Working with electrodiagnosis since last 15 years with all ups and downs and professional struggles, the question CAN A PHYSIOTHERAPIST PERFORM ELECTRODIAGNOSTIC TEST? In simple words can a Physiotherapist perform EMG NCV study independently.
There is a continuous debate going on among healthcare professionals whether a physiotherapist can perform EMG/NCV studies independently or not. Many of the consultants not accepting it, many accepting it with conditions and many readily accepting it. But this continuous debating has given so many points to be discussed and questioned even to the specialists. And the question arises WHO WILL BELL THE CAT
It is said even in books that EMG NCV studies just confirm a tentative diagnosis. It needs a couple of provisional diagnosis and a confirmation of one of them through electrophysiological testing is done. A thorough clinical assessment is mandatory before referring a patient for such test and before performing such test. And these textbook sentences become mere Geeta Shlokas of Bhagvat Geeta of EMG/NCV which are seldom practiced.
A consultant who is often a neurologist is so busy that he hardly has time even to talk to his patient. He who is said to have been certified to perform and interprete this report by so called heredity. When they are so bugged up with so many other commitments, why burden them with so much of electrodiagnosis? Where they have time to spend after doing clinical assessment like muscle charting or even talking and taking proper history of the patient.It is definitely an undoubted fact that he has a better diagnostic skills than a physiotherapist but a physiotherapist too is competent enough to judge the abnormalities and inform his consultant.A physiotherapist is well aware of his/her limitations and would never cross the ethical and moral boundaries.
An electrophysiological diagnosis is different from a neurological diagnosis. If this difference is understood by a consultant, majority of the debate causing issues regarding this matter is solved. For example - A patient with complaint of tingling/numbness over thumb, index and middle finger with prolonged distal motor latency (at wrist) and reduced CMAP amplitude and normal/reduced Nerve Conduction Velocity of Median nerve and prolonged distal sensory latency for Median nerve. Electrophysiological interpretation can be Median nerve compression at/about wrist which a trained Physiotherapist if performs a study can put. But if a Neurologist performs the study can put diagnosis as Carpal Tunnel Syndrome.With this difference why a Physiotherapist cannot perform EMG NCV study independently if PROPERLY TRAINED AND CERTIFIED?
A physiotherapist assesses a patient thoroughly in terms of tone, muscle charting, voluntary control where needed. He/She spends enough time with the patient. Even the curriculum of the Masters in Physiotherapy has Electrodiagnosis in detail. Then why a debate or why a denial that a Physiotherapist cannot perform this study. A physiotherapist learns the same anatomy, physiology, medicine, pharmacology, neurology, orthopedics that a MBBS student learns. Then why he/she is underestimated when it comes to electrodiagnosis.
RATHER THAN KEEPING THIS TEST AS A HEREDITARY RIGHT OF A DOCTOR OR A NEUROLOGIST, WHY A SEPARATE CERTIFICATION CANNOT BE MADE MANDATORY FOR PERFORMING THIS TEST IRRESPECTIVE OF A DOCTOR OR A PHYSIOTHERAPIST PERFORMING IT.AND A CERTIFIED PHYSIOTHERAPIST TOO CAN PRACTICE IT INDEPENDENTLY , NOT AS A TECHNICIAN.
Radiological investigations like Xrays, MRIs are highly sensitive tests and give accurate anatomical lesions, EMG NCV tests are highly specific tests and give accurate functional lesions. And so as a tool of convenience it is a very common practice now a days to perform EMG NCV studies in majority of the patients irrespective of forming provisional diagnosis or not. It may be called playing safe in an era of Consumer Protection. And very rightly and sarcastically described by a Doctor in all majority of his prescriptions which went as - CBC, ESR, EMG/NCV
As rightly said by Sir De Luca ,the most influential person in the recent history of EMG and one of the editors of fifth editions of the book MUSCLES ALIVE by Basmajin " Electromyography is a seductive muse because it provides easy access to physiological processes that cause the muscles to generate force, produce movement and accomplish countless functions that allow us to interact with the world around us...to its detriment electromyography is too easy to use and consequently too easy to abuse". Said in 1997, this is proving true in 21st century
It is said even in books that EMG NCV studies just confirm a tentative diagnosis. It needs a couple of provisional diagnosis and a confirmation of one of them through electrophysiological testing is done. A thorough clinical assessment is mandatory before referring a patient for such test and before performing such test. And these textbook sentences become mere Geeta Shlokas of Bhagvat Geeta of EMG/NCV which are seldom practiced.
A consultant who is often a neurologist is so busy that he hardly has time even to talk to his patient. He who is said to have been certified to perform and interprete this report by so called heredity. When they are so bugged up with so many other commitments, why burden them with so much of electrodiagnosis? Where they have time to spend after doing clinical assessment like muscle charting or even talking and taking proper history of the patient.It is definitely an undoubted fact that he has a better diagnostic skills than a physiotherapist but a physiotherapist too is competent enough to judge the abnormalities and inform his consultant.A physiotherapist is well aware of his/her limitations and would never cross the ethical and moral boundaries.
An electrophysiological diagnosis is different from a neurological diagnosis. If this difference is understood by a consultant, majority of the debate causing issues regarding this matter is solved. For example - A patient with complaint of tingling/numbness over thumb, index and middle finger with prolonged distal motor latency (at wrist) and reduced CMAP amplitude and normal/reduced Nerve Conduction Velocity of Median nerve and prolonged distal sensory latency for Median nerve. Electrophysiological interpretation can be Median nerve compression at/about wrist which a trained Physiotherapist if performs a study can put. But if a Neurologist performs the study can put diagnosis as Carpal Tunnel Syndrome.With this difference why a Physiotherapist cannot perform EMG NCV study independently if PROPERLY TRAINED AND CERTIFIED?
A physiotherapist assesses a patient thoroughly in terms of tone, muscle charting, voluntary control where needed. He/She spends enough time with the patient. Even the curriculum of the Masters in Physiotherapy has Electrodiagnosis in detail. Then why a debate or why a denial that a Physiotherapist cannot perform this study. A physiotherapist learns the same anatomy, physiology, medicine, pharmacology, neurology, orthopedics that a MBBS student learns. Then why he/she is underestimated when it comes to electrodiagnosis.
RATHER THAN KEEPING THIS TEST AS A HEREDITARY RIGHT OF A DOCTOR OR A NEUROLOGIST, WHY A SEPARATE CERTIFICATION CANNOT BE MADE MANDATORY FOR PERFORMING THIS TEST IRRESPECTIVE OF A DOCTOR OR A PHYSIOTHERAPIST PERFORMING IT.AND A CERTIFIED PHYSIOTHERAPIST TOO CAN PRACTICE IT INDEPENDENTLY , NOT AS A TECHNICIAN.
Radiological investigations like Xrays, MRIs are highly sensitive tests and give accurate anatomical lesions, EMG NCV tests are highly specific tests and give accurate functional lesions. And so as a tool of convenience it is a very common practice now a days to perform EMG NCV studies in majority of the patients irrespective of forming provisional diagnosis or not. It may be called playing safe in an era of Consumer Protection. And very rightly and sarcastically described by a Doctor in all majority of his prescriptions which went as - CBC, ESR, EMG/NCV
As rightly said by Sir De Luca ,the most influential person in the recent history of EMG and one of the editors of fifth editions of the book MUSCLES ALIVE by Basmajin " Electromyography is a seductive muse because it provides easy access to physiological processes that cause the muscles to generate force, produce movement and accomplish countless functions that allow us to interact with the world around us...to its detriment electromyography is too easy to use and consequently too easy to abuse". Said in 1997, this is proving true in 21st century
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