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Toni Talks about PT Today

Scope of Practice

Published February 2, 2011 6:09 PM by Toni Patt

Everyone with a physical therapy license should be familiar with the concept of scope of practice. It spells out which therapeutic activities a physical therapist may perform. For example, passing medicines is not permitted but applying autolytic debriders as part of wound care is. For the most part, it is definitive about what is and isn't permitted except for a gray area that overlaps with OT.

In many instances, PTs and OTs overlap in what they're doing. We both do transfer training. We take patients to the bathroom. I might help someone dress. An OT might help someone stand. When describing the differences to patients, I explain that PTs want to walk to the sink. OTs want to work at the sink. I thought that captured the main difference. OTs don't do gait.

Or so I thought until last Saturday. I was working on a general neuro floor. One patient had orders for a PT and OT consult prior to discharge. An hour or so after seeing the patient, the OT called me. She said I didn't have to see the patient because she'd already cleared her for discharge. In fact, the OT said, the patient walked just fine. Since when do OTs decide if a patient walks "just fine?"

As far as I know, OTs don't receive any education on gait or gait training. Obviously they need some knowledge since they often must walk patients to the sink or bathroom. To me, there is a big difference between walking someone 10 feet to the bathroom and determining that person is safe to go home and under which conditions. I don't tell OTs if someone is able to dress himself. I tell them how much and what kind of assist I provided and let them decide.

I was sort of surprised by the whole conversation. I'm not sure why an OT would think I wouldn't need to see someone walk to clear for discharge. Nor do I understand why an OT thought she could make that determination. OTs don't gait-train people. They aren't taught how to assess gait. Sure, they can intuitively see if someone is safe or not. That doesn't mean an OT should clear someone for discharge based on ambulation.

I think this OT thought she was helping me out by saving me an evaluation. I appreciate that. I just don't think it's within her scope of practice to make that determination. I think this is probably unique to my facility. So where did she get the idea it was OK for her to do that? The PTs she normally works with should have stopped the practice before it started. Apparently they didn't. I wonder if this happens routinely. I guess I'll have to ask.

I'm all for PTs and OTs working together. I appreciate her trying to help me out. I was very busy that day. It's just that a PT can't make OT judgments and an OT can't make PT judgments. What would be wrong with both PT and OT seeing the patient for clearance prior to DC? I frequently clear stroke patients for safe discharge. I've had OTs follow me and pick up on things I completely missed because they were outside my area of assessment.

Maybe I'm nitpicking. But it is a fair question.

5 comments

This is in response to Will, from Roanoke. I am in OT school currently, and I've learned how to do the TUG, Tinetti, Berg, etc. and have assessed many patients with them. Balance, and standing balance are not specific to PT. OT's must be able to assess patient balance to ensure they're safe during ADLs, functional mobility, transfers, etc.

If it's bothering you that they are creeping into what you believe is their territory, why not ask them if they can save the balance work for you? Since you're new, you could put a spin on it that you'd like to improve yourself in this area.

Hope this helps :)

Lily, OT - Student, USA January 13, 2012 8:30 AM
St. Augustine FL

The practice of occupational therapy includes

A. Strategies selected to direct the process of interventions, such as

1. Establishment, remediation, or restoration of a skill or ability that has not yet developed or is impaired.

2. Compensation, modification, or adaptation of activity or environment to enhance performance.

3. Maintenance and enhancement of capabilities without which performance in everyday life activities would decline.

4. Health promotion and wellness to enable or enhance performance in everyday life activities.

5. Prevention of barriers to performance, including disability prevention.

B. Evaluation of factors affecting activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, leisure, and social participation, including

1. Client factors, including body functions (e.g., neuromuscular, sensory, visual, perceptual, cognitive) and body structures (e.g., cardiovascular, digestive, integumentary, genitourinary systems).

2. Habits, routines, roles, and behavior patterns.

3. Cultural, physical, environmental, social, and spiritual contexts and activity demands that affect performance.

4. Performance skills, including motor, process, and communication/interaction skills.

C. Interventions and procedures to promote or enhance safety and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, leisure, and social participation, including

1. Therapeutic use of occupations, exercises, and activities.

2. Training in self-care, self-management, home management, and community/work reintegration.

3. Development, remediation, or compensation of physical, cognitive, neuromuscular, sensory functions, and behavioral skills.

4. Therapeutic use of self, including one’s personality, insights, perceptions, and judgments, as part of the therapeutic process.

5. Education and training of individuals, including family members, caregivers, and others.

6. Care coordination, case management, and transition services.

7. Consultative services to groups, programs, organizations, or communities.

8. Modification of environments (home, work, school, or community) and adaptation of processes, including the application of ergonomic principles.

Scope of Practice

American Occupational Therapy Association

7

9. Assessment, design, fabrication, application, fitting, and training in assistive technology, adaptive devices, and orthotic devices, and training in the use of prosthetic devices.

10. Assessment, recommendation, and training in techniques to enhance functional mobility, including wheelchair management.

11. Driver rehabilitation and community mobility.

12. Management of feeding, eating, and swallowing to enable eating and feeding performance.

13. Application of physical agent modalities, and use of a range of specific therapeutic procedures (e.g., wound care management; techniques to enhance sensory, perceptual,

Brian, Hand Therapy - OTR/L,CHT, OSMI April 20, 2011 4:17 PM
Gainesville FL

Please review OT scope of practice before you get so upset.  I recommend discussing the issues to make sure that the needs of the pt's are being met.  I have worked with many compitent therapists over the years, both OT and PT, as well as many incompitent OTs and PTs alike.

Brian, Hand Therapy - OT/CHT, OSMI April 20, 2011 4:13 PM
Gainesville FL

I frequently have this problem at my facility and it is infuriating. I was previously a student at this facility. After being hired on after my last PT rotation, my CI became my fellow PT. She decided to leave a few months later and I was left as the only PT working with an OT who is an amazing OT, but who apparently also thinks she is qualified to assess gait and balance.

The facility has also since hired on an OTA who is as bad or worse as she is. I have seen her make functional transfer goals! WTF?.  I have also watched her attempt to perform vestibular testing without her OT supervisors approval. Being fresh out of PT school, all of this makes for a tense atmosphere at times and being the new green horn bucking the ingrained OT and OTA working out of their scope of practice is stressful (Can't we all just get along? LOL Work inside your scope of practice!)

.

Both ambulate pts as part of txs, come into my gym and perform PNF, and standing balance activities. I have even watched the OT try to perform PT special tests. I am getting fed up. Out of seeking to avoid rocking the boat and building bad blood I have turned my head, but I have about had it up to my eyeballs.

Problem is my rehab manager is an OTA with a 4 year psychology degree which with my company qualifies him as a Rehab manager. I actually love the Rehab manager, and he does a great job. He has been a great supervisor and I have great respect for him. He is simiply an awesome boss to have.

Problem is, it is intimidating to approach him regarding this situation with him being from the OT side, my new PT co-worker and I are hesitant to approach him out of fear of how he will handle the situation. I am tired of these people venturing away from OT land. Its like you said, basically OTs help you stand at the sink and work at the sink etc.... PTs help you get there safely with gait and balance training etc... OTs and OTAs provide an invaulable service. But they need to stay within their scope of practice. As you said, I don't tell them how to dress a patient. If I ever assist a pt getting dressed I do it to assist them getting OOB for PT tx if they aren't ready. It is not a regular occurence!

Why in the hell is an OT even thinking about working with a pt on a biodex balance machine or on a functional squat machine? Are they qualified to perform a TUG or Tinetti? If you haven't been trained in outcomes for balance why in the hell are you balance training. THAT IS MY JOB. Really irks me and we are going to have to put a stop to it. If we are rebuked by the management, then its on the company when a medicare audit occurs and they see OTs performing outside of their scope of practice. They will change their ways when repayment from CMS occurs for double billed services and OTs working outside of the their scope of practice.

Will, SNF PT - Physical therapist, SNF February 4, 2011 7:45 PM
Roanoke VA

If that OT is from the UK, she can do that. Shocked the heck out of me when I first got here!

Otherwise, no excuse.

Cheers, Dean

Dean Metz February 3, 2011 12:09 PM

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