Text Size:   A+ A- A   •   Text Only
Find     
Site Image

Chiropractic Assistants
Additional Policies affecting Chiropractic Assistants
 
Current as of May 2013 
 

The Certified Chiropractic Assistant (CCA) may perform physiotherapy, electrotherapy, or hydrotherapy once he or she has received the certificate from the Board. The CCA scope of practice does not include performing physical examinations, taking initial histories, taking X-rays, interpretation of postural screening, doing manual muscle testing or performing osseous adjustments or manipulations. (See OAR 811-010-0110 )

ANY TRAINED PERSON (including Certified CAs) may perform the following

1)   Clarify initial patient intake history, which includes recording or performing height, weight, blood pressure, temperature, and pulse rate.

2)   Record hand dynamometer readings.

3)   Demonstrate, teach, check and review with patients the doctor’s prescribed exercises

4)   Facilitate provision of vitamins and/or supplements to patients as ordered by the doctor.

5)   Relay doctor’s instructions to the patient on recommendations of nutritional needs.

6)   Facilitate provision of cervical pillow or support as recommended by the doctor.

7)   Make follow-up phone calls to patients on their progress as instructed by the doctor.

8)   Schedule return office visits for patients as instructed by the doctor.

9)   Schedule referrals as instructed by the doctor.

10)Check patient’s body fat percentage.

11)Perform postural screenings under the on-site supervision of a chiropractor, but only a Chiropractor may interpret the information.

12)May apply electrodes and conduct surface EMG testing, but the doctor has to interpret the results.

13)This list is not intended to be all-inclusive.

(Updated 11/16/95, 7/18/96; 11/20/08; 4/3/09)

 

Assistant LICENSES, vALID IN oREGON 

A Chiropractor who practices in Taiwan which recognizes United States Chiropractic licenses asked, “If it is possible, can the State of Oregon issue a chiropractic assistant license for the chiropractic assistants here in Taiwan?  The Board responded “No. A chiropractic assistant certificate is only valid in the State of Oregon and under the supervision of an Oregon licensed chiropractor.”

 

COLONICS or COLONIC THERAPY

See also “Colonic Therapy” under “Chiropractors”

The board determined that colonic therapy does not fall under hydrotherapy, and therefore is not an allowable procedure for CCAs to perform.  The Board felt there were inherent risks, such as causing septic shock by rupturing the bowels.  (9/28/07)

 

COMPUTERIZED MUSCLE AND INCLINOMETER TESTING

Certified Chiropractic Assistants may not do computerized muscle or inclinometer testing.  The Board considers this to be part of the physical examination.  (9/21/00)

 

A follow up request was made asking if the inclinometer may be used by a Chiropractic Assistant.  The Board maintains that this is part of the physical examination; the scope of practice does not allow it. (10/26/11)

 

(DIRECT) SUPERVISION OF CLINIC STAFF

The OBCE was asked if clinic staff  licensed chiropractic assistants could provide therapies in a business space next door to the clinic. The OBCE responded that the chiropractic assistant or staff person who is supervised needs to be in the same office space (defined as the same building or space contiguous) as the supervising doctor.  OAR 811-035-0001 states, "‘Direct supervision’ means that the licensed Chiropractic Physician is physically present in the clinic, is monitoring the activities of the supervisee in the clinic and is available to intervene, if necessary.” 

 

If an employee and/or independent contractor is independently licensed to perform prescribed services within their scope of practice they may do so without direct supervision of the chiropractic physician. (7/31/03) (12/1/11)

 

ENGLISH PROFICIENCY REQUIREMENT FOR CA APPLICANTS

The Board reviewed this matter in light of a question from a licensee - May he interpret or provide an interpreter for non-English speaking CA applicants (to successfully complete the application and exam)?   The OBCE surveyed other state health regulatory boards and determined that most other boards require that licensees be English-speaking proficient.  Many of the other health-related licensing boards already have a policy, rule, or statute requiring applicant’s to be English-speaking.

 

The Board determined that ALL (CA) applicants must be proficient in English in order to complete the chiropractic assistant licensing process in Oregon.  (May 2008)

 

FELONY RECORD

The Board may deny a certified chiropractic assistant applicant certification with a felony conviction in areas that could be harmful to patients. ORS 684.100(1) states, “The board may refuse to grant a license...upon the following grounds: … (d) A conviction of a felony or misdemeanor involving moral turpitude.”

 

Any applicant denied certification for this reason has a right to appeal and make his/her case in a contested case hearing. Upon review of the hearing officer’s recommendations, the Board will then consider whether to approve the application, with or without conditions, or continue to deny.

 

INITIAL TRAINING for CA applicants

Chiropractic Students Training To Be Chiropractic Assistants

Seventh (7th) quarter students and above may use the completed course in Physiological Therapeutics in lieu of the OBCE’s Initial Training Program to be a certified chiropractic assistant. A copy of their transcript or a letter from the course instructor on college letterhead will be accepted as proof of completion of the course. See OAR 811-010-0045 (3) for other specifics. (4/15/93)

 

Massage Therapists

The Board determined that a massage therapist must acquire the 12 initial training because they are not trained in the hydrotherapy or electrotherapy. (11/99) (01/11)

 

Physical Therapist Assistants

Question: May PTAs submit their physical therapist assistant education in lieu of the OBCE's required 12-hour initial training course to be licensed as a certified chiropractic assistant (CCA)?

 

The Board determined that PTA's will be waived from the 12-hour initial training requirement if the PTA education was completed within the past five years, or if they have been continuously employed in the past five years. (11/99) (01/11)

 

Other Training or Certification

If an applicant has a current certificate or license from another state, or adequate documentation of training, the Board may waive the requirements for the initial training course. (11/99)

 

Supervising DC, Training by the

Due to a need for more initial training courses for chiropractic assistants, the Board determined that a supervising DC may train his applying CA. The DC must be in attendance, and directly supervising the CA during the training. 

 

The Board determined that the DC must keep adequate documentation and submit evidence to the Board that the CA was appropriately trained according to OAR 811-010-0110. The OBCE developed a form which will meet all the points of this policy and the administrative rule. The form is available by request at the administrative office.

 

The Supervising DC and chiropractic assistant should understand that this does NOT preclude certification by the OBCE.  This process addresses the 12-hour initial training only.  Each assistant must still apply with the OBCE, take the open book exam and submit the required fees.  OAR 811-010-0110 is still in effect and included in the chiropractic assistant application packet. (11/99) (01/11)

 

Webinar option

It was proposed to the Board that webinars be allowed as a training tool for the eight (8) hours didactic portion of the Chiropractic Assistants initial training.  After considering a draft of the proposed outline/presentation, the Board approved webinars as a viable option for the training.  The Board continues to deny video presentations as they want the live person to person interaction.

 

Any program offered for chiropractic assistant initial training must be pre-approved by the Oregon Board of Chiropractic Examiners (Board). Note: “Pre-approval” is already required with current administrative rule. The Board will ONLY consider for pre-approval a minimum eight (8) hour program which covers all modules of the Board’s required didactic training outline. These programs may be offered either in-person or by LIVE (not pre-recorded) webinar. This policy is drafted to better implement administrative rule 811-010-0110(2)(a)(i) through (iii).

 

When a program for approval is a webinar, it must meet the additional following criteria:

 

1.   The proposed program must include technology which enables participants and the instructor to ASK and ANSWER questions in real time

2.   Must offer some evaluation after EACH module of OBCE’s required outline; the Board requires a minimum of 4 questions be asked

3.   The sponsor/program must be able to demonstrate that interaction on the part of participants is required throughout the presentation. (for example: webcams, question/answer, etc.)

4.   Answers to survey questions must be recorded and made available to the Board, if requested for audit purposes.

5.   The webinar software and/or vendor must be able to record the ACTUAL time each participant spends “in” the webinar.

6.   All webinar sponsors/programs must provide timely evidence of attendance after each full (minimum eight hours) program is completed. This report will include: Actual time each participant spends in the webinar, Each participants name and e-mail address, Evidence of participation for each attendee (questions asked, answers to poll questions, etc.)

 

The board reserves the right to revoke approval for any training vendor that does not comply with the guidelines listed above at any time. It also reserves the right to not accept the training of Chiropractic Assistant applicants who enroll in webinar training but there is insufficient evidence in the opinion of the Board to conclude that they attentively participated in such training by an approved vendor. (08/16/12)

 

Iontophoresis

Chiropractic assistants may perform iontophoresis or phonophoresis under the doctor’s supervision as a form of physiotherapy. (11/20/2008)

 

KINESIOTAPING METHOD

May a certified Chiropractic Assistant perform “Kinesio Taping”?  The Kinesio Taping Method involves taping over and around muscles in order to assist and give support to, or prevent, over-contraction.  The Board determined if the supervising DC is trained in the taping method, that he or she may also train the certified CA also to perform the method in the clinic, and only while the DC is on premise.  The Board considers this a physiotherapy. (3/15/07)

 

The Board was asked for additional clarification on the Kinesiotaping policy.  “Does the board consider the two methods – ‘Kinesiotaping’ and ‘taping’ - one in the same?”  Yes. The Board hasn’t distinguished a difference. And, referring to the policy’s second sentence, the question was asked, “if the DC is trained in the taping does this mean the DC needs to be trained to the extent that he holds a ‘certification’ in Kinesiotaping, or taping?”  No.  The training received in chiropractic college is sufficient.  Other reasonable training would be acceptable also. (05/15/12)

 

LASER LIGHT THERAPY  (Excerpt of Laser Light Therapy in Section I-Procedures)

Following recommendations from the OBCE ETSDP committee (a.k.a. Examinations, Tests, Substances, Devices, And Procedures), the OBCE approved and reaffirmed as standard use of Class I-IIIa lasers/phototherapy for use by chiropractors (as well as certified chiropractic assistants) as a physiotherapy modality.  Chiropractic Assistants are NOT allowed to use the Class IIIb and IV “hot” lasers.   (12/20/06)

 

MASSAGE, OVERSIGHT REQUIREMENTS

See also, “Therapies, including Massage

Question:  Does this mean the supervising chiropractic physician should be entering the treatment room periodically or seeing the patient during the same appointment for massage therapy (performed by the CCA)?

 Answer: No, the OBCE’s policy doesn't say that, although it may be advisable as regards the particular patient's needs.  We would presume there is other contact between the doctor and patient.

 

If a chiropractic clinic decides to have CCAs provide full body massages without having a meaningful patient relationship, the OBCE appreciates the concerns that would raise. That said, massage can be an important part of a chiropractic wellness program.  Abuses of this privilege could lead to additional OBCE rulemaking mandating additional training for CCAs who provide full body massages or limiting their scope in this area.

 

Myofascial release

Myofascial release (MR) may not be performed by chiropractic assistants.  A  CA is not trained adequately to perform myofascial release. MR requires detailed knowledge of anatomy and an understanding of fascial planes and referral patterns. Often MR is accompanied with pre and post testing of range of motion and depending on the test results a different area is addressed to fully address the condition. MR is part of massage therapy and may be performed by a licensed massage therapist.   (3/21/13)

 

phonophoresis (See Iontophoresis)

 

Quantitative Functional Capacity Evaluations (QFCE)

QFCEs are not within the chiropractic assistant scope of practice.  The QFCE requires the doctor’s clinical judgment for evaluation and performance. CAs do not have the required training for this.  The board also determined that QFCEs may not be performed by a Certified Strength and Conditioning Specialist (CSCS) under the OBCE’s “Any Trained Person” policy, thus a CSCS may not perform this as part of the chiropractic clinic’s services in or out of the clinic. The QFCE has to be performed by the chiropractic physician (or other licensed health provider within their scope of practice).  (3/21/13)

 

RANGE OF MOTION

A chiropractor submitted a letter inquiring whether chiropractic assistants or any "trained personnel" may perform range of motion tests.  The Board determined that chiropractic assistants or other persons may not perform range of motion tests.  According to the administrative rule 811-010-0110(7) for CAs, it is clear that "the scope of practice does not include performing physical examinations…"  The performance of range of motion tests is definitely a physical examination.  (12/99)

 

Reflexology

The board was asked whether an UN-licensed person (either CA or DC) may provide reflexology treatment on chiropractic patients within the Oregon chiropractor’s clinic.  The OBCE responded  that this is unlicensed treatment of the chiropractic patients in the chiropractic clinic.

 

The inquiring physician is also a naturopath and this may be allowed under his naturopathic license for his naturopathic patients.  Given this difference in scope, the Board reminded the chiropractor to always remember to chart under which license these services are being provided. 

 

In conclusion, ONLY a person actively licensed in Oregon as a DC or Chiropractic Assistant (under the direct onsite supervision of an Oregon licensed chiropractor), may perform reflexology on the chiropractic patients. (11/20/08)

 

REIKI

A Doctor of Chiropractic asked if his certified Chiropractic Assistant may practice Reike, a form of massage therapy, in his office without his supervision. The Board determined that the certified CA may perform this type of massage ONLY if the supervising DC is also Reike trained, and on premise to supervise.  If the certified CA, trained in Reiki, is also an Oregon licensed massage therapist, then that is already allowed with the LMT scope of practice. (3/15/07)

 

terminology

The use of the terms for chiropractic assistants, “massage therapist” and “therapist” are misleading and should not be used, as per the Oregon Administrative Rule 811-015-0045.  The Board also determined that the designation “CCA” or “CA” (see below) should be spelled out, since many people would not recognize the acronym.  

 

The rule was changed so that “Certified” has now been dropped and we are now referring to them simply as “Chiropractic Assistants.”  (9/16/2008)

 

THERAPIES, Including Massage

All CCA provided therapies must be performed under the supervision of a chiropractic physician who must always be on premise.   A CCA could provide a full body massage if the chiropractic physician prescribes it, and provides instruction on how to do it.

 

Whatever therapy is provided by a CCA has to be justified by the results of the history, examination, and diagnosis for each chiropractic patient, as governed by the Oregon Chiropractic Practice and Utilization Guidelines and other applicable administrative rules.   A CCA may not provide any therapy that is not part of chiropractic patient care. (1/25/12)

 

WORKING FOR OTHER HEALTH-CARE PROVIDERS

A certified chiropractic assistant (CCA) is only certified to work in a chiropractic office under the direction of a licensed chiropractic physician. Other health care providers may not have their personnel take the Board’s CCA exam for certification in their office. (8/15/91)​