physical therapy

Physical therapy
Classification and external resources
This physical therapist from the 1950's is assisting two children with polio holding on to a rail while they exercise their lower limbs.

Physical therapy (physiotherapy in many English speaking countries) is a health care profession which provides services to individuals in order to develop, maintain and restore maximum movement and functional ability throughout life. This includes providing services in circumstances where movement and function are threatened by aging, injury, disease or environmental factors.

Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social well being. It involves the interaction between physical therapist (PT), patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.^[1] Physical therapy is performed by either a physical therapist (PT) or an assistant (PTA) acting under their direction.^[2]

PTs utilize an individual's history and physical examination to arrive at a diagnosis and establish a management plan, and when necessary, incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g. electromyograms and nerve conduction velocity testing) may also be of assistance.^[3]

Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics to name some of the more common areas. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.^[4]

Educational qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others requiring masters or doctoral degrees.

History

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 B.C.^{[5][verification needed]} The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling “Father of Swedish Gymnastics” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise The Swedish word for physical therapist is “sjukgymnast” = “sick-gymnast.” In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare. Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy.^[6] The School of Physiotherapy at the University of Otago in New Zealand in 1913,^[7] and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."^[8]

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA)). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for Polio.^[9]

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.^[10][11] Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers.

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in Orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed,^[12] which has played an important role in advancing manual therapy worldwide ever since.

Education

World Confederation of Physical Therapy recognises the fact that there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends that physical therapist entry-level educational programmes be based on university or university level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. [2] WCPT acknowledges that there is innovation and variation in programme delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any programme should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines.

Professional education prepares physical therapists to be autonomous practitioners. [7]

Physical therapist entry-level educational programmes integrate theory, evidence and practice along a continuum of learning. This begins with admission to an accredited physical therapy programme and ending with retirement from active practice. [2]

Thus, the overall aim of physical therapist professional entry-level educational programmes is to educate physical therapists who are knowledgeable, self-assured, adaptable, reflective, humanistic, and service-oriented and who, by virtue of critical thinking, life-long learning, and ethical values, render independent judgments concerning patient/client needs.

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy,^[13], the American Board of Physical Therapy Specialties list seven specialist certifications, including Sports Physical Therapy and Clinical Electrophysiology.^[14] Worldwide the six most common specialty areas in physical therapy are:^[15]

Cardiopulmonary

Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is utilized in this field to assist in clearing lung secretions experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit from cardiovascular and pulmonary specialized physical therapists.^[15]

Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.^[15]

Neurological

Neurological physical therapy is a discipline focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of; vision, balance, ambulation, activities of daily living, movement, speech and loss of functional independence.^[15]

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions and amputations. Joint and spine mobilization/manipulation, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting.^[16] Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining.^[17][18][19] Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body will benefit from assessment by a physical therapist specialized in orthopedics.

Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis, may be treated by pediatric physical therapists.^[15]

Integumentary

Integumentary (treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.

See also

• Joint manipulation
• Manual handling
• Occupational Therapy
• Physical medicine and rehabilitation

References

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