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A physical therapist who is licensed to practice in the U.S. is eligible to become a clinical electrophysiologic certified specialist (ECS).

Once certified, PTs may perform electromyography (EMG) and nerve conduction velocity (NCV) studies that test for nerve entrapment and myopathies. Pretest diagnoses typically include cervical or lumbosacral radiculopathies; polyneuropathies as seen in alcoholics, diabetics, and patients with poor nutrition; myopathies; and entrapment syndromes such as cubital tunnel syndrome, carpal tunnel syndrome, and peroneal and radial nerve entrapments.

There are currently 117 PTs who are board-certified by the American Board of Physical Therapy Specialties in the clinical specialty of electrophysiology. Rocky Mountain University of Health Professions (RMUoHP) in Provo, Utah, offers a Doctor of Science degree in clinical electrophysiology, where students are comprised of PTs, OTs, physicians, nurses, and physician assistants who meet the basic requirements for entry.

For PTs, this means a master’s or doctorate degree. “We usually have a small group of six or seven students. It is a rigorous program that combines didactic classroom study, lab practice, and a full dissertation,” says Mike Skurja, PT, DHSc, ECS, who is the co-graduate program director of clinical electrophysiology at the university. “It takes so much time to develop expertise that generally only a small group of practitioners goes into this doctoral program.”

PTs who are interested in pursuing board certification in ECS can find the necessary competencies in “Clinical Electrophysiologic Physical Therapy: Description of Specialty Practice,” available on the APTA Web site. The 61-page document covers the required subject content for the clinical specialist examination, including anatomy, neuroscience, physiology, clinical science, critical inquiry, and professional roles and responsibilities. Practice expectations in patient-client management are divided into five sections: examination, evaluation, diagnosis, prognosis, and interventions.

Scope of practice

“EMG has been considered by most states to be within the scope of practice for physical therapists,” says Rick Nielsen, PT, DHSc, ECS, whose practice consists exclusively of clinical electrophysiology testing. Nielsen’s interest in nerve and muscle physiology began when he was in high school, and after graduating with a bachelor’s degree in physical therapy from the University of Utah in Salt Lake City, he joined the U.S. Navy to learn firsthand about treating war-related injuries. While in the service from 1975 to 1994, he and Skurja, his boss, were sent to universities in Washington and California to receive master’s degrees that qualified them to become EMG service providers for the Navy.

“At that time, the only mechanism for credentialing or licensing PTs for EMGs was the state of California. Mike and I took that exam in the early 1980s,” Nielsen says. “EMG and NCV are a good way of assessing the integrity of the neuromusculoskeletal system. It seemed a good fit for me with my interest.” After leaving the Navy, Nielsen and Skurja provided EMG training seminars for health professionals, later organizing Rocky Mountain University of Health Professions in Salt Lake City in 1998.

Robert Sellin, PT, DSc, ECS, had already been board-certified in ECS for 10 years when he applied to the Doctor of Science program at RMUoHP. “Even with that much experience and practice, the program easily doubled my knowledge and skill level. The combination of clinical and theoretical instructors and the interaction with talented students made for an awesome learning environment,” he says.

Despite his enthusiasm and dedication to his full-time EMG practice, Selling acknowledges that it is a difficult specialty to break into due to a relatively low number of trained instructors.

Hot button issue

In order to administer EMG and NCV tests, PTs must depend on referrals from MDs and DOs. “The vast majority of PTs who perform electrodiagnostic testing have an advanced degree or very expensive training. The testing performed by PTs in many cases is much better than by physicians. As a PT, I can provide my patients [with] a more comprehensive service,” says Dimitrios Kostopoulos, PT, PhD, DSc, MCMT, who practices in Garden City, N.Y. Nonetheless, he reports, “On more than several occasions, I have had to defend the quality of my testing.”

Although most states consider EMG services to be within a PT’s scope of practice, some enforce restricted options due to organized opposition by physicians’ organizations. “The main opposition force for PTs doing EMG tests is the American Academy of Neuro-Electrodiagnostic Medicine. They are trying to convince legislation and third-party payors that the practice of EMG should be restricted to those who practice medicine,” Nielsen says.

“Since a PT can only do EMGs and nerve studies upon referral from a physician, that means you have to have a physician refer a patient to you for a study. If I was incompetent, why would a physician send me patients?” Skurja questions.

Michael Dempsey, DO, a physiatrist in New York, agrees. “I have no opposition to referring a patient for EMG or NCV studies as long as [the PT] has the proper training and certification,” he says.

Elaine Armantrout, PT, DSc, ECS, is the president of the American Congress of Electroneuromyography (ACE), a relatively new organization based in Orem, Utah, whose mission is to promote the practice of NCV and EMG studies among PTs by providing the highest quality standard of care to patients and clients. She and many members of this fledgling organization are members of the APTA.

In a position paper discussing the scope of practice and legislative issues, the ACE quotes findings from a joint report issued by the Federation of State Boards of Physical Therapy, National Association of the Boards of Pharmacy, National Board for Certification in Occupational Therapy, and National Council of State Boards of Nursing that states, “Overlap among professions is necessary.” Armantrout agrees.

“The bottom line is to have cost-effective best practice, so the scopes of practice have to overlap. If you are competent, the service is beneficial, and it keeps costs down. Where’s the beef?” she says.

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Laurie Nadel, PhD, is a medical writer for the Gannett Healthcare Group. To comment on this story, send e-mail to pteditor@gannetthg.com.

© Copyright 2009 Gannett Healthcare Group