JUNE 1981 P H Y S I O T H E R A P Y 31 PRESIDENTIAL ADDRESS TO THE 14th NATIONAL COUNCIL MEETING OF TH E SOUTH AFRICAN S O C IE TY OF PHYSIOTHERAPY My p e rio d as P re s id e n t o f th e S o c iety has b e e n a w o r t h w h i l e e x p e rie n c e in a s m u c h as i h a v e h a d th e o p p o r t u n i t y t o ta k e a lo n g h a rd lo o k a t o u r o rg a n i- S a\Vhy d oes a p ro fe s sio n re q u ire a n o rg a n is a tio n a n d how does such a S o c iety e volve? A g ro u p o f re s p o n sible, stro n g ly m o tiv a te d a n d h ig h ly d e d ic a te d p e rso n s, w i t h 'a p a r tic u la r v o c a tio n a l tra in in g , b a n d to g e th e r a n d e n d e a v o u r to f o r m u la te a c o d e o f e th ic s a n d a set of n o rm s to w h ic h p e rso n s w ish in g to jo in su c h an a s s o c i a t i o n will u n d e rta k e to c o n fo rm . T h is will h ave th e im m e d ia te e ffe c t o f p ro te c tin g th e sta n d a rd a n d th e im a g e o f th a t p ro fe s sio n a n d , o f m o re im p o r t a n c e , o f p ro te c tin g th e p u b lic fro m u n sk ille d p ra c - 'titio n e rs . W h a t a re th e a im s of su c h a S o c iety a n d h ow d oes it a ch iev e th e m ? O n th e o n e h a n d , it p ro v id e s a fo ru m f o r d isc u ssio n a n d d isse m in a tio n o f k n o w le d g e a n d skills o b ta in e d fro m p e rso n a l e x p e rie n c e g a in e d fro m c o n tin u e d re s e a rc h a n d e x p e rim e n ta tio n . O n th e o th e r h a n d , it p ro v id e s a fo ru m f o r th e a p p ro v a l a n d d is cussion o f p o lic y a n d th e im p le m e n ta tio n o f such policy by m e a n s o f c o m m u n ic a tio n w ith its m e m b e rs . T h e S o u th A fric a n S o c iety o f P h y s io th e ra p y evolved in ju s t th is m a n n e r a n d th e f u tu r e p ro g re s s o f p h y sio th e ra p y as a p ro fe s sio n lies in its h a n d s. W e a re c o n s ta n tly b e in g re m in d e d t h a t we h a v e a “ p ro fessio n al s ta n d a r d ” to m a in ta in . T o w h a t a re we re fe rrin g ? T h e r e a re b o th a c a d e m ic a n d e th ic a l s ta n d a rd s. A c a d e m ic s ta n d a rd s a re th o se ju d g e d by e x a m i n a tio n o f c o m p e te n c e , e x p e rie n c e a n d d e m o n s tra te d re- sp o n sib ilty . T h e q u a lific a tio n s th u s g a in e d e n a b le th e h o ld e r to re g is te r as a fu lly q u a lifie d p h y s io th e ra p is t (in o u r case w ith th e P ro fe s s io n a l B o a rd fo r P h y s io th e ra p y o f th e S o u th A fric a n M e d ic a l a n d D e n ta l C ouncil). T h e s e s ta n d a rd s a re b o th je a lo u sly a n d z ealo u sly g u a rd e d b y th o se re sp o n sib le fo r th e tra in in g p ro g ra m m e s in th is c o u n try . I t is up to a ll th o s e c o n c ern e d to e n s u re th a t th e s e s ta n d a rd s a re b e in g m a in ta in e d t h r o u g h o u t th e c o u n try . W hen o n e m a k e s an in d e p th stu d y o f th e tra in in g kof th e p h y s io th e ra p is t o f to d a y , o n e a p p re c ia te s ju st m ow f a r th e p ro fe s sio n has p ro g re s se d . T h e em p h a sis has sw ung a w ay fro m th e p a ssiv e to th e a c tiv e a n d th e tre m e n d o u s e x p a n s io n o f sc ie n tific k n o w le d g e a n d re s e a rc h h as fo rc e d th e a b a n d o n m e n t of m a n y a n e m p iric a l te c h n iq u e . T h e e le m e n ts o f c h a n c e a n d g ood in te n tio n h a v e b e e n firm ly re m o v e d . T h e r e a re also m a n y o p p o rtu n itie s fo r c o n tin u in g e d u c a tio n in th e p o st g ra d u a te field s a n d th e e a g e rn e s s th a t p h y s io th e ra p is ts h a v e sh o w n in p u rs u it of th is a d d itio n a l k n o w le d g e b e a rs w itn ess to th e ir d e te r m in a tio n to f u r th e r th e ir s tu d ie s a n d sa tisfy e n q u irin g m in d s. In sp ite o f w h a t w as said a t th e C o n g re ss, p h y s io th e ra p is ts a re n o t b e in g tra in e d as m e re te c h n ic ia n s . P h y s io th e ra p is ts , as n e v e r b e fo re , a re ta u g h t to th in k a n d a c t fo r th em se lv es. T h e y d e m o n s tra te a n a b ility a n d e d u c a tiv e skill w h e re b y th e y a re a b le to assess a c c u ra te ly a p a tie n t’s c o n d itio n a n d e v a lu a te th e n e c e s sa ry t r e a tm e n t b a se d o n a so u n d a n d p e n e tra tin g w isd o m o b ta in e d d u rin g c o n c e n tra te d a c a d e m ic a n d p ra c tic a l tra in in g a t b o th u n d e r- a n d p o s tg ra d u a te levels. It is fo r th is re a so n th a t th e S o c iety h a s m a d e its in itia l a p p ro a c h e s to th e m e d ic a l p ro fe s sio n to a c k n o w le d g e th e c a p a b ilitie s o f th e p h y s io th e ra p is t a n d p e rm it a w id e r in te r p r e ta tio n o f o u r E th ic a l R u les, as h as b e e n d o n e in s e v e ra l o v e rse a s c o u n trie s . T h e e th ic a l s ta n d a rd s o f p h y s io th e ra p is ts in th is c o u n try a re c o n tro lle d by a s tr ic t c o d e o f p ro fe s sio n a l e th ic s laid d o w n by b o th th e S o ciety a n d th e P r o fe ssio n a l B o a rd fo r P h y s io th e ra p y . T h e s e p re sc rib e th e re g u la tio n s re la tin g to p ro fe s sio n a l p ra c tic e a n d d isc i p lin a ry c o n tro l. It is th e d u ty o f a ll m e m b e rs o f a p ro fe s sio n a l so c iety to m a in ta in th e im a g e a n d s ta tu s o f th e p ro fe s sio n re g a rd le s s o f th e ir w o rk s itu a tio n . P h y s io th e ra p is ts a re c o n s ta n tly b e ing to ld th a t th e y d o n o t “ s e ll” th e m se lv e s su ffic ie n tly . T h is w as f o r c e fu lly u rg e d by P ro fe s s o rs A n d re a n d S a n d ra v a n d e r M e rw e a t a re c e n t in te re s tin g , stim u la tin g a n d th o u g h t p ro v o k in g c o u rse on “ m a r k e tin g ” w hich th e y c o n d u c te d fo r p h y s io th e ra p is ts . By th is is n o t m e a n t th a t we m u st a d v e rtis e o u rse lv e s in a n u n e th ic a l m a n n e r b u t o u r b e h a v io u r to w a rd s m e m b e rs of th e p u b lic is o f v ita l im p o rta n c e . I t w o uld be as w ell to re m e m b e r th e w o rd s o f a p ro m in e n t A m e ric a n r e s e a rc h e r in p r o f e s sio n a lism , W a rd D a rle y , w h o says: “ T h e tru ly p ro fe s sio n a l p e rso n is o n e , w ho, by v irtu e o f in te lle c tu a l c a p a c ity , e d u c a tio n a n d m o ra l o u tlo o k is c a p a b le o f th e e x e rc is e o f in te lle c tu a l a n d m o ra l ju d g m e n t a t a h igh level o f re sp o n s ib ility .” Contents - Inhoud P re s id e n tia l A d d re s s to th e 14th N a tio n a l C o u n c il o f th e S o u th A fr ic a n S o c ie ty o f P h y s io th e ra p y A b s tra c ts .................................................................. 32, T he " H ig h R is k ” In fa n t ................................................ R e su lts o f E a rly In te rv e n tio n in th e B a b y w ith C e re b ra l M o to r D is tu rb a n c e .............................. The A t R isk A u tis tic C h ild a n d H is F a m i l y ............ K e e p in g in T o u c h — T he N eed f o r C o m m u n ic a tio n 31 in P h y s io th e ra p y ............................................................ 40 5 4 A R e a p p ra is e l o f E v a lu a tio n o f F in a l Y e a r S tu d e n t 33 P e rfo rm a n c e ..................................................................... 44 3 4 O b itu a rie s .......................................................................... ....50 28 C la s s ifie d — V a c a n c ie s ....................................................51 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. ) 32 F I S I O T E R A P I E JUNIE 1981 T h e s ta n d a rd o f p h y s io th e ra p y in S o u th A fric a c o m p a re s fa v o u ra b ly w ith th a t of o th e r c o u n trie s . H o w ever, in a c o u n try no lo n g er c o n sid e re d a d e v e lo p in g c o u n try b u t o n e th a t is b e g in n in g to ta k e its p lace w ith th e in d u s tria l c o u n trie s o f th e w o rld , th e scope a n d fa c ilitie s a v a ila b le fo r th e to ta l p o p u la tio n a re so m e tim e s w o e fu lly in a d e q u a te . T h e ra p id ly d e v e lo p in g s ta n d a rd s o f liv in g o f th e B lack a n d C o lo u re d p o p u la tio n s will in e v ita b ly lead to a n in c re a s e d d e m a n d fo r sp e c ia lise d m e d ic a l services. It is o ffic ia lly re c o g n ise d in S o u th A fric a th a t th e re is, a n d in th e fo re s e e a b le fu tu re , w ill be, a s h o rta g e o f sk ille d p e rso n n e l. A s f a r as p h y s io th e ra p y is c o n c e rn e d , in view o f th e u p su rg e to U n iv e rs ity e d u c a tio n a n d d u e to in s u ffic ie n t fa c ilitie s a n d lack o f s u ita b ly tra in e d le c tu rin g s ta ff, th e a d m iss io n o f a d d itio n a l s tu d e n ts is o fte n n o t p o ssib le , th u s im p e d in g th e flow of q u a lify in g p h y s io th e ra p is ts . T h is m ak e s it e sse n tia l th a t th e sk ille d p e rs o n n e l a v a ila b le a re u tilise d to b e st e ffe c t, p a rtic u la rly in th e h o sp ita l s itu a tio n . I f o n e is g o in g to o p tim ise th e use of h ig h ly sp e c ia l ised p e rso n n e l, a lo w e r level o f c o m p e te n c e m u st be c re a te d to c o p e w ith th e w ork load. T h e m e rits a n d d e m e rits o f c re a tin g a c a te g o ry o f “ a s s is ta n ts ” h a v e b e en d e b a te d a t le n g th a n d it w o u ld a p p e a r t h a t th e e s ta b lis h m e n t o f such a c a te g o ry is in e v ita b le . T h e m o re re c e n t flo w fro m th e H o s p ita l S e rv ice to th e p riv ate s e c to r has, h o w e v er, c rc a te d a n im b a la n c e . E v e ry e ffo rt s h o u ld th e re fo re be m a d e to ste m the flow as a s h o r t age o f sk ille d p e rso n n e l in h o sp ita l se rv ice s m ay e v e n tu a lly p re c lu d e a d e q u a te su p e rv isio n o f the e sse n tial in -se rv ic e tra in in g w hich will be n e c e ssa ry fo r these a ssista n ts. A n ew era lies b e fo re us. O n e in w h ich we will h a v e to p ro v e a n d m a in ta in o u r e n h a n c e d p ro fe s sio n a l s ta n d a rd s so t h a t we m a y n e v e r feel th r e a te n e d o r fe a r th a t th e im a g e o f p h y s io th e ra p y is in a n y w ay in je o p a rd y by th e in tr o d u c tio n o f p h y s io th e ra p y a ssista n ts. D u r in g th is b rie f a d d re ss , I h a v e trie d to stre ss th e im p o r ta n c e o f p ro fe s s io n a lis m w hich in c lu d e s y o u r im a g e . T h e f u tu r e o f p h y s io th e ra p y in th is c o u n try lies n o t o n ly in th e h a n d s o f th e u p p e r e c h e lo n s o f the S o c iety , b u t in th e h a n d s o f e ac h a n d e v e ry m e m b e r of th e p ro fessio n . W h e th e r y ou re sp o n d to w ild, n e a r h y ste ric a l ex h o r ta tio n s , o r to b u lly in g ta c tic s o f d e le g a tio n , o r to an e a r n e s t p le a fro m a n o ld -fa s h io n e d , b u t n e v e rth e le ss d e d ic a te d , h a rd w o rk in g a n d s in c e re p e er, m y m essage to a ll p ro fe s s io n a l p h y s io th e ra p is ts is R E S P O N D . K . M . Levy ABSTRACTS Y ou n g, C heshire, P ierce and V ivian (1977): Cervical A n k y lo sis w ith A c u te Sp inal Cord Injury. P araplegia 15, 133 - 1 4 4 . T h is v e ry c o m p re h e n s iv e a n d w e ll-d o c tlrh e n te d d is c u ssio n o f th e in c id e n c e o f sp in a l c o rd in ju r y in c e rv i cal a n k y lo s is in c lu d e s a p a r a g r a p h o n “ p r e v e n tio n ” . T h is s h o u ld b e r e a d b y all th o se w h o d e a l w ith p e o p le su ffe rin g fro m c e rv ic a l a n k y lo s is a n d sp o n d y lo sis. It is q u o te d h e r e in fu ll: “ P e rs o n s w ith c e rv ic a l a n k y lo s is c o m m o n ly su ffe r lo w v e lo c ity in ju rie s , p a r ti c u la r ly in th e s p o n d y litic g ro u p . O u r co lle ag u e s in rh e u m a to lo g y , in te rn a l m e d ic in e a n d g e n e ra l p ra c tic e s h o u ld b e a le rte d to th is p o te n tia lity . T h e y sh o u ld c a u tio n a n d in stru c t th e ir p a tie n ts to o b s e rv e su c h p re v e n tiv e m e a su re s as h a v in g n ig h t-lig h ts in th e b e d ro o m , b a th r o o m a n d d im ly -lit h a lls. H a n d r a ils s h o u ld b e a v a ila b le in th e tu b a n d sh o w er. P e rs o n s w ith c erv ica l a n k y lo s is s h o u ld b e in s tru c te d to u se h a n d r a ils w h e n a sc e n d in g o r d e sc e n d in g sta irs . A ll s h o u ld c o n s c ie n tio u s ly use se a t b e lts w h e n r i d in g in a n a u to m o b ile . A b o v e a ll, th e y sh o u ld r e p o r t a ll in c id e n c e s o f h e a d a n d n e c k tra u m a to th e ir p h y s ic ia n a n d lim it c erv ica l m o tio n u n til th e y c a n b e p r o p e r l y e x a m in e d b y th e i r p h y s ic ia n . T h e in itia l a tte n d in g p h y s ic ia n s h o u ld ta k e c a re to o b ta in c e rv ic a l film s, p a y in g p a r tic u la r a tte n tio n to p ro te c tin g v e rte b ra l a lig n m e n t in th e p ro c ess. S uch s im p le m e a su re s w o u ld s ig n ific a n tly re d u c e th e in c id e n c e o f s p in a l c o rd in ju r y in th is su s c e p tib le g r o u p .” T h e d a n g e r o f su c h s e rio u s tr a u m a to th e n e c k in th e s e h ig h -ris k s u b je c ts is n o t suffic ie n tly a p p re c ia te d , a n d sim p le p re v e n tiv e m e a su re s like th o s e o u tlin e d a b o v e c o u ld well sa v e th e p a tie n t f r o m th e d istre s s a tte n d a n t u p o n f ra c tu re s o f th e c e rv ic a l sp in e . T h e s e v e rity o f th e d isc ip lin e s w h ic h o f n e c e ssity a r e im p o s e d u p o n h im in t h e ir tre a tm e n t c a n b e w e ll-n ig h in to le ra b le to th e e ld e rly p e rs o n a n d th e diffic u lties h e e x p e rie n c e s f r e q u e n tly p r o v e to b e in s u rm o u n ta b le a n d h e su c c u m b s. H . C. W a tts P ridm ore, S. A . (1978) H e a v y R esistan ce E xercise W ith ou t A pparatus. A u s tr . J. P h y s io th e r ., 24, 1. A se t o f tw e lv e h e a v y -re s is ta n c e e x erc ises h a s b een d e s c rib e d in w h ic h a k itc h e n c h a ir is th e o n ly n e ce ssa ry a p p a r a tu s . T h e i r v a lu e in r e h a b i li ta t io n a n d s p o rts tr a i n i n g h a s b e e n in d ic a te d . T h e m e c h a n ism s in v o lv e d h a v e b e e n d iscussed. M . J. R u n n a lls R ob erts, G . M ., R ob erts, E . E ., L loyd , K . N ., Burke, M . S., E vans, D . P . (1978): L um bar Sp inal M a n i pu la tio n o n T rial P art II — R a d io lo g ic a l A ssess- m bent. R h e u m , a n d R e h a b . 17, 54. In a tria l o f m a n ip u la tio n f o r c h ro n ic low b a c k p a in , r a d io g r a p h s o f th e lu m b a r s p in e a n d r a d io g r a p h ic a ssess m e n t o f sp in a l m o tio n w e re o f n o v a lu e in p re d ic tin g o r asse ssin g th e re sp o n se o f th e p a tie n ts to m a n ip u la tio n . A lth o u g h r a d io g r a p h y o f th e l u m b a r s p in e is a c o m m o n ly re q u e s te d in v e s tig a tio n , it c o n trib u te s little to th e m a n a g e m e n t o f su c h p a tie n ts e x c e p t to e x clu d e s e rio u s sp in a l p a th o lo g y b e f o re a n y f o r m o f p h y s ic a l tr e a tm e n t is c o m m e n ce d . M . J. R u n n a lls L iftin g , P h y s io th e r a p y 65, 23 8-251 & 2 77-292. T h is is a c o m p re h e n s iv e se ries o f a rtic le s o n th is im p o r ta n t s u b je c t, w hich in c lu d e s th e B io m e c h a n ic s, P a th o lo g y , a n d A p p lie d A n a to m y a n d P h y s io lo g y o f th e b a c k in re la tio n to liftin g . A lso c o v e re d a re B ack C a re in In d u s try , A d v isin g P a tie n ts on B ack C a re , a n d P h y s io th e ra p is ts as T e a c h e rs o f th e P u b lic . T h e re is a v e ry w ell illu s tra te d p u ll-o u t b o o k le t w h ich a n a ly se s a n d d e sc rib e s in d e ta il th e m a n o e u v re s in v o lv e d in effective a n d sa fe liftin g . S afe, th a t is, fro m th e p o in t o f view o f b o th th e p a tie n t a n d th e lif te r ’s b a c k . T h e se ries p r o v id es e x c e lle n t b a c k g ro u n d k n o w le d g e a n d th e b o o k le t a n e q u a lly g o o d g u id e f o r th e p h y s io th e ra p is t w h o finds h e rs e lf in th e p o s itio n o f te a c h in g o th e rs , su c h as n u rs in g staff, th e te c h n iq u e s o f c o rre c t liftin g p ro c e d u re s. H . C . W a tts 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. )