The future of physical therapy could be in danger unless the profession opens up to thinking from across the academic spectrum, according to David Nicholls of the Critical Physio Network.
The focused symposium Critical physiotherapy: new approaches for practice, education, research and policy brings together a panel of five therapists to see how thought from philosophy, history, economics and the humanities can challenge and improve physical therapy today. The aim is to interrogate the very essence of clinical thinking and practice.
“Critical thinking is a part of everything that physical therapists do,” says David Nicholls, associate professor at the School of Public Health and Psychosocial studies at AUT University in Auckland. “It's just that some physios do it despite their training and practice, as opposed to because of it.”
Far from being a negative process, critical physiotherapy creates a positive discussion around how the profession has been shaped by certain ideas in the past, in order to decide what it should focus on in the future. “We're not talking about destroying something or pulling it apart,” says Nicholls. “There’s an element of deconstruction, but critical physiotherapy is asking ‘why do we do these things, and not others?’
“Take the notion of movement. Most would say that the idea of movement is at the very core of physiotherapy. And yet you can have movement at a cellular level, when fluids move between cells in an osmotic motion, right up to the other end of the scale: massive social movements like diasporas and migrations. From a critical point of view you might ask why physical therapists have chosen to focus on just this bit of movement, the bit that's just about flexion and extension of the elbow? Why did we pick that bit, and not other bits?”
The key to this kind of broad thinking is for therapists to study other academic disciplines before returning to physical therapy. The Critical Physio Network consists of therapists who have complemented their classical biomedical training with further study in other fields. The network was set up in 2014 with modest membership expectations. Within a year 300 people had joined, and there are now 500 members from 29 countries around the world.
“One of critical physiotherapy’s basic premises is that you leave physiotherapy for a while, you go outside,” says Nicholls. “Most of the people in the network have at some point gone away and studied the humanities, or they’ve studied history, or they’ve studied philosophy or they’ve studied politics. But their passion for physiotherapy has made them come back with that knowledge. It’s like they’ve gone travelling.”
Also speaking at the session are South African audiologist and language therapist Mershen Pillay, Barbara Gibson from the University of Toronto, and post-doctoral therapist Jenny Setchell from the University of Queensland.
Dr Gibson’s work focuses on children’s rehab and the very idea of rehabilitation itself. She asks what the idea of ‘normal’ means in the context of disability, challenging the convention that says every person should aspire to a standard of mobility. Certain standards may not be appropriate to every child.
“She challenges the idea of how physical therapists engage with the idea of ‘normal walking’ as the ideal bipedal upright,” says Nicholls. “If we were to relinquish that idea and think about the joy of movement in all its forms, it might change the way we rehabilitate children and the years of work and effort and pain they go through.”
Dr Setchell, meanwhile, examines the idea of ideal body shape and stigma around weight, asking how attitudes towards body size might change for the better. Physical therapists may inadvertently stigmatise patients through embedded expectations of what a normal body should be.
“The curriculum itself promotes an idea of an idealised body shape and form,” says Nicholls. “What Jenny’s talking about is the ways in which that stigmatises people who might not necessarily be that idealised body shape. It creates a distance between patients and the therapists, because they feel judged. She’s arguing that that’s not good, from the point of view of therapeutic practice.”
Looking at the future of the profession, Nicholls highlights a number of technological and economic developments which physical therapy will eventually have to adapt to. An increase in driverless cars could, for instance, reduce the total number of traumatic brain injuries worldwide. Advances in genetic modification could minimise the instance of congenital diseases, while innovations in prosthetics could drastically change physical therapy’s role in rehabilitation.
In keeping with the positive critical spirit of the network, though, Nicholls is optimistic for a physiotherapy that can keep pace with a changing world.
“There isn’t anyone better placed than physiotherapists to adapt to the changing economy of healthcare,” he says. “Physios are in exactly the right position – the only problem is that they don’t know it.”