Supervision, Delegation, and the Physical Therapist–Physical Therapist Assistant Relationship
Domain 2 tests how responsibility moves - and how it does not move - when a physical therapist delegates. Most missed items involve who may perform which act at which supervision level, not vocabulary.
The delegation chain
- The PT holds the duty of care for every patient whose care is delegated; the PTA functions as an extension of the PT's plan, not as an independent clinician.
- Delegate only tasks within the PTA's education and training, consistent with the plan of care, and only when the required supervision is in place.
- Unlicensed aides may perform non-skilled, non-treatment work: transporting patients, clerical tasks, cleaning equipment. They may not apply interventions or alter exercise parameters.
Reserved to the PT
- Initial examination and evaluation, establishing and revising the plan of care, re-evaluation, and discharge decisions remain with the PT.
- Know both supervision levels used in Kentucky: direct supervision (the supervising PT is on the premises and immediately available) and general supervision (the PT is available by telecommunication and sees the patient at intervals the regulation requires). Facility policy and payer rules can add requirements on top of the licensure minimum.
Worked example
Mid-session, a PTA finds increased knee effusion and wants to add a new modality. Reasoning: the PTA may adjust within the existing plan and must report the change, but adding a new intervention changes the plan of care, which only the supervising PT may do. The PTA documents the finding and contacts the PT before proceeding.
Traps
- Believing supervision always means the PT is in the building.
- Thinking the PTA's signature shifts primary legal responsibility to the PTA.
- Letting a student or aide treat "just this once."
- Assuming a co-signature cures supervision that never actually occurred.