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Phys ther 2007-cott-925-6

  1. 1. Invited Commentary on the Movement Continuum Special Series Cheryl A Cott and Elspeth Finch PHYS THER. 2007; 87:925-926. doi: 10.2522/ptj.2006.0182.0197.0198.ic1The online version of this article, along with updated information and services, can befound online at: This article, along with others on similar topics, appears in the following collection(s): Kinesiology/Biomechanics Motor Control and Motor Learning Tests and Measurementse-Letters To submit an e-Letter on this article, click here or click on "Submit a response" in the right-hand menu under "Responses" in the online version of this article.E-mail alerts Sign up here to receive free e-mail alerts Downloaded from by guest on April 14, 2012
  2. 2. Commentaries on the Movement Continuum Special Series Invited Commentary Cheryl A Cott, Elspeth FinchThe Movement Continuum Theory ories that are more concrete and ad- to capture the complexity and intri-(MCT), published in 1995,1 built dress specific problems and issues. cacies of, for example, the move-on Hislop’s notion of pathokinesiol- We originally intended to write a ment involved in working for aogy.2 Our intent was to stimulate dis- clinical version of the MCT, but— living.cussion and debate about theory in despite the best of intentions—thisphysical therapy. Although the MCT never transpired. We were very ex- The initial identification of the 6 di-has received international attention, cited, therefore, to see Allen’s pro- mensions does not appear to havemost notably as an influence on the posed dimensions that expand the included the client’s perspective.World Confederation for Physical construct of movement in the MCT The dimensions certainly resonateTherapy’s international definition and are consistent with grand the- with the physical therapy perspec-of physical therapy,3 there has not ory. Her Movement Ability Measure tive and as such are important con-been much academic response or (MAM) is an important step in mov- tributions to a grand theory of phys-further theoretical development in ing the theory to a more clinical, ical therapy. Allen, herself, statesthe physical therapy profession, un- applied level. that many respondents rate all di-like the occupational therapy4,5 and mensions similarly, and, for some,nursing6,7 professions, both of which Allen contends that the 6 proposed this may be because they are nothave given considerable attention to dimensions of movement (flexibility, described in terms that are meaning-theory over the years. A theoretical strength, speed, accuracy, adaptabil- ful to them. It would be very inter-framework is an important indicator ity, and endurance) can be applied esting to conduct qualitative workof an evolving clinical science,8 and beyond the levels of movement of with clients to explore how they un-the arguments we put forward in the body part or body to the person derstand movement and then to try1995 for the need for a theory of in his or her environment. Using a to reconcile their perspectives withphysical therapy remain relevant to- more familiar model, the Interna- the physical therapy view in order today. Allen’s work on further devel- tional Classification of Functioning, develop dimensions that incorporateoping the MCT is very welcome, and Disability and Health9 (ICF), these both perspectives. For example,hopefully her work and this special levels correspond to the levels of im- rather than strength and flexibility,series will encourage others to enter pairment and activity limitations. She clients might talk about ease ofand continue the debate. The follow- presents examples of sports and ac- movement, as they may not differen-ing comments are made in this spirit tivities and of pathologies that can be tiate among strength, weakness, stiff-of advancing debate on physical linked to 1 of the 6 specific dimen- ness, and lack of range of motion,therapy theory. sions (eg, gymnastics, ballet, and particularly if their impairments are flexibility). However, movement at moderate. In a similar vein, the cli-Perhaps one of the reasons that the the level of the person in his or her ents for the psychometric testing ofMCT has not inspired much empiri- environment, we believe, is too com- the MAM were sampled from a rela-cal research on movement is that the plex to be categorized as being rele- tively healthy population with fewMCT is not actually a theory of move- vant to only one of the movement movement impairments. It will bement; rather, it is a theory of how dimensions. One could just as easily important to validate the tool withphysical therapists conceptualize argue that accuracy, adaptability, clients with physical impairmentsmovement and approach problem and endurance are key to ballet and prior to its utilization in research andsolving and decision making with gymnastics. This does not diminish practice.their clients. We identify movement the value of the proposed dimen-as the central unifying concept of sions; rather, it suggests that the fur- These considerations reflect a no-physical therapist practice and at- ther one moves along the movement ticeable change in physical therapisttempt to distinguish what makes continuum, the more necessary it be- practice since the publication ofphysical therapy different from other comes to incorporate all 6 dimen- the MCT—the rise of a discoursemovement sciences. We put forward sions when analyzing movement. in rehabilitation about client-the MCT as a grand theory of physi- Certainly, at the level of the person centeredness.10 The MCT is consis-cal therapy, that is, a theory that pro- in society (or participation as tent with this discourse. For exam-vides broad conceptualizations and defined by the ICF9), the 6 proposed ple, when goal setting using theforms the basis for middle-range the- dimensions are probably inadequate MCT, the starting point is to identifyJuly 2007 Volume 87 Number 7 Physical Therapy f 925 Downloaded from by guest on April 14, 2012
  3. 3. Commentaries on the Movement Continuum Special Seriesthe client’s goals, specifically, the cli- measure has the potential to fill an Referencesent’s preferred movement capacity important measurement gap in phys- 1 Cott CA, Finch E, Gasner D, et al. The movement continuum theory of physical(PMC).11 Despite our reservations as ical therapist practice where the fo- therapy. Physiother Can. 1995;47:87– the extent to which the 6 pro- cus is often on the acquisition of 2 Hislop HJ. Tenth Mary McMillan lecture:posed dimensions represent the cli- motor skills to improve functional The not-so-impossible dream. Phys Ther. 1975;55:1069 –1080.ent’s or the therapist’s perspective, abilities, with little attention on en- 3 World Confederation for Physical Thera-the exciting thing about Allen’s work abling the client to regain former py. Declaration of Principle and Positionis that her measure captures informa- roles and meaningful activities.11,13 Statements. Available at: http://www.wcpt. org/common/docs/WCPTpolicies.pdf.tion about both the PMC and the For example, whereas clients follow- 4 Canadian Association of Occupationalcurrent movement capacity (CMC) ing stroke define recovery in terms Therapists. Enabling Occupation: An Oc-and, as such, may allow for the mea- of returning to the life they lived cupational Therapy Perspective. Ottawa, Ontario, Canada: CAOT Publications ACE;surement of the PMC/CMC differen- before their stroke14 and the activi- 1997.tial. Figures 2 through 7 in the first ties that give them identity and con- 5 Law M, Cooper B, Strong S, et al. Thearticle in the Movement Continuum trol,13 physical therapists tend to fo- Person-Environment-Occupation Model: a transactive approach to occupationalSpecial Series nicely illustrate the cus on improvements in physical performance. Can J Occup Ther. 1996;63:PMC/CMC differential in different function and the ability to perform 9 –23.clients and emphasize the im- basic care tasks.13,15 This disparity 6 Watson J. Nursing—Human Science and Human Care: A Theory of Nursing. Sud-portance of considering the client’s between what is important to clients bury, Mass: Jones and Barlett Publishers;perspective when goal setting. For and to physical therapists needs to 1999.example, on a purely objective basis, be addressed if we are to truly be a 7 Parse RR. Illuminations: The Human Be- coming Theory in Practice and Research.the 72-year-old man may have less client-centered profession. Sudbury, Mass: Jones and Barlett Publish-movement ability than the 25-year- ers; 1999.old athlete. However, in terms of In closing, we believe the MCT re- 8 Richards CL. Enid Graham Memorial Lec- ture: Physiotherapy and the rehabilitationexpectation of movement, the older mains relevant as a grand theory of sciences. Physiother Can. 2005;57:34 – appears quite satisfied with physical therapy. As such, it may 9 International Classification of Function-his movement in the 6 dimensions, not readily lead to the development ing, Disability and Health: ICF. Geneva, Switzerland: World Health Organization;whereas the young athlete identifies of specific hypotheses and proposi- 2001.a quite significant PMC/CMC differ- tions at the clinical level, but it 10 Cott CA. Client-centred rehabilitation: cli-ential. Unfortunately, Allen does not can be used to guide research and ent perceptions. Disabil Rehabil. 2004;26: 1411–1422.suggest how she proposes to use the education around physical therapist 11 Cott CA. Goal setting. In: Pickles B, Comp-PMC data or further develop the practice. We are excited about ton A, Cott CA, et al, eds. Physiotherapymeasurement of the PMC. A discus- the possibilities inherent in Allen’s With Older People. Philadelphia, Pa: WB Saunders Co; 1995:189 –196.sion of how the MAM might be used work, both in expanding our under- 12 Finch E, Brooks D, Stratford PW, Mayo measure the PMC/CMC differen- standing the construct of movement Physical Rehabilitation Outcome Mea-tial and of the further work needed within the MCT and in the develop- sures II. Toronto, Ontario, Canada: Cana- dian Physiotherapy Association; achieve this would be welcome. ment of a measure that has the po- 13 Tyson S, Turner G. Discharge and tential to explore the PMC and the follow-up for people with stroke: whatAnother major change in physical PMC/CMC differential. happens and why. Clin Rehabil. 2000;14: 381–392.therapist practice since the publica- 14 Doolittle ND. A clinical ethnography oftion of the MCT has been the rise of CA Cott, PT, PhD, is Associate Professor, De- stroke recovery. In: Benner P, ed. Inter-evidence-based practice and the use partment of Physical Therapy, Faculty of pretive Phenomenology: Embodiment, Caring and Ethics in Health And Illness.of outcome measures. Most of the Medicine, University of Toronto, 160-500 Thousand Oaks, Calif: Sage; 1994:outcome measures currently in use University Ave, Toronto, Ontario, Canada 211–229.focus on measuring the CMC or us- M5G 1V7. Address all correspondence to Dr 15 Ellis-Hill C, Payne S, Ward C. Self-body Cott at: split: issues of identify in physical recoverying normative data12 to help predict following a stroke. Disabil Rehabil. 2000;a client’s potential (eg, maximum E Finch, BScP&OT, MHSc, is Assistant Profes- 22:725–733.achievable movement potential). sor, School of Rehabilitation Science, Mc- Master University, Hamilton, Ontario,There are fewer available measures Canada.that capture the client’s perspectiveon achievement of outcomes. Allen’s DOI: 10.2522/ptj.2006.0182.0197.0198.ic1926 f Physical Therapy Volume 87 Number 7 July 2007 Downloaded from by guest on April 14, 2012
  4. 4. Invited Commentary on the Movement Continuum Special Series Cheryl A Cott and Elspeth Finch PHYS THER. 2007; 87:925-926. doi: 10.2522/ptj.2006.0182.0197.0198.ic1References This article cites 7 articles, 1 of which you can access for free at: and Reprints for Authors Downloaded from by guest on April 14, 2012