In 1969, there was cause to celebrate for physical therapist assistants (PTAs), as 15 students graduated from the first PTA programs at Miami Dade College in Florida and St Mary's Campus of the College of St Catherine in Minnesota. Just 2 years earlier, these PTA programs began preparing students to fill a need in the physical therapy community-that of an assistant to the physical therapist.

Over the years, the road for the PTA hasn't been completely smooth; few in physical therapy will deny that. But during the past 35 years, PTAs have remained an important part of the field and increasingly have become accepted for their role and contributions. That is reflected in PTA membership in APTA, which has grown from 52 in 1971 to 4,501 today.

To see how far the PTA has come, we've got to go back and see how it all began.

The Need for PTAs

According to David Emerick Sr, PTA, president of the National Assembly of PTAs, people began thinking about the concept of the PTA as far back as the 1940s. By the 1960s, however, a real need emerged as there were too few physical therapists to fill the growing demand. Rather than allow other professions or organizations to pick up the slack, physical therapists began exploring ways of acquiring assisting personnel. At the time, many physical therapists utilized aides, but they needed something more-namely assistants with education specific to physical therapy.

In the early to mid-1960s, support people already were being trained by pioneers such as Viola Robins, PT, at Rancho Los Amigos Hospital in California and by Charles Dorando, PT, at St Joseph's Mercy Hospital in Michigan. But there were no official programs-yet.

In the 1964 APTA House of Delegates, members of the California Chapter introduced a resolution to designate a committee to explore the use of nonprofessional personnel. Helen Blood, PT, EdD, FAPTA, who made the motion, remembers it well. "A group of us had done some research and realized that many of the tasks that people were doing did not require a lot of professional education," Blood says. After heated debate in the House, the motion passed, and Blood became the chair of the Ad Hoc Committee to Study the Utilization and Training of Nonprofessional Assistants. Joining her on the committee were Dorando, Thelma Holmes, PT, Beth Phillips, PT, and Martha Wroe, PT, MA, FAPTA.

Blood says the committee looked at the feasibility of the PTA and considered what the PTA's relationship would be to the physical therapist, the tasks they would perform, the training they should have, who should be responsible for that training, and where the training would be conducted.

"The whole issue was extremely controversial," she recalls. There even was discussion as to whether the position should be called a physical therapist assistant or a physical therapy assistant.

In 1967, the Committee submitted a report to the House of Delegates with a policy statement called "Training and Utilization of the Physical Therapy Assistant," which set policy on education, supervision, function, and regulation for the PTA. (Years later, the name of the physical therapy assistant would be changed to physical therapist assistant to make it clear that PTAs were assisting the PTs.)

Also in that year, Miami Dade and St Mary's began educational programs for PTAs. In 1969, Barbara Bradford, PT, MPH, the first director of the St Petersburg program, presented a paper at APTA's Annual Conference in San Francisco. In it, she said, "[W]e are educating technicians; we are not training physical therapy assistants. In other words, we are not just teaching skills, which is what training implies. We are attempting to afford students the opportunity, through planned learning experiences, to gain knowledge and understanding of basic principles and theories underlying the skills which are also necessary to their practice as technicians under the supervision of a registered physical therapist."

Not everyone, though, was pleased with the PTA position. Some physical therapists at that time were concerned that the PTAs wanted to replace them. Before guidelines were in place, some PTs were unsure how to utilize their PTAs.

Patti Evans, PT, MA, now CEO of APTA's California Chapter, recalls an instance when she was APTA's assistant director of education. After a presentation, someone stood up and said, "Now that you've created the PTA, what is left for me to do?" Evans replied, "If that's what you think all of physical therapy is, then the profession is dead, and we should just stop agonizing about it now." Then she walked out.

"I was young," she laughs. "I'm a little more diplomatic these days." But her point was well-taken.

Sharon Yap, PTA, ACCE at Indian River Community College, recalls that when she first became a PTA in 1976, there were gray areas within the PTA's role and his or her responsibilities. "It's become much more defined within the Association over the years," says Yap. "I've always felt comfortable as a PTA."

Joining the Club

PTAs were granted temporary membership in APTA in 1970. But they wanted permanent membership. In 1973, the House of Delegates voted on whether to approve permanent membership. "I can still see that room where they voted," Patti Evans recalls. "We were in Houston, Texas. Barb Bradford and her students were there, and they had lobbied the delegates all night long. They wanted to be a part of this club."

The House of Delegates passed the motion-by a margin of one vote-and PTAs were admitted as Affiliate members.

Forming a Roundtable

As more community and technical colleges began offering PTA programs, the program directors formed the Physical Therapist Assistant Education Group (PTAEG) to share information on everything from textbooks and clinical education to administrative issues and concerns. With a grant from the Kellogg Foundation, the group, led by Bradford, held its first meeting in St Petersburg.

The group continued to meet every couple years. Eventually, as both the group and its areas of interest grew, it began to meet at APTA conferences. Today, the group, now known as the PTA Educators Special Interest Group of the Education Section, continues to meet and share information.

From Affiliates to Assemblies

In 1983, Cheryl Carpenter-Davis, PTA, MEd, along with Virginia (Bunny) May, PT, MS, PCS, and Tricia Garrison, PTA, led a group of PTAs in the quest for an organized voice. "We said that just as much as some of the APTA sections have special interests, we have special interests, too," says Carpenter-Davis. They formed the Affiliate Special Interest Group and began establishing regions and distributing newsletters.

The APTA Board soon formed the Task Force on Organizational Structure, and Carpenter-Davis participated. In 1989, the House of Delegates amended the bylaws approving a new component-Assemblies. The Affiliate Assembly was formed, with Carpenter-Davis as its first president, giving PTAs a formal voice.

The Affiliate Assembly continued until 1998 when-after much analysis and discussion--the boards of the Affiliate Assembly and APTA arrived at the structure for the National Assembly (NA), a body solely for PTAs. According to Chris Junkins, PTA, ATC, vice president and delegate of the National Assembly, the NA came about to further unify the voice of the PTA. Prior to this point, PTAs could be members of APTA, without being members of the Affiliate Assembly, as to do so they had to pay separate dues.

"We decided that the structure wasn't working as well as it could for all PTAs who were members," says Junkins. "They reformed the structure...Therefore, all PTAs who were members of the APTA also automatically were members of the National Assembly.

"We're definitely working for the profession as a whole. But there are certain issues that may affect the PTA and not the PT, and [the NA] just gives us a better venue to voice them," he says.

Today, the NA has two non-voting delegates-Junkins and John Linberger, PTA-who attend the House of Delegates. Like Section delegates, they can make motions, speak to motions, lobby delegates to persuade their vote on specific issues, but they cannot vote on any motion.

Within the NA is the Representative Body of the National Assembly (RBNA). In the RBNA, PTAs discuss issues related to motions coming before the House and decide which to support or oppose, based on how the motions will affect the PTA and the profession. They also may develop their own motions.

The RBNA annual meeting usually is held the Sunday just prior to the APTA Annual Conference and Exposition and the House meeting. This allows the PTAs to inform their delegates of the viewpoints or motions they wish to bring before the House.

Advanced Recognition and Other Successes

Another step for PTAs, passed by the House last year, is RC 27-03, which states that "Career development is essential for the physical therapist assistant and includes clinical experience, continuing education, increased skill proficiency, clinical mentoring, and the recognition thereof."

As for PTA education, although the entry-level degree for the PT is moving toward the DPT, the educational program for the PTA has remained a 2-year associate's degree. "Some people think as one degree program progresses, the other needs to progress in proportion. That's not really the case," says Emerick.

The need for degree augmentation should be grounded in a concomitant change in the role and scope of work of the PTA in physical therapy. At this time, evidence does not support an expansion or change in the scope of work of the PTA. Nevertheless, as Bradford points out, quite a lot of material is covered in the PTA programs today. "I admire the students who go through these 2-year programs," she says. "It's very intense."

PTAs have made countless strides in the last 35 years. Since 1992, they've been able to hold offices, except for president, on the state and national levels of APTA. They can voice their concerns together through the National Assembly. But these successes don't mean that everything has become easy.

When the Balanced Budget Act was passed, PTAs were hit hard, just as were PTs. Enrollment in PTA schools plummeted, falling from 10,842 in 1997-1998 to 5,693 in 2001-2002. The number of PTA graduates, which had risen steadily from 1,698 in 1989 to 5,455 in 1999, fell to 3,390 in 2001. The future appeared uncertain. Some PTA programs even closed.

But prospects are improving. "Now in 2003, [we're] beginning to see the enrollment start to turn around," says Evans.

And, over the years, PTAs certainly have proven themselves, says Brad Thuringer, PTA, BS, treasurer of the NA. "As physical therapist assistants, we have much to be proud of and to celebrate, but our celebration belongs not only to ourselves but also to our physical therapist colleagues, to the profession of physical therapy, and to APTA"

Most important, PTAs continue to play a crucial role in the physical therapy field.

"Not everybody can be the chef in the kitchen; you need other people to help prepare the meal," says Emerick. "We're part of a team. [We help] the PT.

"It's the trust in working together that makes it successful," he says.

Michele Wojciechowski is a freelance writer in Baltimore, Maryland.

An Employment Profile of PTAs

APTA's most recent survey of member and non-member PTAs designed to assess trends in employment patterns included the following findings:

• More than eight of 10 respondents (84.4%) were female. The average age of respondents was 37.7.
• The largest percentage of PTAs (30.6%) worked in private outpatient offices or group practices. Other practice settings included acute care hospitals (18.3%), health system or hospital based facility or clinic (18.3%), and SNF/ECF/ICF (14.7%).
• A relatively small percentage of respondents (12.7%) indicated that they currently were not working as PTAs. Older individuals were significantly more likely not to be working for any reason. Males and younger respondents (those between 21 and 30) were more likely to be employed on a full-time basis.
• Of those who were unemployed because they lost jobs, the largest percentage (61.9%) were employed in a skilled nursing facility at the time of separation.

APTA Education Program Snapshot

Recent data provide a picture of PTA educational programs and the transition they are undergoing.

• As of October 2003, there were 245 accredited PTA programs. This is down from 252 in 2002 and 280 in 2000.
• In 2002, the average annual tuition for accredited PTA programs at public schools was $2,054 and at private schools was $11,857.
• In 2002, 54% percent of accredited programs offered the traditional curricular model, which begins with basic science, followed by clinical science and then by physical therapy science.
• Nearly 66% of the PTA programs use internet augmentation for some of their courses, with an average of 52% of courses in any program using internet augmentation.
• The percentage of Caucasian PTA students has fallen from 93% in 1995-1996 to 75% in 2001-2002. During the same period, the percentage of Hispanic students has risen from 3% to 9% and the percentage of African American students has risen from 2% to 11%.
• Females made up 78% of PTA program enrollment in 2001.

Source: 2002 Fact Sheet, Physical Therapist Assistant Education Programs. Accessed Nov. 12, 2003.