Physical therapy practitioners are physical therapist (PT) and physical therapy assistant. Physical therapy assistant works under guidance of physical therapist. Physical therapist is an independent therapy provider employed by hospital, group of physician, single physician or owner of physical therapy facility. Physical therapist may own the facility and provide services through his facility. Physical therapist is trained and licensed to practice therapy involving examination, evaluation, diagnosis and treatment. Outcome of physical therapy depends on frequency of treatment. Patients are schedule for treatment 2 to 3 times a week for 6 to 12 weeks. Patient may need long term physical therapy. Long term physical therapy is necessary for patients who are established with severe impairments, functional limitations and disabilities. Initial examination includes history from patient, relatives, friends, referring physician and specialist. History is followed by examination to evaluate anatomical location of pain, deformity, limitations and level of impairments.
Therapist will set a goal after first or second visit to achieve optimum improvement. End result depends on effort by therapist and patient. Physical therapy is performed by either physical therapist (PT) or physical therapist assistant (PTA). PTA always works under direction of physical therapist. Physical therapists may work in conjunction with respiratory therapist and/or occupational therapist. In some cases, physical rehabilitation technicians may provide physiotherapy services.
History of Physical Therapy
- Hippocrates was a Greek physician born in Cos, year 460 BC. He had done most of his work in medicine around 430 years before the birth of Christ. Hippocrates wrote and published medical topics written by him and others. He was called “Father of Medicine”. Reference of manual therapy was found in one of the book.
- Aelius Galenus or Claudius Galenus was a physician, surgeon and philosopher. He was Roman of Greek decent, born and lived in Rome. He was scholar and clinician. He wrote several articles on various subjects in medicine and surgery. He had mentioned importance of manual therapy in one of his journal during AD 162 and later.
- During middle of 18th century, fracture and broken bones were diagnosed following fall and injuries. During this period, orthopedic medicine branch was established to treat all problems related to bones and limbs. Same time physical therapy was established to be a part of orthopedic treatment.
- 1813- Swedish gymnasts used regular massage, manipulation, and exercise during and after training.
- 1881- First training school of physical therapy was started in Boston, USA.
- 1894- Physical therapy was used first time to treat musculoskeletal disorder in children infected with polio at Rutland, Vermont, USA
- 1894- First Charted Society of Physiotherapy was formed by nurses at Great Britain.
- 1913-Physiotherapy school was started at Otago in New Zealand.
- 1914- REED college in Portland, Oregon, USA established first P/T course and graduation
- 1917 Department of Physical Therapy was created as a sub specialty within medical division of US army.
- 1920 Organizational meeting for American Women’s Physiotherapeutic Association held in New York. Mary McMillan elected first President by ballot.
- 1921-The first physical therapy research was published in the United States
- 1921- Mary McMillan organized the Physical Therapy Association called American Physical Therapy Association (APTA).
- 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio.
- 1940- Treatment Established: Exercise, Massage, and Traction.
- 1942 Public Law 828 recognizes women PTs as wartime members of the Army Medical Department, with “relative” rank of 2nd Lieutenant.
- 1946 American Physiotherapy Association changes its name to the American Physical Therapy Association (APTA).
- 1950- Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries
- 1967 The APTA creates policy to approve the training of Physical Therapist Assistants (PTAs).
Initial Clinical Evaluation
- Detailed history is taken to evaluate pain, impairment, limitation of functional capacity and cognitive symptoms.
- Evaluation of Cognitive Symptoms- Examination is performed to evaluate level of sleepiness, confusion, difficulties in arousing patient, and attention deficit.
- Evaluate cranial and peripheral nerve integrity.
- Evaluate gait abnormalities, musculoskeletal locomotion deficiency and loss of balance while performing indoor as well as outdoor activities.
- Evaluate joint strength and mobility.
- Evaluate Motor Function of upper and lower extremity. Detailed examination to assess tone, power and coordination. Assess motor weaknesses.
- Evaluate sensory deficit like numbness and tingling.
- Evaluate reflexes and range of motion of joint in all four extremities.
- Evaluate posture.
- Evaluate Ventilation and Respiration/Gas Exchange by using capno-graph and pulse oxymeter.
- Evaluate ability to walk, turn, and change of posture from sitting to upright or lying down to sitting position. Evaluate body mechanics in ambulation, change of position and change of posture.
- EMG studies to see extend of nerve damage.
- Clinical Impression and diagnosis-
- Evaluation: Evaluate data of the examination such as history, systems review, and tests.
- Diagnosis: Determine a diagnosis that guides future patient treatment.
- Prognosis: Determine patient’s prognoses during and following treatment.
- Manual Therapy
- Physical Therapy Interventions
- Set goals and outcomes.
- Therapeutic Exercise.
- Hot and Cold Pack.
- Functional training of disabled patient to achieve complex self-care and domestic management.
- Functional training of partial disabled patient to perform restricted work.
- Specific Exercises
- Manipulation of Joint
- Wound Care
- Teaching and Evaluation
- Use of Orthotic, Protective, and Supportive Devices.
- Evaluate Prosthetic Requirement and Devices.
- Correct Posture.
- Safe mode of using durable medical equipment including wheel chair.
Advanced Treatments :
- Joint and Spine Mobilization/Manipulation
- Dry Needling
- Electrical Muscle Stimulation
Plan of Care
- Collaborate with:
- Family Members
- Payers – e.g. Medical insurance, worker’s comp and auto insurance companies
- Plan Duration of Physical Therapy
- Set a Goal
- Electrotherapeutic Modalities
Physical Therapy Services
- Hospital inpatient care
- Outpatient Clinic
- Skilled Nursing Facilities
- Extended Care Facilities
- Private Homes
- Sports Training Facilities
- Fitness Center.
Physical therapy may be essential to extend beyond initial 6 to 8 week of therapeutic period to prevent following complication.
- Muscle atrophy
- Stiff Joint
- Prevent the Loss of Mobility
- Learn to Maintain Restricted Active Lifestyles,
- Maintain and Restore Maximum Movement and Functional Ability Throughout The Lifespan.
- Follow up to Reinforce Continuation of Exercise.
- 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.”
- Physical Therapists (PT)
- Physical Therapist Assistants (PTA)
- Physical Therapy Technicians (PT Techs) or Aides
- Curricula for the Physical Therapist and Assistant Associate Degree include:
- Anatomy and Physiology
- Exercise Physiology
- Human Biology
- Clinical Pathology
- Behavioral Sciences
Currently in USA following higher education is available to be a professional Physical Therapist
- Doctor of Physical therapy (DPT) degree
- Master of Physical therapy
- Bachelor of Physical therapy
Accreditation – Training and education is supervised by Commission on Accreditation in Physical Therapy Education, USA.
Physical Therapist Assistants
- Deliver treatments and physical interventions for patients and clients under a care plan established by and under the supervision of a physical therapist.
- Physical therapist assistants in the United States are currently trained under associate of applied sciences
Sub-specialty – Targeted Physical Therapy
Cardiovascular and Pulmonary Rehabilitation
- Joint Effort by Respiratory Therapist and Physical Therapists
- Mostly conducted in hospital or outpatient facilities
- Primary goal is to increase endurance and functional independence
- Respiratory manual therapy is used for clearing lung secretions
- Cystic Fibrosis
- Heart Attack
- Coronary Bypass Surgery
- Pulmonary Fibrosis
- 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.
- Special Need –
Integumentary: Skin and Subcutaneous Tissue Care
- Wound Treatment
- Non-healing wound/ulcer
- Mechanical Lavage
- Topical Agent
Physiotherapy is necessary and helpful in improving following impairment in many debilitating diseases caused by neurological diseases. Physical therapy may restore and improve functional capacity and improve daily necessary activities.
Common impairments caused by neurological diseases are:
- Vision Impairment
- Balance and Gait Abnormalities
- Restricted Ambulation
- Restricted Daily Indoor and Outdoor Activities
- Inadequate Muscle Strength, Tone and Power
Following Diseases May Need Long Term Physical Therapy:
- Alzheimer’s Disease
- Charcot-Marie-Tooth Disease
- Cerebral Palsy
- Multiple Sclerosis
- Parkinson’s Disease
- Spinal Cord Disease
Diseases, injury and post surgical healing causes pain and deformities related to orthopedic medicine and may need long term physical therapy to prevent further deterioration. Common causes of musculoskeletal pain and sufferings are as follows:
- Sports Injury
- Post Surgical Pain and Deformities
- Muscle and Joint Sprains
- Back Pain
- Neck Pain.
Advanced Treatments Are:
- Traditional Physical Therapy- Exercise, hot/cold pack
- Joint and Spine Mobilization/Manipulation
- Dry Needling
- Electrical Muscle Stimulation
Pediatric Physical Therapist is employed after certification and completion of education. Pediatric physical therapist will spend initial one to two years working with experienced senior pediatric physical therapist. Pediatric physical therapy institutions are mostly run through pediatric hospital or facilities. Pediatric population involves two sets of patients, a child and parents. Physical therapy modalities are modified for children to prevent developing muscle and joint injuries. Treatment plan is same as described in treatment section but additional precautions are taken in diagnosis and providing physiotherapy.
- Improve Gross and Fine Motor Skills
- Improve Balance and Coordination
- Improve Strength and Endurance
Children With Following Conditions May Need Long Term Physical Therapy:
- Developmental Deformities
- Cerebral Palsy
- Spina Bifida
- Women’s Health
- Women’s Health Physical Therapy is Directed to Specific Need and Diseases.
- Pelvic Pain
- Urinary Incontinence
- American Board of Physical Therapy Specialties
- American Physical Therapy Association
- Doctor of Physical Therapy
- Joint Manipulation Association.
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