Supervision, Delegation, and Physical Therapist Assistant Roles
What the exam tests
This domain tests who may perform which task, how much supervision a PTA needs, and what may be delegated to aides. The exam favors scenarios where a PTA or aide is asked to do something outside delegated treatment.
Core rules
- The PT is responsible for the initial examination, evaluation, diagnosis, prognosis, plan of care, and discharge. These are not delegated to a PTA.
- A PTA may perform selected interventions and collect data within the plan of care, under PT supervision. The PTA may not independently change the plan, perform an initial evaluation, or make a discharge decision.
- Supervision must be appropriate to the patient and task; the PT must be available for consultation and must review the PTA’s care. The Board’s rules define supervision levels, so know the difference between on-site/direct supervision and indirect supervision.
- A physical therapy aide may perform non-skilled, non-treatment tasks such as transporting patients, cleaning equipment, and clerical work. An aide may not apply modalities, perform manual therapy, or provide skilled exercise instruction.
- Delegation requires clear instructions, demonstrated competence, and documentation.
Worked example
A PTA is treating a patient with a knee replacement. The patient reports new calf pain and swelling. The PTA should stop, assess within their scope, notify the supervising PT promptly, and document the finding and communication. The PTA should not independently diagnose a blood clot or change the plan to “work through” the pain. The PT must determine whether referral is needed.
Traps
Letting a PTA complete an initial evaluation; allowing an aide to apply a modality; assuming “supervision” means the PT must always be in the room; failing to document the PT-PTA communication.