Introduction

This book introduces a conceptual framework about the art of physical therapy to give the entry-level physical therapy student a broad foundation from which to support their journey through the typical physical therapy curriculum. The purpose of this text is to cover the fundamental skills that most physical therapists will use for the rest of their careers. However, it is not possible in many cases to describe these skills without putting them into context with subject matter that will be covered in more depth further on down the curriculum. The reader should not be frustrated or intimidated by this advanced-level content but instead, be galvanized and excited at the prospect of what is to come. As in the previous edition, this text provides a historical perspective on the physical therapy profession, an introduction to healthcare policy, and a definition of evidence-informed practice, and various chapters that describe how movement evolves, how that movement becomes skilled, and how movement dysfunction can occur or develop. Building on this groundwork, the later chapters provide keys to the reader to help develop 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 on the physical therapy profession.

Chapter 2 introduces the reader to essential healthcare policies.

Chapter 3 describes the importance of evidence-informed practice.

Chapter 4 describes all of the neuromuscular structures involved with human movement, the physiology behind this movement, and how individuals develop 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 significant causes of movement dysfunction.

Chapter 7 summarizes the various methods by which a physical therapist can correct movement dysfunction.

With every patient interaction, the clinician should always ensure patient and clinician safety. So, throughout the appropriate chapters, the emphasis is placed on both patient and clinician safety through the use of correct body mechanics, the application of assistive and safety devices, and the effective use of infection control procedures.

Chapter 8 helps to 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 correctly drape a patient, position a patient, and teach a patient how to perform bed mobility skills.

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

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

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

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 by a thorough assessment of movement dysfunction. Assessing function and dysfunction requires a working knowledge of the components of normal movement and how such factors as a neuromuscular control can affect outcomes.

Many aspects of this book draw from the theories and concepts put forward by Thelen and colleagues^1–3 and by Shumway-Cook and Woollacott.⁴

• Thelen and colleagues^1–3 expanded on the work of Bernstein on systems theory by introducing a dynamic systems perspective. Within this perspective, human movement is constrained or supported by a highly intricate network of codependent subsystems (e.g., respiratory, circulatory, neuromusculoskeletal, and perceptual). This network of subsystems is, in turn, composed of a large number of interacting components (e.g., blood cells, oxygen molecules, muscle tissue, connective tissue, and nervous tissue). According to this theory, a small but critical change in one subsystem can cause the whole system to shift, resulting in 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 motor control theories. Their theory emphasizes that movement emerges from interactions between the individual, the task, and the environment during the performance of the task. Thus, an optimal setting is critical, as is the ability to be able to create, break down complex movements into manageable components.

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