RE: lymphadema ?

[Guest guest]

As long as the treatment program (POC) and goals are established, the

PTA is competent and has PT backup ( per state supervision guidelines)

, I see no reason why not.

The only dilemma that may surface would be if a patient needed a PT to

either change or alter a POC based on findings of the day. If you do

not have a PT comfortable/competent in lymphaedema evaluation and care ,

you may have an issue

Ron Barbato PT

Administrative Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

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lymphadema ?

Group, quesiton for you legally and ethically, oout lymphadema PT is

leaving and we have a PTA also trained in it. Can we continue our

lymphadema program with a PTA running it? The PTA told me that at the

last hospital that they were at that the PT would just come in a measure

the leg and then do a quick eval and the PTA would do all of the

treatment with the PT cosigning, can we do this? Thank you for your

input

Jeff Nolder, PT

CRMC

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[Guest guest]

With regard to Complete Decongestive Therapy, my carrier's LCD for

Therapy Services states that one of the qualifying conditions for CDP

reimbursement is:

· The services are being performed by a health care professional who

has received specialized training in this form of treatment.

There is nothing that details " specialized training " , but I took it to

mean " formal " course work. Thus, even though I was shown compression

wrapping and felt competent, I opted to pursue a CDP course

(non-certified).

So, the PTA may be able to legally perform the procedures, but they

MAY not meet insurance requirements.

Ron

--

Ron Carson MHS, OTR/L

Hope Therapy Services, LLC

www.HopeTherapyServices.com

===============<Original Message>===============

On 3/28/2008, nolderj@... said:

jn> Group, quesiton for you legally and ethically, oout lymphadema PT is leaving

and we have a PTA

jn> also trained in it. Can we continue our lymphadema program with a PTA

running it? The PTA told me

jn> that at the last hospital that they were at that the PT would

jn> just come in a measure the leg and

jn> then do a quick eval and the PTA would do all of the treatment with the PT

cosigning, can we do

jn> this? Thank you for your input

jn> Jeff Nolder, PT

jn> CRMC

jn> _________________________________________________________________

jn> In a rush? Get real-time answers with Windows Live Messenger.

jn>

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_rea\

ltime_042008

jn>

[Guest guest]

You may want to contact your state board and asked them that question.

We did twice and got different answers each time.

I don't see how lymphedema is different that any other diagnosis and it is

addressed in schools, so any PT should be able to evaluate. Also there is no

guideline as to what constitutes as a trained lymph therapist. You can go to any

3 day course and call yourself a lymph therapist.

That said as a lymphedema therapist I have to say that there are a lot of

(relative) contra-indications that you are dealing with and it would be better

to have a trained therapist perform the evaluation, and oversee the program.

Odilia Egbers, PT

Springfield, MO

jeff nolder wrote:

Group, quesiton for you legally and ethically, oout lymphadema PT is leaving and

we have a PTA also trained in it. Can we continue our lymphadema program with a

PTA running it? The PTA told me that at the last hospital that they were at that

the PT would just come in a measure the leg and then do a quick eval and the PTA

would do all of the treatment with the PT cosigning, can we do this? Thank you

for your input

Jeff Nolder, PT

CRMC

__________________________________________________________

In a rush? Get real-time answers with Windows Live Messenger.

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_rea\

ltime_042008

[Guest guest]

It sounds to me as if this PTA is trained specifically in manual lymphatic

drainage, lymphedema bandaging, etc. These specific techniques are not part of

most entry level programs. (I took a 2 week course leading to certification).

So the argument is not whether it would be different than any other treatment,

but rather is the PT competent to direct a PTA in the specific intervention

being provided. If not, it would be inappropriate, not to mention risky, for a

PT to supervise without the knowledge and skills to appropriately examine and

treat the patient. How could the PT establish a plan of care involving those

specialized techniques? This would be the same response for any patient

population in which a PT did not feel he or she is competent to treat the

patient him or herself. Recall the definition of a PTA from the APTA: Physical

therapist assistants (PTAs) provide physical therapy services under the

direction and supervision of a physical therapist (emphasis added).

**************************************

Janice Kuperstein, P.T., Ph.D.

Associate Professor

Department of Rehabilitation Sciences

College of Health Sciences

UK T. Wethington Jr. Building

900 South Limestone St

Lexington, KY 40536-0200

ext 80593

Fax:

Statement of confidentiality: The contents of this email and any attachments

are confidential and are intended solely for the addressee. The information may

also be legally privileged. This transmission is sent in trust for the purpose

of delivery to the intended recipient. If you have received this transmission in

error, any use, reproduction or dissemination of this transmission is strictly

prohibited. If you are not the intended recipient, please notify the sender

immediately by reply email or at , ext. 80593, and delete this

message and its attachments, if any.

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

odilia egbers

Sent: Friday, March 28, 2008 1:19 PM

To: PTManager

Subject: Re: lymphadema ?

You may want to contact your state board and asked them that question.

We did twice and got different answers each time.

I don't see how lymphedema is different that any other diagnosis and it is

addressed in schools, so any PT should be able to evaluate. Also there is no

guideline as to what constitutes as a trained lymph therapist. You can go to any

3 day course and call yourself a lymph therapist.

That said as a lymphedema therapist I have to say that there are a lot of

(relative) contra-indications that you are dealing with and it would be better

to have a trained therapist perform the evaluation, and oversee the program.

Odilia Egbers, PT

Springfield, MO

jeff nolder <nolderj@...<mailto:nolderj%40hotmail.com>> wrote:

Group, quesiton for you legally and ethically, oout lymphadema PT is leaving and

we have a PTA also trained in it. Can we continue our lymphadema program with a

PTA running it? The PTA told me that at the last hospital that they were at that

the PT would just come in a measure the leg and then do a quick eval and the PTA

would do all of the treatment with the PT cosigning, can we do this? Thank you

for your input

Jeff Nolder, PT

CRMC

__________________________________________________________

In a rush? Get real-time answers with Windows Live Messenger.

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_rea\

ltime_042008

[Guest guest]

The last job I worked at we had a COTA that was lymphedema certified,

but she was unable to do the initial eval. Just like a regular eval,

COTA's and PTA's are not allowed to assess. She did all treatments

once the eval was completed. I think to cover yourself, send your PT

to the 3 day course so her/his evals show some knowledge of

lymphedema.

Egbert PT WCC

Director of Rehab

Draper, UT

P.S. Congratulations to Brad from St. Louis, who is a frequent

contributor on this sight, for recently receiving his PhD!!! Way to

go Brad!!

>

> Group, quesiton for you legally and ethically, oout lymphadema PT

is leaving and we have a PTA also trained in it. Can we continue our

lymphadema program with a PTA running it? The PTA told me that at the

last hospital that they were at that the PT would just come in a

measure the leg and then do a quick eval and the PTA would do all of

the treatment with the PT cosigning, can we do this? Thank you for

your input

> Jeff Nolder, PT

> CRMC

> __________________________________________________________

> In a rush? Get real-time answers with Windows Live Messenger.

> http://www.windowslive.com/messenger/overview.html?

ocid=TXT_TAGLM_WL_Refresh_realtime_042008

>

>

[Guest guest]

Janice,

In that case do you feel that a PTA working on say 4 different therapists

should be able to perform certain procedures that they should not be able to

perform under other therapists.

Say I have a PTA trained in cranio sacral therapy. I am not trained as a

therapist in these techniques, but other PT " S at my facility are. Even when in

the best interest of the patient with the PTA being properly trained in

craniosacral therapy, are you saying she/he shouldn't be performing the therapy,

just because the therapist has not had the same post-op training as the PT.

I would have to disagree, I am still supervising and directing the overall

plan of care, eventhough I may not be fully trained in all the specific

components of the treatment.

I think same would go for MLD, the therapist should still have adequate

training to oversee and direct the full treatment plan eventhough they are not

trained in the MLD. They should be familiar with indications and

contra-indications of compression bandages (we all apply ACE wraps at times) and

MLD.

Odilia Egbers, PT

Springfield, MO

" Kuperstein, Janice " wrote:

It sounds to me as if this PTA is trained specifically in manual

lymphatic drainage, lymphedema bandaging, etc. These specific techniques are not

part of most entry level programs. (I took a 2 week course leading to

certification). So the argument is not whether it would be different than any

other treatment, but rather is the PT competent to direct a PTA in the specific

intervention being provided. If not, it would be inappropriate, not to mention

risky, for a PT to supervise without the knowledge and skills to appropriately

examine and treat the patient. How could the PT establish a plan of care

involving those specialized techniques? This would be the same response for any

patient population in which a PT did not feel he or she is competent to treat

the patient him or herself. Recall the definition of a PTA from the APTA:

Physical therapist assistants (PTAs) provide physical therapy services under the

direction and supervision of a physical therapist (emphasis

added).

**************************************

Janice Kuperstein, P.T., Ph.D.

Associate Professor

Department of Rehabilitation Sciences

College of Health Sciences

UK T. Wethington Jr. Building

900 South Limestone St

Lexington, KY 40536-0200

ext 80593

Fax:

Statement of confidentiality: The contents of this email and any attachments are

confidential and are intended solely for the addressee. The information may also

be legally privileged. This transmission is sent in trust for the purpose of

delivery to the intended recipient. If you have received this transmission in

error, any use, reproduction or dissemination of this transmission is strictly

prohibited. If you are not the intended recipient, please notify the sender

immediately by reply email or at , ext. 80593, and delete this

message and its attachments, if any.

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

odilia egbers

Sent: Friday, March 28, 2008 1:19 PM

To: PTManager

Subject: Re: lymphadema ?

You may want to contact your state board and asked them that question.

We did twice and got different answers each time.

I don't see how lymphedema is different that any other diagnosis and it is

addressed in schools, so any PT should be able to evaluate. Also there is no

guideline as to what constitutes as a trained lymph therapist. You can go to any

3 day course and call yourself a lymph therapist.

That said as a lymphedema therapist I have to say that there are a lot of

(relative) contra-indications that you are dealing with and it would be better

to have a trained therapist perform the evaluation, and oversee the program.

Odilia Egbers, PT

Springfield, MO

jeff nolder <nolderj@...<mailto:nolderj%40hotmail.com>> wrote:

Group, quesiton for you legally and ethically, oout lymphadema PT is leaving and

we have a PTA also trained in it. Can we continue our lymphadema program with a

PTA running it? The PTA told me that at the last hospital that they were at that

the PT would just come in a measure the leg and then do a quick eval and the PTA

would do all of the treatment with the PT cosigning, can we do this? Thank you

for your input

Jeff Nolder, PT

CRMC

__________________________________________________________

In a rush? Get real-time answers with Windows Live Messenger.

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_rea\

ltime_042008

[Guest guest]

Jeff,

I feel that your PT would be on shaky legal and ethical grounds if

they do an eval on a patient with a " lymphadema " diagnosis and they

have no advanced training in the area. All swelling is not lymphedema

- do they know how to differentiate? ACE bandages are specifically not

used in lymphedema. The patient also loses if they are not seen by a

therapist who is trained in CDT because the educational component is

huge with this population. Yes I am biased - I took the 2 week course

and passed the national LANA exam.

Sue, PT

>

>

> Group, quesiton for you legally and ethically, oout lymphadema PT is

leaving and we have a PTA also trained in it. Can we continue our

lymphadema program with a PTA running it? The PTA told me that at the

last hospital that they were at that the PT would just come in a

measure the leg and then do a quick eval and the PTA would do all of

the treatment with the PT cosigning, can we do this? Thank you for

your input

> Jeff Nolder, PT

> CRMC

> _________________________________________________________________

> In a rush? Get real-time answers with Windows Live Messenger.

>

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_rea\

ltime_042008

>

>

[Guest guest]

Odilia,

Although I believe others have expanded upon the lymphedema question quite well,

it is important to answer the other question you asked. Yes indeed, I believe

that a Physical Therapist Assistant may be likely to provide interventions under

the direction of one therapist that he or she would NOT be able to perform under

the direction of another. Using your example, I would not allow a PTA to treat

a patient for whom I am responsible using craniosacral therapy because

craniosacral therapy is NOT within my personal scope of practice. I have no

specific education or training in it, so it would be a violation of my Practice

Act as well as a violation of the APTA Code of Ethics for me to supervise a PTA,

however skilled, in this practice.

***************************************

Janice Kuperstein, PT, MSEd

Associate Professor

University of Kentucky College of Health Sciences

Department of Rehabilitation Sciences

900 South Limestone St

Lexington, KY 40536-0200

ext 80593

________________________________

From: PTManager [PTManager ] On Behalf Of odilia

egbers [odilia.egbers@...]

Sent: Saturday, March 29, 2008 12:31 PM

To: PTManager

Subject: RE: lymphadema ?

Janice,

In that case do you feel that a PTA working on say 4 different therapists should

be able to perform certain procedures that they should not be able to perform

under other therapists.

Say I have a PTA trained in cranio sacral therapy. I am not trained as a

therapist in these techniques, but other PT " S at my facility are. Even when in

the best interest of the patient with the PTA being properly trained in

craniosacral therapy, are you saying she/he shouldn't be performing the therapy,

just because the therapist has not had the same post-op training as the PT.

I would have to disagree, I am still supervising and directing the overall plan

of care, eventhough I may not be fully trained in all the specific components of

the treatment.

I think same would go for MLD, the therapist should still have adequate training

to oversee and direct the full treatment plan eventhough they are not trained in

the MLD. They should be familiar with indications and contra-indications of

compression bandages (we all apply ACE wraps at times) and MLD.

Odilia Egbers, PT

Springfield, MO

" Kuperstein, Janice " <jkupe0@...<mailto:jkupe0%40uky.edu>> wrote:

It sounds to me as if this PTA is trained specifically in manual lymphatic

drainage, lymphedema bandaging, etc. These specific techniques are not part of

most entry level programs. (I took a 2 week course leading to certification). So

the argument is not whether it would be different than any other treatment, but

rather is the PT competent to direct a PTA in the specific intervention being

provided. If not, it would be inappropriate, not to mention risky, for a PT to

supervise without the knowledge and skills to appropriately examine and treat

the patient. How could the PT establish a plan of care involving those

specialized techniques? This would be the same response for any patient

population in which a PT did not feel he or she is competent to treat the

patient him or herself. Recall the definition of a PTA from the APTA: Physical

therapist assistants (PTAs) provide physical therapy services under the

direction and supervision of a physical therapist (empha! sis

added).

**************************************

Janice Kuperstein, P.T., Ph.D.

Associate Professor

Department of Rehabilitation Sciences

College of Health Sciences

UK T. Wethington Jr. Building

900 South Limestone St

Lexington, KY 40536-0200

ext 80593

Fax:

Statement of confidentiality: The contents of this email and any attachments are

confidential and are intended solely for the addressee. The information may also

be legally privileged. This transmission is sent in trust for the purpose of

delivery to the intended recipient. If you have received this transmission in

error, any use, reproduction or dissemination of this transmission is strictly

prohibited. If you are not the intended recipient, please notify the sender

immediately by reply email or at , ext. 80593, and delete this

message and its attachments, if any.

________________________________

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf

Of odilia egbers

Sent: Friday, March 28, 2008 1:19 PM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Re: lymphadema ?

You may want to contact your state board and asked them that question.

We did twice and got different answers each time.

I don't see how lymphedema is different that any other diagnosis and it is

addressed in schools, so any PT should be able to evaluate. Also there is no

guideline as to what constitutes as a trained lymph therapist. You can go to any

3 day course and call yourself a lymph therapist.

That said as a lymphedema therapist I have to say that there are a lot of

(relative) contra-indications that you are dealing with and it would be better

to have a trained therapist perform the evaluation, and oversee the program.

Odilia Egbers, PT

Springfield, MO

jeff nolder

<nolderj@...<mailto:nolderj%40hotmail.com><mailto:nolderj%40hotmail.com>\

> wrote:

Group, quesiton for you legally and ethically, oout lymphadema PT is leaving and

we have a PTA also trained in it. Can we continue our lymphadema program with a

PTA running it? The PTA told me that at the last hospital that they were at that

the PT would just come in a measure the leg and then do a quick eval and the PTA

would do all of the treatment with the PT cosigning, can we do this? Thank you

for your input

Jeff Nolder, PT

CRMC

__________________________________________________________

In a rush? Get real-time answers with Windows Live Messenger.

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_rea\

ltime_042008