PRO-HEALTH: A Physical Rehabilitation Center and

Research Facility on Musculoskeletal Conditions

A Thesis Submitted to:

The College of Architecture

University of Santo Tomas

In partial fulfilment
Of the
of the requirement
requirement

For
Forthe
theDegree
Degreeofof

Bachelor of Science in Architecture

By:

Samson, John Gabriel R.

5AR-7

2020
August 20, 2020
Ar. RODOLFO P. VENTURA
Dean
University of Santo Tomas
College of Architecture
España Blvd., Manila

I have the honor to submit my thesis proposal entitled, “PRO-HEALTH: A Physical Rehabilitation
Center” as a partial requirement for the degree of Bachelor of Science in Architecture. With the
goal of making an accessible rehabilitation facility for Different-abled people, local athletes, and
occupational-injured individuals within The Cainta Rizal. The facility will aim not only to improve
the increasing rate of physical disability within Taytay Rizal but also its adjacent cities of Pasig
City, Taytay, Marikina and Antipolo.

The following are its project objectives:

1. To establish a provincial paradigm in the provision of rehabilitation towards the public.
2. To create a Rehabilitation Center that will offer accessible services for the locals as well
as its surrounding cities/towns
3. To improve services on restoring the physical and social function of the disabled.
4. To improve the integration Community-Based Rehabilitation in the Province of Rizal

Upon the approval of this proposal, it is understood that I shall proceed with the research work
and submit it on the designated date. Justification and other requirements for the proposal are
included herewith.

Very truly yours,

John Gabriel R. Samson
5AR-7

Recommending Approval: Approved by:

LEAH P. DELA ROSA, Ph D Ar. RODOLFO P. VENTURA, MSc

Thesis Adviser Dean

 The Pontifical and
Royal University of
Santo Tomas España
Blvd., Manila

OFFICE OF THE DEAN

COLLEGE OF ARCHITECTURE

Certificate to Proceed

This Certificate is hereby given to John Gabriel R. Samson whose thesis proposal entitled
“PRO-HEALTH: A Physical Rehabilitation Center and Research Facility on
Musculoskeletal Conditions” has been carefully evaluated and endorsed by the Thesis
Adviser and has subsequently been reviewed and approved by this office.

You are now tasked to proceed with your research works in accordance with the existing
guidelines and policies of the College. You are likewise enjoined to submit the said research
work on the time and date designated by the Thesis Adviser this Semester.

This Certificate to Proceed is issued on August 26, 2020.

Ar. RODOLFO P. VENTURA, MSc.

Dean, College of Architecture
Acknowledgement
Dedication
 Table of Contents
No table of contents entries found.
Table of Tables
Table of Figures
 Chapter I: Introduction

As a person ages comes with an increase of health-related complications experienced. These said

complications, may it be chronic, injury, disease and etcetera…, can have an apathetic effect on

the social, mental and physical aspects of the diseased. Physical disability, according to the DSWD

National Household Targeting System for Poverty Reduction 2011, is the 2nd most disability that

plagues the poor communities in the Philippines, only behind vision impairment. Surgical and

nonsurgical means are done to treat these traumas; spine diseases, sports injuries, degenerative

diseases, infections, tumors, and congenital disorders.

Physical rehabilitation and its allied field of Physical Medicine promotes not only in restoring an

individual’s motor functions but also studies the root of these symptoms. This process

strengthening the core body of a person as well as to educate the mental state of each patient on

confronting different situations. (Eberhard, 2008) It is designed to restore function and quality of

life by means of therapeutic modalities, manual therapies, therapeutic exercises, and patient

education. When these therapies are chosen correctly, initiated at the right time, individualized to

the patient, and implemented in a way to ensure patient compliance, then they offer significant

potential benefit with usually minimal risk. (Wyss and Patel. 2007)

Physical rehabilitation concerns itself with providing physical healing methods for different kinds

of injuries and illnesses not only does it promote recovery but also integration of the patient to a

normal everyday life.

1
 1.1. Background of the Study

1.1.1. Current Condition of Disability in the Philippines

Disability pertains to any condition of the body or mind makes it more difficult for the person

with the condition to do certain activities and interact with the world around them. With

different forms of disabilities, musculoskeletal conditions, according to WHO, are perceived

as the leading contributor to disability worldwide, with lumbar pain being the leading cause

globally. (WHO N.D)

Over a billion people, or about 15% of the world’s population, are estimated to live with

some form of disability. In accord to the International Classification of Functioning,

Disability and Health refers disability to an impairment, activity limitation or participation

restriction that is the result of the interaction between health conditions and environmental

and personal factors. Disability is can be affected by different factors of an individual’s life

these include: the activities an individual may participate, the lifestyle of an individual and

the environment that surrounds. (WHO N.D)

In the Philippines, the prevalence of severe disability among 15 years and older is 12%;

moderate disability, 47%; mild disability, 22%; and no disability 19%. It is indicated that

more women than men experience severe disability with the given percentages of 60 and 40

respectively. Prevalence of severe disability is highest among individuals in the oldest age

group (60 and older) at 32% and least among ages of 15 to 39 at 6%. Access to education

and work pose problem to some 25% and 34% of persons with severe disability. Vision

2
problem, back pain, arthritis, hypertension, and sleep problem are the most prevalent health

conditions for those with severe disability. The prevalence for each of these health conditions

is over 30%. Persons with moderate to severe disability report considerable levels of unmet

needs: respectively, one percent to eight percent report of those who already have personal

assistance and those needing additional assistance. (NDPS 2016)

3
Inpatient and outpatient care are two types of rehabilitation services that is offered in the

country. Of those who received inpatient care in the last 3 years, persons with moderate

disability was highest at almost one in every two individuals (48%), second are those with

severe disability at almost one in every four (24%), then those with mild disability at one in

five (19%), and the no disability at almost one in every ten (9%) individuals.

Outpatient care received in the last 12 months was also highest among those with moderate

disability at 51 percent, the rest, mild (21%) severe (17%) and no disability (11%) also

reported to have received outpatient care in the last 12 months. For inpatient and outpatient

care needed in the last 12 months but did not get care, notably high was both for those with

moderate and severe disability levels, at four to five in every ten (48% and 41%, respectively

for inpatient care; and 43% and 35%, respectively for outpatient care) (NDPS 2016)

4
1.1.2. Current Condition of Occupational Injuries in the Philippines

According to survey by the Bureau of Labor and Employment Statistics, about 358,000 fatal

and 337 million non-fatal occupational accidents in the world, and 1.95 million deaths from

work-related diseases. Occupational injuries in the Philippines showed 22,265 cases in 2003

and 47,235 cases in 2007. The manufacturing industries registered the highest number of

cases out of the reported cases of occupational injuries, 178 resulted in death in 2000, and

116 deaths in 2007. Injury occurred at 6 injury cases per 500 full-time workers or 1 injury

case for every 88 workers in 2000. In the following years, it declined to 4 cases per full-time

worker in 2003, and 3 cases for every 88 workers in 2007. Superficial injuries and open

wounds were the most common type of injuries in 2000, 2003 and 2007. (BLES, PSA 2015)

5
According to the statistics, amongst the occupation groups, plant and machine operators and

assemblers accounted for the highest share of occupational injuries with workdays lost in

2015 at 28.3 percent. This was later followed by laborers and unskilled workers at 22.8%

and service workers and shop and market sales workers at 15.9%. For 2013, laborers and

unskilled workers had the largest share of occupational injuries with w lost at 46.9 percent.

Meanwhile, corporate executives managers, managing proprietors and supervisors had the

least shares of work-related injuries with workdays lost in both 2015 (181 or 1.0%) and 2013

(209 or 1.0). Government and Non-Government Organizations Concerning Orthopedics

(BLES, PSA 2015)

According to the graph, the total cases of occupational diseases in establishments reached

125,973 in 2015. This is comparatively lower by 26.7 percent than the reported cases in

2013. Among industries, 13 out of the 18 major industries nationwide reported varying levels

of declines in the number of cases of occupational diseases in 2015. The biggest decrease

6
(81.3%) was recorded in mining and quarrying from 9,255 in 2013 down to 1,735 in 2015.

On the other hand, the number of occupational diseases grew the most in real estate activities

which increased by 189.6 percent from 240 cases in 2013 to 695 in 2013. The distribution

of occupational diseases across industries in 2015 showed that administrative and support

service activities (34.3% or 43,183) and manufacturing industry (31.1% or 39,143) jointly

comprised almost two thirds (65.4%) of the total cases of occupational diseases during the

year. Meanwhile, industries which posted least shares of occupational diseases included:

water supply, sewerage, waste management and remediation activities (0.4%); arts,

entertainment and recreation (0.3%); and repair of computers and personal and household

goods, and other personal service activities (0.3%). (BLES, PSA)

Cases of Occupational Diseases PSA stated that call center activities posted the highest share

of occupational diseases under administrative and support services industry Noteworthy, call

center activities (voice) exceeded all other sub-sectors in the administrative and support

services industry on the number of cases of occupational diseases in 2015 at 31,270. This is

equivalent to almost one-fourth (24.8 percent) of the total cases which means that 1 out of

every 4 cases of total occupational diseases in the industry originated from this sub-sector.

Specifically, the six occupational diseases with the highest incidences in the call center

activities (voice) subsector were as follows: back pain (23.8% or 7,428); occupational lung

disease (16.8% or 5,266); occupational asthma (13.8% or 4,305); other work-related

musculoskeletal diseases (12.0% or 3,745); neck-shoulder pain (10.9% or 3,410); and

essential hypertension. This may be attributed on the nature of work in the sector mostly

characterized by mental and emotional stress brought about by frequent repetitive tasks

7
coupled with prolonged sitting and lengthy verbal communication with clients. (BLES, PSA

2015)

1 out of every 3 (32.8%) occupational diseases reported in 2015 were back pains. Back pain

is highest in industries involving manual labor such as in manufacturing (34.3% or 14,185

cases) and those that require sitting for long periods of time like that in administrative and

support service activities (25.6% or 10,581 cases) majority of which involve call center

activities. Cases of Occupational Diseases by Type in Call Center Activities (Voice),

Philippines: 2015 Cases of Occupational Diseases Number Percent Share Call Center

Activities (Voice) 31,270, Back Pain 7,428, Occupational Lung Disease 5,266, Occupational

Asthma 4,305, Other Work-Related Musculoskeletal Diseases 3,745, Neck-Shoulder Pain

3,410, Essential Hypertension 3,124 10.0 Other occupational diseases 3,992. Aside from

8
 back pains, also included in the top five occupational diseases in 2015 were essential

hypertension (11.5% or 14,539); neck and shoulder pain (11.4% or 14,392); other work-

related musculoskeletal diseases (7.7%) (BLES, PSA 2015)

1.1.3. Current Condition of Disability in CALABARZON

1.2. Nature of The Study

1.2.1. Physical Rehabilitation Facilities in the Philippines

Rehabilitation according S no. 624 in standardizing Physical Rehabilitation Centers is a

branch of medicine which deals with the prevention, diagnosis, treatment and rehabilitation

of neuromusculoskeletal, cardiovascular, pulmonary and other system disorders which

9
produce temporary or permanent disability in patients as well as the performance of different

diagnostic procedures, including, but not limited to, electromyography and other electro

diagnostic techniques. It also involves specialized medical care and training of patients with

loss of function so that one may regain their maximum potential, physically, psychologically,

social and vocationally with special attention to prevent unnecessary complications or

deterioration and to assist in physiologic adaptation to disability. (S no. 624)

In the Philippines, rehabilitation services are limited, particularly in the public (government-

funded) health sector and are mainly found in major cities in Level 3 hospitals .6 Most

specialists, particularly physiatrists, practice in the National Capital Region Rehabilitation,

as defined for the scope of this paper, is a set of measures that assist individuals with

disabilities, both pre-existing and new, to achieve and maintain optimal body function in

interaction with their environment. Nationwide in 2011, there were 305 729 low-income

households with members having disabilities. (PARM)

Rehabilitation is a set of measures that assist individuals with disabilities, both pre-existing

and new, to achieve and maintain optimal body function in interaction with their

environment. Nationwide in 2011, there were 305 729 low-income households with

members having disabilities. In the past decade, Rehabilitation Medicine as a specialty has

experienced growth in all aspects. The number of trainees, graduates, and certified diplomats

and fellows has increased tremendously. Alarming, however, is the fast pace at which

rehabilitation centers have sprouted throughout the country, all with the noble intent of

delivering expert rehabilitative care to Filipinos suffering from neuromusculoskeletal,

10
 cardiovascular, pulmonary, and other system disorders which produce temporary or

permanent disability. Unfortunately, not all these rehabilitation centers are rendering what

they purport to render. Moreover, many of these rehabilitation centers are not headed by

physiatrist (a medical specialist who has trained a minimum of 3 years in Rehabilitation

Medicine) but by other medical and allied health professionals. By the nature of their

training, physiatrists are in the best position to head rehabilitation centers and supervise the

allied rehabilitative professionals: physical therapist, occupational therapists, speech

therapist, orthotists, and prosthetists. (PARM)

1.2.2. Effect of Environment in Healing

According to Brian Schaller, the environment is concretely defined as “the place”, and the

things which occur there “take place”. The place is not so simple as the locality, but

comprises of concrete things which have physical substance, shape, texture, and color, and

together join to form the environment’s personality, or setting. It is this setting which allows

certain spaces, with similar or even matching purposes, to embody very diverse properties,

in accord with the unique cultural and environmental situations of the place which they exist

(Bachelard)

Phenomenology is considered as a “return to things”, maneuvering away from the

abstractions of science and its unbiased objectivity. Phenomenology engages the concept of

partiality, making the thing and its unique conversations with its place the pertinent topic

and not the object itself.

11
The man-made constituents of the setting become the settlements of opposing scales, some

large - like cities, and some small - like the house. The trails between these settlements and

the many features which make the cultural environment develop the secondary defining

characteristics of the place. The difference of natural and manmade offers one the principal

stage in the phenomenological approach. The second is to succeed inside and outside, or the

connection of earth-sky. The third and final step is to measure character, or how things are

complete and occur as participants in their environment (Palasmaa,)

The placebo effect is known as a “fake treatment” that does not hold any active substances

itself. It helps the body heal simply by the mind’s expectation that it will heal, and the brain

then releases endorphins. Placebos can ultimately reduce swelling and pain, minimizing

stress, which makes the body better able to receive medical treatments. Charles Jencks made

full use of the architectural placebo effect, and through his work shows the importance of

environments of healing. Architecture has the power to indirectly boost the immune system.

He used this philosophy to guide his design of the Maggie’s Centres, a series of retreat

centres for people dealing with cancer. There, people receive practical and social support for

dealing with cancer in an environment that supports their emotional needs. William James,

an American philosopher and psychologist, believed “the greatest revolution in our

generation is the discovery that human beings, by changing the inner attitudes of their minds,

can change the outer aspects of their lives.”

12
 1.3. Statement of The Problem

1.3.1. Lack of Health care resources in the Philippines

The availability of hospital beds reflects the accessibility of service in a hospital. Due to the

Philippines' rapid population growth, hospital capacity has been an issue that needs to be

addressed to assure that the people received the necessary service and access to healthcare.

The study focused on evaluating the needs of Filipino patients in terms of in-patient bed

density or hospital bed ratio per ten thousand populations. Based on the data of Department

of Health, the country's health agency, only 4 out of 17 regions complied with the standard

local hospital bed ratio and in international setting, only one, the National Capital Region,

complied with World Health Organization's requirement. This poses a great challenge to

both the government and its people because the ratio is a good measure of availability, access

and distribution of health service delivery in the country. (PARM)

1.3.2. Lack of availability of rehabilitation services

As of date Physical rehabilitation has always been an unmet concern in the Philippines. The

proposed project will be beneficial to the local communities in the province especially

towards the professionals, may it be blue or white-collared jobs who experiences

musculoskeletal conditions that affects their lives. With Physical rehabilitation not being

accessible towards the public; available only in either in small clinics or Level 3 Hospitals;

these conditions are usually left untreated until to the point of the condition to worsen.

(PARM, 2017)

13
Within the Philippines, vocational rehabilitation falls under the National Occupational

Safety and Health of the Department of Labor and Employment and the National Council

for the Welfare of Disabled Persons. At present, vocational rehabilitation to address work-

related injuries in the Philippines are provided by institutions in private sectors. Community

based in barangays however fathoms only 2% of people with disability to have access to

rehabilitation services. According to Olavides Soriano, occupational rehabilitation in the

Philippines does not differentiate between people with general disabilities and occupational

injuries; these services therefore are addressed by mortality and sick leave rather than the

enhancement of physical, psychological and social aspects of daily life. (Olavides Soriano)

An argument can be made that the examination of the effectiveness of occupational

rehabilitation in the Philippines could lead to the provision of a systematic understanding,

generation and mandatory reporting of data which would promote the delivery of such

services physical complications not only limited to musculoskeletal but also to other

spectrums of illnesses comes with a large amount of patients, in which the current health

care facilities cannot accommodate. According to the Philippine Statistics. Authority (2013)

in 2000 there were 935,551 disabled people which has increased to 1,443,000 in 2010. In

terms of age distribution almost 60% are from the 15-64 age range, majority of whom are at

a working age. With these, there are many conditions where therapy and rehabilitation could

make a significant contribution to improving the lives of those affected; these include low

back pain, stroke, ischemic heart disease, diabetes, road Injuries, neck pain, falls, and other

14
 The project will help these professionals to recuperate and treat these conditions in order to

reduce the risk of on the job injuries and to live their lives as normal as possible With

Physical rehabilitation being an in-demand course, lack of manpower can only be attributed

to lack of job opportunities. (PSA 2013)

Majority of Physiotherapists from the Philippines migrate to the other countries, usually 1st

world or 2nd world, as rehabilitation is a much more mainstream service in contrast to the

developing countries, such as Philippines. (PARM, 2017) The proposed project will not only

adhere to the lack of manpower in specialized field of Physical Rehabilitation and Medicine

but will also provide more job opportunities for the local professionals within the province.

1.3.3. Correlation of disability and poverty in the Philippines

1.4. Significance of Study

1.4.1. Economic Significance

With Physical rehabilitation being an in-demand course, lack of manpower can only be

attributed to lack of job opportunities. Majority of Physiotherapists from the Philippines

migrate to the other countries, usually 1st world or 2nd world, as rehabilitation is a much

more mainstream service in contrast to the developing countries, such as Philippines.

(PARM, 2017)

15
 The proposed project will not only adhere to the lack of manpower in specialized field of

Rehab Medicine but will also provide more job opportunities for the local professionals

within the province. Philippines is a country susceptible to natural disasters. With disasters

having a direct correlation to the number of risks and emergency of disabilities. (World

Disaster Report 2007) The proposed project will greatly benefit the province especially

during trying times of a natural disaster if one would ever occur.

1.4.2. Social Significance

The Philippines ratified the United Nations Convention on the Rights of Persons with

Disabilities (CRPD) in 2008, and several laws and policies to promote the rights of people

with disabilities have been enacted. However, a study commissioned by Disability Rights

Promotion International (DRPI) and the National Federation of Organizations of people with

disabilities in the Philippines (Katipunan ng Maykapansanan sa Pilipinas, Inc., KAMPI) in

2008, found that a number of the rights of people with disabilities were regularly violated

The study interviewed people with disabilities from Metro Manila, and the Luzon,

Mindanao, and Visayas island groups. The authors highlighted that despite having several

policies and laws to protect their rights, people with disabilities often faced discrimination

in educational and employment settings, and experienced barriers to social participation and

access to health and rehabilitation services. The study recommended a set of immediate

measures to eliminate barriers to participation and for the economic empowerment of people

with disabilities. However, socioeconomic factors associated with disability and the level of

16
 access to services and participation in the community compared to people without disability

were not studied (DRPI) (Katipunan ng Maykapansanan sa Pilipinas, Inc., KAMPI)

1.5. Project Goals and Objectives

1.5.1. Project Goals

The aim of the project is to educate and provide the unmet need for rehabilitation in Taytay

Rizal and to provide a facility that will both passively and actively improve the disability

condition within the province. The facility will be an integral part of the community-based

rehabilitation in Rizal. Offering accessible and sufficient service to the public and to

minimize the unconventional negative aspects of health facilities towards its patients. The

goal is to fit the ideal mold of a Rehabilitation Medicine facility in mainstreaming accessible

services in rehabilitation to the country as well as improve the transitional rehabilitation

closer to home.

1.5.2. Project Objectives

Specifically, it aims to answer the following:

5. To establish a provincial paradigm in the provision of rehabilitation towards the public.

6. To create a Rehabilitation Center that will offer accessible services for the locals as well

as its surrounding cities/towns

7. To improve services on restoring the physical and social function of the disabled.

8. To improve the integration Community-Based Rehabilitation in the Province of Rizal

17
 1.6. Scope and Limitations

1.6.1. Scope

The proposed project will follow the objectives of the proposed ordinance of the Philippine

Academy Rehabilitation Medicine. The ordinance aims for the country to have a

Rehabilitation Center for each city/town. The project will include a Rehabilitation center for

both out-patient and in- patient users as additional therapeutic spaces for local athletes as

well as senior citizens.

The rehabilitation center will cater physical rehabilitation for conditions including but not

limited to Musculoskeletal injuries, diseases, neuromuscular, sports medicine, pulmonary

and etcetera. The center will preserve the natural views and features of the area acting as a

scenery in boosting the healing effect within the given environment.

1.6.2. Limitations

Due to different reasons, the proponent will not be able to attain some information. The

following are the unavoidable limitations of this study:

• Data from private health facilities is limited due to privacy concerns

• Due to the Covid-19 pandemic limitations, travel may limit data accumulation

• Specific Data on disability is outdated (2010 and 2011). Interpolation of statistic will in

turn be used;

18
 1.7. Acronyms

DOH – Department of Health

DOLE – Department of Labor and Employme

MsC – Musculoskeletal Conditions

NDPS – National Disability Prevalence Survey

PARM – Philippine Academy of Rehabilitation Medicine

POC – Philippine Orthopedic Center

PSA – Philippine Statistics Authority

WHO – World Health Organization

AD - Assistive device

ADD - Adduction

AD L- Activities of daily living

DJD - Degenerative disc disease

HNP – herniated nucleus pulposus (herniated disc)

HVGS – high-voltage galvanic stimulation

TENS – transcutaneous electrical neuromuscular stimulation

THA – total hip arthroplasty

Ex – therapeutic exercise

UE – upper extremity

19
 1.8. Definition of Terms

Acute and Sub-Acute - A classification for a short term injury or condition from when it occurs

up until four to six weeks, in contrast to a subacute injury between six to twelve weeks, and a

chronic injury that is longer than twelve weeks.

Chronic - A classification for a long term injury or condition, that has persisted for longer than

twelve weeks, and usually the result of overuse of one area of the body, an unresolved injury or

condition.

Contracture - Permanent shortening or stiffening of skin, muscle tissue, tendons, ligaments or

joint capsules that decreases movement and range of motion.

Contusion - Commonly known as a bruise, this is an area of injured skin or tissue where there has

been a rupture of the blood capillaries.

Core stability - A muscular corset known as the ‘core’ surrounding the lower back and abdomen.

Stability of this region provides a solid base for movement, carrying loads and muscular support

to the spine, pelvis and trunk region.

Core strength - A cornerstone of clinical pilates, it can improve postural control and provide

power with stability, whilst reducing the risk of injury.

Dislocation - An abnormal separation in the joint where two bones meet, potentially causing

damage to the joint capsule, nerves, ligaments and soft tissue.

20
Effusion - An abnormal accumulation of fluid in or around a joint, such as a knee, causing

swelling.

Eversion - The process of turning a body part outwards. For example an eversion ankle sprain,

when the sole of the foot moves outwards while the ankle rolls too far inwards, causing injury.

Inversion is the opposite, where a body part turns inwards.

Extension - A movement that usually results in the straightening of a body part, as such an extensor

is a muscle whose contraction causes an extension movement.

Fatal case – case where a person is fatally injured as a result of occupational accident whether

death occurs immediately after the accident or within the same reference year as the accident.

Flexion - The bending of a joint, and as such a flexor is a muscle that produces this movement..

Ligaments - A tough fibrous band of connective tissue that connect bones to other bones. They

medial to the arms, in other words closer to the middle.

Meniscus - A thin semi circular fibrous cartilage between the surfaces of some joins, for example

the knee, functioning as a smooth surface for the joint to move on and as a shock absorber.

Metatarsal - A group of five bones between the ankle region and the toes, a common area that

sustains trauma injury in soccer.

Motor skills - The body’s ability to perform complex muscle and nerve actions that produce co-

ordinated movement. Tying shoes or opening a bottle cap are examples of fine motor skills, where

21
movement is initiated by smaller muscles. Movements like walking and running involve Gross

Motor Skills and are performed by larger muscles.

Occupational accident – an unexpected and unplanned occurrence, including acts of violence

arising out of or in connection with work which results in one or more workers incurring a personal

injury, disease and death. It can occur outside the usual workplace/premises of the establishment

while the worker is on business on behalf of his/her employer, i.e., in another establishment or

while on travel, transport or in road traffic.

Occupational injury – an injury which results from a work-related event or a single instantaneous

exposure in the work environment (occupational accident). Where more than one person is injured

in a single accident, each case of occupational injury should be counted separately. If one person

is injured in more than one occupational accident during the reference period, each case of injury

to that person should be counted separately. Recurrent absences due to an injury resulting from a

single occupational accident should be treated as the continuation of the same case of occupational

injury not as a new case.

Permanent incapacity – case where an injured person was absent from work for at least one day,

excluding the day of the accident, and

1) was never able to perform again the normal duties of the job or position occupied at the time of

the occupational accident, or

2) will be able to perform the same job but his/her total absence from work is expected to exceed

a year starting the day after the accident.

22
Temporary incapacity – case where an injured person was absent from work for at least one day,

excluding the day of the accident, and

1) was able to perform again the normal duties of the job or position occupied at the time of the

occupational accident or

2) will be able to perform the same job but his/her total absence from work is expected not to

exceed a year starting the day after the accident, or

3) did not return to the same job but the reason for changing the job is not related to his/her inability

to perform the job at the time of the occupational accident.

Workdays lost – refer to working days (consecutive or staggered) an injured person was absent

from work, starting the day after the accident. If the person is still absent from work by the end of

the reference year, his/her workdays lost cover the period from the day after the accident up to the

end of the reference year. Temporary absences from work of less than one day for medical

treatment are not included in workdays lost.

Chapter II: Review of Related Literature

2.1. Physical Rehabilitation in a Global Context

2.1.1. History:

23
Physical therapy originated as a professional group that dated back to Per Henrik Ling,

who is known as the “father of Swedish gymnastics.” He founded the royal Central Institute

of Gymnastics in the year 1813 for massage, manipulation and exercise. Physical therapists

(PT) who were once known as reconstruction aides evolved through a series of changes to

become the present ever-growing confident and accomplished professionals in the health

care system. They play a very important role of providing rehabilitation and habilitation

services as well as prevention and risk reduction training. The world in the year 1916

witnessed the devastating polio epidemic. It was in this period that young women began

treating polio patients with residual paralysis by using passive movements. Realizing the

need of the hour, PTs developed Manual Muscle Testing for assessing the strength of the

muscle and thereby implementing muscle re-education techniques for weaker muscles. In

the United States (US), the polio epidemic continued to ravage to such an extent that it

even afflicted a man who would become the future President of the US, Franklin D.

Roosevelt. He went through various therapies, including hydrotherapy for which in 1926

he purchased a resort at Warm Springs Georgia, which was used as a Hydrotherapy Center

for polio patients. This center presently operates as Roosevelt Warm Springs Institute for

Rehabilitation.

The First World War marked the start of the profession. Throughout the world, 16 million

people were engaged in the battlefield. In 1917, the US entered the war and the need to

rehabilitate injured soldiers was recognized by the army. This led to the formation of a

special unit of the army medical department. They also developed 15 ‘reconstruction aide’

24
training programs in 1917 to meet the demand of medical workers who were specially

trained in rehabilitation. In the 1920s, a partnership grew between PTs and the medical and

surgical community, which boosted public recognition and validation. In 1930s, the polio

epidemic was still ongoing, and in the year 1937 the National Foundation for Infantile

Paralysis was established, which gave major support to the growth of Physical Therapy as

a profession.

The world entered the Second World War and the Physical Therapy continued to show its

dominance by treating the individuals who sustained injuries during the war. In the first

half of 1940s with World War II at its peak, the world required the attention of PTs for

wounded soldiers who returned home with amputations, burns, cold injuries, wounds,

fractures, and nerve and spinal cord injuries. The investigation about the application of

electrical stimulation gave a new direction to the Physical Therapy treatment. They realized

it’s not just to retard and prevent atrophy but to restore muscle mass and strength. The

“galvanic exercise” was given by the PTs on the atrophied hands of patients who had an

ulnar nerve lesion from surgery upon a wound. By the year 1942, the therapists started

getting their relative military rankings. Hospital-based practice for PTs was increased by

1946. The main reason for this was the Hill Burton Act passed during 79th US Congress,

to build hospitals across the country. It increased the public access to hospitals and health

care facilities and the demand for Physical Therapy services increased. After the war, the

need for PTs declined and the training of new PTs was suspended. The PTs already on

25
active duty were included in the newly established Women’s Medical Specialist Corps

(WMSC) in 1947.

The post war era brought an increased awareness of the need for rehabilitation. During this

time ‘proprioceptive neuromuscular facilitation’ (PNF) emerged as a part of the

armamentarium of skills of the PTs. Dr. Bobath, neurologist and Mrs. Bobath,

physiotherapist together developed the Bobath concept for the treatment of children with

cerebral palsy and adults with neurological conditions. In their lifetime they travelled

extensively, in teaching and training tutors around the world. They both received many

honors for their pioneering and innovative work. In 1950s gaining independence, autonomy

and professionalism was the need of the hour for the profession when PTs progressed from

technicians to professional practitioners. Two events that took place in 1950s contributed

to this; in 1954, American Physical Therapy Association (APTA) developed a 7-hour-long

professional competency examination in conjunction with the Professional Examination

Service, which was made available to the state licensing boards. The Self-Employed

Section formed as a component of APTA in 1955 as private practice expanded. The role of

PTs in Cardiac Rehabilitation started expanding. In 1952, Levine and Lown openly

questioned the need for enforced bed rest and prolonged inactivity after a myocardial

infarction, which was put forward in 1930s by two physicians, Mallory and White. Based

on the work performed in a Boston hospital during the 1940s, they concluded that the long,

continued bed rest “decreases functional capacity, saps morale and provokes

complications.” Their highly published report caught the attention of many and raised

26
numerous clinical questions about the management o fnoted physician Louis Katz told the

medical community that “physicians must be ready to discard old dogma when they are

proven false and accept new knowledge.” The need to continue research on physical

activity and to assimilate this new information into the practice scheme for cardiac patients

was emphasized. Just like in the previous World Wars, the Korean War also produced a

large number of war causalities for which the services of Physical Therapy once again

proved vital. During the Vietnam War, a female PT was first among the members of AMSC

to volunteer for Vietnam duty posting at Fort Belvoir, Virginia. She arrived with the 17th

Field Hospital, Saigon, in March 1966. In South Vietnam, 43 army PTs, 33 of whom were

women, served between 1966 and February 1973. Physical Therapy restored the use of

damaged arms and legs, rehabilitated surgical wounds, increased range of motion, and

restored flexibility and strength following serious burns, and it speeded patient recovery

and repaired the wounded soldier. A major change occurred after the Vietnam conflict. The

huge army population with neuro-musculoskeletal problems was managed by very few

orthopedic surgeons. The performance record and the scope of practice required in Korea

and Vietnam led to the identification of PTs as “Physician Extenders,” who were

credentialed to evaluate and treat neuro-musculoskeletal patients without physician

referral. During times of peace, PTs worked in a prescriptive environment prior to the early

1970s. Due to the increased need for PTs and the discontinuation of the army-based schools

after the war, APTA recognized the need to educate more PTs. The Schools Section of

APTA made recommendations about admissions, curricula, education and administration

of Physical Therapy programs. Also, APTA embarked on an effort to encourage more

universities and medical schools to create programs and expand existing programs,

27
including creating opportunities for graduate-level education. The decade 1967-1976 saw

the expansion of the profession into the management of orthopedics and cardiopulmonary

disorders. With the advent of open-heart surgery, Physical Therapy began to be practiced

in preoperative and postoperative units. The care to individuals with severe joint

restrictions altered with the increasing practice of joint replacements. Associations for the

promotion of the practice of animal Physical Therapy by PTs have been in existence since

1984 and are continuing to expand. Small numbers of PTs are currently engaged in animal

Physical Therapy especially for racing horses. In the 21st century, the profession has

continued to grow substantially. Patients are able to refer themselves to a PT without being

told to refer themselves by a health professional. New generation PTs consider movement

as an essential element of health and well-being, which is dependent upon the integrated,

coordinated function of the human body at a number of levels. Movement is purposeful

and is affected by internal and external factors. So today’s Physical Therapy is directed

toward the movement needs and potential of individuals and populations. Though we are

in a more scientific and research-dependent era of our evolution, let us not forget those

practitioners of the past, from all professions and doctrines, who have given so much

throughout the centuries of history in Physical Therapy. (Abdul Rahim Shaik, Arakkal

Maniyat Shemjaz; The Rise of Physical Therapy: A History In Footsteps, p.257-260,

2014)

2.1.2. Overview:

28
According to the Global Burden Disease, worldwide rehabilitation needs are growing in

tandem with global population growth, population aging, and higher survival rates for

people with severe health conditions and disability. The GBD 2017 reports data on injuries

in terms of their nature or consequence (e.g., hip fracture or spinal cord injury), in addition

to and apart from their cause]. This new type of data is particularly germane to the planning

of services and resources in physical rehabilitation. (GBD 2017)

Others have used GBD study data to examine rehabilitation needs. In the more recent

example, the World Health Organization used data from the GBD 2015 to examine

worldwide needs for mental and physical rehabilitation. They found a 17.6% increase from

2005 to 2015 in Years Lived Disability for health conditions associated with severe

disability, and that a remarkable 75% of the total world’s YLDs in 2015 came from health

conditions germane to rehabilitation. However, the WHO study did not examine physical

rehabilitation needs distinct from the rehabilitation of mental health conditions. The cost

of rehabilitation can be a barrier for people with disabilities in high-income as well as low-

income countries. Even where funding from governments, insurers, or NGOs is available,

it may not cover enough of the costs to make rehabilitation affordable. People with

disabilities have lower incomes and are often unemployed, so are less likely to be covered

by employer-sponsored health plans or private voluntary health insurance. If they have

limited finances and inadequate public health coverage, access to rehabilitation may also

be limited, compromising activity and participation in society. Lack of financial resources

for assistive technologies is a significant barrier for many. People with disabilities and their

families purchase more than half of all assistive devices directly.

29
 Treatment for acute problems is delivered in general hospital psychiatric units, each with

a maximum of 15 beds. A network of community mental health and rehabilitation centres

support mentally ill people, based on a holistic perspective. The organization of services

uses a departmental model to coordinate a range of treatments, phases, and professionals.

Campaigns against stigma, for social inclusion of people with mental health problems, and

empowerment of patients and families have been promoted and supported centrally and

regionally. Governments in 41 of 114 countries did not provide funding for assistive

devices in 2005. Even in the 79 countries where insurance schemes fully or partially

covered assistive devices, 16 did not cover poor people with disabilities, and 28 did not

cover all geographical locations. In some cases existing programmes did not cover

maintenance and repairs for assistive devices, which can leave individuals with defective

equipment and limit its use. One third of the 114 countries providing data to the 2005 global

study did not allocate specific budgets for rehabilitation services. OECD countries appear

to be investing more in rehabilitation than in the past, but the spending is still low (WHO.

PHYSICAL REHABILITATION CHAPTER III)

2.1.1. Conditions that are referred to Physical Rehabilitation

2.1.1.1 Musculoskeletal Condition

The World Health Organizations described musculoskeletal conditions, comprising of over

than 150 diagnoses, as symptoms that affect the normal range of motion of an individual;

these conditions may involve the muscles, bones, joints and associated tissues such as

tendons and ligaments. As listed in the International Classification of Diseases Symptoms,

30
these conditions are typically characterized by pain and limitations in mobility, dexterity

and functional ability, often reducing people’s capacity to work and their ability to

participate in social roles having impacts on the mental wellbeing of the individual and at

a broader level, the prosperity and progress of communities. In accord to WHO, the most

common and disabling conditions of the musculoskeletal system are osteoarthritis, back

and neck pain, fractures correlated to bone fragility, injuries and systemic inflammatory

conditions. Through life-course conditions of the musculoskeletal system are prevalent and

commonly affects people those of adolescence to of older ages. The prevalence and impact

of these conditions are forecasted to rise as the global population ages and risk factors for

noncommunicable diseases increases, particularly affecting low and middle-income

settings. Musculoskeletal conditions occur commonly with other noncommunicable

diseases in multimorbidity health states. With these conditions affecting the regular

locomotor movement of an individual, it is justifiable that these conditions account for the

greatest portion of dropped productivity in the workplace.

2.1.1.2. Neuromuscular Disorders

Neurological disorders are diseases of the central and peripheral nervous system. In other

words, the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic

nervous system, neuromuscular junction, and muscles. These disorders include epilepsy,

Alzheimer disease and other dementias, cerebrovascular diseases including stroke,

migraine and other headache disorders, multiple sclerosis, Parkinson's disease,

neuroinfections, brain tumours, traumatic disorders of the nervous system due to head

trauma, and neurological disorders as a result of malnutrition.

31
Regarding the involvement of physical therapy (PT) in neurological patients, there are

several treatment methods that available for the neurorehabilitation. A commonly applied

treatment is neurodevelopmental treatment (NDT). PT for the elderly neurologically

involved patient with sensory–motor impairments, postural control (i.e., balance), and

coordination, and it does so through the knowledge of motor learning and motor control.

The PT is part of an interdisciplinary team targeted to prevent functional decline, restore

function, and ADL, prevent secondary complications and comorbidities, allow

compensating to offset and adapt to residual disabilities, and to maintain of function over

the long term. The prevention of falls, frailty, fatigue, and sarcopenia could improve the

patient’s health and life span. PT for neurological patients also has a role in immediate or

acute care, when there is a requirement to provide hospital-based short-term intensive PT

aimed at the recovery of musculoskeletal and neurological function, limbs positioning, and

handling due to hypertonic or spastic muscles.

2.1.1.3. Chronic Respiratory

Chronic respiratory diseases (CRDs) are diseases of the airways and other structures of the

lung. Some of the most common are chronic obstructive pulmonary disease (COPD),

asthma, occupational lung diseases and pulmonary hypertension. In addition to tobacco

smoke, other risk factors include air pollution, occupational chemicals and dusts, and

frequent lower respiratory infections during childhood. CRDs are not curable, however,

various forms of treatment that help dilate major air passages and improve shortness of

32
 breath can help control symptoms and increase the quality of life for people with the

disease.

Physical therapy is involved in the non-medical treatment of patients with acute and

chronic respiratory diseases, including obstructive and restrictive pulmonary diseases,

patients admitted for major surgery and patients with critical illness in intensive care.

Physical therapy contributes towards assessing and treating various aspects of respiratory

disorders such as airflow obstruction, mucus retention, alterations in ventilatory pump

function, dyspnea, impaired exercise performance.

2.2.3. International Guidelines for Rehabilitation Facilities

33
34
2.2.4. International Guidelines in Designing Physical Rehabilitation Facilities

35
36
37
General

• Pathways to places accessed by patients (such as latrines) should be flat or ramped where

necessary, and the ground should be compacted or levelled to facilitate safe, independent

access for people with restricted mobility, such as those using a wheelchair or crutches,

older people and pregnant women.

• At least one latrine should be gender neutral to allow a care provider of the opposite sex

enter with the patient.

38
 • Any ramp should have a gradient of 1:20 and be equipped with a handrail 85–95 cm high

(adjusted to the average height of the population).

• All doors should be 90 cm wide; if possible, sliding doors should be used, otherwise, they

should open outwards. All emergency exits should remain unobstructed Step-down

facilities should ease patients’ return to their home environment by ensuring that utilities

such as latrines, showers and washrooms are as similar as possible to those in the host

country. They should be adapted to maximize patients’ independence and safety.

Consideration should be given to making similar adaptions in their homes, preferably by

referral to a local organization.

Latrines

• The minimum surface of a latrine should include a turning circle of 150 cm to allow full

maneuvering of a wheelchair (ISO measurements are 80 × 130 cm).

• Grab bars should be mounted at a height of 85–95 cm from the floor.

• Latrines, commodes or other seat adaptations should be 45–50 cm high and 45–50 cm

from the wall on which the grab bar is positioned.

39
• Washbasins should be 65–70 cm from the ground and extend 35–45 cm from the wall.

Doorways

• Operational devices on doors, such as levers or pull handles, should be easy to grip with

one hand. Showers and washrooms

• Showers or washrooms should have a seat 45–50 cm high, positioned for easy access to

the showerhead or water source.

• A grab bar should be positioned on the wall opposite the seat and around the back wall,

mounted at a height of 85–90 cm.

40
2.2.5 Case Studies

2.2.5.1. Bridgepoint Active Healthcare

Bridgepoint Active Healthcare in Toronto is the largest facility of its kind in Canada

focused on the treatment of complex chronic disease and rehabilitation. Bridgepoint’s

leaders envisioned a new way of delivering healthcare in a new kind of hospital: a civic

building - an urban centre - in which healthcare and community come together. The

intent is to blur the traditional distinction of institutional space and public access and to

provide an inspirational setting to assist patients in their recovery.

41
42
The design response recognizes the role landscape, nature and community play in

supporting health. It optimizes the therapeutic benefits of natural light, access to nature,

and views of the surrounding park and city skyline to ensure patients and staff feel

constantly connected to the world outside. With an average patient stay of three months,

there was strong impetus to create an environment that facilitates recovery and wellness.

There are 7 inpatient therapy spaces and 1 outpatient therapy space within the building

amounting to approximately 1250 square meters. The design of Bridgepoint’s

physiotherapy spaces is a typical example of restricting the activity to one room. Each floor

contains one therapy gymnasium located in a corner of the building, which grant panoramic

views of the city. The layouts of the gymnasiums vary slightly from one to another, mostly

in regards to the specialized equipment used by each unit and are relatively bland with

unstimulating materials and harsh florescent lighting. In one physiotherapy room,

treadmills and stationary bicycles face the windows looking outwards, while physiotherapy

beds line the wall, each divided only by curtains on ceiling tracks. In some cases, extra

equipment is stored in a corner of the room, in place of a designated area. The gyms, used

daily by various physiotherapy and occupational therapists with their patients, often

become cramped due to overcrowding.

43
The distinctive building envelope contains a fenestration pattern of 492 projecting ‘pop-

out’ vertical frames – one for every patient bed – interspersed with the predominant

horizontal fenestration as counterpoint. The massing rests on a concrete flat slab structure

with cantilever floor plates around the perimeter.

44
45
 To mitigate the scale of this facility, a

vertical campus concept was conceived to

create a community of stacked

neighborhoods of patient units. Each

floor is clearly ordered and organized into

two neighborhoods of 32 beds each

configured with single and double-bed

patient rooms. Shared therapy space is

centralized on each floor at the cores with

common spaces to the north and south.

Nursing stations are in close proximity to

their respective neighborhoods of care.

The adjacent Don Jail (1864) has been restored and repurposed as the hospital

administrative building. A series of jail cells, the gallows and the soaring rotunda have

been preserved and are on view to the public for the first time with interpretive exhibits

about what was North America’s largest reform facility. A dynamic contrast is established

between the restored masonry of the Don Jail and the contemporary materiality of the new

Bridgepoint.

46
The new hospital building re-casts itself as an iconic landmark in order to connect the entire

precinct with the community and the city at large. Socialization is an important part of

therapy, and the building offers many gathering spaces for patients, staff and the

community, including a large ground floor terrace with a cafeteria, a therapy pool with

picture windows onto the park, an expansive green roof terrace and park trail extensions

through the hospital campus. A meditative labyrinth with a pattern of one at Chartres

Cathedral in France is located on the main floor facing the park.

47
This LEED Silver certified facility presents a healing environment that is communal and

accessible and supports wellness and recovery. The choice and variety of materials convey

this objective. Architectural details, textures and finishes de-emphasize the feeling of being

in an institution and instead offer comfort and provide an appropriate human scale and a

feeling of intimacy.

48
2.2.5.2. Woy Woy Rehabilitation Unit

Woy Woy Rehabilitation Unit, co-located and integrated with the Woy Woy Hospital

situated on the Central Coast of New South Wales. A new insertion into the existing health

services complex, the rehabilitation unit is an extension to the hospital’s clinical program

and accommodates patients requiring interdisciplinary restorative care following a range

of injuries, surgery or illness.

49
“Homes in the park” was a central theme in the design. The intention was to create a healing

environment through the provision of generous solar access and landscaped, therapeutic

outdoor courtyards. Towards the back of the facility, the scale of the building is broken

down to a series of pavilion-like buildings on a residential scale.

50
The landscape design intends to fuse the architecture of the unit with a landscape that

complements the existing environs with visual connections integrating interior and external

spaces of the unit.

The design breaks from conventional institutional architecture by providing protective

interior spaces and creating a sanctuary to nurture patients through the healing process.

Sitting within a parkscape environment, the new unit simultaneously plugs into the existing

facility and creates its own architectural gesture.

Bringing the idea of “the garden” into the scheme, the patients’ spatial journey is extended

into the existing groves of eucalypts and native grasses surrounding the site. Landscaped,

tranquil courtyards that change with the passage of time have been inserted into the core

of the space, framing green spaces and enabling ideas of growth and regeneration to

become visibly tangible.

51
Featuring an origami- inspired, triangulated roof at the entrance and distinctive use of brick

and timber details throughout, the design helps to create a residential feel for the exteriors.

The roof brings light into the scheme, encouraging solar access to reach internal corridors,

while the colour of the bricks, shifting from deep blue to grey and dark brown, is inspired

by the Aboriginal meaning of Woy Woy: “Wy Wy” is said to mean "much water" or "big

lagoon’.

In addition to the 30-bed rehabilitation unit, the project scope included an upgrade of the

back of house hospital services and creation of a new car park to service the rehabilitation

unit

52
2.2. Physical Rehabilitation in the Philippines

2.2.1. History

Physical therapy training in the Philippines, in its early form, started when the Department

of Medicine of the Faculty of Medicine and Surgery of the University of Santo Tomas

established the Section of Electrotherapeutics during school year of 1908-1909, under the

directorship of Dr. Bonito Valdes. The Assistant Director was Eulalio Martines and the

professor of Therapeutics and Electrotherapy was Dr. Ignacio Valdes. In 1916, the

curriculum used by the Faculty of Medicine and Surgery at the University of Santo Tomas

to teach physiotherapy was alongside teaching radiography. In August 1938, there was one

US Army physical therapist assigned at the Sternberg General Hospital in Manila. In 1949,

the Philippine General Hospital (PGH) established its own Physiotherapy Section under

the management of the Department of Radiology. After the relocation of the Philippine

Orthopedic Center (POC, the center was first known as the Mandaluyong General Hospital

in 1945 and later successively as Mandaluyong Emergency Hospital, National Orthopedic

Hospital in 1948, National Orthopedic Hospital-Rehabilitation Medical Center (NOH-

RMC) in 1982, before becoming the Philippine Orthopedic Center in 1989) in 1963 from

Mandaluyong, Rizal to Quezon City, courses on physical therapy and occupational therapy

courses were pioneered and introduced by Benjamin V. Tamesis, the then chief physician

of the hospital.

The two courses were later absorbed by the College of Medicine of the University of the

Philippines, later transformed first as the School of Allied Medical Professions (formally

53
known as University of the Philippines - School of Allied Medical Professions, and

abbreviated as UP SAMP) and then as the College of Allied Medical Professions. At one

time, the UP SAMP was the only university in the Philippines offering a bachelor's degree

in Physical Therapy (BSPT). In June 1974, a course in Bachelor of Science in Physical

Therapy was offered by the Institute of Physical Therapy and the College of Rehabilitation

Sciences of the University of Santo Tomas. During the time, the first two years of the four-

year course was managed by the College of Science. The next two years was administered

by the Faculty of Medicine and Surgery. There were 14 students who later graduated in

1977. The four-year course became a five-year course starting the school year of 1988-

1989. The Institute became an autonomous entity within UST on December 15, 1993,

converting the title of its head into a dean.[6] The five-year academic program was

designed to train aspiring allied medical professionals, such as physical therapist clinicians

who would like to work in hospitals, out-patient physical therapy clinics, athletic and sports

training facilities, skilled nursing facilities, hospices, corporate and industrial settings. In

1976, Virgen Milagrosa Institute located north of Manila, began offering the course in

physical therapy which later converted to Bachelor of Science degree in Physical Therapy.

In 1993, the San Juan de Dios Hospital and College began to offer a Bachelor of Science

in Physical Therapy course with Dr. Bee Giok Tan-Sales as the founder and dean.

As of 2011, among the notable schools of physical therapy in the Philippines were the

Angeles University Foundation, Emilio Aguinaldo College, Universidad De Manila

(former City College of Manila), University of Philippines-Manila Campus, the University

of Santo Tomas, the Pamantasan ng Lungsod ng Maynila ("University of the City of

Manila"), the University of the East Ramon Magsaysay Memorial Medical Center, Virgen

54
Milagrosa University Foundation, the Cebu Doctors University, the De La Salle

University- Health Sciences Institute, the Far Eastern University-Nicanor Reyes Medical

Foundation, the Mariano Marcos State University-Batac Campus, the Velez College, the

Saint Jude College-Manila Campus, and the Iloilo Doctors' College. At present, there are

only three institutions in the Philippines where graduate physical therapists can take a

Master of Science in Physical Therapy degree. They are the University of Santo Tomas,

University of the Philippines and Our Lady of Fatima University. There are currently no

schools in the Philippines that offer a Doctorate degree in Physical Therapy. On June 21,

1969, the Board of Examiners for Physical Therapists and Occupational Therapists in the

Philippines (sometimes called as the Board of Physical and Occupational Therapy) was

approved through Republic Act No. 5680, also known as the Philippine Physical and

Occupational Therapy Law.

The law was authored by Congressman José Aldeguer of Iloilo when it was still a bill. The

Board of Examiners was composed of one chairperson, two physical therapist members,

and two occupational therapist members. On November 2, 1972, the rules and regulations

of Republic Act No. 5680 (Implementing Rules and Regulations of the Physical and

Occupational Therapy Law) that the Board of Examiners has promulgated was approved.

The first licensure examination was held on July 23, 1973 for 26 physical therapists and

18 occupational therapists. In 1994 the licensure examinations became partially

computerized. Fully computerized licensure examinations were conducted in 1995. In

1971, the Philippine General Hospital founded its own Department of Rehabilitation

Medicine. Rehabilitation medicine is a part of physiatry (also known as physical medicine

and rehabilitation or PM&R), a branch of medicine that aims to enhance and restore

55
functional ability and quality of life to those with physical impairments or disabilities. It is

related to physical therapy. In 1974, a residency program was started by the Philippine

General Hospital for aspiring physiatrists. Physiatrists are medical personnel who are also

known by the name rehabilitation medicine specialists. They are focused in restoring

optimal function to people who had sustained injuries to the muscles, the bones, the tissues,

and the nervous system (such as stroke patients). The (PPTA) is the main organization of

physical therapists in the Philippines. It was founded by the first Bachelor of Science

degree in Physical Therapy graduates of the University of the Philippines - School of Allied

Medical Professions on December 8, 1964. The founding president of PPTA is Jose

Inoturan. Apart from being accredited by the Professional Regulation Commission (PRC)

of the Philippines, it is also a member of the international organization known as the World

Confederation for Physical Therapy (WCPT).

2.2.2. Overview

Data in the Philippines pertaining to disability contains limited evidence. This in turn can

frustrate the development of health policy which might increase awareness about disability

and ways in which to encourage investment in therapy and rehabilitation services (WHO,

2017) Consecutive Filipino governments have expressed commitment to the principles of

the Alma Ata Primary Health Care Declaration signed in 1978 and the objective of primary

health care for all, this worthy objective became national policy in 2000 (Paterno, 2013).

In order to achieve this, a national health insurance programme (PhilHealth) was initiated

in 1995. As a government owned organisation, PhilHealth was mandated to achieve

56
universal healthcare by 2010 and the Filipino administration has previously expressed

commitment to achieve this by 2016 (Paterno, 2013)

According to the WHO (2011) people with disabilities can be denied equal access to

healthcare, employment, education, and political participation and their dignity can be

compromised as a result. It appears also that people with disabilities are more likely to be

unemployed and earn less when employed, making it difficult to benefit from development

and escape poverty (WHO, 2011). There are estimated to be eight million people with

disabilities in the Philippines with limited therapy options outside of the private sector

(Olavides-Soriano et al, 2011). Occupational therapists working in this field recognise

that work not only fosters financial stability and independence but can contribute towards

self-respect, social inclusion and wellbeing (Sheppard and Frost, 2016).

At present vocational rehabilitation to address work-related injuries in the Philippines are

provided by institutions such as training centres, in enterprises such as private companies

and community based in barangays (or villages); however only 2% of people with a

disability have access to rehabilitation (Olavides-Soriano et al, 2011). According to the

Philippine Statistics Authority (2013) in 2000 there were 935,551 disabled people which

has increased to 1,443,000 in 2010. In terms of age distribution almost 60% are from the

15-64 age range, so these are largely working age individuals. It appears that there are

many conditions where therapy and rehabilitation could make a significant contribution to

improving the lives of those affected; these include low back pain, stroke, ischemic heart

disease, diabetes, road Injuries, neck pain, falls, and other musculoskeletal disorders

(Institute for Health Metrics and Evaluation, 2010) services for the whole population. In

57
recent years the delivery of therapy and rehabilitation services has primarily been through

community based rehabilitation programmes, a model for which has been in place since

1989. Although there are limited studies relating to the impact of therapy and rehabilitation

services in the Philippines there is some evidence to highlight the very real benefits that

are possible. Magallona and Datangel (2011: 48) found that 67% of participants in a

community rehabilitation programme had achieved what they described as a “remarkable

improvement” within less than a year of therapy. For those who participated in the

programme for more than one year but less than two, remarkable clinical improvements

were noted in 73% of participants. These are encouraging findings and demonstrate the

potential positive impact of rehabilitation. The WHO (2011) has called for more research

in developing countries to better understand the benefits of health programmes for people

with disabilities including rehabilitation services for the whole population. In recent years

the delivery of therapy and rehabilitation services has primarily been through community

based rehabilitation programmes, a model for which has been in place since 1989.

Although there are limited studies relating to the impact of therapy and rehabilitation

services in the Philippines there is some evidence to highlight the very real benefits that

are possible. Magallona and Datangel (2011: 48) found that 67% of participants in a

community rehabilitation programme had achieved what they described as a “remarkable

improvement” within less than a year of therapy. For those who participated in the

programme for more than one year but less than two, remarkable clinical improvements

were noted in 73% of participants. These are encouraging findings and demonstrate the

potential positive impact of rehabilitation. The WHO (2011) has called for more research

in developing countries to better understand the benefits of health programmes for people

58
 with disabilities including rehabilitation. Vocational rehabilitation could be considered as

an integral aspect of an effective healthcare system as such services play a vital role in

addressing work-related disability and at the same time improve the active involvement of

individuals to contribute to society in general and workforce in particular. In the context of

the Philippines, initial research priorities could include studies to confirm the number of

people living with disability and the nature of their disability as well as detail regarding the

therapy and rehabilitation workforce.

2.3. Local Guidelines on Rehabilitation Centers

DOH

59
2.4. Activity Flow Chart for Rehabilitation Centers

2.5. Case Studies

Chapter III: Methodology

3.1. Introduction

This chapter will discuss the methodology utilized by the researcher in gathering data from

different modes and sources. It will give emphasis and detail on what and why were these modes

used for data gathering. This chapter will also cover in detail on how these data are gathered and

its relationship to the study. Data was primarily taken from Journals and Books pertaining to the

medical relationship of Musculoskeletal Conditions and Physical Rehabilitation. Topics include

but not exclusive to, Healing Environment Design, Management of Medical Facilities, Relevance

of Musculoskeletal Conditions in the Philippines and the psychology and physiology of patients

with MsC. Interviews will be made to different professionals, ideally practitioners that makes of

the facility at hand. These include, Physical Therapists, Specialized Doctors, Physical

Rehabilitation Directors (Either Independent Organizations or Health Facilities) and those with

experience in designing Medical Facilities preferably of the specific Typology.

3.2. Research Design

60
Qualitative research will be used in the gathering of data. Questioners and interviews will be given

to each research participants followed bt inductive exploration of the data gathered. The data

gathered will be used to identify recurring themes, patterns, or concepts and commonalities in

considering a Rehabilitation Center.

Qualitative will be used to identify the integral environment, setting, and conditions to be met on

designing the facility. This data will be taken from key professionals as well as government

officials from Taytay Rizal that manages the Community-based rehabilitation program

Quantitative research will involve the user demographics of the said users.

3.3. Research Instrument

Different research instruments were used to gather the needed information of the study. These are

used to maintain the validity and effectivity of the data for current and future studies.

3.3.1. Questionnaires

Questionnaires will contain questions based from suggestions and recommendations by

key officials in the different government agencies and both dependent and independent

organizations.

3.3.2. Archival Resources

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 Laws and ordinances pertaining to disability and medical practice will be considered in the

study. Statistics will be taken from government agencies, independent organizations and

major medical facilities.

3.3.3 Case Study

In this approach, comparative analysis will be drawn on similar structures of similar

context. The aim of this approach is to give insight on the hierarchy, zoning, user flow, and

other aspects that should be considered in design. The approach aims to give further

understanding on what requirements should be met on the study and how are these met.

3.3.4 WWW

Data was taken from medical journals online as well from official Government websites.

The data was also taken from Official International Organizations such the World Health

Organization

3.3.5. E-Books

Aside from journals Ebooks was another priority source of data

3.4. Research Participants

3.4.1. Direct Participants

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 Physical rehabilitation has a wide demographic of users. Severity and purpose could vary

from user to user. Physical Rehabilitation Center user’s are usually those of different-abled

individuals, injured or diseased, and also those need of extra guidance due to old age.

3.4.2. Indirect Participants

Disability can plague not only the individual but its contribution to the community. A

rehabilitation center is a health facility that handles transitional care from hospital to home.

Indirect participants will include the families of the users, the staff members and other

institutions found near the area.

3.5. Theoretical Framework

The theoretical Framework will give focus on the four main conditions to be assessed in the

project. The framework will entail the needs of the demographic as well as the conditions that must

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be met to address these said need. The theoretical framework will mostly be used in identifying

the ideal site in consideration the facilities and users available within and area.

3.5. Conceptual Framework

3.6. Timelines

Chapter IV: Site Selection

4.1 Introduction

This chapter will involve the process of site selection of the given project. The section will

elaborate the given site selection criteria and provide justification and thorough investigation

towards the chosen site. The site selection will also be affected by the data taken from the

following: Philippine Statistics Authority, Philippine Orthopedic Center, and DSWD Disability

Housing Population

4.2. Site Criteria

The following are the criteria formulized in the site selection process. Each criterion will

accommodate a certain point system in qualifying the site.

4.2.1. Accessibility (25%)

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The location should have available routes that may accommodate both public and private

modes of transportation. The site must also be easily located by the users

Score: Evaluation:

4.2.2. Location (15%)

The location should be, ideally, in close approximate distance with essential institutional

facilities as well, commercial and residential areas.

Score: Evaluation:

4.2.3. Topography (10%)

The site must be, as much as possible, relatively flat as a requirem for medical facilities.

Flat slope of the site can also provide easy movement for the differently-abled users.

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 Score: Evaluation:

4.2.4. Lot Size (10%)

The total lot area of the site must be capable of accommodating all the facilities for the

project considering the different rehabilitation spaces, open recreational spaces and

inpatient facilities.

Score: Evaluation:

4.2.5. Utilities (10%)

Access to basic services such as electricity, communication, and water connection and

sewer connection is essential of any medical Facility

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 Score: Evaluation:

4.2.6. Land Use Zoning (5%)

The location should follow the CLUP of the city’s planner.

Score: Evaluation:

4.2.7. Orientation (15%)

The site must both have a good sun and wind orientation that can provide a positive

atmosphere towards the patients

Score: Evaluation:

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 1

4.3. Macro Analysis

4.3.1. Profile of the Municipality

Cainta, officially the Municipality of Cainta is a 1st class municipality in the province of

Rizal, Philippines. According to the 2015 census, it has a population of 322,128 people. It

is one of the oldest municipalities in Luzon and has a land area of 4,299 hectares Cainta

serves as the secondary gateway to the rest of Rizal province from Metro Manila. With the

continuous expansion of Metro Manila, Cainta is now part of Manila's conurbation, which

reaches Cardona in its easternmost part, and is therefore one of the most urbanized towns.

As second most populous municipality in the Philippines there are efforts underway to

convert it into a city. Its total assets amounting to Php 3,988,392,142.17 makes it the richest

municipality in the country

4.3.2. Topography

Rizal is bordered by Metro Manila to the west, Bulacan to the north, Quezon to the east,

and Laguna to the southeast. The province also lies on the northern shores of Laguna de

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Bay, the largest lake in the country. Rizal is a mountainous province perched on the western

slopes of the southern portion of the Sierra Madre mountain range. Topography is

characterized by a combination. The flat low-lying areas are located on the western while

the gently rolling hills and a few rugged ridges in the eastern portion.

4.3.3. Land Classification

The Province in general is hilly and mountainous in terrain, most of the province's southern

towns lie in the shores of Laguna de Bay, the country's largest inland body of water..[1]

Talim Island, the largest island situated within the Laguna de Bay, is under the jurisdiction

of the province.

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 4.4.4. Climate

4.5. Socio-Economic

4.5.1. Land Area and Political Subdivision

Rizal covers a total area of 1,191.94 square kilometres (460.21 sq mi)[9] occupying the

northern-central section of the Calabarzon in Luzon. The province is bordered on the north

by Bulacan, east by Quezon, southeast by Laguna, south by the Laguna de Bay, and west

by Metro Manila. Located 20 kilometres (12 mi) east of Manila, commuters take

approximately an hour to reach the provincial seat which is in Antipol. Rizal comprises 13

municipalities and 1 city.

4.6. Flood Map

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4.7 Micro Site Analysis

4.7.1. Site Description

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The site is a 2.4 hectare lot located at Felix Avenue, Cainta Rizal. The area compromises a

mix of commercial, education and medical facilities. Three level II hospitals can be found

5km away from the site while 2 major sports complexes are located within 6 meters from

the site. Despite a creek fronting the rear of the site, the lot experiences little to medium

flooding. The lot is fronted by 2 laned, 2 way, RROW.

4.7.2. Site Justification

According to the National Disability Survey CALABARZON holds the most number of

disabilities in the country. Rizal, according to the annual report of the Philippines

Orthopedic Center, ranks 2nd in admittance outside of the NCR. Taytay, Cainta and

Antipolo have the most, 11th and 3rd most number of disability respectively in the Province

of Rizal. Cainta being near municipalites and cities with the likes of Marikina, Antipolo,

Tatay and Pasig City offers potential not only for local users but also users from adjacent

cities. The site selection process involves basis of PSA data as well as availability of users

72
as well as workers. Our Lady of Fatima Univrersity is in close proximity in the site. The

university is the only academe in CALABARZON that offers Physical therapy as an

undergraduate and graduate course. With an average of 20 board passers per year (2016-

2018), the site will surely benefit from the institution in terms of employment potential.

The site was chosen in consideration of the distance of the following locations; Marikina

is home for numerous of nursing homes; Taytay has the most number of disabilities in the

whole province as well the Taytay sports complex; Antipolo has the third most disability

as well as Sports hub complex; Pasig with the 2nd most number in the NCR 2nd district and

is close proximity with the Philsports Complex. The site although part of the medical

facilities area it is mostly fronted with recreational areas. This can help the patients to feel

less in medical facility but more on a recreational space itself. The site is in close proximity

with residential areas such as Filinvest residentials. The frontal road is a main road that

comprises of bus stop and then jeepney both ways.

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4.7.3. SWOT Analysis

Strengths: Weaknesses:

- Site close to medical hospitals - Rear of the site is fronted with

- Area is within a recreational creek.

commercial area.(2km) - Communication Cables are evident

- Site is in close proximity with within the site.

residential areas (2km) - Site is fronted with a major road

- Site is in close proximity with 2 that may experience traffic from

Major Sports Complexes ; Taytay time to time.

Sports Complex and Philsports

Complex (5km)

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 - Area of Cainta is adjacent to the

Marikina Elder Care area (8km)

- Our Lady of Fatima is the only

university in CALABARZON that

offers PT courses is in close

proximity within the site

Opportunities: Threats:

- Increase number of referrals from - Smell can interfere the overall

medical centers without/ experience within the site.

insufficient outpatient and inpatient - Aesthetic of facility can be blocked

care

- Mall concept for medical facilities

can be easily be implemented.

- Specialized Sports rehabilitation

must be considered

- Specialized care for disabled

elders.

- Sufficient workers may be

employed with programs such as

OJT

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76