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Herman & Wallace Blog

The Role of the PTA

The following is a contribution from Elisa Marchand, PTA, PRPC. Elisa is the first PTA to become a Certified Pelvic Rehabilitation Practitioner! Elisa started a Pelvic Floor program with a locally-owned rehab company where she mentored 3 different PT's through the years. In that time, Elisa also taught as an adjunct with the local PTA program. Elisa works at McKenna Physical Therapy in Peoria, IL.

As a physical therapist assistant, the following should cause me to rethink my passion for and practice within women's health PT. "The SOWH is opposed to the teaching of internal pelvic assessment and treatment to all supportive personnel including physical therapist assistants." (Position Statement on Internal Pelvic Floor Assessment and Treatment: Section on Women's Health, APTA; Feb 2014) It should have stopped me from sitting for and becoming the first-ever PTA certified as a PRPC. Fortunately, this is not the case.

I want to be clear from the start; I understand the need for clear boundaries with regards to the scope of practice of PTAs. However, the interpretation of these rules can get quite muddy. In the APTA's "Guide for Conduct of the PTA", the following clarifications are made, including their interpretations:

3C. Physical therapist assistants shall make decisions based upon their level of competence and consistent with patient/client values. Interpretation: To fulfill 3C, the physical therapist assistant must be knowledgeable about his or her legal scope of work as well as level of competence. As a physical therapist assistant gains experience and additional knowledge, there may be areas of physical therapy interventions in which he or she displays advanced skills...To make sound decisions, the physical therapist assistant must be able to self-reflect on his or her current level of competence.

 

3E. [PTA's] shall provide physical therapy services under the direction and supervision of a physical therapist and shall communicate with the physical therapist when patient/client status requires modifications to the established plan of care. Interpretation: Standard 3E goes beyond simply stating that the physical therapist assistant operates under the supervision of the physical therapist. Although a physical therapist retains responsibility for the patient/client throughout the episode of care, this standard requires the physical therapist assistant to take action by communicating with the supervising physical therapist when changes in the patient/client status indicate that modifications to the plan of care may be needed.

Through the years of working as a PTA, I have practiced in a variety of settings. Some of these settings have allowed for a high level of autonomy (such as in my current workplace), and some have operated in quite the opposite-- where my treatments were dictated step-by-step by the PT. No matter the state in which one lives, physical therapy clinics will vary in their method of treatment and utilization of PTAs. In Illinois, where I practice, the following is the detailed description of a PTA per the Illinois Practice Act:

"'Physical therapist assistant' means a person licensed to assist a physical therapist and who has met all requirements as provided in this Act and who works under the supervision of a licensed physical therapist to assist in implementing the physical therapy treatment program as established by the licensed physical therapist. The patient care activities provided by the physical therapist assistant shall not include the interpretation of referrals, evaluation procedures, or the planning or major modification of patient programs." (http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1319&ChapterID=24)

Additionally, per the APTA's Standards of Ethical Conduct for the Physical Therapist Assistant: "6B. Physical therapist assistants shall engage in lifelong learning consistent with changes in their roles and responsibilities and advances in the practice of physical therapy." (http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Ethics/StandardsEthicalConductPTA.pdf) Personally, I take this as a green light for PTA's to immerse themselves in whatever their niche or passion may be. Thus, if a PTA is following this standard, and the advances in PT call for more trained therapists with an understanding of the pelvic floor, and the appropriate oversight provided-- as in my case; what is the hold-up?

Counter to the above expectations, the Section on Women's Health's Position Statement on Internal Pelvic Floor Assessment and Treatment states:

"Any internal pelvic (vaginal or rectal) myofascial release or soft tissue mobilization techniques that would require a continuous ongoing re-evaluation and reassessment should be performed by the physical therapist and not delegated to supportive personnel including physical therapist assistants. The SOWH recognizes that therapeutic exercise, neuromuscular reeducation and behavioral retraining techniques for pelvic floor dysfunction at times requires ongoing critical decision making while at other times are relatively routine. In the routine circumstances, those techniques may be delegated. When the higher level of critical decision making is necessary those techniques should be performed by the physical therapist and not delegated to support personnel including the physical therapist assistant."

In this above set-up, PTA's are made to sound as if incapable of using any critical thinking skills. Or, at the least, able to operate with very limited critical reasoning. Furthermore, in the typical treatment of pelvic floor conditions, how is the decision-making process required for individualized treatment any different than that to the external pelvis, or the low back, or the foot for that matter?! The skill and awareness that was required in transferring a patient in the ICU when I was a new grad was in some ways more complex with more of a direct impact on a person's survival and well-being, than what I do now. Yet, how am I not qualified to do something in which I have extensive training? This seems inconsistent.

In my opinion, the PTA is more than just "supportive personnel". On the other hand, I also believe that new PTA grads may not have a place in pelvic floor PT. There are complexities within, and knowledge required of anatomy and physiology of the pelvis, which the PTA does not get from his or her program. Though doctorate students entering the PT world today also do not have much exposure to the pelvic floor, they at least have gone through a more thorough coverage of anatomy, physiology, and disease processes. Despite the differences in schooling, MANY physical therapists see their assistants as vital assets to their clinics.

One incredibly positive aspect of being a PTA is the follow-through I have with my clients. I LOVE getting to know my patients, and feel that I am allowed this luxury more frequently than PT's whose schedules may need to stay open for new evaluations. I frequently have clients say to me, "I would never have dreamed that I'd be talking about (fill in the blank) with ANYBODY!" Usually, this is after a few sessions of working together. I cherish seeing the freedom and healing that comes when people feel comfortable enough to open up their physical, emotional, and spiritual selves.

Yes, as a PTA we are limited by the scope of practice placed before us. However, I do not see that as a set of limitations that binds us to a very narrow existence. With the training one receives through continuing education such as with Herman & Wallace, the PTA can gain the necessary skills for treatment. And from this, the possibilities are endless!

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This Week's Featured Certified Pelvic Rehab Practitioner - Lisa Odabachian, MPT, BSN, RN, PRPC!

We're excited to have the chance to interview Lisa Odabachian, MPT, BSN, RN, PRPC, this week's featured Certified Pelvic Rehabilitation Practitioner! Lisa earned her certification in May of 2015 and she was kind enough to share her thoughts with us. Thank you for your contributions to the field of pelvic rehab, Lisa, and congratulations on your certification!


What motivated you to earn PRPC?
For patients and referring providers to have confidence that I have expertise in treating pelvic floor dysfunctions.

What makes you the most proud to have earned PRPC?
That I have evolved into a practitioner that can make a difference in this patient population’s quality of life.

What advice would you give to physical therapists interested in earning PRPC?
Take as many courses with hands on lab work that you can so you can treat with a broad base of knowledge to get the best outcome for your patients!

Tell us a little about your clinical practice:
I am a full-time clinician at a well-known and well-respected hospital-based outpatient women's clinic. I have been at the Beaumont's Women's Urology Center, a multidisciplinary clinic focusing exclusively on women's health, for the past 5 years. incontinence, pelvic organ prolapse, urinary urgency and frequency, chronic pelvic pain conditions (painful intercourse, interstitial cystitis, vulvodynia, abdominal pain), post-surgical pain and weakness, colo-rectal dysfunctions (fecal incontinence, constipation, rectal pain). I have been in clinical practice treating women and men with pelvic dysfunctions for over 14 years at Beaumont Hospital. Prior to that I was a clinical nurse treating patients in a variety of settings. I am currently an ABPTS candidate to sit for the 2016 WCS specialist certification examination in Women's Health physical therapy.

How did you get involved in the pelvic rehabilitation field?
Through the years of being a nurse, family member and friend I have heard many stories from women and men who have had symptoms that were unsuccessfully or only partially helped with medications and/or surgical interventions. When I learned that there were specially trained physical therapists who treat bladder, bowel and sexual problems by providing the patients self-help education and rehabilitation techniques to help resolve these issues, I became charged up to get my master’s in physical therapy so I could then specialize in treating pelvic floor dysfunctions.

What/who inspired you to become involved in pelvic rehabilitation?
When I learned that there were specially trained physical therapists who treat bladder, bowel and sexual problems by providing the patients self-help education and rehabilitation techniques to help resolve these issues, I became charged up to get my master’s in physical therapy so I could then specialize in treating pelvic floor dysfunctions.

What patient population do you find most rewarding in treating and why?
The patients who are motivated in helping themselves by being compliant in their rehabilitation by doing their home exercise program and asking questions are the patients who typically have the best outcomes.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?
There are so many women and men who could benefit from a skilled pelvic floor physical therapist. Many patients with pelvic floor dysfunction have difficulty being appropriately evaluated and referred to pelvic floor physical therapy, and then if that occurs they often have to travel long distances to find a proficient provider.

What has been your favorite Herman & Wallace Course and why?
I have learned so much from each and every course I have taken. My first course was in Akron Ohio in May 2001 with Holly Herman and Kathe Wallace, so of course that is my most memorable course because it was like opening a Pandora’s Box, in a good way! It all made sense!

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
Perform a good orthopedic evaluation first

What do you find is the most useful resource for your practice?
I often refer to course/lab course notes.

What is in store for you in the future?
My application has been approved to sit for the 2016 specialist certification examination in Women’s Health in physical therapy to obtain WCS credentials through the APTA.

What role do you see pelvic health playing in general well-being?
It’s huge! When people have bladder, bowel and/or sexual dysfunction, their relationships, social, career, education, emotional, recreational and/or psychological, etc. well-being is affected to varying degrees. People often do not even know they have pelvic floor muscles until there is pain or a functional impairment.

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Featured Certified Pelvic Rehab Practitioner - Katie Tredo, DPT, PRPC!

This week we get to feature Katie Tredo, DPT, PRPC, one of the first people to earn her Pelvic Rehabilitation Practitioner Certification! Katie co-owned a private practice in Maryland, and has recently relocated to the Milwaukee area to practice her trade. She was kind of enough to offer her insights with the Pelvic Rehab Report today.

Katie Tredo, DPT, PRPCHi Katie! Tell us a little bit about your clinical practice
I recently joined the staff at Health In Balance Physical Therapy in Mequon, WI. Our team is made up of experienced physical therapists with a variety of interests and specialties. Along with two of my coworkers, my practice is focused on treating men, women, and children with pelvic dysfunctions. I think a practice with such a skilled and diverse set of physical therapists allows us to better serve our patients.

What patient population do you find most rewarding in treating and why?
I find treating patients with pelvic dysfunctions, especially pelvic pain, to be extremely rewarding. Pain, incontinence, and other pelvic dysfunctions can leave patients feeling very isolated and hopeless. Watching my patients open up about their issues then progress toward their goals, returning to their previous activities and relationships without pain or dysfunction is amazing. There are so many quality of life issues that go along with pelvic dysfunctions and I am honored to be a part of each of my patient’s journey to recovery.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?
I would encourage physical therapists to get comfortable asking about bowel, bladder, and sexual dysfunction on their initial intake forms. Many people will not think to report these issues without being asked and a pelvic dysfunction can be a major component of a hip or back issue. If your patient reports a pelvic dysfunction, be comfortable acknowledging it and make an appropriate referral for them. I enjoy working closely with and sharing patients with other physical therapists so that we can maximize our patients’ recovery.

What role do you see pelvic health playing in general well being?
In the past discussing pelvic dysfunctions was considered embarrassing or taboo. In the past few years, I have seen more and more of my patients educating themselves, discussing their issues with other men or women, and finding themselves the help they need. Many patients are going into their referring physicians and requesting to receive help instead of waiting for their doctor’s suggestion. Patients are becoming more empowered over their own care. I see pelvic health becoming more and more of a focus in people’s lives and that fewer patients will be content living with their dysfunction.

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Upcoming Continuing Education Courses

Boundaries, Self-Care, and Meditation - Remote Course

Sep 12, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Emory Healthcare

Nutrition Perspectives for the Pelvic Rehab Therapist - Winfield, IL (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Houston, TX (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: Texas Children’s Hospital

Sacral Nerve Manual Assessment and Treatment - Vancouver, WA (Postponed)

Sep 25, 2020 - Sep 27, 2020
Location: PeaceHealth Southwest Medical Center

Pelvic Floor Level 1 - Mequon, WI Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Health In Balance Physical Therapy

Pelvic Floor Level 1 - Atlanta, GA (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Emory Healthcare

Coccydynia and Painful Sitting - Philadelphia, PA (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Core 3 Physical Therapy

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Milwaukee, WI (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Aurora Medical Center

Pelvic Floor Level 1 - Columbia, SC (Postponed)

Sep 26, 2020 - Sep 27, 2020
Location: Columbia Rehabilitation Clinic

Pelvic Floor Level 1 - Self-Hosted

Sep 26, 2020 - Sep 27, 2020
Location: Self-Hosted Course

Pelvic Floor Level 1 - Decatur, GA Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Columbia, SC Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Columbia Rehabilitation Clinic

Pelvic Floor Level 1 - Minnetonka, MN Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Viverant

Pelvic Floor Level 1 - Marietta, GA Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Southern Pelvic Health

Pelvic Floor Level 1 - Satellite Lab Course

Sep 26, 2020 - Sep 27, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Orland Park, IL Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Palos Community Hospital

Pelvic Floor Level 1 - Columbus, OH Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Fitness Matters

Pelvic Floor Level 1 - Colorado Springs, CO Satellite Location (SOLD OUT)

Sep 26, 2020 - Sep 27, 2020
Location: Strive Physical Therapy

Pelvic Floor Level 1 - Torrance, CA Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Women's Advantage Inc

Pelvic Floor Level 1 - Kenosha, WI Satellite Location (Sold Out)

Sep 26, 2020 - Sep 27, 2020
Location: Aurora Health Care

Pelvic Floor Level 1 - Lansing, MI Satellite Location

Sep 26, 2020 - Sep 27, 2020
Location: Physical Therapy Services of Lansing

Mobilization of Visceral Fascia: The Urinary System - Phoenix, AZ (Postponed)

Oct 2, 2020 - Oct 4, 2020
Location: Banner Physical Therapy and Rehabilitation

Mobilization of Visceral Fascia: The Urinary System - Medford, OR Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia: The Urinary System - Self-Hosted

Oct 2, 2020 - Oct 4, 2020
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Urinary System - San Diego, CA Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: FunctionSmart Physical Therapy

Mobilization of Visceral Fascia: The Urinary System - Colorado Springs, CO Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Manual Edge Physiotherapy

Mobilization of Visceral Fascia: The Urinary System - Fairlawn, NJ Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Bella Physical Therapy