Physical Therapy’s Commitment to Interprofessional Collaborative Care

The physical therapy profession is dedicated to collaborative practice for improved patient outcomes and the advancement of population health.  With our broad scope of practice, physical therapists collaborate with a variety of health professionals to provide comprehensive care across many practice settings. 

Physical therapists collaborate with all professions represented in NAP.  Please read the vignettes below that highlight some of many collaborative care experiences occurring in the physical therapy profession.

Read on for vignette details and outcomes! 

Physical Therapy and Audiology

JB is a 2 month infant with Down syndrome being seen by physical therapy for hypotonia. The physical therapist notices an increase in startle reflex and the development of a left typical torticollis. JB is also starting to develop right posterior plagiocephaly. The physical therapist asks parents about JB’s newborn hearing screen. The parents report that the initial test results were inconclusive but were not given further instructions. The PT encourages the parents to follow up with an audiologist.

Once the audiology appointment is made, the physical therapist communicates with the audiologist these findings. JB undergoes automated auditory brainstem response (AABR) testing with the audiologist and it is determined that he is a right unilateral hearing loss. 

The family, PT and audiologist work together to get JB a baha hearing device. The PT documentation is instrumental in qualifying JB for the hearing aid because most health insurance plans do not cover hearing devices. 

Due to the dedication and the collaborative efforts of this team, they were able to correct the torticollis and promote symmetrical head shape development without the need of a helmet. 

- Submitted by Kimberly Beran-Shepler, PT, DPT, OCS, FNAP

Physical Therapy and Dentistry

Patient Sarah Thompson, a 42-year-old female office manager, visited her DMD for a routine check-up, where signs of temporomandibular dysfunction (TMD) were identified. Recognizing the importance of interprofessional collaboration, the Doctor of Dental Medicine (DMD) refers Sarah to a physical therapist (PT) specializing in TMD. The DMD shares Sarah's case details with the PT, emphasizing the need for targeted interventions.

The PT conducts a comprehensive evaluation, taking into account Sarah's symptoms, functional limitations, and musculoskeletal health. Based on this assessment, a specific and individualized treatment plan is developed. For the DMD, this may involve providing recommendations for oral appliances or modifications in dental procedures to alleviate TMD-related issues. Simultaneously, the PT focuses on interventions such as manual therapy techniques, therapeutic exercises, and patient education regarding posture and jaw exercises.

Regular follow-up meetings are scheduled between the DMD and the PT to monitor Sarah's progress, exchange valuable insights, and make necessary adjustments to the treatment plan as needed. The collaboration between these healthcare professionals ensures a coordinated and comprehensive approach to Sarah's care, optimizing her chances for successful outcomes.

Through their integrated efforts, the DMD and PT aim to alleviate Sarah's TMD symptoms, improve her functional abilities, and enhance her overall well-being. This case exemplifies the power of interprofessional collaboration in delivering patient-centered care, with the combined expertise of both providers contributing to a holistic and effective treatment approach.

- Submitted by Arvie Vitente, PT, DPT, PhD, MPH, GCS, PNAP

Physical Therapy and Respiratory Care

Patient George Biale, a 61 year old male landscape manager, was admitted to the hospital with pneumonia and sepsis. Within his first day of hospitalization, his condition worsened and he was intubated, placed on mechanical ventilation, and transferred to the ICU. Over the next two days, his respiratory status stabilized and on a sedation holiday he was able to tolerate having his bed in the chair position with nursing and to begin ventilator weaning with the Respiratory Care Practitioner (RCP). Physical therapy referral was then made to assess his functional performance, start more aggressive early mobility, and make discharge recommendations.

George tolerated his physical therapy initial examination and was able to sit at the edge of the bed, stand with a front wheeled walker, and transfer to a bedside chair. Later that day, the nursing staff helped George use the bedside commode and sit up again in the evening, which he tolerated well with one person assisting him and using the front wheeled walker. The next morning the physical therapist, noting his mobility status with nursing, wanted to progress his mobility and attempt ambulation. She consulted with the RCP to ensure she avoided increasing his mobility during ventilator weaning sessions and to obtain the RCP’s input on his tolerance to advance his activity level given his current ventilator settings and oxygen needs. The PT and RCP collaborated to find a time in the early afternoon to see the patient together. This allowed the PT to focus on assessment and education specific to ambulation and use of the front wheeled walker while monitoring George’s physiologic response to increased activity and gait, while the RCP monitored and made changes to the patient’s ventilator settings on the fly in response to George’s increased cardiorespiratory load while assisting pushing the ventilator and an IV pole. This collaboration allowed George to walk out of his ICU room and a short way down the hallway during this session.

The PT and RCP, in conjunction with the nursing staff, continued to collaborate to allow the PT to advance George’s ambulation ability while on the ventilator. Within two days, George was walking 150 feet continuously with only minimal physical assistance with improved gait speed. He was extubated later that day, and transferred to the medical/surgical floor. PT continued to check in with the RCP to collaborate on George’s supplemental oxygen needs, especially when increasing his activity levels with progressive gait training and exercise during PT sessions. RCP informed the PT of the high likelihood that George would be discharged with supplemental oxygen, which allowed the therapist to adjust their interventions to include George and his family managing both his front wheeled walker and an oxygen tank during ambulation with PT, giving them the skills and confidence to allow for George’s safe discharge to home.

Through their ongoing interprofessional collaboration, PT and RCP were able to progress George’s recovery, ensure his safety, monitor his progress, and anticipate his needs for discharge.

- Submitted by Sharon Gorman, PT, DPTSc, GCS, FNAP

Physical Therapy and Social Work

Patient Morgan Brown is 87 years old and living in the home they have lived in for 60 years. Morgan lives alone and has one child who lives about an 8-hour drive away. Morgan is followed by their local department of elder services and is visited by a social worker monthly as well as having virtual check-ins weekly. This last visit the social worker noticed that Morgan seemed more unsteady on their feet and when walking was grabbing onto the furniture. The social worker asked Morgan if she could put in a referral for physical therapy and Morgan agreed.

The physical therapist conducts a comprehensive examination considering Morgan’s recent fall (which Morgan told the PT), functional limitations, and their anticipated neuromuscular impairments. Based on this examination and subsequent assessment, the patient is diagnosis with a fall risk with impaired mobility due to impaired postural control, impaired muscle performance and impaired aerobic capacity. Based on this assessment, a specific and individualized plan is developed.

The physical therapist contacts the social worker to provide an update, their assessment of the situation and to solicit the social workers’ input and knowledge of the patient and their situation. The social worker informs the physical therapist that Morgan is determined to stay in their home and would rather “risk” staying in their home than spending one day in a nursing home.  Morgan lost their spouse about a year ago and the spouse resided in a long-term care facility for a year. The social worker spoke of the Morgan’s guilt of their inability to keep their spouse at home and divulged the experience for Morgan was not at all positive.

The physical therapist and social worker are in regular communication as they work with Morgan collaboratively to develop a plan to safely keep Morgan in their home. The physical therapist addresses Morgan’s strength, balance, activity tolerance through semi-weekly visits and a home exercise program while the social worker works with Morgan, who agrees, to have more assistance in the home. Through their combined and collaborative efforts, Morgan remains safely in their home.

- Submitted by Jane Baldwin, PT, DPT, NCS, FNAP

Physical Therapy and Veterinary Medicine

Demi Luna is the owner of Katie, a 6 y/o spayed, female Pembroke Welsh Corgi with paraplegia inquiring about direct access physical therapy with a certified canine physical therapist (PT, CCRP) following a T11-T13 hemilaminectomy/disc fenestration.

Recognizing the importance of interprofessional collaboration, the PT, CCRP consulted the DVM (Doctor of Veterinary Medicine) neurosurgeon at the specialty hospital to discuss the case details, request for the referral, operative and discharge note instructions, plan of care for targeted interventions and any specific restrictions. A prescription for PT and Katie’s records were sent to the PT, CCRP.

The physical therapist conducted a comprehensive evaluation including behavioral analysis, the dog’s primary drive, MSK and neurological deficits, functional limitations, home environment and owner’s goals.  Based on the assessment, an individualized plan of care (POC) was developed and sent to the DVM for review with request for signature of approval.

Although Canine physical therapy has been around for many years, it is still a select niche that is just beginning to grow in popularity amongst both general and specialty veterinary practices.

Since the DVM had limited experience collaborating with a PT, CCRP, the DVM called the PT, CCRP to learn more about the interventions identified and how to best work together. The discussion between the two professionals helped to educate the DVM on a PT, CCRP’s expertise, skillset and knowledge base, improve communication on client status and progress, as well respect and ensure that the PT is following the particular state’s regulatory practice act where the animal is being treated. The PT also provided more information about some of the specialized treatment interventions and modalities used in rehabilitation for pain management. One example is the Assisi Loop, a type of PEMF (Pulsed electromagnetic field) used in the multi modal approach. The DVM was not familiar with this non-invasive modality and was glad to learn more about it. Another treatment intervention discussed was manual therapy including grade 1 and 2 joint mobilizations. Specific therapeutic exercises and NM re-education strategies used to facilitate neurological return were also reviewed.  Since Katie was making weekly gains in ambulation and use of both her hind limbs, we concurred she would not need a wheelchair/cart or “no knuckling” braces. The PT and DVM agreed a 30 day re- evaluation was appropriate and would be submitted to the DVM to ensure consistent communication throughout Katie’s course of rehabilitation. The PT, CCRP also communicated they would coordinate care with the owner to mitigate re-injury via proper handling following a surgical procedure and accommodations to the home environment to address stairs, traction for the floor and ergonomically designed feeding stations.

The owner was educated in a home exercise program to work on with Katie to expedite return of ROM, strength and overall function.  Regular weekly sessions were coordinated with the PT for assessment and progression.

The collaboration between the PT, CCRP, DVM neurosurgeon, and owner ensured a coordinated and comprehensive approach to Katie’s care, optimizing outcomes.

This case exemplifies interprofessional collaboration while delivering client centered care, with the combined expertise of both providers contributing to a holistic, and comprehensive treatment approach.

- Submitted by Lisa M. Hoogasian-Klein, PT, CCRP, CCFT, STS, ABCDT and Cheryl Babin, PT, DHS, MHS, C.A.G.S, FNAP