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What are the moral, ethical, legal, and clinical implications for physiotherapy practice when the boundaries of medical and health science are significantly shifted as a result of technological advances?

Physio2050 is a project that asks students to look at the most cutting edge technologies in health care and ask what are the ethical and clinical implications of the widespread adoption of those technologies. Students often crave certainty in their learning but in fact, it is in their uncertainty that we find the most interesting learning  opportunities. The project is premised on the idea that health and medicine – embedded within a broader social construct – will be significantly impacted by rapidly accelerating changes in technology.

Project coordinators:

  • Michael Rowe (University of the Western Cape, South Africa)
  • Joost van Wijchen (HAN University, Netherlands)
  • Veronika Schoeb (Hong Kong Polytechnic, Hong Kong)
  • Ben Ellis (Oxford Brookes University, United Kingdom)

This project will be implemented at the 2018 International Physiotherapy Students Meeting (IPSM) in Portugal. We are designing the workshop so that it is possible for anyone to participate, whether you are in the room or not.

Potential topics for student discussion

  1. Artificial intelligence and algorithmic decision-making. Can computers be ethical? How is ethical reasoning incorporated into machines? How will ethical algorithms impact health, for example, when computers make decisions about organ transplant recipients? Can ethics programmed into machines?
  2. Nanotechnology. As our ability to manipulate our world at the atomic level advances, what changes can we expect to see for physiotherapists and physiotherapy practice? How far can we go with integrating technology into our bodies before we stop being “human”?
  3. Gene therapy. What happens when genetic disorders that provide specialisation areas for physiotherapists are eradicated through gene therapy? What happens when we can “fix” the genetic problems that lead to complications that physiotherapists have traditionally had a significant role in. For example, what will we do when cystic fibrosis is cured? What happens when we have a vaccine for HIV? Or when ALS is little more than an inconvenience?
  4. Robotics. What happens when patients who undergo amputations are fitted with prosthetics that link to the nervous system? When exoskeletons for paralysed patients are common? How much of robotic systems will students need to know about? Will exoskeletons be the new wheelchairs?
  5. Aging. What happens when the aging population no longer ages? How will physiotherapy change as the human lifespan is extended? There is an entire field of physiotherapy devoted to the management of the aging population; what will happen to that? How will palliative care change?
  6. Augmented reality. When we can overlay digital information onto our visual field, what possibilities exist for effective patient management? For education? What happens when that information is integrated with location-based data, so that patient-specific information is presented to us when we are near that patient?
  7. Virtual reality. What will it mean for training when we can build entire hospitals and patient interactions in the virtual world? When we can introduce students to the ICU in their first year? This could be especially useful when we have challenges with finding enough placements for students who need to do clinical rotations.
  8. 3D printing. What happens when we can print any equipment that we need, that is made exactly to the patient’s specifications? How will this affect the cost of equipment distribution to patients? Can 3D printed crutches be recycled? Reused by other patients? What new kinds of equipment can be invented when we are not constrained by the production lines of the companies who traditionally make the tools we use?
  9. Brain-computer interfaces. When patients are able to control computers (and by extension, everything linked to the computer) simply by thinking about it, what does that mean for their roles in the world? What does it mean when someone with a C7 complete spinal cord injury can still be a productive member of society? What does it mean for community re-integration? How will “rehabilitation” change if computer science is a requirement to even understand the tools our patients use?
  10. Quantified self. As we begin to use sensors close to our bodies (inside our phones, watches, etc.) and soon – inside our bodies – we will have access to an unprecedented amount of personal (very personal) data about ourselves. We will be able to use that data to inform decision making about our health and well-being, which will change the patient-therapist relationship. This will most likely have the effect of modifying the power differential between patients and clinicians. How will we deal with that? Are we training students to know what to do with that patient information? To understand how these sensors work?
  11. Processing power. While this is actually something that is linked to every other item in the list, it might warrant it’s own topic purely because everything else depends on the continuous improvements in processing power and parallel reduction in cost.
  12. The internet. While the architecture of the internet itself is unlikely to change much in the next few decades (disregarding the idea that the internet as we know it might be supplanted with something better), who has access to it and how we use it will most certainly change.

Workshop structure

  1. Joost (who is present with the students) opens the session by introducing the topic and why it matters. Maybe a short presentation of novel technologies and ideas that we think may have an impact on the future of physiotherapy clinical practice. We could link it to possible changes in the undergraduate curriculum, although this isn’t necessary.
  2. I do a short presentation by Skype, introducing what I did with my students and some of the outcomes. Alternatively, each of the facilitators (in different countries) says hi to the group in the room, and all students shout and wave at each other.
  3. All students, external (outside the room) and internal (in the room) read through a student information sheet (or watch a video, or go through a slideshow) that describes the activities for the session.
  4. Students with Joost (who are physically in the workshop at IPSM), and external students split into groups, each group choosing one technology or idea to explore.
  5. They spend 30-60 minutes (depending on the session) actively developing their own information handout (we can prepare the outline ahead of time, including some relevant resources for them to refer to). They use Google Docs for this so we can all see what groups are working on.
  6. Local facilitators provide face-to-face facilitation during the session for their own students.
  7. Each group at IPSM does a 2-minute presentation (using Google Slides) e.g. 30 seconds to introduce the technology/idea, 30 seconds to describe a clinical implication, 30 seconds for educational/curriculum implication, and 30 seconds to answer one question from the audience.
  8. A couple of days (no later than a week) after the event, facilitators have a seminar with their own students to make sure that the aims of the session were met and that students aren’t left feeling that they’ve been ambushed.

So much of physiotherapy practice – and therefore, physiotherapy education – is premised on the idea that what has been important over the last 50 years will continue to be important for the next 50. However, as technology progresses and we see incredible advances in the integration of technology into medicine and health systems, we need to ask if the next 50 years are going to look anything like the last 50. In fact, it almost seems as if the most important skill we can teach our students is how to adapt to a constantly changing world. If this is true, then we may need to radically change what we prioritise in the curriculum, as well as how we teach students to learn. When every fact is instantly available, when algorithms influence clinical decision-making, when amputees are fitted with robotic prosthetics controlled directly via brain-computer interfaces…where does that leave the physiotherapist? This project is a first step (for me) towards at least beginning to think about these kinds of questions.


You can find a list of reading material and other resources for students to start with at the #physio2050 hashtag on Twitter.

Examples of student work

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