Joined: January 31, 2005
I was wondering other's thoughts on something: Should PTA's be allowed to perform joint mobilizations? The APTA's position is they should not, as joint mobilizations require constant reevaluation, but PTA's can legally perform these techniques in most states(I know the S.D. practice act specifically says they cannot). Also, some PTA programs teach basic joint mobs and other do not citing the APTA's position. I've found in the rural parts of the country where I have lived, most outpatient PT departments do utilize PTA's for joint mobs to one degree or another.
In the state of Georgia it is legal for a PTA to perform joint mobs. From a PTA with 14 years of experience, I would say that it wasn't until the last 4 years that I had some comfort level with mobs and now it has become my clinical expertise. The IOAM course does offer a COMTA for PTA's
Joined: March 12, 2004
Welcome to RehabEdge! I'm not completely familiar with the level of education PTAs receive in regards to peripheral and spinal joint kinematics. I'm curious to know if there is a restriction on what you can mob, i.e. spine, peripheral joints, or both.
Chris, I would have to say that our formal education was less than adequate in regards to mobs and joint kinematics. Rather it was thru cont ed and having worked for a clinical director whom is an educator and published in Neurodynamics and joint mobilizations where all my techniques were learned. Legally I don't know if there is a restriction on what I can and can't mob, I would have to say that after assessing the situation if I am not totally comfortable I personally won't touch it.
Joined: November 11, 2004
Here in Oklahoma, it is legal for a PTA to perform joint mobilizations, but it is rare that you will find a PT willing to allow the PTA to do so. My supervising PT is very good, in that he does allow me the freedom to perform the mobilizations that I have demonstrated proficiency in, but we mainly use muscle energy techniques for most mobilizations. In fact he rarely uses anything more than a grade 3 mobiliztion himself.
I also work in Atlanta. I have found that most PTAs do not feel comfortable performing manual techniques. One that I work with currently says she didn't learn them in school. I have instructed her on some basic mobs for extremity and spine, and she now feels comfortable using them, but I have discovered she only uses them when I am around for that "just in case situation". I think that PTAs should perform basic mobs, as long as the directing PT is ok with with.
It seems that the PTA's abilities are questioned an awful lot. PTA school is not PT school of course but it's not exactly a mindless program either. If we can't do joint mobs, what will be next that we we can not do? I am not uncomfortable asking questions if I am unsure of something PT related but it really feels as though a large number of PT's look down on the PTA...and this really upsets me. True, it is a 2 year program. However, there are many other two year programs in the allied health field; nursing, dental hygiene, radiography to name a few. It just seems that the PTA is sometimes treated very similar to the aide, which is unfortunate since we have skills to offer too. Well, I have nothing against PT's I wish they could just trust us more.
Joined: January 31, 2005
I agree, Lyn. I think it definitely comes down to getting a good working relationship between the PT and PTA and letting that trust and experience drive what can be done. With all the rehab being done by non-PT providers (which is only fair), I have always thought the profession could make a better committment to the PTA profession and not sometimes treat them as second class citizens.
I think everyone has seen good and bad providers in any field and of course it's the bad ones that stand out in your mind.
I think as a PTA, trying to get a position with a skilled and open-minded PT and working closely with them to develop trust and skills is the best way to maximize your contributions to patient care.
I would say that in my 14 yr. tenure that not only are there PTA's whom don't know how to perform mobs but also a whole lot of PT's whom think they know what a mob is. At least the PTA can use the excuse of not learning it in school and not having the desire or resources to learn it through cont ed. Again, I think it also is the piss poor one's whom stand out in your mind. I found that being a PTA and specializing in some area such as lymph, industrial, sports program and assisting the ATC's with the teams is the best way to find an in for career advancement. I am currently the Industrial Coor. for a private out-pt. practice and I feel that I have the respect of every PT on staff in my area of speciality as well as do they.
Joined: January 15, 2004
From: rochester, NY, USA
I am in Upstate New York and just graduated from a PTA program here. And we did learn peripheral joint mobs in school. In accord with the NYS practice act, they could not teach them to us in the curriculum, but we have to know them so they had us come in after the semester was over and before our 1st clinical for a full day of learning joint mobs. In clinical, some of the CI's would allow the SPTA to perform them with supervision.
We also took Neuroscience which I am learning that alot of the PTA programs do not require.
I totally agree with Lyn. We need to be trusted more. But from what I am seeing in my interviews, it depends on where you work. I interviewed with a PT in a outpatient clinic, and the remark was made to me that PTA's learn just enough to not kill someone. Needless to say I ended the interview really quickly after that!!!
Joined: January 15, 2004
From: rochester, NY, USA
JMA, yes, I agree. It was rather strange that the school basically gave us a "crash course" in learning this. I questioned it, and the answer I got did not make any sense. But, being a non-traditional student, I use to question alot of things they did and the answers just made me scratch my head!!!!! I guess the prof. don't know how to deal with their actions being questioned!!!!!!
futurepta, PTs learn enough in school to not kill somebody. Our education is pretty weak as well. Find a job with experienced PTs and PTAs and you will learn. My advice is don't get too hung up on mobs. They are not magical or complicated and are way too over emphasized. If you stick to the basics of stretching and strengthening you will do fine. Good luck
Joined: December 22, 2007
Here's the APTA stance on the issue of PTA's and mobilizations. Add this to the list of things that don't make sense to me. What the hell are we supposed to allow PTA's to do? While I think some PTA salaries are getting out of control, they are a very valuable asset if they work well with the supervising therapist. With the salaries they are demanding these days, you can bet they'll be doing more than setting up hot packs in my clinic.
In our state practice act (the document that matters), a therapist can delegate most any activity to support staff provided they are adequately trained. I take this with a grain of salt and wouldn't allow a technician to perform a joint mobilization for example. That being said, there is no reason a PT can't supervise a PTA in performing joint mobilizations. I think we might need to be a little less lazy and be willing to teach the PTA how we want the mobilizations performed.
Once again, I really disagree with with the APTA on this one. They are starting to be the cranky grandfather of the family. I love them but find myself disagreeing with them more and more.
PROCEDURALINTERVENTIONS EXCLUSIVELY PERFORMED BY PHYSICAL THERAPISTSHOD P06-00-30-36 (Program 32) [Position] The physical therapist?s scope of practice as defined by the American Physical Therapy Association Guide to Physical Therapist Practice includes interventions performed by physical therapists. These interventions include procedures performed exclusively by physical therapists and selected interventions that can be performed by the physical therapist assistant under the direction and supervision of the physical therapist. Interventions that require immediate and continuous examination and evaluation throughout the intervention are performed exclusively by the physical therapist. Such procedural interventions within the scope of physical therapist practice that are performed exclusively by the physical therapist include, but are not limited to, spinal and peripheral joint mobilization/manipulation, which are components of manual therapy, and sharp selective debridement, which is a component of wound management. (Program 32 ? Practice, ext 3176)
I can see the rationale for PTA's performing peripheral manipulation but would never allow a PTA under my supervision to perform an sort of spinal mobilization especially when talking the cervical spine. This is in no way a knock on PTA's b/c I work with them, utilize them on a regular basis and highly respect there skills. This comes down to a safety issue.
When mobilizing spinal joints there is a constant re-assesment that needs to be made as to how that joint is responding and even more so if there is a weird reaction to a mobilization. If a PTA is mobilizing a cervical spine and a patient experiences dizziness or nausea - now what. A PTA is not trained to evaluate the possible origin of these symptoms or what should be done in this case. And if your answer is I would report this to the PT and let them decide what to do then there is your answer as to why a PTA should not be doing spinal mobs. If you don't have the evaluation skills to asses a situation when someting goes wrong then you shouldn't be performing the technique.
Now I know the saftey issue could be brought up in that with every possible treatment a PTA does exercise, soft tissue, etc and then some would ask what is left for a PTA to do in the clinic. This is where we need to use clinical judgement. I think PTAs perform many valuable rolls in the clinic I just don't think spinal mobs where we are dealing with possible cardinal signs, cauda equina, progressive nerve root compression should be one of them.