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 Home > By Career > Medicine, Health Care > Physiotherapy
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Physical therapy (or physiotherapy), often abbreviated PT, is a health
care profession. Physical therapy is concerned with identifying and maximizing quality
of life and movement potential within the spheres of promotion, prevention, diagnosis,
treatment/intervention,and rehabilitation. This encompasses physical, psychological,
emotional, and social well being.
Overview
Physical therapy involves the interaction between physical therapist, patients/clients,
other health professionals, families, care givers, and communities in a process
where movement potential is assessed and diagnosed, goals are agreed upon, using
knowledge and skills unique to physical therapists. Physical therapy is performed
by a physical therapist (PT) or physiotherapist (physio), and sometimes services
are provided by a physical therapist assistant (PTA) acting under their direction.[2]
PTs are healthcare professionals who diagnose and treat individuals of all ages,
from newborns to the very oldest, who have medical problems or other health-related
conditions, illnesses, or injuries that limit their abilities to move and perform
functional activities as well as they would like in their daily lives.[3] PTs use
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.[4] PT management commonly includes
prescription of or assistance with specific exercises, manual therapy, education,
manipulation and other interventions. In addition, PTs work with individuals to
prevent the loss of mobility before it occurs by developing fitness and wellness-oriented
programs for healthier and more active lifestyles, providing services to individuals
and populations to develop, maintain and restore maximum movement and functional
ability throughout the lifespan. This includes providing services in circumstances
where movement and function are threatened by aging, injury, disease or environmental
factors. Functional movement is central to what it means to be healthy.
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Military Physical Therapists working
with patients on balance problems
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Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic,
orthopaedic and pediatrics. 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 and this workplaces or other occupational environments, fitness centers
and sports training facilities.
Physical therapists also practice in non-patient care roles such as health policy,
health insurance, health care administration and as health care executives.Physical
therapists are involved in the medical-legal field serving as experts, performing
peer review and independent medical examinations.
Education 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.[13][verification needed] After the
development of orthopedics in the eighteenth century, machines like the Gymnasticon
were developed to treat gout and similar diseases by systematic exercise of the
joints, similar to later developments in physical therapy.
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 = someone involved in gymnastics
for those who are ill. 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.[15] The School of Physiotherapy at the University of Otago
in New Zealand in 1913,[16] and the United States' 1914 Reed College in Portland,
Oregon, which graduated "reconstruction aides."[17] Modern physical therapy was
established in Britain towards the end of the 19th century. Soon following American
orthopedic surgeons began treating children with disabilities and began employing
women trained in physical education, massage, and remedial exercise. These treatments
were applied and promoted further during the Polio outbreak of 1916. During the
First World War women were recruited to work with and restore physical function
to injured soldiers, and the field of physical therapy was institutionalized. In
1918 the term "Reconstruction Aide" was used to refer to individuals practicing
physical therapy. The first school of physical therapy was established at Walter
Reed Army Hospital in Washtington D.C. following the outbreak of World War I.
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.
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.[20][21] Later
that decade, physical therapists started to move beyond hospital-based practice
to outpatient orthopedic clinics, public schools, colleges/universities, geriatric
settings (skilled nursing facilities), rehabilitation centers and medical centers.
In 1921 in the United States physical therapists formed the first professional association
called the American Women's Physical Therapeutic Association. This gave birth to
what is known today as the APTA (American Physical Therapy Association), and currently
represents approximately 76,000 members throughout the United States. The APTA defines
physical therapy as: "clinical applications in the restoration, maintenance, and
promotion of optimal physical function."
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 Physical
Therapists was formed,[23] which has ever since played an important role in advancing
manual therapy worldwide.
Education
Main article: Physical therapy education
World Confederation of Physical Therapy (WCPT) recognises there is considerable
diversity in the social, economic, cultural, and political environments in which
physical therapist education is conducted throughout the world. WCPT recommends
physical therapist entry-level educational programs 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 there is innovation and variation in program 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 program 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, that may
work in collaboration with other members of the health care team.
Physical therapist entry-level educational programs integrate theory, evidence and
practice along a continuum of learning. This begins with admission to an accredited
physical therapy program and ending with retirement from active practice.
206 of 213 accredited physical therapy programs in the US are accredited at the
doctoral level offering the Doctor of Physical Therapy degree (DPT) The physical
therapist professional curriculum includes content and learning experiences in the
clinical sciences (e.g., content about the cardiovascular, pulmonary, endocrine,
metabolic, gastrointestinal, genitourinary, integumentary, musculoskeletal, and
neuromuscular systems and the medical and surgical conditions frequently seen by
physical therapists).
Curriculum related to Patient/Client Management includes:
• Screening to determine when patients/clients need further examination or consultation
by a physicaltherapist or referral to another health care professional.
• Examination: Examine patients/clients by obtaining a history from them and from
other sources. Examine patients/clients by performing systems reviews. Examine patients/clients
by selecting and administering culturally appropriate and age related tests and
measures. Tests and measures include, but are not limited to, those that assess:
a. Aerobic Capacity/Endurance, b. Anthropometric Characteristics, c. Arousal, Attention,
and Cognition, d. Assistive and Adaptive Devices, e. Circulation (Arterial, Venous,
Lymphatic), f. Cranial and Peripheral Nerve Integrity, g. Environmental, Home, and
Work (Job/School/Play) Barriers, h. Ergonomics and Body Mechanics, i. Gait, Locomotion,
and Balance, j. Integumentary Integrity, k. Joint Integrity and Mobility, l. Motor
Function (Motor Control and Motor Learning), m. Muscle Performance (including Strength,
Power, and Endurance), n. Neuromotor Development and Sensory Integration, o. Orthotic,
Protective, and Supportive Devices, p. Pain, q. Posture, r. Prosthetic Requirements,
s. Range of Motion (including Muscle Length), t. Reflex Integrity, u. Self-Care
and Home Management (including activities of daily living [ADL] and instrumental
activities of daily living [IADL]), v. Sensory Integrity, w. Ventilation and Respiration/Gas
Exchange, x. Work (Job/School/Play), Community, and Leisure Integration or Reintegration
(including IADL)
• Evaluation: Evaluate data from the examination (history, systems review, and tests
and measures) to make clinical judgments regarding patients/clients.
• Diagnosis: Determine a diagnosis that guides future patient/client management.
• Prognosis: Determine patient/client prognoses.
• Plan of Care: Collaborate with patients/clients, family members, payers, other
professionals, and other individuals to determine a plan of care that is acceptable,
realistic, culturally competent, and patient-centered.
• Intervention:Provide physical therapy interventions to achieve patient/client
goals and outcomes. Interventions include: a. Therapeutic Exercise, b. Functional
Training in Self-Care and Home Management, c. Functional Training in Work (Job/School/Play),
Community, and Leisure Integration or Reintegration, d. Manual Therapy Techniques
(including Mobilization/Manipulation Thrust and Nonthrust Techniques), e. Prescription,
Application, and, as Appropriate, Fabrication of Devices and Equipment, f. Airway
Clearance Techniques, g. Integumentary Repair and Protection Techniques, h. Electrotherapeutic
Modalities,
• Provide effective culturally competent instruction to patients/clients and others
to achieve goals and outcomes.
• Prevention, Health Promotion, Fitness, and Wellness: Provide culturally competent
physical therapy services for prevention, health promotion, fitness, and wellness
to individuals, groups, and communities. Apply principles of prevention to defined
population groups.
• Students completing a Doctor of Physical Therapy program are also required to
successfully complete clinical internships prior to graduation.
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,[25]
the American Board of Physical Therapy Specialties list eight specialist certifications.
Cardiovascular & Pulmonary
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 used 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[citation needed] from cardiovascular and pulmonary specialized physical
therapists.
Clinical Electrophysiology
This specialty area encompasses electrotherapy/physical agents, electrophysiological
evaluation (EMG/NCV), physical agents, and wound management.
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
therapists specialize in treating older adults.
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.
Neurological
Neurological physical therapy is a field focused on working with individuals who
have a neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth
disease (CMT), 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, muscle strength and loss of functional independence.[26] Physiotherapy
can address many of these impairments and aid in restoring and maintaining function,
slowing disease progression, and improving quality of life.
Orthopedic
Orthopedic physical therapists diagnose, manage, and treat disorders and injuries
of the musculoskeletal system including rehabilitation after orthopaedic 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. Additionally, an emerging adjunct to diagnosis and treatment is the use
of sonography for diagnosis and to guide treatments such as muscle retraining.[28][29][30]
Those who have suffered injury or disease affecting the muscles, bones, ligaments,
or tendons 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[citation needed] by pediatric
physical therapists.
Sports
Physical therapists can be involved in the care of athletes from recreational to
professional and Olympians. This area of practice includes athletic injury management,
including acute care, treatment and rehabilitation, prevention, and education.
Women's health
Women's health physical therapy addresses women's issues related to child birth,
and post partum. These conditions include lymphedema, osteoporosis, pelvic pain,
prenatal and post partum periods, and urinary incontinence.
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