Faculty Profile: Rehabilitation Medicine

Overview

Physical Therapy is that branch of rehabilitation medicine which specializes in helping to restore optimal function to persons with injuries or disease. Practitioners employ sophisticated techniques in the use of exercise, heat, hydrotherapy, and massage to restore bodily functions. Joint movements, muscular strength, control, and coordination are the chief concerns in treating the patient. In recent times, however, practitioners of physical therapy have expanded their areas of concern, studying, for example, lung and heart problems, physical stress, athletic injuries, and the preventative aspects of patient care. Physical therapy is primarily interested in the physical aspects of the patient, but not to the exclusion of other concerns.

Development of the client’s ability to function in the home and work place, and to gain independence, is the central concept of Occupational Therapy. Having assessed the abilities and aptitudes of the client, the focus of occupational therapy is on training individuals to use their abilities to their fullest. Through the activities of daily living, at home and at work, the client’s mobility, strength, coordination and inter-personal skills are developed. Depending on the nature of the disability, occupational therapy strives to assimilate disabled persons back into the work force and thus return them to independence.

Occupational therapy and physical therapy have an inherent area of overlap: a client’s physical ability has a direct influence on what that person is capable of doing. Generally, physical therapy begins the client’s treatment by developing movement, coordination, and strength to the maximum. Occupational therapy then complements the physical therapy by helping the client apply his new found or newly regained movement or strength to the functions of daily-living or work. Occupational therapy develops a balance between the client’s physical and psychological needs by concentrating on the functional use of the body.

The Department of Speech Pathology and Audiology within the Faculty of Rehabilitation Medicine is primarily involved in the areas of speech, language, and hearing disorders. Speech pathology is defined as the assessment and treatment of speech disabilities. Common disabilities include articulation, voice, stuttering, and language problems. Audiology involves the measurement of hearing loss and the rehabilitation of those with hearing deficits.

Historically, occupational therapy developed from the philosophy that activity is critical to man’s development and health. The use of activities, now often referred to as arts and crafts, to develop motor skills and improve psychological functioning was undertaken in Canada in the early 1900s by the first graduates from the University of Toronto.

Misconceptions arise from the assumption that arts and crafts are engaged in for purely diversional purposes. The use of activity remains central to occupational therapy; however, the focus of such activity has broadened to include such areas as energy conservation in home management and daily-living tasks and gross and fine motor tasks designed specifically for their type of sensory input.

Misunderstandings, in all three areas of rehabilitation medicine, are to a great extent the result of lack of familiarity with the disciplines and what they can now offer as a result of their greatly expanded body of knowledge and clinical practice.

In speech pathology and audiology, most people who have some familiarity with the discipline are aware of what speech pathology can do in the treatment of the more common speech and language difficulties. Few are familiar, however, with work being done in the treatment of people suffering from language loss resulting from strokes.

Considerable progress in the form of new techniques and methods of treatment has occurred in the recent history of rehabilitation medicine. Because there is a sharing of knowledge between disciplines, developments and discoveries in chemistry, biomechanics, physics, and psychology have allowed new medical techniques to be developed. Rehabilitation medicine has explored and researched areas that until recently were not thought to be of great significance in the treatment of disabilities. One such area is the application of knowledge from the discipline of linguistics to speech pathology and audiology. With new technology and research, rehabilitation medicine has, in recent years, greatly broadened its scope of interest. Injuries or diseases that were once thought to be outside the realm of rehabilitation medicine are now treated along with the more traditional illnesses.

In the case of physical therapy (as stated earlier), nerves, bones, and joints were at one time the sole concern. Today, treatment of heart and lung problems caused by disease or injury is common. In addition, the prevention of stresses and strains that may lead to injury has become a very major concern.

Three distinct professional programs, Physical Therapy, Occupational Therapy, and Speech Pathology and Audiology make up the Faculty of Rehabilitation Medicine. However, there is a strong common bond. All three disciplines have as their primary goal, the education of professionals to assist the emotionally, developmentally, and physically handicapped populations to use their abilities to their fullest in their daily lives. Common goals are found in a concern for public education; to facilitate integration of the handicapped into the mainstream of society; and in research pursuits to further the development of effective treatment procedures and methods of service in rehabilitation.

Within the structure of modern health care and educational services, greater emphasis is being placed on prevention and on decentralization of services, from the traditional large medical institutions to the community resources. The collective skills of Physical and Occupational Therapists together with Speech Pathologists and Audiologists provide much of the framework for the provision of such modern services.

These three disciplines together provide services in the areas of physical restoration, retraining and development; psycho-social rehabilitation; correction and facilitation of communication skills; prevocational evaluation and assistive techniques in activities of daily-living; and training in adaptive techniques for sports and recreation. Curriculum content includes basic sciences such as anatomy and physiology; social sciences, including psychology and sociology; clinical sciences, including the study of diseases, traumatic injuries and psychiatric disorders; and the skills and techniques specific to each of the three individual professions.

The basic tenet of rehabilitation is to restore the client or patient, as far as possible, to his former level of ability, or to as high a level as is compatible with any residual physical or psycho-social disability. In the area of developmental disability the term “habilitation” might be more fitting, as here the task is to develop basic skills rather than restore lost ones.

Integration of the client or patient into the community rather than institutionalizing him has always been fundamental to the concept of rehabilitation. Rehabilitation medicine academics and clinicians alike are encouraged by the recent changes in focus of health care and educational services in Alberta. The government’s increased interest in promoting home-care and other community services, as well as the recent developments in regard to educational programs for the handicapped, will greatly facilitate the goals of rehabilitation in the future. There are many excellent rehabilitation units within acute care medical facilities in Alberta, but only recently have these personnel been provided with funds and facilities to allow them to move into the community with services for the patient following discharge from the active hospital.

The Faculty of Rehabilitation Medicine began as a response to community need for Physical Therapists in the 1950s. Now the Faculty is again responding to community need by developing programs in which rehabilitation professionals will acquire the skills necessary to provide services within the changing concepts of health delivery services in Alberta and elsewhere. Provision of services to communities, especially rural communities, requires higher levels of self-confidence, administrative skills and professional autonomy in young professionals. Unlike the hospital team where professionals work in close association with each other, the community teams must learn new ways of integrating their services; make greater use of supportive services; and develop greater self-evaluative skills necessary for maintaining professional standards.

It is the belief of the Faculty of Rehabilitation Medicine that the changes over the years from diploma programs, to baccalaureate degrees, to the current develop­ments for graduate programs, and the associated refining of curricula, have provided a firm foundation for the graduation of competent professionals in the three disciplines; graduates ready to take on the challenges of health care, and educational developments in the 1980s.

Discussion of the possibility of establishing a program in physiotherapy dates back to 1945.

The importance of this branch of medicine was first recognized here, largely as a result of injuries sustained in World War II, and exposure to the advanced rehabilitation facilities in England. At that time a two-year certificate program was proposed but never materialized. It was not until a severe polio epidemic in 1952 and 1953 that the importance of rehabilitation was reconsidered. Because of the severity of the epidemic, it was decided that a training program should be established as quickly as possible. In 1954, eighteen students enrolled in a two-year diploma program in physical therapy. Programs in occupational therapy, and speech pathology and audiology were introduced later, in 1960 and 1969 respectively.

Courses were expanded to three years of study in 1960 and the name of the school became the School of Rehabilitation Medicine in 1964. The new name was intended to reflect the changing roles and functions of the school. The first degree offered by the school was Bachelor of Physical Therapy in 1969. Rehabilitation Medicine was granted Faculty status in March 1976.

Within the Department of Speech Pathology and Audiology the majority of staff members come from, or were educated in the United States. The Departments of Physical Therapy and Occupational Therapy, in the 1960s were staffed primarily by persons from Britain. At that time, highly trained professionals were not to be found in Canada and, consequently, personnel were hired from other countries. Currently the faculty of these departments includes several Canadians as well as individuals from Britain, Japan, Australia, India and the United States.

In the course of its history, the Faculty of Rehabilitation Medicine has been primarily a teaching Faculty, although considerable research has been undertaken.

Current goals include the establishment of programs beyond the baccalaureate level in all departments. The Faculty believes that Canada is falling behind other countries in the provision of education in this field, particularly in physical and occupational therapy. At present, there are two Canadian universities offering master’s programs in Rehabilitation, with emphasis on teaching and administration. Neither of these programs offers the degree in the specific professional disciplines of physical or occupational therapy, as this Faculty wishes to develop. The Faculty believes that education beyond the baccalaureate level must be provided to fill the future research and teaching requirements of Canadian health education programs. Several Canadian universities offer master’s level degrees in speech pathology and audiology.

Currently, there is no legislation in Alberta that provides licensure for physical therapists, occupational therapists, speech pathologists and audiologists. Negotiations have been in process for some time between the professional organizations and the government of Alberta in an attempt to obtain professional legislation for occupational therapists and speech pathologists (physical therapists have this legislation) and licensing for all three disciplines.

It is hoped that professional acts for these three disciplines would provide greater opportunity for independent professional practice, particularly with reference to the ability to treat some clients without the necessity of a medical referral.

Access to services should be available to the public outside the medical model. Individuals with developmental disabilities, lifestyle concerns and needs for social services are not “sick,” but do require access to services. Current trends in Alberta towards home care, community services, more comprehensive services for the elderly and rural based rehabilitation personnel make the traditional medical model inappropri­ate. Rehabilitation professionals must be integral members of the service team along with social workers, nurses, physicians, psychologists and others.

All three departments in the Faculty of Rehabilitation Medicine restrict entry into programs by means of a quota system. Quotas are made necessary because of the limiting factors of money, space, equipment, and by the availability of clinical facilities in Edmonton for clinical practice.

To qualify for entry into programs in the Departments of Occupational Therapy and Speech Pathology and Audiology students are required to complete a pre-professional year. The pre-professional year can be taken in the Faculty of the student’s choice, but for both departments specific first-year introductory courses are required. Although the pre-professional year serves as the first year of a four-year study program, entry into subsequent years of the program is determined by academic standing in the pre-professional year. A personal interview is also required before admission to Occupational Therapy.

Admittance to the undergraduate program offered by the Department of Physical Therapy is determined by academic achievement in high school, performance in other programs at the University and the Allied Health Professions Admission Test. Applicants must make at least one visit to a hospital department of physical therapy and submit a report in reference to this visit.

Throughout all programs of study, students are encouraged to maintain a high level of achievement. Grades in all prerequisites must be satisfactory before engaging in subsequent courses. First degrees awarded upon successful completion of study programs are Bachelor of Science in Occupational Therapy, Bachelor of Science in Physical Therapy, and Bachelor of Science in Speech Pathology and Audiology.

Unlike some other disciplines, first degree programs in rehabilitation medicine do not allow for a great deal of flexibility. All areas of specialization in rehabilitation medicine tend to have common roots or principles, more individualized or specialized study and research programs are generally pursued alter completion of a first degree.

In 1979, The University of Alberta became the first institution in Canada to offer a graduate degree in physical therapy. The degree of Master of Science in Physical Therapy is also the first graduate degree offered by the Faculty of Rehabilitation Medicine. Entry into the program is restricted to only four students each year. The University of Alberta program goes

beyond other Canadian master’s programs in rehabilitation and emphasizes the training of researchers as well as instructors. Universities in western Canada have had difficulty in finding faculty with post-graduate qualifications, so it is hoped that graduates from this program may help to rectify this problem. The University of Western Ontario is currently looking into the possibility of offering a similar program.

Job prospects in Alberta are favorable for professionals in rehabilitation medicine. Difficulties in finding jobs are more a matter of distribution or location than availability. Because more people prefer to work in or near major centres, the demand here is great and vacancies are filled quickly. Due to the competitiveness in these centres, therefore, newly graduated students may not secure the jobs they desire as quickly as they would like. In the rural districts of the province the situation is reversed. Recent trends in medical care are resulting in the establishment of clinics or health units in small towns and the recognition of rehabilitation medicine as a major part of patient care. Job vacancies in the rural districts are high and are not filled quickly.

Another area presenting a high demand for staff is home-care. At present, government programs are promoting the establishment of home-care services as an integral part of local health units. Although the benefits and sociological effects of getting back into the home as quickly as possible have been realized for quite some time, home-care is a relatively new concept in Alberta. With the development of such community services, many new positions are becoming available across the province.

Physical and Occupational Therapists are primarily employed in medical settings such as hospitals, rehabilitation clinics and health units. However, a growing number of therapists are being employed in home-care services, private practice clinics, the school systems and in industry.

As members of the health care team, Physical and Occupational Therapists consider education of the patients in their own self-care skills to be an important aspect of the rehabilitation program.

At present there is a growing demand for people to work in the field of gerontology (dealing with old age and its diseases). Young professionals sometimes choose not to work in this area, as they perceive extended care as less challenging than acute care. However, individuals who do take positions in facilities providing long-term care to both young and elderly clients frequently find their jobs both challenging and rewarding.

In all areas of the province, staff turnover in rehabilitation is relatively high. Job opportunities are therefore available on a regular basis. This turnover is seen to be partly due to marriage of the female therapists, but more so to the increasing tendency for young professionals, male and female, to travel and to relocate, knowing that they have the opportunity to find employment in many countries.

Although Speech Pathologists and Audiologists may also work in medical settings, much speech pathology and audiology work involves teaching within the school systems and special education organizations.

Research in rehabilitation medicine in general has undergone considerable change within the past five to ten years. There has been a marked shift from research directed and interpreted by medical doctors and assisted by therapists, to research undertaken and interpreted by therapists themselves. Similarly with research publications, therapists are conducting their own research and publishing the results in their own right. Rehabilitation medicine needs qualified researchers. To this end The University of Alberta’s new physical therapy master’s program emphasizes research rather than clinical skills. The Faculty is making a strong push for the establishment of master’s programs in its other two departments.

The Faculty of Rehabilitation Medicine is becoming widely known for its research, and has among its staff a number of people internationally recognized within the discipline.

Research in the Department of Physical Therapy covers a wide range of topics such as the study of stresses and strains that may eventually lead to back problems. The purpose of another study is to evaluate gait or styles of walking, and how faults in gait can affect body mechanics. One study presently being undertaken concerns pregnancy and its effect on gait. Changes in the attitudes of students toward disability and injury is the subject of another project, requiring the involved students to spend weekends in wheel chairs or using crutches, or having an arm immobilized in a splint.

It is thought that the experience will give the therapists empathy with the disabled. Other areas of research are the development of the vertebral column; muscle action and nerve response; and the effects of weight distribution and posture. Sports medicine and injury in athletics are becoming increasingly important as a result of the growth of interest on the part of the public.

The Department of Occupational Therapy has programs of research that reflect the balance which the discipline maintains, between psychological and physical factors. Examples here are topics such as the psychosocial aspects of disability, neurophysiological rehabilitation, and forensic psychiatry. The ability of the handicapped to learn is an area of increasing concern in our society. In this regard, research into the vocational and pre-vocational abilities of the mentally handicapped, and the learning problems children have as a result of visual and perceptual difficulties, will answer many questions. Sexuality of the handicapped is a relatively new interest area. Until quite recently this subject was not considered as a rehabilitation concern and was not freely discussed due to the values of a more modest society. The attitudes of the public to various injuries and disabilities, and preventative care are other important areas of research in the Department of Occupational Therapy.

In Speech Pathology and Audiology, the best procedures for the treatment of stuttering children and the maintenance of fluency in stutterers who have received clinical help are being explored. The Department has been extremely successful with its work related to stutterers. Another widely recognized project is the study of voice problems in people of all age groups. The use of fibre optic photography has been particularly useful here. The communications problems which increase with old age are being studied from several different points of view. One aspect is the change in speech and hearing abilities which are common to many elderly people. Another study related to the speech and hearing problems of old age is the development of successful methods of treatment. Additional areas of research are the aspects of language learning in pre-school children, and the speech problems of the mentally retarded.

Published June 1980.