PTAs performing joint mobilization (Full Version)

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hmgross -> PTAs performing joint mobilization (August 27, 2004 11:08:00 AM)

The APTA's position is that PTs should perform joint mobilizations exclusively. I don't know how many forum members are PTAs but do you agree or disagree with this position? Would you consider muscle energy a joint mobilization or a contract/relax stretch? I mean, really, mobilize means move, so any hands-on techniques to increase joint mobility could potentially be "joint mobilization". In the past, I have just gone with my comfort level and the skill of the PTA, but am I putting myself at risk if a PTA does not perform a mobilization correctly?



PTupdate.com -> Re: PTAs performing joint mobilization (September 1, 2004 5:49:00 PM)

Until the APTA says "only a PT can perform joint mobilizations and all other soft tissue stretches", I have no problem teaching and having a PTA perform this.

For some reason, there is some hang-up within our profession about certain things. Any moron can perform a mobilization, or US, or ES. Knowing WHEN to do this is a different matter. I have no problems teaching either parents or spouses of patients how to mobilize things. I am not some special God that can feel things they cannot!

I think this is another instance of PT ego interfering with what is truly in the best interests of the patient.

John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]



Andrew M. Ball PT PhD -> Re: PTAs performing joint mobilization (September 3, 2004 1:35:00 AM)

In North Carolina (as in some other states), PTA's are prohibited from performing SPINAL mobilizations. Maybe that's the confusion.



hmgross -> Re: PTAs performing joint mobilization (September 3, 2004 7:31:00 AM)

APTA Governance: Procedural Interventions Exclusively Performed by Physical Therapists" HOD 06-00-30-36 It is the position of the APTA that PTs exclusively perform "spinal and peripheral joint mobilization/manipulation, which are components of manual therapy, and selective sharp debridement, which is a component of wound management". Now, please don't shoot the messanger! Note that it is a "position" rather than a "policy" and a position is a "firmly held Association point of view that APTA members are expected to support". Maybe we need input from PTAs before the "position" becomes policy. Any ideas?



ptdan23 -> Re: PTAs performing joint mobilization (September 18, 2004 11:37:00 AM)

I believe you as the treating therapist are responsible for what interventions you allow the PTA to perform on your pt. If you are comfortable with them doing it, they have the knowledge, etc then I would not have a problem with a PTA doing it.

Dan, PT.



modegard -> Re: PTAs performing joint mobilization (September 23, 2004 3:02:00 AM)

I have been a PTA since 1996. Throughout that time, I have attended over 14 cont. education courses. I learned specific techniques, precautions etc. at those courses and have utilized these manual skills as a PTA as a result. I feel that I would not have been competent to do "joint mobilizations" as a new graduate as it was not part of our education. I do believe that with these skills available to me now, I am able to provide quality service to patients. It should be a given that open communication should occur when there is not a comfort level with a certain technique or if the PT has questions with the PTA skills.

Michelle, PTA



Andrew M. Ball PT PhD -> Re: PTAs performing joint mobilization (September 24, 2004 7:17:00 PM)

If your supervising PT, for whatever reason (let's say despite state law, the PT was an active member of the APTA and didn't want to violate the position statement), didn't want for you, the physical therapIST assistant, to do joint mobilizations --- I'm curious as to how you as a PTA would respond.

Drew



modegard -> Re: PTAs performing joint mobilization (September 25, 2004 2:22:00 PM)

I had the misfortune of working in a setting where I worked with two PT's who happened to be new graduates. It so happened that they were my only PT related coworkers. I was put in a position that required me to interupt my treatment to ask for approval to do manual techniques, taping etc (it just so happened that their treatment knowledge span was VERY limited). The answer to your question re: the PT not wanting me to do these treatments is that I did not perform those treatments. I left that job and was very thourough with all future interviews. I could not stay in a job where I felt my patients were not receiving the best care possible. I thought it to be unethical to continue treatment for patients for months with the ole stand by modalities and basic exercises, despite the patient not progressing.
I can respect if a PT does not want me to perform a treatment, but then I hope they resume care of that patient so the patient can receive the treatment necessary.
Does that answer your question...kinda long winded.



hmgross -> Re: PTAs performing joint mobilization (September 29, 2004 5:55:00 AM)

Drew, I guess that was the point I was trying to make. Are there PTAs out there who are members of the APTA involved with this issue? The way I read the position statement, the APTA doesn't care whether or not you have been trained in joint mobs, they are saying that only PTs should do them. Also, if new grad PTs are not doing manual techniques, I would like to know where they went to school, because our curriculum included many different approaches to mobilization. I did work with a PT who rarely touched his patients, and he was a grad of the same program as me, so it might not be the training, but rather what you do with your training. The PTAs should attend their chapter meetings, or get in touch with someone if they don't want to lose their ability to perform this intervention.



Jax -> Re: PTAs performing joint mobilization (October 12, 2004 5:36:00 AM)

I now work with a PT who only believes in one type of treatment. I have always worked with PTs in the past that have been very open to teaching me new techniques, and have felt comfortable with me performing all techniques within the state law. The clinic I work in has always been a hands on type of clinic with a lot of manual therapy and exercise once appropriate. Now the PT I work with will not allow me to use my hand because he feels that all that manual therapy will make the patients dependent on therapy. I am in the same position as "modegard". I feel like my skills lie beyond just exercise and I am no longer doing my patients a justice by only one or two treatments of just exercise or the one type of treatment this PT really performs. I am confused as how to approach this PT about this issue. But in answer to the origional question. I have found it really just depends on the PT that is supervising. I have worked with 5 PTs in 4 years and this is the only one I have found to feel this way.



sinistre -> Re: PTAs performing joint mobilization (November 22, 2004 8:51:00 PM)

"Now the PT I work with will not allow me to use my hand because he feels that all that manual therapy will make the patients dependent on therapy."

That's funny. Manual therapy won't make them dependent on therapy - it's the only therapy I believe in. Well, that and exercise. Modalities? Laser, electrotherapy, ultrasound... JUNK! It might be right for 0.01% of patients... but it's not essential.



David Burns PT -> Re: PTAs performing joint mobilization (November 23, 2004 3:39:00 AM)

If massage therapists can do manual therapy, then why can't PTA's? In a recent Parade magazine article on back pain, it stated that if physical therapy (heat, US, Electrotherapy, Exercise) didn't help then the patient might try spinal manipulation(from a DC, DO, or MsT, but not PT)



pwrandall -> Re: PTAs performing joint mobilization (November 23, 2004 5:38:00 PM)

Two thoughts on this topic that I've heard in discussions with others out here in CA.

1.) Every mobilization treatment is also an evaluation of the joint's motion. Evaluation is not technically part of the PTA scope of practice, thus mobilization is not within their scope of practice. Yes, I realize that this is legalese and semantics, PTA's evaluate all of the time and then report their findings to the PT they work with (hopefully!), but it is one argument I've heard.

2.) While not specific to joint mobilizaion, as a relatively new therapist my toolbox is rather limited (something of which I'm acutely aware of a day-to-day basis)and I love it if a PTA has a suggestion for me, but unless I'm comfortable and familiar both with the technique and the PTA's ability to perform the technique I am unlikely to risk the patient having an adverse response to a treatment I don't do. Its my license if things (god forbid) don't go as expected.

I'd be interested to hear more from other therapists as to what they do in these situations (PTA knows something the PT isn't familiar with).



Alex Brenner PT MPT OCS -> Re: PTAs performing joint mobilization (November 23, 2004 9:24:00 PM)

I am sure everyone is getting tired of me saying "In the Army..." but here goes.

In the Army our PTAs are enlisted soldiers who went through a military PTA similar program although they are not eligible to sit for their PTA exams after school. In the clinics that I have worked, we teach them how to perform joint mobilizations and this builds on what they already learned in school. Having personally taught them how to perform joint mobs I feel very comfortable with them doing this. In my entire time working with our PTAs I have never had a situation where they hurt someone or caused harm to the patient (I typically only have them work grades 1-3 sometimes 4). I personally do not see any problem with this.
Maybe if I were a civilian working in the "sue-happy" public I may practice differently. I am not sure.



SJBird55 -> Re: PTAs performing joint mobilization (November 24, 2004 3:48:00 AM)

I generally don't have a PTA do any manual joint mobilizations for a couple of reasons. The first is that I can't easily, briefly communicate exactly what I am doing with my hands and the second is that what I do with my hands is determined by the patient's response and what I objectively measure. So, in other words, I'm doing a lot of mixing and meshing of manual stuff that I can't explain to anyone and what is done is never the exact same thing treatment to treatment. For me, it always seems that I am doing a lot of re-evaluating and altering, so it just doesn't work to have a PTA do the techniques. And I will admit, a lot of that is my fault because I don't know how to effectively communicate what I am doing.

I will also admit that I really haven't worked with any PTA that impressed me. The PTAs that I have worked with all seemed to tend to have the philosophy of going through the motions, never really seem to analyze anything and never talk to me about progressing patients whether by increasing resistance or increasing activities. That's just my experience and I'm not generalizing because I am sure that there are some great PTAs out there - I just haven't had the luck of working with one.



hmgross -> Re: PTAs performing joint mobilization (November 25, 2004 8:11:00 AM)

I am quite behind, catching up reading all the posts. My past couple of months have been very busy since I started my private practice. It is just me here (really! nobody else, so I am tired but not complaining) and I have to agree with SJBird55 post. I came from a hospital setting with a high ratio of PTAs and it was very hard for me as a manual therapist. I felt I spread myself too thin and couldn't properly explain to the PTA how I was performing my manual techniques since I too "mix it up" and seem to re-eval and modify every time I see someone! When I first started my solo practice, I felt I might be a bit "rusty" with the hands, but surprisingly feel pretty confident. I can palpate and sense the restriction and treat accordingly.
One final thought--Why doesn't Northern MN get any snow anymore? We are obviously on the wrong side of the great lakes. We have a light dusting this morning and I feel envious of those in MI--I am itching to get on my XC skis--everyone have a nice Thanksgiving.



SJBird55 -> Re: PTAs performing joint mobilization (November 26, 2004 2:55:00 AM)

I left a hospital setting this summer after being there 6 years. Management was sort of persuading me to use the PTA at my site with a higher frequency... and that PTA and I were definitely not a good team. Basically, I refused to use her unless I had to. There were a variety of reasons, but she just wasn't of the quality that I would choose to work with me. (I wasn't really concerned about my license, but instead very much concerned about the quality of care - I don't believe in in effective care.) And... when I did attempt to teach her stuff and let her see what I was doing, she didn't appreciate it because a lot of times after I discussed it with her first, I would then have her observe me(as I said because I am unable to communicate what I do very well). She didn't feel that was the appropriate way to learn and didn't feel she should observe me with the patient.

Our snow will be gone by Sunday. It was gorgeous yesterday - although, the roads were quite icy in the morning on the back roads.



Yogi -> Re: PTAs performing joint mobilization (November 26, 2004 4:19:00 AM)

No, Army, speaking for myself, I won't get tired of you saying in the Army, because it gives you unique experiences to share, and wherever the experiences come from, I think the sharing to learn is the purpose of the Forum, and I'm glad to have found the forum. So to you and everyone, Keep it coming.



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