Articulations American Academy of Orthopaedic Manual Physical Therapists | www.aaompt.org Inside Articulations An Official Publication of AAOMPT President’s Message New 140 Club Members New AAOMPT Fellows Fellowship Programs 2011 Meeting Minutes New Members Treasurer’s Report Committee Reports Practice Corner International Delegate Report Clinical Pearl CSM 2012 Photos New Member Application Spring 2012 Bob Rowe, PT, DPT, DMT, FAAOMPT President’s Message Rendez-vous of Hands and Minds! This is the theme of the 2012 IFOMPT Congress being held in Quebec City Canada. It is unbelievably exciting to have this “once every four year event” so close to home, particularly given that the immediate past host cities have been Rotterdam, Netherlands and Cape Town, South Africa. I strongly encourage you to visit the website to view the very impressive list of internationally recognized speakers. Too bad that this event is only every four years since the opportunity to learn from and network with our colleagues from around the world is a very special and unique opportunity. As you know, AAOMPT will not hold our full conference in 2012 since we are committed to supporting the 2012 IFOMPT Congress. However, on Sunday 9/30/12 from 1:00 to 5:00pm in Quebec City, AAOMPT will host an event that will combine our annual Fellow Recognition Ceremony, the Awards Luncheon, and the annual AAOMPT Business Meeting within that one time frame. This will immediately precede the 2012 IFOMPT Opening Ceremonies, so our AAOMPT members will be able to enjoy the AAOMPT functions and then immediately transition into the IFOMPT Congress. We are looking forward to the 2013 AAOMPT Conference being held in Cincinnati, OH from October 16th through the 20th. After taking a 1 year conference hiatus, it will be wonderful to gather once again with all of our OMPT colleagues from across the US. Finally, I wanted to share a “heads up” that we will be transitioning from our current Executive Management group (i.e. Drohan Management Group) to another firm (P&N Association Management Group) based in Baton Rouge, LA. We are thankful to all of the DMG staff who have supported us during the 3 year period that we were associated with them. We have experienced many positive changes while we were being managed by DMG, but we have come to another cross roads in our organizational development and the AAOMPT Leadership believes that P&N is well suited to assist us with our next steps in our evolution. I can assure you that both groups are committed to a smooth transition and your AAOMPT Leadership team will do everything possible to ensure that all of our member’s services are managed appropriately during this transition which will take place beginning now and end on 6/30/12. If you have any questions and/ or comments please feel free to contact me. I look forward to seeing you in Quebec City! Respectfully Submitted Bob Rowe
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1AAOMPT | Articulations | Spring 2012
Articulations
American Academy of Orthopaedic Manual Physical Therapists | www.aaompt.org
Inside ArticulationsAn Official Publication of AAOMPT
President’s Message
New 140 Club Members
New AAOMPT Fellows
Fellowship Programs
2011 Meeting Minutes
New Members
Treasurer’s Report
Committee Reports
Practice Corner
International Delegate Report
Clinical Pearl
CSM 2012 Photos
New Member Application
Spring 2012
Bob Rowe, PT, DPT, DMT, FAAOMPT
President’s MessageRendez-vous of Hands and Minds! This is the theme of the 2012 IFOMPT Congress being held in Quebec City Canada. It is unbelievably exciting to have this “once every four year event” so close to home, particularly given that the immediate past host cities have been Rotterdam, Netherlands and Cape Town, South Africa. I strongly encourage you to visit the website to view the very impressive list of internationally recognized speakers. Too bad that this event is only every four years since the opportunity to learn from and network with our colleagues from around the world is a very special and unique opportunity.
As you know, AAOMPT will not hold our full conference in 2012 since we are committed to supporting the 2012 IFOMPT Congress. However, on Sunday 9/30/12 from 1:00 to 5:00pm in Quebec City, AAOMPT will host an event that will combine our annual Fellow Recognition Ceremony, the Awards Luncheon, and the annual AAOMPT Business Meeting within that one time frame. This will immediately precede the 2012 IFOMPT Opening Ceremonies, so our AAOMPT members will be able to enjoy the AAOMPT functions and then immediately transition into the IFOMPT Congress.
We are looking forward to the 2013 AAOMPT Conference being held in Cincinnati, OH from October 16th through the 20th. After taking a 1 year conference hiatus, it will be wonderful to gather once again with all of our OMPT colleagues from across the US.
Finally, I wanted to share a “heads up” that we will be transitioning from our current Executive Management group (i.e. Drohan Management Group) to another firm (P&N Association Management Group) based in Baton Rouge, LA. We are thankful to all of the DMG staff who have supported us during the 3 year period that we were associated with them. We have experienced many positive changes while we were being managed by DMG, but we have come to another cross roads in our organizational development and the AAOMPT Leadership believes that P&N is well suited to assist us with our next steps in our evolution. I can assure you that both groups are committed to a smooth transition and your AAOMPT Leadership team will do everything possible to ensure that all of our member’s services are managed appropriately during this transition which will take place beginning now and end on 6/30/12. If you have any questions and/or comments please feel free to contact me.
I look forward to seeing you in Quebec City!
Respectfully Submitted
Bob Rowe
2AAOMPT | Articulations | Spring 2012
AAOMPT 140 Club Members | September 1, 2011 – March 2012Timothy AinslieGregory AlnwickJuliana AmentJC AndersenDamon AndersonGloria AndrusWilliam AntonelliSkulpan AsavasoponGary AustinKevin BakerEdward BardanrdAndrew BarrishMichael BeauvaisJennifer BeboRoy BechtelScott BielyPeter BlanpiedGregory BlaskeMark BoncserTodd BourgeoisTimothy BrinkerKent BurnsAnne CampbellMichael CarusoPaul ChristensenJeffery ClarkAndrew ConnollyLeilani ConnorsCarol Courtney
International AffairsPhillip S. SizerTexas Tech University Health Sciences Center (TTUHSC)3601 4th StreetMS: 6280Lubbock, TX [email protected] IFOMPT DelegateTimothy W. Flynn, PT, PhD946 E. Ridgecrest RoadFort Collins, CO 80524C: (970) 988-5405F: [email protected]
Membership Matt J. Lee, PT, DPT, OCS, FAAOMPTKORT Physical Therapy Nicholasville335 Irvine RdLexington, KY 40502W: (859) 881-0333C: (859) [email protected]
Newsletter (Editor)Jim Phillips PT, PhD, OCS, ATC, FAAOMPTDepartment of Physical TherapySeton Hall University400 S. Orange Ave.S. Orange, NJ 07079C: (201) 370-7195F: (201) [email protected]
Carol CourtneyAssociate ProfessorDirector, Fellowship in Orthopedic Manual Physical Therapy Department of Physical Therapy M/C 898 University of Illinois at Chicago1919 W. Taylor Street, 4th Fl.Chicago, IL 60612W: (312) 996-8381H: (708) 660-9473F: [email protected] Student SIG Bob Boyles, PT, DSc, OCS, FAAOMPT1703 Sequalish Street Steliacoom, WA 98388P: (253) [email protected]
AAOMPT Purpose:To acknowledge an individual who has made distinguished
contributions in the orthopedic manual physical therapy
field in terms of contributions that might be demonstrated
through one of many avenues including, but not limited
to, research, education, patient care or legislative efforts.
5AAOMPT | Articulations | Spring 2012
6AAOMPT | Articulations | Spring 2012
Oct 30, 2011
Dear fellow Academy Members;
Having recently returned from our annual conference, I was unsure of what it was that newcomers to our organi-zation might have experienced during our distinguished lecture. As a member since inception and a manual thera-pist for 3 decades I knew the history of AAOMPT and the story lines being played out in the midst of our profes-sional interface. I straddle two distinct eras of growth in OMT and see both history and the future from a position of terra firma in the present.
Our founding fellows were products of a guru era of manual therapy. The volume of our scientific body of knowledge was nascent, while the quantity of expert opinion was prodigious and authoritatively conveyed. I am but one of the many members who were powerfully influenced by superior skill and the willingness to share it. We all owe them a debt of gratitude for their passion in pushing forward on a nonexistent road to the future. That future has arrived in the form of the present state of the profession, and that past is history.
I, like many of us can attribute awakening to my own lack of skill to Dr. Stanley Paris. I attribute my acquisition of skills to he and other of these founders. Seeing our skillful profession unrecognized on a large scale I queried this privately until hearing the same Dr. Paris state publicly “research is what we need”. For years I stopped reading the useless journals, when I was urged by colleagues to look again, I was shocked to see research directed around that which we do.
Scarcely more than a decade ago there was little to no OMT research in existence. A small subset of our commu-nity began to produce the first wave of research evidence that states our case on a scientific level. In research the results stand unaffected by opinion, they don’t care about examiner bias. Cherished opinions become marginalized to their appropriate place.
The emergence of clinical research in OMT altered the paradigm of authority in our profession. The old guard was used to being the final authority. This ego enhancing posi-tion became less stable as the evidence began its’ fledgling
ascent. There is a new generation of intellectual partici-pants in our profession. They have brought with them the building blocks of critical thinking & a willingness to be exposed to critical peer review. It is long overdue, if we are to live up to the lofty goal of being a doctoring profession.
None of the authors referenced in Dr. Paris’ distinguished lecturer address need me to defend them. They stand on a solid platform of intellectual honesty and will defend themselves with continued willingness to allow their work to be exposed to the scrutiny of scientific process and peer review. They will continue to model an exhortation to us all to do the same.
What the young members should know is that they are witnessing the transition of an organization from adoles-cence to maturity. Adolescence does not give way quietly, some require far more attention than others. When it finally does succumb, the emerging adult looks back upon the adolescent with gratitude, both for it’s role in development and for it’s passing.
The maturing adult acknowledges past mistakes, flaws and growth, while embracing the challenges of the present and in so doing builds a mature future.
here is to the future. May we all leave the profession more than it was when we entered it, because of our contribution to building it. Let us all strive to build a profession based on the informed integration of emerging evidence that we participate in developing, clinical skill that we proudly become efficient at delivering and intel-lectually honest about assessing it’s merit with every patient interface.
Sincerely,
Timothy Fearon, PT, DPT, FAAOMPT
2011 AAOMPT ANNUAL CONFERENCE Physical Therapy—The Frontline of Musculoskeletal CareDISNEYLAND® HOTEL | ANAHEIM, CALIFORNIA
I. welcome and Rules of Order – Bob Rowe President Called to order at 4:50pm.
II. Approval of Minutes from Business Meeting 2010 Motion: Approve Minutes from Business Meeting 2010 Seconded and approved unanimously.
III. Approval of Agenda Add – IFOMPT Congress 2012 Agenda Approved
IV. Executive Committee Reports a. Bob Rowe – President
Goals for AAOMPT 1. Improve External Communication
a. You Tube Video Contests i. Professional Members ii. Professional Students
b. Special Issue of JMMT c. Social Media & Technology Utilization Task Force d. Meetings & Continuous Dialogue
i. APTA President ii. ABPTRFE iii. Orthopaedic Section President
2. Administrative Management a. Develop AAOMPT Brand b. Increase Membership Benefits & Value
i. Focus on Membership Categories c. Public Relations & Media
i. Social Media & Technology Utilization d. Business Plan
i. Membership Growth ii. Non-Dues Revenue
e. Goals for AAOMPT
3. Public Policy/Advocacy a. Promote protection and expansion for PT scope
of practice. b. Develop relationships with other healthcare
providers. c. Develop strategies and tactics for Legislative
Agenda. d. Practice Affairs Grants
i. CPTA e. Advocacy Presentation f. Position on Dry Needling g. Goals for AAOMPT
4. Professional Development a. Create 501c3 Foundation for Research b. Develop link between clinicians and
researchers. c. Develop resources for current and newly
developing OMPT Fellowship programs. d. Student SIG
5. AAOMPT Infrastructure a. Committees
i. Development of P&P’s for all Committees ii. Strategic with Activities iii. Succession Planning
6. Development of AAOMPT Governance Manual
7. Additional Activities
8. IFOMPT Monitoring
9. Relationship with the ABPTRFE
10. Investigating Opportunities with ABPTS
11. OMPT Standards Document
AAOMPT Business Meeting Minutes October 29, 2012 | Anaheim, CA
8AAOMPT | Articulations | Spring 2012
12. IFOMPT 2012 a. Rendez-vous of Hands and Minds b. September 30th to October 5th, 2012 c. Quebec City, Canada
13. AAOMPT Executive Management a. Currently have an excellent team in place b. Barriers to Growth
i. 3 Executive Directors and 4 Conference Directors ii. Minimal growth in membership iii. No growth in non-dues revenue
c. RFP d. Timeline e. New AAOMPT Technologies f. AAOMPT on the Go g. AAOMPT Mobilized h. AAOMPT Evidence Mobilized c. Jake Magel – Vice President – no report d. Elaine Lonnemann– Secretary
1. Reviewed Contents of Governance Manual 1. AAOMPT Bylaws 2. AAOMPT Articles of Incorporation 3. Statement of AAOMPT Purpose, Mission, Objectives 4. Description of AAOMPT Governance 5. AAOMPT Positions (both EC and membership) 6. AAOMPT description of “member in good standing” 7. AAOMPT Code of Ethics
Minutes (continued)
8. Officer and Committee Job Descriptions 9. Finance Policies 10. Committees’ & Executive Board Policy & Procedures 11. Description of “due process” and appeal
mechanisms 12. Description of Honorary Fellow Process 13. DMG Contact Info 14. AAOMPT Past-Presidents 15. Past Executive Officers 16. Past Committee Members 17. Past AAOMPT Award recipients 18. Fellowship Programs 19. History of AAOMPT
2. Discussed the new Distinguished Lecturer Award
3. Professional Development Committee is currently working on strategies to assist Fellows with the renewal process though the development of tracking forms, individual assistance and informational reminder in Hand On and Email Blasts. d. Chad Cook – Treasurer
Treasurer’s Report
9AAOMPT | Articulations | Spring 2012
AAOMPT New Members | September 31, 2011 – March 2012
Net Income (Expense) from Operations $ (910) $ (910) $
(33,737) $ (32,827)
Investment Gain (Loss) $ - $ - $ (83) $ (83)
Net Income (Expense) $ (910) $ (910) $ (33,820) $ (32,910)
Practice Affairs Fund
Balance January 1, 2011 $ 74,724
Income $ 14,443
Expenses $ 8,425
Balance December 31, 2011 $ 80,741
Submitted by Chad Cook with assistance from Drohan Management Group
Research CommitteeJean-Michel Brismée, PT, ScD
The CALL FOR RESEARCH PROPOSALS has been posted on the AAOMPT website: www.aaompt.org (deadline June 1, 2012)
Both Cardon ($6,000) and OPTP ($4,000) are sponsoring research grants for 2012, please visit: www.aaompt.org/documents/researchproposals_2012.pdf
Thank You for Supporting Orthopaedic Manual Therapy Research!
Important Information: If you have been selected to present poster or platform presentation at IFOMPT in Quebec this year and are a member of the AAOMPT, include on your poster and/or platform presentation the AAOMPT logo located on the homepage of the AAOMPT website. This will allow you to participate the AAOMPT poster/platform presentation competition and win FREE admission to the 2013 AAOMPT Conference in Cincinnati!
Nominating CommitteeChris hoekstra
The Nominating Committee is currently seeking nominations for the offices of Secretary and Nominating Committee Member for the 2012 elections (Nomination Form on page 12).
The position descriptions have been posted in the members section of the AAOMPT website under the Member Resources tab.
Professional Development CommitteeLaurie Devaney, Committee Chair
This year the Professional Development Committee been tasked primarily with 2 things.
The first is assisting Fellows in the renewal process. Several Fellows have requested assistance with the renewal process and have been matched with a member of our committee by geographical loca-tion. All Fellows are encouraged to become familiar with the renewal requirements.
The second thing we are tasked with is increasing participation in the nomination process for the Kaltenborn and Mennell Awards. Over the past few years the number of nominations has dwin-dled, and the Executive has asked us to take a proactive approach in encouraging nominations. Committee members will be reaching out to the membership in the next few weeks to encourage friends and colleagues to consider nominating a worthy individual.
11AAOMPT | Articulations | Spring 2012
12AAOMPT | Articulations | Spring 2012
Please Note: The number of places on the ballot is limited. If there are more qualified nominees than slots on the ballot, the nominating committee will determine which nominees will be placed on the ballot by vote after careful review of all applications.
Please contact the Nominating Committee Chair if you have not received confirmation that we have received your information within two weeks of sending or by July 1, 2012, whichever is earlier. Please retain a copy of everything you send.
Term: Three Years (Beginning October 1, 2012)
Duties – The Secretary Shall:
q Coordinate the overall review of the Policy Manual and stays alert to the timelines. He/she will keep the updated version of the Governance manual
q Be responsible for reviewing all financial statements, membership figures, and recording/approving all minutes of board meetings
q Be responsible for keeping and maintaining the minutes of the organization
q Commence tenure following the Business Meeting at the Annual Meeting
q Biographical information NOT to exceed 150 words
q A passport sized photo
q A signed statement agreeing to serve if elected
13AAOMPT | Articulations | Spring 2012
Practice CornerKen Olson PT, DhSc, OCS, FAAOMPTChair, AAOMPT Practice Committee and APTA Manipulation Workgroup
As Chair of the AAOMPT practice committee, I have recently seen a return of the debate regarding if mobilization/manipulation interventions are appropriate to be delegated to physical therapist assistants. Both the APTA and AAOMPT have position statements which strongly advise against such delegation, and I have asked practice committee member Stephen McDavitt to provide further perspective on the rationale for these position statements and arguments for why it is vital to the physical therapy profession that these position statements be maintained and followed by our profession.
2012 Mobilization/Manipulation Delegation Debate Rises Again It appears once again the debate addressing the delega-tion of mobilization/manipulation to physical therapist assistants (PTAs) has risen to the forefront as currently witnessed in various PT communication environments. Recently, this has shown up particularly on the APTA Education Section List Serve. Those supporting PTA delegation of mobilization/manipulation challenge the foundation of both APTA and AAOMPT positions on delegation of mobilization/manipulation, the science in conventional practice, and the philosophy and framing of education in the PT and PTA curriculums as it pertains to mobilization/manipulation being interventions that “require immediate and continuous examination and evaluation throughout the intervention”.
Here I have provided the current APTA and AAOMPT posi-tions; Positions on Procedural Interventions Exclusively Performed by Physical Therapists and Procedures Performed Exclusively by a Physical Therapist, respec-tively. I will follow with considerations for what I see as the controversies and provide my opinions and defense for why I feel we need to tenaciously advocate for main-taining the current standards within those APTA and AAOMPT positions.
Procedural Interventions Exclusively Performed by Physical Therapists HOD 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 interven-tions 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 compo-nents of manual therapy, and sharp selective debride-ment, which is a component of wound management.
Procedures Performed Exclusively by a Physical Therapist (10/14/05)
AAOMPT 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 examina-tion and evaluation throughout the intervention are performed exclusively by the physical therapy. 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/manipula-tion, which are components of manual therapy, and sharp selective debridement, which is a component of wound management.
14AAOMPT | Articulations | Spring 2012
The 12 Year history of Debate on Delegation Pertaining to Mobilization/Manipulation and wound Debridement Before The APTA hoD
For over a decade the APTA Position on Direct Interventions Exclusively Performed by Physical Therapists (HOD 06-00-30-36) has been supported and promoted in the affirmative by the APTA BoD, the APTA HOD 2000, all Component Sections including the Sports and Orthopaedic Sections, and AAOMPT. At the APTA HoD 2006, Texas proposed RC-12; that Procedural Interventions Exclusively Performed by Physical Therapists (HOD P06-00-30-36) be rescinded. This was a motion to defeat the current APTA position that excludes delegation of interventions that require immediate and continuous examination and evaluation throughout the intervention to be 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.
Much discussion and debate was heard at the Pre House forums and little support was appreciated across all delegations. At RC-12’s presentation to the 2006 HoD, the Roberts Rule procedure exercised was “Object to Consideration” made by Colorado which was sustained by significantly more than the 2/3 required to sustain the objection”. Significantly more than 2/3 of the required delegates did not want to hear any discussion on RC-12. Normally, such a motion is unnecessary because the objectionable item can be tabled or defeated straight up. Acting by engaging in “Motion to object to the consider-ation” is a Robert’s Rules parliamentary procedure that is utilized when a motion is determined by members of a body to not even be considered. It is not debatable, and it requires a two-thirds vote to pass. Under Robert’s Rules, this was a strong statement by the 2006 APTA HoD.
The Science and Conventional Practice Considerations for PTA Delegation of Mobilization/Manipulation: Is the Issue Osteokinematic or Arthrokinematic?
We are not concerned for PTAs performing PROM, goni-ometry or soft tissue techniques as these have been part of the PTA education and are within the PTA Normative Model. We are also not concerned with any PTA data describing “importance of knowledge” in mob/manip. One can have a value for activities in mobilization/manipulation applied at a very low level of performance and apply them with appreciation (affective domain) in practice without deploying the actual technique (psycho-motor domain). Physical Therapists engage in this action on a regular basis with surgical techniques being consid-ered during patient management but do not perform surgery. Mobilization/manipulation interventions are not part of the PTAs’ skill set or competency education and deploying such a responsibility to a PTA will not be in the best interest of safety for the public or PTA.
To be clear, active and passive ROM are OSTEOKINEMATIC techniques not arthrokinematic techniques. Joint mobili-zations are ARTHROKINEMATIC techniques where passive skilled forces are applied outside the patient’s control to induce intimate joint mechanical loads at various grades (conventionally recognized as I-V) to component and accessory joint movements. This skill requires a detailed understanding of joint surface anatomy and kinesi-ology and a constant ability to modulate the technique throughout the treatment session. On the other hand, AROM and PROM are osteokinematic motion techniques based on total limb movement in cardinal planes and traditionally measured by goniometry and referred to as flexion/extension, internal rotation/external rotation and abduction/adduction.
AROM and PROM are currently in the list of Minimum Required Skills of PTA Graduates at Entry Level (BOD G11-08-09-18) and in the current PTA Normative Model as acceptable interventions that PTAs should be educated and hence perform. PROM and AROM are long axis lever techniques where patients have control on induced forces by the clinician and do not require the level of knowledge, skills, and abilities (KSA) as arthrokinematic
Practice Corner (continued)
15AAOMPT | Articulations | Spring 2012
techniques that are within the manual therapy framework and competencies appreciated as mobilization/manipula-tion (Gr. I-V). This is the crux of the APTA position entitled PROCEDURAL INTERVENTIONS EXCLUSIVELY PERFORMED BY PHYSICAL THERAPISTS. Our concern is further magni-fied when considering for nearly a decade or more there have been APTA and AAOMPT policies and positions against delegating or teaching “mobili-zation/manipulation” interventions to PTAs and those techniques have been out of the Normative Model of PTA education for almost the same duration.
(CAPTE E8 Position Paper 12/20/11 para.3, Line 5 and E9 Para 3 Line 3) (CAPTE ACCREDITATION UPDATE VOL11, NO 1 September, 2006 p. 9)
Association Positions (Consensus); Drive Education, Competency and Practice(Let’s leave the empirical/testimonial preferences out of it.)
Consider that the APTA House of Delegates has stated in multiple documents that only PTs can examine, evaluate, diagnose and prognose. The House has also said that a PTA can only judge a patient’s response to treatment and progress a treatment only within established parameters. Does it follow then that if the House were to allow PTA’s to perform joint mobilization/manipulation that it will be supporting that on-going elements of examination and evaluation are not inherently immediate for both types of interventions? If this is the House’s opinion then there will have to be significant changes to the Guide’s description of wound management, manual therapy, the Normative Model for PTAs, and other documents. For example in the Guide to Physical Therapist Practice, based upon the way it defined the “Joint Integrity and Mobility” examina-tion in Part One, it is very different from what is meant by “Range of Motion” in Part One. If the House allows, explicitly or implicitly, PTAs to perform any sort of mobi-lization/manipulation, as opposed to Range of Motion (a part of Therapeutic Ex - see stretching), we will be saying something about the evaluative component inherent (or not inherent) in the intervention. It is difficult to think of a single piece of literature or a textbook that would support this.
We may also have to look at the valuation of the codes that reimburse for these activities because the level of judgment that goes into manual therapy techniques could be deemed less critical if they are established to be, by House decisions, within the purview of PTAs. This would not only challenge the current payment reform initiatives but also open regulation practice challenges by other professions such as Medicine, Osteopathy and Chiropractic that value and promote the necessary competency for on-going elements of examination, evaluation and diagnosis being inherently part of both mobilization/manipulation and wound debridement.
Additionally, when considering the fallout discussed in 2006 when considering rescinding the APTA Position on Direct Interventions Exclusively Performed by Physical Therapists (HOD 06-00-30-36) one might want to consider the science and practice of the issue and not be distracted by the delegation part. It is a far more decisive philosophical move to say why two interventions (in this case mobilization/manipulation and debridement) should never be delegated that says something about the nature of the two interventions. These two interventions (mobilization/manipulation. and debridement) fall into a unique class, defined as an intervention that always and in every case involves immediate judgment in order to be applied and is not supported by the ENTIRE STRUCTURE
of the PTA curric-ulum. It might also be pointed out that professional educa-tion is not merely the teaching of discrete skills. There is the transmission of an entire theoretical basis for action that accompanies the “how to do it.” That is why the argument that not every PT
learns “how to” is weak. Physical therapists exit with the theoretical framework to support such learned behaviors. You cannot plant a skill set on a weak foundation.
The House has also said
that a PTA can only judge
a patient’s response to
treatment and progress
a treatment only within
established parameters
Practice Corner (continued)
16AAOMPT | Articulations | Spring 2012
The Bottom LineThe APTA and AAOMPT positions are current and define best practice in accordance with consensus of the profes-sion, educational competencies, practice standards and patient/client safety. No matter what the outcome in any decision process as it relates to the PT and PTA delegated roles in practice, it is important that PTs and PTAs prac-tice in concert with, not in conflict with each other. To succeed in this principle, PTs and PTAs must recognize, appreciate and accept their professional differences in competencies and accountabilities that they have chosen and the relevant standards, responsibilities and commitments that they have pledged in acceptance of those respective professional practice decisions, stan-dards and competencies. It is unfortunate but necessary that positions describing delegation responsibilities are necessary in guiding appropriate delegation in practice. Unfortunately, historical monitoring of continuing educa-tion program audiences receiving education on proce-dures that require immediate and continuous examina-tion and evaluation throughout the intervention, past delegation practice patterns and debates such as this have validated both the concern and need for the current APTA and AAOMPT positions on delegation.
Practice competencies are not drawn on “what you can do” but drawn on what you are competent in supported by the rigor of education and the resulting achieved skill sets. This in turn promotes the desires of patient safety and less variance in practice leading to more objective and attainable outcomes. Support for the APTA and AAOMPT positions really is an intellectual issue. It is not and should not be a political one. Therefore, in my opinion, until there is such a time that mobilization/manipulation competencies for the PTA becomes parallel to that of the Physical Therapist, these are positions we must strongly advocate and support.
Stephen McDavitt PT DPT MS FAAOMPT
AAOMPT International Delegate Report
Timothy w. Flynn, PT, PhD Board Certified in Orthopaedic Physical Therapy Fellow American Academy of Orthopaedic Manual Physical Therapists
The AAOMPT Delegate to IFOMPT has been working to accomplish the following activities:
I am currently involved in a number of projects in preparation for the 2012 IFOMPT Congress in Quebec City. We hope to see all of our AAOMPT members there!
At the 2012 Congress the delegates from each of the member organizations will be voting on a number of issues that impact the federation. Specifically, extensive bylaw changes have been proposed that will help with the overall governance of IFOMPT.
In addition, the 2016 IFOMPT Congress bids are being received and evaluated. Each of the member organizations are reviewing these bids over the coming months and will vote on the host city prior to IFOMPT 2012.
Practice Corner (continued)
17AAOMPT | Articulations | Spring 2012
Clinical Pearl
Foam Chip Bag for Knee SwellingMichael Tollan, PT, OCS, COMT, FAAOMPTJanet Todd, DPT, CLTBill O’Grady, PT, DPT, OCS, COMT, FAAOMPT Technique: Use of a foam chip bag for patients with swelling about the knee.
Indication: The purpose of the foam chip bag is to reduce swollen, fibrotic tissue involving the postsurgical knee to allow the tissue to glide and fluid to be removed from the area.
Procedure: One very effective tool for treating your patients with edema, fibrosis or induration at the knee is a combination of a foam chip bag and a short stretch bandage to form a compression bandage. The bag provides compression and tissue massage on a sustained basis.
The bag is easily made using stockinette and chips of foam. You will need to sew the ends together to keep the tubular shape and to keep the foam chips in the bag. The bag is then applied to the edematous knee with an over-wrap of short stretch bandage. The purpose of the short stretch bandage is to provide increased resistance during activity without causing excessive compression at rest.
All of these can be ordered from a supplier who provides materials for lymphatic drainage.
Have the patient wear the chip bag during normal daily activities. They can wear the bag for up to 12 hours as long as it is not too tight. Monitor for swelling above or below to avoid this problem. The bag can be washed and air dried so it can be reused multiple times.
Precautions: Don’t use with patients who are on anticoagulant medications, are hemophilic, or over varicose veins.
References: M. Foldi, E. Foldi, S Kubik (2003) Textbook of Lymphology, Elsevier, Munich Germany
18AAOMPT | Articulations | Spring 2012
Bill O Grady demonstrating at 2012 CSM course.
Anne Hoke demonstrates mobilization technique at 2012 CSM.
Student AAOMPT officers Ellie Allan and Charley Kinney manning booth at 2012 CSM meeting.
Combined Sections Meeting 2012 | Chicago
Anne Hoke demonstrates mobilization technique
Bill O’Grady demonstrating
Student AAOMPT officers Ellie Allan and Charley Kinney manning booth
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19AAOMPT | Articulations | Spring 2012
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