Empi Q2: History of Physical Therapy Practice
correct
OUTLINE
I. Concepts of Physical Therapy Practice
II. Historical Views in Physical Therapy Practice
A. Mechanism
1. Automation Therapy
2. Cyborg
B. Functionalism
1. Computationalism
2. Connectionism
LECTURE | RECORDING | BOOK | IMPORTANT | MNEMONICS
FOCUS OF PHYSICAL THERAPY PRACTICE
● Rehabilitation is primarily focused on two important
aspects of clinical interventions:
○ Validation, measurement and assessment
■ In order to plan a good treatment for patient
○ Quantification of the improvements during the
therapeutic process
■ To know whether interventions are effective
Challenges in Physical Therapy Practice
● Rehabilitation professionals do not know exactly which
therapeutic agents are working to improve motor
disorders
○ D/t lack of researches in the field
● Lacks unified theory to explain the different treatments
○ Each professional explains things in their own way
○ There is diversity of theories & perspectives in a
certain treatment procedure
● Lacks integrative taxonomy that simultaneously explains
and links the therapeutic agents, the physical
impairments and the activities involved in the
improvement of the physical sequels
○ Lack of classification of each intervention
Resolution of the Diversity in the Practice
● Specialists categorized rehabilitation based on the
function:
○ Activity conducted during intervention
■ E.g. walking on treadmill, walking over
obstacles, reaching & manipulation, STS etc.
○ Elements that strengthen the understanding of
rehabilitation treatment
■ Parameters in each intervention
■ E.g. frequency, duration, etc.
○ Impairments that the rehabilitation is attempting to
■ E.g. balance impairment, LOM, weakness, etc.
○ Performance-related interventions
■ E.g. OMTs
○ Therapeutic agents that are applied in the therapy
■ E.g. Physical modalities
HISTORICAL VIEWS IN PHYSICAL THERAPY PRACTICE
● 2 Main Views
○ Mechanism
■ Automation Therapy
■ Cyborg Therapy
○ Functionalism
■ Computationalism
■ Connectionism
MECHANISM
● Human being is a machine
● Defined as “a system of parts that operate or interact like
those of a machine, transmitting forces, motion, and
energy to one another.”
○ Compares each body part to a machine
● Categories of mechanism
● Analogies:
○ Brain to telephone switchboard
■ The switchboard is used to establish
connections with the telephone – the brain has
a lot of neurons that connect to each other for
the body to function
○ Libido in sexual activity to hydraulic system
■ The hydraulic system uses fluids to give
energy – just like libido after the sexual activity
Automaton Therapy
● It was developed during the 17th century
● “For what is the heart, but a spring (pumps); and the
nerves, but so many strings (connects), and the joints,
but so many wheels, giving motion to the whole body.”
Hobbes (1994)
● It presents the human being comprising traditional
physical mechanisms
○ Each body part is like a machine that has a certain
role for the entire body to function
● It is divided into four treatment methods
○ Natural physical therapy
○ Kinesiotherapy
○ Traditional orthopedic therapy
○ Singular therapies

For the quiz: remember the treatment procedures based on the
category (e.g. Is thalassotherapy under natural physical
therapy, kinesiotherapy, etc.)
Automaton Therapy: Natural Physical Therapy
● It utilizes physical elements originate in nature without
the intervention of human beings
● It does not require technology
● The following treatments are:
○ Heliotherapy (sun)
■ Usual source of vitamin D
○ Thalassotherapy (seawater)
■ Good for our lungs
○ Hydrotherapy (running water)
■ For wounds, ROM, relaxation
○ Balneotherapy (thermal and mineral water)
■ Heat → relaxation and pain relief
○ Climate therapy (coastal climate)
■ Use the climate to know the effects of certain
diseases
○ Peloid therapy (mud and sludge)
■ Used as a superficial heating modality for
relaxation & pain relief
Automaton Therapy: Kinesiotherapy
● The therapeutic effects are based on the movement
recovery of a dysfunctional mechanism
● It attempts to restore the anatomo-physiological balance
of the body parts
● The agent is the person who is doing the exercise
● Examples of kinesiotherapy:
○ Stretching
○ Strengthening
○ Joint flexibility
○ Aerobic exercise
○ Massage
○ Passive and active movement
● Attempts to resolve the body dysfunctional mechanism
○ E.g. strengthening for weakness, stretching for
tightness, joint flexibility for ROM, etc.
○ Impairment based exercise; not functional based
● All of these started in the 17th century
Automaton Therapy: Traditional Orthopedic Therapy
● Focuses on correcting and avoiding deformities, such as
substituting for or replacing the mechanical function
● The goal is for the improvement of the dysfunctional
mechanism
○ Does not improve the daily activities of the pt
○ More on the improvement of each body part rather
than the action itself (e.g. improving muscles of the
hands rather than reaching activities)
● Three methodology in orthopedic therapy:
○ Application of non-technological supports to
substitute aesthetically and mechanically for an
organ (e.g. prosthesis for amputation pts)
○ Replacing or increasing the mechanical function of
the damaged body (e.g. orthosis)
■ E.g. Functional wrist splints used for a
damaged nerve; in order to avoid further
impingement, the orthosis keeps the hand in
functional position until healing is achieved
○ Similar to orthosis but does not require continuous
contact with the body to perform its mechanical
function (e.g., assistive devices)
■ E.g. Stander is used for pts who cannot stand
→ in order to prevent osteoporosis or fx on the
pts LE based on Wolff’s law
■ E.g. Crutches to deweight the affected
extremity and allow for healing
Automaton Therapy: Singular Therapies
● Each of these methods has a particular view of how the
treatment must be applied to a person with impairment
● Examples of singular therapies
○ Castillo Morales concept
■ Effects of posture and movement of head,
neck, and jaw in improving oropharyngeal
function
○ Proprioceptive neuromuscular facilitation
○ Hallwick method
■ Concept of aquatherapy in order for the pt to
move and relax inside water
○ Brunnstrom method
○ Vojta method
■ Reflex locomotion
○ Motor relearning method
■ Example of a concept that can be classified in
the functionalist view as it already discussed
the interaction of body and mind which is very
functionalistic
● Remember that these therapies can also be classified in
the functionalist view
○ Classified under mechanistic view in terms of their
goal of improving the body dysfunction and improve
the physical mechanism of the body
○ It is based on the impairment
Cyborg Therapy
● It was developed during 18th century
● Assumes that the human being is like a cyborg
○ Has both organic & biomechatronic properties
● This indicates that the biological body and its artificial
extension must be perfectly coordinated to achieve
mechanical objectives
● The application of this therapy is not only circumscribed
 to a corporal surface but also is related to the inside of
the body and a person’s environment
● Application of technology (robotics) in the treatment
○ Makes it unique from automaton therapy
○ To incorporate the inside of the person’s body to its
environment to achieve mechanical objectives
● In automaton, the therapist is the main therapeutic agent,
while in cyborg, the therapist assumes a secondary role.
○ Automaton: therapist administers the agent &
instructs you to do the exercises
○ Cyborg: technology used helps the PT in achieving
the mechanical objective
● Three therapeutic methods:
○ Artificial physical therapy
○ Robot-assisted therapy
○ Robotic orthopedic therapy
Cyborg Therapy: Artificial Physical Therapy
● This comprises the application of non-ionizing radiation
or other physical phenomena that produce a physical
effect to restore the original balance of the system
○ Impairment based
● Examples of artificial physical therapy:
○ Electrotherapy (electricity)
○ Magnetotherapy (magnetism)
○ Ultrasonic therapy (ultrasound)
○ Microwaves and shortwaves (diathermy)
○ Thermotherapy (hot and cold packs)
○ Phototherapy (infrared)
○ Basically all physical modalities
○ The technology does all the work – pt just
experiences the effects
Cyborg Therapy: Robot-Assisted Therapy
● The focus to restore the dysfunctional mechanism
utilizing robots
● The agents are material supports that can be located
outside or around the body with neurological impairment
○ Use of robot to allow movement
● Examples of robot-assisted therapy:
○ Exoskeleton (robot-assisted arm and robot-assisted
walking)
○ Functional electrical stimulation
■ Giving electricity while pt is doing something to
have an effect on the body function/affected
body parts
■ There is assistance from the machine to move
the limb
● Still based on the body impairment → not the activity of
the pt
Cyborg Therapy: Robotic Orthopedic Therapy
● Utilizing the cyborg body, physical rehabilitation can
replace or substitute for the damaged biological
structures and functions
● Examples of robotic orthopedic therapy:
○ Hydraulic and pneumatic compression (KAFO and
AFO)
■ KAFO and AFO alone fall under traditional
orthopedic therapy
○ Electronic devices (hearing aids, vagus nerve
stimulator, adapted keyboard)
Sir Tope added:
● Biomedical model is based on the mechanistic view
● Psychosocial model is based on functionalistic
● These two are related d/t the cognitive aspect of a human
being and the study of the mind
● These two emerged during the cognitive revolution to
understand the mind out of the mechanistic view
FUNCTIONALISM
● A newer approach
● Claims that a mental state is a functional organization of
the mind, which is not unequivocally related to the brain
activity but to the functional state
● This new paradigm has emerged during cognitive
revolution to understand the mind outside the
mechanistic view
● There is a difference between the mind and the brain
○ Brain is capable of ordering different parts of the
body by its connections
○ Mind processes the motor output before giving it to
the body
● Body is not a machine because it already has its own
processor which is the mind
● Categories of Functionalism
○ Computationalism
○ Connectionism
Computational Therapy
● Has emerged during 1960s
● The main idea is that the mind is equivalent to the
software of a computer
● The way in which the mind processes and manipulates
 information is very similar to how a computer program
does it
● Defined information processing in the mind as the
process in which “the sensory input” is transformed,
reduced, elaborated, stored, recovered, and used”
processing that is similar to a computational system
(Neisser, 1967)
○ Besides the brain that connects one part of the
body to another and let the body function, there’s
also a mind inside the body that is capable of
processing and manipulating information from the
sensory input to the motor output
● This paradigm produced a radical turn in goals of therapy
○ Shifted from mechanistic therapy focused on
recovering movement of the limbs to recovering the
function of movements in the mind
○ Before, we focused on recovering flexion of the
elbow, extension of the shoulder, abduction of the
hip, etc; now our goal is for the patient “to walk, to
run, to be able to transfer, to stand, etc.”
○ There is already a mind that processes the
information and is not just the brain sending signals
to other parts of the body
Two Central Assumptions
● Mind is a computational system that works with symbols
(representationalism)
○ There are already symbols inside the mind
○ Symbols for walking, grasping, manipulation,
running, doing STS
○ You need only to activate and process those in
order for the individual to do that activity
● The symbolic processing is predetermined in the mind;
that is, that the mind possesses an invariant structure
that cannot be modified by experience
○ “Kahit anong experience ni person, hindi na
mababago yung symbolic processes niya”
Allows interventions to be explained on 2 levels:
● The mind is considered as an unconscious process
(sensorial input, storing motor action, understanding and
producing language)
○ Processing of symbols is sequentially or in a
step-by-step method
○ Sensory input → motor prediction → motor
planning → motor command
○ Ex. a child saw a ball far away then his playmate is
making the child get it
■ Child sees the ball (sensory/visual input)
■ Child would think that he needs to move in
order to get the ball (motor prediction)
■ Brain would order LE to walk (motor planning)
■ Act of walking (motor command)
■ Process repeats (i.e. child would then need to
pick up the ball using his UE so that’s another
process naman)
● The motor intervention is considered as conscious
process (higher level of cognitive processes)
○ Executive functions such as planning, judgment,
decision making
○ Ex. the playmate ordering the child to get the ball
so the child thought “ahh, i need to get the ball” →
this is a conscious process
■ Process of getting the ball is an unconscious
process
Examples
● Sensory feedback techniques
● Biofeedback techniques
● Dual task training
● Fragmentation of motor action
● Sequencing of motor action
● Communicative strategies
● Mental practice
● Virtual reality
● Augmented reality
● Computer games
● Mechanistic rehabilitation
○ Applies the concept of mechanistic rehabilitation to
the functionalism approach
○ A mechanistic approach in an activity perspective,
not in a body impairment perspective
○ Ex. stretching (this is still mechanism and not
functionalism)
■ It will only be considered as functionalism if sir
Tope specifies that it is due to the activity of the
patient
■ If general lang, mechanism siya
■ But Sir Tope said he won't include mechanistic
rehab in the quiz so we don’t get confused
Connectionism / Brain Therapy
● Developed during 1980s
● Explains that the mind as the activation of neural
networks
● Not a seperation of the mind and brain
○ There is already a connection
Two Essential Features
● The mind, in opposition to computationalism, is not based
on symbolic representation. It is not understood as a
symbolism processing system; rather, the mind is the
outcome of global cooperation among the neurons that
are activated. The information is processed
simultaneously
○ There will be a unification of function between the
brain and the mind
○ Not merely sensorial in origin because there are
already neural networks inside the brain that can
process information
○ The brain has its own processing unit even though
it does not have any sensory input
○ Not based on the sensory input that the object or
environment provides
● The mind is understood to be a brain process that is
modified by the experience of the subject; the mind is not
 something static but is continuously changing by
interaction with the environment (neuroplasticity /
Hebb’s law)
○ Ex. crossing the road
■ Some people will look right and left then cross
the road
■ Some will look at the guy beside them and wait
for him to cross. Once the person crosses, they
will also cross with him.
■ Some will look right and left then he will run.
■ ^^In this sense, the subject does different
^Memorize this daw
actions but the output is the same (person was
able to cross the road)
■ This is why computational is problematic Conclusion
because it needs a symbolic representation
meaning that there should only be one definite ● We can still use mechanistic and functionalistic view in
approach. You are already considered PT practice however we should not stick to one view
abnormal if you go beyond that particular ● Each view has its own advantage and disadvantage
approach because there is a symbolic ● In terms of impairment-based, mechanistic is
representation inside the brain that is very advantageous
static and not modifiable. ● In terms of functional activities, the functionalistic view
○ Ex. volleyball player can help
■ In volleyball we have jump serves, floating ● Ex. You have a pt with total hip arthroplasty (in-patient
serves, or standing serves setting)
■ The player’s serve will be based on the training ○ Considering that this is in-pt, the pt must be feeling
she got pain, tenderness, LOM, and inflammation in his hip
■ If she got trained doing jump serves, then she ○ For the mechanistic view, we can use modalities via
will likely do jump serves cyborg therapy so we can decrease the pt’s pain
■ No matter what type of serve the player does, and inflammation. We can move the extremity
the output is still the same (she was able to within the pain-free range so that we can maintain
serve the ball) joint integrity and not develop tightness via the
■ Again, this is problematic when it comes to automaton therapy
computationalism in which there should be an ○ For the functionalism view, we need functional
absolute action activities so that the pt can move in bed via
● Ex. Stroke Patient computationalism and connectionism approaches
○ Computationalism: If symbol for standing is ○ We can use these views simultaneously without
impaired, pt cannot stand forever compromising the pt’s condition or prognosis
○ Connectionism: Pt can still walk depending on the
interaction of the pt with the environment
● Neuroplasticity is based on this theory
○ Brain is still able to modify itself

Examples
● Bilateral training
● Mirror therapy
● Constant-induced movement therapy
○ We make the pt use his affected side so that the
brain can modify itself to move the affected
extremity
● Transcranial magnetic stimulation
● Cerebral neuroprosthesis
 b. Computationalism
c. Connectionalism
Formative
d. None of the above

1. Mental practice is classified in what type of therapeutic

view?
a. Automaton
b. Cyborg
c. Connectionism
d. Computationalism
2. Computationalism is developed during ____.
a. 17th century
b. 18th century
c. 19th century
d. 20th century
e. 21st century
3. Application of non-technological substitute aesthetically
and mechanically for an organ is the main goal of ____.
a. Kinesiotherapy
b. Robot-assisted
c. Traditional orthopedic therapy
d. Artificial physical therapy
4. This is under the singular therapies wherein the effects of
posture and movement of the jaw, head, and enck can
lead to improvement of oropharyngeal system
a. Castillo Morales
b. PNF
c. Voljta
d. Hallwick
5. Peloid therapy
a. Automaton
b. Cyborg
c. Computationalism
d. Connectionalism
6. Stretching of the gastrocnemius to prevent tightness and
contracture is classified under _____.
a. Natural physical therapy
b. Kinesiotherapy
c. Traditional orthopedic therapy
d. Singular therapies
7. This therapeutic intervention uses the “sun” to promote
healing or change in the body structure. It is called ____.
a. Thalassotherapy
b. Balneotherapy
c. Heliotherapy
d. Hydrotherapy
8. Automaton therapy is classified as ______.
a. Mechanistic approach
b. Functionalistic approach
c. Both A and B
d. Neither A and B
9. The mind works with symbols or representations. This is
based on what principle?
a. Automaton
b. Cyborg
c. Computationalism
d. Connectionism
10. This approach stated that human beings were like a
machine
a. Automaton