Dual Processing: System 1 and System 2 Thinking

• Dual Processing Theory involves two systems of thinking: System 1 and System 2
• System 1 focuses on the reasoning part of the dual processing theory and then System 2

System 1 Thinking

• Non analytical
• Fast Thinking
• Automatic and Involuntary
• Pattern recognition
• Inductive Reasoning

System 1 Thinking - Advantages

• Speed
• Formulation of working hypotheses based on logic (Inductive)
• Creativity
• Has the ability to feed creative insights into System 2 Thinking
• Patient Centered
• It identifies the variability present with the patients

System 1 Thinking - Disadvantages

• Cognitive, Information, Priming, and Ego Biases Can exist
• Easy Stagnation
• Exemplified by clinicians who have not adapted to changing times

System 2 Thinking

• Analytical
• Slow Thinking
• Conscious and Effortful
• Logical
• Deductive Reasoning
• One question leads to another; one answer generates the next test

System 1 vs System 2 Thinking

• Hypothetico-Deductive Reasoning is predominated by System 2
• System 1 uses Pattern recognition which is developed through experience, training, repetition, seeing what people do, and collaborating with colleagues
• Experience assists in improving a skill, but awareness of the ability is a catalyst to improvement

Pattern Recognition

• The physical therapist quickly recognizes certain features of a case
• Recognition leads to the use of other relevant information from stored knowledge
• If a therapist has no recognizable pattern in a patient, they must revert to hypothetico-deductive reasoning
• Often occurs through memory banks of illness scripts
• A hypothesis
• A mental model that is utilized to organize and retrieve information about a disease or condition
• Patterns are often recognized through educational curriculum
• It relies significantly on the clinical experience
• Implementation occurres during the examination process when a pattern is recognized

The Communicative Detective

• The Crime Detective is equivalent to the victim and their suspects
• Suspects are the hypotheses or potential diagnoses
• Clues are the findings from the tests and measures
• The Crime Scene is equivalent to the Environment
• The circumstances is timing and contextual factors
• The Arrest of the perpetrator is equivalent to successful treatment for the PT Diagnosis

Hypothesis Formation

• It is a supposition or proposed explanation made based on limited evidence as a starting point for further investigation
• Developing accurate hypotheses is significant because it helps to provide a framework by which appropriate treatment plans can be created to decrease pain and improve function

Types of Hypothesis

• Tissue Specific Hypothesis involve:
• Joints and Bony Structures
• Muscle and Tendons
• Ligaments, Nerve and Other Soft Tissues
• Impairment based hypothesis:
• Mobility deficits result in Hypomobility and/or Stiffness
• Movement Coordination Impairments result in Hypermobility and/or Instability
• Radiating Pain results in Nerve Compression and/or Irritation
• Syndromes are formulated based on a recognition of signs and symptoms consistent with designated conditions
• Some Syndromes examples are:
• Shoulder Impingement Syndrome
• Carpal Tunnel Syndrome
• Thoracic Outlet Syndrome
• Sciatica
• Read Flag Hypothesis are hypothesis recognized as a possible emergent condition that requires immediate referral out to a qualified health care provider
• Examples of Red Flag are Cancer, DVT, Tumor, and Infections

Examination Process

• There are 3 steps to the examination process:
• Review of the Medical Intake Forms (Chart Review)
• This includes Initial hypothesis and flagging any red/yellow flags
• Subjective Examination (Patient Interview)
• This includes revised working hypothesis
• Physical Examination (Tests and Measures)
• Can pattern recognition scripts be used for
• Hypothesis Formation
• Sign and/or Symptoms
• Demographics and/or population Stats
• Utilzing System 1 Thinking is paramount to the overall process