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Physical therapy
Classification and external resources

This physical therapist from the 1950s is assisting two children with polio who are holding on to a rail while they exercise their lower limbs..

Physical therapy (also physiotherapy) is a health care profession that provides treatment to individuals to develop, maintain and restore maximum movement and function throughout life. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors.

Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social well being. It involves the interaction between physical therapist (PT), patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.[1] Physical therapy is performed by either a physical therapist (PT) or an assistant (PTA) acting under their direction.[2]

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.[3]

Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics, to name some of the more common areas. 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 workplaces or other occupational environments, fitness centers and sports training facilities.[4]

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.

Contents

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.[5] 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.[6]

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” = “sick-gymnast.” 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.[7] The School of Physiotherapy at the University of Otago in New Zealand in 1913,[8] and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."[9]

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.[10]

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.[11][12] Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers.

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 Therapy was formed,[13] which has played an important role in advancing manual therapy worldwide ever since.

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 in collaboration with other members of the health care team.[7]

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.[2]

202 of 211 accredited physical therapy programs in the US are accredited at the doctoral level.

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,[14] the American Board of Physical Therapy Specialties list seven specialist certifications, including Sports Physical Therapy and Clinical Electrophysiology.[15] Worldwide the six most common specialty areas in physical therapy are:[16]

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Cardiopulmonary

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.[16]

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 therapy helps[citation needed] those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.[16]

Neurological

Neurological physical therapy is a discipline 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, speech and loss of functional independence.[16]

Orthopaedic

Orthopaedic 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. Orthopaedic therapists are trained in the treatment of post-operative orthopaedic 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 orthopaedic setting.[17] Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining.[18][19][20] Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body will benefit[citation needed] from assessment by a physical therapist specialized in orthopaedics.

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.[16]

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.

See also

References

  1. ^ Description of Physical Therapy - The World Confederation for Physical Therapy (WCPT)
  2. ^ American Physical Therapy Association. "Discovering Physical Therapy. What is physical therapy". American Physical Therapy Association. http://www.apta.org/AM/Template.cfm?Section=Consumers1&Template=/CM/HTMLDisplay.cfm&ContentID=39568. Retrieved 2008-05-29. 
  3. ^ American Physical Therapy Association Section on Clinical Electrophysiology and Wound Management. "Curriculum Content Guidelines for Electrophysiologic Evaluation" (PDF). Educational Guidelines. American Physical Therapy Association. http://www.aptasce-wm.org/documents/guidelines/ENMG%20EvaluationGuidelines.pdf. Retrieved 2008-05-29. 
  4. ^ American Physical Therapy Association (2008-01-17). "APTA Background Sheet 2008". American Physical Therapy Association. http://www.apta.org/AM/Template.cfm?Section=Physical_Therapy&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=33205. Retrieved 2008-05-29. 
  5. ^ Wharton MA. Health Care Systems I; Slippery Rock University. 1991
  6. ^ Sarah Bakewell, "Illustrations from the Wellcome Institute Library: Medical Gymnastics and the Cyriax Collection," Medical History 41 (1997), 487-495.
  7. ^ Chartered Society of Physiotherapy (n.d.). "History of the Chartered Society of Physiotherapy". Chartered Society of Physiotherapy. http://www.csp.org.uk/director/about/thecsp/history.cfm. Retrieved 2008-05-29. 
  8. ^ Knox, Bruce (2007-01-29). "History of the School of Physiotherapy". School of Physiotherapy Centre for Physiotherapy Research. University of Otago. http://physio.otago.ac.nz/about/history.asp. Retrieved 2008-05-29. 
  9. ^ Reed College (n.d.). "Mission and History". About Reed. Reed College. http://www.reed.edu/about_reed/history.html. Retrieved 2008-05-29. 
  10. ^ Roosevelt Warm Springs Institute (n.d.). "History". About Us. Roosevelt Warm Springs Institute. http://www.rooseveltrehab.org/history.php. Retrieved 2008-05-29. 
  11. ^ McKenzie, R A (1998). The cervical and thoracic spine: mechanical diagnosis and therapy. New Zealand: Spinal Publications Ltd.. pp. 16–20. ISBN 978-0959774672. 
  12. ^ McKenzie, R (2002). "Patient Heal Thyself". Worldwide Spine & Rehabilitation 2 (1): 16–20. 
  13. ^ Lando, Agneta (2003). "History of IFOMT". International Federation Orthopaedic Manipulative Therapists (IFOMT). http://www.ifomt.org/ifomt/about/history. Retrieved 2008-05-29. 
  14. ^ American Physical Therapy Association (n.d.). "APTA Sections". American Physical Therapy Association. http://www.apta.org/AM/Template.cfm?Section=Chapters&Template=/CM/ContentDisplay.cfm&CONTENTID=36890. Retrieved 2008-05-29. 
  15. ^ [1]
  16. ^ a b c d e Inverarity, Laura; Grossman, K (2007-11-28). "Types of Physical Therapy". About.com. The New York Times Company. http://physicaltherapy.about.com/od/typesofphysicaltherapy/a/typesofpt.htm. Retrieved 2008-05-29. 
  17. ^ Cameron, Michelle H. (2003). Physical agents in rehabilitation: from research to practice. Philadelphia: W. B. Saunders. ISBN 0-7216-9378-4. 
  18. ^ Bunce SM, Moore AP, Hough AD (May 2002). "M-mode ultrasound: a reliable measure of transversus abdominis thickness?". Clin Biomech (Bristol, Avon) 17 (4): 315–7. doi:10.1016/S0268-0033(02)00011-6. PMID 12034127. http://linkinghub.elsevier.com/retrieve/pii/S0268003302000116. 
  19. ^ Wallwork TL, Hides JA, Stanton WR (October 2007). "Intrarater and interrater reliability of assessment of lumbar multifidus muscle thickness using rehabilitative ultrasound imaging". J Orthop Sports Phys Ther 37 (10): 608–12. PMID 17970407. 
  20. ^ Henry SM, Westervelt KC (June 2005). "The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects". J Orthop Sports Phys Ther 35 (6): 338–45. PMID 16001905. 

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