History of Physical Rehabilitation ServicesOne of the first physical therapist to work in the Indian Health Service was Capt Richard “Dick” Mazzacone who arrived in 1968 to work in a 10’ x 10’ space allocated for physical therapy at the Phoenix Indian Medical Center. Physical therapy programs began small often with only one therapist at the larger medical centers. Gallup Indian Medical Center's first occupational therapist arrived in the late 1950’s. Therapy services began in Anchorage, Alaska around the same time.
The concept and format for clinical privileging/competencies for physical therapists was initiated by CAPT Mazzacone and his staff at the Phoenix Indian Medical Center in 1986. A statistically relevant formula for rehabilitation space and staffing to population ratio was developed in the 1970’s. These formulas were utilized in new facility development, insuring PT needs were addressed. Ahead of the times, this requirement is now a component for hospital and clinic accreditation. A common philosophy among the early therapists was the development of a specialty service that would be continued throughout the years. There continues to be emphasis on camaraderie and sharing skills to keep services at state of the art level, and to use the pervading terminology, “evidence based”.
Significant developments contributed to the growth of PT/OT/SLP and audiology staffing to outlying clinics as I.H.S. expanded:
In 1981, with the closure of the United States Public Health Service (U.S.P.H.S.) Merchant Marine hospitals (Norfolk, Staten Island, San Francisco), there was an influx of U.S.P.H.S. physical therapists transferring to the Indian Health Service. During this time, the early OT’s who were in Indian Health Service retired leaving a predominately physical therapy service. It would not be until the 1980’s that OT’s returned to the Indian Health Service.
Physical therapists of the 1970’s and 1980’s provided services which included: significant wound care, diabetic foot care, orthopedics specialty clinics for adult and pediatrics. Surgical residency programs contributed to multidisciplinary clinics with the physical therapists in hand clinics, prosthetics, and shoe/orthotic clinics. The prosthetic and shoe clinics started out with the PT’s fabricating the prosthetics and orthotics since these services were otherwise unavailable.
Other services provided were sports medicine clinics and B.I.A. school sports screening, spinal cord clinics, as well as electrophysiologic testing, pediatric developmental screening, and involvement with special well baby clinics. There was also other longstanding community involvement with tribal nursing homes, local school career days, and significant clinical education with PT/OT schools. In addition, many programs have worked with the local school districts to promote health career education and mentorship for high school students.
In the 1980’s, as a direct result of the Indian Health Service Scholarship Program, more American Indian and Alaskan Natives (AI/AN) completed physical therapy professional degrees and entered into service providing care for American Indians. More importantly, Indian Health Service programs encourage AI/AN health care professionals to return to their home areas to meet the health care needs of their people. This allowed for physical therapy staffing to be filled in the Aberdeen, Alaska, Albuquerque, Billings, Navajo, Oklahoma, and Phoenix areas where new positions were being developed.
During the 1980’s, physical therapists developed registries for pediatrics and adults with disabilities, which helped recognize the needs for population groups at local service units and served to justify staffing. Today there is over 140 rehabilitation staff in the I.H.S.
The addition of speech language pathology and audiology in I.H.S. was first initiated in the Billing's Area in the early 1970's. By the mid-1990’s, Gallup Indian Medical Center added a speech component to their PT and OT staff to facilitate a “Total Rehabilitation” concept.
Legislation in the 1990’s resulted in increased Tribal administration of health care programs. Many of these tribal programs have included physical rehabilitation services at new tribal facilities.
For more information visit the IHS Fact Sheet