Jilen Mar Paulo Q. Isla BSPT-1

2019-00528 Asst. Prof Grace Kang

PT 140 Foundations of Physical Therapy Practice: Overview, Theories and Framework

First semester 2019-2020

Learning Guide on Movement Theories for Physical Therapy

Definition of theory

Read the following article and answer the succeeding questions.

American Physical Therapy Association. (2012). Role of theory in physical therapy. Retrieved from

1. How was theory in physical therapy practice operationally defined? (maximum 3 sentences)

? Theory in physical therapy was operationally defined as a formal statement that has concern with the relationships between and among observable phenomena.

It can describe a pattern in several observations or predict the probability of a future event to happen. Moreover, theory in physical therapy play is vital because it plays an important role in the development, dissemination, and application of the body of knowledge in physical therapy (American Physical Therapy Association, 2012).

2. Differentiate inductive theory from deductive theory. (maximum 2 sentences)

? Inductive theory, also known as grounded theory, is concerned with the generation of new data by describing a pattern in the sea of obscurities from various observations.

On the other hand, deductive theory is the type of schema that gives emphasis on causality and involves the prediction of the occurrence of a future event (APTA, 2012).

Role of theory in physical therapy practice

American Physical Therapy Association. (2012). Role of theory in physical therapy. Retrieved from

1. List down two (2) functions of theory in research and another two (2) in practice of physical therapy.

? Theories in research has a function of (1) enlightenment by providing explanations of observable phenomena and events and (2) yielding verifiable propositions and predictions, including predictions of phenomena and events that is not yet observed.

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Moreover, in physical therapy practice, theory serves a tool in which the practitioner can apply in the (1) selection of intervention which can be expected an appropriate and effective one and anticipation of outcomes which are based from present physical therapy theories. (2) Theories that are concerned with the mechanism of action for interventions serves as an instrument for the clinician to understand why an intervention is expected to be effective (APTA, 2012).

2. In three (3) sentences, describe the figure below depicting interactions between the roles of theory, practice and research.

? Theory provides link and interaction between practice and research because this proposition, which is hypothesized based on relationships between phenomena, can be verified through research and can be integrated into actual clinical practice. Additionally, theory can be used to form decisions and actions in clinical practice and its body of principles, if tested and experimented in research, can develop and expand its own body of knowledge. Clinical practice and research are influenced by theory and both can influence the latter (APTA, 2012).

Overview of movement theories for physical therapy practice

Read up on the following theories, and fill out the table below.

a. Movement Continuum Theory

b. Physical Stress Theory

c. Theories of motor control

• Reflex Theory

• Hierarchical Theory

• Systems Theory

• Dynamical Action Theory

• Ecological Theory

Theory Proponents Key Principles Strengths Limitations

MCT 1. Cheryi A. Cott

2.Elspeth Finch

3. Diane Gasner

4. Karen Yoshida

5. Scott G. Thomas

6. Molly Verrier General Principles:

1. Movement is essential to life.

2. Movement occurs on a continuum from a microscopic level to the level of a person acting in society.

3. Movement is influenced by physical, psychological, social, and environmental factors.

Physical Therapy Principles:

1. Movement at various levels on the continuum is interdependent.

2. There is a maximum achievable movement potential (MAMP) for each level (i.e., molecular, cellular, body part, and person in society) that is influenced by the MAMP at all the other levels.

3. All individuals have a preferred movement capability (PMC) and a current movement capability (CMC) within that MAMP.

4. Disabling factors can change the MAMP or the difference between the PMC and the CMC.

5. Physical therapists’ focus in intervention is to minimize the difference between the PMC and the CMC.

6. Physical therapists intervene through therapeutic movement, modalities, therapeutic use of an individual’s self, education, technology, and modifications to the environment.

(Allen, 2007) The Movement Continuum Theory (MCT) establishes clear connections among movement disciplines, individual movement capability, and the role of movement experts in maximizing people’s movement capability. It defines movement as main concept for evaluating movement and managing movement disorders instead of just focusing on function or disability. Also, one can use its principles to enhance the understanding of movement and potential interventions. The term “movement” in the theory lacks specificity because it is broadly conceptualized in the principles (Allen, 2007).

PST 1. Michael J. Mueller

2. Katrina S.

Maluf Fundamental Principles:

A. Changes in the relative level of physical stress cause a predictable response in all biological tissues.

B. Biological tissues exhibit 5 characteristic responses to physical stress. Each response is predicted to occur within a defined range along a continuum of stress levels. Specific thresholds define the upper and lower stress levels for each characteristic tissue response. Qualitatively, the 5 tissue responses to physical stress are decreased stress tolerance (i.e., atrophy), maintenance, increased stress tolerance (i.e., hypertrophy), injury, and death.

C. Physical stress levels that are lower than the maintenance range result in decreased tolerance of tissues to subsequent stresses (i.e., atrophy).

D. Physical stress levels that are in the maintenance range result in no apparent tissue change.

E. Physical stress levels that exceed the maintenance range (i.e., overload) result in increased tolerance of tissues to subsequent stresses (i.e., hypertrophy).

F. Excessively high levels of physical stress result in tissue injury.

G. Extreme deviations from the maintenance stress range that exceed the adaptive capacity of tissues result in tissue death.

H. The level of exposure to physical stress is a composite value, defined by the magnitude, time, and direction or stress application.

I. Individual stresses combine in complex ways to contribute to the overall level of stress exposure. Tissues are affected by the history of recent stresses.

J. Excessive physical stress that causes injury can occur from 1 or more of the following 3 mechanisms: (1) a high-magnitude stress applied for a brief period, (2) a low-magnitude stress applied for a long duration, and (3) a moderate-magnitude stress applied to the tissue many times.

K. Inflammation occurs immediately following tissue injury and renders the injured tissue less tolerant of stress than it was prior to injury. Injured and inflamed tissues must be protected from subsequent excessive stress until acute inflammation subsides.

L. The stress thresholds required to achieve a given tissue response may vary among individuals depending on the presence or absence of several modulating variable (movement and alignment, extrinsic, behavioral, and physiological factors).

(Maluf & Mueller, 2002) The Physical Stress Theory (PST) presents an effective scheme in taking care of patients. It also addressed factors that can influence the level of physical stress and the response of tissues to stress application. This information can be used by clinicians in approaching these types of situation. Moreover, PST provides a concept for evaluating and treating people who are injured. Tissue adaptation and injury is described by the theory which can be utilized to form appropriate treatments. It guides physical therapy intervention even the pathology of a specific structure is not determined. The theory illustrated the promotion of healing and progressive strengthening of injured tissues. It sheds light on Kinesiology and introduces a framework for the formation of research hypotheses that are focused on treatment techniques by physical therapist. The PST does not define absolute threshold values for tissue adaptation and injury. It does not know if a tissue is about to be injured unless it shows signs of inflammation. It also doesn’t indicate how tissue change is related to functional limitations or disability, therefore, should be used with other theories. Moreover, in PST, issues of adaptation in the Central Nervous System is not addressed. It also doesn’t identify the specific psychosocial factors that influence tissue adaptation and injury the most.

(Maluf & Mueller, 2002).

RT Charles Sherrington 1. Movement is controlled by stimulus-response.

2. Reflexes are basis for movement – Reflexes are combined into actions that create behavior.

3. The basic structure of a reflex includes the receptor, conductor, and effector.

4. The Nervous System triggers, coordinates, and activates muscle.

(Physiopedia.com, n.d.) One of the strengths of Reflex Theory (RT) is that it introduces clinical strategies that helps therapists to predict function since these strategies are designed to test reflexes. It also gave the interpretation of patient’s movement behaviors in terms of the presence or absence of controlling reflexes.

Moreover, RT addressed the fact that refraining motor control for functional skills will center on the enhancement or reduction of the effects of reflexes during motor tasks. The RT failed to adequately explain fast movements, voluntary movements, and the fact that a single stimulus results in varying responses.

Moreover, as it emphasized on reflexes as the basis of movements, it disregarded the fact that a reflex cannot be considered as the basic unit if behavior especially if we take into consideration both spontaneous and voluntary movement (Nair, 2018).

ST Nikolai Aleksandrovich Bernstein 1. The whole body is a mechanical system, with mass and subject to both external forces such as gravity and internal forces including both inertial and movement-dependent forces.

2. Higher levels of the nervous system activate lower levels, while lower levels activate synergies or group of muscles that are constrained to act together as a unit.

3. A person has a goal-oriented behavior.

4. The body has many degrees of movement that needs to be controlled which can be made through synergies and hierarchical control.

(Ganvir, 2017) The Systems Theory (ST) addresses the fact that the body should be understood as a mechanical system. It gives deeper understanding that interventions to be made must not focus on the impairments within a single system but across multiple one since impairments contribute on several systems. The ST doesn’t focus heavily on the interaction of the organism with the environment.

DAT 1. Nikolai A. Bernstein

2. Michael T. Turvey

3. J. A. Scott Kelso

4. Betty Tuller

5. Esther Thelen

1. Self-organization is a fundamental dynamic systems principle.

2. A new movement emerges due to a critical change in in one of the systems called “controlled parameter”. This is a variable that causes change in behavior of the entire system.

3. When a system of individual parts come together, its elements behave collectively in an ordered way. There is no need for a higher center issuing commands in order to achieve coordinated action.

(Vikhe, 2018) The Dynamical Action Theory helps in the comprehension that we can make use of the physical and dynamic properties of the human body to help patients regain motor control. It also introduced that movement is an emergent property (came from the interaction of multiple elements). A limitation of the DAT is that it doesn’t emphasize fair importance of the Nervous System and that the presumption that the relationship between the physical system of the animal and the environment in which it operates primarily determines the animal’s behavior (Vikhe, 2018).

ET 1. Eleanor J. Gibson

2. James J. Gibson

3. Anne D. Pick 1. The person, the task, and the environment interact to influence motor behavior and learning. The interaction of the person with any given environment provides perceptual information used to control movement.

2. The motivation to solve problems to accomplish a desired movement task goal facilitates learning.

(Physiopedia.com, n.d.) A major strength of the Ecological Theory (ET) is that it described an individual as an active explorer of his/her environment. This theory introduced the fact that interventions should also focus on helping a patient achieve a functional task in various ways given that the have a set of limitations. Et gave less emphasis to the organization and function of the

Nervous System that has led to this interaction. It focused more on

Organism-environment interface.

(Nair, 2018).

Applications of movement theories in practice and everyday situations

1. Using the figure as guide, recall an event from your own experience that demonstrated the application of PST or depicted the effect of physical stress on tissue adaptation. It does not need to be focused on injury alone. Limit your answers to 300 words.

? During vacation, I gained a few pounds compared to my former body weight when I was in school for my last year in Senior High School. This happened because I lived a very inactive lifestyle. During these times, my day revolves on sleeping, watching movies, eating additional snacks, browsing the internet and my social media accounts, and sleeping again. So when I noticed the unwanted changes, I decided to have a two-hour jogging around our villa and dance to an hour of dance exercises everyday. This became my physical stress to the tissues of my body, especially the muscles tissues. During the first week of these activities, I noticed that my body becomes so tired even though I just jogged or danced for a few minutes. Moreover, most parts of my body aches after every activity. As I continued doing this for more than two weeks, I noticed that gradually, I became less and less tired after the first few minutes of my physical activities. As my muscle tissues adapted to my everyday activities, during the fourth week, my body has formed an increased tolerance to my everyday jogging session and dance exercise. This showed the effect of physical stress on tissue adaptation. As my body underwent a higher level of physical stress, its tissues eventually adapted to it. The aches and pain were lessened after I continued doing my physical activity to lose weight.

2. Recall an experience that challenged any of the levels/dimensions illustrated below, and explain how this affected your movement and function. Limit your answers to 300 words.

? An experience that challenged some of the levels in the Multidimensional movement continuum happened during my Grade 10 days. There is this competition in school where our class have to make our own Zumba routine and perform it in the said contest. I love dancing that’s why I joined the team. What challenged these levels is when a professional Zumba instructor actually taught us our dance routine. During those days, I had a habit of eating a little and infrequently drinking water. This rendered my body, including from its molecular parts up to the whole bodily systems, unprepared for the very vigorous dance practices that happened the following days. Because of my former habit that affected some levels of my movement continuum, my movements became lesser than how dynamic it should be since I have no enough energy to do so and during practices, I become tired so quickly, affecting my own function as dancer in the group.

3. Identify any physical activity you engaged in last week. Describe how your movement was influenced by the interaction of the task, individual and environment. You may use the figure as guide in illustrating your experience. Limit your explanation to 300 words.

? Last week was our second session for our Physical Education class. As I engaged in this activity, I can say that my movements was affected by the task, myself and the individuals around me, and the environment itself as I was playing various Philippine games The environment which is the Sports Sciences and Wellness Center is wide and open, that’s why during the games, I can freely do large and far movements such as running around the area. Also, the games given by our PE Professor together with the aim of winning them, became the task in this situation. Some games, required me to run and roam around the area whereas others made me stay in my position with little movements. My blockmates were the one who influenced my movement during our PE Class. I can see them playing the games energetically and enthusiastically so I know I need to catch up. Instead of just standing in the corner and watching them play, I joined and moved actively throughout the games so we can win them. In this setting, how I moved in the activity was affected by the three elements because they interacted with each other.

References:

Allen, D. D. (2007). Validity and Reliability of the Movement Ability Measure: A Self-Report Instrument Proposed for Assessing Movement Across Diagnoses and Ability Levels. Physical Therapy, 87(7), 899–916. doi: 10.2522/ptj.20060197

Ganvir, S. (2017, June 10). Theories of motor control. Retrieved from

Maluf, K. S., & Mueller, M. J. (2002, April 1). Tissue Adaptation to Physical Stress: A Proposed “Physical Stress Theory” to Guide Physical Therapist Practice, Education, and Research. Retrieved from

Motor Control and Learning. (n.d.). Retrieved from

Nair, N. (2018, January 15). Motor control. Retrieved from

Vikhe, V. (2018, April 11). Motor control. Retrieved from

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