AMONG the unsung heroes of the Covid-19 pandemic are physiotherapists, many of whom are currently engaged in post-Covid management. Others continue to make the sacrifice and aid patients along their journey to functional ability regardless of their vaccination status.
“Physiotherapists play an integral role in healthcare,” said president of the Physiotherapy Association of Trinidad and Tobago (PATT) Dr Wynelli Pierre.
But for too long, many have been oblivious to their exact role and function. According to Pierre, physiotherapists are university educated medical professionals that are experts in restoring, maintaining and improving not only a patient’s function but their quality of life.
Physiotherapy has long been associated with muscle and bone injuries but the field is much broader than one might imagine. It involves the assessment, diagnosis, treatment and rehabilitation of a wide scope of diseases, disorders and conditions that affect the musculoskeletal (bone, ligament, tendon muscle), cardiopulmonary (heart and lungs) neurological (brain, spinal cord and nerves) and integumentary (skin), said Pierre. Physical therapists also provide respiratory physiotherapy in Intensive Care Units, thoracic wards, outpatient clinics and hospice palliative care.
Some of the most common conditions that require treatment by physiotherapists include strokes, post knee or hip surgery, urinary incontinence in males and females, diabetic wounds, post burns, post amputation education and care.
Physiotherapy in T&T has a long history. In an article titled ‘A Country of Services 1858-1958’, I D Waterman stated that as far back as 1935, an English-trained nurse - Ms Wolfe - was appointed as superintendent sister of the Massage and Physiotherapy Department in Port of Spain General Hospital.
The field of physiotherapy later gained recognition on the national level back in 1954 when T&T was in the grip of a polio outbreak. Marjorie Lasalle and Amber Wooding-Thomas were pioneers of the profession in T&T. The work they did was groundbreaking because at a time when rehabilitation of polio patients was paramount, it demonstrated without a doubt the extent to which physiotherapy can improve the mobility of such ones.
“The public then began to appreciate the value of physical therapists as part of the medical team,” said Pierre.
Twenty years after the polio outbreak in T&T the Physiotherapy Association of Trinidad and Tobago was established but it was not until 1991 that it became a registered company. PATT has been a member of World Physiotherapy/World Confederation for Physical Therapy (WCPT) since 1999.
It is important to note that to practise in T&T, one must be licensed and registered through the Physiotherapists Board of T&T which is a separate legal entity under the Council of Professions Related to Medicine.
Pierre, a doctoral degree registered physiotherapist with a specialty in Aquatic Therapy, was recently elected to serve as president; she served previously on the executive committee as president between 2015-2017.
Her goal as president is to continue advocating for the profession and ensure the provision of courses and symposiums through which physiotherapists can edify the standard of the profession.
In the face of the Covid-19 pandemic, physiotherapists are also working alongside doctors and nurses as they help Covid patients recover. When Covid patients are well enough to be discharged from hospital and return home, they are often ‘deconditioned’ due to their decreased lung function and the significant impact of the symptoms related to the virus. They may require both physical and respiratory rehabilitation. This is where physiotherapy comes in.
“According to the World Confederation for Physical Therapy, ‘Long Covid’ is known as a multi-system disease with the presence of signs and symptoms that develop during or following an infection consistent with Covid-19. It has over 200 symptoms which occur in variable combinations and can fluctuate in predictable and unpredictable patterns.
These can affect persons long after they have been discharged from hospital or even those recovering at home. Physiotherapy can help to provide individualised treatment strategies for patients based on the symptoms they are experiencing.
One of the most common symptoms is shortness of breath, therefore breathing exercises specific to that particular person, will help to improve a patient’s lung function, as well as manage their already developed levels of anxiety and stress,”explained Pierre.
Because the understanding of Covid-19 continues to evolve, physiotherapists have been on a constant learning curve - which is not unusual in the medical profession.
“Post Covid management is not a clear cut case, there are no straightforward protocols. What may work for one patient may not work for another,”said Pierre. “Physical therapists will use their clinical skills as well as current scientific evidence to guide the treatment they provide for each patient. The main goal of the physiotherapist is to improve the quality and function of the patient’s life.”
The global health crisis has revealed a concerning pandemic fallout; physiotherapists are seeing more cases of scoliosis in persons between the ages of 20-40. This is as a result of the shift from face-to-face interaction to a more online based environment for both employees and students.
“We are now seeing an increase in more musculoskeletal disorders regarding neck and back pain. This is due to the increased hours of sitting at work stations from home coupled with the decreased levels of activities or breaks,”said Pierre.
“Our role in regards to these complaints is through patient education where we would advise on setting up workstations at home that can reduce their problems. Also, through referred diagnosis we would be able to assess and provide a tailored rehabilitation programme.”
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