From Wikipedia,
the free encyclopedia.
Physical therapy (also
known as physiotherapy) is
a
health
profession concerned with the
assessment, diagnosis, and
treatment of
disease and
disability through physical
means. It is based upon principles
of
medical science, and is
generally held to be within the
sphere of
conventional (rather than
alternative)
medicine. Physiotherapy is
practiced by physiotherapists
(also known as physical
therapists, e.g. in the
United States), though aspects
may also be practiced under
supervised delegation by
physiotherapy assistants or other
health professionals.
Scope of practice
Physiotherapists' scope of
practice varies considerably
across the world, both in terms of
the degree of professional
autonomy enjoyed and the range of
conditions managed.
Physiotherapists in some
jurisdications, such as the
Australian states, enjoy
professional autonomy, with the
ability to act as primary care
providers and to determine — and
be responsible for — a patient's
management plan. Physiotherapists
in some other juristictions work
primary upon referral from other
professionals (typically
medical practitioners).
The major conditions managed by
physiotherapists can be broadly
grouped into three categories:
musculoskeletal, cardiopulmonary
and neurological. Many areas of
physiotherapy, e.g. rehabilitation
or
paediatrics, cross all three
areas. Depending on the local
healthcare system,
physiotherapists may be involved
in all areas, or may only manage
certain aspects (e.g. in some
United States juristictions,
respiratory therapists manage many
aspects of cardiopulmonary
therapy).
Depending on the structure of
the local healthcare system,
physiotherapists may function
either privately (e.g. in a
private clinic) or publicly (e.g.
in a hospital or community
setting). Furthermore,
physiotherapists may work as
generalists managing a wide range
of conditions, or may specialise
in certain fields. The process of
determining career structure and
specialisation varies
geographically.
History of physiotherapy
Physiotherapy has its origins
in late Victorian England. In 1894
the British Medical Journal raised
concerns about the practices of
some masseuses and masseurs who
were offering massage as a
euphemism for sex. The BMJ called
for an institution to be formed to
regulate massage practice. The
Society of Trained Masseuses was
formed by well-meaning nurses and
midwives who were keen to see
their massage practices
authenticated.
Quickly, the English example
was followed by most of the
colonial countries which adopted
practices and regulatory systems
suitable for their local
conditions. In America, Australia,
Canada and New Zealand 'authenitic'
massage became synonymous with a
discrete body of treatment
modalities including
electrotherapy (and later
actinotherapy - the application of
heat and light for healing
purposes), remedial gymnastic
exercise and, of course, massage
and manipulation.
A concern to provide an
authentic alternative to the
massage parlours, and a desire to
court medical approval, saw early
physiotherapy pioneers adopt a
biomechanical view of the body in
health and illness - something
that dominates the physiotherapy
'philosophy' even to this day.
Massage became a vital service
in both world wars and much was
learnt about the rehabilitation of
injured servicemen from these
unfortunate events. Physiotherapy
grew rapidly after the First World
War with spinal injury units,
orthopaedic hospitals and chest
clinics providing new challenges
to the profession.
In most post-colonial
countries, physiotherapy has
become the largest allied health
profession, and third only behind
medicine and nursing in the number
of graduating health care
students.
Assessment
A physiotherapist will
initially conduct a subjective
examination (interview) of a
patient's medical history, and
then go on to the objective
assessment (physical examination).
The subjective examination is
guided by the presenting system
and complaint, and the objective
assessment is in turn guided by
the history.
This semistructured process is
used to rule out serious pathology
(so called
red flags), establish
functional limitations, refine the
diagnosis, guide therapy, and
establish a baseline for
monitoring progress. As such, the
objective exam will then use
certain quantifiable measurements
to both guide diagnosis and for
progress monitoring. These depend
upon the system (and area) being
managed, e.g. a musculoskeletal
exam may involve, inter alia,
assessment of joint range of
motion, muscle power, motor
control and posture, whilst a
cardiopulmonary assessment may
involve lung
auscultation and exercise
physiology testing.
Treatment
Guided by the assessment
findings, the physiotherapist will
then develop and facilitate a
treatment plan. Aside from the
various physiotherapeutic
teachniques involved in therapy,
the treatment regimen may include
prescribing and advice regarding
assistive walking devices; should
consider functional progress; and
include ongoing review and
refinement. Patient education is a
key aspect of all treatment plans.
It is difficult to explore the
many aspects of physiotherapeutic
treatment options, especially
considering their ongoing
development in the face of an
increasing research base.
Nonetheless, some examples of
treatment options are listed
below.
Musculoskeletal physiotherapy
Various therapeutic
physiotherapy modalities are
available, including exercise
prescription (strength, motor
control, stretching and
endurance),
manual techniques,
soft tissue massage, and
various forms of so-called "electrophysical
agents" (such as
cryotherapy,
heat therapy and
electrotherapy).
Despite ongoing research giving
a clearer picture regarding the
use of various modalities in
specific conditions, the benefits
of electrotherapy are widely
debated.
The practice of physical
therapy should not be defined by
the use of modalities but rather
the integration of examination,
history, and analysis of movement
dysfunction.
Cardiopulmonary physiotherapy
Cardiopulmonary
physiotherapists work with
patients in a variety of settings.
They treat acute problems like
asthma, acute chest infections and
trauma; they are involved in the
preparation and recovery of
patients from major surgery; they
also treat a wide range of chronic
cardiac and respiratory conditions
like Chronic Obstructive Pulmonary
Disease (COPD), cystic fibrosis
(CF) and post-myocardial
infarction (MI). They work with
all ages from premature babies to
older adults at the end of their
life. Physiotherapists are
pioneering new management
techniques for non-organic
respiratory problems like
hyperventilation and other
stress-related disorders as well
as leading the development of
cardio-pulmonary rehabilitation
and non-invasive ventilation.
Cardiopulmonary
physiotherapists use physical
modalities to treat people. This
may involve using manual
techniques to clear infected mucus
from a person's chest, or using
non-invasive ventilation to help a
person breathe, or prescribing
exercises to improve a patient's
functional exercise capacity.
Neurological physiotherapy
Treatment in neurological
conditions is typically based upon
exercises to restore motor
function through attempting to
overcome motor deficits and
improve motor patterns. To achieve
this aim various theoretical
frameworks have been promoted,
each based upon inferences drawn
from basic and clinical science
research. Whilst some of these
have remained static, others are
designed to take into account new
developments, perhaps the most
notable example being the
"movement science" framework. The
various philosophies often
generate considerable debate.
Physiotherapy education
As with many aspects of the
profession, essential
physiotherapy training varies
considerably across the world. As
a general rule, physiotherapy
studies involve a minimum of four
years tertiary education. Some
examples are described here.
In Australia, an undergraduate
physiotherapy degree is typically
undertaken over a four-year
period, with the early components
being predominantly theoretical
and with an increasingly clinical
focus throughout the latter
stages. Postgraduate entry into
physiotherapy in possible in some
institutions, typically involving
two years of study following the
completion of a related (e.g.
exercise physiology or science)
undergraduate degree.
In New Zealand, there are
currently two schools of
physiotherapy offering four-year
undergraduate programs. Many New
Zealand physiotherapists work in
the private health care system as
musculoskeletal physiotherapists
and the curriculum reflects the
need to prepare graduates for
autonomous practice. Students
follow an educational program
similar to Australia with an
emphasis on biomechanics,
kinesiology and exercise.
Postgraduate study typically
involves two years of subject
specific learning.
In the UK university degrees
tend to be three rather than four
years in length, as historically
British students specialise
earlier in their education than in
most developed countries. 35
universities and tertiary level
institutions train
physiotherapists in UK. In the UK
the vast majority of
physiotherapists work within the
National Health Service, the
state healthcare system.
In the United States an
undergraduate student typically
undertakes a science-related
course (such as
biology or
physics) prior to gaining
entry into a graduate program
specialising in physical therapy
in which they undertake their
physical therapy training.
Following basic physiotherapy
training, experienced
practitioners may undertake
further study towards
certification as a specialist
practitioner. For example, in the
United States, experienced
physical therapists may apply to
take a specialty exam to earn
board certification in any of
seven sub-specialty areas:
Cardiovascular and Pulmonary,
Clinical Electrophysiologic,
Geriatric, Neurologic, Orthopaedic,
Pediatric, and Sports physical
therapy.
Qualifications in the United
States
All States (in the
United States) require
physical therapists to pass a
licensure exam after graduating
from an accredited physical
therapist educational program
before they can practice.
According to the
American Physical Therapy
Association, there were 189
accredited physical therapist
programs in
1999. Of the accredited
programs, 24 offered bachelor's
degrees, 157 offered master's
degrees, and 8 offered doctoral
degrees. By
2002, all physical therapist
programs seeking accreditation
will be required to offer degrees
at the master's degree level and
above, in accordance with the
Commission on Accreditation in
Physical Therapy Education.
Physical therapist programs
start with basic science courses
such as
biology,
chemistry, and
physics, and then introduce
specialized courses such as
kinesiology,
biomechanics,
neuroanatomy,
human growth and development,
manifestations of disease,
examination techniques, and
therapeutic procedures. Besides
classroom and laboratory
instruction, students receive
supervised clinical experience.
Individuals who have a four-year
degree in another field and want
to be a physical therapist should
enroll in a master's or a doctoral
level physical therapist
educational program.
Competition for entrance into
physical therapist educational
programs is very intense, so
interested students should attain
superior grades in high school and
college, especially in science
courses. Courses useful when
applying to physical therapist
educational programs include
anatomy, biology, chemistry,
social science, mathematics, and
physics. Before granting
admission, many professional
education programs require
experience as a volunteer in a
physical therapy department of a
hospital or clinic.
Physical therapists should have
strong interpersonal skills to
successfully educate patients
about their physical therapy
treatments. They should also be
compassionate and possess a desire
to help patients. Similar traits
are also needed to interact with
the patient's family.
Physical therapists are
expected to continue professional
development by participating in
continuing education courses and
workshops. A number of States
require continuing education to
maintain licensure.
