Chapter 6: Movement Dysfunction

CHAPTER OBJECTIVES

OVERVIEW

The content of this chapter will likely seem overwhelming, but its intent is to demonstrate how comprehensive the knowledge base needs to be for a practicing clinician. A qualified physical therapist is an expert in recognizing movement dysfunction, which makes an introduction to the causes of movement dysfunction essential even at such an early level of understanding.

Over the past hundred years, various causes of movement dysfunction have been considered¹:

• Peripheral neuromuscular dysfunction. This early approach resulted from findings following war injuries and poliomyelitis (see Chapter 1). The physical therapy diagnosis was based on the results from manual muscle testing (MMT), and the focus of the treatment was to maintain range of motion (ROM) through the use of stretching exercises and braces followed by exercises based on the results from the MMT, designed to strengthen the recovering and uninvolved muscles.

• Central nervous system (CNS) dysfunction. This approach was based on patients with stroke, brain or spinal cord injury, and cerebral palsy. As the previous focus on using MMT to determine the diagnosis was no longer effective, a number of new theories evolved to address the diagnosis and management of the patient with CNS dysfunction.

• Joint dysfunction. This approach incorporated the testing of accessory joint motions based on the belief that soft tissue or joint restrictions were the cause of dysfunction.

However, as outlined in Chapter 4, purposeful and skilled movement is a factor of the integration of many systems, many of which are vulnerable to compromise. Of particular importance are the musculoskeletal, neurologic, cardiovascular, respiratory, integumentary, and metabolic systems. Compromise to any one of these systems can result in movement dysfunction, either directly or indirectly. Thus, an approach that examines and treats each of these systems in isolation is clearly inadequate. Instead, the examination and treatment must incorporate all of these systems as appropriate, how they relate to one another, and how the clinical findings relate to the subjective complaints and any alteration in function.

Much of the detail provided in this chapter will be covered in depth layer in the student’s curriculum, so this chapter can be revisited as each of these specialties are introduced. It is important that the reader becomes aware that the vast majority of conditions seen by physical therapists do not occur in isolation and that ...