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APPENDIX E
Current Trends in Physiotherapy Applicable to the
School Health Service, with particular reference to the
Motor Behaviour of Handicapped Children.
Miss Jean McBride, M.C.S.P., A.P.T.A.,
Superintendent Physiotherapist
1. Introduction
The tenor of physiotherapy over the past twenty years since the inauguration
of the National Health Service has considerably altered both in
terms of the types of patients and the conditions which are treated. The
case load is larger, the referrals are earlier and the periods of hospitalisation
are shorter; the continuing shortage of staff emphasises that skilled
man-power must not be wasted. New ideas have been developed and recognised
in their practical application, with the result that the approach of
present day therapists has become much more flexible. The main emphasis
of our work still lies in the rehabilitation field uniting our discipline with
those of the Speech and Occupational Therapists. There is an urgent need
for us all to think in terms of neurophysiological principles, to provide
ourselves with a rationale for every procedure that we undertake, to adapt
to each others' and patients' needs, and perhaps most important of all continually
to assess our efforts. There must be a common end obtained by the
co-operation of a heterogeneous collection of skill each working through its
own discipline. It is only by so doing that it will be possible to ensure that
the therapists' time is being used most effectively.
2. What is Physiotherapy today?
In the past patients expected to receive passive treatment such as
massage, heat, diathermy, wax and then perhaps to be encouraged to perform
specific exercises relative to their condition. Today, we do not
demand voluntary motor response from our patients; we do not encourage
them to use their heads to run their muscles, because in treatment we can
make use of the inborn reflex control of muscles for movement and posture.
In the past the major emphasis of our treatment was placed upon the motor
side of the nervous system. This was a natural error because it is readily
seen and recorded. However, it is now known that the motor side does not
learn, it is only the sensory side that can be conditioned. These fundamental
changes in emphasis indicate a need for re-education of both professional
staff such as Doctors and Nurses, as well as patients and their relatives.
3. Reasons for the Changing Pattern of Physiotherapy
The physiotherapy profession sorely lacks teaching on the normal
patterns of human growth and on the development of the child, the adolescent,
the adult and the ageing; likewise physical and vocational considerations
appropriate at each level. In general our knowledge is based on the