Physical Therapy History and Purpose

Physical therapy is the treatment of an injury, disease, or deformity that is done by with exercise, massage, or with application of heat. This form of medicine began 1000 BC when Taoist priests from China wrote about therapeutic exercises called Cong Fu that were able to relieve pain and other symptoms. Later in 400 BC a philosopher and the first physician in his time, named Hippocrates, otherwise known as “the father of medicine” started to recommend therapeutic exercise to his patients because he understood how the muscles, ligaments, and bone wasting worked if they were not being used.

He was also the first to use electrical stimulation by applying a torpedo fish to his patients for headaches. During this time Aristotle, a Greek philosopher, recommended using water and oil for massage to relieve tiredness. Then around 180 BC a form of therapeutic exercise was developed by ancient Romans called gymnastics.

By the 1400s therapeutic exercises were first introduced into physical education courses in Europe.

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By the 1500s the first book of exercise book was written by Christobal Mendez of Jaen, called Libro del Exercicio. In the 1700s therapy that originated in England, such as: massage therapy, hydrotherapy, and exercise were introduced in America. Nicolas Andry was then the first scientist to relate the musculoskeletal system to exercise in 1723.

In the 1800s a Swedish man named Per Henrik Ling came up with what was know as and is still known as today as Swedish massage, which was an exercise that involved gymnastics movement. Later in 1860 a physician named George H.

Taylor who was a physician from America introduced Ling’s Swedish massage to America, and electrical stimulation was also introduced at this time to the USA, originating in Europe and having been used in other countries already. In 1864, Gustav Zander, a physician from Sweden invented exercise machines that could be used on people to assist them, but also add resistance to the exercise the patient was performing. In the 1890s, Nikola Tesla, introduced the diathermy as an electrotherapeutic modality, but it was not till the 1900s that it was proved to have deep heating for the joints and circulatory system.

In the 1800s, there was also a man named H.S. Frenkel from Switzerland, who was able to improve unstable results in gait from nerve cell destruction. He had done a numerous amount of attempts to try and figure out what would work best with supervised ambulation. He chose not to work with equipment but instead chose to mark the floor in a way that would help know placement of feet and lead the patient for success in that way. Still till this day do we use Frenkel’s exercise. In the 1950s is when Herman Kabat discovered the stretch reflex, flexion reflex, and tonic neck reflex that helped with neurological issues and were named “proprioceptive facilitation.” Later in 1968, two women by the names of Margaret Knott and Dorothy Voss, discovered a form of physical therapy intervention for anyone with paralysis, stroke, cerebral palsy, or other neurological disorders. This new neurological exercise ended up expanding the proprioceptive neuromuscular facilitation (PNF).

In 1916 Robert Lovett, a professor from Harvard of orthopedic surgery, found that muscle training exercises were the best possible treatment for people with polio. In 1926, Lovetts assistant Wilhelmine G. Wright came up with a ambulation technique using crutches for patients who had paralysis or paraplegia caused by polio, and introduced manual muscle testing. She believed in using muscles that were stronger than others that were affected by polio. She then went on and wrote a book in 1928 called, Muscle Function, describing a systematic method of muscle testing using external manual resistance, gravity, palpation, and the arc of active movement. Sometime between the years of 1917 and 1950s, physical therapist and rehab clinicians, such as: Florence Kendall, Signe Brunnstrom, Marjorie Dennen, and Catherine Worthingham, made the changes to Wrights muscle testing and should take into consideration that it should also involve the patient/clients fatigue, position of their body, and incoordination.

Charles Leroy Lowman came up with a development to help fight the paralysis effects of polio called hydro-gymnastics. He started by turning a lily pond into two treatment pools for the treatment of spasticity and paralysis caused by polio. In the 1920s, Carl Hubbard created the first Hubbard tank, which is a metal tank, and was installed in a hospital for hydro-gymnastics. President Franklin D. Roosevelt then created an institute in the late 1920s known as the Georgia Warm Springs Foundation. The significance of this was that Roosevelt had also developed polio during this time. In 1924, Leo Buerger and Arthur W. Allen created the exercise known as the Buerger-Allen exercise for insufficient blood to the legs through the arteries.

In 1934, Ernest A. Codman, introduced shoulder exercises and in 1953, Paul C. Williams developed a sequence of postural exercises for back pain that would help strengthen the spine flexors and extensors called Williams exercises. These exercises helped to relieve back pain from bad posture and habits just like Joel E Goldthwait’s discovery of bone abnormalities and dysfunctions of the spines curvature. After the 1950s, therapeutic exercise became huge and advanced. By 1967, the Cybex I Dynamometer was created by Helen Hislop and James Perrine’s to help people work physically within their parameters through work, power, and endurance. Then in the 1950s through 1960s back extension exercises that relieved pressure to the spinal disk were further developed by Robin McKenzie’s by doing the swiss ball exercise. These exercises were developed in Switzerland and were brought to America in the 1970s.

In the early 1900s is when physical therapy started developing and growing more because of World War I (WWI) and the polio outbreak in New York in 1916. Many people believed that disability was irreversible and Reconstruction aids were created to help disabled soldiers from the war. During this time the only treatment was splinting, isolation, and casting but in all reality this only made the patients muscle weak therefore causing the patient to need to exercise and have physical therapy done. In august 1917 the Surgeon General of the US authorized for the Division of Special Hospitals and Physical Reconstruction to help soldiers from the war get therapy by reconstruction aids. There were two types of reconstruction aids at this time which one was to help the doctor which would be todays physical therapist who provide exercise programs, massage, and hydrotherapy. Then there was the other type of reconstruction aid who are known as todays occupational therapist that helped the soldiers get back to their activities of daily living and be able to return to work. The reconstruction aids at this time were all unmarried women 25 years of age to 40 years of age. This division had a dozen small facilities located in Europe and hospitals set up all over America. They contained whirlpools, gyms, massage rooms, mechanotherapy rooms, and pack rooms.

The first reconstruction aides who played a major role in the physical therapy profession was Marguerite Sanderson and Mary McMillan. Dr. Joel Goldthwait appointed the position of Chairman to the War Reconstruction Committee of the American Orthopedic Association to help recruit reconstruction aids, where the training program took place in Walter Reed General Hospital. Being that Sanderson withdrew from her position after getting married she passed it down to Mary McMilllan. In 1910 McMillan took her first professional position in Liverpool, England, but later in 1916 returned home to America and was offered a position in 1918 to be sworn into the US Army and so she did. She was sworn in as a medical corps and then later because of her experience with physical therapy she was asked to go to Oregon to train reconstruction aids at Walter Reed General Hospital in Maryland. By 1919 and 1920 reconstruction aids were reduced because there was a large decline in hospitals postwar. The number of hospitals went from 748 to 49. McMillan then resigned and moved on to a normal civilian life, but before resigning she contacted about 800 reconstruction aids, and 30 of them got together and formed the American Womens Physical Therapeutics Association (AWPTA) on January 15, 1921.

The first publication of the AWPTA was called the P.T. Review which contained the constitution and bylaws of the Association. The Association had three categories which were charter members, also know as the reconstruction aids, the active members who were students that just graduated from a physio therapy program, and honorary members, who were students who graduated from medical school. Later in 1922 they changed there name to American Physiotherapy Association to show that they did recognize men for their hard work as physiotherapy during WWI as well.

In the 1930s the APTA was thrown a curve ball. Poliomyelitis was spreading quickly and there were 2500 cases at the Los Angeles County General Hospital in just under a year. To make things worse the Great Depression in 1929 caused a lot of hospitals to shut down reducing the amount of physical therapist services. But by 1937 the National Foundation for Infantile Paralysis was founded, allowing physical therapist who had no work to choose a position in hospital, clinic, outpatient center, schools, or homes.

During WWII the APTA continued to grow under the supervision of Catherine Worthingham. The APTA changed a lot because it growth. Then the first War Emergency Training Course of WWII began at Walter Reed General Hospital, which was directed by Emma Vogel. Anyone who graduated from this training was no know as a physiotherapy aid, but then in 1934 was changed to physical therapist. By 1946- 1950 physical therapy became more popular because of the passing of the Hill-Burton Act and the Korean War.

In 1944 the APTA decided to create what we know as today as the House of Delegates, which has the right to amend or repeal bylaws of the Association, and in 1946 they changed the associations name to American Physical Therapy Association. In 1952 there were several thousand polio cases arising and called for help from physical therapist, and by 1955 clinical trial inoculations or vaccinations were discovered by Jonas Salk with the help of physical therapist and were able to treat 650,000 children. Jessie Wright a PT, MD, was a PT that helped Salk and introduced the muscle grading system that made the patients relax their muscles in order to be able to get the whole range of motion (ROM). Then a little later in 1964 the APTAs journal P.T. Review was changed to Physical Therapy.

In the 1960s our population was growing with elderly people and people that wanted to improve their health causing high demand for physical therapy services. While that was going on the enactment of Medicare and Medicaid also was founded in 1965 and 1966 causing even more physical therapist to be needed. The House of Delegates then decided to create a education program for physical therapy assistants. In 1969 Miami Dade College and College of St. Catherine was where the first 15 PTAs graduated from with an associates degree, and in 1983 the PTAs formed the Affiliate Special Interest Group. By 1989 the House of Delegates made it official that the PTAs had a formal voice in the Association. The first president of the PTAs special interest group was Cheryl Carpenter-Davis, PTA, Med.

During the 1970s and 1980s physical therapy still continued to grow. Occupational Safety an Health Administration (OSHA) and the Individuals with Disabilities ACT (IDEA) helped with the growth of physical therapy as well because now physical therapy was needed for prevention, work management, and job injuries and compensation and the treatment of children with disabilities in school. In 1981 and 1982 the House of Delegated adopted the policy that physical therapy practice that was independent from a referral from a doctor was ethical. In the 1970s the APTA created sections such as: sports physical therapy, pediatrics,orthopedics, etc. and by 1977 the Commission on Accredation in Physical Therapy Education (CAPTE) became the accrediting agency for any educational program in the US, Canada, and Europe. In 1978 the American Board of Physical Therapy Specialties was founded by the APTA. This allowed any members of the APTA to get certified in a special area of their choice, and it wasn’t till 1970-1985 that other specialty areas were created, such as: geriatrics and the cardiopulmonary certification. By 1983 the first ever building purchased by the APTA in Alexandria Virginia, and by 1990 the Americans with Disabilities Act was able to assure in the assistance of physical therapy to everyone.

In 1997 President Clinton signed the Balanced Budget Act suspending Medicare, causing it to be hard for recent graduates from PT and PTA programs to find a job, and not only that but caused a decrease in income for PTs and PTAs that at that time were employed, and led to an unemployment rate of 6.5%. On December 31, 2005 the moratorium was lifted. On January 1, 2010 President Obama signed the Patient Protection and Affordable Care Act, making it a law not to put caps on physical therapy. By 2003 the Association made it legal to allow licensed physical therapist to evaluate and treat patients without a physicians referral.

In 2013 the APTAs new vision was “Transforming society by optimizing movement to improve the human experience.” Which meant that all people would have access to physical therapy services and that PTs and PTAs would have evidenced based interventions that would help improve the quality of life for all people. This vision included guiding principles, such as: Identity, Quality, Collaboration, Innovation, Consumer-centricity, Access/Equity, and Advocacy, which means what they do is always going to be in the best interest of society and their patients. By 2014, all 50 states and the District of Columbia passed a legislation that allowed physical therapist to evaluate and treat anyone that wanted or needed physical therapy done with a doctors referral, which is called direct access. In 2005 the National Assembly of Physical Therapist Assistants was eliminated and formed was what is now known as the Physical Therapist Assistant Caucus. The main purpose of the caucus was to voice the PTAs opinions, interest, and needs to the APTA more loudly. Now as of 2013 the APTA has a majority of females coming in at 79%.

The mission of the American Physical Therapy Association (APTA) is to promote physical therapy and to help improve peoples lives. To better enable physical therapists practice on their patients/clients, to help demonstrate high standards of professionalism and intellectual excellence, to help those that live sedentary lifestyles, and to ensure successful existence in society.

Texas Board of Physical Therapy Examiners (TBPTE) can provide physical therapy in Texas. They license the PTA and only allow them to work under the supervision of a physical therapist.

The PTA program entails learning how to do an intervention, gather data, and assess the clients/safety in an ethical, safe, and legal way. They need to graduate in an entry-level program with at least an associates degree, that is coming from an accredited school. While a PT contributes to society by practice, teaching, administration, and discovery and to apply new knowledge and breadth to allow the acquisition and application of knowledge and skills in physical therapy.

References

1. http://www.apta.org/AboutUs/WhoWeAre/http://www.apta.org/Mission/https://www.ptot.texas.gov/page/physicaltherapyhttps://www.tpta.org/http://www.apta.org/PTAEducation/Overview/http://www.apta.org/PTEducation/Overview/http://www.capteonline.org/AggregateProgramData/