INTRODUCTION TO PHYSIOTHERAPY

HZS 1012

NORZULAIKA BINTI ALIAS

Learning Objectives

To provide information about Physiotherapy profession to the students

Understand the roles and scopes of Physiotherapy practice

Historical view

Physicians like Hippocrates 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.

Henrik Ling, “father of Swedish Gymnastics” who founded the Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation and exercise.

Cont.

After development of orthopedics in the 18th century, machines like the Gymnasticon were developed to treat gout and diseases by systemic exercise of the joints, similar to later developments in physical therapy.

Cont.

The Swedish word for physical is “ sjukgymnast”=“sick-gymnast”.

In 1887, Physiotherapy were registered officially by Sweden’s National Board of Health and Welfare.

Cont.

Over 100 years ago in the UK the Association of Masseurs was formed.

Even with the name change to Charted Society of Physiotherapy and aspiration of professional independence and autonomy were traded for the support, protection and ‘ respect’ offered by the medical professional.

School of physiotherapy began in New Zealand, 1913.

Reed Colleague had graduated “ reconstruction aides” in USA on 1914.

Mary McMillan formed Physical Therapy Association on 1921, later became American Physical Therapy Association (APTA)

In 1980’s history of physiotherapy was on technology (usage of computer, ultrasound, electrical stimulation and other devices)

History of physiotherapy profession in Malaysia

The profession of physiotherapy has started around 1950 by British Expatriate.

The pioneers who brought physiotherapy into Malaysia were the expatriates and later Malaysians were sent on Colombo plan scholarship to serve the country

1977- Sekolah Latihan Fisioterapi, Hospital Kuala Lumpur

Until now- Government & Private Collage, IPTA, IPTS.

Definition of physiotherapy according to: Malaysian Physiotherapy Association (MPA) United Kingdom (UK) Australia United State of America (USA)

Definition

According to Malaysian Physiotherapy Association (MPA), physiotherapist can be defined as:

An individual who is trained and registered as a physiotherapist to promote, prevent, analyze, make physiotherapy diagnosis, carry out physiotherapy treatment, intervene, habilitate and rehabilitate of any form of physical condition and disabilities to restore optimum movement and functional disabilities.

Promotion

Promoting the health and well being of individuals and the general public/society, emphasizing the importance of physical activity and exercise.

Prevention

Preventing any impairments, activity limitations, participatory restrictions and disabilities in individuals who are at risk of altered movement behaviours due to health or medically related factors, socio-economic stressors, environmental factors and lifestyle factors.

Analysis/Diagnosis

Diagnosis and prognosis arise from the examination and evaluation and represent the outcome of the process of clinical reasoning and the incorporation of additional information from other professionals as needed.

This may be expressed in terms of movement dysfunction or may encompass categories of impairment, activity limitations, participatory restrictions, environmental influences or abilities/disabilities.

Treatment and Intervention

Treatment & intervention are implemented and modified in order to reach agreed goals and may include manual handling, movement enhancement, physical, electro-therapeutic and mechanical agents, functional training, provision of assistive technologies, patient related instruction and counseling, documentation and co-ordination and communication.

Cont.

The purpose of treatment and intervention is also for prevention of impairments, activity limitations, participatory restrictions, disability and injury including the promotion and maintenance of health, quality of life, workability and fitness in all ages and populations.

Habilitation

The process of supplying a person with the means to develop maximum independence, in the Activities of Daily Living through training or treatment.

Rehabilitation

The physical restoration of a sick or disabled person by therapeutic measures and reeducation to participation in the activities of a normal life within the limitations of the person’s physical disability.

Cont.

Recognized Physiotherapy body in: UK Australia United States

Definition

Chartered society of Physiotherapy (CSP) Curriculum Framework Jan 2002

Physiotherapy is a health care profession who is concerned with human function and movement and maximizing potential.

It uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status.

Cont.

Chartered society of Physiotherapy (CSP) Curriculum Framework Jan 2002 Physiotherapy access and treat people

with physical problem caused by accident, ageing, disease or disability using physical approaches to maximize patient’s recovery.

Cont.

Australian Physiotherapy Association (APA) Physiotherapy is an holistic approach to

the prevention, diagnosis and therapeutic management of disorder of movement or optimization of function, to enhance the health and welfare of the community from an individual or population perspective.

Cont.

The practice of physiotherapy encompasses a diversity of clinical specialties to meet the unique needs of different client groups.

Physiotherapy services are use in a wide variety of area such as health organization, private practices, school and community and sports and workplace setting.

Cont.

The practice of physiotherapy is founded upon a clinical reasoning process and may incorporate the following activities, the performance of physiotherapy assessment and treatment of any injury, disease or other condition of health, by the use of physical intervention and/or electrophysical agents, and/or exercise prescription within a framework of empowerment of the individual/carer or the community through education.

Cont.

American Physical Therapy Association (APTA) Physical therapy which is the care and service provided by

or under direction and supervision of a physical therapist include:

Examining patient with impairment, functional limitation and disability or other health related condition in order to determine a diagnosis, prognosis and intervention.

Preventing injury, impairments, functional limitations and disability, including the promotion and maintenance of fitness, health and quality of life in all ages population.

Engaging in consultation, education and research.

ROLE OF PHYSIOTHERAPY

Role of physiotherapist

Assessment Intervention Promotion Prevention

Cont.

Diagnose and manage movement dysfunction and enhance physical and functional abilities.

Restore, maintain and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.

Prevent the onset, symptoms and progression of impairments, functional limitations and disabilities that may result from diseases, disorders, conditions or injuries.

Scope of physiotherapy practice

Physiotherapists treat patients with physical difficulties resulting from illness, injury, disability or ageing.

They treat people of all ages including children, elderly, stroke patients and people with sport injuries.

Cont.

Physiotherapists work in many area includes: intensive care mental health neurology (including stroke) long-term conditions breathing problems men's and women's health (including incontinence) recovery after major surgery orthopaedics and trauma sports workplace health paediatrics (children) care of the elderly education and health promotion

Cont.

They work with patients to identify and improve their movement and function. They help to promote their patient’s health and wellbeing and assist the rehabilitation process by developing and restoring body systems such as neuromuscular, musculoskeletal, cardiovascular and respiratory systems.

In addition, they devise and review treatment programmes, comprising manual therapy, movement, therapeutic exercise and the application of technological equipment, e.g. ultrasound. Physiotherapists also provide advice on how to avoid injury.

Cont.

In particular, physiotherapy can help rehabilitate (restore to health) people who have: had a stroke, when the blood supply to

part of the brain is cut off heart problems and breathing difficulties a sports injury recently had surgery that affects their

movement or mobility

Cont.

Physiotherapists work in a range of settings, including hospitals, health centres, industry, private practices and sport clubs.

Treatment involves are encouraging exercise and movement by the use of techniques such as therapeutic movement and exercise therapy, massage, manipulation, electrotherapy and/or hydrotherapy.

Clients

Patient Patient’s family or caregiver Health care provider (e.g. nurse, doctor) Support group (e.g. NGO) General public

Physiotherapy service

To treat patients: In patient (ward)

Outpatient (electrotherapy or gym)

In patient service

Types of treatment: Chest physiotherapy Remove secretion Improve lung expansion Reduce breathlessness

Techniques: Breathing exercise Postural drainage Vibration/percussion/shaking Active cycle breathing

technique (ACBT) Relaxation position Thoracic mobility exercise.

Bed mobility exercise Active and passive

movement Ambulation

Cont.BREATHING EXERCISE VIBRATION/PERCUSSION/

SHAKING

Cont. Postural drainage Therapeutic exercise:

active and passive exercise

Cont.

Bed mobility Ambulation

Out patient service

1)Therapeutic exercise: Active Passive Individual or group exercises

2)Manipulation therapy: Joint mobilization Massage

3)Hydrotherapy

Physiotherapy modalities

Modalities

1)Heat therapy: Hot pack Wax bath Short wave diathermy Infra red ray

2)Electrotherapeutic modalities: TENS NMES

3)Cold therapy: Cold pack Cryocuff

Heat therapy

Hot pack

Wax bath

Cont. Short wave

diathermy (SWD) Infra red ray

Heat therapy

INDICATIONS CONTRAINDICATIONS

Chronic pain Pain Strain or sprain Muscle spasm Joint pain (RA, OA)

Open wound Tumor/cancer Pregnancy Sensation impairment Skin condition problem Metal implant/pacemaker.

Electrical stimulation

Interferential Current (IT) Transcutaneous Electrical Nerve

Stimulation Functional Electrical Stimulation such as

NMES Interrupted Direct Current (IDC)

Cont.

INDICATIONS CONTRAINDICATIONS

Block nerve pain Maintain muscle

properties Muscle paralysis Prevent joint contracture Neurology condition

Metal implant Impaired sensation Arterial circulation

disease Bleeding tendency

Cold therapy

INDICATION CONTRAINDICATION

Acute pain Acute sport injury Acute/chronic muscle

spasm

Open wound Impaired sensation Cold allergy/

hypersensitivity Advanced diabetes

Other modalities

Ultrasound

Ultrasound

INDICATION CONTRAINDICATION

Reduce pain Soft tissue injury Acute swelling Assist relaxation of

muscle pain Joint contracture Overcome capsular

tightness or scarring

Metal implant Open wound Impaired circulation Over tumor

Cont.

Shock wave

Mechanical traction

Lumbar traction Cervical traction

Cont.

INDICATION CONTRAINDICATION

Any orthopedic condition involve nerve root compression

Joint hypomobility Symptomatic facet joints

pain Muscle spasm

TB spine Malignancy Severe osteoporosis Spinal column instability Acute back strains,

sprains & inflammations Rheumatoid arthritis of

cervical spine

Hydrotherapy

INDICATION CONTRAINDICATION

Strengthening exercise Reduce pain during

weight bearing Mobilization exercise Neurology disease Sport injury problem Multiple joint pain

Open wound Infective condition Dermatitis Incontinence

Manipulation therapy

Soft tissue manipulation (STM) Myofascial release Joint mobilization

Soft tissue manipulation

Improve circulation Muscle relaxation Stretch scar tissue

Myofascial release

Advanced system of soft-tissue

Treatment based in the principles of myofascial release

Muscle relaxation Improve circulation.

Joint mobilization

Increase ROM Reduce pain

Therapeutic exercise

Active exercise: Individual Group

Passive exercise

Tools of exercise

References

Porter, S. B. (2003). Tidy’s physiotherapy. 13th. Butterworth Heinemann.

http://www.nhs.uk/conditions/Physiotherapy/Pages/Introduction.aspx

http://www.nhsinform.com/health-library/articles/p/physiotherapy/introduction/

THANK YOU