40 F I S I O T E R A P I E JUNIE 1981 T h e d ia g n o s is o f a u tism is th e re fo re n o sim p le p r o ­ c ed u re . In p s y c h ia try w e d istin g u ish be tw ee n ‘la b e llin g ’, giv in g a c o n d itio n a n a m e , a n d th e p sy c h o -d y n a m ic asse ssm e n t o f th e fa c to rs w h ich h a v e o r a re still c o n ­ trib u tin g to th e p ic tu r e as it p re se n ts a t th e tim e. T h is re q u ire s th e skill o f a v a rie ty o f d isc ip lin e s in th e case o f a u tis m . A fu ll p h y sic a l, n e u ro lo g ic a l a n d , a t tim e s, a b io c h e m ic a l in v e s tig a tio n is a lw ay s n e ce ssa ry . Several p s y c h ia tric in te rv ie w s m ay b e in d ic a te d ; th e p sy c h o m e tric a sse ssm e n t c a n b e e x tre m e ly difficult to e sta b lish a n d th e ir a tta in m e n ts c an sh o w a w ide s c a tte r. A t tim es it m ay b e n e c e ssa ry to, h a v e th e o p in io n o f sp e c ia lis ts in o th e r fields, p a rtic u la rly to assess h e a rin g a n d vision. T h e f o rm e r re q u ir e s sp e c ia l k n o w le d g e a n d te c h n iq u e s. In C a p e T o w n th e c hild is a lso se n t fo r o b se rv a tio n to th e a p p r o p ria te sc h o o l. T h e s e p a in s ta k in g d ia g n o s tic p ro c e d u re s a re re q u ire d b e c a u se ‘a u tis tic fe a tu re s ' c a n o c c u r in a w ide v a rie ty o f o th e r c o n d itio n s. T h e d e ta ile d p ro c e d u re is a lso re q u ire d so as to assess th e a e tio lo g ic a l fa c to rs as a c c u ra te ly as p o ssib le . T h e s e m u s t be k n o w n to th e e x te n t in w hich it is p o s s ib le so as to e n a b le th e te a m w h o w ill be d e a lin g w ith th e c h ild a n d his fa m ily to w o rk o u t a tre a tm e n t a n d e d u c a tio n a l p ro g ra m m e a im e d a t th e m a jo r c au ses o f th e c o n d itio n a n d to u se th e stre n g th s in the c h ild a n d his fa m ily to th e m ax im u m . C O N C L U S IO N I n th is c o u n tr y th e ro le o f th e p h y s io th e ra p is t h a s n o t b e e n e x p lo re d in a n y m e a n in g fu l w ay. I n m y o p in io n sh e c a n be o f g re a t h e lp w ith the s tim u la tio n a n d d e v e lo p m e n t o f th e se n so ry m o d a litie s. By th e v a rio u s te c h n iq u e s o f h e r s p e c ia lity sh e c o u ld a id th e d e v e lo p m e n t o f a b o d y im a g e , a n d th e im b a la n c e o f th e u se o f m u sc le s, so as to m in im iz e c lu m sy a n d b iz a rre g a its a n d th e p o s tu rin g m e n tio n e d e a rlie r. I t m ig h t a lso b e w o rth w h ile e x p lo rin g th e id e a s of O rn itz a n d , w ith re la x a tio n te c h n iq u e s a n d o th e r m e a n s, g e t a b e tte r u n d e r s ta n d in g o f th e p e rio d s o f h y p e r ­ e x c ita tio n . I n a b o o k (G o u w s, 1979) o n th e e d u c a tio n o f th e a u tis tic c h ild th e ro les o f p a ra m e d ic a l sta ff h a v e b e en b rie fly m e n tio n e d , b u t th e p h y s io th e ra p is t h a s been o m itte d . T h is co u ld be a n a c c id e n ta l o m is sio n , b u t it is m o re lik e ly th a t th e skills o f th e p h y s io th e ra p is t h a v e n o t y e t b e e n a p p lie d in th is a re a . U n til th e a u tistic c h ild is se e n as a n a t risk c h ild a n d u n til p h y s io th e ra ­ p ists h a v e a p p lie d th e ir sp e c ia l sk ills a n d k n o w le d g e in a p ra c tic a l s e ttin g a n d w o rk e d in a te a m w ith o th e r d isc ip lin e s , n o o n e is in a p o s itio n to give a n a u th o r i ­ ta tiv e o p in io n . T h e fa m ily is n o t th e c o n c e rn o f th e p h y s io th e ra p is t in te rm s o f p h y sic al p ro b le m s, b u t sh e will h a v e to w ork in close a ss o c ia tio n w ith th e m . F a m ilie s e x p e rie n c e ex ­ tre m e te n s io n s o f v a ry in g k in d s a n d th e h e lp in g p r o ­ fe ssio n s h a v e to k n o w a b o u t it a n d u n d e rs ta n d it as it c a n u n d o m u ch o f th e ir w ork. R eferen ces B e tte lh e im , B. (1967). T h e e m p ty fo rtre ss . F r e e Press. N e w Y o rk . D e p a r tm e n t o f N a tio n a l E d u c a tio n (1971). R e p o r t ofT th e c o m m itte e o f in q u iry in to th e tre a tm e n t, e d u \ ' c a tio n a n d c are o f a u tis tic c h ild re n . G o v e rn m e n t P rin te r. P re to ria . G a rc ia , B. a n d S arvis, M . A . (1964). E v a lu a tio n a nd tre a tm e n t p la n n in g fo r a u tistic c h ild re n . A r c h . G en. P sy c h ia t., 10, 530. G o u w s, M . (1979). O n d e rw y s v ir o u tis tie se kinders. S.A . R a a d v a n G e e s te sw e te n sk a p lik e N a v o rsin g . P re to ria . H a rlo w , H . F . (1963). I n D e te rm in a n ts o f i n f a n t b e ­ h a v io u r. E d . F o s s, B. M . M e th u e n . L o n d o n . O rn itz , E . M . a n d R itv o , E. R . (1968). N e u ro p h y sio lo g ic m e c h a n ism s u n d e rly in g p e rc e p tu a l in c o n s ta n c y in a u tistic a n d sc h iz o p h re n ic c h ild re n . A rc h . G en. P sy ch ia t., 19, 22. R u tte r , M ., L eb o v ici, S., E is e n b e rg , L. et al. (1969). A tria x ia l classifica tio n o f m e n ta l d iso rd e rs in c h ild h o o d . A n in te rn a tio n a l study. J. C h ild P sy ch o l. P sy c h ia t., 10, 41. S a n d e r, L. (1964). A d a p tiv e re la tio n s h ip s in e a rly m o th e r- c h ild in te ra c tio n . J. A m e r. A c a d . C h ild P sy ch ia t., 3, 231, KEEPING IN TOUCH TH E NEED FOR COMMUNICATION IN PHYSIOTHERAPY P . B O W E R B A N K M .C .S .P ., B A , D ip T e r t E d f (U N IS A ) S U M M A R Y T h e n e e d f o r c o m m u n ic a tio n , a t a ll lev els, in p h y s io ­ th era p y, is stressed. C o m m u n ic a tio n is d e fin e d a n d ch a ra c te ristics o f th e c o m m u n ic a tio n m o d e l are g iven, viz. o p e n n ess, e m p a th y , s u p p o r t, p o sitiv e n e s s, e q u a lity, c o n te n t a n d rela tio n sh ip s. A r e a s o f c o m m u n ic a tio n su c h a s v e rb a l c o m m u n ic a tio n , liste n in g , n o n v e r b a l c o m m u n i­ c a tio n , to u c h , p r o x im ity , fa c ia l e xp ressio n a n d w ritte n c o m m u n ic a tio n are discussed. T h e title o f th is p a p e r ‘th e n e e d fo r c o m m u n ic a tio n in p h y s io th e r a p y ’ su g g e sts t h a t th e r e is a c e rta in lack * C h ie f P h y s io th e ra p is t, G r o o te S c h u u r H o s p ita l. P a p e r d e liv e re d a t S A S P C o n g re ss h e ld in P re to r ia M a rc h 1981. R e c e iv e d 29 M a rc h 1981. O P S O M M IN G D ie b e h o e fte aan k o m m u n ik a s ie , o p a lle v la k k e , in fis io te ra p ie , w o r d b e k le m to o n . K o m m u n ik a s ie w o r d ge- d e fin ie e r cn k e n m e r k e van die k o m m u n ik a s ie m o d e l w o r d gegee, nl. o p e n lik h e id , e m p a tie , o n d e rste u n in g , p o si- tiw iteit, g e ly k h e id , in h o u d e n v erh o u d in g s. A r e a s van k o m m u n ik a s ie so o s m o n d e lin g e k o m m u n ik a s ie , luister, n ie -m o n d e lin g e k o m m u n ik a s ie , aa n ra k in g , nabyheicl, g e - sig s u itd r u k k in g en g e sk re w e k o m m u n ik a s ie w o r d be- s p r e e k ., o f c o m m u n ic a tio n o r th a t th e c o m m u n ic a tio n p ro c e ss is n o t b e in g effe c tiv e ly c a rrie d o u t b y p h y s io th e ra p is ts . A s tu d y o f th e l ite r a tu r e su g g ests th a t th is s ta te m e n t m ig h t p o ss ib le b e tru e . F ro m a n a rtic le by J u d ith L o rb e r (1975) I q u o te : W h e n a p a tie n t e n te rs h o s p ita l, h e o r sh e is a n o u ts id e r in th e h e a lth p r o f e s s io n a l’s p la c e o f w ork. L ik e a n y o th e r w o rk e rs, d o c to rs , n u rse s (p h y sio 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. ) C O M M U N I C A T O R A JUNE 1981 — > M E S S A G E ----- P H Y S I O T H E R A P Y 41 C O M M U N IC A T O R B ---------- F E E D B A C K ---------- T H E C O M M U N I C A T I O N P R O C E S S F ig 1. th erapists) try to a rra n g e f o r th e ir w o rk to b e c o n ­ v e n ie n tly a n d e a s ily p e rfo rm e d . T h e id ea l s itu a tio n w o u ld be to h a v e th e p a tie n t ’s self go h o m e w h ile th e d a m a g e d p h y sic a l c o n ta in e r is le ft fo r re p a ir. T h e m e d ic a l staff c e rta in ly d o e s h a v e s u p e rio r k n o w le d g e a n d e x p e rtis e fo r th e ta s k o f tr e a t ­ m e n t a n d th e p a tie n t c a n n e v e r b e a tr u e e q u a l in th is a re a . N e v e rth e le s s , it h a s b e e n a rg u e d t h a t o v e r a n d a b o v e w h a t d e riv e s fro m p ro fe s s io n a l e x p e rtise , d o c to rs , n u rse s (a n d p h y s io th e r a p is ts ) d e lib e ra te ly lim it th e c o m m u n ic a tio n o f in fo rm a tio n to p a tie n ts . I n a d d itio n to sh ie ld in g th e m fro m c ritic ism of p a tie n ts , lim ite d c o m m u n ic a tio n p ro te c ts th e p ro fe s ­ sio n a l sta n c e o f d e ta c h m e n t a n d c o n c e rn . M e d ic a l c a re im poses o n th e p a tie n ts a ro le c h a ra c te ris e d b y su b ­ m ission to p ro fe s s io n a l a u th o r ity , e n fo rc e d c o -o p e ra ­ tio n a n d d e p e rs o n a lis e d s ta tu s . (Ita lic s a u th o r ’s a d d i­ tion.) R a th e r a h o rrify in g s itu a tio n b u t r e g re tta b ly so o fte n true. I w o uld lik e to su g g e st th a t p h y s io th e ra p is ts by th e n a tu re o f th e ir p ro fe s s io n a re o r ie n ta te d p rim a rily to w a rd s tr e a tm e n t o f p h y sic a l d isa b ilitie s a n d sim u l­ ta n e o u sly m u s t be c o n c e rn e d w ith th e n e e d to e sta b lish a n d m a in ta in a n e ffective re la tio n s h ip w ith th e p a tie n t. T o q u o te H e le n H is lo p (1975) w h o p a r a p h r a s e d L ew is C a rro ll: “ T h e tim e h a s c o m e , it m a y b e said to d re a m o f P .T .’s ro le o f life a n d lim b s a n d h e a rts a n d m in d s o f sc ien c es a n d g o a ls ” . I n o r d e r to k n o w h o w w e a re to se t a b o u t th o se (ream s it is n e c e ssa ry to u n d e rs ta n d w h a t th e w ord 'c o m m u n ic a tio n m ea n s. D E F IN IT IO N C o m m u n ic a tio n c o m e s fro m th e sa m e ro o ts as c o m ­ m u n ity a n d c o m m u n io n , a ll o f w h ic h re fe r to a n u m b e r of p e o p le h o ld in g s o m e th in g in c o m m o n , t h a t o f sh a rin g a n e x p e rie n c e . C o m m u n ic a tio n b e tw e e n p e o p le fo rm s o ne of m a n ’s m o st b a s ic n e e d s. H u m a n b e in g s a re social a n im a ls. P e o p le n e e d o th e r p e o p le . M o s t o f us n e ed o th e r p e o p le to ta lk to a n d h a v e th e m ta lk to us; we n e ed to sh o w a ffe c tio n a n d h a v e it r e tu r n e d , a n d we like to lik e o th e rs a n d h a v e th e m lik e us. C o m m u n ic a ­ tio n is a p ro c ess, i.e. it is s o m e th in g t h a t is c re a te d by m a n a n d d o e s n o t h a v e a b e g in n in g o r e n d . A ll th e in g re d ie n ts w ith in a p ro c e ss in te r a c t a n d a ll a ffect e ac h o th e r. C o m m u n ic a tio n c a n th e r e f o r e b e defin ed as: ® A p ro c e ss w h e re b y an in d iv id u a l sh a res h is ideas, op in io n s, v a lu e s a n d fe e lin g s w ith others. ® C o m m u n ic a tio n is th e p u r p o s e fu l e x p re ssio n a n d in te rp re ta tio n o f m essages. T h u s C O M M U N I C A T I O N = M e ssag e s, re c e p tio n an d in te rp re ta tio n . R E C E P T I O N A N D I N T E R P R E T A T I O N = L is te n ­ ing, lo o k in g a n d to u c h in g . C O M M U N IC A T IO N M O D E L L o o k in g a t th is in m o d e l fo rm s (F ig u re 1) it is o b ­ v io u s th a t c o m m u n ic a tio n is: ® D y n a m ic ® C irc u la r ® U n re p e titiv e ® Irre v e rs ib le ® C o m p le x C o m m u n ic a to r A is th e p e rs o n w h o in te n tio n a lly s ta rts to e x p re ss h e rs e lf a n d C o m m u n ic a to r B w o u ld be th e re c ip ie n t to w h o m th e e x p re ss io n is d iv e rte d . E x p re s s io n is th e in tr o d u c tio n o f a c e rta in m a tte r w h ic h is in te n tio n a lly p u rs u e d by th e c o m m u n ic a to r. I t is th e a c tio n o n th e p a r t o f th e c o m m u n ic a to r w h ic h n o t o n ly c o n ta in s h e r p u rp o s e o r a im , b u t a ls o h e r fe elin g s a n d a ttitu d e s to w a rd s so m e th in g . T h is m a y o f te n b e re fle cte d b y fe elin g s, in te n tio n s o r a ttitu d e s . T h e m essa g e re fe rs to t h a t w h ic h th e c o m m u n ic a to r w ishes to s h a re w ith th e re c ip ie n t. T h e c re d ib ility o f th e m essa g e is sa id to d e p e n d o n th e c o m m u n ic a to r ’s e x p e rtis e , h is in te n tio n a n d h is tru stw o rth in e ss . I t is p ro b a b ly tru e to sa y th a t m a n y o f o u r m essa g es a re m is u n d e rs to o d o r o n ly p a r tia lly u n d e rs to o d . T h e c o m m u n ic a to r m a y be a t f a u lt th ro u g h p o o r tim in g , a n i n a p p r o p r ia te se ttin g , o r th e w ay in w h ic h sh e d e liv e re d th e m essa g e, o r th e d ifficulty m a y be th a t th e m essa g e w as o v e rlo a d e d . A h ig h risk m e s sa g e w o u ld b e a n in ­ c o m p le te o r v e ry c o m p lic a te d o n e . C o n sid e r th is rh y m e : T h e c e n tip e d e w as h a p p y q u ite u n til a to a d in fu n said “ P r a y w h ic h leg g oes a f te r w h ic h ? ” th a t w o rk e d h e r m in d to su c h a p itc h s h e la y d is tra c te d in a d itc h c o n s id e rin g h o w to ru n . S o m a n y o f o u r m essa g es a re like this: C o m e on g ra n n y , m o v e y o u r le ft leg rig h t c ru tc h r ig h t leg le ft c ru tc h etc. I n t e rp e rs o n a l c o m m u n ic a tio n c a n v a ry fro m b e in g e x tre m e ly effe c tiv e to e x tre m e ly in effe ctiv e a n d d e p e n d s o n th e fo llo w in g : (F ig u re 2) IN T E R P E R S O N A L C O M M U N IC A T IO N O penn ess F o r effe c tiv e in te rp e rs o n a l c o m m u n ic a tio n to ta k e p la c e th e c o m m u n ic a to rs m u st: • Be w illin g to o p e n u p w ith th e p e rs o n w ith w h o m th e y a re in te ra c tin g . ® B e w illin g to c o m m u n ic a te h o n e stly . • A c k n o w le d g e th a t th e fe e lin g s a n d th o u g h ts a re 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. ) 42 F I S I O T E R A P I E JUNIE 1981 u n iq u e to e a c h p e rs o n a n d a c c e p t re s p o n s ib ility fo r th e m . F ig . 1. “ T o fe el w ith .” T h is c o u ld b e d e sc rib e d as th e a b ility o f o n e p e rs o n to k n o w w h a t a n o th e r is e x p e rie n c in g a t a n y g iven m o m e n t a n d to b e a b le to c o m m u n ic a te u n d e r s ta n d in g ^ . I t is n o t th e sa m e as s y m p a th y . I t is a t r a i t w h ic h is o f te n fo u n d to b e d e fic ie n t in h e a lth p ro fe s sio n a l. P u r tilo (1976) h a s d e c rib e d th e h o sp ita l e n v iro n m e n t as s tim u la tin g f e a r in th e p a tie n t, u p r o o t­ ing h im fro m h is d a ily p a tte rn a n d p la c in g h im in a d e p e n d a n t s ta te . T h e p h y s io th e r a p is t’s d a ily c o n ta c t w ith th e p a tie n ts in h e lp in g th e m to a d ju s t to th e ir n ew e n ­ v iro n m e n t re q u ir e s c o n s id e ra b le e m p a th y . I t is th e in n e r e x p e rie n c e o f s h a rin g a n d c o m p re h e n d in g th e m o m e n ­ ta r y p sy c h o lo g ic a l sta te o f a n o th e r. Support '■ S o m e p e o p le w h o b e c o m e ill o r in ju r e d n e ed m o re s u p p o r t th a n o th e rs , b u t a lm o s t all e x p e rie n c e so m e c o n fu s io n in th e fa c e o f d is ru p tio n a n d n e e d to b e r e ­ a ssu re d . G iv in g s u p p o r t a lso in fe rs a c e r ta in , s ta te of d e p e n d e n c y . T h is w ill b e e x h ib ite d by th e o u t p a t i e n t a s w ell as th e in -p a tie n t; b y th e p a tie n t w h o h a s a s h o rt a c u te illn e ss t h a t w ill lea d to c o m p le te re c o v e ry as w ell as by th e p e rm a n e n tly d isa b le d p a tie n t w h o n e ed s P ositiven ess T h e c o m m u n ic a to r m u s t show : • C e rta in p o s itiv e re g a rd f o r se lf w h ic h m u s t be c o n ­ v e y ed to p e o p le . • P o s itiv e fe e lin g s to w a rd s th e o th e r p e rs o n re g a rd le ss o f c o lo u r, c lass o r c ree d . • P o s itiv e fe e lin g fo r c o m m u n ic a tio n . E qu ality T h is is a p e c u lia r c h a ra c te ris tic . I n a ll s itu a tio n s th e r e is p ro b a b ly g o in g to b e so m e in e q u a lity o f sta tu s. H o w e v e r in te rm s of sp e a k in g a n d lis te n in g th e re m u s t b e a ta c it a rra n g e m e n t a n d re c o g n itio n th a t e a c h p a r ty ’s s h a re o f th e c o m m u n ic a tio n is e q u a lly v a lu a b le . W e te n d to d e v e lo p a c e r ta in s n o b b ish n e ss a b o u t c o m m u n ic a tio n . W e a ssu m e n o th in g c a n be g a in e d fro m su c h in te ra c tio n s a n d t h a t tim e c o u ld b e b e tte r s p e n t F ro m su c h c o m m u n ic a tio n s w e re a lis e th e y c a n in fa c t b e e n jo y a b le , p ro fita b le a n d g e n e ra lly re w a rd in g . E F F E C T IV E N E S S O F M E S S A G E T h e e ffe c tiv e n e s s o f th e m e s sa g e is g o in g to d e p e n d c o n sid e ra b ly on h o w th e re la tio n s h ip s d e v e lo p a n d o c c u r. A n y m essa g e c an b e a n a ly se d o n a t le a st tw o levels: C on ten t and R elation sh ip s T h e level o f c o n te n t c o n sists o f w h a t y o u w a n t to a c c o m p lish as y o u c o m m u n ic a te — th e w o rk ethic. T h e level o f r e la tio n sh ip c o n sists o f c lues in a m essa g e w h ich r e la te p rim a rily t o h o w c o m m u n ic a to rs feel a b o u t e ac h o th e r. R e la tio n s h ip s d e p e n d o n th e d e g re e o f c lo sen e ssrT tr u s t a n d in te rp e rs o n a l s h a rin g w h ic h occu rs. C a n J R o g e rs (H o o p e r, 1979) h a s c a lle d th is th e a c e ssib ility f u n c tio n o f a re la tio n s h ip a n d sta te s: “ A r e la tio n s h ip in w h ic h a t le a s t o n e o f th e p a rtie s h a s th e in te n t o f p r o ­ m o tin g g ro w th d e v e lo p m e n t, m a tu rity , im p ro v e d fu n c ­ tio n in g , im p ro v e d c o p in g w ith th e life o f o th e r s .” S u re ly th is is m u c h o f w h a t p h y s io th e ra p y is all a b o u t. R e la tio n s h ip s a lso d e p e n d o n h o w m u c h th e c o m m u n ic a to rs k n o w a b o u t e a c h o th e r, this c a n b e re p re s e n te d by th e J o h a ri w in d o w . (F ig u re 3). T h e J o h a ri w in d o w re p re s e n ts a to ta l p e rs o n re la tin g to a n o th e r p e rs o n o r p e rso n s. T h e 4 w in d o w p a n e s r e p re s e n t 4 k in d s o f in fo rm a tio n a b o u t th e p e rso n . W in d o w 1 re p re s e n ts th in g s th e p e rs o n k n o w s a b o u t h im s e lf a n d lets o th e rs k n o w o p e n ly . W in d o w 2 re p re se n ts in fo rm a tio n o th e rs c a n see b u t o f w h ic h th e p e rs o n is u n a w a re . W in d o w 3 re p re se n ts i n fo rm a tio n a b o u t h im s e lf o f w h ic h th e p e rs o n is a w a re b u t u n w illin g t o d isclose. W in d o w 4 re fe rs to item s w h ic h a re to ta lly u n k n o w n to b o th self a n d o th ers. T h e m o s t in te rp e rs o n a lly re w a rd in g ty p e o f in te r ­ a c tio n is th a t w h ic h e n la rg e s th e o p e n w in d o w (F ig u re 4). T h e J o h a r i w in d o w c a n b e u se d to in d ic a te a p e r s o n ’s g e n e ra l o p e n n e s s to o th e rs ; th is is c o lle c tiv e ly c a lle d se lf­ d isc lo s u re . S e lfd is c lo su re c a n b e p e rs o n a l a n d re w a r d ­ ing b u t it c a n a t th e s a m e tim e b e risk y . T h is ty p e af~ re la tio n s h ip b rin g s in th e n o n ju d g in g a s p e c t o f a p e r s o n ^ A R E A S O F C O M M U N IC A T IO N I w o u ld n o w like to b riefly disc u ss th e d iffe re n t a re a s o f c o m m u n ic a tio n w h ic h a re v ita lly im p o r ta n t to p h y s io ­ th e ra p is ts in th e i r w o rk w ith p a tie n ts o r s tu d e n ts o r a m o n g th em se lv es. T h e s e c a n b e c la ssified in to v e rb a l, n o n v e r b a l a n d w r itte n c o m m u n ic a tio n s . O n e s tu d y o f a d u lts b y D e rito (1980) fo u n d t h a t 7 0 % o f th e d a y w as s p e n t in th e fo llo w in g c o m m u n ic a tio n a c tiv itie s: lis te n in g 4 5 % ; ta lk ­ in g 3 2 % ; r e a d in g 1 2 % ; w ritin g 1 1 % . V erbal C om m u nication E v e ry p e rs o n in th e p ro c e ss o f liv in g d e v e lo p s a sty le o f c o m m u n ic a tio n u se d in e n c o u n te rs w ith o th e rs. W h e n p e o p le c o m m u n ic a te v e rb a lly m u c h o f th e m se lv e s is a lso b e in g c o m m u n ic a te d . B e sid es th e w o rd s h e uses th e p e rs o n a lity o f th e in d iv id u a l a n d h is e m o tio n s a re a lso in c lu d e d in v e rb a l c o m m u n ic a tio n . W ith in th e fra m e w o rk o f v e rb a l c o m m u n ic a tio n p h y s io th e ra p is ts a d v is e , c o n su lt, c o u n se l a n d te a c h . 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. ) T H E J O H A R I W IN D O W JUNE 1981 P H Y S I O T H E R A P Y 43 O P E N B L IN D 1 2 H I D D E N U N K N O W N 3 4 O P E N H I D D E N O P E N H I D D E N O P E N H I D D E N C L O S E D O P E N R E L A T I O N S H I P R E L A T I O N S H I P F ig . 4. F ig . 3. S u c c essfu l v e rb a l c o m m u n ic a tio n c h a lle n g e s a p h y s io ­ th e r a p is t’s e n e rg y , tim e , ta le n ts a n d in d iv id u a lity . W e c a n n o t b e laz y o r stin g y in o u r e ffo rts to c o m m u n ic a te ve rb ally . F o r a p h y s io th e ra p is t to be a b le to disc u ss issues in d e p th m e a n s t h a t sh e h a s so m e k n o w le d g e o f t h e p e rso n o r su b je c t a n d is w illin g to e x p lo re th e to p ic w ith a n o th e r a n d to lis te n to o th e r p o in ts o f view . T h e fo c u s o f th e c o n v e rs a tio n o r in te rv ie w is o n s h a rin g , e x c h a n g ­ ing a n d q u e s tio n in g . O n e o f th e th in g s G e o ff M a itla n d ta u g h t m e, a p a r t fro m m o b ilisin g te c h n iq u e s , w as th e im p o rta n c e of s ittin g d o w n w ith a p a tie n t a n d fin d in g o u t e x a c tly w h a t is th e p ro b le m b y ta lk in g a n d q u e s tio n ­ ing. Listening W e c a n n o t d isc u ss v e rb a l c o m m u n ic a tio n w ith o u t c o n sid e rin g lis te n in g . W e sp e n d a g r e a t d e al o f tim e isten in g , b u t m o s t p e o p le a re v e ry in efficie n t a t liste n - ng. T h is in c lu d e s f a ilu re to g ra p p le w ith difficult p re ­ se n ta tio n s, fa ilu r e to o rg a n is e th e th o u g h ts o f the sp e a k e r in th e lis te n e r ’s m in d a n d c lo s e -m in d e d r e je c ­ tio n of m essa g es b e fo re w e h e a r th e m o u t. L is te n in g is a skill re q u irin g a c tiv e p a rtic ip a tio n in th e e v e n t. C a rl R o g e rs (H o o p e r, 1979) h a s s ta te d : “ A c tiv e lis te n in g c a rrie s a s tro n g e le m e n t o f p e rs o n a l risk — w e risk b e in g c h a n g e d — w e risk c o m in g to see th e w o rld as h e sees it. I t is t h r e a te n in g to g iv e u p , e v e n m o m e n ­ ta rily , w h a t w e b e lie v e a n d s ta r t th in k in g in so m e o n e else te rm s .” C o n in e (1976) re p o rts th a t p h y s io th e ra p is ts s p e n t 4 5 % o f th e ir tim e in lis te n in g , w ith p ro b a b ly o n ly a 2 5 % efficiency. T h e s ta te o f f e a r a n d lo n e lin e s s e x p e rie n c e d by th e p a tie n ts in to d a y ’s m e d ic a l in s titu tio n o fte n goes by u n re lie v e d , a n d t h e p h y s io th e ra p is t m a y b e th e o n ly p ro fe s sio n a l w o rk e r w h o c a n le n d a n e a r w h ilst c a rry in g o u t h e r s h a re o f th e p a ti e n t ’s fra g m e n te d c are . In m a n y in sta n c e s th e p a tie n t is o n ly se e k in g a n a c c e p tin g a tt e n ­ tiv e p e rso n w h o w ill give h im a c h a n c e to ta lk a b o u t his fe e lin g s a n d a n x ie tie s. L is te n in g to a p a tie n t is o fte n a ll th a t is n e e d e d , sin c e o n c e re lie v e d , th e in d i­ v id u al c a n u su a lly go a h e a d a n d u se h is e n e rg ie s c o n stru c tiv e ly . N o n verb al C om m u nication J a n P e r r y (1975) s ta te s t h a t v e rb a l c o m m u n ic a tio n a c c o u n ts fo r o n ly 7 % o f c o m m u n ic a tio n o f fe elin g s b u t n o n v e rb a l c o m m u n ic a tio n a c c o u n ts fo r 9 3 % . N o n ­ v e rb a l c o m m u n ic a tio n is th e e x c h a n g e o f i n fo rm a tio n th ro u g h n o n lin g u is t signs. A sig n is a s tim u lu s w h ic h f o r so m e c o m m u n ic a to r “ s ta n d s f o r ” s o m e th in g else w h ilst m o s t o f us a re u se d to th in k in g o f c o m m u n ic a tin g in w o rd s — n o n v e rb a l c o m m u n ic a tio n c o n te n t o fte n c a n n o t b e tra n s la te d in to w o rd s e.g. a sh ru g o f th e s h o u ld e r. W h ilst re v ie w in g lite r a tu r e o n n o n v e rb a l c o m m u n i­ c a tio n I c a m e a c ro ss tw o m a g n ific e n t a rtic le s o n its u se d u rin g p h y s io th e ra p y tre a tm e n ts . T h e y a re by J a n P e rry a n d R u t h P u rtilo . I h a v e b a se d m u c h o f th e n e x t p a r t o f m y p a p e r o n th e s e a rticle s. T ou ch T o u c h is p e rh a p s th e m o s t p rim itiv e f o r m o f c o m ­ m u n ic a tio n . I n te rm s o f se n se d e v e lo p m e n t it is p r o ­ b a b ly th e first to b e u tilise d . S o o n a f te r b i r th th e c h ild is f o n d le d , c a re sse d , p a tte d a n d s tro k e d b y p a re n ts a n d frie n d s . T o u c h b e c o m e s fo r th e c h ild a p le a s a n t p a s tim e a n d so h e o r she b e g in s to to u c h h im s e lf, h is m o th e r a n d o b je c ts. B ra in in ju re d c h ild re n will o f te n c u d d le a d o ll b e fo re p e rfo rm in g o th e r a c tiv itie s. T h e v e ry p o w e rfu l ro le o f to u c h as a f o r m of c o m ­ m u n ic a tio n in se x u a l a c tiv ity is o b v io u s. I t a lso play s a p rim a ry ro le in c o n so lin g a n o th e r in d iv id u a l — we w ill p u t o u r a rm s a ro u n d to c o m fo rt, o r w e will h o ld th e h a n d s o f a n e ld e rly o r a g ita te d p a tie n t. F o r th e p h y s io th e ra p is t to u c h offers a s tro n g a n d p o te n t fo rm o f n o n v e rb a l c o m m u n ic a tio n . In th e p h y s io th e r a p is t/p a tie n t r e la tio n s h ip to u c h is n o t o nly a llo w e d , it is e sse n tia l in tr e a tm e n t. T h e to u c h d u rin g tr e a tm e n t c a n te ll th e p a tie n t m u c h o f w h a t th e th e r a ­ p is t’s fe e lin g s a re , w h e th e r th e y b e e n c o u ra g in g , ge n tle , u n su re , h u r r ie d o r u n c a rin g . H o w e v e r, a w o rd o f w a r n ­ ing to th e n e rv o u s p h y s io th e ra p is t w ith c o ld c la m m y h a n d s ; th e y m a y n o t b e as re a s s u rin g as y ou m ay im ag in e! J a n P e r r y (1975) c a rrie d o u t a s tu d y o n p h y sio ­ th e ra p is ts w h ilst th e y w e re tr e a tin g p a tie n ts to d isc o v e r th e c o n te n t o f th e ir n o n v e rb a l c o m m u n ic a tio n a n d 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. ) 44 fo u n d th a t to u c h in g th e p a tie n t w as th e se c o n d m o st c o m m o n ly u se d a f te r fa c ia l e x p re ss io n . B y to u c h in g (lie p a tie n t th e p h y s io th e r a p is t c o m m u n ic a te s a c c e p ta n c e e.g. to u c h in g th e stu m p o f a n a m p u ta te d leg d e m o n ­ s tra te s th a t th e d e fo rm ity is a c c e p ta b le to h e r; to u c h in g th e p a tie n t w ith se v e re skin d ise ase o r b u rn s d e m o n ­ s tra te s t h a t th e p a tie n t is n o t re p u ls iv e a n d a n o u tc a st. W e u se o u r h a n d s as p ro fe s sio n a l to o ls to sta b ilise , to s tim u la te a n d a t th e s a m e tim e to re a s s u re a n d to c o m ­ fo rt. In a n o n to u c h in g so c ie ty to u c h in g as a f o r m of a c c e p ta n c e a n d s u p p o rt is a p riv ile g e g iv en to p h y s io ­ th e ra p is ts. P roxim ity A n o th e r u n iq u e a sp e c t o f th e p h y s io th e r a p is t/p a tie n t re la tio n s h ip is t h e p ro x im ity o r in tim a c y o f th e t r e a t ­ m e n t se ttin g . S o c iety , o r a t le a st t h a t o f th e w h ite p o p u la tio n , d o e s n o t a c c e p t c lose p h y sic a l e n c o u n te rs e x c e p t b e tw e e n e m o tio n a lly close p e rso n s. In th e tre a t­ m e n t se ttin g , p h y sic al c lo sen e ss ev en to th e p o in t of to u c h in g c a n n o t b e a v o id e d . J a n P e rry (1975) s ta te d : “ T h e m e s sa g e p o te n tia l of c lo sen e ss d u rin g tre a tm e n t c e rta in ly s h o u ld n o t b e used c are le ssly ; e v en m o re e m p h a tic a lly , it sh o u ld n o t be ig n o re d o r go u n re c o g n is e d by th e p h y s io th e ra p is t. T h e in fo rm a tio n a v a ila b le to th e p a tie n t a t th is d is ta n c e is so v iv id a n d c o u ld b e so b e n eficia l, t h a t th e th e ra p is t w o uld a p p e a r to b e d o in g an in ju s tic e to th e p a tie n t if s h e is u n a w a re o f th e sig n ific a n ce o f th e p h y sic al c lo s e ­ ness d u rin g t r e a tm e n t a n d fa ils to use th is m essage system e ffe c tiv e ly .” F acial E xpression T h e fa c e is th e p rim a ry c o m m u n ic a to r o f e m o tio n sta tu s . In th e stu d y c a rrie d o u t b y J a n P e rry (1975) fa c ia l e x p re ss io n s a n d m o re sp ecifically e y e c o n ta c t and sm ilin g m a d e u p 4 0 % o f th e n o n v e rb a l c o m m u n ic a ­ tio n b e tw e e n p a tie n t a n d p h y s io th e ra p is t a n d w as seen to e sta b lish r a p p o rt a n d e n c o u ra g e m e n t. T h e p h y s io ­ th e r a p is t m a y c o n v e y by h e r sm ile th a t she is frie n d ly a n d well d isp o se d to w a rd s th e p a tie n t a n d h e r eyes m ay c o m m a n d tru s t a n d c o n fid e n ce . A v o id in g a n o th e r ’s g la n c e a n d a v e rtin g y o u r g aze m a k e s fo r p o o r in te r ­ a c tio n a n d c o m m u n ic a tio n . W ritten C om m u n ication P e rh a p s th is is a n a re a o f c o m m u n ic a tio n w h e re p h y ­ s io th e ra p is ts a re a t th e ir a b s o lu te w orst. T h e p ro fessio n al C o m m u n ic a tio n U n it a t th e U n iv e rs ity o f C a p e T ow n in c o lla b o ra tio n w ith th e S c h o o l of S ocial W o rk have th is to say a b o u t w ritte n c o m m u n ic a tio n : “ P ro fe ssio n a l c o m m u n ic a tio n d e m a n d s th a t y o u r p u rp o s e sh o u ld b e c le a rly defin ed if y ou wish to c o m m u n ic a te effectively. I t is e sse n tia l to d e te rm in e w h a t re sp o n se y o u w ant fro m y o u r re a d e r. D o y o u w a n t h im to u n d e rs ta n d a n d a c c e p t new in fo rm a tio n ? D o you w a n t h im to c h a n g e h is v ie w p o in t to y o u rs a n d d o s o m e th in g as a re su lt? D o y o u w a n t to c o n v e y to h im o r h e r w hat y o u h a v e b e en e x p e rie n c in g ? ” O n e a sp e c t o f m e d ic a l re c o rd s I w o u ld lik e to m e n ­ tio n is th a t fro m th e legal p o in t o f view , m ed ical re c o rd s m u s t b e a c c u ra te a n d o b je c tiv e , as it is possible th a t y o u r re c o rd s m ig h t be u sed as e v id e n c e in a c o u rt case. T h is is a lre a d y h a p p e n in g in N o r th A m e ric a . C O N C L U S IO N D iffe re n t fa c e ts o f c o m m u n ic a tio n a re b e in g usedf d a ily b y p h y s io th e ra p is ts . M o re tim e s h o u ld b e s p e n t irf s tu d y in g c o m m u n ic a tio n f o r o u r p a tie n ts a n d ourselves. F in a lly I w o u ld lik e to finish w ith th is q u o ta tio n : O n e c a n n o t n o t c o m m u n ic a te A c tiv ity o r in a c tiv ity w o rd s o r silen c e A ll h a v e a m essage v alue. (H o o p e r, 1979) R E F E R E N C E S C o n in e , T . A . (1976). L iste n in g in th e h e lp in g re la tio n ­ sh ip . P hys. T h e r., 56, 1 5 9 - 162. D e rito , J. A . (1980). T h e in te rp e rs o n a l c o m m u n ica tio n b o o k . H a r p e r & R o w . N ew Y o rk . H is lo p H . (1975). T h e n o t-so -im p o s sib le d re a m . Pliys. T h e r., 55, 1 0 6 9 - 1080. H o o p e r , R. (1979). T h e h u m a n m essage system s. H a rp e r & R o w . N e w Y o rk . L o rb e r, J. (1975). G o o d p a tie n ts & p ro b le m p atients: c o n fo rm ity & d e v ia n c e in a g e n era l h o sp ita l. J. of H e a lth & S o c ia l B e h a v io u r , 16, 213 -2 2 5 . P e rry , J. F . (1975). N o n v e rb a l c o m m u n ic a tio n during p h y sic a l th e ra p y , P h ys. T h e r., 55, 5 9 3 - 6 0 0 . P u r tilo , R . B. (1976): S im ila ritie s in p a tie n t re sp o n se to c h ro n ic & te rm in a l illness. P hys. T h e r., 56, 279 -284. P u rtilo , R. B. (1978): H e a lth p r o f e s s i o n a l/p a ti e n t in ter^ a c tio n . S a n d e rs, U S A . JUNIE 1981F I S I O T E R A P I E A REAPPRAISAL OF EVALUATION OF FINAL YEAR STUDENT PERFORM ANCE’ J E N N I F E R M . H I L L B .SC . (P H Y S IO ) (S T E L L .) D .T .E . ( U N I S A ) t S U M M A R Y T h e a u th o r ta k e s a lo o k a t e v a lu a tio n o f the p h y s i o ­ th era p y s tu d e n t. S h e d isc u sse s the c riteria necessary f o r e v a lu a tio n a n d g iv e s so m e su g g e stio n s as to m e th o d s w h ich c an be used. * T h is p a p e r is a m o d ific a tio n o f an a ssig n m e n t as p a rt o f th e D .T .E . (U N IS A ) c o u rse, t W as J u n i o r L e c tu re r, U n iv e rs ity o f S te lle n b o sc h and T y g e rb e rg H o s p ita l. N o w D ir e c to r O x f o r d R e h a b ilita ­ tio n P ro je c t, Z im b a b w e . R e c e iv e d 5 M a rc h 1980. O P S O M M IN G D ie s k r y w e r gee 'n oorsig van die e v a ln e r in g van die fis io te r a p ie s tu d e n t. S y b e sp re e k d ie k rite ria w at nodig is v ir evaliteriitg en ste l m e to d e s w a t g e b r u ik k a n word, voor. A s a c lin ica l th e ra p is t in a te a c h in g h o sp ita l o r as a m e m b e r o f th e te a c h in g staff, th e p h y s io th e ra p is t is re g u la rly c a lle d u pon to assess th e c o m p e te n c y o f u n d e r­ g ra d u a te stu d e n ts . T h is is a n ‘a w e so m e ta s k ’ (Davis (1979). T h e a v e ra g e th e r a p is t h a s little b a c k g ro u n d in th e th e o ry a n d m e th o d s o f s tu d e n t e v a lu a tio n . F o rs te r a n d G a lle y (1978) h a v e p re s e n te d a u se fu l a p p ro a c h 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. )