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Movement Science and Its Relevance to Physical Therapy

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Abstract

The purpose for a special series of articles in Physical Therapy devoted to movement science is threefold. First, physical therapists will be exposed to current research in this broad behavioral domain. This may have important implications for the discipline and profession of physical therapy. Second, physical therapists will have access to a body of knowledge that may have been overlooked because it was not seen as immediately relevant to clinical practice. Third, the series could serve as a basis for curriculum development and study in physical therapy education programs. By providing this exposure in Physical Therapy, unjustified barriers to particular research questions, methodologies, and related literatures may be overcome. Two concepts are presented that provide a framework for the 23 contributions to the movement science special series.
Movement Science and
Its
Relevance
to
Physical Therapy
winstein
CJ,
Knecht
HG.
Movement science and its relevance to physical therapy.
Phys Ther.
1990; 70: 759-762.1
The purpose for a special series of
articles in
Physical Therapy
devoted to
movement science is threefold. First,
physical therapists will be exposed to
current research in this broad behav-
ioral domain. This may have impor-
tant implications for the discipline
and profession of physical therapy.
Second, physical therapists will have
access to
a
body of knowledge that
may have been overlooked because it
was not seen as immediately relevant
to clinical practice. Third, the series
could serve as a basis for curriculum
development and study in physical
therapy education programs. By pro-
viding this exposure in
Physical Ther-
apy,
unjustified barriers to particular
research questions, methodologies,
and related literatures may be over-
come.
Two concepts are presented that pro-
vide a framework for the 23 contribu-
tions to the movement science special
series. The first deals with the diver-
sity of topics within the scope of
movement science, and the second
deals with the need for interdiscipli-
nary interactions. The first concept,
diversity of topics, is revealed from an
examination of the contents. There
are topics such as the use of animal
models to provide insights into motor
development (see article by Bradley
in this issue) and the importance of
psychosocial factors with respect to
motivation governing involvement in
physical activity (see article by Lewth-
waite in this issue). These topics span
a broad spectrum and seem to be
only casually related and perhaps dis-
connected.
A
careful look at the fun-
damental questions raised by these
and the other contributing authors
reveals an important commonality
among the topics. The common
ground shared by our contributors is
that their work is motivated by the
desire to understand the nature of
human movement behavior. This
commonality may be seen as the ma-
jor theme of the special series.
How does the scope of movement
science relate to the contents of this
special series? There is no single disci-
pline of movement science per se.
Instead, scientists from multiple disci-
plines have converged to piece
to
gether theoretical perspectives and
methodologies necessary to deal with
such multifaceted and complex ques-
tions as how an organism coordinates
a multipledegree-of-freedom system
to produce functional movements or
how practice repetitions afect the
learning and retention of skilled ac-
tions. The amalgamation of diverse
viewpoints is clearly evident by noting
the academic departments in which
our contributors hold appointments.
CJ Winstein,
PT,
PhD, is Assistant Professor, Department of Physical Therapy, University of Southern
California, 2025 Zonal Ave, CSA 208, Los Angeles,
CA
90033 (USA).
HG
Knecht,
PT,
EdD, is Director of Research, Orthosport Inc, 7736
W
Madison St, Forest Park,
IL 60130.
Carolee
J
Wlnsteln
Harry
G
Knecht
These include human kinetics, human
movement studies, kinesiology, neurol-
ogy, neurophysiology, physical educa-
tion, physical therapy, and rehabilita-
tion medicine. The fields represented
in the special series most certainly do
not
comprise all of the relevant move-
ment science subdisciplines. The sub-
disciplines of exercise, physiology, and
biomechanics, for example, are not
formally represented.
You might ask, "What then is move-
ment science?" The origin of the
phrase is unknown; however, terms
such as "human movement studies"
have been used at least since the
early 1970s, primarily by those in
physical education, to delineate a field
of study.' Recently, some individuals*
have declared that movement science
should be the foundation for physical
therapy, particularly for rehabilitation.
Movement science, or "biological
movement," was the underlying
theme of a recent scientific confer-
ence held in Collingwood, Ontario,
Canada. In describing the mixture of
participants and speakers, Meijer and
Whiting3 captured the dilemma of
defining movement science:
Drawing the lines between levels of
analysis, it could be said that those
arriving in Collingwood came mainly
from Psychology (behavior), Physiology
(mechanisms), and Physics
(constraints), but recent years have
witnessed a complete blurring of such
level-restricted boundaries. Robotics,
for example, would not fit into such a
classification
.
. .
indeed, the very
emergence of
neuroscience
reveals a
Physical Therapy /Volume 70, Number 12 /December 1990
tendency to cluster around fields of
study rather than levels of analysis.
Such, apparently, is the case with the
Science of Mo~ernent.~(~~~3)
Movement science is clearly a multi-
disciplinary field of study. This was
the prevailing sentiment in Colling-
wood and is reflected in the contents
of this special series. Without a doubt,
parent disciplines of biology, com-
puter science, physics, physiology,
and psychology contribute to the sci-
ence of human movement. The partic-
ular field from which each contribu-
tor to this special series comes is, in
most cases, apparent. Even more ap-
parent is that each article is exem-
plary of the science of movement.
Beyond discipline boundaries, the
invited articles fall into three general
areas of movement science research.
These are concerned primarily with
development, control, or learning.
This December issue, which has the
largest number of articles, contains
contributions from all these major
areas to set the stage for the articles
that follow in subsequent issues.
Those special series articles in the
January 1991 issue will be concerned
primarily with disorders of movement
control, whereas those in the Febru-
ary issue will be devoted to issues in
motor learning. The special series
articles in the March issue will focus
on developmental and pediatric
concerns.
The diverse perspectives represented
in the special series reflect a particu-
lar subset
of
work, primarily within
the behavioral areas of movement
science. The authors have attempted
to provide a theoretical foundation
for their work and to relate this per-
spective
to
the concerns of physical
therapy. Recently, Tammivaara and
Shepard4 stated that theory in physical
therapy research is all too often miss-
ing. Such theories would provide ex-
planations for
wby
certain practices
are most effective rather than
how
one should perform those practices.
Moreover, certain research areas, al-
though relatively unknown
to
the
physical therapy community, were
thought by the guest editors to have
important theoretical and practical
implications to the developing knowl-
edge base of physical therapy.
Nearly 50% of our contributors,
though not themselves physical thera-
pists, have interacted with physical
therapy professionals as mentors, col-
leagues, or research collaborators.
The overwhelmingly positive re-
sponse from these people to contrib-
ute to the flagship journal of our pro-
fession is one indication that these
scientific interactions have been per-
ceived favorably, with perhaps mutu-
ally beneficial effects.
The second point focuses on the need
for enhancement rather than restric-
tion of scientific interactions for pro-
fessional growth. Kroll captured the
essence of this issue with regard to
developing disciplines:
Concern that
a
discipline cannot be
born unless
it
can possess
a
unique
body of knowledge is not a critical
issue.
. .
.
Overlapping of disciplines
reflects only the multiple efforts
required in the pursuit of knowledge
and disciplines have long functioned in
symbiotic harmony. Territorial rights
are less important than territorial
development.5(~~~9)
In inviting our colleagues from re-
lated disciplines to contribute, this
special series of articles on movement
science in physical therapy represents
a move
to
the recognition that we are
one among many scientific communi-
ties dedicated to understanding the
nature of movement and its disorders.
This is not to imply redundancy. In-
deed, the way in which research
questions among the different scien-
tific communities are posed differs
considerably. For example, the exper-
imental psychologist asks, "What is the
role of feedback in motor learning?"
This entails comprehension of the
relation between feedback and motor
learning. Although this comprehen-
sion is of direct importance to physi-
cal therapy, the physical therapist who
seeks to use feedback
to
control or
manipulate motor learning for the
benefit of the patient asks a different
question. This mighr be, "How can
feedback be used to enhance motor
learning?" Each is concerned with
issues fundamental
to
feedback and
motor performance, but the ultimate
aim for gaining that knowledge differs
considerably.
Fifteen years ago, Hislop6 declared
that physical therapy was a profession
in search of an identity. Over the
years, as we attempted to define the
boundaries of our profession, it ap-
peared that we either consciously or
unconsciously adopted a rather insu-
lar approach. Only 5 years ago,
M~lder,~ an experimental psychologist
in the Netherlands and a contributor
to this special series, bemoaned the
communication gap between the
physical therapist and the movement
psychologist. In Mulder's view, the
movement psychologist, through labo-
ratory experimentation, is concerned
with determining the fundamental
principles governing motor control;
the movement clinician (eg, physical
therapist) is concerned with the de-
velopment of treatment approaches to
restore motor control. He argued that
communication between those in the
laboratory and those in the clinic
would be mutually beneficial. For
example, an understanding of the mo-
tor control deficits associated with
specific neuropathologies can contrib-
ute to the development of basic prin-
ciples of motor control (see, for
ex-
ample, articles by Corcos and by
Stelmach and Phillips in the January
issue). Conversely, theoretical con-
cepts such as those associated with
feedback, generalized motor pro-
grams, and functional synergies may
have implications for the develop-
ment of treatment procedures for the
retraining of motor control (see, for
example, articles by Scholz in this
issue and by Mulder and Winstein in
the February issue). In retrospect, the
communication gap seemed to have
been a necessary and important part
of our growth.
As
our profession and
discipline mature, it has become time
to foster dialogue with our colleagues
in related fields and to recognize ar-
eas of mutual interest.
Physical Therapy /Volume 70, Number
12
/December 1990
Movement Sclence and Its
Relation to the Profession
and Discipline of Physical
Therapy
The importance of knowledge from
the related field of movement science
to the profession and discipline of
physical therapy is clearly related in
the profession's obligation to keep
abreast of scientific advances perti-
nent to its practice. In particular, a
profession has an inherent responsi-
bility to improve and expand the
scope of its services to society. This
often involves the incorporation of
new knowledge obtained from related
disciplines. The knowledge obtained
from related disciplines is often not
directly or obviously translatable into
practice. The profession thus may as-
sume a research role to obtain the
directly relevant knowledge for devel-
opment of its practices. If the profes-
sion chooses to produce new knowl-
edge itself, an interesting shift in
orientation ensues. That shift implies
a role change from profession to dis-
cipline. The line between profession
and discipline may become blurred.
While the development of new knowl-
edge that affects practice is consid-
ered a necessary service to society
that earmarks a profession, the acqui-
sition of knowledge for fundamental
understanding (ie, to advance sci-
ence) characterizes the orientation of
scholar-researchers within an aca-
demic discipline.
Henry defined an academic disci-
pline as
an
organized body of knowledge
collectively embraced in a formal
course of learning. The acquisition of
such knowledge is assumed to be an
adequate and worthy objective as such,
without any demonstration or
requirement for practical appli~ation.~
Movemerit science can be viewed as
an academic discipline in the sense of
Henry's definition. The acquisition of
the knowledge in the academic disci-
pline of physical therapy is assumed
to be a requirement necessary for
application
of its professional prac-
tices and for the improvement of its
professional services.
Over the last 10 years, the physical
therapy profession has developed an
academic discipline that is considered
in some colleges and universities
worthy of postprofessional graduate
training and graduate degrees that are
considered scholarly in orientation. In
1975, in her Mary McMillan Lecture,
Hislop6 authored the seminal concept
implicating pathokinesiology as the
"distinguishing clinical science of
physical therapy." Hislop argued that
pathokinesiology (ie, the study of
movement dysfunction) embodied the
fundamental and unique concepts of
the "discipline" of physical therapy.
Ten years after Hislop's proposal, aca-
demicians and clinicians debated the
advantages and disadvantages of
adopting "movement dysfunction" as
the academic domain of the physical
therapy profession.g-15 It seems clear
that the debate continues. Despite
definitional disputes related to the
collective scope of a physical therapy
discipline, however, postprofessional
academic programs have been devel-
oped throughout the United States,
Canada, and Australia. In some cases,
scholarly degrees related to the physi-
cal therapy discipline are offered in
exercise science and physical educa-
tion, rehabilitation science, and most
recently movement science. These
programs can be easily characterized
as contributing to and drawing upon
the broader domain of movement
science.
It can be argued that the scientific
foundation of our clinical practice can
be supported by the emerging and
broader science of movement. Carr et
al's recent textbook entitled
Move-
ment Science: Foundations for Physi-
cal Therapy in Rehabilitation2
argues
for the potential usefulness to physical
therapy of the research emerging
from movement science. More impor-
tantly, and beyond its impact on phys-
ical therapy, there is the potential to
contribute to the knowledge base of
movement science. This potential for
a mutually beneficial relationship has
only recently been recognized by sci-
entists working with clinicians.7 The
relationship between physical therapy
and movement science must be culti-
vated slowly, with vision and care.
The partnership of physical therapy
and movement science should be
guided with objectives to develop
both
the practice and the science of
physical therapy. This is clearly a
gradual process, but one that will ulti-
mately lead to more refined and su-
perior practices, based upon appro-
priate theoretical underpinnings that
are needed for any developing
~cience.~
Is Immediate Application
Necessary for Relevance?
A narrow view holds that any research
that is not done in a clinical setting,
with patients as subjects, is useless to
the practice of physical therapy. This
view is perhaps more prevalent in
our profession than we suspect. Is
movement science research relevant
to physical therapy
only
if
it
has an
obvious, direct, and immediate appli-
cation to clinical practice? If physical
therapists view themselves as techni-
cians or craftspersons who allow
someone else to tell them that "this
technique works best for this disabili-
ty,"l6 then nonclinically based re-
search in movement science is defi-
nitely useless to physical therapy.
Physical therapy, however, is not a
craft; it is a profession and a disci-
pline. With this recognition comes the
inherent responsibility to integrate
knowledge from related research into
clinical practice. All physical therapists
should be proficient consumers of
knowledge. This requirement entails
the capability to evaluate and apply
new information to professional prac-
tices.17 Integration and application of
new knowledge may not be straight-
forward, particularly if the knowledge
comes from nonclinical research. It is
the physical therapist, however, who
is best suited to take research, refine
it to allow proper integration, and
apply it, if appropriate, to clinical
practice. Much of the research pre-
sented in this series of articles on
movement science will provide an
opportunity for this process and po-
tential for important new growth.
A recent 4-year citation analysis of
Physical Therapy18
claimed that during
Physical Therapy /Volume 70, Number
12
/December 1990
the period from June 1980 through
May 1984 there were 67 different
journals cited 10 or more times. Of
these, nearly 50% of the citations
were from only 6 different journals.
Nearly 20% of the citations were from
Physical Theram
alone. Surprisingly,
movement science journals such as
the
Journal of Motor Behavior,
the
Journal of Human Movement Studies,
Human Learning,
and the
Journal of
Sport and
Exercise
Psychology
were
not among those cited 10 or more
times. Probably, the cited journals
were appropriate, given the subject
matter of the articles that referenced
this literature. It could be argued that
the topics of these articles constituted
only a portion of the relevant knowl-
edge base. Perhaps most disturbing
was the suggestion that this list of 67
journals may represent the journals
"most relevant" to physical therapy.
As
the physical therapy community be-
comes more aware of the various fac-
ets of movement science through ef-
forts such as this special series, we
will begin to see more integration of
these highly relevant literatures into
our practices, our research, our librar-
ies, and our education programs.
In this introduction, we argue that
interaction between movement sci-
ence and physical therapy could be
mutually beneficial. In the series of
articles that follow, physical therapists
are exposed to the diversity and
scope of movement science research.
Many of the articles present concepts,
theoretical perspectives, research
methodologies, and terminology that
may be unfamiliar, yet the challenge
presented by these perspectives al-
lows for both scientific and practical
advances in physical therapy.
References
1
Brooke JD, Whiting HTA, eds.
Human Move-
ment:
A
Field of Study.
London, England:
Henry Kimpton Publishers; 1973.
2
Carr JH, Shepherd
RA,
Gordon J, et al, eds.
Movement Science: Foundations for Physical
Therapy in Rehabilitation.
Rockville, Md:
As-
pen Publishers Inc; 1987.
3
Meijer 0, Whiting HTA. Report of the 1988
Motor Neuroscience Symposium, Collingwood,
Ontario, Canada.
Jouml of Motor Behavior.
1989;21: 163-175.
4
Tammivaara J, Shepard
KF.
Theory: the
guide to clinical practice and research.
Phys
Ther.
1990;70:57%582.
5
Kroll
WP.
Perspectives in Physical Education.
New York,
NY:
Academic Press Inc; 1971:109.
6
Hislop HJ. Tenth Mary McMillan Lecture: the
not-so-impossible dream.
Phys Ther.
1975;55:1069-1080.
7
Mulder T.
The Learning of Motor Control
Following Brain Damage: Experimental and
Clinical Studies.
Berwyn, Pa: Swets North
America; 1985.
8
Henry FM. Physical education: an academic
discipline.
Journal of HeaNh, Physical Educa-
tion, and Recreation.
1964;35:32-33.
9
Rothstein JM. Pathokinesiology: a name for
our times?
Phys Ther
1986;66:364-365.
10
Schlegel
R.
Is pathokinesiology synony-
mous with physical therapy?
Phys Ther.
1986;66:366367.
11
Zadai CC. Pathokinesiology: the clinical
implications from a cardiopulmonary perspec-
tive.
Pbvs Ther.
1986;66:36%371.
12
Purtilo
RB.
Definitional issues in pathoki-
nesiology: a retrospective and look ahead.
Phys
Ther.
1986;66:372-374,
13
Smidt GL. Walking the trail of physical
therapy research.
Phys Ther.
1986;66:375-378.
14
Rose SJ. Description and classification: the
cornerstones of pathokinesiological research.
Phys Ther.
1986;66:379-381.
15
Walker JM. Research in pathokinesiology:
what, why, and how.
Phys Ther.
1986;
66:382-386.
16
Cubelli MG. Bridging the research gap.
Clinical Management in Physical Therapy.
1989;9(3):7. Letters.
17
Rothstein JM. Letters: Rothstein responds.
Clinical Management in Physical Therapy.
1989;9(4):7. Letters.
18
Bohannon RW, Gibson DF. Citation analy-
sis of
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Phys Ther.
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Physical Therapy /Volume 70, Number 12 /December 1990
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Physical therapists are becoming increasingly aware of the importance of theory in physical therapy research and practice. In this article, we define theory and discuss its uses in both clinical practice and clinical research. We argue that both the quality of current practice and growth of physical therapy as a profession will be enhanced as more physical therapists appreciate and use theory to guide their work.
Article
The University of Southern California Department of Physical Therapy (USC-PT) is honored in being invited to present a review of some of our research activities in pathokinesiology. Specifically, I will address the following questions posed by the organizers of this symposium: 1) Why has USC-PT been conducting research in the field of pathokinesiology? 2) What has been accomplished? 3) How was it accomplished? and 4) How has this effort contributed, if it has, to the science of pathokinesiology? Many individuals deserve credit for providing the impetus, inspiration, and opportunity to conduct research on normal and abnormal movement. I recognize Dr. Helen Hislop, Chairman of USC-PT and author of the pivotal paper “The Not-So-Impossible Dream”¹ that today retains its relevance. As presenter, I am simply a voice for the many who have contributed to these research efforts.
Article
Historically, the body of knowledge in most science-based disciplines has been developed by initially focusing investigative efforts on observing and describing phenomena of interest.1–3 Subsequent to the initial observation and description, refinements were suggested and, eventually, consensus was achieved regarding specific observations. Finally, the observed phenomena were arranged according to systematic rules into classes or groups. I believe we should adopt this model, which has been effective in other disciplines, and commit ourselves to the objectives of observing, describing, and classifying pathokinesiological phenomena that exist in the patients we serve. Our efforts then should provide us with a clinically relevant body of knowledge and substance from which theories regarding treatment can evolve. Fundamental Tasks In the process of describing and classifying disorders of movement, we will need to establish rigorous methods of investigation and experimentation that will enable us to define our observations unquestionably.
Article
In the “Plan to Foster Clinical Research in Physical Therapy,” adopted by the American Physical Therapy Association, clinical research is defined as “a systematic process for formulating and answering questions about the uses of, the bases for, and the effectiveness of physical therapy practice.”¹ Central to physical therapy is the notion of movement dysfunction.² Pathokinesiology is a term that, in my judgment, is analogous to movement dysfunction. In this context, how do we conceptualize the trail of research and where does the trail lead? Physical therapy is a health profession whose primary purpose is the promotion of health and function through the application of scientific principles to prevent, identify, correct, and alleviate acute or prolonged movement dysfunction. To be consistent with science at large, the basic aim of the research in physical therapy should be to generate and test theories.
Article
Ten years have passed since the concept of pathokinesiology was introduced into physical therapy. Examining it from a philosopher's perspective, this article provides a brief retrospective on how the concept originally was described, poses some questions about the type of concept it has become, and suggests what it might now be able to help the profession of physical therapy achieve. INITIAL DESCRIPTION What was the initial description of the concept of pathokinesiology? Many physical therapists in the audience experienced a swell of excitement—like a wave that had been approaching and suddenly broke at the shore—when Hislop introduced the term pathokinesiology into physical therapy during her presentation as a Mary McMillan lecturer stating, “What is physical therapy? Physical therapy is knowledge. Physical therapy is clinical science … pathokinesiology is the distinguishing clinical science of physical therapy.”
Article
By way of introducing this material to you, I believe a few confessions are in order. Number one, I know why I was invited to participate in this symposium. It is no secret that squeaky wheels get greased, and the cardiopulmonary physical therapists have been somewhat squeaky on the topic of pathokinesiology. I credit and compliment the symposium's program committee for their sagacity and chutzpah in inviting the squeaky wheels to participate. They recognized that physical therapists need to get to the business of “making honey” as Dr. Hislop directed us.¹ Yet, you cannot stir up the bees if you know where the nest is and walk around it or if you have been living contentedly inside. To make the best honey, the bees must examine old flying routes, find new routes, and sample pollen from all the flowers. Number two, I am not intimately familiar with the term “pathokinesiology.”