Veni, Vedi, I Voice Out

I am not Julius Caesar nor am I a Latino (I wish) nor do I speak Latin. However we know it means "I came, I saw, I conquered".

Veni Vedi Voice Out

Looking at the physiotherapy scene in Malaysia, again as I have mentioned before, we are still a baby trotting on padded needles as I feel that many of us are progressing not towards development but progressing towards the misinterpreted realm of contentment and satisfaction at minor achievements.

We have all been in a quandary where we, for example have a knee osteoarthritis patient with pain, and unsure of whether to provide TENS, hot pack, shortwave diathermy, ultrasound or other therapeutic modalities.

We have all seen how we physiotherapists educate patients on the correct posture as well as the maintenance of it but we notice how we physiotherapists ourselves have poor posture.

We have all realise how some other health profession dispute the effectiveness of physiotherapy, ridicule the physiotherapists themselves, judging us with the utmost disgust and thinking that we are as equal as the "tukang urut jalanan".

We have all heard how contented some of us physiotherapists are at just having a diploma when we should be getting higher qualifications, possibly to the level of PhD.

We have all seen, heard, realised these problems however are any of us doing anything about it? I know many who are aware of this predicaments and inadequacies but are too fearful of having it voiced out. Many would prefer to live with a problem rather than making a change in fear of jeopardising their reputation amongst other physiotherapists or individuals.

I am not experience, nor am I smart nor the best in physiotherapy, however I dare to voice out things that I see might be improved. I dare to be hated for doing the right thing rather than being loved by doing what has been longed practised which might not be right. I challenge those who care for the profession to express your views, ideas and solutions for the better good of the physiotherapy profession in Malaysia.

Ideas should lead to voices which should end in progressive changes. I am proud to be associated with Malaysian physiotherapists who see possibilities of improvements and putting it to reality.

It Feels Good

It feels good today to walked a stroke patient who have not walked for 8 months.

It feels good the other day to have cured a patient's back pain, suffered for 10 years and have such great trouble sleeping at night.

It feels good to have helped people return to a normal and impairment free life

Don't be contented
with your level of
skills and knowledge,
be hungry for more

Half Done But Quitting?

I know of some people who have ventured into physiotherapy, some with a clear view of what's coming, some venturing into the wilderness hoping to just see light ahead, but some simply stumbled into physiotherapy with no clear vision of what lies ahead.

So you're half done, why quit now?

Many have said, physiotherapy is a profession that will not have u drive a porshce, live in a mansion in a posh neighbourhood, nor would it bring recognisation of one's level of intellectual quotient.

Think again.

Talking about a person's finances, physiotherapy have the potential to bring in big bucks if the graduate is marketable. So how to be marketable? Be specialise in a discipline within physiotherapy that have no or very few specialists. Be very experienced. Work very hard with locums and overtime. Once you have achieved these requirements and built a strong foundation of who you are as a physiotherapist, also with great networks with other health personnel, you'll then see more $$$

Talking about recognition, we have to understand the fact that physiotherapy is a relatively new field in Malaysia. It is still in the stages where the main pillars supporting the profession is in the process of being build, but far from completion. So being in the profession now would allow you to be recognised if you would help in strengthening the foundation of establishing this profession which has so much potential as aspired by the physiotherapists of developed nations like Australia and the US.

Also, some might be aware the profession of physiotherapy has been said to be for those who "tak habis SPM" or for those who are "yang malas belajar kat sekolah". We definitely know these are words of the ignorant, and for us to be ignorant of these inane remarks would create bliss. We know how much we struggle to memorise all the muscles, bones, nerves, physiological systems and the other amazing disciplines of physiotherapy that we know not anyone would be able to do, such a prodigious feat!

The best element of physiotherapy is the ability to be able to change people's lives, to make it better, to improve their quality of life, and many more to-s. It's the satisfaction that we get when a patient comes back to us and say "after you treated me the other day, i feel much better". It's simply heart-opening when a difficult or moody patient, or even patients showing animosity towards physiotherapy would give a great warm smile after our treatment simply indicating they feel better.

Our medicine are our hands. We can treat people anywhere anytime. We uphold the definition of creating bond between health personnel with patients. We embody the principles of healthcare. We are physiotherapists.

"A winner never quits. A quitter never wins"

The 2nd UKM-SGH Joint Conference (2nd - 3rd April 2011)

I was very blessed to have been part of this informative and eye-opening joint conference organised by Universiti Kebangsaan Malaysia (UKM) and Singapore General Hospital (SGH). Speakers were of distinguished credibility, from medical consultants to nurses to physiotherapist consultants to dietitians, occupational therapists and as well speech therapists. It was a great mix of health personnel all working towards one main goal with the motto "Strengthening Multidisciplinary Approach in Health Care & Health Sciences".

Various topics were discussed and I would like to share here bits of what I gathered from the various talks delivered.

1. Stroke:

• The younger you are, the more likely you are to get a hemorrhagic stroke (risk of this increases in those below the age of 45).
• Upon occurence of stroke, the first 3 to 4.5 hours is the most crucial time for provision of a thrombolytic factor as this period is the "window" to save the remaining brain tissues (the ischemic penumbra) from being infarcted.
• The neuroscientific basis of rehab interventions for stroke patients are based on these 2 processes; the network plasticity where activities of infarcted neurones are taken over by adjacent neurones; neuronal plasticity where there would be regeneration and sprouting of new dendrites.

2. Children with Special Needs

• In Malaysia, 10-17% of the children population (between 900,000 to 1.35 million children) require special needs.
• 95% of children walks at 18 months of age and parents should be concern if their child fail to do so.
• An increase in the responds of a mother increases the child's level of responsiveness.

3. Palliative Care for Cancer Patients

• Aims of physiotherapy: to achieve optimal functional capacity.

4. Physical Issues Faced by the Geriatric Population

• Main components of postural control: sensory (eg: vision, vestibular), central processing (eg: speed/attention), effectors (eg: ROM).
• ACSM recommends these exercises to be incorporated in treating geriatric patients: strengthening exercises, aerobic conditioning, flexibility exercises and balance training.

I was also very lucky to have gotten the opportunity to make a poster presentation with regards to low back pain. It was a tremendous experience and being able to mingle with other health personnel simply allows me to have a more global outlook towards provision of healthcare.

It was simply awesome that everyone was recognised to be the experts of their field, with the doctors recognising the importance of physiotherapy and the occupational therapist acknowledges the work of speech therapists and so on. This level of respect and recognition is lacking in the current clinical practise and in some ways, Malaysia has a long way to go before these can truly be achieved optimally

Manual Therapy VS Electrotherapy

Manual therapy has been said to be skills that are more hands on whereas electrotherapy often involve having the patient positioned in a certain manner and be provided with a particular electrotherapeutic modality for specific purposes.

Joint Mobilisation

I have discussed with many physiotherapists about their stand of preferring to perform manual therapy or electrotherapy or a combination of both. One physiotherapist who is very experienced and plays a major role in the MPA has said that he is a strong believer of electrotherapy as it is effective in reducing the impairments patients have especially those concerning pain. He is also trying to revive the usage of electrotherapeutic modalities through a particular electrotherapeutic modality international association (I'm not able to recall the name of the association).

Therapeutic Ultrasound (US)

Shortwave Diathermy (SWD)

Another experience therapist I talked to feels that as physiotherapists, being able to perform manual therapy skillfully is vital to be an effective physiotherapist. He also mentions that patients are mainly cured by performing manual skills instead of the usage of electrotherapeutic modalities.

I agree with both to a certain extent. I believe that electrotherapeutic modalities is useful to reduce the impairments of patients ONLY FOR SHORT TERM. I did a research on the effects of SWD on knee OA and found that the group receiving SWD + exercises has no significant reduction in pain compared to the group performing only exercises. This too has been supported by abundance of literature.

I believe that being able to perform great manual skills sets apart a good physio from a great physio. Also, these electrotherapeutic modalities can be used by various other health personnel, such as the OTs now uses wax, the chiropractors uses SWD and US. So what sets us apart from them and what they can't steal from us is the usage of manual skills. Even simple manual skills like strengthening exercises could be performed by nurses. Therefore it is our duty to always protray the ability of performing ADVANCE manual skills to show that we are physios.

Also, in some clinical conditions, the usage of electrotherapy does not produce significant effects, therefore would consume extra finances and time for its application. Perhaps in some cases, these modalities can be omitted from being applied.

Myofascial Release

However I'm not here to deny the benefits of electrotherapeutic modalities. I'm here to say that electrotherapy is effective only for short term. I'm also here to say that to be a truly great physiotherapist, one is often judge by how one performs manual skills but not by how one sits and give ultrasound to a trigger finger patient.

Forum in UiTM, March 18, 2011

I was very blessed to have "stumbled" into a forum organised by the physiotherapy students association (PHYTAS) of UiTM last Friday, the 18th of March 2011. Distinguished guest speakers were invited and they were:

1. Datin Asiah Haji Hashim
Ketua Perkhidmatan Fisioterapi Malaysia (Former MPA president)

2. Mr. Marc Daniel
Physiotherapist from Prince Court Medical Center (Former MPA president)

3. Dr. Balwant Singh Bains
Current president of the MPA

Students were encouraged to voiced out their thoughts and questions for the panel to comment and answer. Since I came in long after the forum has started, I didn't manage to listen to the previously asked questions but these were some of the infos they provided upon further enquiries.

The panel upon being asked "What is the difference between a diploma and a degree graduate of physiotherapy?", Datin Asiah answered that a degree qualification would expect the physiotherapists to have had a research component in their studies. Therefore they would be expected to have a research-based or evidence-based practise. Also, with the researches that they have performed, a degree qualified physiotherapist should have a greater degree of clinical reasoning upon performance of assessments and interventions.

She also mentioned that with higher qualification of physiotherapists, we would not be bound to the prescriptions of doctors and able to provide own clinical reasons for the necessary provisions of assessments and treatments. Physiotherapists with a postgraduate qualification should take up higher responsibilities in gaining recognition for the field of physiotherapy from the different health disciplines as well as from other professions.

Not related to the previous question, my blog of course has been a bit of an issue in the forum and I justified my stand for my first blog post. The panel agreed with what I have said about the predicaments of studying physiotherapy in certain local institutions and Datin mentioned that these problems shouldn't have arise and she said "in paper it's good, but execution is not as in paper". I agreed with her.

Also, Datin announced that she would be retiring in March 2012 and Dr. Bains would love to have Datin as the advisor of MPA.



Overall, good job to PHYTAS for organising this informative and eye-opening forum!

The Truth As I See It

I am very pleased that I have people reading this little, simple and crawling blog of mine regarding physiotherapy. Some responses were positive but there will never be a continuous rosy responds would it? So definitely I have caused abit of a stir in expressing my opinions in my first post and guess what people, MORE CONTROVERSIAL OPINIONS COMING!


Here's what I believe in. Doing things as how people used to do doesn't mean it is the best way. Doing things how the people newly do might not also be the best way. I'm not smart, nor am I experienced, worse still I'm just a student, not even fully licensed. However, with this little brain of mine and with the limited credentials to my name, I think I can see ways physiotherapy can improve in Malaysia, and perhaps in the world as well.

So here I am writing my ideas and opinions, and perhaps some informations that I could share with the rest of you. Do drop comments if you like, and perhaps with your name as well because it would be slightly difficult for me to leave a comment as such:

"To anonymous 1: fjwo;efjwo

To anonymous 2: sjwfwj

To anonymous 3: fwfjwfwj"





Looks weird huh?

Well, people have known me to be assertive and known me for always speaking my mind. It might not be the best trait in a person surrounded by the Malaysian culture, but I guess things gotta change.

So as the name of my blog goes, PHYSIOTHERAPIST SPEAKS coz I ain't shutting my mouth people.

This is Abang Monyet and he too ain't shutting his mouth

Peace to all and enjoy reading!

Required Improvements For Studying Physiotherapy Locally

We are very familiar with the predicaments the students of many institutions taking physiotherapy. Here are the common issues:

1. Non-conducive population of students

Various institutions have many intakes a year and I know of one college that takes up to 6 intakes a year. What's more "remarkable" is the amount of students per intake is simply abundant. Some institutions takes in as many as 500 students per intake.

How would the authority of the institution expect to create a conducive learning environment for the students? These students would be divided into probably 4-5 groups of approximately 100-150 students per group for practical classes. With just 1 lecturer per group, how would they expect the students to be able to see what the lecturer is teaching?

For example when a lecturer teaches spinal mobilisation, that would require students to get very close to the lecturer and observe the demonstration. But with the great amount of students, how would the student to even have a chance to see where the hands are palpating on the back?

2. Lack of equipments

Many of these institutions have such inadequate equipments. Can you imagine I have heard that many have not even seen a peak flow meter! They even wondered how a spirometer looks like.

Students had to pay huge amounts to finish their diploma or degree in some institutions, ranging between RM45k to RM80k for a 3-year diploma course. Imagine getting RM60k per students, with 3000 students per year. The institution gets a total of RM1800000000 (that's RM1.8 BILLION!) yet they can't even purchase enough peak flow meters for the students? I seriously wonder what they do with the money.

Some students have never even heard of the isokinetic machine. Personally, having studied in a particular university, with only 34 students in my batch and divided into 2 groups of 17 students, we got to practise with spirometers, peak flow meters, isokinetic machine and many other equipments that are necessary for a holistic and complete assessment and treatment.

3. Places for clinical placements

In my 4 years of doing my degree, we're very lucky that the students of my university have always been placed in local government hospitals. Students of other institutions, due to their huge numbers are always placed in homes like mentally handicapped homes or old folks homes. It would be a great exposure with placement in homes however how would they be able to learn if there are no physiotherapists at the homes to guide them? How would they know they are doing things wrongly if there are no physiotherapists to correct them?

Also, these students wouldn't have enough exposure to cardiorespiratory (CR) patients as majority of CR patients can only be found in hospitals. How would they be able to assess and treat CR patients upon fully graduated if they have handled none? Many have NEVER EVEN STEPPED INTO THE ICU.

I'm sure the Malaysian Physiotherapist Association (MPA) and the Ministry of Health (MoH) as well as the Ministry of Higher Education are making efforts to overcome these problems. We hope and pray to see the outcomes of their effort ASAP.

We can't have many more students being CHEATED!