Structured Motion Approach – 2. Current Practice Patterns

Submitted by: Jeremy Nelson PT

In the previous installment, Structured Motion as an approach to restoring function and improving sports performance was introduced. As an investigation and application of clinical decision making strategy and the relationships of component parts of the decision it includes contributions from many seemingly unrelated fields. The arts, business, and other fields of making provide the investigation of the underlying structure of the plan of care itself. With a change of underlying structure, the impact on the outcomes were examined. In particular the capacity to change perspective in supporting the clinician to step in for a close up of the specific motions required for a joint to perform as well as gain perspective by stepping 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. The role of decision making and the different ways the mind reacts to states of unknown.

Too often, as a result of the underlying structure of the plans of care developed, perspective and context is lost as the breadth and depth of the plan of care is inadequate to support the clinical decision making process. Within a standard problem solving model, the outcome is unattainable as the change effort leads to loss of momentum and a return to level of function that promotes recidivism. Using a problems solving structure, the relationship between the numerous data points required to produce a successful change effort are unrecognized and as a result the clinical decision making becomes formulaic and process driven. One process leads to the next until all processes are completed, regardless of the status change of the client in relation to the desired outcome. Short term goals are unrelated to outcomes and are poorly defined, in such that clinical observations of the state of the patient in relation to the goals are difficult to establish.

Why does this happen? When considering the numerous data points and relationships that are required to observe and understand when working with human motion, it is easy to see how the clinician could become overwhelmed by information. In light of not knowing, the mind will do a very natural thing and fill in the gap with previous conclusions and assumptions. The question “Am I seeing what is happening in front of me accurately?” is not asked. The motivation for such a clarification question is absent as the mind assumes that what was true in the past is the reality of what is being observed. On occasion this may be true, however given the wide ranges of human motions and neuromuscular status the past is unlikely to be in the present. The rehab professional comes by this approach honestly as the training received is in improving categorization and not necessarily thinking.

The relationships in the goals are key, however it is the support of the ongoing clinical observations that is engine for the development of a successful change effort. Through an on-going assessment of the state of function and supporting components a clear understanding of the cause and effect relationships is established to support more efficient decision making towards the unique specific outcomes desired by the client or patient. With this relationship of the desired outcome and a clear assessment of the current reality of the patients function in relation to the goal, a new structure is in play that will provide the momentum to complete a change effort over time on behalf of the patients or clients desired level of involvement in their life.