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Physical therapy (or physiotherapy) 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 aging
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:
"Spinal and extremity manipulation; therapeutic exercise; electrotherapeutic and
mechanical agents; functional training; provision of aids and appliances;
patient education and counseling; 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
Contents [hide]
1 History of physical therapy
2 Physical therapists
3 Physical therapy assessment
4 Physical therapy treatment
4.1 Musculoskeletal physical therapy
4.2 Cardiopulmonary physical therapy
4.3 Neurological physical therapy
4.4 Integumentary physical therapy
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
History of physical therapy
Physical therapy has its origins in ancient history with the advent of massage
and other forms of manual therapy 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 the
Country of United Kingdom. Similar organizations 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.
One of it's principle advocates was Sister Elizabeth Kenny, an Australian nurse
who made a great impact on the progression of polio during the 1930s and 1940s.
Physical therapists
Physical therapists (PTs) are health care professionals who evaluate and manage
health conditions for people of all ages. Typically individuals consult a PT for
the management of medical problems or other health-related conditions that;
cause pain, limit their ability to move, and limit the performance of functional
activities. PTs also help prevent health conditions through prevention,
restoration of function and through fitness and wellness programs that achieve
healthy and active lifestyles. PTs evaluate individuals, diagnose conditions,
and develop management 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.
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.
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.
Musculoskeletal physical therapy
Musculoskeletal physiotherapists are able to diagnose, 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).
Nowadays in various countries physiotherapists are specializing in orthopaedic
medicine. Those people can use diagnostic and therapeutic
infiltration/injections to various soft tissue and joints. They are trained to
diagnose and treat various orthopaedic conditions.
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, analysis and restoration of
movement dysfunction.
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.
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.
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.
Physical therapy education
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 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 other developed countries. In order to qualify, students
are required to complete 1000 hours of clinically based learning: this typically
takes place in the final two years; however, some courses also have clinical
placement in the first year. Thirty-five universities and tertiary level
institutions train physiotherapists in the UK. The vast majority of
physiotherapists work within the National Health Service, the state healthcare
system.
In Turkey, the Physiotherapy (BPT) education is provided by physiotherapy
schools in universities (Hacettepe University, Dokuz Eylül University,
İstanbulUniversity, Baskent University, Pamukkale University, Dumlupınar
University, Süleyman Demirel University) after high school education. Education
takes 4 years or 5 years with preb classes. MSc and PHD education is given by
institutes of medical sciences.
In Bangladesh, the Bachelor of Physiotherapy (BPT) course is provided by the
Medicine Faculty of University of Dhaka. There are two affiliated institute who
provides 5 years of Professional education including one year internship.
Bangladesh Physiotherapy Association and Bangladesh Physiotherapy Society are
two professional body of Physiotherapy 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, kinesiology, 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, fire cupping 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 administered
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 Spain university degrees constist of a 3 years program and several
post-graduated courses are available por practicioners. There are 38
universities training physiotherapists in Spain.
In the United States a student completes an undergraduate degree with a strong
science component prior to gaining entry into a Doctor of Physical Therapy
program. Students complete clinical interships as part of their education.
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.
In India, Physiotherapy is offered as bachelor degree after a student
successfully completes four year course of physiotherapy in a college affiliated
to a university. Mangalore city has highest number of physiotherapy colleges in
India.
I n Sri Lanka, Physiotherpay is available as a Diploma course for 2years in
School of Physiotherapy & Occupational Therapy which is affilited to the
National Hospital of Colombo from 1957. After the 6 months of training students
were sending to the Hospitals for clinical practise. From the year 2005 Medical
Faculties of University of Peradeniya & University of Colombo have started the
undergarduate course for 4years.
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.
Qualifications in the United States
Physical Therapists must have a graduate degree from an accredited physical
therapy program before taking the national licensing examination. Most
educational programs now offer the Doctor of Physical Therapy (DPT) degree. All
states (in the United States) require physical therapists to pass the [National
Physical Therapy Examination] 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 2007. Of the accredited programs, 31
offered the Master of Physical Therapy, and 179 offered the Doctor of Physical
Therapy degree. Virtually all programs are in transistion to the DPT 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.
Journals and publications
Physical therapists have access to a wide range of publications and journals.
[3] 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:
Advance for Physical Therapists & PT Assistants
Acta Orthopaedica Scandinavica
American Journal of Physical Medicine & Rehabilitation
Archives of Physical Medicine and Rehabilitation
Clinical Orthopedics and Related Research
Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Journal of Rehabilitation Medicine
Neurology
Physical Therapy: Journal of the American Physical Therapy Association
PT--Magazine of Physical Therapy
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