Selda UZUN ^1* Yusuf Muhammed Kahraman ²

• ¹ Marmara University, Kadikoy, Istanbul, Türkiye
• ² Haliç University, Istanbul, Türkiye

medical branches were not aware of the necessity of physiotherapy. In the 2000s, the profession of physiotherapy started to gain prominence in Turkey due to the opening of special education centers for children with disabilities and the introduction of regulations requiring hospitals to have a sufficient number of physiotherapists based on patient volume. As a result, the demand for physiotherapists in Türkiye has steadily increased, leading to a rise in the number of physiotherapy departments in both state and foundation (private) universities across the country. Currently, there are physiotherapy schools in 56 universities [32 state (57.14%), 24 foundation/private (42.85%)] in Türkiye (85 million people), and approximately 6000 physiotherapists have been graduating from these schools per year. However, the rapid increase in physiotherapy departments has led to the establishment of departments with insufficient academic competence, as some departments now have only three faculty members. The main objective of these departments is focused on graduating undergraduate students without considering MSc (2 years) and PhD (4 years) programs. There are 31 universities with MSc degrees and 15 offering PhD degrees in physiotherapy in Türkiye. Despite an increase of 30.45% in the number of students enrolled in physical therapy undergraduate programs in the last three years, as reported by the Council of Higher Education (Table 1), the number of fulltime academic personnel of physical therapy origin has not reached a sufficient number with an average of 4.54 per faculty in the last 3 years (Gürses et al., 2014). Despite the rapid expansion of physiotherapy programs and numerous postgraduate schools, the number of qualified academics has not increased correspondingly, possibly due to a lack of awareness or incentives for pursuing academic careers. Young physiotherapists are less interested in academic careers due to the long duration of the academic career (2 years master's degree and 4 years PhD), low scholarships and salaries, and the intense academic workload. Therefore, there should be better opportunities for newly graduated physiotherapists and support of academic career pathways in physiotherapy schools. For example, financial support can be provided by giving the opportunity to work in universities/hospitals for physiotherapists who are doing master's and doctorate, and thus academic careers can be incentivized. Physiotherapists may be right to think this way to protect their professional ethics because, in order to acquire these complex therapy skills, it is necessary to have many years of experience after 4 years of undergraduate education or to participate in additional courses.For the last decades, physiotherapists have been using state-of-the-art systems such as robotic devices (locomat, etc.), wearable technologies, and virtual reality, etc. in physiotherapy hospitals and universities in Turkey as in the whole world. Similarly, physiotherapists employed Turkish physiotherapists and other scientists, and a few publications are accepted every year.In the meantime, we think that the awareness of undergraduate or postgraduate students about ISEK or JEK is limited to their specific interests. In order to transfer this knowledge to the younger generation, we think that the STEM approach in physiotherapy education should be integrated into all physiotherapy education programs. Thus, physical therapists can receive multidisciplinary and technology-based education, which enables them to utilize sophisticated devices effectively. In this way, PTs and occupational therapists who are proficient in analyzing and interpreting data will have the opportunity to implement appropriate rehabilitation strategies in their clinical practice. Furthermore, the establishment of rehabilitation engineering institutes in Turkey, in addition to biomedical engineering departments, could facilitate collaboration between physiotherapists and engineers.Looking at the undergraduate education of physiotherapy schools in Türkiye, only a few universities have a single course called "Use of the Latest Technologies in Rehabilitation". The course covers topics such as the functions and uses of assistive devices, including inertial sensors, wearable robotics, muscle stimulation techniques, and improving physical activity technologies used in the rehabilitation process. On the other hand, as the first university in Turkey to establish a physiotherapy department, Hacettepe University offers a course called 'Technology-Based Assessment in Physiotherapy', which covers topics such as isokinetic strength, foot pressure, posture, scapular kinematics and assessment of muscle activation levels3 . However, the content of these courses is not comprehensive and includes only general information about new technology equipment. It only covers superficial topics such as the benefits and difficulties of technology and digitalization. The reason why the content of these technology-based courses is so superficial is that academics with engineering backgrounds are not assigned to physiotherapy departments. These courses should include detailed analysis and interpretation of the data obtained from these measurement systems, focusing not only on the operational benefits and how to use them but also on developing practical skills in data processing, clinical application, and integration of technology.There is generally no standardization between the curricula of physiotherapy and rehabilitation departments. Most of the theoretical and practical courses are similar.Furthermore, the existing courses on electrophysiological research methods are elective and have limited sEMG testing and training materials for analysis in university curricula.Additionally, there are no engineering-based academics commissioned at each level of physiotherapy programs. In the curriculum of physiotherapy schools, literature discussion, and article assignments are included to develop occupational content, process analysis, and scientific literacy. However, there are some deficiencies in the curriculum in terms of creative and innovative thinking, design, entrepreneurship, and technological literacy. These deficiencies may be compensated by some organizations organized by some student groups In some of the course curricula in physiotherapy schools in Turkey, information about neuromuscular electrophysiology and bioelectric signals (ECG, EEG) is generally taught theoretically 4 . In some schools, there is the use of ECG in the clinic, but there is not enough education to gain competence in academic research on signaling. The use of EEG devices in diagnosis (epilepsy etc.) is mentioned in neurophysiology/electrophysiology etc. courses. EEGbased neurorehabilitation applications are applied in a few private physical therapy clinics (by MDs), and the use or analysis of EEG is of little interest to physiotherapists, even those doing academic research. However, research on EEG/ECG and sports performance is of more interest to sports scientists working in collaboration with engineers in the field of sports sciences. According to the regulation of health professionals, "The physiotherapist performs the showing muscle activity parameters in rehabilitation clinics. Thus, it may limit the opportunity to use sEMG to answer to specific biomechanical queries or relevant clinical questions representing the rationale on which the physiotherapy treatment is based on. The main foundation that provides research grants is the Scientific and The use of artificial intelligence-based systems in clinical settings is rapidly increasing in healthcare. Examples of the use of these systems in clinical practice include video analysis, natural language processing (NLP), robotics (myoelectric control with symbiotic neuroprostheses), brain-computer interface technology, perioperative medicine, personalized healthcare, expert systems and predictive algorithms to classify data and make recommendations, etc. (Pokorny et al., 2013;Rowe et al., 2022;Scheper et al., 2024). In this context, it is suggested that some of the routine physical and cognitive tasks in physical therapy practice may be automated by AI-based systems in the near future. If successful clinical practice in the future requires understanding how to interpret the recommendations of machines, when to give them manual control, and when to ignore them, physical therapy education will need to adapt accordingly (Rowe et al., 2022;Scheper et al., 2024). Therefore, the advantages and disadvantages of using AI in clinical practice should be included in the curriculum to provide an overview of developments related to AI in physical therapy. Finally, our future perspective for the physical therapy field is that educational materials involving rehabilitation technologies such as sEMG, related to STEM must be added to the curricula of physiotherapy programs. In this regard, it was suggested that the fast development of technology requires new competencies by the next generation of physical and occupational therapists in the fields of science, technology, engineering, and mathematics (STEM), which, in turn, requires a new educational curriculum (Merletti, 2024). Rehabilitation clinics often cannot use sEMG, motion capture systems, etc. in musculoskeletal system evaluations due to their high cost and limited knowledge of physical therapists and movement scientists. If existing educational materials (Clancy et al., 2023;Del Vecchio et al., 2020;Merletti & Cerone, 2020;Merletti & Muceli, 2019;Muceli & Merletti, 2024;Valli et al., 2024) are integrated into undergraduate education programs, clinical applications including sEMG tests and data interpretation might pave the way.In Turkey, biomedical engineers in many universities apply technological measurements in the field of rehabilitation at an academic level (professor, PhD). Biomedical engineers working as academicians generally look favorably on joint research with physicians (neurologists, physical therapists, and orthopedics) and physiotherapists. The transfer of this information to hospitals and private clinics has recently become important. However, physiotherapists prefer to learn how to use automated systems rather than increase their competence in STEM (biosignal analysis). We have two different suggestions on this subject(1) technological measurements in rehabilitation should be performed by physiotherapists because it would be ethically problematic for engineers or clinical technologists who do not know human body biomechanics and kinesiology to interpret the results and provide recommendations to the patients, or (2) physiotherapists should collaborate with biomedical or other engineers for technological measurements and analyses. To achieve this, engineers should be allowed to work in physiotherapy schools.