RE: PTA's and joint mobs

[Guest guest]

Kathy,

You are so right; and that was my first question and the PTA's first

defense:

" X, the PT, knows I do mob and is okay with it. "

In fact, that PT was okay with never reviewing the plan of care with

the PTA, " You're great-just do what you think they need. " That

included allowing the PTA to do spinal mobs on an elderly man with

osteoporosis and back pain - no xray done for compression fx; and

PT " diagnosed " spinal stenosis. Well, there's a whole 'nother story.

(Query: do you think that warrants reporting to state board?)

Yes, PT was outrageously negligent. BUT, that does not give the go-

ahead for a PTA to have carte blanche. PTA's do not have a license

that says " I make up my own mind if the PT doesn't care " - instead,

the license requires a PTA to seek out direction if not given. It is

as much the PTA's responsibililty to ask for direction as it is for

the PT to give it. If a Dr. does not give a diagnosis to a PT for a

problem, does that mean the PT has carte blanche to make up that

medical diagnosis himself? No, the PT's licensure requires him to

pursue that information from the physician before forging ahead, even

if the physician " doesn't care. "

Here's a question I am recently posing to colleagues: Legally, does

a PTA have the right to choose from a " menu " of interventions when

given a patient. In other words, if the PT turns over the TKR

patient with a statement of " she's doesn't have full extension " , can

the PTA then proceed with whatever she has learned in school and

experience that she knows may improve extension? Can she decide it

needs jt mob, e-stim, hotpacks, myofascial release, splinting, scar

massage, etc. just because she hasn't been told NOT to do each thing

specifically.

I love this forum for discussion!

Lorraine , PT, MS

-- In PTManager , " berger, Kathy "

<kathy.smithberger@c...> wrote:

> 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]

Kathy,

You are so right; and that was my first question and the PTA's first

defense:

" X, the PT, knows I do mob and is okay with it. "

In fact, that PT was okay with never reviewing the plan of care with

the PTA, " You're great-just do what you think they need. " That

included allowing the PTA to do spinal mobs on an elderly man with

osteoporosis and back pain - no xray done for compression fx; and

PT " diagnosed " spinal stenosis. Well, there's a whole 'nother story.

(Query: do you think that warrants reporting to state board?)

Yes, PT was outrageously negligent. BUT, that does not give the go-

ahead for a PTA to have carte blanche. PTA's do not have a license

that says " I make up my own mind if the PT doesn't care " - instead,

the license requires a PTA to seek out direction if not given. It is

as much the PTA's responsibililty to ask for direction as it is for

the PT to give it. If a Dr. does not give a diagnosis to a PT for a

problem, does that mean the PT has carte blanche to make up that

medical diagnosis himself? No, the PT's licensure requires him to

pursue that information from the physician before forging ahead, even

if the physician " doesn't care. "

Here's a question I am recently posing to colleagues: Legally, does

a PTA have the right to choose from a " menu " of interventions when

given a patient. In other words, if the PT turns over the TKR

patient with a statement of " she's doesn't have full extension " , can

the PTA then proceed with whatever she has learned in school and

experience that she knows may improve extension? Can she decide it

needs jt mob, e-stim, hotpacks, myofascial release, splinting, scar

massage, etc. just because she hasn't been told NOT to do each thing

specifically.

I love this forum for discussion!

Lorraine , PT, MS

-- In PTManager , " berger, Kathy "

<kathy.smithberger@c...> wrote:

> 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]

Kathy,

You are so right; and that was my first question and the PTA's first

defense:

" X, the PT, knows I do mob and is okay with it. "

In fact, that PT was okay with never reviewing the plan of care with

the PTA, " You're great-just do what you think they need. " That

included allowing the PTA to do spinal mobs on an elderly man with

osteoporosis and back pain - no xray done for compression fx; and

PT " diagnosed " spinal stenosis. Well, there's a whole 'nother story.

(Query: do you think that warrants reporting to state board?)

Yes, PT was outrageously negligent. BUT, that does not give the go-

ahead for a PTA to have carte blanche. PTA's do not have a license

that says " I make up my own mind if the PT doesn't care " - instead,

the license requires a PTA to seek out direction if not given. It is

as much the PTA's responsibililty to ask for direction as it is for

the PT to give it. If a Dr. does not give a diagnosis to a PT for a

problem, does that mean the PT has carte blanche to make up that

medical diagnosis himself? No, the PT's licensure requires him to

pursue that information from the physician before forging ahead, even

if the physician " doesn't care. "

Here's a question I am recently posing to colleagues: Legally, does

a PTA have the right to choose from a " menu " of interventions when

given a patient. In other words, if the PT turns over the TKR

patient with a statement of " she's doesn't have full extension " , can

the PTA then proceed with whatever she has learned in school and

experience that she knows may improve extension? Can she decide it

needs jt mob, e-stim, hotpacks, myofascial release, splinting, scar

massage, etc. just because she hasn't been told NOT to do each thing

specifically.

I love this forum for discussion!

Lorraine , PT, MS

-- In PTManager , " berger, Kathy "

<kathy.smithberger@c...> wrote:

> 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]

Dave,

Although I do admit to being very proud of what the profession has

achieved in the last decade, my philosophy is based more in reality

than you may want to believe.

The reality is that the disparity in education between the PT and

the PTA is growing larger every day and will continue to do so.

This disparity in education combined with the reality of increasing

out of pocket costs for those seeking Physical Therapy care has

brought about a change in the Physical Therapy profession. The

reality of high co-pays, deductibles, limited visits and medical

savings accounts has resulted in a public that is much more

demanding of it's health care providers, and deservedly so. The

patients who walk through the doors of my clinic would not tolerate

being passed off to a less qualified provider.

From the patient's perspective, those 10-15 mins I spend performing

soft tissue and/or joint mobilizations are often the most important

time I will spend with them during their treatment session. This is

when we discuss what has worked and what hasn't, changes in

medication, home exercise performance, ect. These are things that

often get lost in translation between the PT and PTA, especially if

each has 12 other patients to see that day.

From the professions perspective lets take a look at costs. I am

not an economist so please someone with a bigger brain than mine

(Dick, , Anyone) please chime in if I am getting this wrong.

The way I understand things, costs drive reimbursement. Isn't that

how the RVBS works. Don't clinic owners and hospital administrators

look at their costs to determne which contracts they can afford to

sign and which will lose them money? Many on this list serve

complain about the high cost of employing PT's and seek lower priced

alternatives. I disagree! We should instead direct our energies

towards higher reimbursement! Let me use a hypothetical scenario to

explain my point. Now this may get a bit long but bear with me.

Picture the CEO of a national healthcare company. He wants to

increase revenues. He has a penchant for doodling on cocktail

napkins and is sitting behind his 10k mahogany desk working on some

numbers. He says to himself in his southern drawl, " If I hire me a

bunch of them PTA's to do the job of those high priced PTs I can

undercut all of the other rehab compainies out there and make me a

bunch of money " . Now picture that he does just that, the insurance

compainies jump at his low ball offer and the downward spiral in

reimbursement creates a domino effect. PTs are forced to become

nothing more than evaluation and paperwork machines, the PTA evolves

from the Therapist's assistant to the patient's therapist with the

PT becoming some guy who checks in on things every now and again.

All the while the CEO kicks his alligator skinned boots up on his

mahogany desk and practices a new riff on his electric guitar.

Welcome to 1995!

The above hypothetical scenario proves my point. We all know the

end result and the profession is just beginnig to recover. You

CANNOT grow a profession by devaluing the product that that

profession provides. Specialists in all fields are able to charge

what they feel necessary because they are in high demand. We are

specialists. As Carlin might say, there is not a PT

shortage, Physical Therapists are in High Demand! Let's not repeat

the mistakes of our recent past.

Climbing off of my high horse,

E. s, PT, DPT, OCS

s Orthopedic & Spine Rehab, Inc.

> ,

>

> 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]

Dave,

Although I do admit to being very proud of what the profession has

achieved in the last decade, my philosophy is based more in reality

than you may want to believe.

The reality is that the disparity in education between the PT and

the PTA is growing larger every day and will continue to do so.

This disparity in education combined with the reality of increasing

out of pocket costs for those seeking Physical Therapy care has

brought about a change in the Physical Therapy profession. The

reality of high co-pays, deductibles, limited visits and medical

savings accounts has resulted in a public that is much more

demanding of it's health care providers, and deservedly so. The

patients who walk through the doors of my clinic would not tolerate

being passed off to a less qualified provider.

From the patient's perspective, those 10-15 mins I spend performing

soft tissue and/or joint mobilizations are often the most important

time I will spend with them during their treatment session. This is

when we discuss what has worked and what hasn't, changes in

medication, home exercise performance, ect. These are things that

often get lost in translation between the PT and PTA, especially if

each has 12 other patients to see that day.

From the professions perspective lets take a look at costs. I am

not an economist so please someone with a bigger brain than mine

(Dick, , Anyone) please chime in if I am getting this wrong.

The way I understand things, costs drive reimbursement. Isn't that

how the RVBS works. Don't clinic owners and hospital administrators

look at their costs to determne which contracts they can afford to

sign and which will lose them money? Many on this list serve

complain about the high cost of employing PT's and seek lower priced

alternatives. I disagree! We should instead direct our energies

towards higher reimbursement! Let me use a hypothetical scenario to

explain my point. Now this may get a bit long but bear with me.

Picture the CEO of a national healthcare company. He wants to

increase revenues. He has a penchant for doodling on cocktail

napkins and is sitting behind his 10k mahogany desk working on some

numbers. He says to himself in his southern drawl, " If I hire me a

bunch of them PTA's to do the job of those high priced PTs I can

undercut all of the other rehab compainies out there and make me a

bunch of money " . Now picture that he does just that, the insurance

compainies jump at his low ball offer and the downward spiral in

reimbursement creates a domino effect. PTs are forced to become

nothing more than evaluation and paperwork machines, the PTA evolves

from the Therapist's assistant to the patient's therapist with the

PT becoming some guy who checks in on things every now and again.

All the while the CEO kicks his alligator skinned boots up on his

mahogany desk and practices a new riff on his electric guitar.

Welcome to 1995!

The above hypothetical scenario proves my point. We all know the

end result and the profession is just beginnig to recover. You

CANNOT grow a profession by devaluing the product that that

profession provides. Specialists in all fields are able to charge

what they feel necessary because they are in high demand. We are

specialists. As Carlin might say, there is not a PT

shortage, Physical Therapists are in High Demand! Let's not repeat

the mistakes of our recent past.

Climbing off of my high horse,

E. s, PT, DPT, OCS

s Orthopedic & Spine Rehab, Inc.

> ,

>

> 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]

Lorraine,

I agree both are at fault below. The PT is the one with the ultimate

responsibility, they need to be providing appropriate level of supervision. The

PTA's need to follow what is in the plan of care. If they feel something else

is going to be beneficial, they need to consult with the PT and have the PT

change the plan of care. At least that is my interpretation of Ohio laws. I

could be wrong. Would like to hear what think. Kathy

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]

Lorraine,

I agree both are at fault below. The PT is the one with the ultimate

responsibility, they need to be providing appropriate level of supervision. The

PTA's need to follow what is in the plan of care. If they feel something else

is going to be beneficial, they need to consult with the PT and have the PT

change the plan of care. At least that is my interpretation of Ohio laws. I

could be wrong. Would like to hear what think. Kathy

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]

Lorraine,

I agree both are at fault below. The PT is the one with the ultimate

responsibility, they need to be providing appropriate level of supervision. The

PTA's need to follow what is in the plan of care. If they feel something else

is going to be beneficial, they need to consult with the PT and have the PT

change the plan of care. At least that is my interpretation of Ohio laws. I

could be wrong. Would like to hear what think. Kathy

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!

> > > >