SECTION NEWS & NOTES: President's Perspectve
Access to immediate information, social networking, informed consumers, and global access to information has resulted in a new level of communication that was not conceivable, even as little as 6 years ago. In 2005, the Neurology Section and the Pediatrics Sections of the American Physical Therapy Association had successfully hosted the IIISTEP conference in Salt Lake City, Utah. The IIISTEP conference and this perspective mark the beginning and end of my term as President of the Neurology Section. This past 6 years has been a remarkable time of growth for the Section. In 2005, the Executive Committee established an ambitious strategic plan to bring the Section to the next phase in our development as an organization. During this phase, the leadership team has expanded our educational programming, endowed our doctoral scholarship fund, expanded the scope of the Section's Journal of Neurologic Physical Therapy, and this past Combined Section's Meeting established the “Anne Shumway-Cook Lecture—Translating Neurorehabilitation Research Into Practice,” reinforcing the Neurology Section's commitment to translate knowledge from research in order to inform and advance neurological physical therapy practice.
The exchange within the international rehabilitation community is growing, with an outreach that is truly remarkable. Five years ago the greatest number of international visits to the Section's Web site came from Canada, the United Kingdom, and Australia; this year China and the Russian Federation were the countries with the highest visits. Because of exchange with our international colleagues at IIISTEP, Section members initiated motions in the House of Delegates to adopt the International Classification of Function (ICF) as the disablement framework for US physical therapists. The latest revision to the American Physical Therapy Association's Guide to Physical Therapist Practice includes the ICF.
The ready access to information provides us the opportunity to receive as well as share clinical and research knowledge; thus, the lessons of IIISTEP have rapidly penetrated into the lexicon of physical therapy. Concepts such as neuroplasticity, the potential for functional recovery after injury to the brain or spinal cord, and the effectiveness of rehabilitation approaches that challenge the nervous system are accepted. Evidence applied to practice has created exchange among us that challenges some of the tenets of the past. Clinical research findings reveal important principles of learning and exercise that will lead to new foundational knowledge for neurorehabilitation practice.
Innovations in rehabilitation have resulted from National Institutes of Health–funded trials. For example, constraint-induced movement therapy and the use of treadmill training with body-weight support are examples of treatment modalities that engage a patient in intense forms of task practice that are more effective for improving functional outcomes than usual care. However, more important than the mitt or the treadmill are the principles that can be applied to physical therapist practice. These types of interventions reveal the importance of practice and task-specific training; these findings do not suggest that other forms of exercise such as progressive strength and balance programs are not effective. Rehabilitation research informs but does not dictate practice.
Learning to ride a bike is an analogy that clarifies how motor learning and exercise principles, illuminated by rehabilitation research, can be translated to clinical practice. To ride a bike, a person must have the capacity to pedal with the legs, balance on the seat, and attend to the environment in order to ride the bike safely in the community. Strength training, progressive balance activities, and increased attentional demands during motor tasks would not result in the ability to ride a bike. To ride a bike requires the strength and balance capacity to meet task demands; however, it also requires practice at riding the bike.
Thus, it is not the mitt or the treadmill or a gymnasium full of high-technology equipment that results in rehabilitation for the person with nervous system damage. It is the interaction of a skilled therapist who can apply exercise and motor learning principles to their practice, the determination of the person affected, and the support and involvement of the family that brings recovery to life. Despite advances in the science and practice of neurorehabilitation, health care disparity including access to rehabilitation services and rehabilitation providers has grown.1,2 As a global rehabilitation community, we must all contribute to the continued and accurate understanding of the value of rehabilitation. Advances in medical technology will save or prolong life; however, it is rehabilitation that returns life to the child or adult whose life has been saved, wherever that may be in our global community.
1. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
2. Field M, Jette AM. The Future of Disability in America
. Washington, DC: National Academies Press; 2007.