|
Andrew M. Ball, MS, PT -> Re: The APTA's Vision for 2020 (October 9, 1999 4:34:00 PM)
|
Here's the deal folks, a professional physical therapy degree, at any level (DipPT, BS, MS, or DPT) is no longer sufficient if you plan to retain the freedoms that we have enjoyed in the past. A professional (entry-level degree) AT ANY level, is about as useful as a BS or BA in psychology or communications. Can you get a job? Yes, but most students understand the need to continue their education with an advanced degree. Consider this . . .
Have you considered what the value to a law firm may be of a PT who took 6 months of their time to complete a paralegal certificate?
How about the value of a PT with a master's in computer science or engineering to the biotechnology firm attempting to build a low-cost prothetic limb which actually recieves implules from the central nervous system of the patient?
If pediatrics is your bag, have you considered the value of a PT with a master's in special education to the local school system?
We must also consider the prospect of non-clinical positions such as insurance claims review, or case working.
We have failed in the justification of our profession. Edgerton, Dobkins, Seif, and others have shown the marked effectiveness (70% in terms of ambulatory independence and gait velocity) of partial weight bearing over ANY other method of traditional physical therapy gait training, yet most clinicians still have no clue. The P.S. will be that this opportunity will be another one lost to rehab nurses or exercise phys.
About a year ago a study in the N Engl J of Med entitled "A comparison of physical therapy, chiropractic manipulation, and provision of an education booklet for the treatment of patients with low back pain" showed that:
FOR PATIENTS WITH LOW BACK PAIN . . . PHYSICAL THERAPY AND CHIROPRACTIC MANIPULATION HAD SIMILAR EFFECTS AND COSTS, AND PATIENTS RECEIVING THESE TREATMENTS HAD ONLY MARGINALLY BETTER OUTCOMES THAN THOSE RECEIVING THE MINIMAL INTERVENTION OF AN EDUCATIONAL BOOKLET. WHETHER THE LIMITED BENEFITS OF THESE TREATMENTS ARE WORTH THE ADDITIONAL COSTS IS OPEN TO QUESTION.
As a student of healthcare managment, I'll answer the question quickly for ya'll. NO, it does not. Based on this study, any HMO physician, whose financial incentive is to reduce referrals, will use the booklet method at about 1/4 the cost, and see near-equivocal results in his patients.
We are experts in the function of the neuromusculoskeletal system and few dispute this, but the sad truth is that such an expert is not viewed as particularly necessary by the population at large. Coupled degrees, not elevated degrees may be part of the answer.
As for those of you who ask should BS and MS trained therapists go back to school, in my opinion, the answer is a resounding YES, but only if the advanced degree will improve job prospects as described above, or improve our clinical effectiveness. I've seen more than my share of "experienced" therapists with 20 or more years of experience. Some are in fact excellent, but the vast majority have been practicing on faith, without picking up a journal, or attending a research seminar (NOT a continuing education course where anecdotal stories are presented and skills in less than proven interventions are perfected) for the WHOLE of their professional career. Do you need to go back to school? Depends, but here's a quick test . . .
Can you explain the concept of the central pattern generators to your patients?
Can a human being walk if the cortex is removed? If the entire cerebrum is removed? Why or why not?
What is the most effective intervention for gait training?
_________________________________________
The answers are
1. The central pattern generators are located in the spinal cord. The most significant neuroanatomical area for walking is the reticular formation, without which walking would not be possible. The higher brain controls higher functions only, such as velocity of gait and intended target.
2. Based upon animal studies, a human being, if rehabed correctly, should be able to walk with little error, even if the entire cortex is removed. Given this, it should be possible to rehab any client with any kind of upper motor neuron lesion. The inability to do so markes a serious flaw of our profession. Decerribrate individuals would have a bit more trouble, considering with the thalamus removed, vision would be gone. It should however be possible.
3. Partial weight bearing over a treadmill. The effects of adding facilitation techniques to this therapy are unknown, but this is where we may be able to conduct research to justify our existance! If you are still using NDT or PNF alone, you need to consider either picking up a text or going back to school. You CERTAINLY should not be taking students and re-training them to use ineffective antiquated techniques.
------------------
Andrew M. Ball, MS, PT
MBA/PhD Candidate
|
|
|
|