PT Application of Movement Theories PDF Fall 2024

PT APPLICATION OF MOVEMENT THEORIES MOVEMENT SCIENCE I Sarah Economides, PT, DPT, PCS Year I Fall Semester 2024 ©2024 Mayo Foundation for Medical Education and Research | slide-1  REFERENCES Jette AM. Outcomes research: shifting the dominant research paradigm...

PT APPLICATION OF MOVEMENT THEORIES MOVEMENT SCIENCE I Sarah Economides, PT, DPT, PCS Year I Fall Semester 2024 ©2024 Mayo Foundation for Medical Education and Research | slide-1  REFERENCES Jette AM. Outcomes research: shifting the dominant research paradigm in physical therapy. Phys Ther. 1995;75(11):965-970. Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137(5):535-544. Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2(6):576-582. Cott CA, Finch E, Gasner D, Yoshida K, Thomas SG, Verrier MC. The movement continuum theory of physical therapy. Physiotherapy Canada. 1995;47(2):87-95. Mueller MJ, Maluf KS. Tissue adaptation to physical stress: a proposed “physical stress theory” to guide physical therapist practice, education, and research. Physical Therapy. 2002;82(4):383-403. World Health Organization. Towards a common language for functioning, disability, and health: ICF. 2002. VanSant AF. The international classification of functioning, disability and health. Pediatric Physical Therapy. 2006;18(4):237. DOI: 10.1097/01.pep.0000245823.21888.7 Skjaerven LH, Kristoffersen K, Gard G. An eye for movement quality: a phenomeloghical study of movement quality reflecting a group of physiotherapists’ understanding of the phenomenon. Physiotherapy Theory and Practice. 2008;24(1):13-27. DOI: 10.1080/01460860701378042 Hedman LD, Quinn L, Gill-Body K, Brown DA, Quiben M, Riley N, et al. White paper: movement system diagnoses in neurologic physical therapy. JNPT. 2018;42:110-117. DOI: 10.1097/NPT.0000000000000215 ©2024 Mayo Foundation for Medical Education and Research | slide-2 OBJECTIVES Appreciate the movement system concept in PT practice, education and research Analyze clinical application of theories and models Describe the biopsychosocial model in healthcare and its application to health disparities and social determinants of health Describe the nine principles of the Movement Continuum Theory of Physical Therapy Describe the Physical Stress Theory Describe the International Classification of Functioning, Disability and Health (ICF) Describe the Movement Quality Model (MQM) Describe the Movement System Diagnosis in physical therapy ©2024 Mayo Foundation for Medical Education and Research | slide-3  RATIONALE UNDERLYING PHYSICAL THERAPY PRACTICE Research Types: Quantitative Qualitative Mixed Others PT practice guided by research: Clinical Practice Guidelines (CPGs) ©2024 Mayo Foundation for Medical Education and Research | slide-4  PARADIGMS Paradigm – accepted framework governing the way that science operates Guides research Scientific advances can cause a paradigm shift How much time does it take for things to become mainstream for practice? Students learn and transfer information to clinical practice How they are educated shapes what they believe Practicing clinicians take longer to adjust how they think due to experiences/education they have had and what they are comfortable with Jette, 1995 ©2024 Mayo Foundation for Medical Education and Research | slide-5 EXAMPLE OF A PARADIGM Patient/Client Management Diagnosis Evaluation Prognosis Examination Intervention Outcomes Guide to Physical Therapist Practice 2nd ed. ©2024 Mayo Foundation for Medical Education and Research | slide-6 PT GUIDING THEORIES Understanding and working with patients holistically Biopsychosocial Model ICF Model Engel, 1980 WHO, 2002 Borrell-Carrió, 2004 Movement Continuum Theory Movement Quality Model Cott, 1995 Skjaerven, 2008 Physical Stress Theory Movement System Diagnoses Mueller & Maluf, 2002 Hedman (White Paper), 2018 ©2024 Mayo Foundation for Medical Education and Research | slide-7  Engel, 1980 Borrell-Carrió, 2004 BIOPSYCHOSOCIAL MODEL Old biomedical model Physician focused on body/disease in isolation Based on authority, tradition, and “magical formulae” Expects the patient to agree/follow physician Flaw: Does not include the patient and his attributes as a person “Patch Adams” ©2024 Mayo Foundation for Medical Education and Research | slide-8  Engel, 1980 BIOPSYCHOSOCIAL MODEL Borrell-Carrió, 2004 Biopsychosocial Model Emphasizes importance of understanding human health and illness in their fullest contexts Looks at the connection between biology (medical), psychology, and socio-environmental factors Patient-centered, relationship-centered, and client-centered approaches Physician self-evaluation Creating trust Cultivating curiosity Recognizing bias Emotional education Using informed intuition Communicating clinical evidence ©2024 Mayo Foundation for Medical Education and Research | slide-9 BIOPSYCHOSOCIAL MODEL Each system is at the same time a component of higher systems The person (single individual) at the same time: Highest level of the organismic hierarchy Lowest unit of the social hierarchy ©2024 Mayo Foundation for Medical Education and Research | slide-10  Cott, 1995 MOVEMENT CONTINUUM THEORY Built out of Hislop’s Model of Pathokinesiology Grand theory Pathokinesiology is the study of anatomy and physiology as they relate to abnormal human movement. 2-dimensional model – does not reflect interaction of individuals with society and the environment PT intervention is directed at tissue, organ, system, or person levels but also recognizes that alterations at any one level have the potential to influence all levels. Cells Tissue Organ Systems Persons Family ©2024 Mayo Foundation for Medical Education and Research | slide-11  Cott, 1995 MOVEMENT CONTINUUM THEORY OF PHYSICAL THERAPY Goal: Creat a theory/conceptual framework for physical therapy that would apply to current and future practice Key concept = movement How physical therapy conceptualizes movement is different than other professions 9 Principles of Movement 3 general principles 6 physical therapy principles ©2024 Mayo Foundation for Medical Education and Research | slide-12 MOVEMENT CONTINUUM THEORY: 3 GENERAL PRINCIPLES Movement is essential to human life I Movement occurs on a continuum from the microscopic level to the level of the individual in society II Movement levels on the continuum are influenced by physical, psychological, social, and environmental factors III Cott, 1995 p. 89 – Table I ©2024 Mayo Foundation for Medical Education and Research | slide-13  Cott, 1995 p. 90, Fig. 1 MOVEMENT CONTINUUM THEORY ©2024 Mayo Foundation for Medical Education and Research | slide-14  Cott, 1995 MOVEMENT CONTINUUM THEORY: 6 PT PRINCIPLES p. 89 – Table I Movement levels on the continuum are interdependent IV At each level on the continuum there is a maximum achievable movement potential (MAMP) which is influenced by the MAMP at other levels on the continuum and physical, social, psychological, and V environmental factors Within the limits set by the MAMP each human being has a preferred movement capability (PMC) and a current movement capability (CMC) VI which in usual circumstances is the same ©2024 Mayo Foundation for Medical Education and Research | slide-15  Cott, 1995 p. 89 – Table I MOVEMENT CONTINUUM THEORY Maximum Achievable Movement Potential (MAMP) Finite theoretical upper limit of human movement Influenced by age/gender, stage of development, and presence of pathology Will vary over time Preferred Movement Capability (PMC) Individual’s chosen movement ability Current Movement Capability (CMC) Individual’s present movement ability The PMC/CMC differential is usually very small ©2024 Mayo Foundation for Medical Education and Research | slide-16  Cott, 1995 p. 91 – Fig. 2 MOVEMENT CONTINUUM THEORY ©2024 Mayo Foundation for Medical Education and Research | slide-17 MOVEMENT CONTINUUM THEORY: 6 PT PRINCIPLES Pathological and developmental factors have the potential to change the MAMP and/or create a differential between the PMC VII and the CMC The focus of physical therapy is to minimize the potential and/or existing PMC/CMC differential VIII The practice of physical therapy involves therapeutic movement, modalities, therapeutic use of self, education, and IX technology and environmental modifications Cott, 1995 p. 89 – Table I ©2024 Mayo Foundation for Medical Education and Research | slide-18  Cott, 1995 p. 92 – Fig. 3 MOVEMENT CONTINUUM THEORY ©2024 Mayo Foundation for Medical Education and Research | slide-19 OKSANA MASTERS https://www.youtube.com/watch?v=JrTwi0im4S4 ©2024 Mayo Foundation for Medical Education and Research | slide-20 MATT STUTZMAN – “ARMLESS ARCHER” 4x Paralympian Silver 2012 Gold 2024 https://www.youtube.com/watch?v=eDmO-kMmE6s ©2024 Mayo Foundation for Medical Education and Research | slide-21 OSCAR PISTORIUS “BLADE RUNNER” South Africa sprinter 8x Paralympic medalist – 2004, 2008, 2012 First bilateral amputee to participate in the Olympics (2012) against able- bodied athletes Advanced to semi-finals in 400m race ©2024 Mayo Foundation for Medical Education and Research | slide-22 DANCER WITH WHEELCHAIR ©2024 Mayo Foundation for Medical Education and Research | slide-23  Cott, 1995 MOVEMENT CONTINUUM THEORY Therapeutic Movement Strategies Therapeutic movements performed by the therapist Passive Therapeutic movement where the therapist physically facilitates the individual movement Active-assisted Therapeutic movements that the individual performs under the direction or supervision of the therapist Active Verbal/visual cues ©2024 Mayo Foundation for Medical Education and Research | slide-24  Mueller & Maluf, 2002 PHYSICAL STRESS THEORY Developed to address how tissues, organs, and organ systems adapt to varying levels of physical stress Describes how other factors can modify: Level of physical stress Response of biological tissues to a given stress level Movement is a major source of physical stress on tissues 4 types of tissues Epithelial tissue Connective tissue Muscular tissue Nervous tissue ©2024 Mayo Foundation for Medical Education and Research | slide-25  Mueller & Maluf, 2002 PHYSICAL STRESS THEORY p. 387, Fig. 1 Five Tissue Response to physical stress 1. Decreased stress tolerance (atrophy) 2. Maintenance 3. Increased stress tolerance (hypertrophy) 4. Injury 5. Death Low stress lowers thresholds for adaptation and injury High stress increases thresholds for adaptation and injury 12 fundamental principles See article for details ©2024 Mayo Foundation for Medical Education and Research | slide-26  Mueller & Maluf, 2002 PHYSICAL STRESS THEORY Factors that can change the level of stress on tissues Movement and alignment Extrinsic Muscle performance Orthotics, taping, assistive Motor control devices Posture and alignment Footwear Physical activity Ergonomic environment Occupational, leisure, and Modalities self-care activities Gravity Physiological Psychosocial Medications Age Systemic pathology Obesity ©2024 Mayo Foundation for Medical Education and Research | slide-27 INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF MODEL) ICF Model adapted from Nagi’s Model of Disablement (1965) Nagi “Disablement” Model – 4 categories Pathology – disease/injury, congenital condition Impairment – dysfunctions and structural abnormalities in specific body systems Functional limitations – restrictions in basic physical and mental actions Disability – expression of a physical or mental limitation in a social context Lacks incorporation of social/environmental considerations VanSant, 2006 ©2024 Mayo Foundation for Medical Education and Research | slide-28 ICF MODEL ICF “Enablement” Model – grounded in health rather than disease Health Condition 3 Domains of Human Function Body Functions & Structures Activities Participation 2 Contextual Factors Environmental Factors Personal Factors WHO, 2002 ©2024 Mayo Foundation for Medical Education and Research | slide-29  WHO, 2002 ICF MODEL ©2024 Mayo Foundation for Medical Education and Research | slide-30  ICF MODEL: DEFINITIONS Health Disease, disorder, injury Condition Body Physiologic function of body system (including psychological) Function Body Anatomical parts of the body such as organs, limbs, and their Structure components Impairments Problems in body function/structure, such as a significant deviation or loss Activity Execution of a task or action by an individual Participation Involvement in a life situation ©2024 Mayo Foundation for Medical Education and Research | slide-31  ICF MODEL: DEFINITIONS Activity Difficulty individuals may have in executing activities Limitations Participation Problems experienced in involvement in life situations Restrictions Environmental Make up the physical, social, and attitudinal environment Factors in which people live and conduct their lives Personal Gender, age, coping styles, social background, Factors education, profession, experiences, behavior, character, etc. ©2024 Mayo Foundation for Medical Education and Research | slide-32 ACTIVITY: ICF MODEL APPLICATION Apply the ICF Model to the following conditions Cerebral Palsy Hip fracture Blindness Appendicitis Torn rotator cuff, s/p surgical repair ©2024 Mayo Foundation for Medical Education and Research | slide-33  Skjaerven, 2008 MOVEMENT QUALITY MODEL Goals: Developing the concept of human movement from a health perspective focusing on features and characteristics of movement quality. Investigate the lived experience of movement quality as phenomenon Identify features and characteristics considered important in a physiotherapeutic context 4 Themes of Movement Quality Bio-mechanical Physiological Psycho-socio-cultural Existential Central Theme: Movement quality as a general and unifying phenomenon ©2024 Mayo Foundation for Medical Education and Research | slide-34  Skjaerven, 2008 MOVEMENT QUALITY MODEL p. 21, Fig.1 ©2024 Mayo Foundation for Medical Education and Research | slide-35  Skjaerven, 2008 MOVEMENT QUALITY MODEL 1. Biomechanical – represents spatial aspect 1. Precondition = Postural Stability 2. Movement characteristic of path and form in movement 2. Physiological – represents a time aspect to human movement 1. Precondition = Free breathing and centering Movement quality could originate from a central region in the trunk Breathing and tension are inter-related 2. Movement characteristics of flow, elasticity, vitality, and rhythm Starting/stopping at appropriate times, beginning new movements ©2024 Mayo Foundation for Medical Education and Research | slide-36  Skjaerven, 2008 MOVEMENT QUALITY MODEL 3. Psycho-Socio-Cultural – represents use of energy aspect – 1. Precondition = Awareness “present” = more care with movement “not present” = automatic pilot and more careless with movement; no connection with the body 2. Emotional, cognitive, intentional and socio-cultural aspects in movement Can’t see movement as isolated – dependent on thoughts, emotions, and intention We relate to other people – interplay between people and environment ©2024 Mayo Foundation for Medical Education and Research | slide-37  Skjaerven, 2008 MOVEMENT QUALITY MODEL 4. Existential – personal and unifying aspects 1. Precondition = Self-awareness Without involving yourself there will be no movement quality Ability to self-reflect What do I want… What is important for me… I can make a choice… 2. Personal and Unifying aspects expressed in movement “There is a meaning that goes beyond the joints and muscles” Movement quality mirrors a sense of being whole and unified ©2024 Mayo Foundation for Medical Education and Research | slide-38  Skjaerven, 2008 MOVEMENT QUALITY MODEL 1. Central Theme – movement quality as a general and unifying phenomenon Seen as umbrella phenomenon – global impression of whole moving person Movements that were functional, practical, energy-saving, aesthetic, and harmonic, all at the same time Inner state of the person is expressed in movement quality Associated with experience of well-being and healthy resources Movement Quality as the core of the PT profession ©2024 Mayo Foundation for Medical Education and Research | slide-39  White Paper, (Hedman), 2018 MOVEMENT SYSTEM DIAGNOSIS Movement System Collection of systems that interact to move the body or it’s component parts Core movement observation tasks Sitting Standing Sit to stand, stand to sit Walking Step up/down Reach, grasp, and manipulation ©2024 Mayo Foundation for Medical Education and Research | slide-40  White Paper, (Hedman), 2018 MOVEMENT SYSTEM DIAGNOSIS ©2024 Mayo Foundation for Medical Education and Research | slide-41 SOCIAL DETERMINANTS OF HEALTH Conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks ©2024 Mayo Foundation for Medical Education and Research | slide-42  APPLICATION OF SYNDEMICS Syndemics Framework Examines health consequences of identifiable disease and the social, environmental, or economic factors that promote such interaction and worsen disease Examples: Less education = higher risk of obesity, substance abuse, intentional/unintentional injury More education = longer life, increased health care understanding, action, and prevention Good health associated with academic success ©2024 Mayo Foundation for Medical Education and Research | slide-43 ASSIGNMENT Apply what you have learned about some of theories, models, and conceptual frameworks to a patient scenario from your volunteer or work experience or your own personal experience with an injury or health care condition that you are comfortable disclosing. See “Assignments” in Brightspace Complete by next week – Due Monday, September 16, 2024, by 11:59pm ©2024 Mayo Foundation for Medical Education and Research | slide-44 QUESTIONS? ©2024 Mayo Foundation for Medical Education and Research | slide-45