Submitted by: Jeremy Nelson MPT
About 8 years ago, my colleagues and I at Freedom In Motion began an investigation of the fundamental structure of rehabilitation and sports performance and how the application of different strategic planning approaches would enhance our practice. Motivated by a desire for our patients to have greater involvement in their life, we began to question the underlying assumptions found in treatment planning and treatment progressing. In particular I was interested to see if a change in underlying structure of a plan of care would change the outcomes. Along the way we invented new approaches to assessing movement and over the years a full curriculum of movement lessons to promote improvement in specific functional tasks and movements that we named Structured Motion.
Through this investigation we began to systematize the information we were learning into a series of tools to support the movement curriculum. Along the way we have taken an approach to making, where the value of craftsmanship is present in making specific outcomes for our clients and patients. It is our aspiration that the student will develop and contribute to the work already done and use the tools and systems on behalf of their patients and clients goals in a collaborative manner that involves both more deeply in the practice of improving function and specific activities of life.
The difference between the Structured Motion approach and other approaches is the questions that it starts with. These questions guide the development, implementation, progression, regression, and conclusion of the change effort.
The first question we start with is “What does the client/patient want in terms of an outcome?” This question comes from the value of making things. When working in the medical model, it is common to first start with the question “what is wrong that is causing the symptoms and signs?” This comes from the value of wanting to get rid of something, namely the cause of the problem. From these two very different starting points the end results will be very different.
This is why I have always appreciated the collaborative work with my medical colleagues. Much of the problem solving and elimination of disease or management of disease is in support of the work that we do, namely developing physical capacity in support of life activities that are meaningful to the patient or client. It’s worth clarifying again, the medical model is not functional restoration and the work that rehab professionals perform are not curative of disease. Its worth making the obvious explicit here, because the two have very different value structures and as a result will require different underlying structures to promote the outcomes desired. With this clarified perspective we can be to investigate the work of improving function and the involvement in life that are patients and clients desire.
Some of the ideas here are not new, for human motion has been studied and a variety of disciplines have investigated the inherent relationships in the body that produce function. However what is unique is that the approach presented to improve or restore function is not dependent upon a specific intervention technique or philosophical approach. Furthermore as the organizing principle is the desired level of function, it is not impairment centric. This is a striking difference from approaches that are prescriptive to eliminating an unwanted impairment. Have this problem, apply this technical procedure. The goal of the change efforts developed with a Structured Motion approach is not simply the elimination of loss of ROM or the return of specific muscle strength. You can get rid of all of the impairments in the human body and still not have the function that is desired. It’s worth repeating, you can correct all the problems and impairments and still not have a body with the capacity to be involved in life at a household, community, recreational or professional level.
The reason that the above is true is that human function is not a product of a lack of neuromuscular restrictions, but instead is derived from the coordination of the human form by the nervous system to produce an orchestrated support of the COG BOS relationship. How movement professionals, whether they be rehabilitation and/or performance experts organize the observations, data, conclusions, decisions and actions towards an end result is the subject matter of Structured Motion. What maybe adequate at one level of function may not be successful in supporting a higher level of complexity of movement. In this way, human function becomes a continuum with human form providing the support to orchestrating the progression and regression of the COG BOS relationship notable in functional activity.
Structure Motion is an investigation and application of clinical decision making strategy and the relationships of component parts of the decision. The investigation has been about the underlying structure of the plan of care itself, and the impact that the structures that professionals work in impact the outcomes. This approach supports the clinician to step into the plan of care for a close up of the specific motions required for a joint to perform as well as step back to see how that motion is impacting the overall function. This is supported not only by a knowledge base of human anatomy and kinesiology.
It also includes an understanding of strategic thinking and planning as used by professional artists, business, and other makers of goods and services. The role of decision making and the different ways the mind reacts to states of unknown. And an investigation of the role that the arrangement of relationships between component parts into structures produces tendency to behavior. Form and function is found in the human body and its functional product as well as the form of the plan of care and the decision making it produces.
In the upcoming installments we will examine the role that structure plays in restoring function and the component parts of the Structured Motion approach.