Aged care as a bellwether of future physiotherapy

Abstract

Aged care is becoming an increasingly significant feature of health care, but it is not an area physiotherapists have traditionally favored. Aging populations of increasingly chronically ill people represent the most important community of need in health care however, and so physiotherapists risk being marginalized if they do not adapt their practices to meet this growing need. Aged care may therefore represent a testing ground for a new physiotherapy, and the lessons learned in reforming physiotherapy for older adults may extend to all aspects of practice. In this paper, I explore how our current approach to aged care came about, and make the case for change. Having critiqued biomedicine, I also argue that the newer holistic models of health care are equally inadequate, because they attempt to dissolve important philosophical differences between physical, experiential, and social paradigms into an amorphous whole. I argue that these 'embodied' models of health make a holistic approach to aged care impossible and, instead, suggest new materialism and object-oriented ontologies as alternative physiotherapy paradigms.

Care in physiotherapy – a ghost story

“…Along with dramatically increasing the demand for massage services, these events also reinforced the search for treatments that required fewer resources --while being capable of returning soldiers speedily to the front and rehabilitating polio patients. In this context, massage was seen as excessively comfortable and passive, even as something that might discourage patients from making the effort necessary for recovery (Nicholls, 2018a). Overall, these events tended to reinforce the focus on cure and recovery.…”

“…Physiotherapists utilize different forms of touch through massage, assisted movements, mobilization, and manipulation. However, the profession tends to frown upon passive forms of therapy that do not require an active effort on the patient's part, and where the purpose is simply to create relief and increase the patient's well-being (Nicholls, 2018b;Nicholls & Holmes, 2012).…”

“…Subsequent events, particularly polio epidemics and the multiplicity of injuries generated by the First World War, contributed to the further development of physiotherapy as a profession (Nicholls, 2018a). Along with dramatically increasing the demand for massage services, these events also reinforced the search for treatments that required fewer resources --while being capable of returning soldiers speedily to the front and rehabilitating polio patients.…”

“…In both countries, physiotherapy practice was closely affiliated with medicine. Recovery was seen to result from physical exercises (gymnastics), discipline, and the individual's own motivation to make an effort (Nicholls, 2018a;Nicholls & Holmes, 2012;Ottosson, 2016;Thornquist, 2014). This tended to involve a conscious demarcation, a reconfiguring of both the ends (recovery) and the means (exercise) to enable both to conform with clear categories and measurable standardsdrawn largely from a biomedical vocabulary.…”

“…The primordial role of Cura, or Care, is to keep our body and our soul temporarily together, as a whole, throughout our life. This makes the myth a suitable inspiration for dealing with dualisms and an interesting starting point for rethinking care, both in the health sector as a whole (Kristeva, Moro, Odemark, & Engebretsen, 2018) and more specifically within physiotherapy (Nicholls, 2018a;Nicholls & Cheek, 2006).…”