Department of Consumer Affairs, Board of Occupational Therapy

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Advanced Practices Frequently Asked Questions

The Board receives numerous questions from occupational therapists regarding advanced practice. Listed below are some of the most frequently asked questions we hope will be helpful. We will update this section on a regular basis as questions are received. If you have a specific question, you may e-mail the Board at cbot@dca.ca.gov. For tips on completing your advanced practice application and portfolio, please access the Advanced Practice link from our home page and click on Application for Advanced Practice Certification.

Frequently Asked Questions Regarding Advanced Practice

Q. Is icing considered a modality when performed in the context of sensory stimulation?

A. OT basic training includes sensory stimulation techniques that include icing used for facilitation/inhibition. When used in this capacity, it is not considered a modality requiring advanced practice certification.

Q. Is biofeedback used with someone who has difficulty swallowing advanced practice?

A. Surface biofeedback measures rather than alters tissue response and is not considered to be a physical agent modality.

Q. If I use electrical stimulation (Vital Stim) or ultrasound to improve and facilitate swallowing do I need advanced practice certification in physical agent modalities in addition to dysphagia even though I received training from Vital Stim?

A. Yes

Q. Is diet modification advanced practice?

A. Bolus control assessment begins in the oral phase of swallowing (oral, motor is entry level practice). Food texture modifications and positioning are used to recognize the potential for aspiration in the pharyngeal phase. It is appropriate for the entry-level therapist to make oral intake texture/consistency recommendations, position changes, and oral motor interventions. However, when aspiration risk is suspected, it is incumbent upon the therapist to refer the patient to an appropriate healthcare professional.

Q. What part of the bedside evaluation is considered to be advanced practice?

A. OTs provide clinical feeding evaluations to screen patients for aspiration risk. Screenings occur in a variety of settings including acute hospitals, extended care facilities, community based treatment units and facilities. The evaluation can include determination of bolus control and recognition of aspiration signs. Oral intake consistency recommendations, position changes, and oral motor interventions are methods that can be used to improve feeding ability or determine aspiration risk. When risk is suspected, it is incumbent on the therapist to refer the patient to the appropriate provider. Further evaluation of aspiration risk and development of an intervention plan is considered advanced practice, requiring advanced practice certification.

Q. What kind and how much supervision is required for OTs who are in the process of meeting the experience requirements for an advanced practice?

A. The Board will be developing regulations that address this issue. Until they take effect, the Board suggests that experience be gained in a structured and progressive mentoring program that has the following components: (1) Ongoing mentoring throughout the training process; (2) Intensity and degree of mentoring should be appropriate for the skill level of the therapist; and (3) Documentation of mentoring should include meeting dates, attendees, and review of the learning plan.