Scope of Practice, Supervision, and Delegation: PT and PTA Roles
The core division of labor
The PT performs the examination, evaluation, diagnosis, prognosis, and establishes and modifies the plan of care. The PTA implements selected interventions within that plan and reports back. The PTA does not evaluate, does not perform initial examinations, does not establish or independently change the plan of care, and does not perform acts reserved to the PT. Aides and unlicensed personnel may assist with non-clinical tasks but may not provide skilled physical therapy.
Supervision levels
Arkansas law and Board rules define supervision expectations that vary by setting and by the PTA's role. Candidates should understand the concept of direct versus indirect supervision: direct generally means the supervising PT is physically present or immediately available; indirect means available by communication. The key exam skill is recognizing that supervision is not a single fixed rule-it depends on the setting, the patient's condition, and the governing rule. When a question gives a specific setting, look for the answer that matches the required supervision level rather than a generic answer.
Delegation principles
Delegation must be consistent with the plan of care, the delegatee's competence, and patient safety. A PT cannot delegate an act that requires the PT's professional judgment. Traps include: delegating evaluation to a PTA; delegating to an aide a task that requires skilled judgment; and assuming that "supervision" means the PT must always be in the building.
Worked rule of thumb
Ask three questions: Is the task within the delegatee's scope? Is it in the plan of care? Is the required supervision present? If any answer is no, the delegation is improper.
Trap to avoid
Students often overestimate PTA independence. When in doubt, the PTA's role is implementation under direction-not autonomous practice.