It is the belief of Physical Therapists that each human being is a uniquely organized and functioning combination of body, mind, and spirit. They believe that health is a state of complete physical, emotional and spiritual well-being. They believe that each individual is responsible for his or her own life and possesses the power to achieve an optimum state of health and empowering individuals to achieve this optimum state of health is the core purpose of health professionals. They believe that all human beings are deserving of interactions consistent with an inherent respect for their dignity and recognition of their unique cultural and social beliefs and values. Physical Therapy best supports these beliefs and is a profession dedicated to service, to people and society, and physical therapists practice in an artful, competent, compassionate, caring, legal and ethical manner. Physical therapists practice mindful of the art and science of their profession. Physical Therapists commit to lifelong learning and to searching for the evidence that supports and advances practice. Critical thinking, problem solving, intellectual perseverance and courage are all essential characteristics of the successful physical therapist. Physical Therapists are involved in health promotion, prevention, and rehabilitation of individuals and populations throughout their lifespan. Physical therapists diagnose movement dysfunctions based on skillful examination and evaluation regardless of the cause and provide skilled therapeutic intervention to foster improvement in physical functioning and maximizing overall quality of life. Physical Therapists provide the initial access into the health care system for persons with impairments and functional limitations amenable to physical therapy and engage in referral relationships with other health care professionals. Physical Therapist’s role also includes that of case manager, teacher, researcher, and consultant. [Courtesy of Samuel Merritt University website] Physical Therapy is a Science…it heals the sick and helps the suffering, and keeps the well from pain and suffering. Physical Therapy is an Art…through sensitized touch and deepened knowledge; it discovers and rehabilitates a malfunctioning body. Physical Therapy is a Philosophy…it believes that the life of man is an expression of infinite life. Physical Therapy is a Profession…it has a duty to perform in maintaining its code of ethics and an obligation to practice freely and unhindered for the good of all mankind. Physical Therapy is a Way of Life…it believes that every man has a right to health, a will to happiness, and a capacity to live fully and richly and in harmony with a Nature that is both creative and kind. [Adopted from “The Chiropractic Story” by Marcus Bach] Purpose: It is the purpose of a Physical Therapist to figure out which parts of the body are causing a person to suffer and to establish a rehabilitation program that, when completed, assists each person in performing his everyday activities in a more functional, successful, independent and pain free way. What is physical therapy? A physical therapist can improve a body’s ability to move and function, while also benefiting general fitness and health. Physical therapists are experts in “the science of healing and the art of caring.” The Science of Healing Patients and physicians are demanding the talents of physical therapists for conservative management of a wide variety of conditions. In many cases, patients are being sent to physical therapy instead of surgery. Physical therapists help people with orthopedic conditions such as low back pain or osteoporosis; joint and soft tissue injuries such as fractures and dislocations; neurologic conditions such as stroke, traumatic brain injury, or Parkinson’s disease; connective tissue injuries such as burns or wounds; cardiopulmonary and circulatory conditions such as congestive heart failure and chronic obstructive pulmonary disease; and workplace injuries including repetitive stress disorders and sports injuries. Physical therapists practice in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. Some physical therapists seek advanced certification in a clinical specialty, such as orthopedic, neurologic, cardiovascular and pulmonary, pediatric, geriatric, sports physical therapy, or electrophysiological testing and measurement. The Art of Caring The individualized, “hands on” approach that characterizes physical therapist care is highly valued by patients. When a physical therapist sees a patient for the first time, he or she examines that individual and develops a plan of care that promotes the ability to move, reduces pain, restores function, and prevents disability. The physical therapist and the patient then work side-by-side to make sure that the goals of the treatment plan are met. Therapeutic exercise and functional training are the cornerstones of physical therapist treatment. Depending on the particular needs of a patient, physical therapists may “manipulate” a joint (that is, perform certain types of passive movements at the end of the patient’s range of motion) or massage a muscle to promote proper movement and function. Physical therapists may use other techniques such as electrotherapy, ultrasound (high-frequency waves that produce heat), hot packs, and ice in addition to other treatments when appropriate. Physical therapists will also work with individuals to prevent loss of mobility by developing fitness and wellness oriented programs for healthier and more active lifestyles. It is important to know that physical therapy can be provided only by qualified physical therapists or by physical therapist assistants working under the supervision of a physical therapist. [Description provided by the American Physical Therapy Association] History of Physical Therapy Physicians like Hippocrates and later Galen 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. The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling “Father of Swedish Gymnastics” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare. Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy. The School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States’ 1914 Reed College in Portland, Oregon, which graduated “reconstruction aides.” Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA)). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for Polio. Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s. Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers. Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopedic Section of the APTA being formed for those physical therapists specializing in Orthopedics. In the same year, the International Federation of Orthopedic Manipulative Therapy was formed, which has played an important role in advancing manual therapy worldwide ever since. What is the difference between a Physical Therapist and an Occupational Therapist? The Physical Therapist provides services aimed at preventing the onset and/or slowing the progression of conditions resulting from injury, disease, and other causes. The Physical Therapist provides these services to people of all ages who have functional conditions resulting from back and neck injuries, sprains/strains and fractures, arthritis, burns, amputations, stroke, multiple sclerosis, birth defects such as cerebral palsy and spina bifida, injuries related to work and sports, and others. Occupational Therapists work with patients who are stroke victims and the like, to teach them how to dress and feed themselves, and generally live independently. OT’s are in the business of re-teaching people basic skills, some fine motor skills, etc. For people who have suffered strokes or other completely debilitating injuries, just strengthening the muscle isn’t always good enough. A lot of people lose their most basic abilities, like tying shoelaces or turning a doorknob, and it’s up to OT’s and OTA’s to re-teach them those skills. What Is Occupational Therapy? Technically, it is defined by the American Occupational Therapy Association executive board (1976) as: “The therapeutic use of work, self-care, and play activities to increase development and prevent disability. It may include adaptation of task or environment to achieve maximum independence and to enhance the quality of life.” First, let’s focus on the word “occupation”, the dictionary definition of occupation is, “that which chiefly engages one’s time, trade, profession, or business.” One’s occupation can therefore be defined as the way in which we occupy our time. Thus, our time is divided into three categories of activities in which we take part daily: • Self-Care: sleeping, eating, grooming, dressing, and toileting • Work: effort that is exerted to do or make something, or perform a task • Leisure: free, unoccupied time in which one chooses to do something they enjoy (i.e., hobby, TV, socializing, sports, “chill out”, read, write, listen to music, travel, etc.) If you read these very carefully, you will see that any task or use of our time during the day fits into one of these three categories. This is critical to understand as our basis for the meaning of the term “occupation”. It IS how we spend our time; whether paid or unpaid, restful or fun, obligation or choice and that which fulfills us, gives us purpose, and allows us to interact with, be productive, and function in the world around us to the best of our ability. Here is where the “therapy” comes in: If, at any point in our lives (whether present at birth or onset at a later time), illness, injury or disability prevents us from effectively or independently functioning in one or more “occupational” areas, then it is the job of Occupational Therapy to provide intervention which will help you regain function, maintain level of functioning, or make accommodations for any deficits you may be experiencing. The History of Occupational Therapy Looking at the history of Occupational Therapy allows us to see its relationship to Physical Therapy. I feel that these two professions share an interesting history. Many people believe that Occupational Therapy is a new profession. As you will see, this is not so. Its development is woven into the fabric of human existence; as, “occupation” has been central to our survival since the beginning of time. Many different ideas have been presented throughout history concerning; who should work, what type of work should be performed, what is considered to be “work”, who should play, and when the “playing” should begin and end. Health and occupation have evolved to become intertwined, after all, when health suffers, so too does the ability to perform an “occupation” and take part in daily activities. In the 1700’s, during the “Age of Enlightenment”, Occupational Therapy began to emerge. It was during this period that revolutionary ideas were evolving regarding the “infirmed” and mentally ill. At that time in history, the mentally ill were treated like prisoners; locked up, chained, drugged and considered to be a danger to society. It wasn’t until two gentlemen; Philippe Pinel (a French physician, philosopher, and scholar) and William Tuke (an English Quaker) started to challenge society’s beliefs about the mentally ill, that a new understanding, philosophy and treatment would emerge. In 1793, Philippe Pinel began what was then called “Moral Treatment and Occupation”, as an approach to treating people with mental illness. He firmly believed that moral treatment meant treating one’s emotions. This Moral Treatment Movement then began to define occupation as “man’s goal directed use of time, energy, interests, and attention”. Treatment for the mentally ill thus became based on purposeful daily activities. Pinel began advocating for, and using, literature, music, physical exercise, and work as a way to “heal” emotional stress, thereby improving one’s ability to perform activities of daily living. Around the same time, William Tuke was also trying to challenge society’s beliefs about how the mentally ill should be treated. He too was disgusted by the way patients were treated and the horrendous conditions they had to endure in the insane asylums. Tuke therefore developed many principles that would advocate “moral treatment” for the mentally ill. His basic premise which underlined these principles was to treat these people with “consideration and kindness” Tuke felt occupations, religion (which helped bring in the concept of family), and purposeful activities should be prescribed in order to maximize function and minimize the symptoms of the patient’s mental illness. Tuke then became a unique and positive influence when he founded a retreat center in England based on some of the same ideas. He encouraged patients to learn and grow by engaging them in a variety of employment or “amusements” (what we now call leisure activities) that were best adapted to their level of functioning and interests. Well, 1840-1860 were the “golden years” for the application of Moral Treatment and Occupation in American hospitals. It was during this time that the benefits of arts and crafts began to be noticed. Arts and crafts thus became a highly used activity to promote both relaxation and feelings of being productive, at the same time. A whole new approach was just about to emerge! Unfortunately, during the 19th century, in the U.S., moral treatment almost became extinct in the chaos and aftermath of the Civil War. It became less of a priority and there seemed to be no one to carry on the ideas and insightful philosophies from Tuke and Pinel. Luckily, a nurse by the name of Susan Tracy came along just in time (in the early 1900’s)! She successfully brought back the use of “occupation” with the mentally ill. She began to specialize in this field and even initiated educating student nurses on the therapeutic use of activities as part of treatment. Tracy coined the term “Occupational Nurse” for those she successfully trained in this specialty. In 1914, two people began a series of correspondences concerning the founding of an organization for individuals interested in “Occupation Work” (as Occupational Therapy was originally known until this time). George E. Barton, an architect, contacted Dr. William R. Dunton, Jr. because he was interested in learning about the response of the human body to the therapeutics of occupation. On March 15, 1917, the National Society for the Promotion of Occupational Therapy (NSPOT) was founded. This organization flourished through the 1920’s and 1930’s until the Great Depression. It was during this time that Occupational Therapy became more closely related to and aligned with organized medicine, thus creating a more “scientific approach” to this field of study. It is also this organization that would later be known as the American Occupational Therapy Association of today. Following the Great Depression, however, it was difficult to find therapists due to low budgets and poor staffing of clinics. Then World War II necessitated the use of every available therapist possible! It was this time that Occupational Therapists were called on to develop programs and treat injured soldiers, of which there were too many! From the 1940’s through the 1960’s, the “Rehabilitation Movement” was in full force. With the thousands of injured soldiers (physically and mentally) returning home from the war, there was a surge in the demand for Occupational Therapists (or, OT’s as they now call themselves). At this point, OT’s were not only treating the mentally ill who were already institutionalized, but began treating physical disabilities due to the injuries sustained in battle. Besides the mentally ill, the injured war veterans, OT’s also became called upon to treat an ever increasing number of survivors of “modern medicine’s miracles”. Now OT’s hit physical disabilities at high speed with the aforementioned, PLUS survivors of spinal cord injuries, amputations, traumatic brain injuries, and cerebral palsy. In 1947 “The journal, Occupational Therapy and Rehabilitation” and the first major textbook, “Willard & Spackman’s Principles of Occupational Therapy”, were finally published. Occupational Therapists achieved military status. This recognition provided other opportunities to gain financial support from the federal government for the education of OT personnel, and it provided leadership training skills for members of the American Occupational Therapy Association. In 1956 The Certified Occupational Therapy Assistant (COTA) position was created to alleviate the demand for OT’s who were required to attend 4-6 years of schooling. The COTA required only minimal training and was utilized as an assisting body and aide. The field of Occupational Therapy kept growing. During the 1960’s, as medicine became “specialized”, so did OT. Occupational Therapists were also called upon and qualified to treat in the fields of pediatrics and developmental disabilities. And, with de-institutionalization came an even greater need to help mentally ill, physically infirmed, and developmentally challenged individuals become independent and productive members of society. It was Occupational Therapists that could easily fill this role, and the surge for competently educated therapists was on. In 1965, under the amendments to the Social Security Acts, Medicare now covered inpatient occupational therapy services. In 1975, The Education of the Handicapped Act was passed and Occupational Therapy was included in the schools as a “Related Service”. During the 1980’s and 1990’s, Occupational Therapy began to focus more on a person’s quality of life, thus becoming more involved in education, prevention, screenings, and health maintenance. Goals of occupational therapy could now focus on prevention, quality, and maintaining independence. Today, occupation is the main focus of the profession. It is certainly an ever-evolving and dynamically moving profession. You will find Occupational Therapists working in a variety of settings with several different age groups and disabilities. Anyone with a physical, emotional, or developmental deficit can be referred by his/her physician, school, or parent for any one of the following reasons: prematurity, birth defect, spina bifida, attention deficit disorder, developmental disabilities, cerebral palsy, sensory dysfunction, autism, hyperactivity, down syndrome, amputation, stroke, arthritis, burns, head injury, dementia, diabetes, or cardiac conditions. Occupational Therapy is a product of, and dependent on, a social environment that values the individual and believes that each person has the capacity to act on his/her own behalf to achieve a better state of health through occupation.