Lo Statuto Epistemologico legame tra due complessità – scienza e morale

The Epistmiological Statute, a link between two complexities: science and moral

Autori

Filippo Cavallaro (Università degli studi di Messina)

Rosario Fiolo (Università degli studi di Palermo)

Mariachiara Ceccio (Università degli studi di Messina)

Teresa Pintaudi (Università degli studi di Messina)

Francesco Bonanno (Università degli studi di Messina)

Introduction

In 2013, “The Epistemological Statute of Physiotherapy” was drafted in Messina and then was published in Aifi’s official journal “Fisioterapisti” 55/2014. It was the synthesis gained in months, studying the founding documents of the profession.

The Professional Profile, Code of Ethics, Core Competence and Core Curriculum represent the foundation on which the Epistemological Statute is built. This foundation charter would have described the physiotherapy discipline allowing its growth and development.

There was an awareness that physiotherapy, like medicine, dealing with living and unique beings, needed a practice of tailored therapeutic interventions, activities and treatments in the management of the person’s functional recovery.

The Epistemological Statute was proposed as a link between the complexity of science and the heterogeneity of morality

Methods

The congress theme led us to take a fresh look at the documents produced since the promulgation of the Professional Profile DM 741, 14.9.1994.

These are: Code of ethics, Core competencies and Core curriculum.

The references that helped us to look with a different point of view were the rereading of the works of Maturana and Varela and the enlightening contribution of Edgar Morin.

Results

Maturana and Varela state that “all living beings are equal as long as they are alive” because by the fact that they are all living, in them are fulfilled all the necessary conditions for an uninterrupted ontogeny of the individual. They also declare that with the study and the development of knowledge we have moved from the “innocence of knowledge” to the “knowledge of the knowledge”. In fact the knowledge of knowledge obliges us to keep an attitude of permanent vigilance against the temptation of certainty. The relationship that we create with others, with the patient, is an act of coexistence, and for this reason it is human. “This bond between human beings is the foundation of all ethics as a reflection on the legitimacy of the other’s presence”.

Morin teaches us that “The sciences … have not only a proper complexity to human realities, but also a particular issue, because the researchers of these disciplines are human beings, who works on, with and for other human beings.” He directs us toward a reasoning that can grasp the multidimensionality of realities, recognizing the interactive and retroactive interplay, dealing with complexities, rather than giving up to the ideological oppositions or to the mutilations dictated by exaggerated specialization (the new pathology of knowledge). For Morin, “Human needs are not only economic or technical, but also affective and mythological.”

However, this does not detract that medical treatments that do not take into consideration the wholeness of the organism and its complexity. Often these dimensions have undesirable side effects. Health and disease should both be considered as subjective experiences, Morin says, emerging from the specific bio-psycho-social-environmental evolutionary interweaving that characterizes each individual uniquely and unrepeatably. For this reason personalized intervention procedures are required, and nowadays the lack of these tailor-made protocols is severely complained

Discussion and Conclusion

Only with a link between the complexity and the ongoing relationship between scientific education and moral growth we will have a new epistemological status

REFERENCES

• Cavallaro F., Fiolo R., Giordano G. Lo Statuto Epistemologico della Fisioterapia, Fisioterapisti 55/2014
• a cura di Ferrari MG., Il Codice Deontologico dei Fisioterapisti, Ed Libreria Cortina 2014
• AA.VV., Linee guida per la formazione del fisioterapista – core competence, Masson 2003
• AA.VV., La formazione “core” del Fisioterapista, Scienza Riabilitativa 13(3) 2011
• Maturana H., Varela F., L’albero della conoscenza, Garzanti 1992
• Morin E., Ancora un momento, Raffaello Cortina Editore 2024
• Manti F., Il giudizio morale. Phronesis e complessità della moralità, TEORIA 2018/2

Il futuro che già c’è. Dalla fantascienza di Isaac Asimov al post umano di Ian McEwan: Le competenze di fisioterapia in Stroke unit.

The future is already here: from Isaac Asimov’s science fiction to Ian McEwan’s posthuman. The physiotherapy skills in Stroke unit

Autori

Filippo Cavallaro (Università degli studi di Messina)

Francesco Grillo (AOU “G. Martino” Messina)

Mariachiara Ceccio (Università degli studi di Messina)

Teresa Pintaudi (Università degli studi di Messina)

Francesco Bonanno (Università degli studi di Messina)

Introduction

Science and technology have always been directed toward solving the present problems while at the same time assessing and managing the new life conditions and development that the future will propose. A look into the future that creates new opportunities but also poses new problems. Health for WHO (1948) can be defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

In 1995 a professional profile had been legislated indicating universities as the principal training site for the professional, and the Wcpt General meeting in Washington recommended a minimum duration of 4 years. In 2003 and 2011 AIFI had proposed guidelines for the training of the physiotherapist.

Today, the widespread well-being that led to the lengthening of the average life span and both technological innovation and new therapies ensure the survival chance of people with chronicity and overlapping diseases. For this reason there has been the establishment of new operational units and among them the Stroke Units within the emergency area as a time dependent structure.

Methods

Starting from the structure given to the Core training of the physiotherapist and looking at the spaces that have been opened for this profession, a small group of physiotherapists discussed about the training experience lived by each of the participants and a questionnaire aimed at specific knowledge related to physiotherapy’s training and new developments in medicine was proposed.

The study focused on the Stroke Unit, especially:

– The evaluation of the space allocated to physical therapy in a stroke unit

– The analysis of the organization of the stroke unit team

– The management and the definition of physiotherapy times in relation to thrombolised patient’s times

Results

Health care advances in both clinical and organizational settings require a definition of the modalities and the intervention type in new hospital locations with patients on whom the pathology has a drift modulated by innovative therapies. An inconsistency between what is dictated by international LGs and the position in Italy was noted.

There seems to be confusion about the size of the team, because the high specialization leads lot of complications, related to the inescapable need of a holistic approach to complex problems, whatever their nature (especially in health care field). Medicine, in fact, in the biopsychosocial model, deals with the person, as a complex system that cannot be investigated and treated as it was an assembly of mechanical components. Overcoming these difficulties requires individual pathways between the frames of the individual disciplines. Depending on how these boundaries are traversed, we can adopt a multidisciplinary, interdisciplinary, or a more articulate transdisciplinary approach.

We can talk about a multidisciplinary approach if the comparison is held between professionals in the same field with different specializations (it is AIFI as a whole with GIS NIS). In this case it is an intradisciplinary juxtaposition.

Interdisciplinary approach occurs when experts from different fields talks in order to face and overcome a complex critical issues (it is AIFI when at ISS or GIMBE Foundation discuss with Scientific Societies and experts of various disciplines).

Since 1970, with Jean Piaget and Basarab Nicolescu, the term transdisciplinary has the ambition to cross the boundaries separating paradigms, rigid institutional norms and disciplinary labels. “Multidimensionality,” “inclusiveness,” and “creativity” are terms that best denote the transdisciplinary approach.

In the case of Stroke units, we will find ourselves thinking about decubitus prevention (prevention area), managing a monitored and assisted person in IC (emergency area), managing the risks of hospital infections and immunocompromised individuals (infectious disease area).

Discussion and Conclusion

The complexity of managing patients in the early stages of disease requires revisiting the directions of the physiotherapist’s core training, considering the complex organization of the “iron maiden” trapping erudition.

REFERENCES

• AA.VV., Linee guida per la formazione del fisioterapista – core competence, Masson 2003
• AA.VV., La formazione “core” del Fisioterapista, Scienza Riabilitativa 13(3) 2011
• Stafford Beer prefazione in Autopoiesi e cognizione di H.R. Maturana, F.J.Varela, Marsilio Editori 1988
• Angus Mc Murtry, Jenny Sasser (2020), Interdisciplinary and transdisciplinary approaches to ageing and gerontology, in Maria Łuszczyńska (ed.), Researching Ageing Methodological Challenges and their Empirical Background, Routledge.
• https://isa-aii.com/

THE IMPORTANCE OF MOVEMENT RELATED TO THE ENVIROMENT: WHAT OUR ANCESTORS TEACH US

Introduction

An active lifestyle is important to prevent cardiovascular, musculoskeletal and metabolic alterations through different exercises (for example the importance of walking is established in stroke prevention¹).

In light of this, we have organized urban walks in order to improve people to engage physical activity.

This experience showed improvements in meters travelled at 6MWT² (specifically from 360.9 meters to 563,8)

In order to establish a “prevention continuum”, our aim is to realize an Hellenic outdoor gym in the little town of Tripi (Messina) where everyone (child, adult and elderly) could train psychomotor skills, improving the knowledge of their body in activities related to an everyday life. To give life to this project, modern and technologies devices will not be used, but only human capacities and strategies will be allowed. With this project we hope to improve disability inclusion, too.

Methods

Through items of daily living, we will organize balance, coordination and psychomotor activities for children and elderly.

For adults, panhellenic games (sport activities) are provided, such as: race, long jump, javelin and discus throw.

Results

With this project we expect to see improvements in balance, coordination and motor skills in people who perform the activities proposed. It can be an opportunity for children to better know how their bodies “work”, how they can interact with the environment and how their bodies evolve in different age stages (especially in children with disabilities).

For adults and elderly it can be a chance to maintain previously acquired skills, to delay the physiological decay and to prevent cardiovascular, musculoskeletal and metabolic diseases.

Discussion and Conclusion

The invitation to an active lifestyle is an opportunity to point out the importance of physiotherapy, in prevention (monitoring the development and motor skills), health (with a therapeutic exercise tailored to the health condition of the subject and his potential recovery) and rehabilitation (with the potential dictated by the accessibility of services and the constant monitoring of impaired skills).

With this work, we want to highlight the importance of  physical activity both in childhood and adulthood. In children it is fundamental for the development of motor skills and the perception of their body related to the environment, which has been threatened, in the last twenty years, by new technologies.

For adults, the exercise is linked to the field of prevention, in fact the different activities and disciplines that will be performed, will have a beneficial effect on the cardiovascular, blood pressure³ and musculoskeletal system.

REFERENCES

1. Jefferis BJ, Whincup PH, Papacosta O, Wannamethee SG. Protective effect of time spent walking on risk of stroke in older men. Stroke. 2014 Jan;45(1):194-9. doi: 10.1161/STROKEAHA.113.002246. Epub 2013 Nov 14. PMID: 24232448.
2. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7
3. Araya-Ramírez F, Moncada-Jiménez J, Grandjean PW, Franklin BA. Improved Walk Test Performance and Blood Pressure Responses in Men and Women Completing Cardiac Rehabilitation: Implications Regarding Exercise Trainability. Am J Lifestyle Med. 2021 Feb 22;16(6):772-778. doi: 10.1177/1559827621995129. PMID: 36389052; PMCID: PMC9644150.

Pain scales towards an enhancement of the description

Introduction

Pain is, according to the International Association for the Study of Pain (IASP), “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,” and has always been an element with which the physiotherapist interfaces in taking care of the person who has a damage to complex sense-motor structures.

Everyday life and the campaigns promoted for a pain-free health care led us to use the VAS scale to assess and monitor the discomfort. However, it limits the value to a quantitative dimension. Even in the ungraded version with the emoticons (cheerful/ sad) at the extremes of a straight line, there is the same limit, leaving out all other aspects of this important complex factor.

Methods

Mc Gill University’s proposal of a pain scale where many aspects of pain perception are analyzed and valued, makes it possible that our professional figure can approach the patient’s body conscientiously, as well as with the tools of science, respecting it in timing, in space, in pressures and temperature, in discomfort or fear, in tension and emotionality. These are all aspects that can influence a rehabilitative act, where the storytelling accompanies the therapeutic interventions and the exercises performed by the patient. Our aim was to promote the validation of this scale, in fact, after a study of some literature papers, 12 colleagues proposed the scale to 25 patients, aged between 52 to 90 years.

Results

14 of them state that they were more aware of the type of their pain.

From that survey emerged some critical issues:

– The unevenness in the mode of presentation of the scale’s targeted questionnaire

– The presence of two Italian version of the same scale, but none validated

– The approximation of our translations, which were also different.

This made it difficult to submit the test to the patients, who were quite confused by the multitude of shades of the pain sensation (some of them they had never thought before).

Discussion and Conclusion

However, the critical issues described before, the potential of this new tool came out. In fact, the questions certainly helped to increase awareness of the location, intensity, and quality of their pain and the area of the body from which it origin.

The terms used in the questions made the patient’s explication of his condition more complex in some cases, but for most cases they were definitely helpful.

REFERENCES

Melzack R. – The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;

1:227-299

Padovani A., Caratozzolo S. – Il dolore in neurologia: aspetti clinici e valutativi. Focus on brain 2017; 2:55 – 57

https://www.fisioscience.it/wp-content/uploads/2022/08/McGill-Pain-Questionnaire-italiano-pdf.pdf