SCOPE OF PHYSIOTHERAPY
What is Physiotherapy?
“Physiotherapy means “ a health care profession which includes assessment, examination, interpretation, diagnosis, planning, and implementing rehabilitative programs that improve or restore human motor functions, maximize movement ability, relieve pain syndromes, prevent and treat physical challenges associated with injuries, diseases and other impairments using broad range of physical therapies and techniques, but not limited to exercises, mobilization, manipulation, mechanical and electrotherapy modalities, activities and devices”
Physiotherapy may be defined as a health science that seeks to improve movement dysfunction, promote optimal health and functions of the human body.

About Physiotherapy by WHO
WHO defined as, Physiotherapist is recognized as a Health Professional in the health care sectors who assess, plan and implement physiotherapy treatment (Click to view Reference 1:Reference 2). "Physiotherapists assess, plan and implement rehabilitative programs that improve or restore human motor functions, maximize movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with injuries, diseases and other impairments. They apply a broad range of physical therapies and techniques such as movement, ultrasound, heating, laser and other techniques. They may develop and implement programmes for screening and prevention of common physical ailments and disorders"

The nature of Physiotherapy
Physiotherapy provides services to individuals and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by ageing, injury, disease or environmental factors. Functional movement is central to what it means to be healthy.

Physiotherapy is concerned with identifying and maximising quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social well being. Physiotherapy involves the interaction between Physiotherapist, patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to Physiotherapists.

Physiotherapists are qualified and professionally required to:

• Undertake a comprehensive examination/assessment/evaluation of the patient/client or needs of a client group
• Formulate a diagnosis, prognosis, and plan.
• Provide consultation within their expertise and determine when patients/clients need to be referred to another healthcare professional
• Implement a Physiotherapist intervention/treatment programme
• Determine the outcomes of any interventions/treatments
• Make recommendations for self management

The Physiotherapist’s extensive knowledge of the body and its movement needs and potential is central to determining strategies for diagnosis and intervention. The practice settings will vary according to whether the Physiotherapy is concerned with health promotion, prevention, treatment/intervention, habilitation or rehabilitation.

Physiotherapists operate as independent practitioners (Practitioner – the term practitioner encompasses all roles that a Physiotherapist may assume such as patient/client care, management, research, policy maker, educator, and consultant.), as well as members of health service provider teams, and are subject to the ethical principles of WCPT. They are able to act as first contact practitioners, and patients/clients may seek direct services without referral from another health care professional.

Physiotherapy is an established and regulated profession, with specific professional aspects of clinical practice and education, indicative of diversity in social, economic, cultural and political contexts. But it is clearly a single profession, and the first professional qualification, obtained in any country, represents the completion of a curriculum that qualifies the Physiotherapist to use the professional title and to practice as an independent professional.

The nature of the Physiotherapy process

Physiotherapy is the service provided only by, or under the direction and supervision of, a Physiotherapist. It includes examination/assessment, evaluation, diagnosis, prognosis, plan of care/intervention and re-examination.
Assessment includes:
the examination of individuals or groups with actual or potential impairments, activity limitations, participation restrictions or abilities/disabilities by history taking, screening and the use of specific tests and measures the evaluation of the results of the examination of individuals/groups and/or the environment through analysis and synthesis within a process of clinical reasoning to determine the facilitators and barriers to optimal human functioning
Diagnosis and prognosis arise from the examination and evaluation and represent the outcome of the process of clinical reasoning and the incorporation of additional information from other professionals as needed. This may be expressed in terms of movement dysfunction or may encompass categories of impairments, activity limitations, participatory restrictions, environmental influences or abilities/disabilities.
Prognosis (including plan of care/intervention) begins with determining the need for care/intervention and normally leads to the development of a plan of care/intervention, including measurable outcome goals negotiated in collaboration with the patient/client, family or care giver. Alternatively it may lead to referral to another agency or health professional in cases which are inappropriate for Physiotherapy.
Intervention/treatment is implemented and modified in order to reach agreed goals and may include manual handling; movement enhancement; physical, electro-therapeutic and mechanical agents; functional training; provision of assistive technologies; patient related instruction and counselling; documentation and co-ordination, and communication. Intervention/treatment may also be aimed at prevention of impairments, activity limitations, participatory restrictions, disability and injury including the promotion and maintenance of health, quality of life, workability and fitness in all ages and populations.

Re-examination necessitates determining the outcomes.

Where is Physiotherapy practised?
Physiotherapy is an essential part of the health and community/welfare services delivery system. Physiotherapists practice independently of other health care/service providers and also within interdisciplinary rehabilitation/habilitation programmes to prevent, gain, maintain or restore optimal function and quality of life in individuals with loss and disorders of movement.
Physiotherapists are guided by their own code of ethical principles. Thus, they may be concerned with any of the following purposes:

• promoting the health and well being of individuals and the general public/society, emphasising the importance of physical activity and exercise
• preventing impairments, activity limitations, participatory restrictions and disabilities in individuals at risk of altered movement behaviours due to health or medically related factors, socio-economic stressors, environmental factors and lifestyle factors
• providing interventions/treatment to restore integrity of body systems essential to movement, maximise function and recuperation, minimise incapacity, and enhance the quality of life, independent living and workability in individuals and groups of individuals with altered movement behaviours resulting from impairments, activity limitations, participatory restrictions and disabilities
• modifying environmental, home and work access and barriers to ensure full participation in one’s normal and expected societal roles
• Physiotherapists may also contribute to the development of local, national and international health policies and public health strategies.

Settings in which Physiotherapy is practised
Physiotherapy is delivered in a variety of settings which allow it to achieve its purpose.

• Prevention, health promotion, treatment/intervention, habilitation and rehabilitation take place in multiple settings that may include, but are not confined to, the following:
• community based rehabilitation programmes
• community settings including primary health care centres, individual homes, and field settings
• education and research centres
• fitness clubs, health clubs, gymnasia and spas
• hospices
• hospitals
• nursing homes
• occupational health centres
• out-patient clinics
• Physiotherapist private offices, practices, clinics
• Treatment for prisons
• public settings (e.g., shopping malls) for health promotion
• rehabilitation centres and residential homes
• schools, including pre-schools and special schools
• senior citizen centres
• sports centres/clubs
• workplaces/companies

What characterises Physiotherapy?
Assumptions underlying the knowledge and practice of Physiotherapy
The following assumptions are embedded in this description and reflect the central issues of Physiotherapy.
Movement
The capacity to move is an essential element of health and well-being. Movement is dependent upon the integrated, co-ordinated function of the human body at a number of different levels.
Movement is purposeful and is affected by internal and external factors.
Physiotherapy is directed towards the movement needs and potential of individuals and populations.
Individuals
Individuals have the capacity to change as a result of their responses to physical, psychological, social and environmental factors.
Body, mind and spirit contribute to individuals’ views of themselves and enable them to develop an awareness of their own movement needs and goals.
Ethical principles require the Physiotherapist to recognise the autonomy of the patient/client or legal guardian in seeking his or her services.

Populations
Physiotherapists may direct their interventions to specific populations. Populations may be Nations, States and Territories, regions, minority groups or other specified groups (eg. screening programmes for scoliosis amongst school children and falls prevention programmes for the elderly).
Interaction
A mutual understanding between the Physiotherapist and the patient/client/family or care giver is an integral part of Physiotherapy.
This kind of interaction is necessary to positively change the body awareness and movement behaviours that may promote health and well-being.
Members of inter-disciplinary teams also need to interact with each other, and with patients/clients/family and care givers, to determine needs and formulate goals for Physiotherapy intervention/treatment.
Physiotherapists also interact with administration and governance structures to inform, develop and/or implement appropriate health policies and strategies.

Professional autonomy
Professional education prepares Physiotherapists to be autonomous practitioners.
Physiotherapists exercise their professional judgement to reach a diagnosis which will direct their Physiotherapy interventions/treatment, habilitation and rehabilitation of patients/clients/populations.

Diagnosis
Diagnosis in Physiotherapy is the result of a process of clinical reasoning which results in the identification of existing or potential impairments, functional limitations and abilities/disabilities.
The purpose of the diagnosis is to guide Physiotherapists in determining the prognosis and most appropriate intervention strategies for patients/clients and in sharing information with them.
In carrying out the diagnostic process, Physiotherapists may need to obtain additional information from other professionals.
If the diagnostic process reveals findings that are not within the scope of the Physiotherapist’s knowledge, experience or expertise, the Physiotherapist will refer the patient/client to another appropriate practitioner.

Physiotherapy includes the following but not limited to

• Initial Examination/Assessment, Evaluation, Diagnosis, and Prognosis
• Plan of Care/Interventions/Treatments
• Interventions/Treatment
• Re-examination/Evaluation of Progress
• Discharge/Discontinuation of Intervention/Treatment

Physiotherapy assessment may includes but not limited to :
Subjective - chief complaints, history taking, history of present illness personal, past and present medical and socioeconomic history, informed consent, Pain assessment, Intensity, character, aggravating and relieving factors of various signs and symptoms.
Objective examination includes observation, palpation, inspection, examination, special test and investigations.
Subjects and objective Examination includes in various areas of assessment includes but not limited to :
Orthopaedic/ Musculoskeletal examination and investigations, Cardio-respiratory and Cardiopulmonary examination and investigations, Neurological and neurosurgical examination and investigations, Burns, Plastic surgery, Pediatric, Sports, Obstetric and gynecology physiotherapy/ Women health, Oncology, Obesity and weight control, intensive care unit, Industrial/Ergonomics and Various systemic examination and investigations, Veterinary physiotherapy , Community physiotherapy.

Problems listing and goal setting, clinical decision making, Prescription of home program. Documentation of case records, and follow-up.
Developmental assessment and diagnosis, Developmental screening.
Anthropometric measurements. Functional Capacity Evaluation (FCE).
Investigations interpretation includes: Blood Investigations, Biochemical Investigations, Radiological Investigations, Cardiovascular Investigations, Cardio-respiratory Investigations, Neuro-physiological Investigations, Electro-diagnosis and other relevant investigations.

Physiotherapy Intervention/Treatment method may includes but not limited to:

• Exercise Therapy- Aerobic capacity/endurance conditioning or reconditioning, Balance, coordination and agility training, Body mechanics and postural stabilisation, Flexibility exercises, Gait and locomotion training, Neuromotor development training, Relaxation, Resistant/ Weight/Strength, power, and endurance speed training, Progressive resistance training, Functional training in self-care and home management, Barrier accommodations or modifications, Device and equipment use and training, Isokinetic training, body Support systems, Decompression traction, manual and mechanical traction, treadmill and exercise training using various equipments, Plometrics, Pilates, Range of motion exercises. Proprioceptive Neuromuscular Facilitation technique, Soft tissue Massage calisthetics, Manual therapy techniques, Frenkel’s Exercises, suspension therapy, Aquatic therapy, Functional training programs, Activities of Daily Living[ADL] training, Instrumental activities of daily living [IADL] training, Injury prevention or reduction, Functional training in work (job/school/play), community, and leisure integration or reintegration. Prescription and training of orthotics and prosthetics, Gait training, Postural training, Transfer Training, Wheelchair Training, A.D.L training, occupational work.

• Electrotherapy – Neuromuscular Electrical stimulation- faradic and Galvanic currents, Functional Electrical Stimulation (FES), Interferential Current (IFC), Russian Current, High Voltage Pulsed Galvanic Stimulation, Transcutaneous Electrical Nerve Stimulation (TENS), Iontophoresis, Plain direct current, Ultrasound, Phonophorosis, Cryotherapy, Physical agents – light, sound, heat, cryotherapy, hydrotherapy, Infrared therapy, ultraviolet therapy, PUVA therapy, Rebox current, Shortwave diathermy therapy, Mircowave diathermy therapy, Shockwave therapy, Microcurent, Long wave diathermy, LASER, Faradic foot bath, fluidotherapy, Moist heat, Wax therapy, Magentron, Magnetotherapy, Cyclotheram, and EMG Biofeedback.

• Orthopaedic physiotherapy techniques:  Taping Techniques, Myofascial Release technique and Muscle Energy technique, Manual therapy: soft tissue manipulations and mobilization, neural mobilization, Cyriax, Maitland, Butler, McKenzie, Kaltenborn, Mulligan, Joint manipulation – peripheral joints and vertebral joints, acupressure, acupuncture, Dryneedling, Positional release technique, Integrated manual therapy, Functional manual therapy. Implementation of various exercise therapy and electrotherapy techniques in rehabilitation of orthopaedic conditions.

• Physiotherapy management following general Medical & Surgical conditions. Physiotherapy management of peripheral vascular disorders.

• Neurological and Neurosurgical Physiotherapy: Treatment approaches in neurological rehabilitation: Brunnstrom Movement therapy, Bobath technique, Motor Relearning program(MRP), Neuro Developmental Therapy (NDT) Sensory Integration (SI), PNF techniques, Roods approach, Vojta Therapy, Facilitation & Inhibition techniques, EMG Biofeedback training, Motor training & retraining, Sensory training & retraining , Neuro-Psychological training, Perception training, Psychosomatic disorders rehabilitation, Coma Stimulation, Cognitive Rehabilitation, Vestibular Rehabilitation, Bladder & bowel rehabilitation, Gait training & Rehabilitation, Balance training, Postural control training, Co-ordination training, Proprioceptive training, Cranial & Peripheral nerve Rehabilitation, Neural mobilization, Activities of Daily Living(ADL) & Instrumental Activities of Daily Living(IADL) rehabilitation, Functional Electrical Stimulation (FES), Neuro Muscular Electrical Stimulation (NMES), Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Current (IFC), Galvanic Stimulation, Faradic Stimulation, Russian Current, Pre and post neuro surgical rehabilitation and Neurological physiotherapy protocols.

• Industrial Therapy, Occupational Health and ergonomics: Work Conditioning and Work Hardening Programs, Ergonomics. Monitoring at-risk employees and work processes. Ergonomics. Education and training, Health promotion, Retum-to-work case management, Occupational health committee/team development. Functional Capacity Evaluation (FCE).

• Cardiopulomonary Physiotherapy: Physiotherapy techniques to increase lung volume – controlled mobilization, positioning, breathing exercises, Neurophysiological Facilitation of Respiration, Mechanical aids -Incentive Spirometry, CPAP,IPPB. Physiotherapy techniques to decrease the work of breathing – Measures to optimize the balance between energy supply and demand, positioning, Breathing re-education – Breathing control techniques, mechanical aids – IPPB, CPAP, BiPAP and oxygen therapy. Physiotherapy techniques to clear secretions – Hydration, Humidification & Nebulisation, Mobilisation and Breathing exercises, Postural Drainage, Manual techniques – Percussion, Vibration and Shaking, Rib Springing, ACBT, Autogenic Drainage, Mechanical Aids – PEP, Flutter, IPPB, Facilitation of Cough and Huff, Nasopharyngeal Suctioning.

• Physiotherapy assessment and management in intensive care unit such as Medical ICU, Post Surgical ICU, Neurological ICU, Neurosurgical ICU, Neonatal ICU, Paediatric ICU, Burns and Plastic Surgery ICU, Oncology ICU, Cardio ICU, Cardiothoracic surgical ICU, Renal and Nephro ICU.
• Physiotherapy treatment techniques in Cardiac and Pulmonary Rehabilitation.
• Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR),
• Exercise ECG testing and monitoring.
• Physical fitness testing and training.

• Physiotherapy Rehabilitations Protocols: Postural Stability Training, Mobility and Flexibility Training, Aerobic Training, Training Strategies to Develop Pulmonary, Endurance Training, Specific Exercise Regimens, Sports Physiotherapy, ortho-physiotherapy rehabilitative protocols, Neurorehabilition protocol, Cardiopulmonary rehabilitation protocol, Paediatric physiotherapy rehabilitation protocol, Community Rehabilitation.
• Management of wound ulcers- Care of ulcers and wounds - Care of surgical scars-U.V.R and other electro therapeutics for healing of wounds, prevention of Hypergranulated Scars Keoloids, Electrotherapeutics measures for relief of pain during mobilization of scars tissues.
• Integumentary repair and protection techniques – Debridement (non-selective, selective), Dressings, Topical agents,
• Physiotherapy in dermatology -Documentation of assessment, treatment and follow up of skin conditions. U.V.R therapy in various skin conditions.
• Mechanical modalities – Acupuncture, dry needling, Compression therapies, Gravity – assisted compression devices, Mechanical motion devices, Traction devices.
• Early intervention of high risk babies, Neonatal care and management, Management of Neuro-paediatric patients, Paediatric surgeries and its post-operative management, Adaptive equipment for physically challenged children, Sports and fitness in paediatrics.
• Cardiac rehabilitation – Conservative and post-operative management. Pulmonary Rehabilitation, Exercise Prescription for health promotion and fitness for special populations. Exercise testing, planning and prescription: aerobic and anaerobic exercise training.
• Community Physiotherapy- Disability Screening, Disability evaluation and diagnosis and prescription, Health Education and health promotion.

Branches:
Orthopaedic/ Musculoskeletal physiotherapy, Neurology and neurosurgery physiotherapy, Sports physiotherapy, Cardio-respiratory physiotherapy, Physiotherapy in intensive care unit, community based rehabilitation, physiotherapy in post burns, Obstetrics and Gynaecology physiotherapy/ Women health, Exercise prescription and physical fitness, Ergonomics, ENT-physiotherapy, General physiotherapy, Geriatric physiotherapy, Industrial physiotherapy, Obesity and weight control, Oncology physiotherapy, Paediatric physiotherapy, , Veterinary physiotherapy, and Community physiotherapy.