Kinesiotherapy: Past, Present, and Future

Kinesiotherapy: Past, Present, and Future

The need to write this article has been on my mind for quite some time. All kinesiotherapists have a working concept of our discipline and our basic history, but I feel that many may not be aware of how it evolved from its inception to our current level of practice. We all know how the physical conditioning core that began in 1946 during the latter stages of World War II later transitioned to the Veterans Administration (VA) hospitals as Corrective Therapy following the end of the war. Physical Therapy, the discipline that we are most often compared to or confused with had begun as a formal discipline somewhat earlier than us, but still had not advanced very far beyond an on the job training discipline at the time of our inception. Early in my career I worked with a physical therapy supervisor whose credentials were a ten month certificate she received in the Navy. She later completed a college degree on her own initiative. There are parallels in each of our disciplines as they evolved and over time had developed a refined education curriculum.

When I began my career in 1967 at the VA hospital in Indianapolis, Indiana Corrective Therapy had only been in existence for just a little over twenty years. Most of the original corrective therapists were still actively involved in the field. As a matter of fact, Paul Roland, one of our founding fathers hired me. These early corrective therapists were true innovators in that they conceived and developed many of the therapeutic exercise approaches that eventually emerged as standard treatment during that period. If you look back through old VA manuals you will see evidence of this. They were especially quite adept at developing exercise equipment and apparatus to meet specific needs. They were also very passionate about their discipline. Our Annual Board of Governors meetings during that time lasted two days and I can remember observing many passionate and spirited debates that often continued well past the dinner hour on the second day. It saddens me somewhat when I attend our current annual general assembly meetings and the primary concerns of many of our attendees are (1) are we providing coffee and doughnuts for breakfast, and (2) is there any way that we can reduce a two hour presentation down to ten minutes. We desperately need to regain the passion of our predecessors.

Looking back on the evolution of Kinesiotherapy (Corrective Therapy), a fundamental mistake we made was initially focusing exclusively on VA employment. This was understandable in that World War II engaged the greatest number of military personnel in United States history, second only to the Civil War. Compounding that need, the Korean conflict began as World War II was concluding. As a result, the rehabilitation needs for veterans was extensive. Jobs for corrective therapists were quite plentiful and appeared to be never ending. Students from our university based programs were being grabbed up as fast as they could graduate. Corrective Therapy became a tight knit fraternity. By the mid 1970s when we realized the need to begin expanding our scope of practice into the private sector, many opportunities had passed us by. Physical Therapy, on the other hand, had begun in the private sector and had continued to expand.

Over the years the kinesiotherapy discipline has met numerous challenges; several have been threatening; others have been just downright annoying. Most of these threats were underhanded and driven by ulterior motives. For each crisis that occurred, a nucleus of kinesiotherapists would come together with an intervening solution to effectively deal with or resolve the issues. The reason we were always successful is that there were always those willing to step up and meet the challenge. Most often it was the current president of our association who would lead the charge and mobilize the right persons for the task at hand. Over the years I had the opportunity to work with many of these individuals and to also help alleviate many of these crises. Facing and overcoming each of these challenges always left us in a stronger position than before. In most instances, we developed some essential documents that further refined our discipline, and proved useful in future crisis interventions.

In 1984 when I was ACTA President, I had one of these unique opportunities to intervene in a crisis. I was less than 6 months from finishing my term in office and the year had been fairly routine up to that point. One Monday morning I received a call from Warren Smith, our VA Central Office representative at the time, informing me that a proposal had been submitted to the Chief Medical Director in VA Central Office, specifically outlining a plan to eliminate all of the corrective therapists in the VA and replace them with physical therapy assistants. The consensus was that this proposal was being given serious consideration. I immediately contacted the Chief Medical Director and was granted an appointment to come in and meet with him. With the assistance of Leonard Greninger and Mickey Woodhouse, we developed an extensive rationale to explain the need to maintain corrective therapy and to explain how elimination of our services would be detrimental to veteran care. Our meeting was successful and as always we gained from the experience. Following our meeting we then went to the offices of the Chairs of the Senate and House Veterans Affairs Committees and met with their representatives to inform them of our position and to make them aware of who we were and why we were viable. I can still remember the exhilaration of that day. Over time other crises emerged and were met with effectively. The key point to take away from this is that with each experience our discipline was strengthened.

In my opinion, kinesiotherapy is still a viable discipline, but we need to regain the focus and zeal of our founding fathers. We need to become innovators as opposed to imitators. A weakness of the therapy group we are most often compared to may indeed be their lack of imagination. They often tend to look for established treatment approaches and then base their practice around it. I remember several years back when Pilates became trendy, that our therapy counterparts began building their treatment practice around Pilates.

Perhaps the most distinguishing trait that has always set us apart from others, most specifically in the VA setting, is our “can do attitude”. Numerous physiatrists over the years have personally told me that they prefer to work with kinesiotherapists because they don’t argue; they don’t reject work assignments; they just go about doing their job. In essence they are proactive as opposed to being antagonistic.

When answering the continuous question of “What is the difference between kinesiotherapy and physical therapy?” we generally explain that while physical therapy uses a variety of treatment modalities we focus exclusively on exercise. This of course is in essence, the correct answer, but it could possibly be interpreted as limiting on our part. We need to seek ways to present our unique exercise approach as an advantage and something that we are uniquely qualified to administer. As our definition implies, we adapt and modify scientifically based exercise principles. We also need to become aware of those within our field who were innovators in exercise application. One such individual was Robert Shelton who coined the term kinesiotherapy. Another was Bob Gajda who studied under Robert Shelton. Bob Gajda was able to take Shelton’s basic principles, expand on them, and in turn develop several unique methods of training that are in use today. Bob in turn has trained numerous kinesiotherapists who have become highly recognized for their expertise, most specifically Doug Klieber and Terry Roach.

I had the opportunity to meet Bob Gajda many years ago and develop a friendship with him. On numerous occasions I would drive to Chicago just to meet with him, observe his clinical practice, and listen to him explain his rationale for his exercise concepts. In addition to Bob’s knowledge and unique way of explaining things, his most mesmerizing trait was his sheer passion for what he was doing. I know a young kinesiotherapist practicing today who made his decision to seek a degree in Kinesiotherapy after reading Bob’s book entitled “Total Body Training”.

What I have presented is just a snapshot of the conception and evolution of our profession. In time, I plan to write more extensively about these issues. The point I want to make at this time is that we the current practicing kinesiotherapists control our destiny. Rather we sink or swim will be determined by either the regaining of our passion or our total loss of it. I have committed the past forty five years to kinesiotherapy and I am willing to commit the next forty five years. There are lyrics from a Willie Nelson song that states, “You were always on my mind.” Kinesiotherapy is always on my mind, even during times when my intensity wanes, I cannot escape it.

We need all members and most specifically the younger members to make a concerted effort to get involved with the management and continuous improvement of our discipline. I have always approached this as a marathon as opposed to a sprint. This is an ongoing process. Early in my career, I made a conscious decision to get involved in the organizational structure and management of our profession and to remain involved. Many other members such as Doris Woods, Bridget Collins, and Loralee Hansen are still tirelessly doing so. There are many others as well who made tremendous contributions.

Becoming involved in the leadership of a group or organization does not always result from an organized well thought out plan. I remember driving from Indianapolis up to Battle Creek, Michigan to attend a regional corrective therapy meeting just to see what this was all about. When I left to come home the next day I was vice president of the regional chapter. I still have not quite figured out how that happened. However, that was the impetus that I needed to get going. On another occasion, I volunteered to be our liaison to the National Strength and Conditioning Association. The AKTA Board told me that what they really needed was for me to assume the duties of our Certification Director. I did not feel that I was prepared for that but I took on the challenge and learned from it.

What is critically needed if we are to remain viable is for all members to make a personal commitment to improving our profession. Consider applying for a position on the AKTA Executive Board or the Council on Professional Standards. Other ways to contribute include writing a scholarly article for publication, engaging in a research project, or volunteering to take on a specific task assigned through the AKTA Executive Board. However, perhaps the most significant contribution that any of us can make is to remain passionate about our profession at the base practitioner level.

Achieving state licensure is another task that we need to continue to pursue. The late Bill Chambers is legendary for his efforts to achieve licensure for kinesiotherapy in the state of Mississippi. Bill came very close on at least two occasions. Had it not been for his untimely death, he might very well have achieved it by now. Most recently, committed kinesiotherapists have pursued licensure in Ohio and Virginia. In each of these cases, although the effort fell short, the experience gained will be most beneficial in future attempts. We can build on this experience. We all know that in 1995 the Commission on Accreditation of Allied Health Professions (CAAHEP) officially recognized kinesiotherapy, which in turn led to the development of nationally, recognized accredited Kinesiotherapy programs. What many may not be aware of is that prior to that 1995 achievement there were at least three failed attempts to gain this recognition. I was involved in two of them. However, we were able to build on each failed attempt until we ultimately succeeded. The same thing can happen with the state licensure effort if we continue to diligently pursue this goal. I firmly believe that it is attainable.

Another area that we need to continue to diligently work on until it is resolved is the issue of third party reimbursement. Over time we have made improvements in this area, but we along with many other viable groups are currently shut out from Medicare reimbursement. We are continually working to some extent with several of our peer groups to overcome this. Much of what we have accomplished in understanding and further entrenching ourselves as a viable reimbursement alternative is due to the efforts of Mike Westmoreland. All of us need to personally thank Mike for his efforts and work to build on what he has established.

During the past few years we have developed a good working alliance with the Medical Fitness Association (MFA). We currently partner with them to conduct our Annual Conference. Our Executive Director, Melissa Ziegler is working closely with MFA to expand employment opportunities for employment of kinesiotherapists in medical fitness facilities. Employment of someone with our unique ability to adapt and modify exercises to accommodate those with functional limitations would be an asset to these facilities as they work to expand their client base.

As a final note on getting involved, as the Coordinator for the Council on Professional Standards for Kinesiotherapy, I am willing to mentor someone who would be interested in learning about the procedural functions in preparation for a future position on the Council. If you are interested, please contact me and submit your resume. However, bear in mind that I am not looking for someone who wants to put in a year or two just to pad their resume. This position will require a commitment of some of your spare time. Just remember my philosophical approach is that the pursuit of our goals is a marathon, not a sprint. If you knock on enough doors you will make a sale; or remember in that memorable race, the turtle eventually beat the rabbit.