Evolution in Physical Therapy.

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What do you want to do with your life? You probably have heard this question dozens of times and probably have changed your mind dozens of times. Perhaps you already know that for every doctor in our complex medical centers there are several "associated health workers" involved in patient care. In earlier days, doctors usually had a one-on-one relationship with their patients. Today however, doctors delegate the performance of certain tests, measurements, and treatments to other qualified personnel because modern doctors do not have the time to assume responsibility for all phases of patient care. One group of professionals to whom doctors delegate is that of physical therapists.

PHYSICAL THERAPY DEFINED

Literally, physical therapy means "treatment with physical agents." In the earlier days of the profession, therapy was described as "the diagnosis and treatment of disabilities and diseases by the use of physical agents."



A new more encompassing definition and description comes from the Occupational Outlook Handbook:

Physical therapists provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent disabilities of patients suffering from injuries or disease. They restore, maintain and promote overall fitness and health. Their patients include accident victims and individuals with disabling conditions such as low back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy.

Physical therapy has often been called "the cornerstone of rehabilitation" because the long road back from injury or disease begins with physical therapy treatments to relieve pain and restore function. If the therapist is to give each patient complete and comprehensive care during the long process of rehabilitation, he or she cannot work in a vacuum. A physical therapist must work closely with the physician, occupational therapist, social service worker, speech pathologist, psychologist, orthopedist and prosthetist, and vocational guidance worker.

IS PHYSICAL THERAPY THE CAREER FOR YOU?

Have you considered why you are thinking of becoming a physical therapist? Is it because you, or someone dear to you, recovered more rapidly from an accident or illness after physical therapy relieved pain and restored function?

Are you a high school or college athlete who wishes to use his or her own motor skills and knowledge of coordination and endurance-building activities to help another person walk and become independent again?

Are you a young person who looks forward to the love and security of marriage and a family, but who desires a health career that will challenge your ingenuity without requiring the long years of study necessary to become a physician?

The choice of a career is one of the most important decisions you will have to make. It will influence not only the way you earn your living, but the place where you live and the people you will meet. Because the choice of a career has such long-reaching and all-encompassing effects, the decision must be both emotional and practical.

Emotionally, you must want to enter a service profession, and you must enjoy working with people of all intellectual and social levels because your coworkers and your patients will come from all segments of the population. You must not fear or resent touching or being touched because physical therapy requires a great deal of close personal contact.

Practically, you must consider the job potential. Spending many years and many thousands of dollars preparing for a career in an already overpopulated profession is neither sound nor sensible.

Fortunately, the job outlook for physical therapy is excellent. Although some worry about the field becoming overcrowded, the government predicts that physical therapy careers will continue to be among the fastest growing careers.

According to the Occupational Outlook Handbook, physical therapists held 115,000 jobs in 1996. That number is expected to grow as the population ages. The baby boom generation is now at greater risk for illnesses like stroke and heart attack, so more of them may eventually need the services of a physical therapist. At the other end of the spectrum, more newborns with severe birth defects are surviving and more young people are surviving traumatic accidents. All these trends suggest that physical therapists will be in greater demand in years to come.

Physical therapists are also being used in a more proactive way-to prevent illness and injury. They may be hired to evaluate the safety of work sites, to teach safe work habits, or to design exercise programs. Many companies invest in the safety and wellness of their employees, and, therefore, they turn to physical therapists for assistance.

QUALIFICATIONS

Because physical therapy involves serving patients with impaired functions, physical therapists strive to improve their own coordination, and their sense of rhythm, movement, and balance. Before the therapist can teach correct posture to patients, he or she must possess and practice correct posture. Physical therapy is hard work; most therapists have strong hands, endurance, stamina, and a high energy level. According to the Occupational Outlook Handbook, physical therapy is "physically demanding; therapists stoop, knead, crouch, and stand for long periods. Physical therapists move heavy equipment and lift patients or help them turn, stand, or walk."

In the earliest years of the profession, most physical therapists were physical education graduates. Although this is no longer a requirement, many still have had a great deal of experience in swimming, dance, or other athletic background.
Physical therapy courses are difficult, and average-to-superior intelligence is required. Also, the field is constantly changing and growing, making continuing self-education necessary. As in all fields, computer literacy is an advantage both in getting through school and in staying up-to-date after entering the work force.

Scientific aptitude is essential. Several science courses are included in the prerequisites for the physical therapy courses, and students have to read a great deal of scientific literature. Remember that physical therapy curricula require a minimum grade point average ranging from 2.5 to 3.5 (out of 4.0), depending upon the university where the work is done.

Perhaps the most important quality a physical therapist must possess is emotional stability. Because the therapist's life is usually busy to the point of being hectic, and decision making is a constant and ongoing responsibility, he or she must be able to think quickly. There is little or no time for meditation.

Most physical therapists deal constantly with patients who are ill, so some stressful situations may occur. But patients who receive physical therapy are getting better, so they usually are optimistic and obey directions eagerly. A few, however, have terminal illnesses. It is necessary to sympathize and empathize with these patients. However, sometimes the best thing for the patient may be prodding and insistence upon independence.

Occasionally, a patient in a general hospital or nursing home may develop cardiac or pulmonary arrest-the stoppage of the heartbeat or breathing. A few patients have died in physical therapy departments, and more will die there in the years to come because physical therapists are treating more very old, very ill people. The death of a patient during treatment can be an extremely disturbing experience.

Day-to-day care of patients usually is less traumatic, but it certainly has its disagreeable aspects-especially for student therapists and those who are new to the profession. Physical therapists treat patients who have been badly-burned, who have deep and odorous ulcers, or who cough and spit up lung secretions. Patients are people who are sick, and they don't stop being sick during their physical therapy sessions. Occasionally, patients will vomit or have bowel or bladder movements during treatment. Then it is necessary for the therapist to wash the patient and clean the floor.

Tact is an important personality trait for the physical therapist to possess, because people are your business. You won't be working just with machinery or laboratory equipment. Patients are living individuals who, when you encounter them, will be in physical and emotional crises. You must be able to inspire confidence in them and build a solid working framework with them and their families.

Moderate mechanical aptitude is helpful, too. Knowing how to handle a screwdriver, a hammer, and a wrench is useful. It isn't necessary to understand all the intricate workings of the machines you use, but you will have to be able to lengthen and shorten crutches and canes. Mechanical ingenuity, the ability to conceive and develop new devices, is a great asset because many physical therapists are called upon to improve and adapt self-help equipment.

Some knowledge of the fundamentals of basic office procedures is also important, particularly the principles of budgeting and accounting.

Dealing with people demands a good vocabulary and the ability to speak and write clearly, You will be directing patients, teaching families, instructing nursing school classes, supervising physical therapy students, reporting on patients' progress to doctors, and demonstrating physical therapy procedures at medical staff conferences. You must be able to write effectively because you will be preparing clinical notes on your patients, annual reports of the department's activities to the hospital board of trustees, and letters to business leaders and prospective employers.

People come in all sizes, shapes, colors, religions, ethnic backgrounds, social levels, and tax brackets. If you cannot deal with people as they are, with love, understanding, and total acceptance, physical therapy is not the career for you. Because duties, especially those in the clinical field, involve very close contact with patients, it is necessary that you be willing to have close bodily contact with people, no matter how beautiful or ugly, brilliant or stupid, rich or poor they are. You must also be able to shift your mental gears very quickly because you must adapt to different personalities in rapid succession.
Most physical therapists are of above-average intelligence and are happy, boisterous, athletic, and optimistic people. No rule states that a physical therapist may not be introverted, but because the profession's responsibilities involve people as patients, people as coworkers, and people on the hospital or agency staff, the gregarious individual may find the field more appealing and easier to work in.

As a physical therapist, you must be innovative, looking constantly for improved methods of performance. You must be analytical in order to compare the patient's performance from one day to the next, to compare patients with the same problems, and to determine how new approaches to old problems can be tried.

You will need to be courageous. Sometimes it takes courage to convince a physician that a different approach to treatment is worth trying. It will take even more courage to fight a legislative assembly in the state capital, or in Washington, for the rights you think are legally yours.

Many people believe the pioneer era in our national history has ended. But pioneering still exists, not on the western frontier, but on the frontiers of science. Pioneers on any frontier must possess the same basic characteristics. First, they must be nonconformists, willing to take criticism for what they believe in. They must have the physical ability to work long hours, sometimes against overwhelming odds, to achieve their goals. They must thrive on the adventure of new ideas and opportunities.

Robert Service, in his ballad "The Land of Beyond," describes the pioneer's personality and attitudes:

Thank God! There is always a Land of Beyond

For us who are true to the trail; A vision to seek, a beckoning peak,

A fairness that never will fail; a pride in our soul that mocks at a goal,

A manhood that irks at a bond, and try how we will, unattainable still

Behold it, our Land of Beyond

Is physical therapy your Land of Beyond?

*From the Collected Poems of Robert Service, published by Dodd, Mead and Co. Reprinted by permission of the publisher.

HISTORY OF PHYSICAL THERAPY IN MEDICINE

Physical therapy is probably the oldest method of medical treatment. When a caveman hurt his back lifting a rock, he probably lay on hot sand to relieve the pain. When his arthritic joints ached (we know he had arthritis), he probably applied the rocks heating beside his cooking fire because he had observed that stone retained heat for long periods. When he scraped his arm on brush or rocks and it became infected, he probably bathed his wounds in running streams. When he stumbled over a fallen tree trunk, he rubbed (massaged) his shin. He knew the importance of physical fitness because if he lost his endurance, speed, or sure-footedness, he lost his race with the next predator he met-and perhaps his life. He observed that when the sun shone brightly for long hours in the summer, his wounds healed faster than they did in the short, gray days of winter.

The Use of Heat and Cold

Thousands of years later, the Egyptians worshipped the sun's healing powers and erected temples to the sun god Ra. The Greeks worshipped Phoebus Apollo as a sun god. In India the Aryans idolized Savitar as a sun god and divine physician, and in Persia, Mithra was the god of sun and healing. In Germany, Wotan-Odin was the god of healing, and people called the sun Wotan's Eye; they also had Odin's fields, recovery places in the sunlight where the sick went to recuperate. In Peru, the pre-Incans and Incans used the sun to heat their houses and water, and to improve their health. People seem to use heat intuitively. It is effective, generally available in some form, and relatively inexpensive and safe.

The Greeks were the first to use fever therapy as treatment. The Romans were the first to claim relief of pain from the use of hot wax. Many Roman patients lay on heated sheep hides, rolling from side to side. Their methods would seem primitive and strange today, of course, but many of the principles are still sound.

The Renaissance in Europe sparked the reawakening of art and literature, but it was the Industrial Revolution that revived crafts, commerce, and business. When bakeries arose in France, many doctors ordered "stoving" for arthritic patients. The patient was lifted into a hot oven after the bread has been taken out. A few years back, physical therapists placed patients in fever cabinets-essentially the same thing.

 A popular treatment in more recent years has been cryotherapy, or the use of ice or cold. Although Roman emperors used snow to cool water and wine, and a few Persian caliphs and emirs enjoyed sherbets, the use of ice was never widespread because it could not be produced artificially until 1750. A few early Greek and Roman physicians recommended cold drinks to combat fever. Early Russians used ice more extensively because it was plentiful. They used ice packs to reduce high fevers, to control infections, and to treat wounds and meningitis. They also used it long ago for treatment of diseases of the central nervous system, an application that is relatively new in the United States. Arthritic Russians and those suffering from responded well to ice in the 1800s, but only recently has this treatment for arthritis been introduced gout to America. Napoleon's surgeons observed in their Russian campaign that amputations of frozen legs were easier, less bloody, and generally more successful than other methods. A revolutionary use of ice in America came from the Vallejo Rehabilitation Center in California, where patients with multiple sclerosis are plunged into a tub of thirty-four-degree ice water for four minutes.

Hypertherapy, or heat in the form of microtherm or ultrasound treatment, has been used in experimental cancer research and treatment.

Hydrotherapy

The use of water for healing began when primitive people bathed their wounds in running streams. Later, the religions of more civilized cultures endowed water with sacred healing properties. The Hindus believed that the Ganges River and six other sacred waters had hearing power. Egyptians conferred the same status on the Nile. The Greeks made frequent use of baths in treating wounds, and we read in Homer that the wounded Hector was cured in this way. Galen used water to treat his wounded and injured athletes. Many Native American tribes used sweat baths and other rituals involving water therapies, some of which are still in use today.

The Romans were the first people we know of who made extensive use of hydrotherapy. They had eight hundred public baths at one time, charging adults a small fee and admitting children free. They had "sweat houses" with hot and cold rooms- the forerunners of the modern Turkish bath. The Romans were also the first to use underwater exercises in warm springs to treat paralysis from war wounds, as well as the pains of normal aging in the civilian population.

In modern times, the spas of Europe have become famous health resorts, and the hot springs in many parts of the United States are treatment centers. The Scandinavians, especially the Finns, have used sauna baths extensively, and this, too, has become a popular treatment in the United States.

The first documented use of hydrotherapy in military medicine was in the French Revolution, when a surgeon reported his success in treating wounds with large quantities of hot water.

At approximately the same time, an Austrian peasant, injured by a fall from a horse, treated himself with hot packs similar to those he used on his animals. His cure was so spectacular that he became famous and began teaching foreign physicians his method. Today we use Hydrocollator packs to relieve pain and heal the sick.

Electrotherapy

The use of electricity for therapy originated in 641 B.C. when Thales of Miletus discovered that amber, when rubbed vigorously, attracted light objects to itself. Also in ancient times, a number of people claimed healing properties from contact with electric "eels," electric catfish, and other fish known to give off electric shocks. (This electrical property of some fish species is presumed to be a method of self-defense, so any healing properties would be one of nature's strange accidents.) Eventually, a Roman official suggested the deliberate application of electric fish to gain the benefits of the shock. In A.D. 400, a Greek physician suggested holding a magnet over the arthritic joints of his patients.

Until approximately 1600 no real advances were made in the use of electricity in medicine. The British scientists William Gilbert and Gilbert Colchester began research on electrotherapy, and Dr. Colchester published a treatise titled "de Magnete." At about the same time, John Wesley wrote the first book in English on electrotherapy.

Each generation and each nation since then has contributed to the development of electrotherapy, but the great heroes are Luigi Galvani, Michael Faraday, and Alessandro Volta.

When electricity became a part of everyday living, life changed dramatically, and so did medicine. Scientists were able to produce heat and cold and to regulate temperatures. In 1934, a scientist developed a form of heat using high-frequency current. This was called long-wave diathermy. It was subsequently improved to short-wave diathermy for more effective treatment and easier application. This is the same form of heat as the inductotherm used in steel mills. More recently, Dr. Frank Krusen, a physiatrist at the Mayo Clinic, produced another method of using extremely short waves, which he called microwave or microtherm.

On the eve of World War II, German scientists were working on adapting sound waves for use as a therapeutic agent. The war interrupted the program, but, in 1949, reports on the results of research projects on sound were made by seventy-five scientists. By the mid-1950s, ultrasound was an important treatment modality.

Massage and Exercise

An ancient, and unfortunately anonymous, medical historian wrote, "Nature early taught man to knead his flesh and bend his body to relieve him of certain ills." Although some cultures regarded massage and exercise as separate forms of treatment, most areas of the world used the massage and exercise combination.

In 3000 B.C, Kong-Fu, a Chinese practitioner, wrote a book on the value of massage and exercise. The Japanese also used massage extensively during the same period. The Hindus, too, were among the first to use therapeutic exercises. In the Vedic legends, which are the origin of the Hindu religion, there are detailed descriptions of postural exercises to cure specific diseases. Today in India, Ayurvedic physicians still rely on the Yoga positions to cure physical and mental illness.

Ancient Greek gymnasts were teachers of massage and exercise. They directed the treatment of fractures, dislocations, and other traumatic injuries. Greek physicians gained much of their knowledge from gymnasts. Galen (A.D. 130-201), who gave the first accurate description of bones and muscles, was the surgeon of the Roman gladiators. There are frequent references in the Bible and in Greek and Roman poetry to "anointing with oils," undoubtedly a form of massage.

During the Dark and Middle Ages of Europe, medicine was kept alive in the Western World in the Arab-dominated areas. Several Islamic physicians refer to the use of massage and exercise. In the thirteenth century, two Middle Eastern authors reported on the hygienic and therapeutic effects of exercise. In the sixteenth century, there were three major works on the value of physical agents, massage, and exercise in the treatment of diseases and injuries. By the seventeenth century, two of England's famous surgeons were writing about the value of exercise, and by the middle of the eighteenth century, French and German physicians were writing of the effect of massage on circulation and general health.

The story of therapeutic exercises in modern times is tied closely to the life of Sweden's Pehr Henri Ling (1776-1839). Ling studied theology and had a brief career in the navy before, in 1805, he received an appointment as Master of Fencing at the University of Lund. Here he developed and taught a new system of movement much different from that of the ancient Greeks, which was then still popular in Sweden. Ling studied anatomy, physiology, and natural sciences. Then he demonstrated that properly employed exercise could remedy disease and bodily defects. In 1813, he established the Central Institute of Massage and Corrective Exercises in Stockholm, the first of many institutes for medical and orthopedic gymnastics throughout Europe and the United States. Resistive exercises originated with the Swedish system, as did isometric exercises.

In 1889, a Swiss physician, H. S. Frenkel, made a great impact on the medical profession when he introduced a series of exercises for patients with certain diseases that affected the nerves and balance centers. Frenkel was the first person to use exercises for the purpose of coordination.

The Chinese have used acupuncture for many centuries to treat a variety of diseases and as an anesthetic. A needle is inserted into sensitive points in the fourteen meridians, or vertical lines, in the body. Later, the Japanese applied pressure to the same points, and called their method "Shiatsu." Today, physical therapists are using acupressure and electrical stimulation on the same ancient Chinese acupoints.

Now, physical therapists are making their own history through research. In clinical practice as well as in research centers, physical therapists are finding out why certain things work and are documenting their own results.

HISTORY OF PHYSICAL THERAPY AS A PROFESSION

As therapeutic medicine developed into a more sophisticated profession, various specialties were formed in order to concentrate on conquering specific diseases.

One group, called orthopedist, treated patients who had problems with bones, joints, and muscles. The orthopedist knew the value of heat to relieve pain, of massage to relax muscle spasm, and of exercises to strengthen weak muscles and stretch tight joints and muscles. The application of the combination of heat, massage, and exercise proved too time-consuming for many orthopedist with busy practices. In England, toward the end of the nineteenth century, British orthopedists selected young women who were graduates of schools of physical education to administer these special treatments. Because of their physical education background, they had a knowledge of anatomy, physiology, and kinesiology (muscle function). The orthopedists trained them on the job, as apprentices, to direct the special corrective exercises of orthopedic patients.

On the opposite side of the Atlantic, from 1915to1917, a polio epidemic swept the United States. Dr. Robert Lovett of Vermont copied the British example and trained two women, Wilhelmine Wright and Janet Merrill, in the muscular re-education techniques for the treatment of poliomyelitis or, as it was then called, infantile paralysis.

In 1917, the United States entered World War I. Battle casualties most frequently involved orthopedic injuries of arms and legs. Because physical training and muscle re-education were not a part of nursing, medical, or surgical care, the Surgeon General's office formed a new department. It was called the Women's Auxiliary Aides, under the Division of Orthopedic Surgery, and it assumed responsibility for this phase of caring for the wounded.

In 1916, the first American physical therapy department was established at Walter Reed Hospital, in Washington, DC. It consisted of two small rooms in the basement. This undoubtedly established a fashion in physical therapy departments, because for years departments continued to be tucked away in hospital basements. That first department at Walter Reed Hospital was so small that most of the treatments had to be given at the patient's bedside.
When World War I began, there were no established schools of physical therapy in the United States. The only qualified person in the Army was Marguerite Sanderson, who quickly organized a crash course in physical therapy at Walter Reed Hospital.

As soon as the battle casualties began arriving, it was obvious that the Army would need more therapists than one school could produce. Soon, fourteen more schools opened in different parts of the country. Their graduates received a new title: Reconstruction Aide.

An outstanding leader in the development of physical therapy education in this country, and one who was generally instrumental in fostering the progress of physical therapy as a profession, was Mary McMillan. During World War I she directed the training of reconstruction aides at Reed College in Eugene, Oregon. This college produced the largest number of graduates during the war.

During the two war years, fourteen schools trained eight hundred physical education teachers to become reconstruction aides, and three hundred of them served overseas. At the beginning of the war they served with the Army as civilians. Although they had to obey all the military rules, they did not receive any of the military benefits. Byron's line "Among them, not of them" seems to describe their plight.

When the war ended, civilian practice wasn't ready for the specialty of physical therapy. The reconstruction aides returned to the teaching of physical education, or other occupations.

A few schools continued teaching physical therapy. Dr. Frank Granger, a staunch advocate of physical therapy, and Mary McMillan codirected a course of study at the Harvard Medical School. This course emphasized electrophysics, electrotherapy, and muscle re-education.

When the country had adjusted to civilian life, a few of the reconstruction aides met for dinner at Keene's Chop House in New York City, on January 15, 1921, to form an organization that they called the American Women's Physical Therapeutic Association. Its 245 members elected Mary McMillan as their president.

A year later, when they decided to include men in the group, they changed the name to the American Physiotherapy Association. In March 1921, they began publishing a quarterly journal to inform members of the newest advances in physical therapy. By 1928, the Physical Therapy Review was being published bimonthly, and in 1931, after the first decade of its existence, the organization had 534 members.

The American Medical Association in 1925 established a Council on Physical Therapy. They outlined courses to be given in medical schools. Graduate nurses and graduates from schools of physical education were accepted for a nine-month course. By 1940, there were sixteen schools graduating 135 students a year. One school had begun to offer a bachelor's degree course. The field of physical therapy was gaining momentum. There were approximately one thousand active therapists and two hundred inactive therapists in the United States.

The entrance of the United States into World War II created an urgent need for a greater number of therapists than the existing schools could possibly supply. To meet this need, seven army hospitals and several private hospitals instituted courses, and fifteen civilian schools accelerated their courses.

To avert some of the problems of World War I, Congress declared in December 1942, that a qualified physical therapist would receive the rank of second lieutenant in the Army. Women holding a bachelor's degree who had graduated from approved schools of physical therapy were eligible for a commission in the Women Appointed for Voluntary Emergency Service (WAVES). The WAVES did not receive foreign assignments. During the war, sixteen hundred women served in the Army and eight hundred went overseas-about half to the European-Mediterranean Theater and the other half to the Pacific.
The war record of physical therapists is inspiring. The Japanese captured and imprisoned several physical therapists. One of these was Mary McMillan. When the Japanese bombed Pearl Harbor, she was in Manila waiting for a ship to take her back to her teaching post at the Medical College in Peking. She went to the Army hospital immediately, and volunteered to serve for the duration of the war as a physical therapist. Her second Army stretch lasted only a few days. She spent all the war years in the prison camp of Santo Tomas, trying to aid and comfort other prisoners. Another physical therapist serving in Southeast Asia received an award for her espionage work in Indonesia. When the war ended, most of the schools discontinued the short emergency courses but, by 1946, twenty-one schools had a capacity for 480 students.
In 1944, the United States suffered the worst polio epidemic in history, with 14,500 cited cases. In 1945, the National Foundation for Infantile Paralysis gave the American Physiotherapy Association $1,267,000 for two thousand scholarships to train physical therapists and other necessary personnel. Simultaneously, the therapists at Warm Springs, Georgia, were developing many new treatment procedures for polio. Many of these were applicable to other disease and mechanical problems, also.

The 1940s were important years for physical therapy. Battlefront casualties, industrial accidents in defense plants, and polio epidemics brought the attention of the public to the necessity for physical therapy. Physical therapy was no longer a pioneer field. In the 1950s several baccalaureate programs were developing, and graduate school courses were being planned.

As the number of physical therapists increased, the strength of the American Physical Therapy Association grew. There are now fifty-seven chapters in the fifty states, Washington, DC, and Puerto Rico. The Journal of the American Physical Therapy Association has received an award for excellence in its category. In 1971, the APTA celebrated its fiftieth anniversary in Boston, looking back to its years of challenge and rejoicing in its achievements. The succeeding years brought even more exciting periods of development and change.

Today we stand on the brink of new research. Biomechanical engineers are devising new types of braces and artificial limbs. Physiatrists are developing many new kinds of equipment that represent dramatic improvements to relieve pain. Several research centers are working on programs using computerized equipment to enable paralyzed patients to become partially independent. New information on muscle function and neurology has increased the efficacy of rehabilitation programs in many areas.

CARING FOR THE HANDICAPPED

During the past half century there has been a growing understanding and acceptance of the handicapped person as "a person with a handicap." Everyone, whatever his or her physical abilities and challenges, is a person with the same basic sensitivity, emotions, desires, and drives. Although total independence is the patient's goal, the damage caused by a disease or injury may be irreparable. In such a case, the rehabilitation plan must teach the patient to live with the disability.
The word disability is not synonymous with the words disease, injury, or defect. Physical therapists often use the word disability to describe the conditions of patients that, in some way, make them physically handicapped. Such conditions frequently prevent the patients from functioning independently and can make them physically, emotionally, and financially dependent on others. While diseases, injuries, or physical defects may cause disabilities, the presence of such conditions is not always considered a disability. In addition, disability can result when a condition is inadequately treated or when a condition is mismanaged. The rehabilitation of the disabled is now emerging as a major challenge to modern society, and laws like the Americans with Disabilities Act protect the rights of the disabled. The associated health professions must unite to meet this challenge.

The combination of religious, ethical, and social development in the United States today has resulted in our recognition of the responsibility of caring for disabled citizens by providing them with housing, food, and medical care, if they cannot provide these things for themselves. Few private citizens have the financial resources to assume care of another person burdened with large medical bills.

The federal government and every state government provide for medical aid and vocational training for the handicapped. At the national level, the Department of Health has investigated the problems of the handicapped of all ages both in urban and rural communities.

The goal of federal and state programs is to restore handicapped persons independence. However, funding for these programs varies because it is tied to the federal and state budgets. Therefore, the availability of these services changes from year to year and from one geographic region to another. As our nation ages and the number of persons who could benefit from physical therapy grows, the federal and state programs will face difficult choices about how to ensure quality care and how to fund it.

Given the cost of physical therapy and the growing demand for services, we must be realistic about patient outcomes. Physical therapists can help by getting to know patients and their families and by helping they set goals. While a full recovery is always the goal, it will never be possible or practical for every patient. Therefore, some patients may decide to work in a sheltered shop where they perform simple repetitive motions in a noncompetitive environment and earn a minimal salary. Some patients learn to manage a house, so that their spouses can maintain paid employment outside the home. Some patients never advance beyond basic activities of eating and personal hygiene, and some remain dependent on complete custodial care in a nursing home.

Rehabilitation is not a magic word. It began with a philosophy, became an objective, and developed into a method of coordinating services of several specialties in the allied health fields. Those who work in rehabilitation have serious responsibilities because they must blend academic scientific knowledge with wisdom born of experience and boldness born of faith.
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