How do you know and use what you see? Visual analysis of movement as a fundamental skill in physical therapy.
Purpose
This session will serve two concurrent purposes to promote the physical therapist as the movement expert and the practitioner of choice for movement system dysfunction. First, participants will utilize a structured visual analysis of movement (VAM) approach applied across three cases. Discussion of each case will allow for application of a systematic identification of movement dysfunction and utilization of available evidence to enhance clinical reasoning for examination and intervention. Secondly, participants will integrate this explicit approach and knowledge into the classroom, the residency experience, and the clinic thus guiding the skill development for the novice to expert.
Methods and/or Description of Project
“Although no single generally accepted model of medical decision making exists, there is general agreement that the process begins with observation” (Shapiro, Rucker, Beck; 2006) and proficiency in observation is indelibly linked with diagnostic skill. (Garino, 2008) Visual analysis is a perceptive and cognitive process which links what a therapist observes to what impairments are examined and what intervention is utilized to address the identified movement dysfunction. It is an essential skill that must be explicitly taught (Braverman, 2011) to elucidate to all stakeholders what physical therapists “do” and “should do” during visual analysis of movement (VAM) and how it impacts the clinical decision process. As the profession moves towards documenting “competencies” (Tschoepe and Davis, 2015); arguably VAM may be one of the most important skills to establish competency in our profession as experts in the human movement system.
A structured approach to VAM based on current evidence and theory (Fisher and Yakura, 1993; Hedman, 1996; Gentile,2000; Schenkmann 2006) will be introduced that is universally applicable across activities, populations and settings. At the core of the method is the establishment of a directed search strategy using the known temporal sequence of the observed movement. Applied to the observation of the temporal sequence is the identification of critical features (phase, range of motion, etc.) of key functional activities (evidence informed and presented as available) culminating in the formation of a movement analysis statement linking the biomechanical critical features with the qualitative components of the patient’s movements and documented impairments.
The systematic model will be explained here in three parts: 1) a directed search strategy, 2) precise knowledge of the movement or activity and 3) ability to extract useful information. Participants will identify faults and strengths within a movement performance by comparing them to optimal movement using the VAM method. They will discuss a variety of evidence-based approaches consistent with current motor control and learning principles for resolution of the movement dysfunction and client centered goals within three different case presentations from a curriculum, residency, and clinical perspective. Individual perspectives by each presenter within the case will actualize how the structured VAM influenced treatment choices. International Classification of Functioning, Disability and Health (ICF) terminology will be emphasized to highlight the importance of precision and commonality of language to skill development and both written and verbal communication. This presentation utilizes foundational concepts for successful teaching and learning to advocate for use of the skill of VAM facilitating excellence in physical therapist education and physical therapists as movement experts.
Results/Outcomes
Through participation in this presentation, participants will achieve course objectives. Specifically, they will be able to:
Advocate that the skill of visual analysis of movement (VAM) is a foundational and recognizable skill set of the physical therapist
Utilize VAM in written and verbal communication of clinical reasoning for the human movement system in physical therapy education and practice for fundamental daily movements
Integrate a universally applicable, structured VAM approach into classroom, residency and clinical experiences to optimize outcomes and promote the profession of physical therapy as movement experts
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
This presentation highlights the importance of being explicit in teaching and learning methods to develop clinical reasoning from novice to expert across the continuum of patient care. It emphasizes visual analysis of movement as a fundamental skill, that in combination with current evidence, drives examination and intervention decisions. It must be taught and assessed for competency for PTs to be recognized as practitioners of choice for movement system dysfunction. This focus on movement, role identification, and competency appear inline with the Education Leadership Conference 2015 innovation forum discussions on the current and future directions of excellence in physical therapist education and practice. This important conversation must continue.
References
Blonna, D., Zarkadas, P., Fitzsimmons, J., & O'Driscoll, S. (2012). Accuracy and inter-observer reliability of visual estimation compared to clinical goniometry of the elbow. Knee Surg Sports Traumatol Arthrosc, 20(7):1378-1385.
Braverman, I. (2011, 05//). To see or not to see: How visual training can improve observational skills, Editorial. Clinics in Dermatology, pp. 343-346. Retrieved from http://ezp.slu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a2h&AN=60042339&site=eds-live
Calvo-Merino, B., Ehrenberg, S., Leung, D., & Haggard, P. (2010). Experts see it all: configural effects in action observation. Psychol Res, 74(4):400-406.
Fisher, B., & Yakura, J. (1993). Movement Analysis: a different perspective. Orthopaedic Physical Therapy Clinics of North America, 2(1), 1-14.
Garino, A. (2008). Improving observation skill in physician assistant students. J Physician Assist Educ, 19(1), 47-52.
Gentile, A. M. (2000). Skill acquisition: Action, movement, and neuromotor processes. In J. H. Carr, & R. D. Shepherd (Eds.), Movement science: Foundations for physical therapy (2nd ed., pp. 111-187). Rockville, MD: Aspen.
Hayes, S., Timmis, M.,, & Bennett, S. (2009). Eye movements are not a prerequisite for learning movement sequence timing through observation. Acta Psychol (Amst), 131(3):202-208.
Hedman, L., Rogers, M., & Hanke, T.. (1996). Neurologic Professional Education: Linking the Foundation Science of Motor Control With Physical Therapy Interventions for Movement Dysfunction. JNPT, 20(1), 9-13.
Klima, D.,, Anderson, C., Samrah, D., Patel, D., Chui, K., & Newton, R. (2015). Standing from the floor in community-dwelling older adults. J Aging Phys Act, doi: 10.1123/japa.2015-0081
Knudson, D. (2007). Qualitative biomechanical principles for application in coaching. Sports Biomech, 6(1), 109-118.
Moreno, F., Saaverdra, J., Sabido, R., Luis, V., & Reina, R. (2006). Visual search strategies of experienced and nonexperienced swimming coaches. Percept Mot Skills,103(3):861-872.
Moseley, A., Descatoire, .A, Adams, R. (2008). Observation of high and low passive ankle flexibility in stair descent. Percept Mot Skills, 106(1):328-340.
Ness, B., Taylor, A., Haberl, M., et al. (2015) Clinical observation and analysis of movement quality during performance on the star excursion balance test, Int J Sports Phys Ther, Apr 10(2):168-77.
Shapiro, J., Rucker, L., & Beck, J. (2006). Training the clinical eye and mind: using the arts to develop medical students' observational and pattern recognition skills. Med Educ, 40(3), 263-268. doi:MED2389 [pii] 10.1111/j.1365-2929.2006.02389.x
Schwickert, L., Oberle, C., Becker, C., Lindemann, U., Klenk, J., Schwenk, M., . . . Zijlstra, W. (2015). Model development to study strategies of younger and older adults getting up from the floor. Aging Clin Exp Res. doi: 10.1007/s40520-015-0397-1
Schenkman, M., Deutsch, J., & Gill-Body, K. (2006). An integrated framework for decision making in neurologic physical therapist practice. Phys Ther, 86(12), 1681-1702. doi:86/12/1681 [pii] 10.2522/ptj.20050260
Takeuchi, T., & Inomata, K. (2009). Visual search strategies and decision making in baseball batting. Percept Mot Skills, 108(3):971-980.
Tschoepe, B., & Davis, C. (2015) ACAPT First Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum: Doctor of Physical Therapy (DPT): So What? Now What? Educating DPTs as Leaders to Meet Future Societal Needs, JOPTE, 29(2):84-87.
Course Objectives
At the end of this educational session, the participant will be able to:
Advocate that the skill of visual analysis of movement (VAM) is a foundational and recognizable skill set of the physical therapist
Utilize VAM in written and verbal communication of clinical reasoning for the human movement system in physical therapy education and practice for fundamental daily movements
Integrate a universally applicable, structured VAM approach into classroom, residency and clinical experiences to optimize outcomes and promote the profession of physical therapy as movement experts
Instructional Methods
Audience polling with multiple choice questions & answers
Small group discussion: Pair/share
Practical application through assessment of self kinematics and visual analysis of movement with real patient video case examples
Utilization of apps and current technology for video case examples
Tentative Outline/Schedule
Evidence, theory and call to action for the skill of visual analysis of movement to optimize and promote the profession of physical therapy as movement experts (10 min)
Presentation of the structured visual analysis of movement approach and teaching methods (20min)
A directed search strategy
Precise knowledge of the movement or activity
Ability to extract useful information.
Application with case examples:
Classroom - Sit to Stand case (15 min)
Residency - Overhead reach case (15 min)
Clinic - Floor to stand case (20 min)
Summary & Questions (10 min)