Chapter II: Review of Related Literature

2.1. Global History

Physical Rehabilitation has been an ancient practice and can be traced back as far as 640 BC. A

man by the name of Hector practiced a technique of using water to rehabilitate, also known

Hydrotherapy. As a formal practice physical Therapy first appeared in the year 1814. Per Henrik

Ling, known as the father of Swedish Gymnastics, founded the Royal Central Institute of

Gymnastics which orchestrated healing through massage, manipulation and exercise. During the

year 1916, the Polio epidemic has surged itself in a Global scale. In response PT’s have

developed the Manual Muscle Testing in which assessment of the strength of muscle is done.

This resulted in muscle re-education technique on the weaker muscles of the patient

World War I was the mark where areas Physical Therapists was acknowledged as a profession.

During the year 1917, a heavy need of rehabilitation for injured soldiers was recognized by the

army. As a result, a special unit of the army medical department was formed. Due to demand,

this led 15 medical training programs specializing in rehabilitation. The International Federation

of Orthopedic Manipulative Therapy was formed as result of the practice spreading

Internationally. In the 1920s, a partnership between PT’s and medical and surgical department

developed. This gave a big boost in the acknowledgement of the public towards the validation of

the profession. In the 1930s, with the Polio epidemic still at large and prevalent in the US. In

response, The National Foundation for Infantile Paralysis was established in the year 1937. This
organization gave major support in the profession of Physical Therapy. After the war the need

for PT has declined and training was then suspended.

Renowned figures in Physiotherapy, Dr. Bobath, neurologist and Mrs. Bobath during their

lifetime travelled globally, teaching and training tutors around the world. During the 1950s the

profession started to gain independence; PTs have progressed from technicians to professional

practitioners. In the 21st century, the profession has observed great development and demand.

The new generation PTs consider the profession as an essential on maintaining the health and

well-being of the functions of the human body.

2.2. Rehabilitation Centers

2.2. Demographic User conditions of Physical Therapy

2.2.1. Pediatrics

Children tend to develop in a different manner from adults. Pediatrics program attains

that the patients to undergo the procedures for rehabilitation would be appropriate for

their given age.

2.2.2. Sports Medicine

Sports injuries are tackled by a more specialized field in Rehabilitation. The intricacy of a

program depends on the severity of the given injury. Services include physical Therapy

that addresses Musculoskeletal Conditions such as trauma, fractures, tendon tears and

sports-related injuries. Sports medicine focuses not only to rehabiltate the said conditions

but also strengthen core parts of the body to avoid further injury.
2.2.3. Cardiovascular and Pulmonary

Physical therapy for Cardiovascular and Pulmonary diseases can benefit the patient’s

motor movement due to severe heart or circulatory system problems. The goal of this

kind of physical therapy is to increase the endurance of key muscles and to give the

patient the ability to be self-reliant in the future.

2.2.5. Neurology

Injuries or conditions relating to brain and/or spine may need neurological physical

therapy. While these conditions are most likely chronic, physical therapy can drastically

improve the quality of life patients in improving their motor movements

2.2.6. Orthopedics

Orthopedic physical therapy is treatment to conditions that is a result from

Musculoskeletal injuries. Atrophy from immobility after surgery or even prolonged

reduction of muscle use because of an old injury will often need special therapy to regain

the former strength of the muscles.

2.2.7. Oncology

2.2.8. Geriatrics

One of most common cases for physical therapy are for older patients. As one gets older,

some of the muscles can no longer work as they used to. Physical Therapy can help a
 patient learn to compensate for weakened muscles, adjust their posture and gait, and even

reduce the likelihood of future injuries.

2.2.9. Occupational

2.3. Rehabilitation Services on Independent Facilities

Rehabilitation Facilities are mostly found inside or within a vicinity of a Hospital. Despite this,

there are cases in where areas Rehabilitation Facilities are of separate vicinities. The rationale

mainly comprises of, convenience of proximity of the targeted demographics, effectivity on

giving specialized care, facilities are more suited on the specific conditions, and avoidance of

feelings of convalescence and disability.

2.4. Transitional Care

Transitional Rehabilitation Program (TRP) is distinctly a separate environment in where

areas the location is desired to be away from the institutional hospital. Inpatient units or

patients deemed to have recovered from surgery can be transferred to TRP in order to

assist them transitioning back to the community. In some cases, patients who have

relapsed in the community may go into this type of rehabilitation center for intensive

assessments and focused treatment

2.4.1. Location:

The Transitional Rehabilitation Center may be in several locations:

1. Within the hospital but finished as a separate environment of care

functions.

3. A complete separate building on the hospital campus.

4. A separate building on an off-campus site.

2.4.2 Outpatient Care

Outpatient care is a term where areas no admittance will be held. Surgeries, assessments,

rehabilitation will all be done within prescribe appointments or session. These types of

care are usually done to patients with mild conditions or patients that are about to

recover. Outpatient care in rehabilitation can mostly be found in hospitals and

independent clinics. Outpatient care is usually cheaper in terms of price vs the likes of

inpatient and transitional care. This unit differs from a typical hospital outpatient clinic as

patients, staff and specialized treatment can all be concentrated in one area. Patients will

be assessed and can be treated in a group as well as an individual setting.

2.4.3. Functional Graphs

The Following graphs showcases the relationship of these three types of units towards the

given demographic:

A. Inpatient, Transitional, and Outpatient Units within the main hospital/medical center

proper, adjacent to each other.

B. Inpatient and Outpatient Units within the hospital/medical center proper, with

Transitional Unit separated by physical distance within the proper.

Figure 2
 C. Inpatient and Outpatient Units within the hospital/medical center proper, with

Transitional Unit separated by greater physical distance on the campus grounds or at an

off-campus location.

Figure 3

2.5. Psychosocial Factors

2.6. Health Facility Paradigms in the 21st Century

2.6. Effect of the Environment

2.7. Therapeutic effects of Biophilic Architecture

2.8. Effect of Commuting in ones Health

2.6. Case Studies

2.6.1. International
[Link]. Bridgepoint Active Healthcare
 Bridgepoint Active

Healthcare in Toronto is one

of the largest rehabilitation centers in Canada. The facility mainly deals with

chronic injuries and diseases. Bridgepoint pioneers a new system of this type of

facility. Bridgepoint is found at an urban center in which healthcare and

community can come together. This is done to differentiate from the traditional

norms of institutional space and public access and to provide a social active space

to improve the patients in their recovery. The facility houses seven inpatient

therapy spaces and 1 outpatient therapy amounting to approximately 1250 square

meters. The design of Bridgepoint’s physiotherapy spaces is a typical example of

restricting the activity to one room. Each floor contains one therapy gymnasium

located in a corner of the building, which grant panoramic views of the city. The

layouts of the gymnasiums vary slightly from one to another, mostly in regards to

the specialized equipment used by each unit and are relatively bland with

unstimulating materials and harsh florescent lighting. In one physiotherapy room,

treadmills and stationary bicycles face the windows looking outwards, while

physiotherapy beds line the wall, each divided only by curtains on ceiling tracks.
In some cases, extra equipment is stored in a corner of the room, in place of a

designated area. The gyms, used daily by various physiotherapy and occupational

therapists with their patients, often become cramped due to overcrowding. The

distinctive building envelope contains a fenestration pattern of 492 projecting

‘pop-out’ vertical frames – one for every patient bed – interspersed with the

predominant horizontal fenestration as counterpoint. The massing rests on a

concrete flat slab structure with cantilever floor plates around the perimeter. To

mitigate the scale of this facility, a vertical campus concept was conceived to

create a community of stacked neighborhoods of patient units. Each floor is

clearly ordered and organized into two neighborhoods of 32 beds each configured

with single and double-bed patient rooms. Shared therapy space is centralized on

each floor at the cores with common spaces to the north and south. Nursing

stations are in close proximity to their respective neighborhoods of care.