Role of the PTA
In each patient encounter, the PTA must think critically, engage diverse values and perspectives, create solutions, communicate effectively, apply learning to ensure skilled physical therapy services. Within each element of the patient encounter, a PTA uses analytical skills to recognize when changes or new data elements may indicate treatment is:
- unsafe or,
- no longer aligns with the current POC
and communicates these findings (subjective and objective) with the supervising PT
The supervising PT analyzes all of the examination elements to develop a treatment prognosis and plan of care designed to progress the patient and meet treatment goals. A PTA must integrate evaluation findings and:
- affirm safety parameters have been met before initiating treatment
- select appropriate interventions and test and measures as directed by the PT
- monitor the patient response (subjective pre-, during, and post-) each encounter
- modify selected interventions as needed based on patient response (safety, comfort, participation, progression)
- document the treatment outcomes as it relates to the POC using relevant and aligned terminology, including:
- accurately interpret neurological terms included in the PT evaluation
- accurately describe observations using neurological terms
- distinguish normal from abnormal responses in tests, measures, and functional activities
- communicate signs and symptoms of emerging neurological changes or deficits
- seek additional direction and supervision when patient is unable to progress as directed or if goals are exceeded or met
The role of the PT is to interpret the examination results, perform and/or delegate interventions in the plan of care, reexamine the patient as needed to assess response to PT, make changes to the treatment plan as needed, and consult with other health care personnel, including the PTA, as needed.
In addition to the essential role elements above, the following table summarizes the role of the PT and of the PTA in the examination and care planning process for patients with neurological dysfunctions:
|
Pt/Client Management |
PT |
PTA |
|
History |
Collects relevant history, consults multiple data sources, integrates knowledge of prior level of function (PLOF) and contextual factors (pathology, personal, environmental) into treatment approaches and planning |
Comprehend relevant history and it's impact on POC as indicated by supervising PT; collect relevant subsequent subjective and changes to condition Integrates information about patient's cognition, safety, and situation into subsequent treatment planning (e.g., communication and communication support, rest breaks, equipment, family/caregivers, coordinating treatment times with multidisciplinary team as indicated, etc.)
|
|
Body Systems |
Screen for conditions that indicate a need for referral to additional medical care providers; interpret systems review outcome and integrate information into prognosis and treatment plan |
Comprehend the general purpose and outcomes of a systems review (e.g., role of body systems in health maintenance, general knowledge of normal vs. abnormal responses, and "red flags"). Repeat relevant systems review with patient and compare results
|
|
Vital Signs and Pain |
Integrate findings into safety, frequency, intensity, prognosis, multidisciplinary care planning, and treatment |
Repeat prior and during treatment as indicated; recognize normal and abnormal findings; select and interpret standardized pain assessments Recognizes activities, positioning, and postures that aggravate or relieve pain or altered sensations
|
|
Observation |
Continuous process during patient encounter, includes posture, movement patterns and strategies, mental status, signs and symptoms of neurological involvement (e.g. gaze preference, limb neglect, etc.) |
Recognizes alignment of trunk and extremities at rest and during activities Recognize normal and abnormal movement patterns Recognizes and monitors responses to positional changes and activities Recognizes changes in the direction and magnitude of patient's state of arousal, mentation and cognition Recognizes activities, positioning and postures that aggravate or relieve pain or altered sensations, or that can produce associated skin trauma Distinguish language deficits versus memory deficits, so there is confidence in the accuracy of patient responses during assessment, activity tolerance, and consent to treat
|
|
Sensation |
Integrate outcomes of multimodal sensory assessment (exteroceptive, prioprioceptive, and combined cortical sensory function) into knowledge of condition and prognosis for return, recovery and/or adaptation (e.g., equipment, assistive devices and strategies) when forming the plan of care |
Repeat relevant sensory tests and measures and report outcomes (diminished, intact, absent) Recognize sensory patterns that increase risk of injury (skin, limbs, safety) Recognize deficits that correlate to specific movement impairments |
|
Motor |
Integrate analysis of multimodal motor assessment (tone, reflexes, righting reactions, coordination, movement patterns, and strength) into knowledge of body systems and resultant functional limitations |
Repeat relevant motor tests and measures and report outcomes Recognize the influence of neuromuscular tone on efficient and effective volitional movement Recognize movement patterns or deficits that increase risk of injury Recognize normal versus abnormal developmental reflexes and the resultant impact on progressing toward PT goals
|
|
Cranial Nerve Exam |
Screen for damage to peripheral nerves that originate from the brain; interpret impact on function |
Repeat relevant cranial nerve tests and measures and report outcomes Recognize abnormal vs.normal sensory and motor responses within cranial nerves Apply understanding of cranial nerve deficits when preparing for safe and effective treatment |
|
Balance |
Integrate analysis of posture, base of support, righting and protective reactions, and balance recovery strategies in static and dynamic situations; assess senorimotor functional as it relates to efficiently maintaining the center of gravity within a base of support |
Repeat relevant standardized assessments, test and measures and report outcomes Recognize normal versus abnormal righting reactions Apply understanding of limits of stability, equilibruim, strategies, and function to progress balance control as directed |
|
Functional Activities |
Integrate a combination of standardized and individualized functional assessments that are relevant to primary impairments and sensitive to changes; apply understanding of evidence to develop a prognosis and plan of care |
Repeat relevant standardized assessments, test and measures and report outcomes Interpret standardized outcomes as it relates to level of assistance, level of disability, fall risk, agility, etc. Select interventions as directed that are directly linked to minimizing impairments and resultant loss in function noted in plan and goals
|
|
Patient Participation |
Interpret patient report of impacts of impairments and functional limitation on ability to engage in individual life and community activities; apply understanding of evidence to develop a prognosis and plan of care
|
Employ approaches and techniques as indicated in the plan of care to optimize patient participation and mininimize participation restrictions in life and community |