3. Scopes of Practice

To provide guidance to healthcare providers and to patients seeking the appropriate healthcare providers for the appropriate care, an understanding of the scope of practice for each healthcare profession typically involved in concussion care will be provided. This should further strengthen collective competence in concussion care. Professional regulating bodies in Ontario were contacted to determine the guidance and information they provide to their members related to standards of care for concussive injuries. There is value in working with regulated health professionals as there is a complaints process available to them and quality assurance measures in place. This is not the case with non-regulated healthcare professionals. This does not imply that non-regulated professionals are not knowledgeable, capable and competent; it is just to point out that there is no regulatory body that they are accountable to and who will act to protect the public from professional misconduct.

In Ontario, the regulatory bodies for the recognized healthcare professions provide general direction in the form of standards of practice. There is no defined scope of practice for concussion for each discipline, except for Speech Language Pathology. In some cases, general information about education, assessment, and/or treatment for brain injury formed the sole guiding standards.

In the absence of specific standards of practice or guidelines related to concussion care, it is important to use the defined scopes of practice for each regulated healthcare profession and the protected acts they are able to perform. Currently, many regulatory bodies are considering whether they should be developing specific scopes of practice for concussion care. ONF will be working collaboratively with the professional regulating bodies to facilitate and encourage the development of specific scopes of practice for concussion care as they have indicated interest in developing this relationship.

The chart below provides a summary of the defined scopes of practice for various healthcare professionals.

Key Messages

  • Most of the healthcare professional regulating bodies do not have specific standards of practice or guidelines related to concussion care; the general scope of practice is the default practice guideline
  • Healthcare providers must be mindful to always work within their scope of practice and their level of competence
  • ONF will be working with the professional regulating bodies to facilitate and encourage the development of specific scopes of practice for concussion care

Information Provided on Scope by Professional Regulating Bodies

ProfessionRegulating BodyGeneral ScopeScope Defined for ConcussionGeneral Information Provided
Audiologists

Speech-language pathologists

College of Audiologists and Speech-Language Pathologists of Ontario“Identify, diagnose and treat communication and swallowing disorders across the lifespan.”
Not from the College, but “Concussion and Speech Language Pathology: How we can help” was produced by OSLA
Document entitled "Practice Standards and Guidelines for Acquired Cognitive Communication Disorders". College of Audiologist and Speech Language Pathologists of Ontario
ChiropractorsCollege of Chiropractors of Ontario“Assessment of conditions related to the spine, nervous system and joints and the diagnosis, prevention and treatment, primarily by adjustment of:
- dysfunctions or disorders arising from the structures or functions of the spine and the effects of those dysfunctions or disorders on the nervous system; and
- dysfunctions or disorders arising from the structures or functions of the joints.”
NoEvidence-based practices from Canadian Chiropractic Guideline Initiative:
- Descriptive information about concussion
- Detailed guidelines regarding treatment of headaches
KinesiologistsCollege of Kinesiologists of Ontario“Assessment of human movement and performance and its rehabilitation and management to maintain, rehabilitate or enhance movement and performance.”NoNone
Massage Therapists College of Massage Therapists of Ontario“Assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissue and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain.“NoNone
Nurses

Nurse Practitioners
College of Nurses of Ontario“Health care for promoting, maintaining and restoring health. Prevention, treatment and palliation of illness and injury, primarily by assessing health status, planning and implementing interventions, and coordinating health services.”NoNone
Occupational TherapistsCollege of Occupational Therapists of Ontario“Assessment of function and adaptive behaviour and the treatment and prevention of disorders which affect function or adaptive behaviour to develop, maintain, rehabilitate or augment function or adaptive behaviour in the areas of self-care, productivity and leisure”NoONF guidelines
OptometristsCollege of Optometrists of Ontario“The practice of optometry is the assessment of the eye and vision system and the diagnosis, treatment and prevention of:
- disorders of refraction;
- sensory and oculomotor disorder and dysfunctions of the eye and vision system;
- and prescribed diseases”
NoNone
PhysiciansCollege of Physicians and Surgeons of Ontario
And registered with CPSO

1. “Every physician’s scope of practice is unique.”
2. “A physician’s scope of practice is determined by the patients the physician cares for, the procedures performed, the treatments provided, and the practice environment.”
“A physician’s ability to perform competently in his or her scope of practice is determined by the physician’s knowledge, skills and judgment, which are developed through training and experience in that scope of practice.”
NoTool for head and neck pain that was developed by the Centre for Effective Practice
PhysiotherapistsCollege of Physiotherapists of Ontario“Assessment of neuromuscular, musculoskeletal and cardio respiratory systems, the diagnosis of diseases or disorders associated with physical dysfunction, injury or pain and the treatment rehabilitation and prevention or relief of physical dysfunction injury or pain to develop, maintain, rehabilitate or augment function and promote mobility.”NoGeneral “concussion 101” information
Psychologists
(Clinical)
College of Psychologists of Ontario“Assessment of behavioral and mental conditions, the diagnosis of neuropsychological disorders and dysfunctions and psychotic, neurotic and personality disorders and dysfunctions and the prevention and treatment of behavioral and mental disorders and dysfunctions and the maintenance and enhancement of physical, intellectual, emotional, social and interpersonal functioning.”
NoRecent evidence-based guideline for assessment and treatment of concussion

Definition of Practice Areas for Psychology and Clinical Neuropsychology
Social WorkersOntario College of Social Workers and Social Service Workers“Assessment, diagnosis, treatment and evaluation of individual, interpersonal and societal problems through the use of social work knowledge, skills, interventions and strategies, to assist individuals, dyads, families, groups, organizations and communities to achieve optimum psychosocial and social functioning.”NoNone