MARCH 1981 P H Y S I O T H E R A P Y 15 causes vasodilation which modifies the kpc value for each tissue. Thus the tissue does not display the same heating pattern as would be expected in a similar system, without blood flow. Tem perature increases stimulate an increase in blood flow and this has a cooling effect on the tissue (Stoll, 1960). It was observed that the lateral subcutaneous tissue cooled down most rapidly, followed by the muscle and medial subcutaneous tissue, bone having the lowest cooling rate. In those cases where blood flow changes appear to have been minimal, cooling occurred more rapidly after the 1,5 M Hz application than the 3 M Hz applications. However, once blood flow changes had been induced, this pattern changed. The cooling rate was variable, probably due to inconsistencies in blood flow changes. CONCLUSION The results of the trials conducted led us to conclude . that an increase in temperature can be induced with J continuous ultrasound at therapeutic frequencies, inten­ sities and times. The amount of heat produced at different depths changed with intensity and time. We feel that this study highlights the need for further research to determine the point at which high intensities produce dangerous temperature increases. References Ter H aar, G. (1978). Basic physics of therapeutic ultra­ sound. Physiother. 64, 100- 103. Licht, S. (1958). Therapeutic Heat. E. Licht. Dyson, M. and Suckling, J. (1978). ‘Stimulation of tissue repair by ultrasound: A survey of the mechanisms involved’. Physiother. 64, 105 - 108. Hahn, G. M. (1978). Ultrasound for the induction of localized hyperthermia. International Journal of Radiation Oncology, Biology and Physics 4, 1117- 1118. Lipkin, M. and Hardy, J. D. (1954). M easurement of some thermal properties of human tissues. Journal o f Applied Physiology 7, 212 - 217. Stoll, A. M. (1960). The role of skin in heat transfer. Transactions o f the A S M E J. of H eat Transfer 82, 239 - 242. M EDICAL O F FIC E R S ’ ATTITUDES TOWARDS PHYSIOTHERAPY S. MORFORD, Dip. Physiother. (U.C.T.)* and D. GOODLEY, Dip. Physiother, (U.C.T.)t SUMMARY A simple questionnaire was distributed amongst the Medical Officers o f the Cape’s D ay Hospitals Organisar tion to ascertain their knowledge o f and attitudes towards physiotherapy. The results are analysed and discussed. In August 1978 the Day Hospitals Organisation’s Physiotherapy Department decided to conduct a survey amongst their Medical Officers to assess their knowledge | of and attitudes towards Physiotherapy in general and their attitudes towards physiotherapy within the Day Hospitals Organisation. The Day Hospitals Organisation consists of seventeen small community hospitals throughout the Cape Penin­ sula. Well-equipped physiotherapy departments of varying sizes are found in nine hospitals and treat a wide variety of patients with acute and chronic con­ ditions on an out-patient basis. Medical Officers are frequently required to rotate between the different Day Hospitals. It was noticed that this often radically affected the referral rate to, and therefore the work-load in, the Physiotherapy D epart­ ments. This created obvious staffing problems. A depart­ ment staffed by one full-time physiotherapist could change rapidly to need two full-timers or conversely to be run on a part-tim e basis, depending on which Medical Officers moved and where they moved. * Principal Physiotherapist, Day Hospitals Organisation, Cape Town. t Senior Physiotherapist, Day Hospitals Organisation, Cape Town. Received 4 March 1980. OPSOM M ING ’n Eenvoudige vraelys is aan die M ediese Beamptes '. van die Kaapse Daghospitaalorganisasie gestuur om hulle kennis van en houding jeens fisioterapie vas te stel. D ie resultate word ontleed en bespreek. We decided to conduct a simple survey by drawing up a short questionnaire which they would be likely to complete. We tried not to be too intimidating and in an attem pt to elicit honest answers they could remain anonymous if they wished. T he questionnaires were distributed to all the Day Hospitals, to seventy Medical Officers in all, in August 1978. CONTENTS OF SURVEY AND ANALYSIS OF RESULTS Of 70 questionnaires distributed 48 were returned completed. Two were returned uncompleted by Medical Officers working in hospitals without Physiotherapy Departments who felt the survey did not apply to them. The following questions were asked. Each question has an analysis of how they were answered with our comments. (Figures in brackets indicate the actual number of Medical Officers who answered.) Question 1 W hat conditions do you refer for physiotherapy as part of their treatm ent? (a) Respiratory conditions ................... 96% (46) (b) Arthritic c o n d itio n s ........................... 68% (33) 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. ) 16 F I S I O T E R A P I E MAART 1981 (c) Sports injuries ................................... 64% (31) (d) Burns ...................................................33|'% (16) (e) Fractures ...........................................33$% (16) (f) Cerebro-Vascular accidents ........... 39% (19) (g) Back conditions ........................... 25% (12) (h) Hand injuries and acute Tendonitis 12% (6 ) (i) Pelvic infections ........................... 8% (6 ) (j) Cerebral P a l s y ................................... 8% (3 ) (k) Neurological c o n d itio n s ................... 8% (3 ) (1) Spinal injuries ................................... 8% (3 ) (m) U l c e r s ................................................... 2% (1 ) (n) Septic wounds ................................... 2% (1 ) (o) Pre-operative c a s e s ........................... 4% (2 ) (p) Post-operative c a s e s ........................... 4% (2 ) This list is self-explanatory. It was noted that most Medical Officers only referred a very small variety of conditions to Physiotherapy and were unaware of the range of conditions treatable in an out-patient physio­ therapy department. Question 2 Is the physiotherapy you prescribe mainly prophylactic or curative? (a) Prophylactic only ........................... 8% (4 ) (b) Curative only ................................... 16% (8 ) (c) Both ................................................... 75% (36) Self-explanatory answers. Question 3 Do you think your knowledge of physiotherapy is sufficient? If not, how could it be improved? (A com­ ment was asked for). Yes ........................................................... 14% (7 ) W ithout comment ... (6 ) (1 ) 86% (41) (4 ) (37) hat there was a need With comment ........... No ........................... W ithout comment ... With comment ........... Some of the comments were for: better liaison between Medical Officer and Physio­ therapist (12); lecture/dem onstrations (18); individual hospital staff talks by the Physiotherapist (7); more physiotherapy lectures at undergraduate level (3); visits/ demonstrations in Physiotherapy Departments (11). One improved his knowledge by reading. From the Medical Officers’ comments there was an obvious awareness of their lack of knowledge and a marked willingness to learn more. Question 4 When you prescribe Physiotherapy, are you aware of what physiotherapy modalities will be used? Yes ........................................................... 56% (27) No ........................................................... (0 ) Unsure ........................................... ... 44% (21) This was an interesting result. It is our general experience that though most Medical Officers are aware of some modalities physiotherapists use, they do not seem to know their specific applications, nor the full range. Question 5 Are you aware of the Day H ospital’s Domiciliary Physiotherapy Service? Yes ........................................................... 50% (24) . No ........................................................... 50% (24) A self-explanatory analysis. One presumes it is our fault that half of the Medical Officers had no knowledge of the service. Question 6 Do you feel there is adequate communication and co-operation between the Physiotherapist and the Men; cal Staff of the Day Hospitals? No ........................................................... 33J% (16) Yes ........................................................... 66f% (32) Six of the negative answers commented that there was co-operation but poor communication with regard to report back on patients. In a small hospital com­ munication should not be a problem. However, it is our experience that a physiotherapist running a busy department single-handed often forgets to report back to the Medical Officer. We feel the effort should be made and physiotherapists are constantly encouraged to do Question 7 Do you feel it would be detrimental to your hospital’s service and to the community, if your physiotherapy, department was closed? f ' Yes 92% (44) Without comment (17) With comment ... (27) N ot applicable 8% (4 ) No Physiotherapy Depart­ ment in their hospital Comments of the Medical Officers indicated physio­ therapy has an important function in rehabilitation, was an adjunct to medical treatm ent and th at it would be retrogressive to stop physiotherapy services. They felt it was an important part of the medical team, especially in acute traum a and helps to reduce wasted manpower hours. Many patients attending Day Hospi­ tals need physiotherapy and would be deprived of proper treatment. Slower and less recovery would result, leading to dissatisfied patients. We felt this showed an obvious awareness of our contribution towards better patient care. The last three questions required some thought and comments only. A large proportion of the Medical Officers did not answer or answered minimally. Question 8 Do you have any specific ideas on the role of the Physiotherapist? No comment ........................................... 41'% (20) Comments ................................................... 59% (28) Interesting comments stated the physiotherapist’s ro k to be education (kinetic handling and teaching r e l a t i v ^ to handle patients); a vital link who should be consulted" more often for her expertise; as a placebo! I t was felt that the physiotherapist should not be abused for patient support and dependance, nor was she of any use in “burnt out” cases, but should work more with acute traum atic rather than chronic cases. Again she was mentioned as a member of the health team and an adjunct to medical treatment. An interesting cross-section of ideas on the Physio­ therapist’s role. It was noted that some Medical Officers felt we were definitely wasting time on chronic cases and we were just a placebo 1 Question 9 If you do not use Physiotherapy — Why? Nil comment 92% (44) N ot applicable 8% (4 ) (No physiotherapy avail­ able in their hospitals) An interesting result. This question was included as certain Medical Officers do not refer patients to the Physiotherapy Department. We had hoped to hear some of the reasons why. These were obviously not forth­ coming, and makes in our opinion the analysis of the 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. ) MARCH 1981 P H Y S I O T H E R A P Y question invalid. No comment ........................................... 62% (31) With c o m m e n t........................................... 38% (17) Additional com m ents were basically a repetition in that it expressed appreciation having physiotherapy available as it is a vital adjunct to the treatm ent of a significant percentage of patients and to close an essen­ tial service would be retrograde. Talks and demonstra­ tions are needed as doctors could make better use of the service with improved knowledge of physiotherapy. CONCLUSIONS This survey highlighted areas where we as physio­ therapists had fallen down in communication. It gave us guidelines for methods in which we can improve the doctors’ knowledge of physiotherapy. It also boosted our morale in that we realised that the majority o f the 17 Medical Officers appreciated us even if they were not all too sure exactly what we did! Although the survey was conducted amongst the Day Hospital Medical Officers, we feel th a t it probably reflects the attitudes of Medical Officers in general. A similar survey conducted in a general teaching hos­ pital may produce slightly different results. Finally, the lack of knowledge of physiotherapy was obvious to all involved1 in this survey. W here does the fault lie? In the Medical Officers’ under-graduate training or in our poor physiotherapy public relations? Would effective physiotherapy treatment, good results and active communication of these results not be one of the best public relations methods we could use? Reference Fehler, B. R. (1976). A personal analysis of physiothe­ rapy. S.A. Journal Physiotherapy 32, 4, 7 - 14. T H E R O L E O F PHYSICAL EDUCATION AND SPORT IN A C ER EB R A L PALSY SCHOOL AND T H E INTERACTION OF THERAPISTS AND PHYSICAL EDUCATIONISTS M. M. VAN D ER SPUY, M.C.S.P., O.N.C., J. GOOD, Dip. Physio. (U.C.T.), D.T.S.E. G. LIDDLE, Dip. Physio. (U.C.T.), D.T.S.E., B. SCOBLE, B.Sc. (Physio.) (Wits.)* OPSOMMING Die junksies van terapeute en liggaamlike opvoedkun- diges in skole vir serebraalverlamdes word omskryf. Samewerking tussen terapeute en liggaamlike opvoed- kundiges in die seleksie van sportaktiwiteite en posisio- nering van elke serebraalverlamde kind word beklem- toon. Die adolessente en volwasse serebraalverlamde het die reg om te besluit aan watter aktiwiteite hy wil deel- neem, maar m oet op die nadelige gevolge en fisiese agteruitgang wat verkeerde aktiwiteite tot gevolg mag gewys word. Die voor- en nadele van verskeie sportaktiwiteite word bespreek. In order to clarify some misconception about the role of sport and physical education in a cerebral palsy school, it is necessary to define the aims of physical education and sport, and decide whether the methods of applying these aims are suitable for the physically handicapped, cerebral palsied child. AIMS: • Physical fitness and the development of agility, flexibility, strength and stamina. _ ■ • Movement development, i.e. the learning of new movement skills or patterns. • Emotional and social well-being through self-achieve­ ment, competition and team spirit. • Intellectual development — by way of physical edu­ cation. * Department of Physiotherapy, Vista Nova School for Cerebral Palsied Children. Received 25 September 1980. SUMMARY The roles o f therapists and physical educationists in cerebral palsy schools are described. Cooperation be­ tween therapists and physical educationists in selecting sporting activities and positioning o f each individual cerebral palsied child is emphasised. The adolescent and adult cerebral palsied have the right to decide in which activities he wishes to participate, but the adverse effects and physical deterioration that can result from incorrect activities, should be pointed out. The advantages and disadvantages of different sporting activities are dis­ cussed. One can see that there should be no difficulty in applying these aims to the psycho-neurologically dis­ turbed (P.N.D.) or minimal cerebral dysfunction (M.C.D.) child, or to the child who is really minimally cerebral palsied (M.C.P.). This is said with certain qualifications, which we shall enlarge on later. I t is also possible to apply them to the child with physical handi­ caps resulting from spinal or peripheral neurone damage such as paraplegia, poliomyelitis and even spina bifida in the absence of cerebral involvement. To some extent the problem which we are about to discuss has arisen because of the exciting development of sport for the disabled which has taken place over the years, originating at the famous Stoke Mandeville Hospital, where one had the type of patient to whom the above aims would apply, with modifications. How­ ever, most of the children with physical handicaps in our South African cerebral palsy schools are there because of brain damage. They are referred directly, or indirectly, by the doctor who diagnosed the condition; to a special school where he expects th a t the child will receive the necessary remedial therapy. 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. )