Section 1315.162  Modalities in Occupational Therapy

Occupational therapy services include the use of physical agent modalities for occupational therapists and occupational therapy assistants who have the training, skill and competency to apply these modalities.

a)         Physical agent modalities:

1)         refer to those modalities that produce a response in soft tissue through the use of light, water, temperature, sound, electricity, or pressure;

2)         are characterized as adjunctive methods used in conjunction with or in immediate preparation for: patient involvement in purposeful occupation or daily life activity; the use of ergonomic principles; the adaptation of environments and processes to enhance functional performance; or the promotion of health and wellness; and

3)         include but are not limited to the following:

A)        modalities using electricity.  These would cover pain control, edema reduction, and muscle reeducation.  Examples include, but are not limited to, biofeedback, neuromuscular electrical stimulation/functional electrical stimulation (NMES/FES), transcutaneous electrical nerve stimulation (TENS), high volt pulsed stimulation (HVPS), interferential, and iontophoresis;

B)        thermal modalities, including superficial and deep heat and cryotherapy.  Examples include, but are not limited to, hot and cold packs, ice massage, fluidotherapy, warm whirlpool, cool whirlpool, ultrasound, phonophoresis, paraffin and contrast baths, and lasers;

C)        modalities using mechanical forces including touch, pressure, traction, stretch, stroke, petrissage, friction, vibration, oscillating and/or translating in different vectors/planes.  Examples include, but are not limited to, soft tissue mobilization such as manual lymph drainage, elastic taping application, joint mobilization and tool assisted fascial remodeling such as assisted soft tissue mobilization (ASYM), dynamic cupping or pneumatic compression; and

D)        dry needling/Intramuscular Manual Therapy.

b)         Training required for occupational therapists and occupational therapy assistants to use physical agent modalities that use electricity, thermal or mechanical forces.

1)         The training shall include:

A)        a minimum of 14 hours of didactic training in a program defined in subsection (b)(2) that includes demonstration and return demonstration as part of a lab component and an examination.  The training session shall include the mechanics and precautions of using the modality safely as well as case studies and problem solving on when to use.  The ethics, economics, liability, and insurance issues related to using modalities shall also be addressed in the educational process.

B)        five clinical treatments in each modality supervised by a licensed health care professional trained in the use of the modality.

2)         The didactic training shall be obtained through educational programs, workshops, or seminars offered or approved by a college or university, the Illinois Occupational Therapy Association, the American Occupational Therapy Association and its affiliates, the Illinois Physical Therapy Association, the American Physical Therapy Association, the National Board for Certification in Occupational Therapy (NBCOT), or the Hand Therapy Certification Commission.

3)         The training shall be documented and made available to the Division or Board upon request.  Training shall be completed prior to the use of these modalities.  Documentation shall include:

A)        a transcript or proof of successful completion of the coursework, including the number of educational hours;

B)        the name and address of the individual or organization sponsoring the activity;

C)        the name and address of the facility at which the activity was presented;

D)        a copy of the course, workshop, or seminar description that includes topics covered, learning objectives, credentials of presenters and instructional methods; and

E)        documentation of the 5 clinical treatments that includes date of the treatments, the modality and the name and credentials of the supervisor.

4)         The clinical treatment demonstration shall include:

A)        The ability to evaluate or contribute to the evaluation of the client, and make an appropriate selection of the modality to be utilized;

B)        A thorough knowledge of the effects of the modality that is to be utilized;

C)        The ability to explain the precaution, contraindication and rationale of the specific modality utilized;

D)        The ability to formulate and justify the occupational therapy intervention plan, specifically delineating the adjunctive strategy associated with the use of each modality;

E)        The capability to safely and appropriately administer the modality; and

F)         The ability to properly document the parameters of intervention, which include the client's response to treatment and the recommendation for the progression of the intervention process.

5)         The clinical supervisor for the treatment session shall:

A)        Be licensed or certified and in good standing in this profession or another profession within Illinois that permits the use of the physical agent modalities; and

B)        Be a practitioner with demonstrated competence in the physical agent modality; and

C)        Have a minimum of 1 year of clinical experience, within the previous 3 years, in the use of the physical agent modalities.

c)         Occupational therapists and occupational therapy assistants who, prior to January 1, 2002, have attended training programs and have developed competencies in the use of physical agent modalities may demonstrate competency through proof of one or more of the following:

1)         documentation of previous attendance and completion of the required training as stated in subsection (b);

2)         documentation of professional experience at the work place through policy and procedures indicating the use of modalities, in-service training, proof of prior use.  The experience shall include at least 20 applications for each modality within the last 3 years;

3)         documentation of attendance at educational programs, including post‑professional programs, in-service training and specific certifications in the use of modalities; or

4)         documentation of certification as a hand therapist from the Hand Therapy Certification Commission.

d)         The training required for the use of dry needling/intramuscular manual therapy under Section 3.7 of the Act must include:

1)         Successful completion of 50 hours of college-level instruction from an accredited program approved by the Division in the following areas:

A)        the musculoskeletal and neuromuscular system;

B)        the anatomical basis of pain mechanisms, chronic pain and referred pain;

C)        myofascial trigger point theory; and

D)        universal precautions.

2)         Completion of at least 30 hours of didactic course work specific to intramuscular manual therapy.  This requirement can be fulfilled, regardless of delivery method, by the didactic pre-study required for the intramuscular manual therapy practicum course.  This may include, but is not limited to, distance learning such as web-based courses or webinars, required textbook assignments and pre-course work.

3)         Practicum Hours.

A)        Successful completion of at least 54 practicum hours in intramuscular manual therapy offered through an approved CE sponsor as defined in Section 1315.145.  Each instructional course shall specify what anatomical regions are included in the instruction and describe whether the course offers introductory or advanced instruction in intramuscular manual therapy.  Each instruction course shall include the following areas:

i)          intramuscular manual therapy technique;

ii)         intramuscular manual therapy indications and contraindications;

iii)        documentation of intramuscular manual therapy;

iv)        management of adverse effects;

v)         practical psychomotor competency; and

vi)        the Occupational Safety and Health Administrations Bloodborne Pathogens standard.

B)        Classes qualifying for completion of the mandated 54 hours of intramuscular manual therapy shall be in one or more modules, with the initial module being no fewer than 27 hours.  The 54 practicum hours must be completed within 24 months after the start of study.

4)         Completion of at least 200 patient treatment sessions.

A)        Occupational therapists must complete the treatment sessions under general supervision by a medical professional who has previously fulfilled the necessary dry needling/intramuscular manual therapy credentials.

B)        Occupational therapy assistants must complete the treatment sessions under direct line of sight supervision by a licensed occupational therapist who has previously met the requirements for dry needling/intramuscular manual therapy credentials.

5)         Successful completion of a competency examination approved by the Division.  The Division will accept competency examinations administered as part of the intramuscular manual therapy practicum course work.

6)         Each licensee is responsible for maintaining records of the completion of the requirements of this subsection (a) and shall be prepared to produce those records upon request by the Division.

7)         Intramuscular manual therapy may be performed by a licensed occupational therapist and only be delegated to a licensed occupational therapy assistant that has met the requirements of this subsection (d) and is supervised by a licensed occupational therapist who has met the requirements of this subsection (d) and maintains direct line of sight observation and supervision of the occupational therapy assistant at all times while the treatment is rendered.

8)         An occupational therapist or occupational therapy assistant shall not advertise, describe to patients or the public, or otherwise represent that dry needling/intramuscular manual therapy is acupuncture, nor shall he or she represent that he or she practices acupuncture unless separately licensed under the Acupuncture Practice Act [225 ILCS 2].

e)         Nothing in this Section shall be construed as preventing or restricting the practices, services or activities of any person licensed in this State by any other law or occupation for which the person is licensed.

(Source:  Amended at 48 Ill. Reg. 5980, effective April 5, 2024)