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April 18, 2002
Judy Bolewicz President
Montana Occupational Therapy Association
3221 Rosebush Lane
Belgrade, MT 59714
Dear Judy:
Later this year, upon election of Montana legislators, we wish to send a letter of support to your representatives. The following, with any minor modifications, will be included in that correspondence. A task force is currently re-evaluating our position statement and it may be updated prior to our addressing your representatives.
On behalf of the American Society of Hand Therapists (ASHT), I wish to write in support of legislation being presented by the Montana Occupational Therapy Association, specifically regarding the introduction of iontophoresis to the occupational therapy scope of practice. ASHT’s official position regarding the use of physical agent modalities is as follows:
The American Society of Hand Therapists endorses the safe and effective use of physical agent modalities in upper extremity rehabilitation by licensed or registered occupational therapists and physical therapists who have acquired the appropriate level of knowledge and training in their use as recommended by the position paper on physical agent modalities.
To best understand the ramifications of restricted iontophoresis use by Occupational Therapists as it relates to the hand therapy profession, it is important for legislators to understand the following: 1) hand therapy is a subspecialty of both occupational and physical therapy, but is predominated by occupational therapists; and 2) the credentials of Certified Hand Therapists are indicative of the highest level of competency relative to upper extremity rehabilitation.
Hand therapists are either occupational or physical therapists who, through advanced study, specialize in rehabilitating patients with conditions affecting the hands or upper extremity. These individuals operate both within the standards of practice mandated for occupational and physical therapy, as well as additional competencies required for hand therapy. However, despite this demographic, the majority of hand therapy professionals are Occupational Therapists, who represent around 85% of the population. This ratio is also consistent with the profile for Certified Hand Therapists.
Certification, as the highest indicator of hand therapy competence, is only available to those therapists who have a minimum of five years clinical experience, including 2,000 hours plus exclusive to hand therapy. Eligible therapists must pass a comprehensive examination (including test matter specific to physical agent modalities) to obtain initial certification and maintain this credential through ongoing continuing education. ASHT contends that advanced training and education qualifies the use of physical agent modalities.
Given the knowledge base needed for correct use of physical agent modalities, we recommend that Montana follow the example of other states and establish competency levels for occupational and physical therapists to use physical agent modalities in their practice. To preclude or restrict the use of iontophoresis or other physical agent modalities by Occupational Therapists outright, could compromise patient care by denying them the level of care fundamental to hand therapy specialization.
In support of ASHT’s position, we recommend that the state solicit additional information from the Hand Therapy Certification Commission (HTCC) and the American Occupational Therapy Association (AOTA). Another resource of possible interest to the state is Alfred Bracciano, EdD, OTR, professor and founding Chair of the Occupational Therapy program at Saginaw Valley State University. He is author of the text Physical Agent Modalities: Theory and Application for Occupational Therapists.
On behalf of the American Society of Hand Therapists, we appreciate your consideration of the information relayed above as you deliberate over the legislation presented. If there is any additional information we can provide. I would welcome the opportunity to speak to you directly.
Sincerely,
Ginger Clark, OTR, CHT President
cc: Amy Sullivan, MOTA Lobbyist
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