CHAPTER 7: Correcting Movement Dysfunction

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

1. List the factors that, when dysfunctional, can have a negative impact on movement

2. Describe the various methods by which physical therapy can have a positive impact on movement dysfunction

3. List three stages of learning according to Fitts and Posner

4. Describe the differences between an open skill and a closed skill

5. Describe the differences among the various types of practices

6. Describe the types of feedback that can be provided by a patient and the advantages and disadvantages of each

7. Discuss the importance of measuring functional outcomes

8. Apply the various principles behind the provided patient example in a variety of situations

OVERVIEW

The correction of movement dysfunction requires a detailed analysis of the various components of movement. As described in Chapter 4, the production of movement is a complex process involving a number of interrelated systems and normal development of those systems. Each of these systems controls a number of critical components that work together to allow normal movement to occur. As described in Chapter 6, these critical components are subject to breakdown, resulting in movement dysfunction. These components include, but are not limited to:

• Strength

• Range of motion

• Flexibility

• Coordination

• Proprioception

• Pain

• Balance

• Cardiovascular endurance

All of the listed components can be viewed as separate entities, with each having the potential to have a negative impact on movement if dysfunctional. The focus of physical therapy is to view the body as a whole and to determine the sum effect of each component breakdown on an individual's function. Movement without purpose and control is both inefficient and ineffective. Skilled performance requires cooperation among strength, endurance, speed, and accuracy. In addition, skilled performance is dependent on practice or experience.

A trained physical therapist can observe a patient and determine a working hypothesis for the reason behind every abnormal movement observed. Once the diagnosis is correct, the intervention consists of methods to rehabilitate and retrain the dysfunctional structures.

As the physical therapy student progresses through his or her studies, a wide array of tools and techniques will be learned that will enable the student to correctly diagnose a condition and then design an appropriate treatment plan. The goal of a therapeutic intervention is to maximize function and thereby minimize disability; however, accomplishing this goal requires an understanding of the path from disease to disability.¹ Planning for the intervention begins with role performance, considering the best combination of remediation, adaptation, and compensation in order to promote the patient/client-identified level of functioning to fulfill desired roles. Recovery of the patient/client can occur:

• Spontaneously, without the benefit of any intervention

• By force, where ...