Marilyn Moffat

The History of Physical Therapy Practice in the United States

&NA; Physical therapy practice in the United States evolved around two major historical events: the poliomyelitis epidemics of the 1800s through the 1950s and the effects of the ravages of several wars. Marguerite Sanderson and Mary McMillan were the first two individuals involved in the training of “reconstruction aides” responsible for caring for those individuals wounded in World War I. Poliomyelitis raged throughout the country in the 1920s and 1930s. The primary modes of treatment were isolation, immobilization, splinting, bed rest, and later surgery. During World War II, drastic improvements in medical management and surgical techniques led to increasing numbers of survivors with disabling war wounds. In 1940, Sister Elizabeth Kenny brought her treatment techniques for the management of patients with poliomyelitis to the United States. The passage of the Hospital Survey and Construction Act of 1946, the “Hill Burton Act,” led to an increase in hospital‐based practice for physical therapists. The Korean War again challenged physical therapists with the treatment of those with disabilities related to war wounds. The Salk vaccine virtually eradicated poliomyelitis in the United States by 1961. The role of the physical therapist progressed increasingly in the 1950s from that of a technician to a professional practitioner. Amendments to the Social Security Act (SSA) in 1967 added a definition of “outpatient physical therapy services.” Increasing numbers of states enacted such practice acts during the 1950s and 1960s. The practice of physical therapy for patients with neuromuscular disorders dramatically changed. In the 1960s and 1970s, cardiopulmonary physical therapist practice expanded with increasing chest physical therapy programs for pre‐ and postoperative patients. With the expansion of joint replacements, new avenues for orthopedic physical therapist practice emerged. The 1970s and 1980s saw the increased opportunities for practice with the implementation of Occupational Safety and Health Administration (OSHA) rules and regulations, the passage of the Education for All Handicapped Children Act (PL 94‐142), and the AIDS epidemic. Physical therapists began providing services in the areas of womens health, oncology, and hand rehabilitation. Specialty certification was developed. In the 1990s, the Americans with Disabilities Act and the National Center for Medical Rehabilitation Research led to new opportunities for practice. Physical therapists were faced with the challenges of increasing governmental cost savings, decreasing reimbursement, increasing governmental regulations, the influences of the insurance industry and corporate America, and the sudden personnel supply exceeding demand for services. In the new millennium, the American Physical Therapy. Association developed the Guide to Physical Therapist Practice, the CD‐ROM version of the Guide, and the “Hooked‐on‐Evidence” project. Most states had some form of direct access, and bills were introduced on Capitol Hill to allow Medicare patients direct access to physical therapist services.

The effects of soft tissue mobilization on the immature burn scar : Results of a pilot study

The purpose of this pilot study was determine the effects of soft tissue mobilization (STM) on range of motion (ROM), scar pliability, and vascularity. Patients received either one treatment session of standard physical therapy or standard physical therapy plus 10 to 15 minutes of STM. Before and after ROM, scar pliability and vascularity measurements were obtained. The students t test was used to compare measurements and revealed the STM group (n = 5) had significant (p < 0.10) gains in wrist extension and radial deviation, and the control group (n = 5) had significant gains in wrist extension and ulnar deviation. No significant difference was found in ROM, scar pliability, and vascularity when the STM group was compared to the control group. Further study of a larger sample over multiple treatment sessions is necessary to determine the true efficacy of STM.

Effect of knee joint cooling on the electromyographic activity of lower extremity muscles during a plyometric exercise

During sporting events, injured athletes often return to competition after icing because of the reduction in pain. Although some controversy exists, several studies suggest that cryotherapy causes a decrease in muscle activity, which may lead to a higher risk of injury upon return to play. The purpose of this study was to investigate the effect of a 20-min knee joint cryotherapy application on the electromyographic activity of leg muscles during a single-leg drop jump in twenty healthy subjects, randomly assigned to an experimental and a control group. After the pre-tests, a crushed-ice bag was applied to the knee joint of the experimental group subjects for 20 min, while the control group subjects rested for 20 min. All subjects were retested immediately after this period and retested again after another 20 min of rest. Average electromyographic activity and ground contact time were calculated for the pre- and post-test sessions. Decreases in electromyographic activity of the lower extremity musculature were found in pre-activation, eccentric (braking), and concentric (push-off) phases immediately after the icing, and after 20 min of rest. The results lend support to the suggestion that cryotherapy during sporting events may place the individuals in a vulnerable position.

Toward core inter-professional health promotion competencies to address the non-communicable diseases and their risk factors through knowledge translation: Curriculum content assessment

BackgroundTo increase the global impact of health promotion related to non-communicable diseases, health professionals need evidence-based core competencies in health assessment and lifestyle behavior change. Assessment of health promotion curricula by health professional programs is a first step. Such program assessment is a means of 1. demonstrating collective commitment across health professionals to prevent non-communicable diseases; 2. addressing the knowledge translation gap between what is known about non-communicable diseases and their risk factors consistent with ‘best’ practice; and, 3. establishing core health-based competencies in the entry-level curricula of established health professions.DiscussionConsistent with the World Health Organization’s definition of health (i.e., physical, emotional and social wellbeing) and the Ottawa Charter, health promotion competencies are those that support health rather than reduce signs and symptoms primarily. A process algorithm to guide the implementation of health promotion competencies by health professionals is described. The algorithm outlines steps from the initial assessment of a patient’s/client’s health and the indications for health behavior change, to the determination of whether that health professional assumes primary responsibility for implementing health behavior change interventions or refers the patient/client to others.An evidence-based template for assessment of the health promotion curriculum content of health professional education programs is outlined. It includes clinically-relevant behavior change theory; health assessment/examination tools; and health behavior change strategies/interventions that can be readily integrated into health professionals’ practices.SummaryAssessment of the curricula in health professional education programs with respect to health promotion competencies is a compelling and potentially cost-effective initial means of preventing and reversing non-communicable diseases. Learning evidence-based health promotion competencies within an inter-professional context would help students maximize use of non-pharmacologic/non-surgical approaches and the contribution of each member of the health team. Such a unified approach would lead patients/clients to expect their health professionals to assess their health and lifestyle practices, and empower and support them in achieving lifelong health. Benefits of such curriculum assessment include a basis for reflection and discussion within and across health professional programs that could impact the epidemic of non-communicable diseases globally, through inter-professional education and evidence-based practice related to health promotion.

Application of Educational Theory and Evidence in Support of an Integrated Model of Clinical Education

Background and Purpose. The integrated model of clinical education has been incorporated into the educational curricula of various professions for decades. Currently, however, there is variability among physical therapist education programs in the use and design of such models. This position paper will not only highlight the pedagogy of early integrated clinical experiences, but also provide 2 examples of integrated clinical education models from successful physical therapist education programs. Position and Rationale. Evidence exists to demonstrate the utility of integrated and experiential learning models of clinical education in reinforcing the cognitive, psychomotor, and/or affective domains of learning. Early patient exposure in genuine clinical environments provides students with critical skills necessary for future professional practice. Further, integrated clinical education stimulates transfer, application, and reinforcement of classroom learning to authentic patient/client situations; provides exposure to varied service delivery models; and promotes self‐assessment and opportunities for skill development and professional growth. Discussion and Conclusion. Successful outcomes from integrated clinical experiences rely upon carefully constructed learning opportunities. Designing models wherein didactic and clinical faculty demonstrate consistent practice philosophies and hold students accountable for learning based upon the extent of didactic education completed provides for a seamless approach to student learning. The integrated model of clinical education allows faculty to control the type, sequence, and duration of clinical experiences, as well as the qualifications of the involved clinicians. To maximize student readiness for patient/client demands within the twenty‐first century and beyond, integrated clinical experiences should be viewed as an essential component of the core curriculum in physical therapist education.

Evidence-based exercise prescription: raising the standard of delivery

Abstract This article represents the deliberations that took place at the June 2011 meeting of the World Confederation for Physical Therapy (WCPT) during a panel that was convened to discuss ‘Evidence-based Exercise Prescription: Raising the Standard of Delivery’. The panel consisted of five physical therapists and one exercise physiologist. After introductory remarks by the panel chair, each of the other participants was given the opportunity to do an opening presentation. Several questions (Should physical therapists be exercise experts? Are physical therapists truly the exercise experts they should be? Has physical therapist education prepared them to be exercise experts?) were then posed to the panelists for their response. After those responses, the floor was opened up to the audience for response and input. A verbatim transcript of the proceedings enabled audience participation to be reflected.

Effects of Cooling on Ground Reaction Forces, Knee Kinematics, and Jump Height in Drop

This study investigated the effect of knee joint ice application on vertical ground reaction forces (VGRF), knee angle (KA), and jump height (JH) during a single-leg drop jump in 20 healthy participants randomly assigned to an experimental or control group. VGRF were measured using a force plate, KA was measured using an electrogoniometer, and JH was derived from VGRF. After the pretests, a crushed-ice bag was applied to the experimental group participants for 20 minutes, whereas the control group rested. All participants were retested immediately and again after 20 minutes of rest. Significant decreases in average braking phase VGRF (–0.18±0.14 body weight) and increases in contact time (51±39 ms) were found after icing. In addition, several nonsignificant trends toward force reduc tion were identified. These findings support the statement that when athletes return to competition after icing, an altered neuromuscular behavior might lead to potential re-injury situations.

Incorporating Business Practices into Physical Therapy Education Program Practices

&NA; The purpose of this article is to look at the business practices of physical therapy academic administrators in this millennium. The roles must encompass ever‐expanding market analyses, assessment of competition, marketing, financial management, fund raising, and determining ways to satisfy their consumers—their students. The business practices will include developing the description of the physical therapy education program, market analyses, marketing, competition, operations, management/faculty/staff financial management, contracts, servicing the customers/consumers, and resources. A yearly SWOT (strengths, weaknesses, opportunities, and threats) analysis and use of the SWOT matrixes will help the program to analyze fulfillment of its plan.