Kathmandu:

The branch of medical science that treats physical ailments by concentrating on the physical movement and the functioning of the human body is known as physiotherapy. Patients who require physiotherapy are those with permanent disabilities, who have lost the function of their limbs due to an accident, or those with disabling conditions like arthritis, heart disease, head injuries, cerebral palsy, and low back pain.

A physiotherapist builds up a complete treatment strategy after doing a comprehensive assessment of the problems faced by the patients. They have a detailed knowledge of how the human body works, the healing process and can distinguish between normal and abnormal posture, balance, movement and function.

Physiotherapists provide rehabilitation by developing and restoring body systems, in particular the neuromuscular, musculoskeletal, cardiovascular and respiratory systems, enabling patients to improve their movement and function.

They treat patients of all ages for a variety of conditions like injuries and fractures (including sports injuries), orthopaedics and joints, strokes, post-surgical rehabilitation, intensive care or terminal illness, abdominal conditions, chest conditions, posture and movement, neurological conditions, learning difficulties and even mental illness.

Job responsibilities:

The job of a physiotherapist is physically very laborious as it involves physically lifting and supporting patients. They require strength and high fitness levels. Their day-to-day job involves relieving patients of pain and helping them recover from specific physical ailments.

A hospital needs physiotherapists in different departments, from general outpatients to pre- and post-operation cases. At the pre-operation stage, they help the patient clear the chest with deep breathing exercises, and in post-operation they help in mobilising the limbs. A physiotherapist needs to coordinate with other doctors like orthopaedic and neurosurgeon and in order to know about the patient’s medical situation and background. They also have to supervise their assistants regarding the treatment plan formulated by them.

The job responsibility of a physiotherapist includes —

• Planning the treatment course according to the patient’s requirement.

• Implementing the treatment including exercises and other modalities.

• Collecting the patient’s statistics and evaluating the progress.

• Writing the case notes and maintaining the reports.

• Educating both the patients and their carers about the treatments being used and what they can do at home to prevent or improve the condition of the patient.

• Keeping up to date about the new technologies that can be useful for the treatment of their patients.

A physiotherapist also works with mentally- and physically-challenged children and elderly people with mobility problems. They also help patients get acquainted with assistive walking devices like wheelchairs and crutches.

“The treatment process can be both long-term and short-term. We use physical exercises and different modalities for the treatment,” says Dr Kushal Ranabhatt from the Norvic-Escorts Health Care and Research Centre.

The modalities used are Ultrasound Technique, Electrical Muscle Stimulation, TENS (Transcutaneous electrical nerve stimulation).

The timeline of the courses depends on the type of injury or the problem. For neurological problems, the courses are generally of long-term than that for orthopedic ailments. For fracture injuries, patients have to visit the doctor every session, while for degenerative cases they can learn the physical exercises and do them at home.

Physiotherapy in Nepal

Although in foreign countries, physiotherapists are doing consultancy work in schools, offices and certain communities where people are at risk from injury from their occupation or activity, in Nepal physiotherapy is limited just to the hospitals. However, the potential is ever growing with more and more patients being referred for physiotherapy.

Dr KP Nepal from TU Teaching hospital says, “In the past even if people had minor trauma associated with stiff joints, they never regained full functioning of their body parts because of lack of guidance for specific exercise. It is not so nowadays as physiotherapy is referred.”

Despite this independent practice has not been possible. All physiotherapists are attached to hospitals and only work on referral cases.

Dr Kushal Ranabhatt from the Norvic-Escorts Health Care and Research Centre says, “We should make an effort to reach the district level. The government needs to allocate seats in hospitals.”

The other obstacle is that the four-and-half-year-long bachelor level education for physiotherapy is not available in Nepal, though diploma and certificate courses are being provided for the post of assistant physiotherapist and physiotherapy helpers.

Nepal also does not provide specialisation course. “Every other field has a post graduation course but we still lack even the graduation programme within the country due to lack of proper attention from authorities concerned,” says Dr Nepal.

All physiotherapists who have completed their Bachelor in Physiotherapy (BPT) should register themselves at the Nepal Health Professional Council for practice.

As the full potential of this field is yet to be exploited, the scope is definitely high. For all physiotherapy aspirants, the only advice from seniors is to focus on quality and be prepared to face competition.

What makes a good physiotherapist:

Unlike other areas of medicine, there is a regular check-up routine for treatment in physiotherapy. Further a physiotherapist has to work in a team as there will be regular liaising with other doctors.

Dr Anupama Poudel from B and B hospital says, “Communication skill and an amicable personality is a major plus point as the profession is very people-oriented.”

Other qualities one should have to be a good physiotherapist are —

• Ability to establish a good rapport with the patients and to have an empathetic approach toward the patients.

• Ability to be convincing, encouraging, sensitive and tactful.

• Pragmatic with logical reasoning and fine problem solving skills.

• Strength of mind, patience and physical stamina to work long hours.

• Good observation power, tolerance and dedication.

• Should be able to cope with occasional disappointment and frustration, and deal with the fact that patients do not always get better.