Normann B1
1University of Tromsø The Arctic University of Norway, Tromsø, Norway
Background: Hands-on therapeutic interactions are essential to neurological physiotherapy. Facilitation of movement is a particular aspect of such interactions that potentiates self-initiation of movement. This process involves interactions between the physiotherapist and the patient through three integrated phases: 1) 'make movement possible', 2) 'make movement necessary', and 3) 'let movement happen', in which non-verbal communicative aspects are important. Facilitation of movement is under-theorized in literature, particularly regarding the communicative aspects.
Purpose: The purpose was to explore the theoretical foundation for facilitation of movement, including the communicative and sense-making aspects, targeting to anchor this skill and thereby guide clinical practice, teaching and provide a model for analysis in qualitative research.
Methods: An integrated theoretical framework, consisting of dynamic systems theory, neurosciences, phenomenology and enactive theory, is utilized for comprehensive analyses of the physiotherapist's actions and interactions with the patient during the three phases of facilitation of movement.
Results: Dynamic systems theory explains the physiotherapist's specific handling as adjusted manipulations of the patient's constraints for movement, complemented by tailoring of the specific attributes of the task and the environment. The phase “making movement possible” involves the physiotherapist's manipulations of the musculoskeletal system to optimize alignment to allow for adequate input through the somatosensory system to update body schemas. Handling targeting to “make movement necessary” and “let movement happen” involves constriction of some degrees of freedom for movement and initiation of adequate muscular recruitment that aim to optimise the self-regulating system of movement control. Dynamic systems theory, however, provides inadequate anchoring of the involved interactional aspects.
Phenomenology, which perceives the body as the center of experience and expression, offers a path to understanding hands-on interactions as communication. Optimizing the individual's subsystems involve strengthening the patient's feeling that it is my body that is moving and I am (to some extent) initiating and controlling the movements. As body schemas, perceptions of ownership and agency comprise pre-reflective aspects of the self, the physiotherapist's adjusted physical interaction with patient involves communication between two embodied subjects. Awareness of bodily changes and active movement allow for perceiving new possibilities and thus contributes to the patient's reflective aspects of the self.
Enactive theory clarifies the physiotherapist's adjustments as a professional orientation towards the patient aiming to achieve coordination with each other, as happens when the physical interactions is successful and the patient moves actively together with the physiotherapist or independently. End result of successful loops of professional physical interactions, complemented by gaze and verbal cues, are co-construction of meaning for both the physiotherapist and the patient that is inaccessible in other ways.
Conclusion(s): This model provides a theoretical anchoring of facilitation of movement that addresses new and unique developments in theory. The model allows for framing the essential dynamic, communicative and sense-making aspects involved while integrating neuro- and movement sciences, which is an important issue in neurological physiotherapy.
Implications: This comprehensive theoretical model may be implemented in postgraduate training to anchor physiotherapists' conception of the body and professional hands-on interactions, serve as an analytic tool in qualitative research, and thus indirectly guide clinical practice.
Keywords: Facilitation of movement, embodied interactions, co-construction of meaning
Funding acknowledgements: This work was conducted as a part of my job as Associate Professor at UiT The Arctic University of Norway.
Purpose: The purpose was to explore the theoretical foundation for facilitation of movement, including the communicative and sense-making aspects, targeting to anchor this skill and thereby guide clinical practice, teaching and provide a model for analysis in qualitative research.
Methods: An integrated theoretical framework, consisting of dynamic systems theory, neurosciences, phenomenology and enactive theory, is utilized for comprehensive analyses of the physiotherapist's actions and interactions with the patient during the three phases of facilitation of movement.
Results: Dynamic systems theory explains the physiotherapist's specific handling as adjusted manipulations of the patient's constraints for movement, complemented by tailoring of the specific attributes of the task and the environment. The phase “making movement possible” involves the physiotherapist's manipulations of the musculoskeletal system to optimize alignment to allow for adequate input through the somatosensory system to update body schemas. Handling targeting to “make movement necessary” and “let movement happen” involves constriction of some degrees of freedom for movement and initiation of adequate muscular recruitment that aim to optimise the self-regulating system of movement control. Dynamic systems theory, however, provides inadequate anchoring of the involved interactional aspects.
Phenomenology, which perceives the body as the center of experience and expression, offers a path to understanding hands-on interactions as communication. Optimizing the individual's subsystems involve strengthening the patient's feeling that it is my body that is moving and I am (to some extent) initiating and controlling the movements. As body schemas, perceptions of ownership and agency comprise pre-reflective aspects of the self, the physiotherapist's adjusted physical interaction with patient involves communication between two embodied subjects. Awareness of bodily changes and active movement allow for perceiving new possibilities and thus contributes to the patient's reflective aspects of the self.
Enactive theory clarifies the physiotherapist's adjustments as a professional orientation towards the patient aiming to achieve coordination with each other, as happens when the physical interactions is successful and the patient moves actively together with the physiotherapist or independently. End result of successful loops of professional physical interactions, complemented by gaze and verbal cues, are co-construction of meaning for both the physiotherapist and the patient that is inaccessible in other ways.
Conclusion(s): This model provides a theoretical anchoring of facilitation of movement that addresses new and unique developments in theory. The model allows for framing the essential dynamic, communicative and sense-making aspects involved while integrating neuro- and movement sciences, which is an important issue in neurological physiotherapy.
Implications: This comprehensive theoretical model may be implemented in postgraduate training to anchor physiotherapists' conception of the body and professional hands-on interactions, serve as an analytic tool in qualitative research, and thus indirectly guide clinical practice.
Keywords: Facilitation of movement, embodied interactions, co-construction of meaning
Funding acknowledgements: This work was conducted as a part of my job as Associate Professor at UiT The Arctic University of Norway.
Topic: Neurology; Professional issues; Education
Ethics approval required: No
Institution: University of Tromsø the Arctic University of Norway
Ethics committee: Regional Committee North for Medical and Health Research Ethics
Reason not required: Development of theory within a profession is considered not to require approval from the Regional Committee for Medical and Health Research Ethics
All authors, affiliations and abstracts have been published as submitted.
