The World, Disability, and Physical Therapy on World PT Day

World Physical Therapy Day has been around for not quite as long as I have, and the day (September 8) holds a special place in my heart. As a special treat, the focus of this year's Day is inflammatory arthritis related to mental health. I am trained as a physical therapist, so in this week's post I want to explore my favorite aspects of physical therapy, as well as connecting to one book I'm reading for class (Amy Kenny's My Body is Not a Prayer Request) and another two I'm reviewing for a lecture (Johnson 2018; Probst & Skjaerven 2018).

Here are some of my past posts about or referencing physical therapy:

• Five Books Worth Re-Reading (on Probst & Skjaerven 2018)
• How to Read when you Don't Feel like Reading (reading in one's interests)
• Reflections on Reading After Graduation (pre- and post-DPT)
• History: Culture and Physical Therapy (a bit more discussion)

Brief History of Physical Therapy Outside the USA

For a history of physical therapy inside the United States, I refer you to this post of mine from earlier in 2023. To summarize, wars and polio epidemics brought the need for reconstruction aides, as they were called, in the early 20th century. Before that, however, physical therapy focused on muscle mobilization had been in practice in Europe for several decades.

Regardless of the specific approach to therapy and rehabilitation, people who need therapists' services tend to do so because pain, weakness, or injury/disease is negatively affecting their quality of life. PTs, as we will see in the next section, focus on optimizing human movement to improve this quality of life.

How PT is Different from Personal Training

When people hear the term “PT,” most think of a physical therapist, but a substantial fraction likely think of personal trainer instead. Is there a difference? If so, what is it?

When I was being trained as a physical therapist, I learned about scope of practice, which varies slightly by geographical region (state/country) but has general consistent boundaries regardless of where one practices. General things that physical therapists do in the United States include:

• Refer to themselves as "PT", "physio", or "DPT" (if they have a doctorate degree) - only physical therapists may do this
• Examine, evaluate, and test movement dysfunctions of patients/clients seeking services
• Practice with direct access (no physician referral) with certain diagnoses
• Administer interventions such as specific exercise, instructing patients or their support systems, clear airways, administer modalities like ultrasound or electrical stimulation, debride or remove dead tissue from wounds, mobilize joints and soft tissue, perform joint manipulations, retrain in functional activities (related to leisure or work), prescribe and apply/make orthotics and other supportive devices - only physical therapists may perform certain interventions
• Promote health and wellness even if there's no injury or disease
• Refer to other health care providers as indicated (including medically determining whether patients are appropriate for physical therapy)
• Supervise physical therapist assistants and unlicensed personnel (e.g., student physical therapists)
• Deliver services via telehealth in most states
• PTs may do more if they are specially trained to do so (e.g., administer copyrighted cognitive tests, perform sharp debridement)

Personal trainers, in the United States, have a different scope of practice. General things that trainers do in the US include:

• Refer to themselves as personal trainers (not PTs)
• Develop and administer individualized exercise programs for individuals and groups of clients
• Work from strengthening, endurance, and flexibility types of exercises
• Motivate others toward physical fitness and health
• They may not:
• Make medical diagnoses
• Give specific dietary advice
• Provide body massage
• Provide psychological counseling

Both types of providers have in mind the International Classification of Functioning, Disability and Health (ICF) model when treating the whole person. This means, especially for physical therapists, that the patient who comes to us is much greater, more whole, than their diagnosis (total knee replacement, chronic low back pain). 

PTs look at the specific problems happening at the body system level (decreased range of motion at the knee), how those impairments connect to functional activities the person wants to improve on (walking, negotiating stairs), and the life participation roles (mother, roofer) that the activities are a part of. They also take into account the positive and negative personal and environmental factors (motivation, safe housing) that impact the person's ability to participate in therapy and their other roles and activities.

Concepts of Disability and the Self

I said earlier that the model used by physical therapists is the International Classification of Functioning, Disability, and Health. What is meant by "disability"? According to the World Health Organization, a task force of which developed the ICF model, aspects of disability include

• Being human in a particular society
• Temporary or permanent nature
• Individual with a health condition in relation to their personal and/or environmental factors

A point I want to highlight, especially as it relates to Amy Kenny's book, is the person-environment and person-personal-factor interaction. Kenny is a scholar of Shakespeare who has a childhood-onset disability that she doesn’t identify by name in her book. She is also a Christian who, it seems, grew up in the charismatic/evangelical tradition. 

Kenny’s central point is that her disability is a significant part of her identity because her body and mind exist in the same space. Disability occurs for her primarily due to others’ (harmful) opinions and physical inaccessibility of many environments, especially church buildings. 

I found myself thinking back to Carl Trueman’s history of the self, from social to psychological. Kenny admirably asserts that the body, just as it is, is important to one’s identity, contrary to some camps today that claim that the mind and feelings are the true seat of one’s identity (hence the body must be changed to match how one feels in order to be healthy). However, she is inconsistent with her view of the body throughout, which I find to be a weakness of the book.

Tying it Together: Christianity, Disability, and Physical Therapy

I am reading and discussing Kenny in the context of a course I am teaching, within a doctor of physical therapy program at a Christian university, where faculty are expected to maintain active church membership and incorporate the Christian faith into their teaching both implicitly and explicitly. What are some links between the concepts she is discussing, specific to physical therapy (which she for the most part discounts)?

Our bodies, in this creation, are prone to disability because (1) they are subject to entropy, (2) original and actual sin corrupts individual behavior and society (creating barriers), and (3) we are unable by ourselves to rectify the situation completely. In the new creation (after heaven), we will have vocations, likely pain as a warning signal (its true function), and renewed bodies to better be image-bearers. We are "new creations" even at this time, but in this present creation the image of God in us is corrupted due to sin.

One of Kenny's points is that her disabled body glorifies God and therefore doesn't need to be changed. I think she is half correct--accepting disability is (for overall health) usually a better response than fighting something that cannot be changed.

Another of Kenny's points is that the Church as a whole reacts the same way that the larger culture does to persons with disability (stare, ignore, exclude, intrude). This is partially accurate, but I think there is a heavy effect of one's training and socialization (e.g., working in clinical environments during professional training as a physical therapist) on inward and outward reactions to persons with disability. She faults the church for fighting the Americans with Disabilities Act, ignoring the fact that many churches (outside her tradition in particular) can barely afford to pay a pastor's salary, let alone make extensive structural modifications to old buildings.

All told, I do recommend that you read My Body is Not a Prayer Request. However, I recommend simultaneously reading

• The Problem of Pain (C. S. Lewis)
• Surprised by Hope (N. T. Wright)
• Rise and Triumph of the Modern Self (C. R. Trueman)

Happy World PT Day!