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Physical therapy (or physiotherapy) is a healthcare profession concerned with prevention and management of movement disorders occurring throughout the lifespan. Physical therapy can only be performed by either a qualified physical therapist (physiotherapist) or physical therapist assistant (PTA).  Despite this, various alternative health professions continue to employ the use of some physical therapeutic modalities in practice. Individualized management may involve the interaction between patient/client, families, caregivers, and healthcare team in a process of assessing movement potential and in establishing goals and objectives using knowledge and skills unique to physical therapists.
The physical therapists’ distinctive view of the body and its movement needs and potential is central to determining a diagnosis and an intervention strategy and is consistent whatever the setting in which practice is undertaken. These settings will vary in relation to whether physical therapy is concerned with health promotion, prevention, treatment or rehabilitation.
Physical therapy interventions may include:
"Spinal and extremity manipulation; therapeutic exercise; electrotherapeutic and mechanical agents; functional training; provision of aids and appliances; patient education and counseling; documentation and coordination, and communication. Intervention may also be aimed at prevention of impairments, functional limitations, disability and injury including the promotion and maintenance of health, quality of life, and fitness in all ages and populations."
Physical therapy has its origins in ancient history, It is reported as a form of manual therapy in China circa 2500 BC. Hippocrates described massage and hydrotherapy in 460 BC.
However, even before that the need for physical (manual) handling of patients body was well understood and advocated in "Ayurveda" - the oldest medical system known. A tradition of Ayurvedic Therapists still exists in India and is an integral part of Health care.
Modern physical therapy
The modern practice of physical therapy was developed in London in 1896, believing hospital patients needed to be mobilized on a regular basis in order to maintain adequate muscle function and mobility. This special interest group grew rapidly and in 1920 the Chartered Society of Physiotherapy was formed in the Country of United Kingdom. Similar organizations were developed in other countries, including the USA.
The care and rehabilitation of the large numbers of amputees resulting from the World Wars of the early 20th century, as well as care of patients suffering from diseases such as polio galvanized the development of physical therapy worldwide. One of its principal advocates was Sister Elizabeth Kenny, an Australian nurse who made a significant impact on the treatment of polio during the 1930s and 1940s.
Physical therapy and science
For decades, Physical therapy practice has been the subject of criticism for its lack of a research base. In a late 1990s survey of English and Australian physical therapists, fewer than five percent (5%) of survey respondents indicated that they regularly reviewed scientific literature to guide practice decisions. Despite an overall positive attitude towards evidence based practice, most physical therapists utilized treatment techniques with little scientific support. Although numerous calls have been made for a shift toward the use of research and scientific evidence to guide practice decisions, most physical therapists continued to base practice decisions largely on anecdotal evidence.
To overcome these limitations, the World Confederation for Physical Therapy (WCPT), the American Physical Therapy Association (APTA), and a number of authors have called on the profession to adopt and adhere to evidence based practices formally based on the best available scientific sources. The move towards the Doctor of Physical Therapy (DPT) professional postbaccalaureate degree indicates increased awareness of and training in the sciences, research, and interventions.
Physical therapists (PTs) are health care professionals who evaluate and manage health conditions for people of all ages. They may use the title "Dr." as some complete doctorate programs. Typically, individuals consult a PT for the management of medical problems or other health-related conditions that cause pain, limit ability to move, or limit the performance of functional activities. PTs also help prevent health conditions through prevention, restoration of function and through fitness and wellness programs that achieve healthy and active lifestyles. PTs evaluate individuals, diagnose conditions, and develop management plans using treatment techniques that promote the ability to move, reduce pain, restore function, and prevent disability. They provide care in hospitals, clinics, schools, sports facilities, and more.
Physical therapy assessment
A physical therapist will initially conduct a subjective examination (interview) of a patient's medical history, and then provide objective assessment in the form of a physical examination. The subjective examination is guided by the presenting symptoms and complaint, and the objective assessment is in turn guided by the history. This semistructured process is used to rule out serious pathology (so called red flags), establish functional limitations, establish the diagnosis, guide therapy, and establish a baseline for monitoring progress. The objective exam will then use certain quantifiable measurements to both guide diagnosis and monitor progress. The particular focus of a regimen will depend on the system and area being managed. Whereas a musculoskeletal exam might assess joint range of motion, muscle power, and posture among other metrics, a cardiopulmonary assessment might involve lung auscultation and exercise physiology testing. In some countries a physical therapist may order diagnostic imaging tests such as x-rays and MRIs to obtain more information about a patient's presenting condition and determine a treatment plan, including referral to other practitioners. Physical therapists may also perform sonography, electromyography and nerve conduction testing to aid in the diagnostic process.
Physical therapy treatment
Guided by the assessment findings, the physical therapist will then develop and facilitate a treatment plan. Aside from the various physiotherapeutic techniques involved in therapy, the treatment regime may include prescribing and advice regarding assistive technology including mobility aids, standing frames, and walking devices. The physical therapist should consider functional progress; and include ongoing review and refinement. Patient education is a key aspect of all treatment plans.
It is difficult to explore the many aspects of physiotherapeutic treatment options, especially considering their ongoing development in the face of an increasing research base. Nonetheless, some examples of treatment options are listed below.
Musculoskeletal (Orthopaedic) physical therapy
Musculoskeletal (Orthopaedic) physiotherapists are able to diagnose, treat and using the range of techniques outlined below help with prevention of pain/pathology.
Various therapeutic physical therapy modalities are available, including exercise prescription (strength, motor control, stretching and endurance), manual therapy techniques like joint mobilization/manipulation, soft tissue massage, and various forms of so-called "electrophysical agents" (such as cryotherapy, heat therapy, iontophoresis and electrotherapy).
Nowadays, in various countries physiotherapists are specializing in orthopaedic medicine. Those people can use diagnostic and therapeutic infiltration/injections to various soft tissue and joints. They are trained to diagnose and treat various orthopaedic conditions.
Despite ongoing research giving a clearer picture regarding the use of various modalities in specific conditions, the benefits of electrotherapy are widely debated.
The practice of physical therapy should not be defined by the use of modalities but rather the integration of examination, history, analysis and restoration of movement dysfunction.
Cardiopulmonary physical therapy
Cardiopulmonary physical therapists work with patients in a variety of settings. They treat acute problems like asthma, acute chest infections and trauma; they are involved in the preparation and recovery of patients from major surgery; they also treat a wide range of chronic cardiac and respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD), cystic fibrosis (CF) and post-myocardial infarction (MI). They work with all ages from premature babies to older adults at the end of their life. Physical therapists are pioneering new management techniques for non-organic respiratory problems like hyperventilation and other stress-related disorders as well as leading the development of cardio-pulmonary rehabilitation and non-invasive ventilation.
Neurological physical therapy
Treatment in neurological conditions is typically based upon exercises to restore motor function through attempting to overcome motor deficits and improve motor patterns. To achieve this aim various theoretical frameworks have been promoted, each based upon inferences drawn from basic and clinical science research. Whilst some of these have remained static, others are designed to take into account new developments, perhaps the most notable example being the "movement science" framework. The various philosophies often generate considerable debate.
Integumentary physical therapy
Treatment of conditions involving the skin and related organs. Common conditions include wounds and burns. Treatment interventions include debridement of wounds and burns, dressings, scar prevention and reduction.
Paediatric physical therapy
Treatment and management of paediatric neurological, cardiothoracic, and musculoskeletal conditions. Common conditions include asthma, cerebral palsy, developmental delay and torticollis.
Physical therapy education
Programs around the world
As with many aspects of the profession, physical therapy training varies considerably across the world. As a rule, physical therapy studies involve a minimum of four years of tertiary education. Some examples are described here.
Following basic physical therapy training, experienced practitioners may undertake further study towards certification as a specialist practitioner. For example, in the United States, experienced physical therapists may apply to take a specialty exam to earn board certification in any of seven sub-specialty areas: Cardiovascular and Pulmonary, Clinical Electrophysiologic, Geriatric, Neurologic, Orthopaedic, Paediatric, and Sports physical therapy.
Qualifications in the United States
Physical Therapists must have a graduate degree from an accredited physical therapy program before taking the national licensing examination. Most educational programs now offer the Doctor of Physical Therapy (DPT) degree. All states (in the United States) require physical therapists to pass the [National Physical Therapy Examination] after graduating from an accredited physical therapist educational program before they can practice.
According to the American Physical Therapy Association, there were 209 accredited physical therapist programs in 2007. Of the accredited programs, 31 offered the Master of Physical Therapy, and 179 offered the Doctor of Physical Therapy degree. Virtually all programs are in transistion to the DPT degree.
Physical therapist programs start with basic science courses such as biology, chemistry, and physics, and then introduce specialized courses such as kinesiology, biomechanics, neuroanatomy, human growth and development, pathology, diagnostics, physical examination techniques, and therapeutic procedures. Besides classroom and laboratory instruction, students receive supervised clinical education.
Journals and publications
Physical therapists have access to a wide range of publications and journals.  Some are strictly limited to physical therapy, while others (eg. various orthopedic and surgical journals) are not as specific, yet physical therapists contribute to them and read them. Here are a few:
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Physical_therapy". A list of authors is available in Wikipedia.|