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The Roles of Occupational Therapy, Physical Therapy, and Speech/Language Pathology in Primary Care
Lauren Peranich, Kristen B. Reynolds, Shirley O’Brien, Joni Bosch, and Tamara Cranfill

ABSTRACT Occupational therapy, physical therapy, and speech language pathology services may be of significant help to patients of nurse practitioners (NPs) in primary care. NPs should be aware of the depth andbreadth of services offered by these colleagues, and consider early referral to them. This article describes the different rehabilitation disciplines and some of the ways in which their services may benefit patients. Keywords: occupational therapy, physical therapy, primary care provider, speech/language pathology © 2010 American College of Nurse Practitioners

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The Journal for NursePractitioners - JNP

Volume 6, Issue 1, January 2010

hat do a 73-year-old woman with age-related macular degeneration, a 35-year-old woman with the hypermobility form of Ehlers-Danlos syndrome, and a 6-year-old boy who has problems paying attention in school but has not benefited from stimulant medication have in common? They may all benefit from a referral to an occupational therapist (OT),physical therapist (PT), or speech-language pathologist (SLP). Nurse practitioners (NPs) should be aware of the breadth and depth of services offered by practitioners in other disciplines, as they may be able to contribute to health and wellness in our patient populations. Just as NPs believe early identification and treatment improves outcomes, early referral to our colleagues in OT, PT, and SLP mayimprove outcomes as well. Our colleagues are autonomous primary care professionals; their services need not be prescribed or supervised by another professional. They may even be a source of referral for our services, as they identify needs in their own patient populations.

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OCCUPATIONAL THERAPY Origin and Education The National Society for the Promotion of Occupational Therapy, now calledthe American Occupational Therapy Association, was founded in 1917.1 Certification in occupational therapy requires a post-baccalaureate degree (either a master’s or a doctorate) from an accredited college/university by the Accreditation Council of Occupational Therapy Education (ACOTE).2 Coursework includes anatomy, neuroscience, psychology, kinesiology, and courses that focus on schoolsystems/pediatrics, mental health, physical disabilities, health care delivery systems, management, health promotion, and research. To practice as an occupational therapist, graduates must pass a certification examination administered by the National Board of Certification in Occupational Therapy (NBCOT). OTs are regulated in all 50 states, required to hold licensure in 48 states, and have specificrequirements by state licensure for continuing competency.3 OTs are primarily responsible for evaluation, intervention, and discharge of a client needing services. Occupational therapy assistants (OTAs), who are graduates of associate degree programs, gather evaluation data and perform intervention under the supervision of an OT.4 Occupational therapists are known for their problem-solving abilities incontextual adaptation fostering client-centered engagement in valued activities for individuals and populations.
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Childhood OTs work with children in acute and long-term rehabilitation, hospital, outpatient, home health settings, and in the school system. Children with sensory integrative disorders such as tactile or auditory hypersensitivity may benefit from an early referral to OTeither through the school system or private outpatient services. Sensory integrative disorder can hinder a child’s performance at school or in the home, due to the child’s inability to appropriately regulate his or her proprioceptive, vestibular, and tactile sensory systems. It is sometimes confused with ADHD.5 OT services benefit children with autism spectrum disorders. In the school system,...