PHYSIOTHERAPY
Introduction to Physiotherapy
Physical therapy is the field of medical care that uses exercise and such physical agents as heat, light, water, and massage to treat certain physical disabilities. Among its objectives are the relief of pain caused by surgery or by medical problems; the improvement of muscle strength and mobility; and the improvement of such basic functions as standing, walking, and grasping in patients who are recovering from debilitating illness or accidents or who are physically handicapped. In the context of this paper, the terms physiotherapy and physical therapy are one and the same and are used interchangeably.
The daily responsibilities carried out by physical therapy specialists are as varied as the patients they serve. Historically, physical therapy was regarded by some as a diversionary activity; pigeon holed as being specifically for people who were recovering from a traumatic injury or a debilitating illness. Over the years it has significantly developed: a central part of the service looks at how people manage in their home environment and perform daily tasks. Technology has come a long way and it means the range of adaptive equipment that physical therapy can offer people to help them have grown enormously.
Physiotherapy, as it is often called in many countries, has restored function to limbs or organs stricken by poliomyelitis, arthritis, muscular dystrophy, effects of tumors in the brain or nervous system and accidental injury. Patients with physical handicaps may be trained in learning or relearning elementary motor functions, such as holding a spoon or turning a doorknob, or they may be taught how to use crutches, prosthetic devices, or other mechanical aids. Even parts of the body totally disabled are sometimes restored to partial or complete use.
A variety of equipment and methods are utilized in physical therapy. An overview of these equipments and methods are given in the succeeding paragraphs and further discussion will be provided in the later part of the paper. High frequency electrical current can be directed deep into the tissue of the body with a diathermy machine or infrared lamp, and is frequently used in treating inflamed joints, bursitis, infections of the sinus, and other conditions difficult to penetrate.
Hydrotherapy, treatment by water in tanks, pools, or large baths, makes use of the buoyancy of water to treat paralyzed arms and legs. The whirlpool, a special water device in which water circulates in a whirling motion at any desired temperature, produces a mild massaging movement and is used, for example, on a leg in which circulation of the blood has been retarded. In the constant-flow bath, the disturbed patient is placed in a canvas-type cradle with only his head above the surface and gently circulating tepid water soothes the nerves and induces relaxation and sleep.
During recent years, physical therapy is faced with the challenge of producing evidence that physical therapy interventions are effective. The fundamental question confronting physical therapy is whether or not physical therapy interventions make a contribution to function, health, and well-being. The individual's ability to perform actions can serve as a theoretical construct related to movement and health around which physical therapy interventions can be assessed (2005). However, physical therapy is a practice which is evidence-based and its use over the years has benefited more than it may have harmed many individuals.
Scope of Practice
Physiotherapists are not generally associated with saving lives. But thousands of people across the United Kingdom owe their lives to the field of physical therapy or physiotherapy, with practitioners specializing in everything from helping to prevent the elderly from falling to reducing the number of deaths following heart attacks and strokes (2004).
The most common idea of physical therapists is that they help patients restore normal function to painful muscles and joints especially in the back. Physical therapists manage and prevent movement dysfunctions for the purpose of promoting optimal health and function as defined by the individual receiving services.
Function is defined as those activities identified by the individual as essential to support physical, social, and psychological well-being. Yet, the degree to which the "promotion of optimal function" may be linked to underlying movement dysfunction has not been fully determined. For example, a movement dysfunction may be caused by an impairment of strength, like the force exerted by a muscle to overcome a resistance, that might be measured with a dynamometer and addressed by implementation of a therapeutic exercise program. Physical therapy can help improve the strength and will lead to increased independence of the patient in dressing, bathing, or performing home chores ( 2005).
There is a commonly held belief that physiotherapy is all about back pain and sports injuries, as is what the previous paragraph is all about. But physiotherapists are science-based professionals who view movement - from the way we move our limbs to the way we breathe - as central to human health and wellbeing. As such, the areas in which they work are very wide-ranging. Physiotherapy is increasingly focusing on today's big public health issues: obesity, smoking, work-related ill health and stress, to name a few ( 2004).
Some practitioners also focus on specific areas like neurology or respiratory care, while others focus on clinical specialties such as burns management. Some have expertise in specific interventions like acupuncture; meanwhile others work with particular groups of people like the elderly or people with learning disabilities. Some physiotherapists even work with animals, with racing horses and racing dogs among the most common patients. These physiotherapists apply the same principles that they would to humans to achieve things like maintaining strength and mobility ( 2004).
Physiotherapy is also used in most dialysis programs. The frequent complaints of weakness, difficulty with ambulation, fatigue, decreased range of motion, pain and difficulty with activities of daily living are all indications for a physiotherapy referral. The primary goal of physiotherapy in a chronic care setting such as dialysis is to optimize each patient's functional ability. Physiotherapists can help to keep dialysis patients as safely mobile as possible and for as long as possible (2004).
In most hospitals in developed countries, physiotherapy is seen as an integral part of the management of patients in intensive care units (ICU). The precise role that physiotherapists play in the ICU varies considerably from one unit to the next, depending on factors such as the country in which the ICU is located, local tradition, staffing levels, training, and expertise.
The referral process is one example of this variation, whereby in some ICUs, physiotherapists assess all patients, whereas in other ICUs, patients are seen only after referral from medical staff. The most common techniques used by physiotherapists in the ICU are positioning, mobilization, manual hyperinflation (MH), percussion, vibrations, suction, cough, and various breathing exercises. Some physiotherapists routinely treat most, if not all, ICU patients with a combination of these techniques, regardless of the patient's underlying pathophysiologic condition, with the intention of preventing pulmonary complications, whereas other physiotherapists use such techniques selectively when they believe they are specifically indicated ( 2000).
Physical rehabilitation also fosters a positive attitude towards cancer. Physical therapy won't cure the patient but it gives him or her something positive to focus on. Because of the nature of the disease - sometimes incurable, sometimes recurring - this line of physiotherapy more than most concentrates on holistic care - seeing the patient as a whole person, not a knee or shoulder to be fixed. Amid the strong painkillers associated with cancer, physiotherapists may administer treatments such as acupuncture. Physiotherapists see the patient throughout the treatment, and help in long-term monitoring. There are so many problems that patients face, and the physiotherapist will be there to help and assist the patient (2003).
As you can see in the previous paragraphs, much of physiotherapy is really about illness prevention and health promotion. Many physiotherapists spend a great deal of their time providing lifestyle advice or introducing projects that enable people to live more healthily. An example of physiotherapists working with illness prevention is their growing involvement with schools, where they focus on things like ensuring children have the right equipment and use the right bags to prevent them storing up musculoskeletal problems for the future (2004). Physiotherapy is not all about youngsters, however, and work with other age groups can be equally successful.
Community-based older people use a variety of health care providers to maintain or improve their health. Physical therapists are one group of providers who primarily focus on improving, maintaining, or limiting decline in the physical function of the older person. Physical therapy may be provided in inpatient, outpatient, or home settings (2005). There has therefore been an increase in physiotherapists working in fields such as care of the elderly and of children with disabilities. Physiotherapy has also extended their client base to include, for instance, people with learning disabilities or mental health problems ( 2003).
Physical therapists therefore need to be able to relate to people from a variety of different backgrounds. They need excellent communication skills and should be good at motivating people - if a patient finds a task difficult or frustrating, the physical therapist needs to make sure that they don't become discouraged and give up. Physical therapists need to have plenty of initiative and be able to take decisions on their own, but should also work well as part of a health care team. Organizational skills are thus a major requirement of physical therapists.
The range of types of patients and individual problems that the physical therapist encounters means than he or she will need to be practical, adaptable and creative. He or she will also need patience and good communication skills - and should enjoy working in partnership, both with other healthcare professionals and with patients’ families and caregivers.
Traditionally, physiotherapists have worked in National Health Service hospitals. But increasingly there are opportunities in the community, the independent sector, general practitioner practices, patients' own homes, community centers and also in education and research. Practicing therapists may now work in hospitals and other health-care institutions for physicians or for other therapists, for private or government agencies, in schools, or in private practice. There are many different areas of work within the larger bracket of physiotherapy including occupational health, sports clinics and orthopedics.
They may also be found in the workplace offering advice on healthy lifestyles and ergonomics, as well as treating patients. By working on placement, the physiotherapist experiences a large range of these areas and also have to deal with real people rather than figures in a textbook (2001). Their work is also often closely coordinated with that of the occupational therapist because both fields involve training patients to improve their motor abilities. However, physiotherapists also work with a variety of health care professionals in the planning and delivery of health care, thus making it a multidisciplinary approach to providing health care.
Physical Therapy Treatment
Various treatments are used by physical therapists on different patients, depending on the illness or injury of the patient. The physical therapist uses different types of rehabilitative treatment ranging from water to heat to massage to some other intervention.
Treatment to restore weakened muscles usually begins by subjecting them to a gentle motion, as in hydrotherapy. Hydrotherapy is useful for the slow work of rebuilding wasted muscles. The patients are individually assessed by a physical therapist, and if hydrotherapy can benefit their medical condition, the patients are entered into an exercise program which is designed for the pool and supervised by a physical therapist. Some hydrotherapy programs are provided in a group setting and some are individually conducted.
Heat may be applied to ease stiffening and pain in the joints. Heat therapy can provide both pain relief and healing benefits for many types of lower back pain. Massage is also used by physiotherapists for easing pain and for improving circulation.
Physical therapy treatment may also include special devices such as stationary bicycles, weight lifts, and walkers. In the case of a paralyzed diaphragm, a machine which alternates air pressure and partial vacuum, such as the iron lung, enables the lung to move.
The most frequent type of treatment, however, is exercise, chosen to increase joint mobility or to improve muscle strength and coordination. The patient performs simple exercises which increase in complexity as the muscles strengthen and become better coordinated.
Progressive resistance exercise is a method of increasing the ability of muscles to generate force. The principles of progressive resistance exercise for increasing force production in muscles have remained virtually unchanged over the years. These principles are (1) to perform a small number of repetitions until fatigue, (2) to allow sufficient rest between exercises for recovery, and (3) to increase the resistance as the ability to generate force increases ( 2005).
Traditionally, progressive resistance exercise has been used by young adults who are healthy to improve athletic performance. However, recent reviews have emphasized the potential health benefits of including progressive resistance exercise as part of the promotion of physical activity in the community.
The potential health benefits of incorporating progressive resistance exercise into an overall fitness program include helping to reduce risk factors associated with osteoporosis as well as diseases such as cardiovascular disease and diabetes. The health benefits associated with progressive resistance exercise also may make it a useful intervention in physical therapy. A reduced ability of muscles to generate force, due to injury, pathology, or disuse, is a common impairment in clients seen by physical therapists. If a lack of force generation by muscles is an impairment contributing to an inability to perform everyday activities, then this provides a rationale for physical therapists to apply the principles of progressive resistance exercise when designing treatment programs (2005).
Although many physical therapy interventions are not unique to physical therapists and therefore are not its chief defining characteristic, physical therapist practice is distinctive in its contribution to health care because it specifically targets movement dysfunction through these interventions. If movement dysfunction universally underlies physical therapist practice, then a person could presume that general measures of movement dysfunction would be commonly available in physical therapist practice and research (2005).
Issues in Physiotherapy in the United Kingdom
Despite the radical developments in physiotherapy there is a shortage of practitioners, with government targets set to increase the number of physiotherapists by 59 per cent by 2009. In the past, government calculations for the number of physiotherapists required didn't take into account the fact that there are a growing number of opportunities outside the NHS. Now that the total number of opportunities is taken into account, the number of students required has shot up (2003)
Conclusion
Physical therapy or physiotherapy is the treatment of disease and disability by physical means, often by use of water, air, heat, massage, electricity, and exercise. This branch of medicine has undergone extensive and specialized development in recent years and enormously benefited innumerable paralyzed and disabled persons. The role of the physiotherapist is evolving constantly. Changes in the last few years have also led to physiotherapy becoming a far more diverse and autonomous career, extending their services not only to those who are paralyzed and disabled. Physiotherapists not only help people to recover from injuries or debilitating conditions to lead full lives, they also encourage physical activity and promote good health. Helping people improve and restore their abilities to perform normal daily activities is the focus of the physical therapist and the entire field of physical therapy.
The development of new equipment has aided in the advancement of the entire field of physical therapy and today highly trained and specialized technicians are required to administer treatment under the supervision of the doctor. This gratifying profession offers a diversity that makes it quite appealing to aspiring students. Their job is performed in varied settings such as hospitals, businesses, schools, clinics, private homes, community centers, rehabilitative institutions or nursing homes. Their patients range from newborns to geriatrics, and the mix of health issues they address are just as diverse. Working in collaboration with other healthcare professionals such as general practitioners, consultants, psychologists and speech and language therapists is also becoming commonplace in many areas of physiotherapy. The concept of a multidisciplinary care includes the field of physiotherapy.
The benefits of physiotherapy are known by using evidence based practice for different types of exercise programmes, management of spasticity, respiratory function, management of contractures, and other situations that can benefit from the use of physiotherapy. Despite many issues, the field of physiotherapy has continued to prosper in recent years. The field of physiotherapy has therefore come a long way from the hot water bottle and heating pad.
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