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INTRODUCTION

OBJECTIVES

After completion of this chapter, the physical therapist should be able to do the following:

  • Define the movement system and relate to the trajectory of physical therapist practice in the United States.

  • Relate The Guide to Physical Therapist Practice and the four elements of the disablement model as described by Saad Nagi to emerging movement system thinking.

  • Describe the ICF model and relate to the movement system.

  • Compare and contrast pathoanatomic and pathokinesiologic models of diagnosis.

  • Describe the importance of clinical reasoning as related to decision making regarding evaluation, diagnosis, prognosis, and intervention.

  • Contrast novice and expert decision making and clinical reasoning in physical therapist practice.

  • Apply clinical reasoning to relating movement system diagnoses and intervention selections in order to provide high-quality physical therapy services.

  • Relate evidence-based practice to clinical reasoning.

  • Articulate a functional movement system philosophy upon which to construct plans for intervention in physical therapy practice.

Physical therapists play an exciting and vital role in the provision of health care. As a profession, physical therapists contribute in a variety of ways to the health care system, and are guided in the United States by the American Physical Therapy Association (APTA) Vision Statement: “transforming society by optimizing movement to improve the human experience.”1 No longer are physical therapists seen only as providers of rehabilitation, but also as vital participants in patient and client screening and education, movement optimization across the lifespan, disease prevention, and promotion of health and wellness. Physical therapists of the 21st century and beyond must promote with a united voice our scope of practice, our models of health care delivery, and the types of patients and clients we serve, as well as the types of examination measures and interventions we use to remedy or prevent impairments, functional limitations, and disabilities in our patients and clients. We must be active, knowledgeable educators of the public, other health care providers, third-party payers, and health policy makers as we promote the profession of physical therapy. We must be active advocates for the profession of physical therapy, as the profession promotes health, wellness, and optimal function of the human movement system.

THE HUMAN MOVEMENT SYSTEM

The physical therapy profession has been and often continues to be characterized or defined by the treatments that are performed (“what we do”) rather than by our distinct body of knowledge (“what we know”).2,3 The problem with this characterization is that it relegates physical therapists (PTs) to a technician role (what we do) and ignores the highly refined skills of assessment and clinical reasoning (what we know) used by PTs in order to accurately diagnose, prognosticate, and manage many types of dysfunction that are present in our patients and clients. Furthermore, characterizations such as this have the potential to mislead the public and other health professionals to underestimate our education/training, knowledge, and capabilities as primary care health providers. ...

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