Question: I have some experience using a cold laser and would like to use it in the clinic and potentially also in my school-based practice. What are the legal and ethical considerations for using this modality?
Answer: As a first step, read your state licensure law and regulations for any language related to modalities. In general, language in state practice acts is quite general so it’s unlikely you’ll see anything very specific, particularly for a relatively new physical agent modality (PAM) such as cold lasers. However, some states do have very defined regulations related to the use of PAMs in practice. If there is no specific language related to PAMs, then an interpretation/decision from your state licensure board would be the next step. Be aware that licensure boards often refer practitioners to AOTA but since they are the legal body, you should at least attempt to get their decision first. If they do not provide a directive, then documented competency to utilize the modality (including application/modification, precautions, clinical indications, evidence of efficacy, etc.) is an ethical imperative. Training should also include appropriate use within the context of an occupational therapy program, not as a stand-alone modality. The AOTA position paper on Physical Agent Modalities provides helpful information and is available here.
If you are proposing to treat children in a school setting, in addition to parental permission it may be a good idea to make the principal and team members aware that you are now integrating this PAM into your practice and the criteria for its usage.