Hiro Wood made some comments about PT in Japan that merit further
discussion.

"PT in Japan is generally unknown by almost people including doctor.
They don't know what PT is and what PT can do."

I agree that if you run into someone on the street, he or she is not
likely to recognize what a PT is, even when the proper Japanese term
for PT is used. But if you say that a PT does "rehabili", then
everyone "understands". Doctors in general DO know what PT is, whether
or not they have a high regard for it. I generally find that they have
a positive attitude toward PT. I agree that many doctors do not
adequately understand what PT can do. But this can be said of some of
the more poorly functioning PTs in Japan as well. Somehow I do not
have the impression that this is a problem unique to Japan.

"PT in Japan is generally 'exercise therapist'. For example we often
do only 'Wiliams exercise' without any evaluation in back pain
treatment. Few PT do AKA (arthrokinetic approach), which is like
chiropractic, not scientific, not global standard."

PTs in Japan indeed rely heavily on therapeutic exercise for
treatment. For historical reasons, use of physical agents is usually
considered work for pseudo-PTs, and thus, physical agents are not
integrated very well into treatment programs to help solve patients'
problems. I do not believe that Williams exercises are overused by PTs
in Japan any more than any other exercises. I don't think it is a fair
statement to say that PTs in Japan have patients perfunctorily do
exercises of any kind. Indeed, some do, but certainly not all. Again,
I am not sure that Japan should be singled out as being particularly
offensive in this area.

A number of PTs in Japan have studied the arthrokinetic approach quite
thoroughly, but other "orthopedic approaches" have their well trained
advocates in Japan as well. There is also an approach that has been
developed in Japan called "myotherapy", and this has been taught by
Japanese to PTs in North America. As to which approaches are
scientific, what resembles what, and what a global standard is, these
are all complex issues beyond the scope of this letter.

"PTS in Japan is educated PT should be involved in disability level
and should be a servant of physiatrist (member of rehabilitation
team). I think we must adovocate what PT can do and acquire an ability
to be involved in impairment level especially in orthopedics."

I interpret the first sentence to mean that PTs in Japan have been
brainwashed with the ideas that the job of the PT is only to serve the
physiatrist and be concerned with disabilities of patients and not
with their impairments. I seriously doubt that any PT school in Japan
educates students in this way. "Physiatry" is not a strongly developed
discipline in Japan, but Japanese law specifies that PTs must work
under the direction of a designated "rehabilitation" physician. This
physician boss does not have to have any formal training in
rehabilitation medicine to qualify for that position. In general, the
"boss" is an orthopedic physician who may have taken some extra
courses in rehab medicine. The relation between the physician in
charge and the therapists varies from hospital to hospital. I have
heard some horror stories about these relations, but they do not form
an epidemic all over Japan. There are enough sad stories, however,
that this is indeed problematic in Japan.

PT has developed well in Japan since it was first introduced here in
the 1960s. PTs here have their battles to fight and various problems
to overcome, but they are far from being nonthinking technicians.

The Japanese Physical Therapy Association is proud to host the WCPT
Congress in Yokohama next May. Many Japanese PTs will present papers
and posters, so those of you who visit and participate in the congress
will be able to see for yourselves where PT in Japan stands. I
encourage as many of you as possible to come. Yokohama and Tokyo make
up the most populous part of Japan--a truly vibrant scene that you
will never forget. And the Japanese PTs hosting you will be able to
give you that extra dimension of a country that simple tourists find
so hard to get--real contact with the people themselves.





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