Physical therapy

From Wikipedia, the free encyclopedia

Physical therapy (or physiotherapy^[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. It includes the provision of services in circumstances where movement and function are threatened by the process of ageing or that of injury or disease. The method of physical therapy sees full and functional movement as at the heart of what it means to be healthy.

Physical therapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. It involves the interaction between physical clients, families and care givers, in a process of assessing movement potential and in establishing agreed upon goals and objectives using knowledge and skills unique to physical therapists.

The physical therapists’ distinctive view of the body and its movement needs and potential is central to determining a diagnosis and an intervention strategy and is consistent whatever the setting in which practice is undertaken. These settings will vary in relation to whether physical therapy is concerned with health promotion, prevention, treatment or rehabilitation.^[2]

Physical therapy interventions may include:

"Manual handling; movement enhancement electrotherapeutic and mechanical agents; functional training; provision of aids and appliances; patient related instruction and counselling; documentation and coordination, and communication. Intervention may also be aimed at prevention of impairments, functional limitations, disability and injury including the promotion and maintenance of health, quality of life, and fitness in all ages and populations."

Some of the conditions that physical therapists manage include:

back and neck pain
spinal and joint conditions, such as arthritis
biomechanical problems and muscular control
cerebral palsy and spina bifida
heart and lung conditions, such as chronic obstructive pulmonary disease and atelectasis
sport-related injuries
headaches (cervicogenic and tension-type headache)
stress incontinence
neurological conditions, such as stroke and multiple sclerosis

1 History of physical therapy
2 Physical therapists
3 Physical therapy assessment
4 Physical therapy treatment
5 Physical therapy education
- 5.1 Programs around the world
- 5.2 Qualifications in the United States
6 Journals and publications
7 See also
8 References
9 External links

[edit] History of physical therapy

Physical therapy has its origins in ancient history with the advent of physical treatments and massage in China circa 2500 BC. Hippocrates described massage and hydrotherapy in 460 BC.

The modern practice of physical therapy was developed in London in 1896, believing hospital patients needed to be massaged on a regular basis in order to maintain adequate muscle function and mobility. This special interest group grew rapidly and in 1920 the Chartered Society of Physiotherapy was formed in Great Britain. Similar organisations were developed in other countries, including the USA.

The care and rehabilitation of the large numbers of amputees resulting from the World Wars of the early 20th century, as well as care of patients suffering from diseases such as polio galvanized the development of physical therapy worldwide.

[edit] Physical therapists

According to the [American Physical Therapy Association] (2006), physical therapists (PTs) are health care professionals who diagnose and treat people of all ages who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs also help prevent conditions associated with loss of mobility through fitness and wellness programs that achieve healthy and active lifestyles. PTs examine individuals and develop plans using treatment techniques that promote the ability to move, reduce pain, restore function, and prevent disability. They provide care in hospitals, clinics, schools, sports facilities, and more. PTs must have a graduate degree from an accredited physical therapy program before taking the national licensure examination. The minimum educational requirement is a master's degree, yet most educational programs now offer the doctor of physical therapy (DPT) degree. Licensure is required in each state in which a physical therapist practices. ^[3]

[edit] Physical therapy assessment

A physical therapist 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, establish 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, neurological assessment, motor control, and posture, whilst a cardiopulmonary assessment may involve lung auscultation and exercise physiology testing.

In some countries a physical therapist may order diagnostic imaging tests such as x-rays and MRIs to obtain more information about a patient's presenting condition and determine the treatment plan including referral to other practitioners. Physical therapists may also perform electromyography and nerve conduction testing to aid in the diagnosis of muscle and nerve disorders.

[edit] Physical therapy treatment

Guided by the assessment findings, the physical therapist will then develop and facilitate a treatment plan. Aside from the various physiotherapeutic techniques involved in therapy, the treatment regime may include prescribing and advice regarding assistive technology including mobility aids, standing frames, and walking devices. The physical therapist 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.

[edit] Musculoskeletal physical therapy

Musculoskeletal physiotherapists are able to diagnosis, treat and using the range of techniques outlined below help with prevention of pain/pathology.

Various therapeutic physical therapy modalities are available, including exercise prescription (strength, motor control, stretching and endurance), manual therapy techniques like joint mobilization/manipulation, soft tissue massage, and various forms of so-called "electrophysical agents" (such as cryotherapy, heat therapy, iontophoresis 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.

[edit] Cardiopulmonary physical therapy

Cardiopulmonary physical therapists 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. Physical therapists 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 physical therapists 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.

[edit] Neurological physical therapy

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.

[edit] Integumentary physical therapy

Treatment of conditions involving the skin and related organs. Common conditions include wounds and burns. Treatment interventions include debridement of wounds and burns, dressings, scar prevention and reduction.

[edit] Physical therapy education

[edit] Programs around the world

As with many aspects of the profession, physical therapy training varies considerably across the world. As a rule, physical therapy studies involve a minimum of four years of tertiary education. Some examples are described here.

In Pakistan there are 8 colleges offering Bsc.Physiotherapy and 2 colleges offering Msc in PT.physical therapist have a good scope in government and private hospitals and they are awarded 17 grade pay scale.

In Australia, where physical therapy is called physiotherapy, an undergraduate physiotherapy degree (B.Phty) is typically undertaken over a four-year period, with the early components being predominantly theoretical including basic anatomy, biology, physics, psychology, kinesioloy, goniometry and physiology. In the latter half of the degree students partake in practical components focusing on musculoskeletal physiotherapy, neuromuscular physiotherapy (notably Souvlis pain mechanisms), paediatric physiotherapy, geriatric physiotherapy, cardiothoracic physiotherapy, Vicenzino manipulations, Cupit massage and womens health. The program generally progresses with an increasingly clinical focus and usually the final year involves practical placements at clinics, and research. Postgraduate entry into physiotherapy is possible in some institutions, typically involving two years of study following the completion of a related (e.g. exercise physiology or science) Bachelor degree. Students in these courses are often supported by specific Physiotherapy societies, however the introduction of VSU by the Australian Government has reduced the functioning and support of these groups.

In Canada, entry-level physiotherapy education is offered at 13 universities. Many of these university programs are at the Master's level, meaning that applicants must have already completed an undergraduate degree prior to applying. (All entry-level programs in Canada are slated to be at the Masters level by 2010.) Many universities also offer graduate programs in physiotherapy, rehabilitation, or related disciplines at the masters or doctoral level. Many physiotherapists may advance their education at these levels in such Clinical Practice Areas as cardiorespirology, geriatrics, neurosciences, orthopaedics, pediatrics, rheumatology, sports physiotherapy, and women's health.

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 Philippines, physical therapy programs are generally 5 years in length and award the B.S. Physical Therapy degree upon graduation. The program consists of 2 years of general education, 2 years of physical therapy subjects, and a final year of internship & research/thesis. Some schools require students to complete a full 12 months of internship while other schools only require 10. During the internship year, students are required to fulfill clinical affiliations with hospitals, outpatient clinics, and other healthcare facilities. Due to the healthcare structure in the Philippines, clinics and therapy departments are often headed by a Physiatrist who writes out specific treatment orders for the PT to follow, and majority of the treatments are cash-based since not a lot of people have health insurance. Recently, the M.S. Physical Therapy postgraduate program has been made available by the University of Santo Tomas (Manila, Philippines). Once a student graduates from the BSPT program, he/she is then required to pass a national licensure exam adminstered by the Professional Regulation Commission. The said paper-based exam is a grueling 2 day ordeal which consists of approximately 730 questions. It is only administered twice a year and the names of those who pass the exam are published in several national newspapers. Those who pass the exam become licensed PTs and are then entitled to add the initials PTRP (Physical Therapist Registered in the Philippines) after their name.

In South Africa the degree (B.PhysT, B.Sc Physio or B.Physio) consists of four years of general practice training, involving all aspects of Physiotherapy. Typically, the first year is made up of theoretical introduction. Gradually, time spent in supervised practice increases until the fourth year, in which the student generally spends about 80% in practice. In the fourth year, students are also expected to complete Physiotherapy research projects, which fulfills the requirements of an Honours degree. Professional practice and specialization can only be entered into after a state governed, compulsory year of community service is completed by the student after graduation.

In the United Arab Emirates [1] the Bachelor Of Physiotherapy (BPT) consists of a 4 year undergraduate degree program. In the first year of the program they are introduced to pre-clinical subjects such as Anatomy, Physiology, Biochemistry, Human Behaviour & Socialisation & Basic Medical Electronics & Computers. The students also get hands on experiences in cadaveric dissections while learning Human Anatomy during the first year of the program. The students progressively are introduced to supervised clinical practice and the integrated curriculum offers the best learning experiences in addition to extensive inhouse elearning programs. The course offers Case Based Learning experiences and focusses on Evidence Based Practices. The program culminates with a six month internship ending with a research project work.

In the United Kingdom university degrees tend to be three rather than four years in length, as British students historically specialise earlier in their education than in most developed countries. Thirty-five universities and tertiary level institutions train physiotherapists in UK. The vast majority of physiotherapists work within the National Health Service, the state healthcare system.

In the United States a student completes an undergraduate degree prior to gaining entry into a graduate program (Masters or Doctorate level) specializing in physical therapy. While many physical therapy programs offer the Master of Physical Therapy degree, an educational transition is presently underway to require an entry-level Doctor of Physical Therapy degree for physical therapy practice.

In the Republic of Ireland, Physiotherapy is available as an undergraduate course in four universities, Trinity College, University College Dublin, Royal College of Surgeons and University of Limerick. Courses are four years in length with clinical practice in the final two years. Students are required to complete 1000 hours of clinical practice before graduation.

Following basic physical therapy 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, Paediatric, and Sports physical therapy.

[edit] Qualifications in the United States

Physical Therapists must have a graduate degree from an accredited physical therapy program before taking the national licensure examination. Most educational programs now offer the Doctor of Physical Therapy (DPT) degree. 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 209 accredited physical therapist programs in 2006. Of the accredited programs, 46 offered the Master of Physical Therapy, and 163 offered the Doctor of Physical Therapy degree.

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, pathology, diagnostics, physical examination techniques, and therapeutic procedures. Besides classroom and laboratory instruction, students receive supervised clinical education.

Physical therapist education is rigorous, 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, and sometimes to interact positively 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.

Many physical therapists pursue board certification in one of seven specialty areas (orthopaedic, pediatric, neurologic, sports, electrophysiologic, geriatric, and cardio-pulmonary). Board certified specialists must have demonstrated special expertise in their clinical area.

[edit] Journals and publications

Physical therapists have access to a wide range of publications and journals. ^[4] Some are strictly limited to physical therapy, while others (eg. various orthopedic and surgical journals) are not as specific, yet physical therapists contribute to them and read them. Here are a few:

[edit] See also

This article concerns the health profession. For the band by the same name, see Physical Therapy (band).

[edit] References

^ The terms physical therapy and physiotherapy are synonymous and can be used interchangeably. The term physical therapy appears to be favored in the United States, while physiotherapy - or physio - appears to be favored in Canada, England, Australia, and many other countries.
^ Description of Physical Therapy - What is Physical Therapy? WCPT website
^ APTA description. Retrieved Sept. 2, 2006
^ Mapping the literature of physical therapy. E M Wakiji. Bull Med Libr Assoc. 1997 July; 85(3): 284–288.