Advanced Physical Therapy

Rehabilitation counselors help people with emotional and physical disabilities live independently. They work with clients to overcome personal, social, and professional effects of disabilities as they relate to employment or independent living.

Rehabilitation counselors typically do the following:

• Provide individual and group counseling to help clients adjust to their disability
• Evaluate clients' abilities, interests, experience, skills, health, and education
• Develop a treatment plan in consultation with other professionals, such as doctors, mental health counselors, and psychologists
• Create treatment plans based on clients' values, strengths, limitations, and goals
• Arrange for clients to get service, such as medical care or career training
• Help employers understand the needs and abilities of disabled people
• Assist clients in creating strategies to develop their strengths and overcome their limitations
• Locate resources, such as wheelchairs or computer programs, that help clients live and work more independently
• Monitor clients' progress and adjust the treatment plan as necessary
• Advocate for the rights of people with disabilities to live in the community and work in the job of their choice

Rehabilitation counselors help people with physical, mental, emotional, or social disabilities at various stages in their lives. Some work with students to develop strategies to live with their disability and to move from school to work. Others help veterans cope with the mental or physical effects of their military service. Still others help elderly people adapt to disabilities developed later in life due to illness or injury. Because rehabilitation counselors deal with employment issues, they typically work with older students and adults rather than young children.

Some rehabilitation counselors work in private practice. These counselors must spend time marketing their practice to prospective clients and working with insurance companies and clients to get paid for their services.

Physical therapists, sometimes referred to as PTs, help people who have injuries or illnesses improve their movement and manage their pain. They are often an important part of rehabilitation and treatment of patients with chronic conditions or injuries.

Physical therapists typically do the following:

• Diagnose patients' dysfunctional movements by watching them stand or walk and by listening to their concerns, among other methods
• Set up a plan for their patients, outlining the patient's goals and the planned treatments
• Use exercises, stretching maneuvers, hands-on therapy, and equipment to ease patients' pain and to help  them increase their ability to move
• Evaluate a patient's progress, modifying a treatment plan and trying new treatments as needed
• Educate patients and their families about what to expect during recovery from injury and illness and how best to cope with what happens

Physical therapists provide care to people of all ages who have functional problems resulting from back and neck injuries; sprains, strains, and fractures; arthritis; amputations; stroke; birth conditions, such as cerebral palsy; injuries related to work and sports; and other conditions.

Physical therapists are trained to use a variety of different techniques--sometimes called modalities--to care for their patients. These techniques include applying heat and cold, hands-on stimulation or massage, and using assistive and adaptive devices and equipment.

The work of physical therapists varies with the type of patients they serve. For example, a patient suffering from loss of mobility due to Parkinson's disease needs different care than an athlete recovering from an injury. Some physical therapists specialize in one type of care, such as pediatrics (treating children) or sports physical therapy.

Physical therapists work as part of a healthcare team, overseeing the work of physical therapist assistants and aides and consulting with physicians and surgeons and other specialists. Physical therapists also work at preventing loss of mobility by developing fitness- and wellness-oriented programs to encourage healthier and more active lifestyles. For more information, see the profiles on physical therapist assistants and aides and physicians and surgeons.

Both physical therapist assistants and physical therapist aides work under the direction of physical therapists. They help patients who are recovering from injuries, illnesses, and surgery regain movement and manage pain. Physical therapist assistants are involved in the direct care of patients. Physical therapist aides often do tasks that are indirectly related to patient care, such as cleaning and setting up the treatment area, moving patients, and clerical tasks.

Physical therapist assistants typically do the following:

• Observe patients before and during therapy, noting their status and reporting to a physical therapist
• Help patients do specific exercises
• Use a variety of techniques, such as massage and stretching, to treat patients
• Use devices and equipment, such as walkers, to help patients
• Educate a patient and family members about what to do after treatment

Physical therapist aides typically do the following:

• Clean treatment areas and set up therapy equipment
• Help patients move to or from a therapy area
• Do clerical tasks, such as answering phones or helping patients with insurance paperwork

Physical therapist assistants help physical therapists provide care to patients. Under the direction and supervision of physical therapists, they give therapy through exercise; therapeutic methods, such as electrical stimulation, mechanical traction, and ultrasound; massage; and gait and balance training. Physical therapist assistants record patients' responses to treatment and report the results of each treatment to the physical therapist.

Physical therapist aides help make therapy sessions productive, under the direct supervision of a physical therapist or physical therapist assistant. They usually are responsible for keeping the treatment area clean and organized and for preparing for each patient's therapy. They also help patients who need assistance moving to or from a treatment area.

In states where physical therapist assistants must be licensed, aides are not licensed and so cannot do tasks involving direct patient care. The duties of aides include some clerical tasks, such as ordering depleted supplies and filling out insurance forms and other paperwork.

Health and safety engineers develop procedures and design systems to keep people from getting sick or injured and to keep property from being damaged. They combine a knowledge of health or safety and of systems engineering to make sure that chemicals, machinery, software, furniture, and other products are not going to cause harm to people or buildings.

Health and safety engineers typically do the following:

• Review plans and specifications for new machinery or equipment to make sure it meets safety requirements
• Inspect facilities, machinery, and safety equipment to identify and correct potential hazards
• Evaluate the effectiveness of various industrial control mechanisms
• Ensure that a building or product complies with health and safety regulations, especially after an inspection that required changes
• Install safety devices on machinery or direct the installation of these devices
• Review employee safety programs and recommend improvements
• Maintain and apply their knowledge of current policies, regulations, and industrial processes

Health and safety engineers also investigate industrial accidents, injuries, or occupational diseases to determine their causes and to see whether they could have been or can be prevented. They interview employers and employees to learn about work environments and incidents leading up to accidents or injuries. They also evaluate the corrections that were made to remedy violations found during health inspections.

Health and safety engineers are also active in two related fields: industrial hygiene and occupational hygiene. 

In industrial hygiene, they focus on the effects of chemical, physical, and biological agents. They recognize, evaluate, and control these agents to keep people from getting sick or injured. For example, they might anticipate that a particular manufacturing process will give off a potentially harmful chemical and recommend either a change to the process or a way to contain and control the chemical.  

In occupational hygiene, health and safety engineers investigate the environment in which people work and use science and engineering to recommend changes to keep workers from being exposed to sickness or injuries. They help employers and employees understand the risks and improve working conditions and working practices. For example, they might observe that the noise level in a factory is likely to cause short-term and long-term harm to workers and recommend ways to reduce the noise level through changes to the building or by having workers wear strong headphones.

Health and safety engineering is a broad field covering many activities. The following are specific types of health and safety engineers:

Aerospace safety engineers work on missiles, radars, and satellites to make sure that they function safely as designed.

Fire prevention and protection engineers design fire prevention systems for all kinds of buildings. They often work for architects during the design phase of new buildings or renovations. They must be licensed, and they must keep up with changes in fire codes and regulations.

Product safety engineers investigate the causes of accidents or injuries that might have resulted from the use or misuse of a product. They propose solutions to reduce or eliminate any safety issues associated with products. They also participate in the design phase of new products to prevent injuries, illnesses, or property damage that could occur with the use of the product.

Systems safety engineers work in many fields, including aerospace, and are moving into new fields, such as software safety, medical safety, and environmental safety. These engineers take a systemic approach to identify hazards in these new fields so that accidents and injuries can be avoided.

For information on health and safety engineers who work in mines, see the profile on mining and geological engineers.

Social and human service assistants help people get through difficult times or get additional support. They help other workers, such as social workers, and they help clients find benefits or community services.

Social and human service assistants typically do the following:

• Work under the direction of social workers, psychologists, or others who have more education or experience
• Help determine what type of help their clients need
• Work with clients and other professionals, such as social workers, to develop a treatment plan
• Help clients get help with daily activities, such as eating and bathing
• Coordinate services provided to clients by their or other organizations
• Research services available to their clients in their communities
• Determine clients' eligibility for services such as food stamps and Medicaid
• Help clients complete paperwork to apply for assistance programs
• Monitor clients to ensure services are provided appropriately

Social and human service assistants have many job titles, including case work aide, clinical social work aide, family service assistant, social work assistant, addictions counselor assistant, and human service worker. They serve diverse populations with a range of problems. Their work varies, depending on the clients they serve.

With children and families, social and human service assistants ensure that children live in safe homes. They help parents get the resources, such as food stamps or childcare, they need to care for their children.

With the elderly, workers help clients stay in their own homes and under their own care whenever possible. They coordinate meal deliveries or find personal care aides to help older people with day-to-day needs, such as doing errands or bathing. In some cases, human service workers help look for residential care facilities, such as nursing homes.

For people with disabilities, social and human service assistants help find rehabilitation services that aid their clients. They may work with employers to adapt positions to make them accessible to people with disabilities. Some workers find personal care services to help clients with daily living activities, such as bathing or making meals.

For people with addictions, human service assistants find rehabilitation centers that meet their clients' needs. They also find support groups or twelve-step programs. They work with people who are dependent on alcohol, drugs, gambling, or other substances or behaviors.

With veterans, assistants help people discharged from the military adjust to civilian life. They help with practical needs, such as finding housing and applying skills gained in the military to civilian jobs. They also help with navigating the overwhelming number of services available to veterans.

For people with mental illnesses, social and human service assistants help clients find resources to cope with their illness. They find self-help and support groups to provide their clients with an assistance network. In addition, they help those with more severe mental illnesses care for themselves by finding personal care services or group housing.

With immigrants, workers help clients adjust to living in a new country. They help clients locate jobs and housing. They also may help clients find programs that teach English, or they may find legal assistance to help immigrants get their paperwork in order.

With former prison inmates, human service assistants help clients re-enter society by finding job training or placement programs. Human service assistants help former inmates find housing and connect with programs that help them make a new life for themselves.

With homeless people, assistants help clients meet their basic needs. They find temporary or permanent housing. They find places, such as soup kitchens, that provide meals. Human service assistants also help homeless people find facilities for other problems they may have, such as joblessness.