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THERAPEUTIC MODALITIES AS A CURRICULAR THREAD

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Traditional classroom and lab-based education in the principles and administration of therapeutic modalities has remained a cornerstone in educational programs within the rehabilitation sciences. The history and evolution of the clinical rehabilitation sciences have shown that certain areas of practice, such as electrical stimulation for denervated muscle or ultraviolet treatment for psoriasis, have waned, whereas other areas of clinical practice, such as integumentary or wound care and oncology, have grown immensely over the past few decades. Consequently, curricular content has undergone continual change and updating. This flux of curricular content reflects the advancement of scientific discovery and application and the mounting rise of literature to bolster evidence-based practice. The fact that curricular content given to principles and application of therapeutic modalities has remained pervasive in educational programs within the rehabilitation sciences substantiates the continued contribution of this area of practice to the more encompassing patient management model.

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Although principles and applications of therapeutic modalities remain foundational content in most programs in the rehabilitative sciences, this content is far too often insular or taught apart from other curricular content, such as orthopedics, neurological rehabilitation, integumentary care, patient management, and other areas. This is wholly ironic because therapeutic modalities represent a group of interventions used to augment or supplement interventions taught in these course areas. Many areas of rehabilitative science, such as orthopedics or neurological rehabilitation, are taught with strategic course sequencing with content increasing accordingly in more advanced courses. However, content in therapeutic modalities often exists in a single "how to" course or, worse yet, a smaller part of a single course. Few educational programs sequence curricular content in therapeutic modalities in a progressive manner. Rather, therapeutic modalities are often taught separate from the interventions they complement. For example, orthopedic or musculoskeletal courses include instruction in rehabilitation following surgical repair of the anterior cruciate ligament. Incorporation of therapeutic modalities, such as neuromuscular electrical stimulation, biofeedback, or cryotherapy, reflects the reality of clinical care and better represents the complete patient management model than teaching these elements in a separated or disengaged manner. Because therapeutic modalities are too frequently taught in isolation, students receive a limited "one-time" exposure. It is our intention that this book be used not only in the primary therapeutic modalities course but also in courses where therapeutic modalities supplement or complement the interventions taught in those content-specific course areas, such as orthopedics, neurological rehabilitation, and so on.

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At risk is clinical competency when therapeutic modalities are taught in isolation with little to no carrythrough in the curriculum to relate or connect therapeutic modalities to those conditions or impairments for which they are advocated. It is our suggestion that the content of this book be used throughout the curriculum where therapeutic modalities offer adjunctive interventions. By maintaining continuity throughout the curriculum between therapeutic modalities and the specific clinical areas of their supported application, a curricular thread is created, thereby improving clinical decisionmaking skills and competency.

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The following table represents specific chapter content in this text and the potential curricular areas where use of therapeutic modalities are part of common clinical practice. It is our belief that the content of this text may be threaded or cross-referenced across the curriculum to reinforce the supplementary role that is offered by therapeutic modalities.

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James W. Bellew, PT, EdD
Susan L. Michlovitz, PT, PhD, CHT
Thomas P. Nolan Jr., PT, DPT, OCS

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