Essential Functions of the Physical Therapy Profession

Background

Pursuant to Sacred Heart University’s Catholic Identity and Mission statement, the Doctoral Program in Physical Therapy at Sacred Heart University welcomes all qualified Doctor of Physical Therapy (DPT) applicants regardless of age, gender, heritage, ethnicity, race, religion, or disability. The Doctoral Program in Physical Therapy is in compliance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, including changes made by the Americans with Disabilities Amendments Act of 2008.

Sacred Heart University’s Doctoral Program in Physical Therapy is committed to graduating high quality physical therapists who are safe and proficient in the practice of physical therapy. The training of students for the complexities of clinical physical therapy practice requires a variety of skills and aptitudes. For example, students must search and evaluate a large body of scientific knowledge. Students must also become proficient in a variety of physical therapy clinical skills such as transferring patients, analyzing gait, instructing in exercise programs, and communicating with patients, patient families, members of the community, and other members of the healthcare team.   

Sacred Heart University DPT students are socialized into altruistic professional attitudes and behaviors espoused by the Doctoral Program in Physical Therapy at Sacred Heart University and the American Physical Therapy Association (APTA). The curriculum of the DPT program at Sacred Heart University utilizes a problem-based learning approach. PBL places emphasis on the development of a reflective practitioner by teaching students to learn from and solve clinical problems. Curriculum con­tent is organized around carefully designed patient or professional practice problems that students study, discuss and research in small groups called tutorials. Students develop the ability to identify, organize and synthesize materials relevant to each case in a self-directed manner that demonstrates respon­sibility for one's own learning as well as the learning of the group. The tutorial group work develops reasonable inter­de­pendence among students and supports the use of peers in learning and problem solving. Students also participate in self and peer assessments of individual performance as part of the tutorial process. Prospective students should consider themselves comfortable with this highly interactive, small group-focused learning style.

Essential Functions are the academic, clinical, and interpersonal aptitudes and abilities that allow physical therapy students to complete the professional curriculum. These essential functions are necessary to perform the clinical skills consistent with physical therapy practice as outlined by the APTA’s Guide to Physical Therapist Practice. Essential Functions apply in the classroom, tutorial, laboratory, and clinical settings. Students may meet the requirements of Essential Functions with or without reasonable accommodations. Sacred Heart University Doctoral Program in Physical Therapy uses independent clinical education sites that may or may not be able to offer the same reasonable accommodations that are made available by Sacred Heart University.

The domains of essential functions include: sensory, communication, motor, cognition, and affect.

Application of Essential Functions

The Doctoral Program in Physical Therapy at Sacred Heart University selects applicants based on attributes and accomplishments portraying the candidate as highly likely to succeed in the academic and clinical coursework and in the profession. Sacred Heart University must ensure that patients/clients are not placed in jeopardy by students with impaired intellectual, physical or emotional functions.

In accordance with the accreditation standards of the Commission on Accreditation for Physical Therapy Education (CAPTE), the DPT program has the prerogative and ultimate responsibility for selection and evaluation of its students, the design, implementation, and evaluation of its curriculum, and the determination of who is eligible to be awarded a degree.

Admission and retention decisions made by the faculty are based on academic achievement as well as non-academic factors. Students are evaluated to insure that they can successfully perform the essential functions of the academic program required for graduation.

An offer of admission may be withdrawn and/or a student may be recommended for dismissal from the program if:

  1. after a student has requested and received a reasonable  accommodation, he or she is unable to meet program qualifications including these Essential Functions.
  2. it becomes apparent that the student cannot meet the Essential Functions even with reasonable accommodation
  3. the requested accommodation(s) would fundamentally alter the nature of the Doctoral Program in Physical Therapy at Sacred Heart University, or
  4. the requested accommodation(s) would create a significant risk of harm to the health or safety of others.

Student Responsibilities Regarding Essential Functions:

  1. Upon admission to the Doctoral Program in Physical Therapy at Sacred Heart University, all students must sign a form acknowledging that they have read and understand the essential functions described, and believe that they are capable of meeting these functions.
  2. Students must demonstrate the ability to perform, or learn to perform, the essential functions.
  3. Students who may have concerns about meeting these expectations are required to meet with the Chair of the Department of Physical Therapy.
  4. If a student feels that he/she requires reasonable accommodation for didactic and/or clinical components of the program, he/she must contact Jandrisevits Learning Center located in the Student Success Center (JLC’s Main Office: 203-371-7820)with required documentation before any accommodations can be made.
  5. Students who have a change in status at any point during their matriculation in the DPT program requiring accommodation must begin this process at the time of the status change.
  6. Due to the time it takes to properly evaluate a student’s needs and to implement reasonable accommodations, it is recommended that students request accommodations as early as possible. While it is possible that the need for reasonable accommodation may arise unexpectedly, it is preferable to make a request for accommodation at least 30 days before the start of a course or clinical education experience.

Students with Disabilities

Individuals with disabilities (as defined by Section 504 of the Rehabilitation Act and the Americans with Disabilities Act) may be qualified to study and practice physical therapy with the use of reasonable accommodations. A student requesting accommodations will be required to provide documentation in the form of testing and/or medical opinions. After reviewing that documentation the university may require him/her to submit to our own testing and/or medical evaluations. To be qualified for the study of physical therapy in the Doctoral Program in Physical Therapy, students must be able to meet both our academic standards and essential functions, with or without reasonable accommodation. Accommodation is viewed as a means of assisting students with disabilities to meet essential standards by providing them with an equal opportunity to participate in all aspects of each course or clinical experience. (Reasonable accommodation is not intended to guarantee that students will be successful in meeting the requirements of any one course or clinical education.)

The Use of Auxiliary Aids and Intermediaries

Qualified students with documented disabilities, who are provided with reasonable accommodations, may use an intermediary or an auxiliary aid. Such reasonable accommodations should be designed to help the student meet learning outcomes without eliminating essential program elements or fundamentally altering the DPT curriculum. No disability can be reasonably accommodated with an intermediary that provides cognitive support or substitutes for essential clinical skills, or supplements clinical and ethical judgment. Thus, accommodations cannot eliminate essential program elements or fundamentally alter the DPT curriculum.

Sacred Heart University Doctoral Program in Physical Therapy: ESSENTIAL FUNCTIONS

The faculty in the Doctoral Program in Physical Therapy at Sacred Heart University identifies the following Essential Functions as fundamental to the curriculum and profession of physical therapy.  Students must be able to perform these Essential Functions during classroom, laboratory and experiential learning activities (including but not limited to participation in one-on-one interactions, small group discussions and presentations, large-group lectures, and patient encounters) in both the academic and clinical settings.

I.  Sensory Abilities

Includes the ability to perceive all information necessary for effective patient/client management inclusive of functional use of vision, hearing, olfaction and tactile sensations.

  • Visual observation of: 
    • Audiovisual presentations and written materials.
    • Demonstrations and procedures.
    • Patients/clients (at a distance and close at hand).
    • Treatment equipment and environment (at a distance and close at hand).
    • Auditory ability for:
      • Conversation.
      • Effective auscultation/auditory evaluation inclusive of but not limited to:  lungs, heart, apical pulse, blood pressure, joint noises, prostheses.
      • Environmental cues inclusive of but not limited to: phones, overhead paging systems, verbal communication in a setting with competing ambient noise.
  • Olfactory ability for:
    • Assessment of wound and skin integrity and presence of infection
    • Tactile ability for:
      • Appropriate feedback related to safe application of gradient pressures during examination and intervention (including but not limited to: palpation, manual muscle testing, joint mobilization, facilitation, percussion)
      • Appropriate feedback for manipulation of dials, sensors, switches on all examination and therapeutic equipment.
    • Multi-sensory processing for:
      • Rapid decisions and communication in dynamic academic and clinical environments.

II.  Communication

Use appropriate verbal, nonverbal, and written communication with all individuals when engaged in physical therapy practice, research, and education, including patients, clients, families, care givers, practitioners, consumers, payers, and policy makers.

     Verbal:

  • Express own ideas and feelings clearly and demonstrate a willingness and ability to give and receive feedback.
  • Receive and send verbal communication in emergency situations in a timely manner within the acceptable norms of clinical settings.
  • Analyze and communicate information on the patient's status with accuracy in a timely manner to members of the health care team, including seeking supervision and consultation in a timely manner.
  • Demonstrate interpersonal skills as needed for productive classroom discussion, respectful interaction with classmates and faculty, and development of appropriate therapist –patient relationships.
  • Communicate clearly and audibly during interactions with classmates, professors, patients and members of the healthcare team.
  • Listen attentively and actively in order to receive and interpret oral communication.
  • Communicate effectively and sensitively in English with other students, faculty, staff, patients, family, and other professionals, in both oral and written formats.
  • Elicit a thorough history from patients; and communicate complex findings in appropriate terms to patients and to various members of the health care team.

     Written:

  • Receive, write, and interpret written communication in both academic and clinical settings.
  • Read and record observations and plans legibly, efficiently, and accurately in documents such as the patient's record, which may be written or electronic.
  • Complete reading assignments and search and evaluate the literature.
  • Complete written assignments and maintain written records, including both handwritten and electronic.

     Non-Verbal:

  • Establish rapport with faculty, classmates, clinical instructors, clients, caregivers and colleagues.
  • Observe patients for the purposes of eliciting information; accurately describing changes in facial expression, mood, activity, and posture; and perceiving nonverbal communication.
  • Recognize and promptly respond to emotional communications such as sadness, worry, agitation, pain and lack of comprehension of therapist communication.
  • Use therapeutic communication, such as attending, clarifying, coaching, facilitating, and touching.

III.  Motor

Students of physical therapy must possess a variety of gross and fine motor skills. These skills are reflective of the physical capacities required to perform the job of a physical therapist in a wide variety of settings. Students must be able to:

  • Maintain and assume a variety of positions including sitting and standing for up to 3 hours continuously, frequent walking, bending, squatting, kneeling, stair climbing, reaching forward, reaching overhead, turning and movement of the trunk and neck in all directions.
  • Perform manual material handling and manipulation of various sizes and weights including lifting and transferring patients, guarding patients during gait training on level surfaces/uneven surfaces/ramps/stairs, pushing and pulling to provide resistance and to assist in maneuvering patients.
  • Specific requirements include:
    • Safely lift up to 50 lbs independently
    • Safely lift up to 200 lbs with assistance  
    • Safely push and pull up to 200 lbs
    • Demonstrate strong bilateral grasp during joint mobilization / manipulation and manually resisted exercise, bilateral gross and fine motor control and strength to perform therapeutic soft tissue mobilization, transfers and facilitation of movement, fine motor control to manipulate testing instruments/equipment/ writing instruments/computers.
    • Manually palpate various body structures during examination and intervention procedures.
    • Balance self and provide support and balance to patients on a variety of surfaces including level and uneven ground, ramps, curbs, and stairs.
    • Have sufficient endurance to continue performing a variety of exertional activities for up to 8-12 hours with occasional rest breaks.
    • Respond quickly to emergency situations by lifting/pushing/pulling patients, applying force to perform CPR, assist with transporting patients.

IV.  Cognitive

Students of physical therapy must possess sufficient intellectual-conceptual ability that includes the capacity to use integrative and quantitative abilities and make decisions. These cognitive skills are critical for the physical therapist to make clinical decisions during the examination, evaluation, diagnosis, prognosis, and intervention activities for patient/client management. Students must be able to:

  • Recall and retain information in an efficient manner in order to meet the minimal requirements classroom and clinical environments to provide safe and effective patient care.
  • Gather information during patient examinations and throughout patient/client management to make clinical decisions.
  • Appraise information to determine appropriate tests and measures during the patient/client examination.
  • Evaluate the information gleaned from the patient/client examination, including patient history and any available medical/surgical/radiologic information, to formulate patient/client diagnoses, prognoses, and plans of care.
  • Acknowledge limitations of knowledge and/or performance in order to provide safe, effective patient care including the necessity of referring the patient/client to other healthcare professionals.
  • Prescribe therapeutic home programs as indicated by the results of the examination, utilizing a variety of instructional methods for patient/clients and/or family members.
  • Attend to critical information in a dynamic and stimulating environment.

V.  Affective

  • Possess the emotional health required for the full utilization of his or her intellectual abilities, the exercise of good judgment, the prompt and safe completion of all responsibilities attendant to the diagnosis and care of patients and families.
  • Maintain mature, sensitive, and effective relationships with patients, students, faculty, staff and other professionals in academic and clinical environments including highly stressful situations.
  • Possess the emotional stability to function effectively under stress and to adapt to an environment that may change rapidly without warning and/or in unpredictable ways.
  • Understand that his or her values, attitudes, beliefs, emotions, and experiences affect his or her perceptions and relationships with others.
  • Possess the ability to reason morally and practice physical therapy in an ethical manner.
  • Demonstrate willingness to learn and abide by professional standards of practice.
  • Possess attributes that include compassion, empathy, altruism, integrity, honesty, caring, fairness, responsibility, concern for others, accountability, interest, tolerance and motivation.
  • Interact effectively with individuals, families, and groups from a variety of social, emotional, cultural and intellectual backgrounds in a variety of settings.
  • Acknowledge and respect individual values and opinions in order to foster harmonious working relationships with colleagues, peers, and patients/clients.
  • Demonstrate the ability to be self-reflective.
  • Maintain general good health, self-care, and hygiene in order not to jeopardize the health and safety of self and individuals with which one interacts.
  • Possess adequate endurance to tolerate physically, emotionally, and mentally taxing workloads and to function effectively under time constraints, proactively making use of available resources to help maintain both physical and mental health.
  • Accept suggestions and criticisms and, if appropriate, to respond by modifying their behavior.
  • Demonstrate appropriate assertiveness, delegate responsibilities, and function as part of a healthcare team.

References:

American Physical Therapy Association. Minimum Required Skills of Physical Therapist Graduates at Entry Level. BOD G11-05-20-449.

American Physical Therapy Association. Guide to Physical Therapist Practice. Alexandria, Virginia, 2008.

AASIG Technical Standards, Essential Functions Document. Section on Education, September 1998.

Ingram, D. (1997). Opinions of Physical Therapy Program Directors on Essential Functions, Physical Therapy, 77(1).

Portions of this document are adopted from University of the Sciences in Philadelphia, PA Essential Functions document, with permission. Sacred Heart University Physical Therapy faculty gratefully acknowledges the University of the Sciences in Philadelphia.  

Acknowledgement

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