Introduction

This book is designed to introduce a conceptual framework about the art of physical therapy and to give the entry-level physical therapy student a broad foundation to support their journey as they begin the in-depth study of a typical physical therapy curriculum. Included in this conceptual framework are a historical perspective on the physical therapy profession, an introduction to healthcare policy, and a definition of evidence-informed practice. In addition, various chapters describe how movement evolves, how that movement becomes skilled, and how movement dysfunction can occur or develop. Finally, the later chapters introduce the reader to the knowledge and practical skills that are necessary for the general practice of physical therapy as well as providing a foundation for the development of specific areas of clinical expertise, including how to enhance a patient’s function in such tasks as bed mobility, transfers, and gait training.

Chapter 1 provides a historical perspective to the physical therapy profession.

Chapter 2 introduces the reader to healthcare policy.

Chapter 3 describes the importance of evidence-informed practice.

Chapter 4 describes all of the neuromuscular structures involved with movement, the physiology behind move-ment, and the development of skilled movement.

Chapter 5 outlines the sequence behind the typical interaction between a physical therapist and the patient/client.

Chapter 6 familiarizes the reader with all of the major causes of movement dysfunction.

Chapter 7 summarizes the various methods by which a phy-sical therapist can correct movement dysfunction.

Once the reader has completed these chapters, the next step is to put these concepts into practice. Often, these concepts cannot be taught to, or practiced by, a patient without the clinician first taking and then monitoring the patient’s vital signs (heart rate, blood pressure, and body temperature). All of these skills, techniques, and procedures will be used by the physical therapist throughout his or her professional career to varying degrees. With every patient interaction, the clinician should always ensure patient and clinician safety. Although patient safety is paramount, it must not be forgotten that clinician safety is also extremely important. The potential for injury or harm is a real threat to the practicing clinician, whether from incurring an injury while lifting a patient, or from contracting an infection or disease from a patient. Throughout the appropriate chapters, emphasis is placed on both patient and clinician safety through the use of correct body mechanics, the application of assistive and safety devices, and effective infection control procedures.

Chapter 8 helps prepare the clinician for patient care.

Chapter 9 describes the various methods by which a clinician can take a patient’s vital signs and the significance of each of these vital signs.

Chapter 10 covers the various methods to drape a patient, position a patient, and teach a patient how to perform bed mobility skills.

Chapter 11 teaches the reader how to perform a range of motion assessment and how to apply range of motion techniques as a method of treatment.

Chapter 12 describes in detail the various methods to specifically test the strength of each of the patient’s muscles.

Chapter 13 describes the various methods by which the clinician or clinical team can perform the transfer of a patient from and to a variety of surfaces. Wheelchair mobility skills are also described.

Chapter 14 details the various components of gait and how the clinician can train a patient to ambulate with or without an assistive device.

Physical therapy involves clinical decision making in a wide range of situations in order to enhance human movement and function, which is accomplished by a thorough assessment of movement dysfunction. Without the necessary background information, decision-making errors will be made that will affect patient safety, clinician safety, and the effectiveness of care. Clinical decision making is easier if there is a natural progression of basic principles to follow. Without the necessary tools, decision making is made more difficult. The progression of a patient from dependence to independence is often measurable. The simplest such measurements include strength and range of motion; at the other end of the continuum are measurements of function. Assessing function and dysfunction requires a working knowledge of the components of normal movement and how such factors as a lack of range of motion or muscle weakness can affect outcomes. Thus, the assessment of range of motion using goniometry, and strength using manual muscle testing, are critical skills for the physical therapist.

No two clinical situations are the same, as there are many internal and external factors to consider. Such factors include the environment, the patient, and the specific task being undertaken. Many aspects of this book draw from the theories and concepts put forward by Thelen and colleagues^{1, 2, and 3} and by Shumway-Cook and Woollacott.⁴

• Thelen and colleagues^{1, 2, and 3} expanded on the work of Bernstein on systems theory and introduced a dynamic systems perspective (see Chapter 4), in which human movement is thought to involve a highly intricate network of codependent subsystems (e.g., respiratory, circulatory, neuromusculoskeletal, and perceptual) composed of a large number of interacting components (e.g., blood cells, oxygen molecules, muscle tissue, connective tissue, and nervous tissue) within an individual that constrain or support movement. According to this theory, a small but critical change in one subsystem can cause the whole system to shift, resulting in a new motor behavior.

• Shumway-Cook and Woollacott’s approach is related to dynamic systems theory, but also incorporates many of the concepts proposed by other theories of motor control. This theory emphasizes that movement emerges from interactions among the individual, the task, and the environment in which the task is being carried out. Thus, it is important that the student clinician be able to create an optimal environment, break down complex movements into manageable components, and relate to the patient in such a way that task performance is maximized.

It is important to remember that once a physical therapy intervention has been delivered, the continuum of patient care may involve a referral to, or consultation with, another healthcare professional if some of the barriers to attaining full function require expertise outside of the scope of physical therapy.