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The Power of Words

Field-Fote, Edelle PT, PhD

Journal of Neurologic Physical Therapy: June 2009 - Volume 33 - Issue 2 - p 67
doi: 10.1097/NPT.0b013e3181a70c4e
Editor's Note

We are in the midst of an evolution—some might even say a revolution—in the way we use language. This transformation is largely due to a growing recognition that words have the power to shape the way we think. Anthropologist-linguist Edward Sapir noted that “Human beings do not live in the objective world alone … but are very much at the mercy of the particular language they speak. … We see and hear and otherwise experience very largely as we do because the language habits of our community predispose certain choices of interpretation.”1 In recent years, our culture began a transformation toward more sensitive use of language. Collective awareness and respect for human rights have resulted in a change in the words that we use to describe individuals with disability. Accordingly, we are no longer building hospitals for “crippled” children and homes for the “retarded,” and although it was once commonplace to hear language such as “the stroke in bed 239A,” such expressions are no longer acceptable. Emphasis on the use of “person-first” language has emerged with the acknowledgment that people are not defined by their disabilities.

Physical therapists pride themselves on their ability to form collaborative relationships with those who seek our services. For this reason, many physical therapists eschew the term “patients,” choosing to refer to those they serve as “clients.” Increasingly, the term “patient,” defined as someone who is undergoing medical treatment or to whom something is done, is regarded as neglectful of the person's individuality, subjugating the individual to an identity characterized by their being under the care of another. For this reason, the Associate Editors and I have recently revised the JNPT instructions for authors to encourage the use of language such as “individuals with stroke” rather than “patients with stroke” as the former recognizes that the person is an individual and a partner in the healthcare process. Likewise, if the individuals to whom the reference is being made have consented to participate in a study, then the term “participants” is appropriate.

In light of the forgoing, I recently had a spirited and invigorating email discussion, with dear colleagues for whom I have the highest regard, about the use of the term “activity-based therapy.” I argued that this term is impotent, providing no information that would guide the reader or would-be practitioner. Back in the days when I was in Physical Therapy school, we had similarly amorphous terms, such as “derangement of the knee” and “organic brain syndrome.” However, as the sciences evolved to permit the identification, classification, and treatment of the many different disorders that were injudiciously lumped into these categories, these terms became obsolete. Those in clinical fields related to training and rehabilitation have much more precise and specific terms than “activity-based therapy” to describe the interventions that facilitate the improvements that we observe in functional performance. Our literature is rich with evidence of the effectiveness of interventions based on the principles of motor learning, task-specific training, and repetitive task practice, which involve structured training protocols developed with an explicit purpose. To relegate these protocols to the vague, amorphous category of “activity-based therapy” confounds the reader and does a disservice to those who strive to base their protocols on the best available evidence. It would be a pity for us to regress our language simply because a term has become a popular catchphrase.

Language is powerful; improperly used, it can confuse and obfuscate. Properly used, it can clarify and illuminate. I advocate for the latter; let us resolve to say what we mean and mean what we say.

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1. Carroll JB, ed. Language, Thought and Reality: Selected Writings of Benjamin Lee Whorf. Cambridge, MA: MIT Press; 1956.
© 2009 Neurology Section, APTA