As allied health professionals, physiotherapy is a constantly evolving field. The rate of change and quality of change is a very delicate matter. Needless to say, as our society is turning to a “Doctor shopping/ Doctor hopping” culture and getting more litigious, some of the changes have been inadvertent!
The ‘patient’ has the same joints in their body as before and the aches and pain or other symptoms which stem from structural causes, remain unchanged. Then what is different?
The clinical reasoning model evolving from – ‘merely basing your interventions on what has been told (known) about the condition’ à to trying to put the information to tell a ‘story’ and hopefully complete it by being ‘Patient Centric’ is the key. We often hear ‘science/medicine has evolved’.
Without actually knowing the amount of change ‘we’ as health professionals have undergone, to be accountable for carrying out those revolutionary changes and making safe and better practice a standard concept.
Multi-Disciplinary Team (MDT) approaches towards any condition is the current best practice. As we understand the healing process and recovery process, we can make the necessary changes to the progression to the rehabilitation. Allied health professionals, along with the patient and their clinicians can participate actively in the process for best outcomes. Evidence based practice is encouraged in every field.
While we still make use of simple electrotherapy (different modulated currents used for medical purposes) modalities like TENS (transcutaneous electrical nerve stimulation), IFT (interferential therapy) and US (ultrasound), the latest current modulations offer a wider range of possibilities which have either one or more of these in combination. More advanced forms of treatments, like LASER and Shockwave therapy are also available-to name a couple. These modalities can be used in acute stages of a condition to help reduce pain or swelling or both. Another very interesting modality from this branch is a ‘Stimulator’ which, as the name suggests, is used to stimulate a nerve causing a particular muscle to produce action. This form of therapy is commonly used in conditions like foot drop or facial palsy where a single nerve is involved.
Hydrotherapy is another widely used mode of delivering therapy. This can form basis of any form of rehabilitation. Usual progression would be either water based / land based or à based in a gymnasium. However, we can associate other forms of therapy incorporating hydrotherapy. Aqua-aerobics is one such commonly used name in western world. Now this very simple and effective mode can also be utilised and converted into sophisticated combinations like ‘Aquatreadmills’. This entails a treadmill which a patient can use while immersed in water to get the best of both worlds. This can be used in weight management issues (making use of the buoyancy), knee pain (reduced loading), and post-operative rehabilitation like Anterior Cruciate Ligament injury/surgery rehabilitation.
The terms Rehabilitation (rehab) or Pre-rehabilitation (prehab): When we consider a holistic approach, the clinicians need to initiate awareness amongst their patients. This is then taken forward by the allied health professional(s). It is crucial to follow-up with correct exercises pre or post-operatively or simply to get into the conditioning they need to get to so as to achieve best possible outcomes. Some commonly used rehabilitation protocols are Neuro-Rehab, CardiacRehab, Sports-Rehab, Vestibular-Rehab, Pediatric-Rehab, and Orthopedic-rehab and so on.
Patient safety measures along with staff health care, has also taken a big leap with the use of technology. A patient can now be safely transferred from one position to another, one room to another or get them off the floor onto a chair or a bed, by using ‘hoists or lifters’. In this, slings/specialised mats of various shapes and sizes are used to minimise handling of the patient to avoid bruises or skin injuries to the patients. This not only ensures safe manual handling practices for patients but also encourages staff to keep away from sustaining injuries.
Since we are discussing Rehab, we must talk about the latest innovations of them all – ‘Robotics.’ Robotics has taken over each and every field of our lives, so why would physiotherapy fall behind! A simple tilt table has been modified to make people do functional leg movements ensuring fewer complications. Machines with specialised sensors attach to them determine the amount of force generated by a particular patient and match it to what is expected – giving a good feedback not only to the patient but also to the therapist. This makes replicating the same therapy much easier. It also helps in quantifying the actual therapy to assess progression and also see actual recovery. This technology has been used to make a non-weight bearing, paralysed patient walk!
We now have robots, which when used with proper harness, can make a patient upright and then create a near normal gait pattern. The loading on one or both legs or any body part can be modified with these robots, to ensure a pain free transition. This not only motivates a patient but also makes the functional motion of walking reproducible and measurable. Also, minimal handling of an already fragile patient reduces further complications.
The latest versions have incorporated ‘tasks’ a patient can complete and ‘rewards’ they can earn and this is a major boost to the psyche of a patient and works wonders.
So, for a physiotherapist, the earnest is firstly on the professional to choose the correct therapy for their patient by addressing the case and doing necessary tests. The patient needs to take onus and needs to compliant. The current trends can only work as aids to make therapy and patient transition (start to finish) as smooth, as quick and as practicable as possible. The goals (realistic) could be achieved within a reasonably shorter time frame when the correct candidate is selected for (pre)rehabilitation and recovery could be ‘functional’.