Nature of the Work:
Physical therapists work to improve the mobility, relieve the pain, and prevent or limit the permanent disability of patients suffering from injuries or disease. Their patients include accident victims or handicapped individuals with such conditions as multiple sclerosis, cerebral palsy, nerve injuries, amputations, head injuries, fractures, low back pain, arthritis, and heart disease. Patients range in age from the newborn to the elderly.
Some physical therapists treat a wide variety of problems; others specialize in such areas as pediatrics, orthopedics, sports physical therapy, neurology, and cardiopulmonary physical therapy.
As the first steps in treatment, therapists assess the patient's personal background and medical history and gain the patient's trust and confidence. It is at this time that therapists need to be supportive, because patients at the outset of treatment, particularly those who are newly disabled, are likely to be experiencing emotional and physical stress.
Next, the physical therapist evaluates the patient by performing tests and taking measurements that determine a patient's strengths, weaknesses, and ability to function. Each evaluation, and the time required to conduct one, depends upon the nature of the injury or impairment. For instance, football players with knee injuries usually require considerably less time than automobile accident victims with broken bones and head in-juries.
After reviewing the patient's medical history and completing the evaluation, the physical therapist decides whether to refer the patient to another practitioner or to treat the patient. If the decision is to treat the patient, the therapist develops a treatment plan. Treatment plans, include the treatments to be provided, each treatment's purpose, and their anticipated outcomes and goals. The goals include helping patients attain maximum functional independence, improved muscle strength, and physical skills while helping them adapt to what may be permanent changes in their physical abilities.
The plan of treatment may include exercise for patients who suffer from a lack of flexibility that often results from being immobilized for long periods of time. The physical therapist may first use a tilt table to help the patient who has been bedridden readjust to a vertical position. Using a technique known as passive exercise, the therapist increases the patient's range of motion by stretching and manipulating stiff joints according to the patient's tolerance. Physical therapists also use heat, electricity, or ultrasound to relieve pain or improve the condition of muscles or related tissues. Cold and water may be used in other treatments, including the reduction of swelling and the treatment of burns.
Other therapeutic techniques are designed to improve strength, endurance, and coordination. These include the use of weights to strengthen muscles or gymnastic exercises to improve balance and coordination. Therapists also teach physically impaired patients how to use assistive devices in order to perform day-to-day activities and instruct them in therapies to do at home.
Physical therapists continually observe and assess their patients as treatment progresses. These observations, along with periodic evaluations, help the therapist to decide whether to continue, modify, or end a course of treatment
Physical therapists maintain documentation of initial evaluations, daily progress, medical team conferences, and reports to physicians and insurance companies. Documentation is used to track the patient's progress, to identify areas requiring more or less attention, and to justify billings. Records are also kept for legal purposes; physical therapists are legally responsible for their actions whenever they evaluate a patient, plan a physical therapy program, and carry it out.
Working Conditions:
The working environment of physical therapists varies from specially equipped facilities in hospitals or clinics to schools, private offices, and private homes where furniture may need to be moved to provide room for treatment. Thus, a physical therapist must be adaptable.
Evening and weekend hours may be required, especially for those in private practice or home care, who must be available at times convenient for their patients. The job can be physically demanding because therapists often have to stoop, kneel, crouch, and stand for long periods of time. In addition, therapists must move equipment and lift patients or help them turn, stand, or walk. Physical therapy can be emotionally demanding, and frustration can result from seeing little or no improvement in their patients over time.
Employment:
Hospitals were the largest employer of physical therapists, providing 2 out of 5 salaried jobs. Many other jobs were in private clinics, physicians' offices, home health agencies, nursing homes, and outpatient care facilities. Therapists also worked in residential facilities for handicapped children, school systems, and health maintenance organizations. About 1 physical therapist in 10 was in private practice. Some private practitioners provided physical therapy services on a contract or consultant basis to hospitals, rehabilitation centers, nursing homes, home health agencies, adult day care programs, and public schools. Other physical therapists taught in academic institutions and conducted clinical and basic research.
Training, Other Qualifications, and Advancement:
In order to practice physical therapy, all States require that applicants have a degree or certificate from an accredited physical therapy educational program and pass a licensure examination.
Two types of programs provide educational preparation for entry into physical therapy: Baccalaureate degree programs and entry level master's degree programs. While a bachelor's degree is the minimum educational requirement for entry into the profession, some experts feel an expanded curriculum has become necessary to teach the rapidly growing body of knowledge. As a result, most schools are changing their baccalaureate program to a master's degree level.
The physical therapy curriculum includes basic science courses such as anatomy, physiology, neuroanatomy, and neurophysiology; it also includes specialized courses such as biomechanics, human growth and development, manifestations of disease and trauma, evaluation and assessment techniques, and therapeutic procedures. Besides classroom and laboratory instruction, students receive supervised clinical experience in hospitals and other clinical environments.
Competition for entry to physical therapy programs is keen. Consequently, students interested in becoming physical therapists must attain superior grades in high school and college, especially in science courses. High school and college courses useful when applying to physical therapy programs include health, biology, chemistry, social science, mathematics, and physics. Individuals who want to know more about physical therapy before making a commitment are advised to volunteer for summer or part-time work in the physical therapy department of a hospital or clinic. Indeed, such experience is required for admission to most education programs.
Physical therapists need such personal traits as patience, tact, persuasiveness, resourcefulness, and emotional stability to help patients and their families understand the treatments and adjust to their handicaps. Physical therapists should also have manual dexterity and physical stamina.
Physical therapists should expect to continue to develop professionally by participating in continuing education courses, workshops, and symposia from time to time throughout their careers. A number of States require continuing education for maintaining licensure.
Whether in solo practice, group practice, or associated with a consulting group, private practitioners commonly treat patients referred to them by physicians. In turn, when faced with a condition beyond their scope of practice, physical therapists refer patients to the appropriate practitioner.
Job Outlook:
Employment of physical therapists is expected to grow much faster than the average for all occupations in response to the rapidly growing need for rehabilitation and long-term care services. Advances in rehabilitation and therapeutic techniques are likely to create more employment, as will the expansion of physical therapy's role from primarily rehabilitation to health maintenance and disease prevention as well. Other openings will result from replacement needs.
Many new positions for physical therapists will result from advances in medical science and technology which permit more disabling conditions to be treated, thereby increasing the need for rehabilitative services. For example, the technology which made arthritic hip and knee replacements possible has created extra demand for rehabilitative services. In addition, the quantity of services is projected to increase as the number of people requiring rehabilitation grows. Among these will be the rapidly growing elderly population, subject to such disabling conditions as heart attack and stroke.
As the baby-boom generation ages and the risk of heart disease and stroke increases, the need for cardiac rehabilitation programs is expected to rise. More young individuals will also need physical therapy. Advances in medicine now save lives that a few years ago would have been lost Children with severe birth defects, for example, and car accident victims, a disproportionate number of whom are teenagers and young adults. Future biomedical developments will permit even more trauma victims to survive, creating a need for more rehabilitative care.
The growth of sports medicine and widespread interest in health promotion should also spur demand for physical therapy services. As more people exercise, the number of injuries requiring physical therapy treatment should also grow. On the other hand, the growing number of industrial health programs will use physical therapists to evaluate worksites, develop exercise programs, and teach safe work habits in the hope of reducing injuries.
The increasing willingness of insurance companies to pay for services provided by a physical therapist will contribute to very rapid growth in the number of physical therapists in private practice. More contracting by hospitals, nursing homes, and home health agencies should also spur growth of private practitioners.
Home health is an increasingly important area of practice, not only because hospitals discharge people more quickly, but be-cause of disabilities among older persons who are physically unable to travel to a health care facility for services. There have been shortages of physical therapists in recent years. This situation should ease somewhat as the number of graduates of physical therapy programs continues to expand - particularly those from entry level master's degree programs.
Related Occupations:
Physical therapists treat and rehabilitate persons with physical or mental disabilities or disorders. They may use general or specialized exercises, massage, heat, water, electricity, and various therapeutic devices to help their patients gain independence. Others who work in the rehabilitation field include occupational therapists, speech pathologists and audiologists, ortholists, prosthetics, respiratory therapists, chiropractors, and athletic trainers.
