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By Teresa McUsic

They may look like a bowl of alphabet soup behind many physical therapists’ names, but PTs are increasingly finding that adding specialty designations can increase their patient base and enable them to explore cutting-edge therapies.

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PT News Feature Continued

The course work for different certifications varies considerably, from a weekend to several years. The cost can be several hundred or several thousand dollars. The pass rate on some tests can be as low as 50%. But with a specialty credential under his or her belt, a PT can distinguish his or her facility, become more marketable and even garner a salary increase.

Take, for example, certified hand therapists, who are in “huge demand,” according to Cindy Johnson, PT, DPT, CHT, a senior instructor at the University of Colorado Denver. “I get offers on a daily or weekly basis. You will never be wanting for a job,” she said.

ABPTS offerings

While most PTs are not pursuing specialty credentials for financial gain, certification can increase credibility in the eyes of referral sources, John Lowman, PT, PhD, CCS, chairman of the American Board of Physical Therapy Specialties, said. “It’s nice to have your own niche as a PT,” he said. “It’s important to have advanced competency in that area.”

ABPTS, an arm of the American Physical Therapy Association, oversees eight specialty certifications (see sidebar), and discussions are under way for adding acute care, oncology, occupational health and wound care, Lowman said. Almost 13,000 PTs are certified in ABPTS specialties, with 1,400 of those designations earned in 2012.

A minimum of 2,000 hours of clinical experience is required to sit for the exams. Tools are available to help assess readiness for the exam, and ABPTS has the ability to connect therapists in a geographic location and specialty area via email to form study groups. The application review fee is $500 for APTA members ($845 for nonmembers) and the exam costs $800 for APTA members ($1,525 for nonmembers).

About half of employers cover some or all of the costs associated with obtaining clinical specialization, Lowman said.

Other entities also have created certification programs for therapists, which generally include continuing education units recognized by APTA and other professional associations.

Hand therapy

Although the first exam for a certified hand therapist was administered in 1991, PTs have been slow to pick up the specialty, making up only 14% of the almost 5,400 physical and occupational therapists certified in this area, said Johnson, who also is president of APTA’s Hand Rehabilitation Section.

Johnson sees more PTs entering the field, however, as new research suggests a strong link between the upper extremity and hand conditions. “Research is coming out stating you can’t treat the hand without treating the spine,” she said. “That is not part of an OT practice, but it is part of a PT practice.”

Certification for the specialty is administered by the Hand Therapy Certification Commission ( In order to sit for the exam, therapists must have completed at least 4,000 hours of direct practice in hand therapy. “The certification has high standards,” Johnson said. “The test is very difficult with only a 50% pass rate.”

HTTC offers a number of prep courses. Other courses can be taken during section meetings with APTA or through the American Society of Hand Therapists and the Hand Rehabilitation Foundation, Johnson said.

In 2011 CHT salary surveys by the commission, 96% of those polled said the CHT had strengthened their position in the job market, and 76% reported an increase in base pay, averaging about 15%.

Cost for the four-hour exam is $500 for an online version of the test and $600 for a paper version. CHTs are required to demonstrate continued professional development and competency by recertifying every five years.

Johnson said many clinics will pay for the continuing education and CHT test for their therapists in order to expand their scope of practice. “There is a lot of flexibility with having a PT with a CHT on staff,” she said. “They can treat a blended case load so you can keep that PT much busier.”

Stroke rehab

About 60 PTs, PTAs, occupational therapists and occupational therapy assisants are scheduled to sit this month for the first exam of the Certified Stroke Rehabilitation Specialist (CSRS) offered through the National Stroke Association and Neurorecovery Unlimited.

The new certification requires 32 hours of coursework through four seminars, but that will be trimmed to 26 hours in 2014, according to Stephen Page, PhD, OR/L, FAHA, co-producer of the CSRS program material and seminars and associate professor at Ohio State University’s School of Health and Rehabilitation Sciences.

Therapists are jumping at the chance to earn this designation, which focuses on material not generally covered in physical therapy higher education, Page said. “We had a waiting list of dozens of people for the first course in Chicago,” he said. “Some asked if they could sit on the floor.”

The designation is designed to address the growing population of stroke patients by allowing therapists to tap into the expanding knowledge of rehab for this patient group, Page said. “There was a need for a concentrated, explicit, interdisciplinary approach to this care,” he said.

Areas covered in the course work, which is 40% lab time, include gait and balance, modified constraint-induced therapy and management of the hemiplegic shoulder.

Two more CSRS seminars are scheduled this year in Salem, N.H., and Seattle. Cost is $200 per course and each course offers eight hours of continuing education units. Rehab Lab ( also will offer the courses to healthcare facilities on site.

Cost for the certification test is $150 for NSA members ($175 for nonmembers). To maintain certification, 16 hours of continuing education specific to stroke are required every two years, and there is a recertification fee of $75 for NSA members ($100 for nonmembers).

Aquatic therapy

The Aquatic Therapy and Rehab Institute ( in Lutz, Fla., has offered the ATRIC designation for therapists in aquatic therapy and rehabilitation for more than a decade, according to Melissa Lewis,PT, MPT, ATRIC, AEA, a staff therapist at Kinetic Institute Physical Therapy in Sanford, N.C. To date, 785 therapists, including PTs, OTs, speech and others have become certified.

Lewis said she received the training and certification as part of her exercise physiology degree at West Virginia University in Morgantown. “I’ve always loved the water,” she said. “When I got involved in aquatic therapy, I was amazed at how much people could do in the water. It can help about anything.”

Lewis said the certification helped her land her first job treating patients in the Wounded Warriors program while working as the aquatic therapy section chief at Walter Reed Army Medical Center, Bethesda, Md. “I worked with patients with traumatic brain injury, stroke, amputations and burns,” she said. “It was easier to work in the water with patients with multiple traumas. You could work more than one functional activity at a time.”

Eligibility to take the ATRI certification exam includes completing 15 hours of education in aquatic therapy, rehabilitation or aquatic therapeutic exercise education. Therapists can complete this education through hands-on or online courses. Candidates are encouraged to have experience working in aquatic therapy and rehab before taking the exam.

Lewis said PTs with the certification have been able to secure new jobs and earn raises at their current jobs. Some employers even require the certification, she said.

The three-hour exam costs $255. Ten hours of continuing education is required each year for certification renewal.


The Lymphology Association of North America ( administers the test to become a certified lymphology therapist.

“My clinic paid for it,” said Linda Boyle, PT, DPT, CLT-LANA, clinical team leader of oncology at Lehigh Valley Health Network, Allentown, Pa., and a LANA board member. “But we have many therapists taking the exam and paying for it out of their own pockets.”

Boyle said the patient group for breast and lymph node cancer is large and growing, and survivors seek out PTs trained in this area. “Every single one of my patients comes in and is motivated,” she said.

Getting reimbursed by Medicare and private insurers for lymphology treatment has been difficult, but that is changing with new documentation and coding, Boyle said.

Requirements to take the exam include 135 classroom hours of complete decongestive therapy course work and hands-on training. There are six schools teaching LANA courses, many of which are offered on weekends, Boyle said. The certification is available to a variety of healthcare professionals, but the majority who sit for the exam are PTs and PTAs, Boyle said.

“It would make a job opportunity much more available to a person who had this in their back pocket,” she said. “But there’s not an increase in salary with the certification at this time because we don’t have APTA certification.”

The test costs $375. Recertification can be obtained by taking the test again or providing proof of continuing education courses.


Astym ( is a soft tissue treatment therapy certification for PTs, PTAs and OTs, said Thomas L. Sevier, MD, FACSM, medical director at Performance Dynamic, which developed the treatment.

The evidence-based therapy was developed through a decade of collaboration with scientists, physicians and therapists at Ball Memorial Hospital at Ball State University in Muncie, Ind., and Midwest HealthStrategies, Sevier said.

“We spend 10 years working on a way we can stimulate soft tissue to regenerate,” he said. The treatment also works on reducing scar tissue.

The Astym treatment stimulates the tissue and allow the body to start laying down new, healthy collagen, Sevier said. Then the therapist works with the patient on stretching and strengthening to condition the new collagen for the tasks or sports of the patient. “PT is the perfect place for the Astym protocol because a PT can then follow up with proper functional exercises and movement patterns to mimic their lifestyle,” Sevier said.

Astym can be used to treat conditions such as plantar fasciopathy, carpal tunnel syndrome, nonradicular back pain and patellar tendinosis. Athletes, both professional and amateur, use the treatment to address performance problems, Sevier said.

The first test for Astym certification was in 2000. Since then, about 3,000 therapists have been certified, 80% of whom are PTs, Sevier said.

“People get Astym to basically get more patients,” he said. “The certification can help get you a better patient mix.”

Certification requires three days of coursework in upper extremity and shoulder (15.75 CEUs) and lower extremity, pelvis and lumbar (8 CEUs). Cost for the courses, exam and a lifetime of educational and marketing materials is $5,000, Sevier said.

Teresa McUsic is a freelance writer.

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