PO 001.01- Introduction to Physical Therapy

1. PO 001.01- Introduction to Physical Therapy

2. Learning Objectives • In order to describe the profession of physical therapy, the physical therapist technician (PTT) will be able to : • Define physical therapist • Define physical therapist technician • Describe the scope of practice of the two • Describe the physical therapist technician program • Describe the layout of a physical therapy clinic

3. Physical Therapy (PT) • “Services for individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan” • PT is aprofessional title and term used to describe the profession's practice varies and depends largely on the historical roots of the profession in each country • The most generally used terms are “physical therapy” and “physiotherapy”

4. World Confederation of PT • The WCPT is the international voice for the physical therapy profession • The WCPT represents more than 350,000 physical therapists worldwide through its 106 member organizations • To become a member of WCPT, a national physical therapy association must meet specific criteria laid down in WCPT’s Articles of Association

5. Schooling • To become a qualified Physical Therapist, a degree in physical therapy or rehabilitation from a recognized university is required • Currently there are no recognized institutions in Afghanistan that provide this qualification • Degrees can be at the Bachelors, Masters or PhD level depending on the school

6. Physical Therapist • A professional who has successfully completed a professional entry level program that enables them to identify and maximize quality of life and functional movement potential, within the spheres of promotion, prevention, maintenance, intervention/treatment, habilitation and rehabilitation • Encompasses physical, psychological, emotional and social wellbeing • The term physical therapist is a protected title: • legal system whereby title/titles may only be used by those holding a recognised qualification or who are registered with a competent authority

7. Continued . . . • Involves the interaction between the physical therapist, patients or clients, families, care givers, other health care providers and communities, in a process of assessing movement potential and in establishing agreed upon goals and objectives using knowledge and skills unique to physical therapists

8. Rehabilitation • A process aimed at enabling people with medical conditions to reach and maintain their optimal levels of physical, sensory, intellectual, psychological and social functioning • Rehabilitation provides disabled people with the tools they need to attain independence and self-determination • Physical therapists are rehabilitation specialists

9. 3 Branches of PT • Cardio-Respiratory: • The branch of PT that deals primarily with conditions related to the cardio-respiratory system • Example- COPD, pneumonia, heart attack, heart disease, post-surgical • Neuromuscular: • The branch of PT that deals primarily with conditions related to the nervous system and it’s effects on the muscular systems • Example- Stroke, TBI, spinal cord injuries

10. Continued . . . • Musculoskeletal (MSK) • The largest area of PT • Is common to physiotherapy around the world • Includes orthopedic medicine, manual therapy, the alternative therapies • MSK encompasses the “hands on” manual techniques and exercise prescription for the relief or prevention of disorders of the musculoskeletal system • Examples- fractures, sprains, strains, amputations, ligament and tendon injuries

11. Where Do PTs Work? • PTs can work in a variety of settings including: • Hospitals • NMH • Clinics • Polyclinic • Rehabilitation Centers • ICRC Prosthetic Center • Private Clinics

12. PT Settings • PT departments are usually classified as: • In-patient clinic • A medical facility that treats patients who are admitted for at least a 24-hour residence (or at least overnight) • Out-patient clinic • A medical facility that treats patients that are not admitted for an overnight stay • Combination of in and out-patients

13. Who Do PTs Treat? • A wide variety of clientele including: • Pediatrics • Children from 0-18 • Geriatrics • Aging or elderly people (Elders) • Athletes • Normal adult population • In the ANA, the clientele will include ANA soldiers and their immediate family • Could include any of the above

14. Physical Therapist Technician (PTT) • Works as part of a team to provide physical therapy services under the direction and supervision of a physical therapist • Implements selected components of patient treatment and obtains data related to the interventions provided • The physical therapist is responsible for the services provided by the PTT

15. PTTs Continued . . . • The only individual other than a physical therapist who provides physical therapy services • General supervision is the minimal supervision required for a PTT by a physical therapist • Defined as “requiring the initial direction and periodic inspection of the actual activity”

16. Codes of Ethics • Both PTs and PTTs requirecodes of ethics: • A set of conventional principles and expectations that are considered binding on any person who is a member of a particular group • Currently, there is no existing code of ethic in Afghanistan for either PT or PTT • Due to the fact there is no licensening body that regulated PT services

17. Code of Conduct Continued . . . • The physical therapist practices according to a Code of Ethics that is consistent with WCPT’s ethical principles • The American Physical Therapy Association’s (APTA) code of ethics for the Physical Therapy Assistant (Technician) can be used as a reference: • http://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/PR_and_Marketing/Market_to_Professionals/TodaysPhysicalTherapist.pdf

18. Scope Of Practice • The range of responsibility that determines the boundaries within which a Physical Therapist, or other professional, practices • i.e. types of patients, caseload, practice guidelines • Implies that the profession has a regulating body, which is not the case for PT in Afghanistan: therefore, “scope of practice” is not an applicable term at this time in Afghanistan

19. PT Scope of Practice • Physical therapy scope of practice is dynamic, evolving with changes in the evidence base, policy, and needs of service users • WCPT's description of physical therapy sets out the internationally agreed scope of practice • Each WCPT member organization will interpret and further develop the scope within the context of the regulatory environment and evidence base for practice in their country

20. Example Scope of Practice

21. PTT Scope Of Practice • Differs from the PT scope of practice • Within the ANA, there is an established Qualification Standard (QS) and a Job Description (JD) which outlines the PTT trade instead of a scope of practice • Outlines what the PTT will be taught and what they need to know when they arrive for the first day on the job

22. ANA Physical Therapist Technician • The QS and the JD outline the requirements students must obtain in order to be qualified PTTs • These documents provide the structure and the requirements for the PTT course • Based on the North American physical therapy assistant trade with modifications to make appropriate for the ANA and Afghanistan

23. Controlled Acts • An act by an employee or worker which is controlled by law • Procedures with high risk of harm or injury • Performance is restricted and authorization is needed to perform these acts • Performance is restricted to certain professions with the skill, competence and accountability to perform these skills

24. Ways to Receive Authorization • There are 2 ways to receive authorization to perform controlled acts: • Members of a profession can be directly authorized to perform an activity (by law or regulation under a law) or; • Individuals can receive indirect authority - most commonly by a transfer of authority from another authorized health professional, but also by exemption or exception to the rules

25. Controlled Acts of PTs • Under the Physical Therapy Act, qualified physical therapists are permitted to perform the following controlled acts: • Spinal manipulation • Tracheal suctioning • Communicating a diagnosis • Treating a wound beneath the dermis • Administering a substance by inhalation • Assessing or rehabilitating pelvic musculature • Ordering the application of energy

26. Controlled Acts of PTTs • PTTs in the ANA are not permitted to perform any of the previous controlled acts, as well as theyare subject to these additional controlled acts: • Determining a working diagnosis including analyzing clinical findings • Manipulation

27. PTTs Controlled Acts • Therefore, the following are controlled acts for PTTs in the ANA: • Spinal manipulation • Tracheal suctioning • Communicating a diagnosis • Treating a wound beneath the dermis • Administering a substance by inhalation • Assessing or rehabilitating pelvic musculature • Ordering the application of energy • Determining a working diagnosis including analyzing clinical findings • Manipulation

28. Continued . . . • In order for PTTs to perform these specific controlled acts, they require all of the following additional training: • 2 years of clinical practice • Continuing Physical Therapy Education with focus on differential diagnosis and assessments skills • A minimum of 2 month practicum with a qualified Doctor of Physical Therapy; and • Direct supervision by a Doctor of Physical Therapy during the performance of any diagnosis, analysis of findings, or manipulation

29. PTT Course Outline • The PTT course will be a year long program that will be administered through AFAMS • The course will consist of both academic lectures, clinical labs, case studies, class presentations and clinical rotations • Students will have the following prerequisites before starting the PTT course: • Grade 9 education • Basic Warrior Training • Combat Medic

30. Mission, Objectives, and Purpose • The physical therapy service has a statement of mission, objectives and purpose that reflects the needs and interests of the patients/clients served, the physical therapy personnel affiliated with the service and the community • The statement of mission, purposes and goals: • Defines the scope and limitations of the physical therapy service • Identifies the goals and objectives of the service • Is reviewed annually

31. PTT Course Mission • To provide students with the knowledge, clinical competency and integrity to positively impact their patients, community, and profession • To provide optimal learning experiences in a diversity of conditions that will prepare students to provide the highest quality of patient care • Committed to the development of health care practitioners who appreciate and value racial, social, and cultural diversity, and who are dedicated to the safe, legal, and ethical practice of physical therapy

32. PTT Course Objectives • Prepare competent, entry-level graduates who will work under the direction of a physical therapist or senior physical therapist technician in ANA health care settings • Provide students with learning experiences which reflect best physical therapy practices • Apply knowledge of basic PT to the application and appropriate modification of selected PT procedures • Interact with patients and others in a manner that reflects appreciation of the worth of an individual

33. Continued . . . • Demonstrate appropriate and effective written, oral and non-verbal communication with patients, families, colleagues, and the chain of command • Recognize their own strengths and limitations, interpret for others their scope and function, and understand the need for continued education and growth • Demonstrate a commitment to safe, ethical and legal practice • Understand basic concepts of health care and the mechanics of providing health care services

34. Purpose of the PTT • Technician’s primary role will be to assist with the provision of rehabilitative services in both an inpatient and outpatient setting • This encompasses the maintenance of patient scheduling and charts, provision of initial patient screening, basic assessment, treatment planning, provision of treatment and other duties as directed by a senior Physical Therapy Technician, Physical Therapist or supervising clinician

35. Evaluation Process • Throughout the PTT course, there will be several forms of evaluation to assess student’s comprehension of the material including: • Questions at the end of each lecture • Review questions of material previously taught • Formal written exams at the end of each topic and each section • Practical exams with simulated patients • Clinical placements

36. Continued . . . • Written evaluations will consist of: • Short answer • Multiple choice • Fill in the blank • True and False • Clinical assessments will be evaluated by means of checklists

37. Grading • A minimal grade of 70% is required for all written evaluations • For clinical assessments, students must complete all tasks on the check list in the required order • Students who do not meet these requirements will need to re-test or else may require a review board if still unsuccessful

38. PT Clinic • The physical setting designed to provide a safe and accessible environment that facilitates fulfillment of the mission, purposes and goals of the physical therapy service • The equipment is safe and sufficient to achieve the purposes and goals of physical therapy and accommodate a wide range of patients and conditions

39. PT Clinic Continued . . . • Constructed and equipped to provide adequate space, and the proper environment to meet the professional, educational, and administrative needs of the service with safety and efficiency

40. PT Clinic Continued . . . • The physical setting of the PT clinic shall: • Meet all applicable legal requirements for health and safety • Have fire exits that are clearly marked and kept free of obstruction • Meet space needs appropriate for the number and type of patients/clients served • Provide reception and waiting facilities with consideration to people with disabilities • Provide treatment areas that offer privacy, security and comfort

41. PT Equipment • The equipment must meet all applicable legal requirements for health and safety, and accessibility • The equipment must be inspected and maintained routinely • The equipment must meet the needs of the patient population to be treated at that specific clinic

42. ANA PT Clinics • In Kabul, there are two PT clinics: • Polyclinic (out patient) • NMH Hospital (in and out-patient setting) • There are various regional hospitals throughout Afghanistan that have PT departments • After graduating from the PTT program, you will be assigned a position at one of these clinics

43. PT Department Visits • Visits to Polyclinic PT department and NMH PT department to familiarize with: • The layout of the clinic • The available resources and supplies • The different PT treatment modalities • The various exercise equipment • Meet the staff

44. Summary • Physical therapist is a protected title for those graduating from a recognized PT school • The ANA will train physical therapist technicians which will work under the direct supervision of a Physical therapist or senior PTT • Physical therapy plays a critical role in rehabilitation with qualified physical therapist being rehab specialists

45. Summary Continued . . . • The JD and QS are documents that outline the PTT job standards and requirements • There certain skills that require additional training which are called controlled acts and apply to PTTs • Each PT clinic is different but must reflect the needs of the patient population at that facility

46. Questions?

47. Comprehension Check • What is physical therapy? • What is the difference between a physical therapist and a physical therapist technician?\ • What are the three branches of physical therapy and give an example of an appropriate condition for each? • What is the international governing body for PT?

48. Comprehension Check • What are the two types patients PTTs treat and define each? • What is a controlled act? List the 9 controlled acts applicable to PTTs • What is a scope of practice? Does this term apply to ANA PTTs? If not why?

49. Answers • Physical therapy is “services for individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan” • A physical therapist is a protected title reserved for those professionals who have a degree of PT at a recognized school. A physical therapist technician is an Afghanistan specific term for those individuals who work as part of a team to provide physical therapy services under the direction and supervision of a physical therapist

50. Answers • The three braches of PT are: • Cardio-Respiratory: • COPD, pneumonia, heart attack, heart disease, post-surgical • Neuromuscular: • Stroke, TBI, spinal cord injuries • Musculoskeletal: • Fractures, sprains, strains, amputations, ligament and tendon injuries • The World Confederation of Physical Therapy (WCPT) is the international governing body