DECEMBER 1981 P H Y S I O T H E R A P Y 91 E D I T O R I A L TH E DISABLED AND PHYSIOTHERAPY - T H E FUTURE? D uring 1981, th e In te rn a tio n a l Y ear of the D isabled Person we have all been aw are of the disabled, their problems and th eir needs. P rofessional bodies, v o lu n ­ tary groups, the business and public sectors all high­ lighted various aspects, pledged and gave generously in time, service and support. T h e disabled them selves, individually and collectively, participated in events and made their needs known. W hat have we learn t and where do we go from here? H ow do we physiotherapists figure in th e future? Physical disability brings social alienation (H islop, 1976), and, according to D arw in, ad ju stm en t and id ap tatio n to the env iro n m en t is essential fo r survival. Physiotherapy has a m eaningful role supplying the lieans of a d ap ta tio n w hich can am elio rate disability and im prove the quality o f life. Since the disabled have to m eet norm al needs in abnorm al ways, jobs, transport, education, and the like have to be m odified for regular access. T h eir resolve fo r self-determ ination is as strong as o r stronger th an th a t of th e society, often feeling little obligation, on w hom they are de­ pendent. T he greatest penalty of physical disability is possibly the conflict betw een dependency and ag­ gressiveness, fru stratio n and enterprise, and the phy­ siotherapist, by u n d erstanding these consequences, can assist the p atien t to ad ap t personal priorities and perspectives in o rd e r to achieve a m ode o f perform ance and style of living th a t will exact the least p enalty over the years. T he disabled have expressed acute physical and psychological shock after extensive trau m a such as spinal cord injury (Joubert, 1980) and highlighted the special needs for accom m odation, care and em ploym ent in o rder to becom e once m ore w orthy contributing members o f the com m unity, often a fte r long and a r ­ duous rehabilitation. Since physical dependence could lead to isolation, com m unication is o f m ajo r im p o r­ tance to m aintain and enhance social interaction. Society often has negative and am bivalent attitu d es to physical disability, which is equated to m ental, em otional and intellectual disability, leading to in ­ e q u a lity in encounter. T h e disabled need to be p re ­ p a re d fo r this during rehabilitation by encouraging p ositive self-image, self-respect and self-com m unication, which in turn will enable them to com m unicate th eir situation to others and to establish new behaviour m ethods. T h e re a fte r the initiative rests w ith th e dis­ abled to m a k e contact, ask fo r help, explain his situation, Jisten attentively, accept the w heelchair as a reality an d becom e involved in com m unity services. T hey should be encouraged to express th eir feelings and m ore atte n tio n could be given to sexual ad ju s t­ m ent and problem s. O peness, love, honesty and m utual respect for the situ atio n of each o th e r will im prove com m unication. K enedi (1980) feels th a t the M air R e p o rt o f 1972, which defines reh ab ilitatio n as the resto ratio n of the patien t to the fullest physical, m ental and social cap ­ ability, pro b ab ly satisfies th e w idest scope, bu t Ager- holm in 1979 pro b ab ly expressed it m ore specifically as no rm ality of ab n o rm ality , since m ost h andicaps and im pairm ent are n o t tem porary. H e fu rth e r defines the reh ab ilitatio n clinic team as the p a tie n t and a diag­ nostic and tre a tm e n t group who can effect solution(s) of the p a tie n t’s problem s. T his im plies th a t every m em ­ ber is a professional and o f e q u iv alen t collaborative status, not supplem entary, su perfluous o r subservient. M utual respect, a u th o rity an d status relevant to fu n c­ tion are essential characteristics o f (he team . V arious studies have been m ade to evaluate cost effectiveness o f rehabilitation, but th ere a re m any un q u an tifiab le factors such as h u m an suffering o r pleasure which are m ost im p o rtan t in the success o r not o f reh ab ili­ tation. It also seem s to be m ore productive in the dom estic ra th e r th an th e in d u strial sphere, fo r ex­ am ple assisting o ld er w om en to achieve functional independence ra th e r th an retrain in g young m en after traum a; reh ab ilitatio n fo r retire m en t ra th e r th an em ­ ploym ent; overcom ing m in o r problem s in self-care and m obility ra th e r th an helping th e ^severely disabled to achieve fu nctional im provem ents. T he professional is the kingpin and re h ab ilitatio n can be viewed as a total concept o r as a series of specialities. Specialty com ­ partm ents seem to be b arriers to effective reh ab ili­ tation, as are shortage o f tim e, com petition fo r tim e and space w ith acute services, in ad eq u a te social and functional support, lack o f glam our, sev ere/m u ltip le com plications suffered by patients, lack of scientific m ethod and fear of a d eq u ate d elegation to non- rriedical team m em bers. Contents - Inhoud S p in a l C ord In ju ry — L a n e F lin t 93 B o o k R e vie w s ... To be D iffe re n t — P. C o m p a a n ... 96 C.S.P. C o n g re s s — P s y c h o lo g ic a l A s p e c ts o f P a ra p le g ia - - R. W o o d N o tic e s ............ an d J. B a r re tt .............................. 97 M an a g e m e n t o f S e v e re ly D is a b le d — R e p o rt ... 98 V a c a n c ie s /C la s s ifie d N.C.R. — R e p o rt .................................... 102 C o n te n ts 1981 R e p o rt 105, 106, 109 ................... 107 107, 108, 109 109, 110, 111 .................... 112 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) K enedi defines a professional as a person who re­ ceives objective input (m easurable d ata such as tem ­ perature) as well as subjective (intuitive) input, which com bine to form a recognisable pattern, can be clas­ sified and used for diagnosis and treatm en t selection. E ducation an d training influence both inputs, but especially subjective input and p attern recognition. The m odern concept o f degree education accepts th at practical and vocational aspects are incorporated (cf m edicine and engineering) and could only enhance the creation of an environm ent th at encourages the developm ent of intellectual and im aginitive skills and powers. Such an education (basic or postbasic) should not only increase know ledge, but should also stim u­ late an enquiring, analytical and creative approach with independent judgem ent and critical self-aw areness which can see relationships and relate to actual situations with inform ed aw areness o f factors influencing social and physical environm ent. To date physiotherapy has developed m ainly p rac­ tically, with little o r no system atic evaluation of its effectiveness (P artridge, 1980). Physiotherapists now have the academ ic background and financial support to accept the challenge to instigate and undertake investigations. C ooper (1981), suggests th at physio­ therapists stop pleading ignorance of skill to conduct investigations, but rath er set their own param eters 92 and play with statistics in order th a t objective fair trials are set up, so that physiotherapy is no longer relegated to the ranks of expensive nonsense contri­ buting little to treatm ent. P artridge warns of the difficulties since treatm ent is a dynam ic process w ith interaction betw een therapist and patient, with individual approach, m ethods and m anagem ent, all influenced by the th e ra p ist’s skill and experience and the p atien t’s reaction to his condition, the therapist and treatm ent. She suggests th a t diag­ n o se s/co n d itio n s referred for physiotherapy be grouped in four m ain groups; associated prognoses and natural history, broad aim s of treatm ent and focus of outcome be defined; careful assessm ent, m onitoring and measure­ m ent will then supply som e factors fo r evaluation. References C ooper. R. J. ( 1981): G u ys H ospital G azette, 95, 261 -2 . H islop, H . J. (1976); T h e penalties o f physical dis­ ability. Phys. Ther. 56, 271 -278. Joubert. J. (1980); D ie eerste benadering. S.A .J. Occup. T h er: 10 (2), 2 - 3 . * Kenedi, R. M. (1980); E ducation in rehabilitation P hysiother. 66, 364 - 366. Partridge, C. J. (1980); T h e effectiveness of physio­ therapy. A classification fo r evaluation. Physiother. 66, 153 - 155. DESEMBER 1981F I S I O T E R A P I E THE EMS THERASONIC a truly portable Ultrasonic Unit Weight; only 5.7 kg. Size; 30,5 x 17,8 x 19,0 cm. Q Output; Up to 3 watts per sq./cm. Continuous as well as pulsating output For further details contact the Sole S.A. Agents and Distributors M E D I C A L D I S T R I B U T O R S edL 'bpk Medical Distributors (Pty) Limited P O Box 3378 Johannesburg 2000 P O Box 195 Cape Town 8000 P O Box 5298 Durban 4000 Phone ; 29-0611 Phone : 47-4440 Phone : 37-1501 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )