Medical Rehabilitation 2008, 12 (4), 28-35

The need and possibility of teaching clinical neurophysiology

at faculties of physiotherapy
Potrzeba i możliwość nauczania neurofizjologii klinicznej studentów
fizjoterapii

Ryszard Kinalski

The Institute of Cosmetology and Health Care in Bialystok, Poland

Key words
undergraduate education, clinical neurophysiology, physiotherapy

Abstract
Introduction: Although fundamental issues of clinical neurophysiology constitute a part of standard education of students at physiother-
apy faculties, the graduates from these faculties do not associate their professional and/or scientific career with this category of clinical
diagnostic studies. These diagnostic tools, however, are very important for neurorehabilitation. Thus, students are not trained by profes-
sional clinical neurophysiologists. Problems related to clinical neurophysiology are implemented in different study and training contents
that disintegrate transfer of knowledge and are harmful for the rank of clinical neurophysiology in the environment of physiotherapists.
Aim of the study: To show that, in conformance with the standards of physiotherapy education, there is a need to teach clinical neuro-
physiology as a separate subject and that there are possibilities to reliably utilise the existing infrastructural and financial potential to
introduce the lectures and practical training of clinical neurophysiology into the physiotherapy faculties curricula.
Study form: to perform an initial assessment to estimate: 1. which issues of clinical neurophysiology are implemented in core standards
of education of the physiotherapy faculty students; 2. in which and how many of the country districts medical or physical education
universities and other public or private high schools have faculties of physiotherapy; 3. in which districts, bordered territorially by these
schools, there are establishments licensed to conduct training in clinical neurophysiology; 4. what type of scientific status do persons
certified in clinical neurophysiology have, who are listed in the districts with physiotherapy faculties. 5. how many persons among phy-
sicians and physical culture teachers receive scientific degrees for research in clinical neurophysiology associated with rehabilitation
and physiotherapy.
Conclusions: There is a need, infrastructure and financial support to include clinical neurophysiology into the curricula of the physio-
therapy undergraduate education.

Słowa kluczowe
edukacja przeddyplomowa, neurofizjologia kliniczna, fizjoterapia

Streszczenie
Wstęp: Aczkolwiek treści kształcenia z zakresu przedmiotu neurofizjologii klinicznej należą do standardów studiów I i II stopnia na
kierunku fizjoterapii, absolwenci studiów fizjoterapii nie wiążą swojej kariery zawodowej i naukowej z tą, ważną dla neurorehabilitacji,
dziedziną diagnostyki klinicznej. Studenci nie są nauczani neurofizjologii klinicznej jako dziedziny diagnostyki medycznej, ale poznają
jej fragmenty włączone do innych przedmiotów nauczania. Taka dezintegracja przekazu wiedzy obniża rangę tego przedmiotu i szkodzi
jego reputacji w środowisku fizjoterapeutów.
Cel pracy: Wykazanie, że zgodnie z obowiązującymi standardami edukacji fizjoterapeutów istnieje potrzeba nauczania neurofizjologii
klinicznej jako wyodrębnionego przedmiotu, oraz że są możliwości wykorzystania istniejącej infrastruktury i środków finansowych dla
zrealizowania takiej innowacji.
Projekt pracy: Dokonanie wstępnych ocen dla ustalenia: 1) jakie z treści kształcenia dotyczące neurofizjologii klinicznej są włączone
do treści kształcenia innych przedmiotów nauczania; 2) w ilu i w których województwach są rozmieszczone wydziały fizjoterapii aka-
demii medycznych i wychowania fizycznego oraz innych szkół wyższych publicznych i niepublicznych; 3) w których województwach,
związanych terytorialnie z tymi szkołami wyższymi, są rozmieszczone placówki uprawnione do prowadzenia szkoleń w zakresie neuro-
fizjologii klinicznej; 4) jaki jest status naukowy certyfikowanych w zakresie neurofizjologii klinicznej osób, które są ewidencjonowane
w województwach, gdzie są prowadzone studia fizjoterapii; 5) ilu spośród lekarzy i nauczycieli WF uzyskuje stopnie naukowe za zwią-
zane z rehabilitacją i fizjoterapią, prace naukowe z neurofizjologii klinicznej.
Wnioski: Istnieje potrzeba, infrastruktura i są możliwości finansowe dla wyodrębnienia neurofizjologii klinicznej w programie nauczania
studiujących na kierunku fizjoterapia.

Received: 18.06.2008; accepted 20.08.2008

Medical Rehabilitation e ISSN 1896-3250 © ELIPSA-JAIM & WSA Bielsko-Biała

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 Medical Rehabilitation 2008, 12 (4), 28-35

Introduction after training in one of the centres ac- 2.93 (practical classes), while for use-
credited by the Polish Association of fulness – 2.87 (lectures) and 3.0
The development of bioengineerng Clinical Neurophysiology (PTNK). (practical classes). At the same time a
and the dissemination during the Only medical doctors may try for a population (2006) of MScs (5) BScs
years of the Decade of the Brain EMG licence covering also ENG, (4) and physiotherapy technicians
(01.01.1990-31.12.2000) of apparatus while in the case of EEG and EP li- (42) employed at 8 treatment rehabili-
(instrument) research in the field of cences equally medical doctors tation clinics was surveyed. It turned
clinical neurophysiology (CNP) en- though in justified cases also psy- out that none of those surveyed un-
abled a verification of hypotheses on chologists and biologists. Those who dertook tests in classic electrodiagno-
the regeneration and the plasticity of have been a member of the Techni-
the structures and functions of man’s sis and that doctors did not send pa-
cians’ Section of PTNK for at least tients for such tests7.
central and peripheral nervous sys- two years may try for EMG and EP5.
tem. This has advanced and main- The undervaluation of CNP
Doctors of neurology, neurosurgeons, amongst doctors and physiotherapists
tained clinical neurohabilitationA at orthopaedists, otolaryngologists, psy-
the fore of other fields of medical re- results from it marginalization during
chatrists and dental surgeons possess-
habilitation, independent of changes the course of pre-diploma education.
ing the title of specialist or 2nd degree
in the concept of man’s health. The A student of physiotherapy does not
specialisation in the field of medical
World Health Organisation estab- acquire conviction as to the signifi-
rehabilitation following training or-
lished in 2001 the International Clas- cance of CNP as a result of improper
ganised by the Centre for Medical
sification of Functioning, Disability Post-Diploma Education may try for a conditions for the realization of the
and Health (ICF) and adopted (2005) certificate of competency allowing content of education in this field.
a resolution on the prevention, treat- them to provide CNP services. Other Knowledge about CNP is conveyed by
ment and rehabilitation of disabled doctors may equally try to obtain such various teachers unqualified in this di-
individuals1,2. This initiated a process a certificate but only after attending agnosis within the framework of vari-
for the standardization of the concep- training sessions rooted in a specialist ous taught subjects. This lessens the
tual model of physical and medical programme with an extended range of ranking of CNP as a field for doctorial
rehabilitation as a health strategy3,4. In clinical internships and theoretical studies in physiotherapist circles.
this model, and particularly in relation courses6. In the light of the above le- The reason why the knowledge on
to an individual with central and pe- gal directives, a graduate of a faculty CNP amassed, delivered and de-
ripheral nervous system damage, of physiotherapy can not try for a scribed since the 1950s is not used by
physiotherapy constitutes a key link PTNK certificate or a CMPK diploma physiotherapists in cognitive goals in
in which the physiotherapist plays a despite interest in the field of CNP a comparable way to doctors, psy-
key role. The physiotherapist employs during the course of their studies. chologists and biologists is a puzzle.
physical procedures with the aim of This appears only, however, at institu- There is an absence of information as
improving the incorrect or reinforce- tions of HE where the subject is sepa- to what degree CNP research was
ment of residual nerve control, the rated in the teaching programme and used for the physiotherapy needs of
function of standing, involuntary the lectures and practical classes are neurological patients for the years
movements and locomotion through conducted by qualified and competent 2005 and 2006, when the number of
the utilisation of the physiological phe- teachers. physiotherapists was 10,000 and the
nomenon of the reaction of the nervous In the 2004/2005 academic year number of specialist doctors in
system to physical stimuli. The task of there was conducted amongst 132 stu- physical medicine and rehabilitation,
a physiotherapy specialist is the utilisa- dents of physiotherapy at two medical 900.16,17. AroundE 76 neurophysi-
tion of the energy from these stimuli academies an anonymous survey ological specialists, 332 possessing
with three aims, i.e. the recognition of evaluating (on a scale of 0-6) the com-
the causes of neurodysfunction, treat- EEG licences, 81 in EMG and 23 in
prehensibility and usefulness of lec- EP could have undertaken such re-
ment in acordance with the EBM re-
tures and practical classes in CNP. In search in this area.
quirements and the evaluation of the
one institutionB from amongst the gen- Current events, like the subject mat-
effects of the chosen method of con-
eral number of 23 taught subjects, the ter of the Second Eductional Congress
duct. The EBM requirements fulfil
CNP which is a field of medical diag- subject of CNP came in 5th place in Physiotherapy18 organised by the
nostics of central and peripheral nerv- (lectures) and 6th (practical classes). European Region of the World Con-
ous system damage, covering various The values of average marks were for federation of Physiotherapy, taking
categories of electro-neurodiagnostic comprehensibility 4.52 (lectures) and place in many countries are the ten-
research (Table 1). CNP research is 4.54 (practical classes), while for use- dencies for a redefinition of the role
professionally conducted by medical fulness – 4.19 (lectures) and 4.23 of a physiotherapy specialist19, and
employees with tertiary or secondary (practical classes). In the second insti- particularly the model realised for
education in possession of an appro- tutionC the average marks for compre- the education of specialists of physi-
priate certificate (license) obtained hensibility were 2.85 (lectures) and cal medicine and rehabilitation in the

A physiotherapy of the neurologic patient during hospitalization

B lectures and classes taught by a physician specialist of rehabilitation medicine with a CNP licence
C lectures and classes taught by a neurologist
D according to an undated list of persons possessing a PTNK licence

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Medical Rehabilitation 2008, 12 (4), 28-35

Table 1 graduate from a faculty of physio-

therapy should have knowledge and
Categories of electrodiagnostic tests (selected from CNP) practical abilities in the conducting
of CNP tests for a patient with cen-
Classical Electrodiagnosis Rheobase
chronaxis tral and peripheral nervous system
curve i/t damage. The achievement of the
accommodative cooefficient abilities and skills to conduct such
Electroencephalography (EEG) primary activity diagnostic procedures involves the
activated activity application of the content of the edu-
Electomiography (EMG) basic studya cation received during the first and
global studyb
polyelectromiographyc second degrees of study. In relation
Electroneurography (ENG) nerve conductivityd
to the first degree the teaching of the
muscle reflexe theory and practice of CNP is exclu-
nerve-muscle transmissionf sively in the content of physiology
parasympathetic skin respanceg teaching (the group of rudimentary
Invoked Potential (IP) exogeneh content) as well as physical therapy,
endogenei
motorl
general physiotherapy, clinical
physiotherapy and the clinical
Special tests
a
physiotherapy of dysfunctions in the
tests with needle electrodes; b tests with surface electrodes; c test of many muscles organs of locomotion (the group of
with surface electrodes; d motor and sensory nerves; e monosynaptic and polysynaptic;
f
so-called myasthenic trial; g testing the exciteability of the sympathetic nerve system specialised content). In relation to the
(so-called ‘lie detector’); h somatosensory; dermatomal; visual; auditory; i thought proc- second degree, the teaching of the
esses not connected with an external stimulus but with an event: P300; contingent theory of CNP practice is incorpo-
negative variation CNV; readiness potential; j induced by through-cranial brain magnetic rated within the content of instruc-
stimulation and through-skin peripheral nerves magnetic stimulation
tion from the methodology of tests
(the rudimentary content group) as
area of electrodiagnostic medicine20, ditioned by the principle of cost- well as physical medicine and bal-
should be conducive to undertake ini- effectiveness that is always observed neoclimatology and functional diag-
tiatives in Poland which would lead to by the insurer. nosis (the specialised content group).
innovations within the standards of 1st The scientific academic basis of There is required the allocation of at
and 2nd degree on physiotherapist both physiotherapy and CNP tests least 75% of the hours given for the
courses through the introduction of conducted on patients with central teaching of content through clinical
CNP as a subject for teaching, the crea- and peripheral nervous system dam- practical exercise classes (Table 2).
tion of legal regulations, the utilisation age is biophysics and the paradigm This is in accordance with the funda-
of the existing infrastructure and fi- of the quantitative description of mental principle of education23. How-
nancial resources from European Un- neurophysiological phenomena. In ever, the programme does not specify
ion funds. units of the Systeme International the necessity for practical CNP classes
d’Unites – SI there is controlled and and in terms of the educational content
measured the effects of activities on this is conveyed by various academic
The need for the teaching of teachers from a range of varied aca-
clinical neurophysiology the organism of energies from vari-
ous physical and chemical stimuli. demic disciplines. The lack of practical
In 1989 Paul Bach-Y-Rita21 claimed Both the energy of stimuli activating classes and the disintegration of CNP
that the fundamental barriers in the de- receptors as the energy released by knowledge transfer results in the stu-
velopment of neurorehabilitaiton is the activated neurons changes within the dent being unable to understand its sig-
lack of a scientific tradition and an un- nervous system into its own energy nificance for the physiotherapy needs
derstanding of the necessity for the of bioelectrical impulses. The energy of a patient with central and peripheral
creation of theory for this area of of these impulses is received, proc- nervous system damage. As a conse-
medicine. He pointed to the need to essed, strengthened registered and quence a student is unable to become
search for answers to key questions: depicted by technical instruments in interested in taking up a specialisation
what is the role of neurotransmiters the form of bioelectrical potentials of a PhD programme in this field.
in the treating of central and periph- measured automatically in SI units. A physiotherapist who wishes to
eral nervous system damage, whether In Polish state and private institu- objectivise the function of a damaged
the mechanism of reorganisation and/ tions of higher education as of the 1st central and peripheral nervous sys-
all regeneration is modified through of October 2007, education in facul- tem in a neurological patient can re-
the procedures based on EBM that ties of physiotherapy encompassing fer him to CNP tests, for example to
are applied, and how motivation, en- day and extramural courses of the a neurologist. The knowledge in the
vironment and family translate into first and second degree are con- field of CNP required from a neu-
the neuromechanisms of functional ducted according to the standards for rologist touches, however, chiefly the
regeneration. For from the defining education as covered by the Euro- interpretation of results and not prac-
of the biological basis of physio- pean Area for Tertiary Education22. tical abilities in the conducting of
therapatic effectiveness will be con- In accordance with these standards a EEG, EMG, ENG or EP tests. Such

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 Medical Rehabilitation 2008, 12 (4), 28-35

Table 2
Core standards of undergraduate physiotherapy courses pertaining to clinical neurophysiology in educational
programmes of various rudimentary and specialised subjects of the 1st and 2nd degree at faculties of
physiotherapy*
1st Degree 2nd Degree
Divisions Education in Concerns clinical neurophysiology Education in Concerns clinical neurophy-
Core standards siology
and other re-
quirements
Rudimentary Physiology Fundamentals of neurophysiology. Central Testing methods Reliability, reproducibility,
content group and peripheral nervous system. Muscles as verification, registration and
well as: the types of fibres; neuromuscular norms of test results; quantitative
junctions; recruitment of motor units; conduc- methods; problem of quantifying
tivity and exciteability of nerve fibres; electric the test results in rehabilitation
action of muscles; reflexes, controlling of and physiotherapy; current test
movements; plasticity of the nervous system possibilities in physiotherapy.
and muscles; reinnervation; neurophysio-
logy of pain
Specialist con- Physical therapy Electrodiagnosis – qualitative and quantita- Physical medicine Physical diagnostic methods
tent group General physiotherapy tive methods and the balneocli- useful in physiotherapeutic prac-
Clinical physiotherapy Suitability and significance of various matology; func- tice. Abilities and competencies
Clinical physiotherapy apparatus tests tional diagnostic in the selection of diagnostic
in the dysfunction of Conducting of functional tests in neurology methods testing for the verification and
movement Undertaking of tests essential for the modification of the programme
selection of physiotherapy means for the of the rehabilitation of individuals
physiotherapy of neurological patients with with nervous system dysfunc-
movement dysfunctions tions

Other require- At least 75% of teaching hours in the At least 75% of teaching hours in
ments above mentioned content should be the above mentioned content
realised in the form of clinical practical should be realised in the form of
exercises clinical practical exercises
* on the basis of appendix no 33 to the regulation of the Minister of Science and Tertiary Education of the 1st October 2007 www.rgsw.edu.pl)

practical skills are acquired by a doc- categories of CNP tests can be ob- nostic procedures independently or has
tor during only three 2-3 day special- tained by the doctor within the assisted during their realisation24.
ist courses. These are the courses: framework of a specialising intern- A neurologist responsible for the
EEG (3 days of 6 lecture hours), ship in the bases of neurology. The evaluation of the link between the re-
EMG and ENG (3 days of 6 lecture verification of practical skills is con- sults of the CNP test and the result of
hours) and EP (2 days of 6 lecture firmation given by those running the subject and object test conducted
hours). Additionally the abilities in courses and specialising internships by him is usually, as a result of lack
the interpretation of results for these that the doctor has carried out the diag- of time, referring the patient himself

Table 3
MSc and PhD degrees awarded between 17.10.1997 and 24.11.2005 for research connected with neurophysiology
in medicine, physical education and medical biology
Area
Specialization In total*
Medicine Physical education Medical biology
Rehabilitation 26 A, B 30 C, D 8 64
Physiotherapy 17 E,** 17
Physiotherapy and rehabilitation 11 11
Rehabilitation and others 7 1 8
Electrophysiology 3 3
Neurophysiology 3 3
Neurophysiology and others 7 7
In total 43 59 11 113**
A,B,C,D,E
= letters represent one work at the post-doctorial level of habilitacja; other= clinically other, * = on the basis of data obtained 11.03.2006 from the
Centre for Information Processing in Warsaw; ** = represents a single doctorial defence on the subject of chronaximeter clinical tests of nerves and muscles.

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Medical Rehabilitation 2008, 12 (4), 28-35

for CNP tests. However, an individual

who does not carry out CNP tests suffi-
ciently often and independently, who is
not a clinical neurophysiologist or one
having direct contact with one, should
not and is not able to interpret appro-
priately the results of specialist electro-
diagnostic tests. In an identical though
more difficult situation is the physio-
therapist, from whom there is no re-
quirement to carry out CNP tests while
studying. Yet a student of physiother-
apy who becomes acquainted in prac-
tice with the procedure for the conduct-
ing of, for example, muscle and nerve
excitability, understands the purpose of
measurement in SI units of the magni-
tude of the response of the excited tis-
sue, and is able to interpet the result of
the CNP test and to correlate it with the
disease symptom (Photography 1).
Photography 1 The consequence of an insufficient
A student of the University of Cosmetology and Health Care in Białystok during promotion of CNP during studies is
clinical neurophysiology classes (20.02.2006). Examination of the median nerve the small level of interest on the part
motor conduction velocity. Transcutaneous electrostimulation of the nerve at the
wrist region while observing the amplitude (expressed in mV) of action potential
of HE medical school and PE gradu-
elicited in the muscles of the thenar. ates to obtain academic degrees
within this area of specialisation. For
the period from 17.10.1997 to the
24.11.2005 113 PhDs were awarded
Table 4 in Poland (including 5 post-doctorial
degrees of habilitacja) to individuals
Localisation and number of units licenced to conduct training courses connected with rehabilitation or
in EEG, EMG, and EP physiotherapy, for works in the field
No Provincial administrative division EEG EMG EP total centres of medicine, physical culture and
medical biology. In the field of medi-
1 Dolnośląskie (Wrocław) 1 1 1 3
cine 43 people gained PhDs includ-
2 Kujawsko-Pomorskie (Bydgoszcz) ing 10 for works connected with neu-
3 Lubelskie (Lublin) 1 1 2 rophysiology. While in the area of
physical culture, out of 59 individu-
4 Lubuskie (Zielona Góra)
als only one gained the degree of
5 Łódzkie (Łódź) 2 2 PhD in classic electrodiagnosis
6 Małopolskie (Kraków) 2 2 4 (Table 3). The number of individuals
to gain the status of academic em-
7 Mazowieckie (Warszawa) 8 3 5 16
ployee in the field of CNP coincides
8 Opolskie (Opole) with the statistics showing the low
9 Podkarpackie (Rzeszów) level of interest in comparison to the
EU average in continual education25.
10 Podlaskie (Białystok)
11 Pomorskie (Gdańsk) 3 3
The possibility of teaching
12 Śląskie (Katowice) 3 1 2 6 clinical neurophysiology
13 Świętokrzyskie (Kielce) 1 1
The teaching of CNP within the
14 Warmińsko-Mazurskie (Olsztyn) framework of standard education in a
15 Wielkopolskie (Poznań) 2 1 3 physiotherapy degree requires the
setting aside of an appropriate num-
16 Zachodniopomorskie (Szczecin) 1 1 2 ber of hours for the running of lec-
Razem placówek 21 8 13 42 tures and practical classes, the em-
*/ = according to www.cskwam.mil.pl/ptnk/kursy_szk (20.05.2008)
ployment of appropriately qualified
and competent individuals as well as
finding sources of finance for the re-
alisation of this aim.

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 Medical Rehabilitation 2008, 12 (4), 28-35

Table 5
The academic status of 584 clinical neurophysiologists* evidenced in the district divisions of PTNK** located close
to medical academies (AM), academies of physical education (AWF) and other state institutions of HE where
a total of 71 classes are at 1st and 2nd degree programme level.
State Private
AM AWF IP INP All
No Provincial administrative division I II I II I II In total I II In total I II Total
1 Dolnośląskie (Wrocław) 1 1 1 1 5 9 4 4 11 2 13
2 Kujawsko-Pomorskie (Bydgoszcz) 1 1 2 1 1 2 1 3
3 Lubelskie (Lublin) 1 1 4 1 7 2 1 3 7 3 10
4 Lubuskie (Zielona Góra)
5 Łódzkie (Łódź) 1 3 4 2 2 6 6
6 Małopolskie (Kraków) 1 1 1 2 5 4 1 5
7 Mazowieckie (Warszawa) 1 1 1 1 5 9 4 4 11 2 13
8 Opolskie (Opole) 2 2 2 2
9 Podkarpackie (Rzeszów) 1 1 2 1 1 2
10 Podlaskie (Białystok) 1 1 2 1 1 3 3
11 Pomorskie (Gdańsk) 1 1 1 3 1 1 3 1 4
12 Śląskie (Katowice) 1 1 1 1 5 9 16 6 13 2 15
13 Świętokrzyskie (Kielce) 2 1 3 5 5 7 1 8
14 Warmińsko-Mazurskie (Olsztyn) 2 1 3 1 1 2 3 2 5
15 Wielkopolskie (Poznań) 1 1 1 1 4 8 2 2 8 2 10

16 Zachodniopomorskie (Szczecin) 1 2 3 3 3

Razem placówek 11 7 6 5 38 4 71 29 2 31 84 18 102

*/ = according to data from institution websites (20.05.2008)

Clinical neurophysiology should (120 hours), IT (30 hours), General skills. These individuals are linked
become a separate subject for teaching, Studies (60 hours) as well as for with specialist health care centres
or hours should be designated for CNP groups with a rudimentary and spe- equipped with equipment and instru-
coming from the general number of cialised content (1515 hours). Ac- ments for the testing of CNP. In the
hours allocated for the content of rudi- cording to the guidelines the above territories of provincial administra-
mentary and specialised courses. Such principle should also relate to second tive divisions that are the seat of in-
an innovation is possible and in accor- degree courses in physiotherapy26. stitutions of HE there exist PTNK
dance with the adopted (27.11.2007) The introduction of the teaching of accredited centres that conduct training
position of representatives of medical CNP in schools of HE under the ju- in the field of EEG, EMG and IP
and state and private instutions of HE risdiction of the Ministry of Science (Table 4) testing. According to PTNK
which run degree courses for 1st and and Tertiary Education that teach in data there are 21 centres that train for
2nd degree physiotherapy. The effect of faculties of physiotherapy requires EEG (for children – 9 for adults – 12),
the agreements adopted are the Guide- the employment of academic teach- EMG – 8 and for IP – 13. These cen-
lines of the Department of Science and ers. This is difficult as a result of the tres are within the territorial range of
Tertiary Education and Ministry of relatively low level of pay in the state and private institutions of HE
Health taking into consideration the public sector and the phenomenon of which run 1st and 2nd degree studies in
possibility of allocating 115 hours of holding multiple posts connected physiotherapy (Table 5).In these cen-
classes, to increase the number of with it. In such circumstances it ap- tres are registerd by PTNK individuals
hours of classes defined in the stan- pears justified to search for possibili- of various academic status in posses-
dards of HE education for the first de- ties of utilising the infrastructure that sion of certificates entitling them to
gree of physiotherapy. These hours the existing departments and centres provide medical treatment in the
constitute the difference in hours re- within the field of CNP create. Mem- field of CNP (Table 6). According to
sulting from the subtraction from the bers of the Polish Association of the lists compiled by PTNK there are
global hour total of 2900 the figure Clinical Neurophysiology (PTNK) in Poland 76 neurophysiology spe-
of 1785 hours designated for PE possess the appropriate knowledge cialists, 332 with a CNP licence, 81
classes (60 hours), foreign languages and experience as well as practical an EMG and 23 with a IP licence.

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Medical Rehabilitation 2008, 12 (4), 28-35

Table 6

The academic status of 584 clinical neurophysiologists* evidenced in the district divisions of PTNK** located
close to medical academies (AM), academies of physical education (AWF) and other state institutions of HE
where a total of 71 classes are at 1st and 2nd degree programme level.
Clinical neurophysiologists AM AWF IP

No Provincial administrative division Dr Dr hab Prof Without In total I II I II I II In total

2 18 30 1 1 1 1 5 9
1 Dolnośląskie (Wrocław) 10

2 Kujawsko-Pomorskie (Bydgoszcz) 1 1 2
3 Lubelskie (Lublin) 8 2 13 23 1 1 4 1 7
4 Lubuskie (Zielona Góra)
5 Łódzkie (Łódź) 9 3 29 41 1 3 4
6 Małopolskie (Kraków) 13 3 5 51 72 1 1 1 2 5
7 Mazowieckie (Warszawa) 62 7 24 48 141 1 1 1 1 5 9
8 Opolskie (Opole) 2 2
9 Podkarpackie (Rzeszów) 1 1 2
10 Podlaskie (Białystok) 7 2 1 11 21 1 1 2
11 Pomorskie (Gdańsk) 8 6 47 61 1 1 1 3
12 Śląskie (Katowice) 24 2 10 67 103 1 1 1 1 5 9
13 Świętokrzyskie (Kielce) 3 2 18 23 2 1 3
14 Warmińsko-Mazurskie (Olsztyn) 2 1 3
15 Wielkopolskie (Poznań) 14 3 2 34 53 1 1 1 1 4 8

16 Zachodniopomorskie (Szczecin) 7 2 7 16 1 2 3
Razem placówek 165 20 56 343 584 11 7 6 5 38 4 71

* = possessing a PTNK licence in EEG, EMG or EP testing

** = according to www.cskwam.mil.pl/ptnk/kursy_szk (20.05.2008); ***= according to data from institution websites (20.05.2008)

Such an infrastructure, existing in a neurological patient does not ac- therapy on a neurological patient
15 of the 16 wojewódzstwos, may be company the finding of methods of (neurophysiatry) is CNP. This field
used by institutions of higher educa- quantitative testing, the result of concerns the separation from the ho-
tion on the basis of the budget sur- which would be a comprehensively listic conception of neurorehabilita-
plus of €4,100,000,000 available to descriptive integral, various dis- tion of its biological aspect and
the Ministry of Science and Tertiary turbed biological, psychological and points to one of the routes of enquiry
Education for realisation in the Op- social phenomena – domains – of the for a scientific theory for neurophys-
erational Programme Human Capital life of such a person. For this con- iatry based on biophysics and the
Priority IV Tertiary Education and cerns the coincidences of changes in quantification of physiological phe-
Science, within the framework of various structures, various organs nomena in SI units. This is con-
which beneficiaries will be institu- and systems of the human organism, firmed by fact. in accordance with
tions of HE and students27,28. A part changes in various cognitive and mo- which in the assessment of the ef-
of this amount may be applied for by tor behaviours of man as well as fects of treatment of spasticity the
institutions of HE on the basis of the changes in the means of its function- most reliable results of tests accred-
guidelines of the Ministry of Re- ing, in various ontogenetic age, in the ited to the former I, turn out to be ob-
gional Development concerning the changing physical and social envi- tained by means of electrodiagnostic
Operational Programme Human ronment. There are needed therefore techniques33.
Capital planed for 2007-201329. instruments adequately adjusted to
tests in each of the above mentioned Conclusions
End Piece domains30. For as the fundamental
domain of health is the state of the 1. There exists a need to introduce to
The new concept of health strategy biological functions of the human a standard pre-diploma programme
and the process for the unification of organism, the most useful instrument in physiotherapy the subject of
the conception of a holistic model of for the quantitative evaluation of the clinical neurophysiology and for
bio-psychosocial rehabilitation of neurobiological effects of physio- academic teachers in possession of

34
 Medical Rehabilitation 2008, 12 (4), 28-35

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