The 4-Element Movement System Model to Guide Physical Therapist Education, Practice, and Movement-Related Research

2021 ◽  
Author(s):  
Philip McClure ◽  
Michael Tevald ◽  
Ryan Zarzycki ◽  
Shailesh Kantak ◽  
Philip Malloy ◽  
...  
Keyword(s):  
Physical Therapists ◽  
Physical Therapist ◽  
Human Movement ◽  
Element Model ◽  
Qualitative Assessment ◽  
International Classification Of Functioning ◽  
Personal Factors ◽  
Education Practice ◽  
Movement System ◽  
Element Movement

Abstract The movement system has been adopted as the key identity for the physical therapy profession and recognition of physical therapists’ primary expertise as managing movement dysfunction is an important achievement. However, existing movement system models seem inadequate for guiding education, practice, or research. Lack of a clear, broadly applicable model may hamper progress in physical therapists actually adopting this identity. We propose a model composed of 4 primary elements essential to all movement: motion, force, energy, and control. Although these elements overlap and interact, they can each be examined and tested with some degree of specificity. The proposed 4-element model incorporates specific guidance for visual, qualitative assessment of movement during functional tasks that can be used to develop hypotheses about movement dysfunction and serve as a precursor to more quantitative tests and measures. Human movement always occurs within an environmental context and is affected by personal factors, and these concepts are represented within the model. The proposed scheme is consistent with other widely used models within the profession such as the International Classification of Functioning, Disability and Health and the Patient Management Model. We demonstrate with multiple examples how the model can be applied to a broad spectrum of patients across the lifespan with musculoskeletal, neurologic, and cardiopulmonary disorders.

scholarly journals A Collaborative Model of Service Delivery for Children With Movement Disorders: A Framework for Evidence-Based Decision Making

2006 ◽  
Vol 86 (9) ◽  
pp. 1295-1305 ◽  
Author(s):  
Robert J Palisano
Keyword(s):  
Decision Making ◽  
Service Delivery ◽  
Movement Disorders ◽  
Physical Therapists ◽  
Physical Therapist ◽  
International Classification Of Functioning ◽  
Evidence Based ◽  
Personal Factors ◽  
Collaborative Model ◽  
Evidence Based Decision Making

AbstractModels of physical therapist service delivery provide a framework for integration of knowledge, research, and assumptions in a clinically relevant context that facilitates evidence-based decision making. In this perspective, a collaborative model of service delivery for children with movement disorders is presented. The focus is on services that address child and family priorities and preferences in settings where children live, learn, and play. The International Classification of Functioning, Disability and Health (ICF) is applied to identify relationships among the components of functioning, environmental, and personal factors that are important for the plan of care and achievement of outcomes. An assumption of the model is that physical therapists use multiple types of evidence to guide decision making. Application of the model and how child and family priorities change over time are illustrated through a longitudinal case report of a child with cerebral palsy. [Palisano RJ. A collaborative model of service delivery for children with movement disorders: a framework for evidence-based decision making. Phys Ther. 2006;86:1295–1305.]

scholarly journals Creating an Interface Between the International Classification of Functioning, Disability and Health and Physical Therapist Practice

2010 ◽  
Vol 90 (7) ◽  
pp. 1053-1063 ◽  
Author(s):  
Reuben Escorpizo ◽  
Gerold Stucki ◽  
Alarcos Cieza ◽  
Kandace Davis ◽  
Teri Stumbo ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Physical Therapists ◽  
Physical Therapist ◽  
International Classification ◽  
International Classification Of Functioning ◽  
Clinical Documentation ◽  
Disability And Health ◽  
Comprehensive Classification ◽  
American Physical

The American Physical Therapy Association (APTA) has endorsed the International Classification of Functioning, Disability and Health (ICF) as a framework to be integrated into physical therapist practice. The ICF is a universal and inclusive platform for the understanding of health and disability and a comprehensive classification system for describing functioning. The APTA's Guide to Physical Therapist Practice was designed to guide patient management, given the different settings and health conditions that physical therapists encounter in their daily clinical practice. However, physical therapists may be unclear as to how to concretely apply the ICF in their clinical practice and to translate the application in a way that is meaningful to them and to their patients. This perspective article proposes ways to integrate the ICF and the Guide to Physical Therapist Practice to facilitate clinical documentation by physical therapists.

scholarly journals The Human Movement System: Our Professional Identity

2014 ◽  
Vol 94 (7) ◽  
pp. 1034-1042 ◽  
Author(s):  
Shirley A. Sahrmann
Keyword(s):  
Physical Therapy ◽  
Physical Therapists ◽  
Human Movement ◽  
The Body ◽  
Physiological System ◽  
Musculoskeletal Conditions ◽  
Clear Identification ◽  
Movement System ◽  
American Physical

The 2013 House of Delegates of the American Physical Therapy Association adopted a vision statement that addresses the role of physical therapy in transforming society through optimizing movement. The accompanying guidelines address the movement system as key to achieving this vision. The profession has incorporated movement in position statements and documents since the early 1980s, but movement as a physiological system has not been addressed. Clearly, those health care professions identified with a system of the body are more easily recognized for their expertise and role in preventing, diagnosing, and treating dysfunctions of the system than health professions identified with intervention but not a system. This perspective article provides a brief history of how leaders in the profession have advocated for clear identification of a body of knowledge. The reasons are discussed for why movement can be considered a physiological system, as are the advantages of promoting the system rather than just movement. In many ways, a focus on movement is more restrictive than incorporating the concept of the movement system. Promotion of the movement system also provides a logical context for the diagnoses made by physical therapists. In addition, there is growing evidence, particularly in relation to musculoskeletal conditions, that the focus is enlarging from pathoanatomy to pathokinesiology, further emphasizing the timeliness of promoting the role of movement as a system. Discussion also addresses musculoskeletal conditions as lifestyle issues in the same way that general health has been demonstrated to be clearly related to lifestyle. The suggestion is made that the profession should be addressing kinesiopathologic conditions and not just pathokinesiologic conditions, as would be in keeping with the physical therapist's role in prevention and as a life-span practitioner.

scholarly journals The results of the analysis of the criteria of therapeutic alliance of patients orthopedic profile of outpatient physical therapy program

2019 ◽  
Vol 5 (3) ◽  
pp. 15
Author(s):  
S.M. Fedorenko ◽  
V.V. Vitomskyi ◽  
О.B. Lazarіeva ◽  
M.V. Vitomskа
Keyword(s):  
Statistical Analysis ◽  
Physical Therapy ◽  
Therapeutic Alliance ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Medical Center ◽  
Scientific Information ◽  
International Classification Of Functioning ◽  
Therapy Program ◽  
Literary Sources

<p><strong>Objective:</strong> to determine the peculiarities of forming a therapeutic alliance in outpatients with disorders of orthopedic profile after completing a course of physical therapy and their physical therapists depending on the psychotype of patients.</p><p><strong>Methods of research:</strong> theoretical analysis and generalization of literary sources, method of systematization of scientific information; Working Alliance Inventory questionnaire Form SF Hatcher (WAI). Patients were grouped using the International Classification of Functioning and Disease Types. The obtained results were processed by adequate methods of mathematical statistics. The study involved 113 patients who underwent a course of physical therapy at FESCO Medical Center during 2013-2015.</p><p><strong>Results.</strong> According to the results of the statistical analysis, patients with irrational attitude to the disease (irrational psychotypes) had significantly lower scores on the eight items of the WAI questionnaire out of twelve, as well as on all three totals. In particular, the «goal» score was significantly better in patients with rational psychotypes: Me (25; 75) scores were 14 (12.75; 15) points, versus 12 (11; 14) scores among patients with irrational psychotypes (p&lt;0,01). Similarly, the score of the "task" was 15 (13; 15) points against 12 (11; 15) points (p &lt;0.01), and the total score of the "bond" points 16 (16; 17) points against 14 (13; 15) points (p &lt;0.01). Thus, it can be stated that the evaluation of the “goal” items showed the lowest results, which were the farthest from the maximum values.</p><p><strong>Conclusion.</strong> The results obtained and the statistical analysis made it possible to evaluate the different sides of the level of formation of the therapeutic alliance, to identify the strengths and weaknesses and, thus, necessitated the development of ways to improve the union of the patient and the physical therapist.</p>

Shared Responsibilities for Full Participation in Society: Planning Further Integration of the ICF Into AAC

2016 ◽  
Vol 1 (12) ◽  
pp. 83-93 ◽  
Author(s):  
Mary Blake Huer ◽  
Travis T. Threats
Keyword(s):  
Environmental Factors ◽  
Augmentative And Alternative Communication ◽  
Functional Limitations ◽  
Community Support ◽  
World Health ◽  
International Classification Of Functioning ◽  
Personal Factors ◽  
Social Service Agencies ◽  
Persons With Disabilities ◽  
Full Participation

The World Health Organization's (WHO's) 2001 International Classification of Functioning Disability and Health (ICF) has as one of its central tenets the full inclusion of persons with disabilities in society. It acknowledges the need for medical and rehabilitation intervention in its biopscychosocial framework. However, the WHO realizes that society must do its part to facilitate this full participation and empowerment. Persons with complex communication needs (PWCCN) often need augmentative and alternative communication (AAC) in order to express themselves. However, in order to access and successfully use AAC, PWCCN need access to the necessary AAC devices and services, as well as a willing society to interact with them as full contributing members of society. The factors outside of a person's specific physical and/or cognitive functional limitations are addressed in the ICF via the Personal and Environmental Factors. Personal Factors include the individual's personality traits, lifestyle, experiences, social/educational/professional background, race, gender, and age. Environmental Factors include community support systems, social service agencies, governments, social networks, and those persons that interact with the PWCCN. This article addresses the sociopolitical influences on PWCCN and their functioning from a human rights perspective. The necessary introspective role of speech-language pathologists in this process is explored.

scholarly journals Automatically evaluating balance using machine learning and data from a single inertial measurement unit

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Fahad Kamran ◽  
Kathryn Harrold ◽  
Jonathan Zwier ◽  
Wendy Carender ◽  
Tian Bao ◽  
...  
Keyword(s):  
Machine Learning ◽  
Inertial Measurement Unit ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Model Performance ◽  
Machine Learning Techniques ◽  
Measurement Unit ◽  
Balance Performance ◽  
Inertial Measurement ◽  
Self Assessments

Abstract Background Recently, machine learning techniques have been applied to data collected from inertial measurement units to automatically assess balance, but rely on hand-engineered features. We explore the utility of machine learning to automatically extract important features from inertial measurement unit data for balance assessment. Findings Ten participants with balance concerns performed multiple balance exercises in a laboratory setting while wearing an inertial measurement unit on their lower back. Physical therapists watched video recordings of participants performing the exercises and rated balance on a 5-point scale. We trained machine learning models using different representations of the unprocessed inertial measurement unit data to estimate physical therapist ratings. On a held-out test set, we compared these learned models to one another, to participants’ self-assessments of balance, and to models trained using hand-engineered features. Utilizing the unprocessed kinematic data from the inertial measurement unit provided significant improvements over both self-assessments and models using hand-engineered features (AUROC of 0.806 vs. 0.768, 0.665). Conclusions Unprocessed data from an inertial measurement unit used as input to a machine learning model produced accurate estimates of balance performance. The ability to learn from unprocessed data presents a potentially generalizable approach for assessing balance without the need for labor-intensive feature engineering, while maintaining comparable model performance.

scholarly journals Rethinking Telerehabilitation: Attitudes of Physical Therapists and Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110343
Author(s):  
Fereshteh Saaei ◽  
Susan G Klappa
Keyword(s):  
Patient Population ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Patient Survey ◽  
Patient Perspectives ◽  
Remote Care ◽  
Virtual Therapy ◽  
Therapy Sessions

COVID-19 has accelerated the adoption of telehealth among various specialties, including rehabilitation. The fast-paced implementation of telerehabilitation has laid bare its challenges, providing an opportunity for innovation in order to enhance the experience of remote care. The purpose of this study sought to understand the attitudes toward telerehabilitation from physical therapist (PT) and patient perspectives. Two surveys administered to PTs, and the general patient population explored beliefs regarding telerehabilitation. There were a total of 289 participant responses in this study. There were 228 PT respondents and 61 patients who responded to the patient survey. Qualitative results describe current attitudes toward telerehabilitation. Results indicated both groups were receptive to virtual therapy sessions; however, some challenges were also reported. Current challenges and trends in utilizing telerehabilitation are further discussed.

scholarly journals Inter-examinerreliability study of physical examination procedures to assess the cervical spine

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Karthik V. Hariharan ◽  
Michael G. Timko ◽  
Christopher G. Bise ◽  
Meenakshi Sundaram ◽  
Michael J. Schneider
Keyword(s):  
Cervical Spine ◽  
Physical Examination ◽  
Facet Joint ◽  
Physical Therapists ◽  
Clinical Status ◽  
Clinical Findings ◽  
Qualitative Assessment ◽  
Segmental Mobility ◽  
Convenience Sample ◽  
Pain Provocation

Abstract Objective The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. Materials: Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other’s findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure. Results When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88–0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53–0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45–0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test. Conclusions Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.

scholarly journals Evaluation of Individualized Functional Electrical Stimulation-Induced Acute Changes during Walking: A Case Series in Children with Cerebral Palsy

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4452
Author(s):  
Nicole Zahradka ◽  
Ahad Behboodi ◽  
Ashwini Sansare ◽  
Samuel C. K. Lee
Keyword(s):  
Cerebral Palsy ◽  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Case Series ◽  
Phase Detection ◽  
Lower Extremity Muscle ◽  
Children With Cerebral Palsy ◽  
Muscle Groups

Functional electrical stimulation (FES) walking interventions have demonstrated improvements to gait parameters; however, studies were often confined to stimulation of one or two muscle groups. Increased options such as number of muscle groups targeted, timing of stimulation delivery, and level of stimulation are needed to address subject-specific gait deviations. We aimed to demonstrate the feasibility of using a FES system with increased stimulation options during walking in children with cerebral palsy (CP). Three physical therapists designed individualized stimulation programs for six children with CP to target participant-specific gait deviations. Stimulation settings (pulse duration and current) were tuned to each participant. Participants donned our custom FES system that utilized gait phase detection to control stimulation to lower extremity muscle groups and walked on a treadmill at a self-selected speed. Motion capture data were collected during walking with and without the individualized stimulation program. Eight gait metrics and associated timing were compared between walking conditions. The prescribed participant-specific stimulation programs induced significant change towards typical gait in at least one metric for each participant with one iteration of FES-walking. FES systems with increased stimulation options have the potential to allow the physical therapist to better target the individual’s gait deviations than a one size fits all device.

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