1. Sullivan, Katherine J. PT, PhD, FAHA

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This year the American Physical Therapy Association's Annual meeting and House of Delegates was held in Baltimore, MD, June 7-13, 2009. As our Section delegate, I was able to represent our Section in the House and absorb the messages emanating from the dynamic atmosphere. As usual, I learned much about the national issues that have particular importance this year, as President Obama, Congress, and our country negotiate the treacherous path to much needed healthcare reform.


There were many other highlights at this year's conference; however, the issue that has the most potential to affect our profession is the outcome of the Healthcare Reform Act. Justin Moore, Vice President for Government Advocacy, shared with us the major issues related to healthcare reform, the APTA position on the need for reform, and the role that physical therapy can contribute to decreased costs. (For the most recent updates on the status of healthcare reform, please visit: and


Healthcare reform is a critical issue for physical therapy, especially for those of us who are in the area of neurologic physical therapy practice. Many of us deal on a day-to-day basis with the inequities in our healthcare system. Individuals with neurologic disease or injury such as spinal cord injury, brain injury, multiple sclerosis, stroke, and other conditions that seriously affect mobility are most often the individuals who during the course of their injury or illness lose healthcare benefits or end up in government programs such as Medicare and Medicaid. Despite the Americans with Disabilities Act, many of these individuals live in relative social isolation due to lack of transportation, receive inadequate long-term healthcare for routine medical conditions, and require the assistance of overburdened family members to provide their daily care.


In addition, the aging of the American population poses a catastrophic increase in the numbers of Americans who will have chronic health conditions and increased disability that are cumulative as the population gets older. Based on the US Census Bureau data, the most recent estimates of disability in the noninstitutionalized population, aged 6 years and older, living in the United States (from June to September 2005) indicate that 18.7% of the population had some level of disability, and of those, 12% had severe disability. These individuals place a huge financial toll on the current healthcare system, making this one of the most important concerns in revisions to healthcare and reimbursement policy that will both increase access to meaningful healthcare and reduce its cost.


According to the US government, a person is considered to have a severe disability if they have a confirmed record of communication, mental, or physical impairment(s) that limits functional activity (ie, requires another person to assist with their activities of daily living) and prevents the person from engaging in an age-appropriate major life activity. Major life activity (ie, the "participation" domain in the International Classification of Functioning) is defined based on age grouping as follows: (1) 0-5 years, ability to play, (2) 6-17 years, ability to participate in school; (3) 18-64 years, ability to work or take care of a home, and (4) 65 years and older, ability to live independently in one's home. Figure 1 depicts the increase in severe disability level that occurs during the life-span such that >50% of the oldest age group (ie, 80 years and older) need some kind of assistance in their activities of daily living or instrumental activities of daily living.

Figure 1 - Click to enlarge in new window Disability in America. From 2005 US Census Bureau data, severe disability was reported at 12.1% of the population. Prevalence increases in the older age groups. More than 50% of the elderly population aged 80 years and older requires some level of assistance in activities of daily living or instrumental activities of daily living. Source: Brault, Matthew,

Because physical therapists play a major healthcare delivery role for individuals with mobility restrictions, the US census data can be used to identify the prevalence of individuals in the US population that use wheeled mobility devices and their associated health conditions. Figure 2 uses 2005 US population census data to indicate the prevalence of wheeled mobility use (ie, wheelchairs or scooters) in working age adults 18-64 years old and those 65 years and older by their individual health conditions. The most prevalent main conditions associated with wheelchair/scooter use among working age adults are multiple sclerosis, paraplegia, and cerebrovascular disease. In the population aged 65 years and older, osteoarthritis or cerebrovascular diseases are the primary causes of severe functional or activity limitations that require the use of wheeled mobility. These individuals are the ones with chronic health conditions who need access to a physical therapist. A physical therapist is the most qualified healthcare professional who can serve as the healthcare manager for these individuals with chronic health conditions that involve mobility problems; the physical therapist is the preferred provider for preventive healthcare and interventions to increase health and wellness in this population.

Figure 2 - Click to enlarge in new window Health condition associated with wheeled mobility use in adults 18-65 years old compared with adults aged 65 years and older. The health conditions with the greatest prevalence of working age adults requiring wheeled mobility use are multiple sclerosis, paraplegia, and cerebrovascular disease. For adults aged 65 years and older, either osteoarthritis or cerebrovascular disease are the primary cause of functional or activity limitation. Source: Kaye HS, Kang T, and LaPlante, MP (2000).

Disability that results in mobility issues for 12%-18% of the US population, the increasing age of Americans, and the need for immediate healthcare reform that can accommodate the healthcare needs of all Americans is a call to action for our profession and the individuals whom we serve. Physical therapists, especially those of us who specialize in neurology, can contribute an important, cost-effective solution for healthcare that is now compromised by healthcare policy such as direct access to physical therapy and the Medicare therapy cap on healthcare to the most needy and vulnerable in our population. Please take action.


What You Can Do in Health Care Reform: APTA encourages our members and their patients to get involved in the debate. There are a multitude of avenues you can take to get your voice heard. You can write, call, or fax your Congressman or Senator using our Legislative Action Center. You can encourage your patients to do the same by having them visit the Patient Action Center ( You can also attend a White House Regional Summit or take part in a town hall meeting with your member of Congress.