I work with the physiotherapy assistant, massage therapist, physicians and physician assistants in our the clinic

• Physiotherapy Assistant (PTA): The physiotherapy assistant helps me complete the treatment plan by showing patient experiences, doing gentle range of motion. I delegate the treatment plan to them and they help me to carry out. I do not have to be present for delegated work, I have to be confident that they can carry this out competently, which I have evaluated.
• Registered Massage Therapists: I refer people to massage therapy for soft tissue work. I do speak with the RMT at our clinic before she sees our initial visit, and how the patient is progressing.
• Physician: We send progress notes to physicians, or call the office if it was urgent to ask for a response. We may also ask about surgical restrictions and post-op surgical protocols.
• Physician Assistants: I basically go to the PA first prior to going to ask the Orthopaedic Surgeons. I tend to consult PAs for imaging questions, exercise restrictions post-surgery, I have helped to facilitate referrals for imaging, we reviewed imaging as entry-level physiotherapists we are not trained to read x-rays (some advanced practice physiotherapists can). We have brought up concerns to the PA about potential infections, poor progression with physiotherapy, any new problems and change in health status. Some benefits of this PA/PT communication is that continuity of care is significantly faster since the PA is more accessible than the physician at our clinic, we would have to wait long or didn’t hear back.

I enjoy working in physiotherapy, as it is a very rewarding profession in terms of working with people and helping achieve their functional goals.
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Physiotherapists are primary care providers – which means that patients can directly access physiotherapists without requiring a referral. Often patients receive a referral from a physician’s office; however, this is usually for insurance purposes to allow for coverage of the physiotherapy visit from the patient’s extended health care benefits.
This includes:

• New Assessments and Follow-up Assessments (physio history, physical, can be trained additionally to interpret imaging results)
• Therapeutic Treatments may involve:
  • Manual Therapy – hands on, mobilizations (moving a joint passively) and manipulations, soft tissue work
  • Modalities – TENS machine, Interferential current, muscular stimulation, biofeedback, heat, ice, ultrasound therapy, taping, laser therapy, shockwave which help decrease pain and/or swelling, and improve healing
  • Exercise Prescription
  • Patient Education

here are different areas a physiotherapist can work in:

• Physiotherapists in respiratory rehabilitation / pulmonary rehabilitation: these physiotherapists may work with patients who are suffering from issues such as COPD, emphysema and chronic bronchitis.
• Physiotherapists in cardiovascular rehabilitation may work with patients who are recovering from a heart attack, heart surgery or other heart conditions.
• Physiotherapists in neuro rehabilitation may work with patients in hospital and in the community who may be recovering from a stroke, spinal cord injury, acquired brain injury, or suffering from conditions such as Parkinson’s, Multiple Sclerosis and ALS.
• Physiotherapists in MSK / Orthopaedics / Sports Medicine  see patients with a variety of conditions which may include such sprains, strains, soft tissue tears, arthritis, fractures, and post- operative conditions to name a few.  They may also treat people with sports injuries, workplace injuries, or post motor vehicle accident injuries.
• Paediatrics
• Wound Care
• Women’s Health
• Critical Care
• Occupational Health
• Education and research

Learning does not stop after physiotherapy school. There are many continuing education courses that physiotherapists can complete, and many different directions a physiotherapist can go in to focus their practice.
For example, these special skills workshops go beyond what is taught in physiotherapy school, some of these courses is just on a weekend, a few weeks, or some a few years. Here are a few examples of some special skills workshops:

• Acupuncture
• Manual therapy courses (i.e. Canadian Academy of Manipulative Physiotherapy: CAMPT manippt.org/)
• NDT for adults with stroke, brain injury and other neuromotor
• Pelvic Health (urinary incontinence, pelvic pain, post and pre-natal care)
• Vestibular Rehab (e.g. dizziness, vertigo)
• Active Release Therapy
• Concussion Rehab
• Golf Rehab
• Taping
• Wound Care

PTA’s are not able to prescribe any treatment outside of the treatment plan set out by their licensed physiotherapist to ensure public safety and proper care of patients. There are also specific controlled acts that physiotherapists are trained to use during the course of treatment that PTAs are unable to have delegated to them. 

Some of the controlled acts are:

• Acupuncture
• Communicating a diagnosis
• ​Spinal manipulation
•  Internal assessment or internal rehabilitation of pelvic musculature 

 
(College of Physiotherapists of Ontario, June 2017) (3 

References:
(1) Canadian Physiotherapy Association, Becoming a PT or PTA, 2017 (https://physiotherapy.ca/becoming-pt-or-pta ) 

(2 ) Essential Competency Profile for Physiotherapist Assistants in Canada, 2012 

(3) College of Physiotherapists of Ontario: Controlled Acts and Other Restricted Activity Standards, 2016 (https://www.collegept.org/rules-and-regulations/controlled-acts-and-other-restricted-activities-standard) ​

Written by: Stephen Horvath, PTA, ISM Rehab 

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This past weekend ISM Rehab staff got certified for use of an AED, which helps diagnose life-threatening cardiac arrhythmias & treats through defibrillation. 

We have an AED on site should it be required during a sudden emergency. 

Suffer from arthritis? Enjoy swimming? In addition to the relaxation and fun that comes along with splashing around in a pool, physiotherapy can be enhanced with pool exercise. It’s a win-win situation! Exercising in a pool has been done for years with classes such as aqua-fit to get the heartrate up, and provide a safe environment to increase cardiovascular fitness while being gently on the joints. Aqua-fit classes are offered at many local community centres, and the YMCA. Although they offer a great workout, most classes are designed for uninjured people. How can you get the benefits of the water (and there are many) if you are rehabilitating an injury, or have recently had orthopedic surgery?
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Aqua-Therapy exercises are designed for just that!  They are designed and modified to use the water as resistance, to reduce the body weight felt on the joints, to increase ease of motion, reduce swelling, and provide a safe progression to land exercises. Aqua-therapy exercises and techniques can help add variety to your therapeutic regime and offer progression in your movement that may be challenging on dry land. 

Recent research has found that aqua-therapy has positive effects on pain, disability, and overall quality of life in people with knee and hip osteoarthritis, total knee replacement, total hip replacement, and after rotator cuff repair due to improved function, range of motion, and decreased swelling. What that means, is by adding in just a few water based exercises into your therapy program we can move along your recovery and help you reach your therapy goals sooner.

​By now you must be wondering how you can begin to incorporate aqua-therapy into your rehab. If you have access to a pool regularly, the physiotherapists at ISM Rehab can determine if aqua-therapy is appropriate for your injury and stage of rehabilitation,  as well as select and teach you (on dry land) the aqua-therapy exercises that will work for you. 

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