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Recent advancement in the field of Physiotherapy

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Amrit Biswas at paramedical college durgapur
Amrit Biswas
  • paramedical college durgapur
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The practice of physiotherapy has changed a lot in recent past. From using the movements as treatment means to the effect of microgravity on human body system and integration of knowledge from development of pain science with changing facets of rehabilitation along with uses of ultra modern technical support in motion study and electrotherapy with integration of ergonomics and artificial limb and robotics research is rapidly changing the scope and limitations of physiotherapy practice.
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Recent advancement in the field of Physiotherapy
Submitted by: Biswas Amrit & Paul Mantu, June, 2012.
Authors information:
Biswas Amrit, Physiotherapist, BPT, MSPT; (UK); MIAP, Sr Lecturer IPTST (An undergraduate and
postgraduate Physiotherapy college under WBUHS), Consultant Vivekananda hospital (A 170 bed
multispeciality hospital, Durgapur), Consultant Apollo clinic Durgapur. amritbiswas@gmail.com
Paul Mantu, Physiotherapy undergraduate student at IPTST under WBUHS. montupaul18@yahoo.com
Abstract:
The practice of physiotherapy has changed a lot in recent past. From using the movements as
treatment means to the effect of microgravity on human body system and integration of knowledge
from development of pain science with changing facets of rehabilitation along with uses of ultra
modern technical support in motion study and electrotherapy with integration of ergonomics and
artificial limb and robotics research is rapidly changing the scope and limitations of physiotherapy
practice.
Physiotherapy has evolved a lot since its beginning era. Earlier it was a part of rehabilitation
with merely two broad sector, namely electrotherapy and exercise therapy. However, with time
there have been many other sectors of interest in the field of physiotherapy. The purpose of
this article is to sum up the diverse field of physiotherapy as a united one.
To list up the different sectors that has gained popularity with time within the field of
physiotherapy are;
1.
Movement based physiotherapy also called as manual therapy. This is the most
researched field of physiotherapy
(Petty N J, 2006)
. Movements are used as a treatment
means in this approach. There have been many schools of thought in this field since its
origin in late 1960s (Butler D S, 2001). Few very popular concepts are, Maitland concept,
McKenzie concept, Mulligan concept and neural mobilization concept (
Maitland G D,
2005; Maitland G D, 2005; McKenzie R A, 1981;
Mulligan B R, 1999; Butler D S, 1991). Along
with these concepts, the biggest development manual therapy has brought in the field
of physiotherapy is probably the process of clinical reasoning, which is a step for
evidence based practice and making the practice more science oriented than individual
clinical expertise and treatment by convention (
Boyling JD and Palastanga N,1994; Jones M
and Rivett D, 2004).
Though it must be remembered that all the treatment techniques are
rather more matter of art than science (Mulligan B R, 1999).
2.
Effect of weightlessness on our body systems is a very recent field of study in the field of
physiotherapy. It has been found that loss of muscle strength and mass is more rapid if
the person spends long duration in weightlessness that is without the effect of gravity.
This ongoing field of research is concentrating on the astronauts returning from space
and on deep sea divers who spend long time in absence of or in reduced gravity
environment (
Prampero di P E & Narici M V, 2003; Sawin C F et al, 2007; Goodship A E et al,
1998; Peterman et al, 2001).
3. Pain science and integration of vast emerging body of knowledge in this field had
affected the practice of physiotherapy in past couple of decades. Sometimes the
development in pain science and it’s understanding is referred as ‘the pain revolution’
(Melzack R & Wall P D, 1988)
. Pain has evolved from just a sensation to a perception and
experience with time. There are situations where pain is present though there is no
actual tissue damage; for example phantom limb pain (Butler D S, 2001). To explain this
scenario biopsychosocial model of pain has been developed
(Zusman M, 1994)
. The
biochemistry of pain, pain mechamnisms and plasticity of the central nervous system
has been the most amazing development of this field in recent past (Butler D S, 2001;
Gifford LS, 1998; Gore J & Butler D, 2010
).
4. Ergonomics another very exciting field in applied physiotherapy is the study of human –
machine interface. This specialized field of physiotherapy has very important role to play
in designing, architecture, human posture, their correction and to provide ergonomic
solution to industrial sector
(Bridger R S, 2003)
.
5. Sports physiotherapy and exercise rehabilitation is another exciting field of
physiotherapy. Rehabilitation is the process of bringing back the individual towards
normal lifestyle. The facets of rehabilitation has changed dramatically in recent past and
today it do not mean just healing but accelerated healing and complete healing.
Rehabilitation not only sees locally now, but also see globally
(Biswas A, 2007)
. Explained
in Fig 1.
6. Biomechanical study and analysis of human motion is being carried out in complicated
gait laboratory with instruments like high-speed cameras, motion sensors, force plate,
3D motion analyzers, isokinetic dynamometers, pressure sensors, ultrasonography
machine, pressure algometry to objectively measure pain, electromyography has been
set up
(University of Brightn, 2007)
.
7. Another emerging field of study in physiotherapy is the study of artificial limb, their
training and exploring the scope and limits of these types of limbs for functional activity
and sports. Myoelectric limbs and their uses with functional electrical stimulation and
knowledge of robotics is showing a new horizon in the field of prosthetic rehabilitation
(Lin V W, 2003)
.
Fig 1, Different facets in the spectrum of rehabilitation
8. There has been integration of numerous new instruments beyond traditional
electrotherapy instruments like long wave diathermy (LWD), LASER, Shock wave therapy
and diagnostic ultrasound imaging in recent time
(University of Brightn, 2007)
.
New developments in future will make this field of medical science more evidence based,
scientific and objective.
Rehabilitation
Muscle and
other soft
tissue
dysfunction
Joint
dysfunction
Weight
bearing
Unilateral
weight
bearing
Movements
of the low
back and
pelvis
other
muscle
diet
Nerve
dysfunction
Muscular
endurance
Type of
muscle
contraction
Duration
of
activity
Speed of
the
movement
Chain of
the
movement
References:
1) Butler D S, 2001, The sensitive nervous system, NOI group publication, Adelaide.
2) Butler D S, 1991, Mobilization of the nervous system, Churchill Livingstone, London.
3) Maitland G D, 2005, Maitland’s peripheral manipulation, 4
th
ed., Elsevier, Edinburgh.
4) Maitland G D, 2005, Maitland’s vertebral manipulation, 7
th
ed., Elsevier, Edinburgh.
5) McKenzie R A, 1981, The lumber spine mechanical diagnosis and therapy, Spinal publications,
New Zealand.
6) Petty N J, 2006, Neuromusculoskeletal examination and assessment, 3
rd
ed, Elsevier, Edinburgh.
7) Mulligan B R, 1999, Manual therapy, NAGs, SNAGs, MWMs etc. 4
th
ed, Plane view
services, New Zealand.
8)
Boyling JD and Palastanga N,(1994) Grieve’s Modern Manual Therapy, 2nd ed., Churchill
Livingstone, Edinburgh.
9) Gifford LS, (1998), Pain, Ch 5, 196-232; In Pitt-Brooke J, Reid H, Lockwood J and Kerr K, (1998)
Rehabilitation of movement: Theoretical Basis of Clinical Practice, WB Saunders, London.
10) Jones M and Rivett D,(2004) Clinical Reasoning for Manual Therapist, Butterwoth-Heinemann,
Edinburgh.
11) Zusman M, 1994, The meaning of mechanically produced responses, Australian journal of
physiotherapy, 40, (1), 35 – 39.
12) Gore J & Butler D, December, 2010, NOI notes, Newsletter from Noigroup, Adelaide, Australia.
13) Melzack R & Wall P D, 1988, The challenge of pain, London, Penguin books.
14) Prampero di P E & Narici, M V, 2003, Muscles in microgravity: from fibers to human motion,
Journal of biomechanics, 36, 403 – 412.
15) Sawin C F, Hayes J, Francisco D R & House N, 2007, Considerations for development of
countermeasures for physiological decrements associated with long-duration space missions,
Acta Astronautica, 60, 488 – 96.
16) Goodship A E, Cunningham J L, Oganov V, Darling J, Miles A W & Owen G W, 1998, Bone loss
during long term space flight is prevented by the application of a short term impulsive
mechanical stimulus, Acta Astronautica, 43, 3 – 6, 65 – 75.
17) Peterman M M, Hamel A J, Cavanagh P R, Piazza S J & Sharkey N A, 2001, In vitro modeling of
human tibial strains during exercise in micro-gravity, Journal of biomechanics, 34, 693 – 698.
18) Bridger R S, 2003, Introduction to ergonomics, 2
nd
ed., Taylor & Francis, New York.
19) Biswas A, 2007, Refelection on exercise prescription for knne joint osteoarthritis patients,
Unpublished research work, Exercise rehabilitation module, Msc Physiotherapy, University of
Brighton, UK.
20) University of Brightn, 2007, MSc Physiotherapy , Analysis of function module study material.
21) Lin V W, 2003, Spinal cord medicine; Principles and practice, Accessed online via
http://www.ncbi.nlm.nih.gov/books/NBK8850/?depth=2, on 22/06/2012.
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  • Apr 2024
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... The development of manual therapy has occurred through a process of clinical reasoning, which is a step toward evidence-based practice. This shift makes the practice more science-oriented than reliant on individual clinical expertise and treatment by convention [27]. ...
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Article
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  • Dec 2023
Physical therapy is a healthcare discipline that is dedicated to help individuals and patients in maintaining their health while optimizing their strength, function, and movements. Pakistan being a developing country, experiences a slower pace in the establishment of advancements in the medical professions. Whereas physical therapy is significantly improving day by day in Pakistan; additionally, this study aims to discuss the advances, in manual therapy concerning the physical therapy profession in Pakistan. This study aimed to evaluate the perception of clinical leadership and its recent advancements concerning the manual physical therapy practice in Pakistan for the preceding year. For this purpose, semi-structured interviews were conducted with 10 physical therapists from 5 different cities in Pakistan. Physical therapists with at least 10 years of clinical practice were included in the data collection. The interviews were audio/video recorded, data verbatim transcribed, and analyzed manually by open coding and in-vivo coding. Furthermore, thematic analysis was done to identify different elements of recent advancements concerning manual physical therapy by finding the appropriate patterns in the gathered data. The results showed that advancements occurred in the last decade, such as international certifications, workshops, hands-on practice and master programs. There is lack of awareness, gender barriers, and financial constraints in adopting new advancements. The focus was shifted more toward muscle energy technique and myofascial release. Modalities were preferred in the past for pain relief; however, in the recent decade, they have been replaced by manual therapy techniques. Pain management and prognosis are better with manual therapy. These advancements will be cost-effective for the patient. This study concluded that manual therapy in Pakistan has undergone a significant transformation during the last preceding years. There is still great potential for more advancement in manual therapy techniques in Pakistan.
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Clinical Reasoning for Manual Therapists
Book
  • Jan 2004
A practical text covering the theory and the practice of clinical reasoning skills for all physical therapists. Provides readers with activities to improve their own clinical reasoning within their own clinical setting. With a range of very high-caliber international contributors in the field of physiotherapy practice, this book gives the answers to the practitioners question of how does one apply the theoretical knowledge involved in clinical reasoning to practice and how can one become a better practitioner as a result.
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The meaning of mechanically produced responses
Article
  • Dec 1994
  • AUST J PHYSIOTHER
The precise source and cause of mechanically evoked sensory and motor responses can sometimes be surprisingly difficult to identify. Accurate interpretation of these responses may be confounded by peripheral as well as central nervous system mechanisms. Examples of such peripheral nervous system mechanisms likely to be of relevance to therapists have been selected from basic and clinical research. Symptomatic relief has been inferred to endorse the diagnostic specificity of mechanical stimulation. The extent to which this would be valid for relief acquired by neurological means is discussed in terms of endogenous pain inhibitory systems.
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Introduction to Ergonomics Artwork
Data
  • Nov 2013
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Considerations for development of countermeasures for physiological decrements associated with long-duration space missions
Article
  • Feb 2007
  • ACTA ASTRONAUT
Countermeasures are necessary to offset or minimize the deleterious changes in human physiology resulting from long duration space flight. Exposure to microgravity alters musculoskeletal, neurosensory, and cardiovascular systems with resulting deconditioning that may compromise crew health and performance. Maintaining health and fitness at acceptable levels is critical for preserving performance capabilities required to accomplish specific mission tasks (e.g.—extravehicular activity) and to optimize performance after landing. To enable the goals of the exploration program, NASA is developing a new suite of exercise hardware such as the improved loading device, the SchRED. This presentation will update the status of current countermeasures, correlate hardware advances with improvements in exercise countermeasures, and discuss future activities for safe and productive exploration missions.
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In vitro modeling of human tibial strains during exercise in micro-gravity
Article
  • May 2001
  • J BIOMECH
Prolonged exposure to micro-gravity causes substantial bone loss (Leblanc et al., Journal of Bone Mineral Research 11 (1996) S323) and treadmill exercise under gravity replacement loads (GRLs) has been advocated as a countermeasure. To date, the magnitudes of GRLs employed for locomotion in space have been substantially less than the loads imposed in the earthbound 1G environment, which may account for the poor performance of locomotion as an intervention. The success of future treadmill interventions will likely require GRLs of greater magnitude. It is widely held that mechanical tissue strain is an important intermediary signal in the transduction pathway linking the external loading environment to bone maintenance and functional adaptation; yet, to our knowledge, no data exist linking alterations in external skeletal loading to alterations in bone strain. In this preliminary study, we used unique cadaver simulations of micro-gravity locomotion to determine relationships between localized tibial bone strains and external loading as a means to better predict the efficacy of future exercise interventions proposed for bone maintenance on orbit. Bone strain magnitudes in the distal tibia were found to be linearly related to ground reaction force magnitude (R(2)>0.7). Strain distributions indicated that the primary mode of tibial loading was in bending, with little variation in the neutral axis over the stance phase of gait. The greatest strains, as well as the greatest strain sensitivity to altered external loading, occurred within the anterior crest and posterior aspect of the tibia, the sites furthest removed from the neutral axis of bending. We established a technique for estimating local strain magnitudes from external loads, and equations for predicting strain during simulated micro-gravity walking are presented.
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Bone loss during long term space flight is prevented by the application of a short term impulsive mechanical stimulus
Article
  • Aug 1998
  • ACTA ASTRONAUT
In long term space flight, the mechanical forces applied to the skeleton are substantially reduced and are altered in character. This reduced skeletal loading results in a reduction in bone mass. Exercise techniques currently used in space can maintain muscle mass but the mechanical stimulus provided by this exercise does not prevent bone loss. By applying an external impulsive load for a short period each day, which is intended to mimic the heel strike transient, to the lower limb of an astronaut during a long term space flight (5 months), this study tests the hypothesis that the bone cells can be activated by an appropriate external mechanical stimulus to maintain bone mass throughout prolonged periods of weightlessness. A mechanical loading device was developed to produce a loading of the os-calcis similar to that observed during the heel strike transient. The device is activated by the astronaut to provide a transient load to the heel of one leg whilst providing an equivalent exercising load to the other leg. During the EUROMIR95 mission on the MIR space station, an astronaut used this device for a short period daily throughout the duration of the mission. Pre- and post-flight measurements of bone mineral density (BMD) of the os-calcis and femoral neck of the astronaut were made to determine the efficacy of the device in preventing loss of bone mineral during the mission. On the os-calcis which received the mechanical stimulus, BMD was maintained throughout the period of the flight, while it was reduced by up to 7% on the os-calcis which received no stimulus. Post-flight, BMD in both the stimulated and non-stimulated os-calcis reduces, the extent of this reduction however is less in the stimulated os-calcis. For the femoral neck, the mechanical stimulation does not produce a positive effect.
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Muscles in microgravity: From fibres to human motion
Article
  • Apr 2003
  • J BIOMECH
In simulated or actual microgravity, human and animal postural muscles undergo substantial atrophy: after about 270 days, the muscle mass attains a constant value of about 70% of the initial one. Most animal studies reported preferential atrophy of slow twitch fibres whose mechanical properties change towards the fast type. However, in humans, at the end of a 42-days bed rest study, a similar atrophy of slow and fast fibres was observed. After microgravity, the maximal force of several muscle groups showed a substantial decrease (6-25% of pre-flight values). The maximal power during very short "explosive" efforts of 0.25-0.30s showed an even greater fall, being reduced to 65% after 1 month and to 45% (of pre-flight values) after 6 months. The maximal power developed during 6-7s "all-out" bouts on an isokinetic cycloergometer was reduced to a lesser extent, attaining about 75% of pre-flight values, regardless of the flight duration. In these same subjects, the muscle mass of the lower limbs declined by only 9-13%. Thus, a substantial fraction of the observed decreases of maximal power is probably due to a deterioration of the motor co-ordination brought about by the absence of gravity. To prevent this substantial decay of maximal absolute power, we propose that explosive exercise be added to the daily in-flight training schedule. We also describe a system aimed at reducing cardiovascular deconditioning wherein gravity is simulated by the centrifugal acceleration generated by the motion of two counter rotating bicycles ridden by the astronauts on the inner wall of a cylindrical space module. Finally, cycling on circular or elliptical tracks may be useful to reduce cardiovascular deconditioning in permanently manned lunar bases. Indeed, on the curved parts of the path, a cyclist generates an outward acceleration vector (ac). To counterbalance ac, the cyclist must lean inwards, so that the vectorial sum of ac plus the lunar gravity tends to the acceleration of gravity prevailing on Earth.
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The lumber spine mechanical diagnosis and therapy, Spinal publications
  • Jan 1981
  • R Mckenzie
McKenzie R A, 1981, The lumber spine mechanical diagnosis and therapy, Spinal publications, New Zealand.
Refelection on exercise prescription for knne joint osteoarthritis patients, Unpublished research work, Exercise rehabilitation module
  • Jan 2007
  • A Biswas
Biswas A, 2007, Refelection on exercise prescription for knne joint osteoarthritis patients, Unpublished research work, Exercise rehabilitation module, Msc Physiotherapy, University of Brighton, UK.