The American Physical Therapy Association’s Vision Statement of 2013 asserts that physical therapists optimize movement in order to improve the human experience. In accordance with this vision, physical therapists strive to be recognized as experts in movement analysis. However, there continues to be no accepted method to conduct movement analysis, nor an agreement of key terminology to describe movement observations. As a result, the Academy of Neurologic Physical Therapy organized a Task Force that was charged with advancing the state of practice with respect to these issues, including the development of a proposed method for movement analysis of tasks. This paper presents the work of the Task Force, which includes: 1) development of a method for conducting movement analysis within the context of the movement continuum during 6 core tasks (sitting, sit to stand, standing, walking, step up/down, and reach/grasp/manipulate); 2) glossary of movement constructs that can provide a common language for movement analysis across a range of tasks: symmetry, speed, amplitude, alignment, verticality, stability, smoothness, sequencing, timing, accuracy and symptom provocation; and 3) recommendations for task and environmental variations that can be systematically applied. The expectation is that this systematic framework and accompanying terminology will be easily adapted to additional patient or client-specific tasks, contribute to development of movement system diagnostic labels, and ultimately improve consistency across patient/client examination, evaluation, and intervention for the physical therapy profession. Next steps should include validation of this framework across patient/client groups and settings.
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The Task Force proposes that diagnostic classifications of movement system problems need to be developed, tested, and validated with the long-range goal to reach consensus on and adoption of a movement system diagnostic framework for clients with neurologic injury or disease states.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A198).
The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by American Physical Therapy Association in 2013. Attaining success with the profession’s vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction. Over the past two years, a Balance Diagnosis Task Force, a subgroup of the Movement System Task Force of the Academy of Neurologic Physical Therapy (ANPT), focused on developing diagnostic labels (or diagnoses) for individuals with balance problems. This paper presents the work of the Task Force that followed a systematic process to review available diagnostic frameworks related to balance, identify ten distinct movement system diagnoses that reflect balance dysfunction, and develop complete descriptions of examination findings associated with each balance diagnosis. A standardized approach to movement analysis of core tasks, the Framework for Movement Analysis developed by the ANPT Movement Analysis Task Force, was integrated into the examination and diagnostic processes. The aims of this perspective paper are to 1) summarize the process followed by the Balance Diagnosis Task Force to develop an initial set of movement system (balance) diagnoses, 2) report the recommended diagnostic labels and associated descriptions, 3) demonstrate the clinical decision-making process used to determine a balance diagnosis and develop a plan of care, and 4) identify next steps to validate and implement the diagnoses into physical therapist practice, education, and research. Impact The development and use of diagnostic labels to classify distinct movement system problems is needed in physical therapy. The ten balance diagnosis proposed can aid in clinical decision making regarding intervention.
Approximately 20% of the general population is affected by a vestibular disorder. Vestibular dysfunction is recognized as an important intrinsic factor leading to falls.Despite research on balance strategies with platform perturbations, limited information exists on neuromuscular performance of the knee with perturbations during functional tasks. Improved understanding of the effects of BVL on neuromuscular control of the knee will aid researchers and clinicians in developing rehabilitation programs that address the adaptations and balance deficits that occur with vestibular loss. Hence, the main purpose was to examine accuracy of performance, knee muscle activation patterns and long latency responses in response to unexpected perturbations during a controlled single leg squat in healthy individuals and those with bilateral vestibular loss (BVL).The first study provided information about the ability to improve performance accuracy with perturbations based on the feedback available. It also showed concomitant changes in the LLR of quadriceps muscles with learning. In the second study, it was found that competent subjects with BVL show similar performance accuracy as healthy individuals during the SLS, with the exception of endpoint error. Muscle strategies are slightly different and vary on firm and foam surfaces. A significant finding was that the LLR is reduced in this group in response to unexpected perturbations, especially when visual feedback is absent. Rehabilitation and/or time living with bilateral vestibular deficiency can lead to a reorganization of the central nervous system, which may partly explain the alterations in neuromuscular control. More research is needed to determine the relationship between the long latency response and fall risk and if different training dosages with perturbations affect these in both healthy and vestibular-deficient populations. Abstract Approved: _________________________________________ Thesis Supervisor _________________________________________ ___________________________________ Deema Fattal For every fact there is an infinity of hypotheses. Robert M. Pirsig ii ACKNOWLEDGMENTSThe completion of this work was certainly not a simple endeavor and it is my pleasure to thank and recognize the many people that supported me during this process.The inspiration for my research came from previous work performed in this lab. I owe sincere thankfulness to Bryon Ballantyne and Sangeetha Madhaven for their work and guidance. In particular, special thanks to Bryon for his immense support throughout this research experience. Sincere thanks also to the individuals who rendered their valuable time and effort to participate in my study. Without their generosity, this project would never have been completed.
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