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APTA's House of Delegates approved the concept of specialization in 1976 and established the Task Force on Clinical Specialization, which developed the Essentials for Certification of Advanced Clinical Competence in Physical Therapy. The House of Delegates adopted this document in 1978. The House of Delegates appointed the Commission for Certification of Advanced Clinical Competence, the predecessor to ABPTS, in 1979.

As each of the specialty areas was recognized by the House of Delegates, ABPTS appointed a specialty council that identified and defined advanced skills, established eligibility criteria, and developed the examination.

The Specialty Council on Cardiopulmonary Physical Therapy was the first to complete the process, and the cardiopulmonary specialist certification examination was first administered in 1985. Since then, 9 additional specialty areas - Clinical Electrophysiology, Geriatrics, Neurology, Oncology, Orthopaedics, Pediatrics, Sports, Women's Health, and Wound Management Physical Therapy - have been established.