Introduction
First and foremost, let us be reminded that the course we are presently pursuing is laborious and would require extensive amount of patience, perseverance, and hard working. Being part of the medical field, we have to prove our colleagues and our patients that we rightfully deserve their trust and confidence. And so from hereon, we must learn to appreciate the privilege we were given to study under the BS Physical Therapy program of this institution. Bearing this in mind, we have to study harder and more fervently to keep the tradition of excellence in PLM-CPT.
Rehabilitation and Physical Medicine
Physical therapy is an allied health discipline under physical medicine. In turn, physical medicine is a well-known branch of rehabilitation medicine.
But what is rehabilitation medicine? Rehabilitation medicine obviously is involved in rehabilitation. And rehabilitation refers to the “development of a person to the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with his or her physiological and anatomical impairment and environmental limitations (Pablo-Santos)”. In other words, rehabilitation is a process of facilitating an individual’s adaptation and even recovery from his or her lost functions and environmental limitations.
We may discover that rehabilitation medicine has many facets. We can readily observe that patients may require rehabilitation for their mental health. Others require rehabilitation to do away with drug abuse. Still others do require physical rehabilitation. In the latter type of rehabilitation, we physical therapists are primarily and very much involved.
Physical rehabilitation entails us to address problems regarding pain, joint swelling, joint tightness, muscle weakness, poor cardiovascular endurance and others. This specific process is under the practice of physical medicine. And so we define physical medicine as “a branch of medicine concerned with the diagnosis and treatment of physical disorders with special emphasis on the use of neurodiagnostic techniques and therapeutic application of physical agents such as heat, cold, water, and electricity (Pablo-Santos)”.
Branches of Physical Medicine
Aside from physical therapy, physical medicine employs occupational and speech therapy, in addressing physical problems of patients holistically. All of these disciplines are incorporated to one another to address impairments, disabilities, and handicaps.
Impairment, disability, and handicap are terms we often use interchangeably. But mind you, they are three different terms. The World Health Organization was able to come up with specific definitions for each. They are the following:
Impairment
• Any loss or abnormality of psychological, physiological, or anatomical structure or function, whether permanent or temporary
• Impairment is independent from the disease.
• An impairment does not necessarily indicate that a disease is still present or active.
• Examples include loss of leg due to amputation and speech disorders.
Disability
• Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a person of the same age, culture, and education
• May be permanent or temporary
• Loss of leg inhibits an individual from walking. Or patients with aphasia cannot speak appropriately.
• Not every impairment results in a disability.
Handicap
• Is a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents fulfillment of a role that is normal for that individual
• Inability to perform what is expected of him or her by the society
• A professional driver who has lost a leg can no longer drive.
Now let us define physiotherapy, occupational therapy, and speech therapy. Physical therapy refers to use of physical agents such as water, heat, electricity, cold, exercises, traction, massage, mobilization, maneuvers, and manipulation for the treatment of various neuromusculoskeletal and cardiopulmonary problems. Occupational therapy is defined as the science of directing man’s response to selected activity to promote and maintain health, to prevent disability, to evaluate behavior, and to treat or train patients with physical or psychosocial dysfunction (Rusk, 1977). Speech-language pathology/ therapy are involved in evaluating and treatment of communication problems.
You might be wondering how physical therapy differs from occupational therapy. In physiotherapy, we employ techniques to restore foundation of individual movements and functions. And in order for these functions to have a functional carry-over, occupational therapy is required. Physical therapists help improve muscle strength, realign bones, and restore range of motion while occupational therapists use the results gained by physiotherapists to train patients in preparation for going back to their usual activities in the society, to work, and others.
History of Physical Therapy and Rehabilitation
Physical therapy rehabilitation started centuries ago. Hippocrates advocated massage and Hector used hydrotherapy in 460 B.C. The earliest documented origin of actual physical therapy as a professional group dated back to 1894 when nurses in England formed the Chartered Society of Physiotherapy. Other countries soon followed and started formal training programs, such as the School of Physiotherapy at the University of Otago in New Zealand in 1913. In the United States, physiotherapy began in 1914 in Portland, Oregon with Reed College and Walter Reed Hospital graduating the first physiotherapists, then called “reconstruction aides” (a term used to imply to the professionals’ role in managing the devastating effects of World War I).
Research has been incorporated to the profession as early as in 1921. The first physiotherapy research was published in the US in March 1921 through the first edition of the PT review. In this same year, Mary McMillan, PT first organized the Physical Therapy Association, which eventually changed its name to American Physical Therapy Association. Truly, 1921 was a landmark year as educational standards for university professional physiotherapy programs were instituted and started to shape the profession.
As physical therapy was already on its way up, it was only in 1946 that rehabilitation medicine became institutionalized. The practice of physical medicine was termed physiatry. Dr. Howard A. Rusk was an important personality in instituting the said medical field.
In the Philippines, physical therapy was also introduced earlier than rehabilitation medicine. In the Philippine General Hospital, a physiotherapy section was opened in 1949 under the Department of Radiology. It was only in 1971 that a Department of Rehabilitation Medicine was created. And in 1974, the residency program among aspiring physiatrists started.
Members of the Rehabilitation Team
Physiatrist
• Doctor of medicine who took residency training to specialize in physical medicine and rehabilitation
• Orders and performs various diagnostic procedures such as radiological examinations, nerve conduction studies, electromyography, and others
• Evaluate, diagnose, and medically manage all potentially disabling diseases
Physical Therapist
• Are also trained to evaluate and manage orthopedic, neurologic, and cardiopulmonary conditions
• Device exercises, mobilization and manipulatory techniques; apply and control dosage and frequency of physical agents to be applied to patients
Occupational Therapist
• Use purposeful activities in managing debilitated patients
Speech-Language Pathologist
• Expert in the evaluation and treatment of communication problems
• Facilitates detailed evaluation of language processes and swallowing mechanisms and correction of any irregularities
Rehabilitation Nurse
• Undergoes the same type of training as all other nurses
• Assigned to rehabilitation facilities
Social Worker
• The bridge that links the hospitalized disabled patient with his life outside the hospital, his family, and community
• Evaluates the patient’s total living situation, including lifestyle, family, finances, employment, and community resources
Psychologist
• All patients who require rehabilitation have psychological problems.
• This is when a psychologist sets in.
Orthotist-Prosthetist
• Fabricates orthoses and prostheses and measures patients accordingly
• Prosthesis is a device used to replace lost body part (e.g. artificial hand or leg).
• An orthosis is a device used to improve patient functions, provide support or corrections to impaired body parts.
Patient and Family
• Most important members of the team
Others
• Vocational counselors
• Chaplain
• Respiratory therapists
• Chiropractors
• Etc.
Team Approaches Employed in our Practice
Practice of medicine requires team effort. One member of the team cannot do well without the others. It is a wrong perception that a physiatrist can handle everything regarding patient care. Below are team models we may observe in our healthcare practice. Each model has its own advantages and disadvantages.
Medical Model
• Refers to the traditional model
• The physician attends to the patient’s needs.
• When the services of another discipline are needed, the doctor consults the professional but the former will give specific instructions or general requests on what is to be done.
• Any new problem or recommendation must always be consulted to the attending physician.
• Advantage: There is a clear chain of responsibility, which is important medico legally.
• Disadvantage: Coordination of the other health workers, the physician, and the patient may be limited and compromised.
Multidisciplinary Model
• Efforts of the team are discipline oriented.
• This model however is still physician-controlled.
• Under the physician are the rest of the team members, including the patient.
• Each discipline provides its own unique activity for the patient.
• During team meeting, communication is only vertical.
• Advantage: provides means for multiple professionals who require frequent interactions to meet and coordinate efforts on consistent basis.
• Disadvantage: no lateral communication
Interdisciplinary Model
• Team members from various disciplines work in tandem toward a common goal.
• Lateral communication becomes present.
• Whenever a certain decision is to be made, all of the members of the team should have been consulted.
• In addition, the responsibility of deciding does not only fall on the physician, but to the whole team.
• Advantage: more collaborative; health workers from other disciplines do not merely become a physician’s follower but are also able to practice their own clinical skills in devising managements for the patient
• Disadvantage: requires high level of competence from other team members
Job Description of Physical Therapist
“Physical Therapists treat a wide variety of medical conditions. These conditions can include: Traumatic Brain injury, Stroke (cerebrovascular accident or CVA), Spinal Cord Injury, Amputations, Cardiac conditions such as a heart attack (Myocardial Infarction), Respiratory conditions such as Chronic Obstructive Pulmonary Disease (COPD), Neurological disorders such as Multiple Sclerosis and Parkinson’s disease, as well as most types of musculoskeletal injuries. These injuries result in specific deficits that impair one’s ability to function independently and in a safe environment. Through Physical Therapy, as well as other types of rehabilitation, these deficits can be accommodated for to improve someone’s quality of life (Northeast Center for Special Care, NY)”.
As a clinician (California Occupational Guide), a physical therapist is expected to accomplish the following:
• Reviewing and evaluating patients’ conditions and medical records, performing tests or measurements, interpreting findings, and maintaining documentation.
• Developing programs for treatment plans in keeping with the doctor’s directions.
• Helping patients attain maximum muscle strength and motor skills as well as accepting and adjusting to the limiting effects of their disabilities.
• Planning and executing exercises for increasing strength, endurance, coordination, and range of motion.
• Introducing stimuli to facilitate motor activity and learning.
• Instructing in the activities of daily living and use of assistive devices.
• Administering traction, massage, and other treatments such as moist packs, ultraviolet and infrared lamps, and ultrasound machines to improve patient’s comfort and aid in recovery.
• Motivating and instructing patients, families, and other caregivers to help patients through the treatment and convalescent period.
• Evaluating the effectiveness of treatment with other team members with an eye towards fine-tuning therapeutic procedures and treatments.
Physiotherapists can also purse a career in the academe. We can teach in colleges and universities offering a degree in BS Physical Therapy. Our knowledge in anatomy, physiology, and diseases could also come in handy as we may educate not only physical therapy students, but also other aspiring students from the different allied health professions.
Other physiotherapists are involved in research and ergonomics. Some universities have research arms that employ physiotherapists and other health professionals in order to improve our healthcare system. Advanced studies in research methodologies are of course, required in order to be efficient in this career. And still, other physical therapists are involved in occupational health evaluation and management.
Advanced Studies after Graduation
After becoming licensed, we can pursue advanced studies in physical therapy. In the Philippines, there are only two institutions that grant degree as Master of Science in Physical Therapy. These are the University of Santo Tomas and the University of the Philippines. Unfortunately, there are no institutions in the Philippines that presently grant Doctorate degree for the said profession. Other local physiotherapists also pursue graduate studies in physiology and health sciences education. Moreover, others pursue their studies as students of Medicine.
Lastly, it is important to understand that whatever career we are to pursue in the future relies on the concepts and disciplines that we shall learn today.
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