Technology

The Physical Therapist 3.0 integrates manual therapy with instrumental therapy. Today, he has to be able to use a computer and interact with the world of information.

For a patient, finding out his/her diagnosis is a pathway of consultations to determine what happened to him/her. Furthermore, he/she wants to understand the reason behind his/her injury. The therapist combines the information that is given to him/her by the doctor, who first evaluated the patient, with the data he collected through his functional evaluation.

By doing so, he is able to create a database that can be consulted at any time. This allows the therapist to check at any time the effectiveness of the rehabilitative-therapeutic process and to adjust the time and energies that are involved.

This constant feedback provides confidence to the therapist that is performing the treatment, but also to the patient, making him feel monitored and cared for.

Keeping track of what is being done and what has been done is crucial to find replicability and reproducibility of treatments.

If you are a freelance worker, you are the one that asks questions and gives answers. However, if you are in a group at a 1st level recovery and functional rehabilitation center, how can you effectively communicate with others? How is the information passed on? Does the patient always work with the same therapist or does he/she go from one therapist to another?

Technology means precision, being organized, identifying the objectives, time optimization and most importantly, a working system that is the same for everyone… The brain, however, must be turned on before turning on the machine.

A therapist with technologically advanced scientific tools is able to achieve the goal in a short amount of time, to maintain the progress by educating the patient, and to keep improving by integrating manual and functional therapy.

We created an integrative system of tools that, once a solution has been found, allows us to measure dysfunctions.

Regarding biological damage, we have different devices that a doctor uses to confirm the diagnosis (diagnostic tests). As therapists, we need instruments that can measure function or that can, at least, give us information on the pathophysiological mechanism that leads to pain and to the actual pathology.

After 20 years of research and consulting in the world of professional sports, I discovered many different tools of analysis with different levels of complexity. I would like to sum them up into 2 groups:

  • Devices that are accurate and reliable but provide results that require a long time to be evaluated and analyzed.
  • Devices that are fast and easy in terms of analysis but that did not go through a validating process and are not accurate and replicable.

 

It was not easy, but throughout my long journey I was able to identify different devices that give a fast, accurate and replicable evaluation:

  • Stabilometric Platform ARGOPLUS
  • Body Impedance Analysis IN BODY 770
  • Cardiac Variability HRV SA 3000
  • Global Postural Analyzer GPA
  • Hand Grip JAMAR

 

The tests that can be done with these devices are quick and are also supported by software that allow data analysis. They do not measure fitness levels, but there are many other devices that allow us to do so. We come in right after a medical evaluation, thus we analyze the patient in a subacute state and we identify his/her critical and weak points (postural or proprioceptive alterations), as well as his/her abilities and strengths.

After 10 years of using these devices in the field, we have been able to identify who is more predisposed to healing and who struggles a bit more. This allows us to choose the best treatment and adapt the therapeutic-rehabilitative process for each patient.

We created the idea of “functional and technological evaluation.” First we analyze the rehabilitative treatments and then, through follow-ups, we are able to identify what worked better based on the results. This allowed us to continuously check the effectiveness of our work, turning every pathology into a challenge to solve the problem.

 

Instrumental Physical Therapy

In the last 20 years, thanks to the great technological advances, we witnessed an incredible evolution of Instrumental Physical Therapy devices.

Mine was a school of manual therapy and, at the time, the devices were of really poor quality and not effective. In fact, the therapeutic-rehabilitative process was 20% physical therapy and 80% manual therapy. There was not an actual 3-year physical therapy school like there is today, and the therapist could be compared to a factory worker who had to sweat and work really hard in order to carry out his job.

Today patients’ demands have changed, and the need of a fast recovery requires us to have all the information and tools that can allow us to do so. By only using our hands we can be effective, but not fast.

Consider this: how many patients can a physical therapist treat in 8 hours of work? Can he maintain the same physical and mental efficiency from the first patient of the day until the last one? In a center where there are many different people working, can a therapist always follow the same patient? Can we give the same information to our colleagues when we need to pass a patient onto them? What about applying the same kinesitherapy?

Working with others is a really complex process. The medical environment is always more oriented towards performance rather than the therapeutic result. This always results in the patient losing confidence and trust towards the therapist.

Ironically, technological advances in physical therapy offer us a new point of view, allowing us to adopt systems that take advantage of weighed physical energy and defined by wave power, frequency, and length.

These protocols, which are crucial for working with other people, allow us to pass on the right information for every patient. By doing so, even if a patient goes from one therapist to another, the devices can maintain replicability (therapeutic power) as well as reproductivity (applicative reason) thanks to the references we have on the application zone.

Thanks to technological innovation we can be efficient without side-effects. With all the safety measures, we went from the idea of medicine to the one of therapy. This working method focuses on the coherence of the energy applied with objective values, resulting in much more reliable data for clinical research.

Another really important aspect is the incredible number of technological devices that have flooded the Italian physical therapy market. Many of these are no more than just “toys” with questionable effectiveness to achieve what they claim to do. Some others, on the other hand, were created by actual research engineers and companies who wanted to produce high-quality devices.

Physical therapy means using physical energies with wave power, frequency, and length properties that are able to modify the equilibrium of biological tissues.

The concept of applying physical energies is fundamental for a physical therapist that already utilizes manual therapy, but who often cannot identify the optimal dose-effect relationship. This can cause insecurity to a physical therapist that is trying to define a strategy, limiting his choices.

With manual therapy we can promote functional recovery, but it is not enough to promote biological recovery. In fact, when working with inflammation or lesion to the biological tissue, drugs need to be used. When there is a severe lesion to the tissue, help from orthopedic medicine is necessary.

In these 20 years of experience at different levels, technology has developed dramatically. Not only to design and develop high quality physical therapy devices, but in some cases also to promote scientific research. However there was just a small impact on clinical research, especially because the physical therapist is not used to work with specific values, thus not using what the Anglo-Saxon school defines as outcome research.

In a specific sector, these systems were integrated, both the value of analysis and, more importantly, the technological functional evaluation with the latest physical therapy devices. In these environments, sports medicine was able to face what we call as Fast Track Rehab, thus interacting with all these new technologies in order to recover faster from an injury. With ultrasound we are able to accurately identify biological damage, and when ultrasound is not enough we can use MRIs and CT scans.

With all these tools, a sports physician can collect a lot of information and can discuss them with other therapists who are working with the same athlete, focusing on the rehabilitation track, which has a beginning, a progression, and an end. By doing so, he is able to collect what is defined as EBP clinical evidence.

These mechanisms are studied in clinical research. Unfortunately, due to the speed with which modern engineering develops new systems and to the high costs of scientific research, these technologically advanced devices are not used in the most efficient and effective way. This not only penalizes the manufacturers, but also the whole physical therapy and rehabilitation field.

In order to better explain the importance of instrumental physical therapy I give you this equation: instrumental physical therapy is to the therapist as the drug is to the physician.

In this section of the website I am going to describe different devices that I have been using for some years, for which I have been able to test and verify the therapeutic effectiveness during my patients’ rehabilitation process. I did not base my work solely on these devices, but the reason why I used them is because they went through a process of technological and scientific research. They allowed me to identify dosages, so that I was not the only one that had references and guidelines to patient responses.

In my line of work I was also responsible for teaching, both in Italy and abroad, and I heavily focused on the repeatability/replicability of treatments. This is because I want other physical therapists to be able to achieve the same clinical results that we achieve in our rehabilitation center.

The creation of our rehabilitation center in 2006 pushed me to study and research what was actually effective, and not base myself solely on what others were claiming to be effective. This is why I created a 1st level pilot center of recovery and functional rehabilitation.

 

Different types of devices for instrumental functional therapy

Today we are able to define the characteristics of the devices we have in Italy and we divided them into 4 categories.

1) Devices that act on acute pain and biological damage

  • Frems (fisiofrems – speeder)
  • Ultrasound
  • Magnet Therapy
  • Laser LLL
  • Laser HP

2) Devices that act on functional damage in combination with manual therapy

  • Diathermy
  • Electric stimulation for amyotrophy and partially denervated muscles
  • Mechanical sound vibrations (vibra)

3) Devices that act in combination with therapeutic exercise

  • Mechanical sound vibrations (vibra)

4) Devices that act in combination with rehabilitative exercise

  • Anti-gravity treadmill
  • Robotic systems for balance exercises and proprioceptive exercises (HUNOVA)
  • Electrical-mechanical beds for postural training
  • Gym

 

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