History of Physiotherapy
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.
Physical therapy interventions may include:
"Manual handling; movement enhancement electrotherapeutic and mechanical agents; functional training; provision of aids and appliances; patient related instruction 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
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 the 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 (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 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).
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, and analysis 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.
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- Follow this link of Development of Physical Therapy in the United States as presented by Marilyn Moffat, current President of the WCPT.