Physiotherapy For Disorders Research Articles

Reflections on the career of Janet Carr--a physiotherapy trailblazer.

Janet Carr was one of the profession’s leading lights and she had a life-long passion for advancing physiotherapy. Following her death in 2014, it is timely to reflect not only on her life and contribution to physiotherapy, but also on our profession’s origins, directions and future. During the last 50 years – the period in which Janet treated, taught, thought and wrote – the physiotherapy profession has faced significant challenges, which have resulted in unprecedented changes in our professional role. In particular, these years have encompassed the period when physiotherapists developed independence, both in reasoning and professional practice. For the first time, physiotherapists were developing career paths in scholarship and learning, as well as in the clinical setting. Entry programs were increasingly located in universities, such that academic pathways became possible, leading to the growth of higher degrees and research within the profession. The move from hospital-based to university-based education coincided with a shift in the profession towards scientific rigour. There was strong recognition of the importance of deriving clinical implications from the literature, particularly the related sciences, and of conducting research on human function. In addition, there was a rapid development of interventions that were based on a wider and sounder theoretical basis, the development of reliable measurement tools, and the vigorous testing of outcomes. Over the decades, Janet Carr and her close colleague Roberta Shepherd have been at the forefront of many of these changes. The drive for change in the conceptual basis for professional practice is particularly evident in their scholarly work and academic leadership. This scholarship is evidenced in the progression of their writing over time, which is mirrored in the scientific evolution of our profession. A marker of the early stage of their influence was the publication of their first internationally available textbook in 1980 – Physiotherapy in Disorders of the Brain – a book that was specifically published to clarify the changing role of physiotherapy in the treatment of adults with brain damage. Unlike previous physiotherapy texts, this book was extensively referenced to support their arguments, a feature that was particularly unusual at that time. By providing detailed reference lists and giving, where possible, reasons for the treatments described, they provided a basis for further investigation into treatment effectiveness. The three main themes of this early text illustrate the beginning of the paradigm shift towards the need for: a problem-oriented approach to assessment and treatment, an understanding of the processes involved in motor skill relearning, and an understanding the pathological and psychological reasons underlying the problem. The next textbook – The Motor Relearning Programme for Stroke – was published in 1982. It also illustrates the change from inductive thinking to scientific rigour. In it, Janet and Roberta wrote: