Leading the charge
VCU’s Department of Physical Therapy marks 80 years as an industry pioneer
By Drew Vass
In her speech at the 16th annual Mary McMillan Lecture in 1981, Susanne B. Hirt, RPT, M.Ed., said, “To be able to move into the future we must have the capacity for change and must be able to respond to change.” Hirt, then chair of the Virginia Commonwealth University Department of Physical Therapy, spoke to the industry at large, while receiving its highest honor: the Mary McMillan Lecture Award. She retired a year later, after nearly 30 years of service to VCU and four decades of professional activity, but not before watching the department drive physical therapy’s evolution through decades of research and national involvement.
Physical therapy research began — at least in part — with VCU. The department helped form the beginnings of physical therapy education in the 1930s, when the field remained under great scrutiny due to a lack of scientific research. At that time, it was the Medical College of Virginia that hosted Virginia’s first accredited physical therapy program and produced its inaugural graduates in 1932, then appeared on the American Medical Association’s approved physical therapy programs list in 1936. In the 1940s, the school was catapulted into the national spotlight as a primary source of education and research following what Hirt labeled the “big bang” for physical therapy — otherwise known as the Baruch grant.
The Baruch grant stemmed from the Baruch Committee on Physical Medicine, which was commissioned in 1943 by President Franklin D. Roosevelt to explore the possibilities of physical rehabilitation among wounded soldiers. William T. Sanger, M.D., then president of MCV, chaired the Subcommittee on Basic Research. In 1944, the committee offered more than $1 million to three medical centers to facilitate teaching and research in physical medicine. MCV was one of them. Hirt was called on to develop an educational program for the resulting Baruch Center of Physical Medicine.
“From 1931 to 1941, the department had more of a local impact,” explains Mary Snyder Shall, PT, Ph.D., associate professor in the Department of Physical Therapy. “In the 1940s, with the Baruch grant, research came into play. That’s when our influence grew to more of a national presence.”
Shall documents the department’s history in her book "Evolution of Physical Therapy at the Medical College of Virginia and Virginia Commonwealth University." She says that after years of fielding questions about various parts of the department’s history, she finally decided to pool the information together into a single source.
Despite the immediate and lasting effects of the Baruch grant, physical therapy faced an uphill battle toward becoming its own scientifically based medical entity. In the mid- to late 1980s, however, VCU faculty members began publishing information that suggested physical therapy should be fueled by data resulting from precise measurement of muscle performance. The notion was radical for its time.
"[VCU faculty members] fueled the start of this thing through the papers they wrote and the research they conducted regarding the reliability and validity of what we do as physical therapists," says Peter Pidcoe, PT, D.P.T., Ph.D., associate professor of physical therapy. "They were instrumental in promoting research and focusing treatment on research evidence."
VCU faculty members’ efforts led to what was later named the "evidence-based movement," which propelled physical therapy toward applied science by collecting and using data to prove the effectiveness of various techniques. Science conducted by Pidcoe at the University of Illinois at Chicago, early in his career, helped fuel the pre-stages of the evidence-based movement. Ironically, his efforts helped to form a new field of research that later became the focus of his career.
Pidcoe studied at UIC in the early to mid-1980s, around the same time that VCU faculty members were pressing for evidence-based research. He was a bioengineering student who worked in the UIC Department of Physical Therapy’s laboratories, designing equipment and software systems that measured such things as body movement and balance. In 1992, UIC hired him, allowing him to continue his work on a professional basis. In the meantime, he was joined by Jules M. Rothstein, PT, Ph.D., a former VCU Department of Physical Therapy faculty member who moved to UIC to chair its department. Rothstein was among those pressing for evidence-based research. When Pidcoe expressed an interest in earning a medical degree, Rothstein urged him in a different direction: physical therapy. Pidcoe took his advice.
"[Rothstein] was very dedicated to promoting the concept of evidence-based practice," Pidcoe says. "When I got my physical therapy degree, I was probably one of a handful of therapists with an engineering background. I have found the combination of degrees very valuable both in clinical practice and research."
In 1998, Pidcoe left UIC to join VCU. Ironically, the move landed him where the seeds that helped to shape his career were first sewn.
Pidcoe took over a biomechanics laboratory created in 1980, transforming it into what could be described today as the pinnacle of evidence-based research facilities. He and other members of his primarily student-staffed lab facility produce technologies capable of mapping human movement — down to the exact motions of each limb, including such minute details as eye movement and the pressure generated by each toe. They also measure balance to determine the physical impact of motions on the overall body. All of these measurements produce data, that can be used to support the development of new technologies.
"With physical therapy, you see a profession that’s building on itself," says Matt Wilks (M.S. '99/PT), who directs inpatient therapy services for Sheltering Arms Physical Rehabilitation Center in Richmond, Va. "These days, we have valid outcome tests, so we can measure which treatments are more effective than others for particular types of injuries."
Arriving in the future
Wilks directs a comprehensive walking recovery program for Sheltering Arms known as iWALK. The program isn’t focused on any one diagnosis, but is for anyone suffering from a walk-inhibitive injury or disease. Pidcoe says iWALK represents the height of evidence-based practice.
"With programs like iWALK, we’re basically pushing practice as close to the real-time science as possible," Wilks says.
One of iWALK’s machines, the ZeroG, is touted as the world’s most advanced body-weight support system for over-ground walking and balance retraining. The device consists of a zero-footprint trolley and harness, which replaces the use of multiple therapists and other rudimentary equipment to support a patient. Lokomat Pro, a similar but even more advanced robotic walk re-trainer machine, allows patients who aren’t yet able to walk — or even stand — to move impressive distances.
"Traditional methods, using supportive equipment and the help of several people, would allow someone to walk maybe five feet," Wilks says. "And that method isn’t entirely safe or perfect. You take that same person who can only walk five feet and place them on the Lokomat, and they can then walk a half mile. The additional repetition and intensity is critical for optimal recovery."
iWALK and machines like Lokomat produce real-time data, supporting evidence that suggests recovery times are significantly boosted with early therapy. Even before patients are capable of supporting any weight or moving limbs independently, machines like Lokomat allow them to pass through the natural walking motions. The effect not only helps to build range of motion (like earlier forms of physical therapy), but it also helps build new neural pathways to circumvent damaged areas of the brain.
"You’re basically trying to get them to rebuild these pathways sooner," says Pidcoe, who recently entered into an agreement with Sheltering Arms to help evaluate the effectiveness of iWalk’s equipment. "Old PT still did it, but we didn’t do it with the same volume. I’m looking at the rehab side of things and applying neuroscience techniques to helping these people."
New technology fuels excitement among physical therapy students, especially through hands-on experience.
"You just want to get out there and start using this stuff," says Stephen Vesely, a second-year VCU student.
"Every couple of Wednesdays, we get the chance to sit in and participate in the clinical setting — observing, interacting with real patients and assisting in hands-on," Vesely says. "Recently, during one of these visits, I was actually getting to do some hands-on when I thought to myself, ‘Wow … I’m really going to be doing this. And soon!’"
Physical therapy’s next "big bang" could arrive not via new research and technology, but rather via a push for national standards in higher education — beyond the level of basic accreditation. The effort is backed by a newly formed Academic Council of Physical Therapy, which is part of the American Physical Therapy Association. Thomas Mayhew, PT, Ph.D., chair of VCU’s Department of Physical Therapy, serves on the council’s inaugural board of directors.
"This is a significant change in physical therapy education," he says, adding that no standard for excellence in higher education has ever existed.
The council results from a fouryear effort, including 16 department chairs, with the primary goal of creating a governing voice among APTA members for matters pertaining to education. Prior to the council’s formation, Mayhew says that there was no unified voice representing the physical therapy programs on educational matters. With the formation of the council, now when it comes to voting on matters of education, only council members are allowed to render their votes. He sees this as a starting point for developing educational standards driven by department chairs.
"There’s never been a voice for physical therapy education that’s made up of the programs themselves," Mayhew says. "[The APTA has] done a great job for a number of years, but, as a professional association, it’s concerned with many issues, including practice acts, legislation, reimbursement, etc. [and not educational standards]."
Mayhew says that if the council manages to gain the support of the majority of physical therapy departments, this could represent a tipping point for physical therapy education, toward standards for excellence.
In her 1981 speech at the Mary McMillan Lecture, Hirt not only incited change, but also relayed a challenge McMillan had posed to the field’s earliest founders: "What we need now is a unanimous effort to establish high standards for our profession — and enthusiasm that knows no bounds." Thirty years later, Hirt and McMillan would be pleased to see VCU faculty members leading the charge.
Drew Vass (B.A. '02) is a contributing writer for VCU Allied Health.
"The Evolution of Physical Therapy at the Medical College of Virginia and Virginia Commonwealth University"
By Mary Snyder Shall, PT, Ph.D.
Get your copy, and support future generations of physical therapists, with a donation of $80 or more to the 80-Year Anniversary Scholarship fund. (Please note the book's value of $20 is not tax deductible.)
To order your copy, call (804) 828-0234.