If you signed up for the Student Health Clinic…… ► Write what day AND time you signed up for:  A.m. appointments: from 9:00 am until 11:00 am (sign up for at least a one hour appointment)  P.m. appointments: from 12:00 pm until 3:30 pm (sign up for at least a one hour appointment) ► NO FRIDAY APPOINTMENTS!! ► Call to make an appointment for yourself ► Show up on time, BRING GRADESHEET!!, dress appropriately, be ready to learn and take notes for your paper ► Directions: Student Health and Wellness Center (Building just north of the football stadium)  Come to the south, east entrance (behind building), it is the first door on your LEFT as you come in the doors

If you are interested in going with Curt to do home visits… ► Get with Curt to decide and specific date and time ► Write that date and time down ► Show up on time, BRING YOUR GRADESHEET, dress appropriately, be ready to learn and take notes for your paper ► Curt’s ► Curt’s phone:

Introduction to, and History of Physical Therapy

Objectives ► 1. Be able to provide a definition of physical therapy ► 2. Describe the components of the Disablement Model of health care and give an example of each component ► 3. Describe the characteristics of a profession ► 4. Provide a brief history of physical therapy in the US and the major factors that influenced its growth

What is Physical Therapy? ► Before we can understand physical therapy we must know how to define the profession:  What does a Physical Therapist (PT) do?  What settings do PT’s work in?  How do what PT’s do differ from a Chiropractor, Occupational Therapist or an athletic trainer?

What can PT’s Do? ► State regulation of physical therapy  Each state has a Practice Act that determines the scope of what a PT can do ► American Physical Therapy Association (APTA) has tried to help states collectively to unify the individual state’s scopes of practice  Examination of patients  Interventions to treat problems  Consultation  Education  Research  Prevention

Examination ► Examinations in physical therapy are done to:  Identify a diagnosis  Determine a prognosis  Establish a plan of care ► Examinations typically include:  Medical history  Systems review  Tests and measures

Examination ► Medical history can include:  Past medical history  How it happened, when it happened, where it hurts, and what has been done to treat it so far (if anything)  Medications  Social history  Patient goals ► what patient wants to accomplish with physical therapy visits

Examination ► Systems review  Musculoskeletal ► Muscles, bones, joints, etc  Integumentary ► Skin color, scars, temperature, etc.  Neuromotor ► Reflexes, sensation, two point discrimination  Cognitive ► Who, what, when, why

Examination: Typical Tests and Measures ► Gait, locomotion, and balance ► Range of motion ► Muscular Performance ► Posture analysis ► Aerobic capacity and endurance ► Sensation ► Reflexes ► Environmental, home and community barriers ► Joint integrity and mobility ► Prosthetic requirements ► Ventilation, respiration, and circulation

Typical Interventions ► Therapeutic exercise ► Functional training  Balance  Stairs, bed mobility, etc. ► Manual therapy  Massage  Joint mobility ► Wound care ► Electrotherapy  Interferential stimulation ► Airway clearance ► Application of assistive devices, braces, orthotics, prosthetics, etc.

Who Provides PT? ► According to APTA:  Physical therapy is “provided by or under the direction and supervision of a physical therapist”. ► PT’s ► Physical Therapist Assistants (PTA) working under the direction of a physical therapist

Exam and Intervention are Anchored in the Disablement Model ► Disablement differs from medical model  Traditional medical model treats the “symptom” ► Ex: treating the headache with pain killers  Disablement Model focuses on the “functional abilities” that result from the medical condition ► Ex: can’t walk because leg broken ► Ex: can’t drive because neck is in brace

Thinking about Physical Therapy Differently ► Fixing Person vs. Fixing Environment  Medical Model—Fix person  Disablement model—Fix environment ► Discussion: If you had a disability, which would you prefer and why? ► Examples

Physical Therapy as a Profession ► “Physical therapy is a health profession whose primary purpose is the promotion of optimal health and function. This purpose is accomplished through the application of scientific principles to the processes of examination, evaluation, diagnosis, prognosis, and intervention to prevent or remediate impairments, functional limitations and disabilities as related to movement and health.” (page 7, class text)

PT as a Profession ► Profession hierarchy that defines a profession:  1. Lifetime commitment  2. Representative organization  3. Specialized education  4. Service to clients  5. Autonomy of judgment

History of Physical Therapy ► Some accounts of massage, hydrotherapy, etc BC-1800 AD  Chinese and Romans ► Electrotherapy in 1600’s ► Most significant beginnings in Europe  England and France prior to coming to US ► Techniques came over to US with polio epidemics and W.W.I

Impact of W.W.I ► Injuries sustained in W.W.I  Many soldiers left wounded and in need of PT ► US Surgeon General sent US physicians to Europe to learn about physical therapy techniques  Resulted in Division of Special Hospitals and Physical Reconstruction in 1917 ► Responsible for training/managing “Reconstruction Aides” ► Women exclusively

Impact of Poliomyelitis ► Polio epidemics in US of 1894,1914, 1916  Many children left paralyzed ► Vermont plan in 1916  Program to study polio and its effects on children  Physiotherapists ► Provided massage, muscle strength assessments, and exercise as treatments

Post W.W.I and Polio ► Shift of focus from “Preserving” a fighting force to “maintaining” a working force ► Shift from the military to a civilian setting  Provided a need to establish an organization ► American Women’s Physical Therapeutic Association 1921  Mary McMillan as president ► Known as first “physical therapist”

Early PT History ► 1922 name changed to American Physiotherapy Association  1923 – 2 males admitted to profession ► PT requirements: graduates of schools of physical education or nursing

Early PT History (con’t) ► 11 approved programs for physiotherapists in 1930, 13 in 1936, etc. ► 1947 now termed “Physical Therapists” and new organization name  American Physical Therapy Association

1960’s – 1980’s ► Various organizational and legal changes to profession in general:  Regarding legal use of aides and assistants  1960 PT requirement: bachelor’s degree  1979 – PT requirement: by 1990 must have an advanced degree (post bachelors degree)  1983 – APTA sole governing force for PT and PTA educational programs  1988 – 20 states had “direct access”

1990’s ► New reimbursement patterns (legal issues)  Ex: Medicare cap of $1500 per year on certain services  Restriction of physical therapy visits  Job availability plateaued and salaries decreased in some facilities ► APTA took a stronger lobbyist role to impact governmental legislation ► Shift to more evidence based practice  Research and evidence used to influence third party payers

Present Day ► Job opportunities are more plentiful ► Changes in legislation ► Better training in evidence based practice ► Better trained physicians on what PT’s can do ► Shift to Doctorate prepared PT’s  Diagnosis and direct access

In Summary, You Should Now be Able to: ► 1. Provide a definition of physical therapy ► 2. Describe the components of the Disablement Model of health care and give an example of each component ► 3. Describe the characteristics of a profession ► 4. Provide a brief history of physical therapy in the US and the major factors that influenced its growth

Questions?