英国における盲人に対する理学療法教育と業務

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Japanese Physical Therapy Association

NII-Electronic Library Service

JapanesePhysicalTherapy Association

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The

Education

and

Practice

of

Physiotherapy

by

Visually

Impaired

Persons

in

the

UK"

David

In

the United

Kingdom,

_{phy$iotherapy} offers a

professionalcareer forblind and _partiallysighted

persons inwhich they can enjoy _paritywith their sighted colleagues.

This

positionrefiects a history

dating

from the

late

Nineteenth

and early

Twenti-eth Century.

Early

History

'

In

!895

the

first

blind

students were

formally

trained inmassage inthe United Kingdom. Itwas

recognised that blindstudents had a _particular_gift

for

this therapy and training wa6 organised on a continuing

basis.

Even

from

these

early

days

those

responsible

for

the training stressed that parity

with simalarly trained sighted masseurs was

possi-ble.

In

1915 the Royal National Institutefor the Blind took over the responsibility for the school,

Since

that

date approximately

1,OOO

blind _persons

have entered the _professionwith fullyrecognised

qualificationson equal terms with theirsighted

col-leagues.

Prefessional

Recognition

In

1916

the

Incorporation

Society

of Trained

Ma$seurs

_(which

later

became

the

Chartered

Socie-ty of Physiotherapy) accepted

for

examination all

candidates from the Institute'sschool.

Over

the

years, during which the profession

developed,

visually impaired students have continued to com-plete the

full

educational programme approved by

the Chartered

Society

of

Physiotherapy.

With

the

Teager"

'

ptasICfoC･t6'fijkeisc"4mp7whthigffe\ff

H' _Vice _President,_W. _C._P._T.

('trtsupa\estltmemeesUftft)

Profession

Supplementary

to

Medicine

(1960)

Act

theschool was approved

for

theteaching of

physio-therapy

by

the

Council

for Professions

Supple-mentary to

Medicine

and students successful in

the

examinatien were admitted _to_the

State

Register.

These

developments

have

occurred against a

back-ground of a progressively

high

level

of secondary

education

for

visually

impaired

children so that

they can achieve the necessary university entrance qualifications. The development of special

gradu-ate teaching techniques and special aids and

appli-ances has enabled b!ind physiotherapists to

prac-tice

allaspects of _{physiotherapy} including

electro-therapy techniques. Today, with

the

development and availability of modern technologiealadvances,

including

the use of computers and speech

syn-thesisersmany ofthe

limitations

irnposed

by

visual

impairment

are even

less.

Visual

Impairment

Itisimportant to remember that the experience of visual

handicap

is

very individualand even two

people with identicalclinical conditions may see

differently.

Itfollows that allthose involved with

the

education of visually

impaired

people must

be

flexible

in theirapproach tomeet

individual

prob-lems

at

the

pointof need.

The majority of students trained at the North

London

School of Physiotherapy have partialsight resulting from a variety of eye conditions and as a result of accidents. Eye conditions range _through

Retinitis Pigrnentosa, Optic Atrophy, GIaucoma, Cataract and Albinism. The _phi!osophy of the

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422

ve#vazaG}k

school

is

to deal with the effect of the visual loss

rather than

by

the _perceiyed

dis'ability

resulting

frornthe eye condition.

WHO,

the United

States

of

America

and the

United

Kingdom all use

different

categories of visual impairment. The World Health Organisation

defines

"profound

blindness"

as

the

inability

to

count

fingers

at a

distance

of

10

feetor

less.

Par-tialsight

is

more

dithcult

to

define,

but

the

WHO

defines

"severe

low

vision" as the

inability

toeount

fingersat 20 feetor less.Throughout thispaperI

use the term

Visual

handicap

to

include

blindness and _partialsight. Itisalso important tonote that

thg

prevalence of eye conditions

is

different

in

vari-ous age _groups. More than 20,OOOchildren are

grow-ing

up in

Britain

with a visual handicap.

More

than halfof these youngsters have additional

dis-abilities such as

deafness,

physical

handicaps,

or

learning

difficulties,

which complicate their

educa-tional needs-this, of course, will

prevent

their entry to the_professionof _{physiotherapy.} Although

in

Britain nearly 1 million _people are blind or

partiallysighted

(worldwide

there are

421

million

blind

people) only a small proportion will

be

suita-ble

to enter theprofessionof physiotherapy,

The

keynote

of the successful education

pro-gramme

for

blind

physiotherapists

in

the UK

is

the

selection of only suitable students.

Selection

The specially designed residential assessment

programme was instituted in 1978. The

pro-gramme assesses

the

_qualityof mobility and spatial awareness, ability to respond appropriately

in

a

hospital

environment, _practicalskiils and manual

dexterity,

physical fitness,communication skills

and motivation to enter a caring _profession.

Stu-dents

must also comply with academic entry

re-quirements foruniversity courses.

Academic

con-cessions apply for the admission of mature

stu-dents. Intellectualability has to be accompanied

by

the development of study methods within

the

students limitatienof vision.

eg

2o

_gee

7

_g

The medical examination has been standard2sed

to

highlight

_potentialareas of difficulty,for

exam-ple,the prognosis of _progressive eye conditions.

Clinical

examination pays particular attention to

the

level

of other sensory abilitiesand other

neuro-logical

deficits.

In

making the assessment programme more

ob-jective

it

can also

be

applied

by

other admission

committees

in

other centres.

The

achievement

We believe that suitably selected educated and

qualified blind persons can continue to practice physiotherapy

in

parity with their sighted

col-leagues; blind _{physiotherapists}

have

won the re-spect of _patients,mernbers of the medical profes-sion _and colleagues.

If

the _practice

gf

physiothera-py by bl'indpersons istobe assured for thefuture

the

highest

possible standard of education and

prac-ticemust be confirmed ina continually

developing

profession. When the

Chartered

Society

of

Physio-therapy

decided

to move _to

internally

examined,

externally moderated educational programmes, the

NLSP-together

with all other schools of

physio-therapy in theUK had to re-design its_programme.

The

NLSP

took the oppertunity to

design

an

Hon-ours degree programme specifically for visually

im-paired physiotherapists. This was achieved

in

part-nership with the

City

University

of

London.

BSc

(Hons)

Physiotherapy

with

Human

Sciences

The degree programme was introduced

in

1989.

The

course aims topreduce competent

physiothera-pistscapable of exercising sound

judgment

in

a

va-riety of clinical situations, able to evaluate and

adapt therapeuticpracticetomeet patient needs.

1) Content

The course elements are _{physiotherapy} studies,

human sciences and clinical education.

2) Course Design

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stu-Japanese Physical Therapy Association

The

Education

an

dents receive theoreticaland _practicalteaching

in-tegrated with experience of working with _patient$.

Clinicaiexperience

is

gained

in

a number of

pre-mier hospitalsand clinics inthe

London

area.

3)

CourseAssessment

The course isassessed throughout the four _years

and allassessments, after the

first

year,contribute

to the final

degree

classification. The standard of

the course

is

monitored

by

the

Chartered

Society

of

Physiotherapy, the

Council

for

Profession

Supple-mentary to Medicine and two external examiners

appointed by the

University.

4) StaMng

NLSP has a high staff/student ratio and the

course operates a system of _personal,subject and

year tutors,each taking responsibility fora specific area of the course. Tutor$ are specialists in areas of thecourse and additional speeialist input is pro-vided

by

outside

lecturers

and consultant$.

5) Funding

UK

and EEC students are

funded

from

National

Health Service _grants and overseas students are

normally

funded

from government sources.

The

Royal National Instituteforthe Blind continues to

support a

large

deficiton the annual cost of

run-ning the schooL

6)

Facilities

The

North

London

School

of Physiotherapy

pro-vides special facilitiesequipment and tuition to

enable visually impaired students toachieve

excel-lence.

New

Deyelopments

Over thepast

five

years,

largely

as a result of the

success of the NLSP programme and the increasing

willingness of many colleges and universities to

admit

disablecl

students on the same

basis

as other

students, an increasing number ef visually

im-pairedstudents

have

_gained access tosighted phys-iotherapy programmes.

Following

a clese assessment of the number of

d

Practiee

of Physiotherapy

by

Visually

Impaired Persons intheUK 423

suitable students _presenting

for

_{physiotherapy} edu-cation to the North London

School

of

Physiothera-py,

it

has

recently

been

decided

tochange the

ap-proach tothe education of visually

impaired

physio-therapiststo one

in

which they can

be

fully

in-tegrated into the higher education sector. We be-lieve thisisa success story forthe NLSP which

would have been impossible in the absence of the

achievements which ledup tothe decision.

Conse-quently

the

current

four

year

Honours

degree

pro-gramme which was specifically

designed

fer

visual-ly

impaired students is

being

wound

down

in

favour of

the

wider admission of visually impaired

students to the schools of theirchoice throughout the

United

Kingdom.

The

Open

Opportunity

Equal opportunity legislationand theopen access

policiesof UK universities to disabled students has

facilitated

an

increasing

number of students with

disabilities

entering higher and

further

education,

This

integration

follows

the

pattern of

integration

of handicapped children

in

secondary education

programmes.

In

recognition of these trends the

RNIB

has

launched

a new

Physiotherapy

Support

Service which will _give thgspecialist support

previ-ously offered only within the NLSP _programme to

a wider constituency of students in the open

system,

The

Physiotherapy

Support

Service

The

service

is

managed

by

a team of

physiother-apy teachers

fully

experienced inthe education of

visually

impaired

students.

We

also provide a

Re-source

Centre

offering a wide range of specialised

equipment and services to all visually

impaired

physiotherapy students throughout the UK. Our

service aims to provide

information,

advice and

practicalassistance toindividuals or organisations

interested

in

physiotherapy as a career for visually

impaired _people.

Students

are offered advice on study and re-search rnethods, tutorialsupport,

learning

materials

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424 ve7tszallg

in Braille,large _print,on tape and in the form of

raised diagrams, hi-techequipment, and _personal

counselling. This advice isextended to visually

impaired _{physiotherapists} on _{post-registration}

courses.

For

academic establishments we advise on

the selection of visually

impaired

candidates and

attend

interview

p.anels

if

requested.

The

service

acts as a consultancy on allaspects of visual

im-pairment as

it

relates tophysiotherapy.

For

the

Future

Blind physiotherapists are employed inall grades

of the profession including teaching and the

man-agement of _{physiotherapy} services. Many _practice

ig

2e

tsig

7 e

is specialist areas of work, The high demands of

their education, whether in the specialist or

in-tegrated setting, _promotes a _positiveand

stimulat-ing environment inwhich students are encouraged

to

achieve

the

highest

standards and

belief

in

the

contribution they can make to the

_profession

and society.

The

high

standard of practice

is

the

justifi-cation

for

thecontinuing education of

blind

physio-therapists.

Patients

respond _particularlywell to

being treated by our

graduates

and there is

some-thinguniquely attractive about theconcept of

some-one who has overcome such a disadvantage

con-tributingtothe care and rehabilitation of other