History of Physical Therapy Practice in the United States, The

Journal of Physical Therapy Education, Winter 2003 by Moffat, Marilyn

In the meantime, the Social Security Act was amended in 1956 to include benefits for workers who were 50 years of age and over and who were totally disabled.15 This amendment led to expanded opportunities for physical therapists to provide services for these individuals.

Activity continued in Congress on the Medicare program. In 1960, the Kerr-Mills bill was signed into law, providing federal grants to the states for medical services for the "medically indigent" elderly. Of interest was the American Medical Association's (AMA) opposition to any Medicare program during this time. In 1961, the AMA established its American Medical Political Action Committee (AMPAC) to raise funds to oppose the legislation. A compromise Medicare measure was attached to a welfare bill in 1962, but was tabled. The assassination of President John F Kennedy interrupted action on a revised Medicare bill. Finally, a compromise bill was introduced in 1965 that was primarily an inpatient Insurance bill with some outpatient coverage. On July 30, 1965, President Lyndon Johnson signed a bill that added the Medicare program to the Social Security Amendments (SSA).14 Physical therapy outpatient services were not included in the original statute. Congress added a definition of "outpatient physical therapy services" in the SSA of 1967, which actually became law in 1968. The inclusion of these outpatient physical therapy services was due in large part to the contacts of Clem Eischen, then chair of the Self-Employed Section's Legislative Committee with his House of Representative member, Al Ulhnan (DOR), and also of John Fellow with his Oklahoma House and Senate contacts.6 Justification for inclusion of physical therapy services in the Medicare legislation was probably also due in part to the fact that by this time, the majority of states had licensure laws regulating the practice of physical therapy. Therefore, services provided by physical therapists were recognized and included in the Medicare program, thus assuring our rightful place in this system.

Other developments in the 1950s had an impact on physical therapist practice. During the late 1950s and into the 1960s, increasing numbers of states saw the enactment of state licensure laws for physical therapists. (Pennsylvania was the first state to license physical therapists in 1913, followed by New York in 1926.) In 1954, a 7-hour professional competency exam was developed by APTA in conjunction with the Professional Examination Service (PES) and was made available to state licensing boards, thus increasingly assuring a level of proficiency of physical therapists at just beginning to practice. By 1959, 45 states and the territory of Hawaii had physical therapy practice acts in place.6

Also during that period, a number of individuals greatly changed the practice of physical therapy for patients with neuromuscular disorders. Margaret Rood, a physical therapist and occupational therapist, broke new ground in the treatment of individuals with central nervous system (CNS) disorders.16 She discarded the traditional orthopedic approach to management of these individuals and looked more at the neurophysiological bases of rehabilitation of patients with CNS disorders. Her techniques of icing and brushing and her use of patterns of stability and mobility gave therapists new tools for the management of these patients.