listserve that includes PTA's!

Connors, MPT

Carrollton, TX

[Guest guest]

Lorraine,

I was going to chime in, but your answer was the best one there.

Connolly, PT

PT Plus of Oak Creek

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >

[Guest guest]

Lorraine,

I was going to chime in, but your answer was the best one there.

Connolly, PT

PT Plus of Oak Creek

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >

[Guest guest]

Lorraine,

I was going to chime in, but your answer was the best one there.

Connolly, PT

PT Plus of Oak Creek

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >

[Guest guest]

,

That's a very high-sounding philosophy, but I think it has more pride in it

than practical reality. Allow me to challenge you on two fronts.

First, this perpetual claim that a PTA cannot learn how to properly perform

joint mobilizations simply must go away. There is no magic to joint

mobilizations, they are simply a skill like any other--aquired through

training and refined by application, just the sort that good PTAs get. A

reasonable analogy to your claim would be that PTs couldn't learn to

properly diagnose any problem that an orthopedist might diagnose.

Second, and more important, is that your pronouncement that profits must

take a back seat to patients' best interests is true only so far as you

allow your patients to define their own interests. By that I mean that it's

more than likely that some patients would PREFER that a qualified PTA

perform their joint mobilizations. First from loyalty to a particular

practitioner (the most recent PTA we hired in our practice brought a devoted

patient base with her to our practice!), second to save money--why not help

patients (who desire it) by giving them a break on payments through the use

of PTAs?--your statement suggests that profits can be sacrificed only after

you have enough of them to pay your PTs.

Dave Milano, PT

Director of Rehab Services

Laurel Health System

[Guest guest]

,

That's a very high-sounding philosophy, but I think it has more pride in it

than practical reality. Allow me to challenge you on two fronts.

First, this perpetual claim that a PTA cannot learn how to properly perform

joint mobilizations simply must go away. There is no magic to joint

mobilizations, they are simply a skill like any other--aquired through

training and refined by application, just the sort that good PTAs get. A

reasonable analogy to your claim would be that PTs couldn't learn to

properly diagnose any problem that an orthopedist might diagnose.

Second, and more important, is that your pronouncement that profits must

take a back seat to patients' best interests is true only so far as you

allow your patients to define their own interests. By that I mean that it's

more than likely that some patients would PREFER that a qualified PTA

perform their joint mobilizations. First from loyalty to a particular

practitioner (the most recent PTA we hired in our practice brought a devoted

patient base with her to our practice!), second to save money--why not help

patients (who desire it) by giving them a break on payments through the use

of PTAs?--your statement suggests that profits can be sacrificed only after

you have enough of them to pay your PTs.

Dave Milano, PT

Director of Rehab Services

Laurel Health System

[Guest guest]

yes, except for: " perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills. Check out the San Tx. St. Curriculum-I

think you find you're way off, on the one semester part.

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com<http://www.inhomerehab.com/>.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >

[Guest guest]

yes, except for: " perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills. Check out the San Tx. St. Curriculum-I

think you find you're way off, on the one semester part.

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com<http://www.inhomerehab.com/>.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >

[Guest guest]

yes, except for: " perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills. Check out the San Tx. St. Curriculum-I

think you find you're way off, on the one semester part.

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com<http://www.inhomerehab.com/>.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >

[Guest guest]

To group:

I think this is a great forum for these discussions - out in the

trenches. I have great confidence in APTA advocacy but there is

always more meaning when batted around by the people with first hand

experience.

First, I know that as a PTA I frequently felt constrained by license

when I felt I was able to do more. But remember, license is not an

indicator of potential, intelligence, skill, or desire - it is simply

the legal recognition of substantiated and expected knowledge for a

level of licensure. It is for consumer protection. If that is the

level of your education and licensure law, don't take it personally.

But be legal!

1) I did a PT clinical for a private practice PT in a state that did

not have direct access yet. This PT had previously worked in a

direct access state and felt his skills were not being fully

utilized. So he repeatedly violated this state's licensure agreement

with him by seeing patients without physician referral. His

reasoning " When this state gets direct access, someone is going to

have to show everyone else how to do it...so I'm doing it for the

good of the profession. " Well, he needed to go to a state where he

felt his skills were fully utilized or he needed to become legal in

recognizing the current parameters he had accepted by applying for

licensure in this state. Nobody makes you be a PT or PTA and forces

you to abide by law - you chose that. But PTA's, I know I did not

fully appreciate this: when you choose to take the chance with your

license, you are also taking the chance with the PT's license and

they have not had a say in it. Just as for PT's, if you choose to

take the chance with your license, you may be jeopardizing the

physician's license, too.

If you feel you are constrained to the point of unfulfillment, pursue

further education to attain another license, or recognize that you

may be exceptional but still must be legal. Look to be stellar in

areas that are open to you until you have helped to expand the legal

limits.

2) PTA's and PT's do not EVALUATE with every patient encounter - that

is looking at new and different presenting information, analyzing

what it implies and means, deciding clinically what new direction to

take to address it.

PTA's and PT's do ASSESS with every patient encounter - with all

previously known conditions and responses, is this presentation and

response within parameters we would expect?

If assessment reveals an unexpected or new problem or response, then

an evaluation ensues.

3) PTA's have enormous credibility and impact within their licensure

parameters - limits do not say it's all or nothing -it does not mean

you can either do it all or you're worthless. When PT's do not have

direct access in a state, does that mean they're worthless because

they are legally restricted from that one area they feel competent to

do?

4) PTA's who tell me (as my previous 'jt. mob on a TKR patient' PTA

did) " Other PT's let me do this without checking with them " - I

respond " I am sorry those PT's did not respect you enough to insist

on the legal limits of your license being observed. I will never

disrespect what it took for you to get that license, and what it

means to you in terms of professional purpose and livelihood. I will

not be a silent conspirator in you operating outside the law because

that is disrespectful to you. "

PT's do not need to feel unfulfilled because they are not given the

parameters (and responsibilities!) of a physician; PTA's do not need

to feel unfulfilled because they are not given the parameters (and

responsibilities!) of a PT. Having the intelligence and aptitude,

and the opportunity to learn whatever education we have had is an

honor we can appreciate and celebrate

Lorraine , PT Tech, PTA, PT, MS

(and most recent title: Grandma!)

> ,

>

> That's a very high-sounding philosophy, but I think it has more

pride in it

> than practical reality. Allow me to challenge you on two fronts.

>

> First, this perpetual claim that a PTA cannot learn how to properly

perform

> joint mobilizations simply must go away. There is no magic to joint

> mobilizations, they are simply a skill like any other--aquired

through

> training and refined by application, just the sort that good PTAs

get. A

> reasonable analogy to your claim would be that PTs couldn't learn to

> properly diagnose any problem that an orthopedist might diagnose.

>

> Second, and more important, is that your pronouncement that profits

must

> take a back seat to patients' best interests is true only so far as

you

> allow your patients to define their own interests. By that I mean

that it's

> more than likely that some patients would PREFER that a qualified

PTA

> perform their joint mobilizations. First from loyalty to a

particular

> practitioner (the most recent PTA we hired in our practice brought

a devoted

> patient base with her to our practice!), second to save money--why

not help

> patients (who desire it) by giving them a break on payments through

the use

> of PTAs?--your statement suggests that profits can be sacrificed

only after

> you have enough of them to pay your PTs.

>

> Dave Milano, PT

> Director of Rehab Services

> Laurel Health System

[Guest guest]

To group:

I think this is a great forum for these discussions - out in the

trenches. I have great confidence in APTA advocacy but there is

always more meaning when batted around by the people with first hand

experience.

First, I know that as a PTA I frequently felt constrained by license

when I felt I was able to do more. But remember, license is not an

indicator of potential, intelligence, skill, or desire - it is simply

the legal recognition of substantiated and expected knowledge for a

level of licensure. It is for consumer protection. If that is the

level of your education and licensure law, don't take it personally.

But be legal!

1) I did a PT clinical for a private practice PT in a state that did

not have direct access yet. This PT had previously worked in a

direct access state and felt his skills were not being fully

utilized. So he repeatedly violated this state's licensure agreement

with him by seeing patients without physician referral. His

reasoning " When this state gets direct access, someone is going to

have to show everyone else how to do it...so I'm doing it for the

good of the profession. " Well, he needed to go to a state where he

felt his skills were fully utilized or he needed to become legal in

recognizing the current parameters he had accepted by applying for

licensure in this state. Nobody makes you be a PT or PTA and forces

you to abide by law - you chose that. But PTA's, I know I did not

fully appreciate this: when you choose to take the chance with your

license, you are also taking the chance with the PT's license and

they have not had a say in it. Just as for PT's, if you choose to

take the chance with your license, you may be jeopardizing the

physician's license, too.

If you feel you are constrained to the point of unfulfillment, pursue

further education to attain another license, or recognize that you

may be exceptional but still must be legal. Look to be stellar in

areas that are open to you until you have helped to expand the legal

limits.

2) PTA's and PT's do not EVALUATE with every patient encounter - that

is looking at new and different presenting information, analyzing

what it implies and means, deciding clinically what new direction to

take to address it.

PTA's and PT's do ASSESS with every patient encounter - with all

previously known conditions and responses, is this presentation and

response within parameters we would expect?

If assessment reveals an unexpected or new problem or response, then

an evaluation ensues.

3) PTA's have enormous credibility and impact within their licensure

parameters - limits do not say it's all or nothing -it does not mean

you can either do it all or you're worthless. When PT's do not have

direct access in a state, does that mean they're worthless because

they are legally restricted from that one area they feel competent to

do?

4) PTA's who tell me (as my previous 'jt. mob on a TKR patient' PTA

did) " Other PT's let me do this without checking with them " - I

respond " I am sorry those PT's did not respect you enough to insist

on the legal limits of your license being observed. I will never

disrespect what it took for you to get that license, and what it

means to you in terms of professional purpose and livelihood. I will

not be a silent conspirator in you operating outside the law because

that is disrespectful to you. "

PT's do not need to feel unfulfilled because they are not given the

parameters (and responsibilities!) of a physician; PTA's do not need

to feel unfulfilled because they are not given the parameters (and

responsibilities!) of a PT. Having the intelligence and aptitude,

and the opportunity to learn whatever education we have had is an

honor we can appreciate and celebrate

Lorraine , PT Tech, PTA, PT, MS

(and most recent title: Grandma!)

> ,

>

> That's a very high-sounding philosophy, but I think it has more

pride in it

> than practical reality. Allow me to challenge you on two fronts.

>

> First, this perpetual claim that a PTA cannot learn how to properly

perform

> joint mobilizations simply must go away. There is no magic to joint

> mobilizations, they are simply a skill like any other--aquired

through

> training and refined by application, just the sort that good PTAs

get. A

> reasonable analogy to your claim would be that PTs couldn't learn to

> properly diagnose any problem that an orthopedist might diagnose.

>

> Second, and more important, is that your pronouncement that profits

must

> take a back seat to patients' best interests is true only so far as

you

> allow your patients to define their own interests. By that I mean

that it's

> more than likely that some patients would PREFER that a qualified

PTA

> perform their joint mobilizations. First from loyalty to a

particular

> practitioner (the most recent PTA we hired in our practice brought

a devoted

> patient base with her to our practice!), second to save money--why

not help

> patients (who desire it) by giving them a break on payments through

the use

> of PTAs?--your statement suggests that profits can be sacrificed

only after

> you have enough of them to pay your PTs.

>

> Dave Milano, PT

> Director of Rehab Services

> Laurel Health System

[Guest guest]

I agree, I know at the PTA schools in our area, even though it is looked at as a

2 year program, the students actually spend 1-2 years getting the

pre-reqs(english, biology, psych, etc...) before they are accepted into the 2

year program that is spent on the physical therapy classes. The PTA's

graduating in our area are spending more time on clinical decision making as

well as treatment techniques.

My concern with the example below is: Why didn't the PTA know that this was a

TJR. I review with my PTA's diagnosis, precautions, as well as the treatment

plan I want for the patient. (I don't mean to indicate that the person below did

not, just stating what I think is essential to communication with the PTA's) If

the PTA is doing joint mobilizations without the PT's direction, or without

consulting with the PT, then that is a bigger concern to me than the fact the

PTA was doing joint mobilization.

As far as the " assessment " part. Every time we use a modality, soft tissue

mobilization, complete a strengthening exercises, complete a contract relax

stretching, instruct a patient on how to make gait changes, etc... aren't we

assessing how the tissue, strength, movement is responding to the treatment and

do we not make clinical judgments whether to continue with the

techniques/advance those techniques or not. Is this not what the PTA is

educated on when they are learning how to " do " the techniques. If not how are

they any different than that aide the physician has " pulled off the street " . I

would hope the my PTA is capable of advancing the stretch, the exercise

repetition, knowing a tissue restriction has released or not, without my direct

supervision, otherwise the PTA is of no value to me. I need to be do the

techniques myself.

Again, I think it gets back to 1) effective communication between PT and PTA, 2)

knowing the skill levels and yes the clinical decision making of the PTA

Kathy Smtithberger, PT

Manager of Physical Therapy

Mercy Medical Center

Canton, Ohio

Re: Re: PTA's and joint mobs

yes, except for: " perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills. Check out the San Tx. St. Curriculum-I

think you find you're way off, on the one semester part.

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com<http://www.inhomerehab.com/>.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >

[Guest guest]

I agree, I know at the PTA schools in our area, even though it is looked at as a

2 year program, the students actually spend 1-2 years getting the

pre-reqs(english, biology, psych, etc...) before they are accepted into the 2

year program that is spent on the physical therapy classes. The PTA's

graduating in our area are spending more time on clinical decision making as

well as treatment techniques.

My concern with the example below is: Why didn't the PTA know that this was a

TJR. I review with my PTA's diagnosis, precautions, as well as the treatment

plan I want for the patient. (I don't mean to indicate that the person below did

not, just stating what I think is essential to communication with the PTA's) If

the PTA is doing joint mobilizations without the PT's direction, or without

consulting with the PT, then that is a bigger concern to me than the fact the

PTA was doing joint mobilization.

As far as the " assessment " part. Every time we use a modality, soft tissue

mobilization, complete a strengthening exercises, complete a contract relax

stretching, instruct a patient on how to make gait changes, etc... aren't we

assessing how the tissue, strength, movement is responding to the treatment and

do we not make clinical judgments whether to continue with the

techniques/advance those techniques or not. Is this not what the PTA is

educated on when they are learning how to " do " the techniques. If not how are

they any different than that aide the physician has " pulled off the street " . I

would hope the my PTA is capable of advancing the stretch, the exercise

repetition, knowing a tissue restriction has released or not, without my direct

supervision, otherwise the PTA is of no value to me. I need to be do the

techniques myself.

Again, I think it gets back to 1) effective communication between PT and PTA, 2)

knowing the skill levels and yes the clinical decision making of the PTA

Kathy Smtithberger, PT

Manager of Physical Therapy

Mercy Medical Center

Canton, Ohio

Re: Re: PTA's and joint mobs

yes, except for: " perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills. Check out the San Tx. St. Curriculum-I

think you find you're way off, on the one semester part.

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Looking to start your own Practice?

> > > Visit www.InHomeRehab.com<http://www.inhomerehab.com/>.

> > > Bring PTManager to your organization or State Association with a

> > > professional workshop or course - call us at 313 884-8920 to

> arrange

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[Guest guest]

I agree, I know at the PTA schools in our area, even though it is looked at as a

2 year program, the students actually spend 1-2 years getting the

pre-reqs(english, biology, psych, etc...) before they are accepted into the 2

year program that is spent on the physical therapy classes. The PTA's

graduating in our area are spending more time on clinical decision making as

well as treatment techniques.

My concern with the example below is: Why didn't the PTA know that this was a

TJR. I review with my PTA's diagnosis, precautions, as well as the treatment

plan I want for the patient. (I don't mean to indicate that the person below did

not, just stating what I think is essential to communication with the PTA's) If

the PTA is doing joint mobilizations without the PT's direction, or without

consulting with the PT, then that is a bigger concern to me than the fact the

PTA was doing joint mobilization.

As far as the " assessment " part. Every time we use a modality, soft tissue

mobilization, complete a strengthening exercises, complete a contract relax

stretching, instruct a patient on how to make gait changes, etc... aren't we

assessing how the tissue, strength, movement is responding to the treatment and

do we not make clinical judgments whether to continue with the

techniques/advance those techniques or not. Is this not what the PTA is

educated on when they are learning how to " do " the techniques. If not how are

they any different than that aide the physician has " pulled off the street " . I

would hope the my PTA is capable of advancing the stretch, the exercise

repetition, knowing a tissue restriction has released or not, without my direct

supervision, otherwise the PTA is of no value to me. I need to be do the

techniques myself.

Again, I think it gets back to 1) effective communication between PT and PTA, 2)

knowing the skill levels and yes the clinical decision making of the PTA

Kathy Smtithberger, PT

Manager of Physical Therapy

Mercy Medical Center

Canton, Ohio

Re: Re: PTA's and joint mobs

yes, except for: " perhaps 75% of which is in basic

requirements for a degree (english, biology, etc.). That leaves

approximately 1 semester (? about 500 hours) to learn PT-specific

knowledge and skills. Check out the San Tx. St. Curriculum-I

think you find you're way off, on the one semester part.

Re: PTA's and joint mobs

> I think I have a fortunate perspective at times.

>

> I started in rehab as a Rehab Tech for 2 years.

>

> I enrolled in a program and became a PTA. I practiced for 15 years.

>

> I got my Bachelor's and then went to PT school and got my M.S. I have

> been a PT for 14 years. (Yes, add it up...that does make me older

> than dirt!)

>

> Everyone agreed I was an extremely bright and skilled PTA. I was

> told constantly by " people " that they couldn't tell the difference

> between myself and PT's working side by side as we were doing the

> same things in much the same ways. I, of course, totally agreed! And

> PT's, of course, were counstantly telling me to go to PT school!

>

> I thought being a PTA would give me an edge in PT school. It

> did...for the first half hour. There definitely is a difference in

> depth (not the same thing as scope) of knowledge, even for the most

> experienced PTA's. And the difference is enormously in the sciences.

>

> I thought I was going to PT school to " learn more " but the lightbulb

> went on in the first hour - what I was really feeling was wanting to

> learn clinical decision-making (and I didn't even know what that was

> until then.)

>

> PTA's can have the same and even superior hands-on clinical skills

> coompared to individual PT's. But clinical decision-making is the

> difference.

>

> PTA education, by purpose, is focused on what to do and how to do it.

>

> PT education, by purpose, is focused on why to do the what and how,

> and how did you come to that decision?

>

> Now, I'm shooting from the hip here, to show proportionately the

> difference:

>

> PTA's receive a 2 year degree, perhaps 75% of which is in basic

> requirements for a degree (english, biology, etc.). That leaves

> approximately 1 semester (? about 500 hours) to learn PT-specific

> knowledge and skills.

>

> PT's receiving a Master's degree will spend about 4 semesters + (?

> about 2000 hours?) learning PT-specific knowledge and skills. (They

> got their basic requirements getting a Bachelor's degree - 4 years).

>

> The PT's do not spend 4 semesters learning the same thing 4 times

> over, but learn 4 times deeper. (This is not a quantifiable comment -

> just food for thought.)

>

> PTA's doing joint mob?

> Maybe - does it carry a higher risk factor of damage to patient if

> done wrong than, say, hot packs? I don't know. Licensure and

> practice act is all about consumer protection.

>

> Here is my guideline - if the PTA can tell and show me not just WHAT

> to do and HOW to do it, but WHY to do it in that particular way and

> not in another way, DESCRIBING WHAT IS HAPPENING KINESIOLOGICALLY (is

> that a word?)then maybe. I have in the past (but no longer) directed

> stage I, II, III mobs - but not more than that because knowing when

> to stop the movement is a clinical decision falling into EVALUATION

> of NEW INFORMATION (because after all you've ventured into new range,

> or why are you doing it?)and its implications. PTA's ASSESS status

> and response to ALREADY IDENTIFIED INFORMATION(within the known non-

> harmful range, what is happening?)

>

> Here is an example from my very recent trip into a clinic covering

> for a PT:

> a PTA with great intelligence and reputation was very skillfully

> applying joint mobs at the proximal tibia to increase knee

> extension. The patient had minus 15 degrees of extension. The PTA

> was doing the technique correctly and the patient was enthusiastic

> about it.

>

> The problem: she was doing it to a brand new Total Knee Replacement -

> that the type of prosthesis, cemented or uncemented, etc. was not

> known. On examination, I found that the lack of extension was totally

> due to the mechanical limitations and insertion of the prosthesis and

> was never going to change.

>

> When I directed her to stop, she said " why would they teach us joint

> mob if they didn't intend us to use it? And she lacks extension and

> this increases extension. " The issue is that she could not visualize

> and describe what the movement was doing to the joint surfaces, what

> the joint " surfaces " looked like, and how she would know when she was

> going as far as she should- that is, the clinical decision-making to

> stop at this degree or angle and not another.

>

> I would give a challenge to all PTA's and PT's: Can you do a simple

> drawing of what the joint surfaces look like (e.g. concave end

> opposed to convex end, etc.) and describe what the mob will do to

> that relationship? And how does changing that relationship end up

> changing the range? If you can't do that, you should not be doing

> jt. mob, even if you are an orthopedic surgeon. It's not enough to

> know how to do a movement and that " it increases extension " .

>

> Well, as my staff has always told me: " Lorraine, when all is said and

> done...you go on and on, anyways. " :-)

>

> Signing off,

> Lorraine , PTTech, PTA, PT, MS

>

>

>

>

>

>

>

> > > >

> > > > Group,

> > > > How bout an informal survey?

> > > >

> > > > For or against PTA's performing joint mobs?

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

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> > > professional workshop or course - call us at 313 884-8920 to

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> > > PTManager encourages participation in your professional

> association.

> > > Join and participate now!

> > >