Opening Up Possibilities Through Genomics

Abstract

During the World Conference of Physiotherapy held last summer in Vancouver, British Columbia, I had the opportunity to participate in a panel discussion about the role of genetics in the future practice of physical therapy. In light of the recent mapping and sequencing of the human genome and its implications for rehabilitation and the practice of physical therapy, my specific role was to address the implications and strategies of genetic education for the physical therapy profession. Although the audience members asked many interesting questions, one particular question continues to resonate with me. A member of the audience who identified herself as a physical therapist educator asked, Given the amount of content we have to cover in a student's professional training, and the constraints of curricular space, is teaching genetics really a priority in physical therapist education at this point in time? In retrospect, I have come to appreciate the significance of this question for the education of future physical therapists. If we should, as Steve Wolf said in his Thirty-Third Mary McMillan Lecture, keep pace with contemporary and clinical pursuits, how do we determine what pursuits are worth integrating into our already crowded curricular space? Part of the answer to this question, I have come to conclude, should be predicated upon a constant reassessment of who we are, what we do, and how we want to practice as professionals in the present and future balanced with the possibilities that are presented by new and evolving scientific and clinical discoveries. More precisely, what criteria should we as educators use to judge what avenues of knowledge and skills are significant if physical therapists are to promote advances in clinical practice? Core and consensus documents of the American Physical Therapy Association (APTA), including the Vision 2020 Statement,2 have determined that physical therapists that are doctors of physical therapy should be autonomous practitioners of choice in the prevention, diagnosis, and treatment of patients with impairments in movement. Leaders in our profession such as Helen Hislop,3 and more recently Shirley Sahrmann,4 have provided theoretical models that describe movement impairment to explain the affect of physical therapy intervention at the cellular, tissue, organ, and whole-person levels. If we are, in fact, experts in the diagnosis and restoration of movement impairments, then it follows that we should be concerned with all possibilities that explicate interventions capable of influencing normal homeostatic movement on body structure (ie, cellular, tissue), body activity, and body participation in social tasks. Our patients would expect nothing less. The mapping of the human genome and subsequent discoveries of the genetic basis of many diseases has the potential to revolutionize our understanding and current approaches to health and health care -particularly in the field of physical therapy. Steve Wolf1 writes about the possibilities of genetics for physical therapy: Embracing the discoveries contained within molecules and genes affords an entirely new playing field to view impairments and how the impact of our current and as yet to be discovered interventions can be evaluated and quantified. If we are not prepared to meet the exciting interfaces between these emerging sciences and restoration of normal movement, then certainly someone else will. …