Registered Kinesiology and Regulated Healthcare in Ontario – Part One

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If you have had a chance to read my most recent post, you would know that I am a graduate of kinesiology and health science studies and, that I am a registered health professional practicing kinesiology in Toronto, Ontario, Canada – the first governing province in the entire world to regulate the profession of kinesiology. By regulating kinesiology, the public is in a safer position to use kinesiology services as they are bound to a governing college with strict guidelines, policies and ethics. Kinesiology services in Ontario, in this regard, are also a tax deductible service as a medical expense in the province of Ontario and, are covered by several health plans including Manulife, DesJardins and Great West Life.

As “exercise is medicine” is becoming a household phrase, so too is “kinesiology”.

Kinesiology by definition, is the study of human movement, or in other words “exercise” or “physical activity”.  Because of this simple definition many may still understand a degree in kinesiology as just that – a degree in physical activity, exercise, recreation and sport — and not as a science degree. The title of the degree which I achieved from Toronto’s York University in 2005 includes not only “kinesiology”, but “kinesiology and health science” and, for good reason.  What I studied goes beyond physical activity, fitness, recreation and sport. My degree includes the study of science, physiology, nutrition, anatomy, skilled performance and motor learning, statistics, research and data collection, biomechanics, chronic disease, neuroscience, endocrinology, epidemiology, bone and joint health, psychology, behaviour, counselling , and more.

Is exercise without the science easy, nonetheless? 

One may think so.

Is physical activity simple provided one is motivated to get active?

Even still, if plain old exercise were so easy, everyone would be doing it and not only that, doing it properly (dose, intensity, time, type) so that they were reaching all of their goals without hitting any obstacles or getting sick or injured along the way.

What if you have a chronic condition or disease? How about an eating disorder? What if your child is diagnosed with diabetes? Would you be curious as to whether or not he/she still be allowed to play soccer? Whom would you trust to send your child to see about this besides your family doctor?

The more physical activity and similar studies have evolved over the years, the more closely the relationship has become to not just limit the department of kinesiology and health science studies to sport and recreation, but to branch out into studying health and chronic disease as they relate to exercise. In fact, kinesiology and health science studies have been focusing on heart disease, diabetes, acquired brain injury, stroke and spinal injury as they relate to exercise and movement for many years now.

One main focus of such studies often pertains to “dose”.  Similar to pharmacology the “dose” of exercise is different for each individual. Both the type and the intensity may be varied depending on the physical pharmacondition of the person. The timing can be precise depending on not only the current medical condition, but it can also be customized to work with a person’s current medical prescriptions, chronic ailments and adjoining side-effects from one or the other. The duration of the exercise session can also be curtailed to elicit a precise response in order to treat a condition and to potentially heal it. This all requires expertise and years of study to properly define, prescribe and monitor.

Thus, a kinesiologist knows the ins and outs of the body and how it functions and dysfunctions. With regard to myself, I have both a strong knowledge and broad background of chronic disease and psychology and the various medications that go with such disease and how they may be affected by movement. I also understand various common ailments and of course, injuries related to sport, physical activity and work.

During my four year course of study, along with the 48 credits of core courses that focused on the study of the basic ins and outs of the body and mind as it relates to physical activity and health, 52 of my other credits were electives.  Some examples of the electives I chose to were exercise and addictive behaviours, which focused on disordered eating and physical activity habits and their relationship with correlative mental health conditions. I chose to learn more about phyiscal actvitiy and chronic disease which delved into post traumatic stress disorder and using exercise as an adjunct to cancer and stem cell therapy in order to improve symptoms of depression.  I also very much enjoyed my practical course in African and Caribbean Dance, in addition to the specialized Coaching Certificate Program I enrolled in, where I received my National Coaching Certification Program Level 3 Therory designation in my favourite sport, triathlon.

Historically speaking, kinesiology and health science degrees are relatively new.  The University of Toronto only changed the name of their program from Physical Education and Health to Kinesiology and Physical Education in 2012.  Previous to the 1990’s most schools were offering only physical activity or physical education degrees, not kinesiology and health science degrees.

As the study of sport science and physical activity continues to evolve, many schools have come to the realization that they are no longer studying just sport and physical activity, but that they are on to something much broader and more encompassing.

As a result, the popular title “kinesiology and health science” was born and continues to grow today. In fact, most – if not all – Canadian universities (and many more around the world) have changed or, are in the process of changing their outdated undergraduate “sport and physical activity” programs to “kinesiology and health science” studies or similar.

So, if you’ve reached this point you know a bit more about me and a lot more about kinesiology. But, I need to help you understand one more thing.  That is how one practices kinesiology and how the practice of kinesiology fits into the regulated healthcare model in Ontario, Canada.

First of all, I will inform you of the scope of Registered Kinesiology in Ontario:

The practice of kinesiology is the assessment of human movement and performance and its rehabilitation and management to maintain, rehabilitate or enhance movement and performance. 2007, c. 10, Sched. O, s. 3.

In layman’s terms as redefined by the Ontario Kinesiology Association, the scope is as follows:

 The practice of Kinesiology is the assessment of movement, performance and function and the rehabilitation, prevention and management of disorders to maintain, rehabilitate or enhance movement, performance and function, in the areas of sport, recreation, work, exercise, and activities of daily living.

This is where things may get confusing, or how I more like to explain it in terms of “overlapping” scopes of practice. Whereas, no single health profession has exclusive ownership of a specific skill or health service, different professions may provide the same health services. A Kinesiologist in this way may seem similar to a Physiothersapist or a Chiropractor. Let me explain the differences.

Chiropractors and Physiotherapists are classified as Health Practitioners and can diagnose disease.  As a Kinesiologist, I am classified as a Health Professional and can make a clinical impression.  

A clinical impression is not to be confused with communicating a diagnosis of a disease.

To further explain,

Chiropractors are authorized to (Chiropractic Act, 1991):

  • Communicate a diagnosis identifying, as the cause of a person’s symptoms,
    • a disorder arising from the structures or functions of the spine and their effects on the nervous system, or
    • a disorder arising from the structures or functions of the joints of the extremities.
  • Move the joints of the spine beyond a person’s usual physiological range of motion using a fast, low amplitude thrust.
    • Put a finger beyond the anal verge for the purpose of manipulating the tailbone.

Physiotherapists are authorized to:

  • Communicate a diagnosis identifying a physical dysfunction, disease or disorder as the cause of a person’s symptoms.
  •  Treat a wound including by cleansing, soaking, irrigating, probing, debriding, packing or dressing the wound.
  • Administer, by inhalation:
    • i. oxygen, or
    • ii. a drug or substance that has been ordered by person who is authorized to do so by the Chiropody Act 1991, the Dentistry Act, 1991, the Medicine Act, 1991 the Nursing Act, 1991 or the Midwifery Act, 1991.
  • Putting an instrument, hand or finger beyond the labia majora or the anal verge for the purpose of assessment or treatment.

Kinesiologists are not currently authorized to perform any of the controlled acts outlined (above) and in section 27 of the Regulated Health Professions Act, 1991.

While most of these controlled acts are relatively easy to recognize and are clearly defined, the first controlled act, referred to commonly as “communicating a diagnosis” is an area that often causes confusion for regulated health professionals.

Let me explain.

In a comprehensive and consistent process, kinesiologists assess their patients’/clients’ movement and performance for the purposes of rehabilitation and enhancement. Kinesiologists base their clinical decisions on this assessment, and may offer professional opinions, appropriate interventions and recommendations. In this way, they are making a chartingclinical impression. This clinical impression can help the kinesiologist treat you right away provided it is appropriate, and it may also help to serve any other health professional involved with your treatment, either to enhance their own clinical impression or to assist them with making a diagnosis should they be authorized to do so.

The kinesiologist may also discuss findings with the patient/client, inculding a plan for follow-up with the appropriate diagnosing professional. In this process, it is essential that the kinesiologist provide the patient/client with an explanation of the nature of the problem that includes providing a label or name for the identified dysfunction (e.g. Hyperlordosis, reduced proprioception, Trendelenburg gait, etc.). This is considered by the College to be communicating a dysfunction, not a disease or disorder, and therefore does not fall within the definition of the controlled act of communicating a diagnosis.

Let me recap.

Outside of a communicating a complete diagnosis, the administration of oxygen, treating an open wound, moving joints beyond their normal range of motion and lastly, internal pelvic examinations – the many services that are provided by your various health care professionals may overlap.  This is to your benefit, as it only gives you more options to choose from during your Ontario healthcare service journey.

Below is a list of services your Registered Kinesiologist is authorized to provide in Ontario:

Assessments:

Goniometer

  • Gait Assessment
  • Musculoskeletal Assessment
  • Biomechanical Assessment
  • Postural Assessment
  • Ergonomic Assessments/Work Station Analysis

Services:

  • Therapeutic/Remedial Exercise
  • EducationFascial Stretch
  • Cardiac/Stroke Rehabilitation
  • Work Hardening
  • Work Conditioning
  • Modalities including, ultrasound, TENS (Biofeedback, Surface EMG), laserhttp://kine.info.yorku.ca/
  • Assisted Devices UtilizationManual Therapy
  • Corporate wellness programs
  • Work Design/Re-Design/Adaptation
  • Treatment Coordination/Communication
  • Manual Therapy
  • Myofascial Trigger Point Therapy
  • Soft Tissue Therapy
  • Sport Massage
  • Injury prevention and rehabilitation, including taping
  • Exercise with Special Populations
  • Chronic digeriatricsease prevention and management (e.g. Cancer, Diabetes, Arthritis, Heart Disease, MS, Fibromyalgia)
  • Acute illness recuperation
  • Exercise and fitness programs for weight loss, cardiovascular training and muscular conditioning/development
  • HydrotherapyRock Tape
  • Cryotherapy
  • Movement disorder therapies
  • High performance training
  • Occupational Health and Safety
  • Personal Fitness Training
  • Fitness and health related mental health and addiction programming

So, how does all this relate to how Registered Kinesiology fits into the current regulated healthcare model?

A Registered Kinesiologist is your healthcare expert on exercise. Although many other health care professions prescribe and monitor exercise and may even involve themselves in exercise programming, this is secondary to what their profession is primarily trained to do.  On the flip side, if your Registered Kinesiologist is providing manual therapy, or using modalities such as laser or ultrasound for a few examples, this is secondary to what they are primarily educated to do. Neither scenarios are wrong, or better or worse that the other. Getting the two to work together in order to get you moving better faster is key.

So how do we do this? How do we all fit into the regulated healthcare model in Ontario?  And, by all  – I mean not just the health professionals themselves, but YOU – the patient!

Stay tuned for Pahealth professionalsrt 2 of Registered Kinesiology and Regulated Healthcare in Ontario.

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