In the previous installments, a number of introductory components of the Structured Motion approach have been described. Starting with a focus on making specific results, the client or patient is then engaged to ensure that the result being made is really what is wanted by the patient or client. As part of being an expert in the field, it is easy to decide for the patient or client what they should want. It is also important, given that these processes and actions are expressions of the value of freedom, that the patient be a collaborator in the outcome. This is an active process of collaboration in which the client or patient identifies what they want and the professional organizes around that outcome. Included in this is the freedom of the patient to not accept the intervention by the rehab professional. It is essential that the client or patient is choosing to be involved, and choosing to act on behalf of their involvement in life. If the client or patient refuses service, then further referrals to the appropriate professional can be made. It has been our experience that there are different levels of desired involvement in life. This is different than depression or a withdrawing which again would require a referral to the appropriate provider. It is this initial process of organization by the professional that will be introduced in this article.
At this point a report that presents the comparison of the desired level of function as identified by the client and the current levels of ability is generated to assist in the assessment process. Each specific activity identified will have one or more performance skills category which includes those movements that observable. These are typically what is referred as functional movements. These movements are often tested using standardized testing such as the berg test. Examples include: sitting and standing, turning in a circle, reaching for something on the floor and a host of many more functional activities. These movements become the entry point into the assessment of the person’s ability to perform the desired specific activities identified earlier. These performance skills are more than just movements on a macro scale, but are really movement strategies of the brain in orchestrating the body to manipulate the COG BOS relationship. All motion includes the controlling of the COG either statically or dynamically in an ever changing BOS.
The movement skills are further defined in terms of the COG and BOS relationship within the observable Performance skill category. For example within the category of bridging, the COG will start out in the BOS which is the length of the body as the person is resting in supine. The BOS will then change to a 3 point of both feet on the ground and the trunk as the person attains hook lying position. The COG then is dynamic as the body raises the COG above the 3 point BOS and the BOS further changes from the trunk to only the upper spine, scapulae, neck and head in contact. After attaining maximal rise, the lowering begins, requiring a different muscle contraction and level of control, until the beginning level is returned to.
This clarification of the functional movement as it relates to the desired specific activity and its related definition of COG and BOS relationship provides a framework in which the COG and BOS relationship will be present throughout the assessment, evaluation, and change effort. In this way questions regarding the impact of an intervention on body movement or posture can be compared with its result on the COG BOS relationship as it will determine the functional involvement in the desired activity.