Sunday, May 19, 2024

PT direct access fight -response summary

Ted Trower

My original posting was:

We here in Michigan are also engaged in fighting P.T. direct
access. (though we’ve not gotten any national attention or support) Our
problem is that the Michigan bill instructs the regulating body for P.T.
practice to create their regulations
“shall promulgate rules to establish standards of ethics
and standards of practice for physical therapists. The
department shall incorporate by reference into the rules the
standards of ethics, standards of practice, and supervision
guidelines contained in the document entitled “Guide to Physical
Therapy Practice”, second edition, published by the American
physical therapy association, Alexandria, Virginia, January 2001. ”

This is a 700+ page document written by the PT association that is about to
be written into Michigan statute without anyone in the Michigan legislature
ever even reviewing it. We have gotten our hands on a hardcopy version of
this text. Is there anyone on the list that is familiar enough with this
publication to direct us where to look for the elements that would impact
the practice of O&P by the PT community?

Responses follow:

I attended a Negotiated Rule Making session at the request of John Billock.
The APTA feels by their education the are qualified to provide complete O&P
services without Physcician referral. I presented at that meeting showing at
least Medicare representatives that most PT programs provide a minimal
on training and PT for people using a device. There is no PT or OT program
in the Boston area that provides anyting close to the ABC standards. As my
proof to my case I presented to the meeting the Course Curriculum at each of
these schools to show a minimal education in O&P. That may be your best
to present.

John Wall PT, CPO, FAAOP


>We have had that fight in WA for the past few years. Look mainly in the
>scope of practice area.


>Go to pages 84-85 (S76-S77) of the Guide – Orthotic, Protective and
>Supportive Devices.
>Go to pages 120-121 (s112-s113) – Prescription, application, and, as
>appropriate, fabrication of Devices and Equipment
>These are the references to O&P for PT’s.

Would you also keep me posted on the events. ABC will be glad to send a
letter to key state legislators opposing the “direct access” proviso’s and
language that would enable PT’s to provide comprehensive O&P.

>Lance Hoxie
>Executive Director
>American Board for Certification
> in Orthotics and Prosthetics, Inc.


>Ted, welcome to the fight. Walt Gorski at AOPA should be able to help you
>with this. Attached are the current text from nine states that infringe
>on O&P. The AZ language is the text from the Model you are looking
>for. Be greatful that they did not go with the language from this year
>like Kansas did and CA is trying to use (also attached). In it it says
>that a PT can prescribe, provide and fabricate orthoses and prostheses. MI
>better start working on their O&P practice act again or it will be too
>late. Terry


> I am starting the MSPO program at Georgia Tech in the Fall, but this
> past year I did a year of PT school before deciding on switching
> paths. We had a couple classes where we used this publication. I’m sure
> there are people on this listserv better qualified than I, but I will
> peruse my notes and the publication and see what I can find. It
> frustrates me that the PT community can get so up in arms about other
> groups (chiropractic, message therapists, etc) infringing on what they
> do, but don’t give a second thought to stepping on other groups feet. I
> have already written my Congressmen in Georgia concerning such
> matters. Hope this helps,
>Daniel Elseroad


Hi Ted! I have an older version (1997) and I have the Guide To Physical
Therapist Practice (part one only). I think if you had the guide it would
help, but bottom line is that PT’s claim in their Scope of Practice as well
in this guide to provide O&P services. They have it broken down into
chapters and sections. So Chapter 2 teals with What Type of Tests and
Measures Physical Therapist use and Chapter 3 is What types of Intervention
physical therapists provide.

For example, in my guide (again it is from 1997) on page 2-19 it reads as

“Prosthetic Requirements
A prosthesis is an artificial device used to replace a missing part of the
body. Physical therapists use specific tests and measures for
patients/clients who might benefit from a prosthesis or fro patients
wearing a prosthesis. The physical therapist selects a prosthesis that
will allow optimal freedom of movement and functional capability with
minimal discomfort and inconvenience.

Then they have Clinical Indicators, Specific Tests and Measures and Data
Generated with specific tasks.”

Another one on page 3-10 is as follows:

Direct Intervention:

“Prescription, Application and as Appropriate, Fabrication of Devices and
Equipment (Assistive, Adaptive, Orthotic, Protective, Supportative, and
Prosthetic) include the use of broad group of therapeutic appliances,
implements, devices, and equipment to enhance performance tasks or
movements, support weak or ineffective joints or muscles, protect…………..
The physical therapist targets the problems in performance of movements or
tasks and selects (or fabricates) the most appropriate device or equipment,
then fits it and trains the patient/client in its use and application. The
goal is for the patient/client to function at a higher level and to
decrease functional limitation.

There is one other reference to orthotics in chapter 2 or page 2-16.

Hope that helps. The PT’s also have in their “Normative Model of Physical
Therapist Professional Education” many references to O&P. NCOPE has been
battling them at the Negotiated Rule Making meetings. We know that
educationally they receive very little education on comprehensive
O&P. Hope this helps. I am sure you had others respond, but wanted to
share what NCOPE had.



I am a PT currently in training to be an orthotist. I am really not sure
why O&P is concerned about PT’s getting direct access.

However, the answer to your question : in the PT guide to practice
fabrication of orthotics is listed under Interventions in several sections
– one such section is Section 4G Impairments/Fracture on page s246/254.


My sincere thanks to all who responded. This will be very helpful

Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA


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