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Maryland OT Physical Agent Modalities

A licensee who is credentialed as a certified hand therapist is exempt from the requirements below.


 "Didactic education" means an educational activity:

    • That includes a method of evaluating and testing the knowledge of the licensee relative to electrical physical agent modalities; and
    • Relevant to the practice of electrical physical agent modalities in occupational therapy including:
      • In-service education;
      • Conferences;
      • Workshops;
      • Seminars;
      • Formal graduate academic education; or
      • Formal undergraduate academic education.

"Direct clinical education" means supervised instruction provided on a face-to-face basis by the educator during the application of electrical physical agent modalities to a client.

"Educator" means an individual who has successfully met the competency requirements as set forth in this chapter and provides didactic or direct clinical education, or both, but does not need to be an occupational therapist or occupational therapy assistant.

"Electrical physical agent modalities" means therapeutic modalities which induce heat or electrical current beneath the skin.

"Electrical physical agent modalities" includes, but is not limited to:

    • Therapeutic ultrasound;
    • Phonophoresis;
    • Iontophoresis; and
    • Electromuscular stimulation (FES), including biofeedback, transcutaneous electrical nerve stimulation (TENS) and laser light therapy.

"Superficial physical agent modalities" means therapeutic modalities including, but not limited to:

    • Hot packs;
    • Cold packs;
    • Paraffin;
    • Fluidotherapy; and
    • Icing.

Standards of Competence for Electrical Modalities

An occupational therapist, or occupational therapy assistant under the periodic supervision of an occupational therapist, who wishes to use occupational therapy procedures involving electrical physical agent modalities shall maintain, for the duration of the licensee's professional career, verification of didactic education and clinical requirements.

Didactic Education

For each electrical physical agent modality, didactic education shall include:

    • Principles of physics related to specific properties of light, water, temperature, sound, and electricity;
    • Physiological, neurophysiological, and electrophysiological changes which occur as a result of the application of the selected modality;
    • The response of normal and abnormal tissue to the application of the modality;
    • Indications and contraindications related to the selection and application of the modality;
    • The guidelines for treatment or administration of the modality within the philosophical framework of occupational therapy;
    • The guidelines for educating the patient, including instructing the patient about the process and possible outcomes of treatment, including its risks and benefits;
    • Safety rules and precautions related to the selected modality;
    • Methods of documenting the effectiveness of immediate and long-term effects of treatment;
    • Characteristics of equipment including safe operation, adjustment, and care of the equipment; and
    • Application and storage of patient specific pharmacological agents.

Clinical Requirements

Before applying physical agent modalities to a client under this chapter, a licensee shall:

    • Complete fifteen (15) contact hours of continuing education relative to electrical physical agent modalities which includes a minimum of:
      • Five (5) contact hours specific to ultrasound; and
      • Five (5) contact hours specific to electromuscular stimulation; and
    •  After completing all fifteen (15) contact hours of education, a licensee shall apply a minimum of five client treatments within the context of a therapeutic treatment program for each specific modality under the direct clinical education of an educator.

Documentation of Education

The occupational therapist or occupational therapy assistant is responsible for maintaining verification of education relative to electrical physical agent modalities.

Verification shall include:

    • Identification of the specific courses or training where the therapist learned content related to each subject area;
    • Proof of fifteen (15) contact hours of didactic education by virtue of a certificate of completion or proof of education, if applicable;
    • An official grade report or official transcript to verify academic education;
    • Written verification from an educator that five client treatments have been completed under direct clinical education for each specific modality; and
    • Additional verification requested by the Board as deemed necessary.

A licensee shall retain verification documentation and direct clinical education relative to electrical physical agent modalities for the duration of the licensee's professional career in occupational therapy.

Treatment Plan Guidelines for Physical Agent Modalities

The occupational therapist does not need to meet the competency requirements in order to develop a treatment plan which includes recommendations for use of physical agent modalities.

The therapeutic parameters for physical agent modalities shall be established by the occupational therapist or occupational therapy assistant administering the modality.

Superficial Physical Agent Modalities

A licensee may apply superficial physical agent modalities including, but not limited to, hot packs, cold packs, paraffin, fluidotherapy, and icing.









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