Vous êtes sur la page 1sur 5


Physical agent modalities (PAMs) are those procedures and interventions that are
systematically applied to modify specific client factors when neurological,
musculoskeletal, or skin conditions are present that may be limiting occupational
performance. PAMs use various forms of energy to modulate pain, modify tissue
healing, increase tissue extensibility, modify skin and scar tissue, and decrease edema
or inflammation (Bracciano, 2008). Although the American Occupational Therapy
Association (AOTA) already asserts that PAMs may be used by occupational therapists
and occupational therapy assistants in preparation for or concurrently with purposeful
and occupations-based activities or interventions that ultimately enhance engagement in
occupation (AOTA, 2008a, 2008b), a retrospect look at the fierce debate of inclusion of
PAMs in occupational therapy is worth the time, because it can provide practitioners
with insights about our professions philosophy and practicality. The author of this paper
will first review and comment the historical debate of inclusion of PAMs into occupational
therapy, then state her opinion about why PAMs is important in occupational therapy
practice, and why this debate provide valuable insight into the growth of our profession.

Historical Debate
The inclusion of PAMs is considered one of the ten milestones in AOTA history, and the
debate started 40 years ago on a national dialogue on treatment media. It started with
an article and a series of letters to the editor published in the American Journal of
Occupational Therapy. The article and letters share same message: to protect against
the use of only crafts and purposeful activity in occupation, and to introduce pure
exercise and passive methods of facilitating, enabling, and preparing the patients
(West, 1992). The debate escalated with the publication of the Task Force Report on
Physical Agent Modalities (1991a), and the Representative Assemblys official statement
on this subject (AOTA, 1991b). Multiply articles had since published to support and opp
ose the Representative Assemblys official statement, and the debates surrounding most
ly one idea: whether the inclusion of PAMs as intervention violate the philosophical core
of occupational therapy?
Some opponents believed PAMs have nothing to do with contributing to the recovery of
clients lost function. Wilma L. West and Ruth Brunyate Wiemer (1991) in their The Issu
e Is article strongly argued again the inclusion of PAMs, and claimed practitioners using
PAMs as their intervention as inappropriate practice methods. They reasoned their opp
osition by saying the central theme of occupational therapy philosophy is use of occupa
tion (purposeful activity) as a means of influencing health, such occupation should instill

a respect for the realities of life, and should based on normal functional patterns of moti
on; and since PAMs only serve to increase in range of motion, muscle strength, coordin
ation, physical endurance or psychological adjustment, PAMs make no reference to way
s in which those gain can enhance self-care and independence (West & Wiemer, 1991).
I dont agree with this argument, actually I reckon that West and Wiemer (1991) started t
o contradict themselves by the next paragraphs when they further explained the philoso
phical theme of occupational therapy is to recover the patients impaired ability and will. I
f recovering the patients impaired will is the central theme of occupational therapy, and i
t is noted that patients with physical conditions often suffering pain that inhibiting them fr
om functioning; PAMs, methods that are proven to be effective in decreasing patients p
ain should not be considered as incompatible with occupational therapys central them
e (West & Wiemer, 1991).
Another reason Wilma and Wiemer (1991) were again the inclusion of PAMs was the uni
queness of occupational therapy being threatened. They argued since PAMs are often u
tilized by physical therapy, inclusion of PAMs as one of the occupational therapy interve
ntion will confuse the line between OT and PT, and risk letting ourselves once again fall i
nto a head-on confrontation with PT, a position we have tried to avoid for decades. Othe
r practitioners expressed the same concern, in a letter wrote to the editor of AJOT, Gail
Fidler (1992) expressed PAMs are consonant with physical therapy, use of PAMs in oc

cupational therapy will create cognitive dissonance for ourselves and others. I dont agr
ee with this argument either. For one thing, as I stated in the last paragraph, PAMs can
be highly effective, if we choose to ignore the effectiveness of PAMs, and choose to avoi
d conflict with other profession over to prioritize the interest of our clients, that seems to
be a violation of another core philosophy of our profession: client-center. For another thi
ng, I think combining PAMs and other traditional OT intervention can optimize the effecti
veness of intervention while upholding our philosophical value.
Some proponents use their practices to prove my point. In Ahlschwede (1992) article, sh
e stated her support for the use PAMs and asserted that in her own practice she will spe
nd the 15-min interval during which patients receive PAMs to discuss occupational perf
ormance or daily living components, collaborative goal setting, and paint education or a
ddressing psychosocial concerns or issues that the patient may have. And she believed
such practice adhere to the holistic practice, another major philosophical core of our prof

Personal Thoughts
I think our professions lack of a clear definition of what do we do and how do we do it,
also lack of a strong advocacy was the reason the inclusion of PAMs as our intervention
had been controversial. This debate provides us insight into the practical issue behind o

ur philosophical value. One thing I like about occupational therapy is the flexibility of our
profession, instead of being dogmatic we should be more creative, incorporating more e
ffective elements into our treatment to serve our clients interest. AOTAs final decision of
including PAMs as preparatory methods proves that our profession is able to respect our
philosophical value while growing dynamically.