• A video taken in a physical therapy clinic shows an athlete with a recent ACL reconstruction taking a running jump and landing—poorly. There's a collective groan in the audience. How do they all know that this athlete is not ready to return to play? Chris Powers, PT, PhD, FACSM, FAPTA, can tell them: "We're the experts in movement."

    Powers and colleagues presented "The Human Movement System: Physical Therapist Practice" on Saturday to a capacity crowd. The 2-part session followed the conference's annual Rothstein Roundtable, which also addressed the movement system and included many of the same panelists.

    The human movement system is our professional identity, Lisa Saladin, PT, PhD, FAPTA, said, as described in the guiding principle "identity" of APTA's vision for the profession. That principle calls the movement system "the core of physical therapist practice, education, and research." And developing this identity is needed, she indicated, because despite inroads in making other providers and the public aware of physical therapy's unique role in health care, the profession still is too often mischaracterized.

    Physical therapists need to be defined not by the techniques they use but by their body of knowledge and skills, Saladin said. "We have to be done talking about what we do. We need to talk about what we know."

    To that end, an association work group, charged by APTA's House of Delegates, has developed a definition: "The human movement system comprises the anatomic structures and physiologic functions that interact to move the body or its component parts."

    The definition is purposely broad, noted Sharon Dunn, PT, PhD, OCS. "APTA or physical therapy shouldn't ‘own' the human movement system," she said. The definition must resonate with the profession's collaborative partners in health care.

    However, because of the nonspecific definition, the work group added language on the roles of physical therapy that describes, among other things, their unique perspective on purposeful, precise, and efficient movement across the lifespan.

    Shirley Sahrmann, PT, PhD, FAPTA, put the movement system into context with other disciplines, saying, "Highly respected professions gain their respect because they're experts about the body systems they treat." Think of cardiologists, neurologists, and endocrinologists, she suggested. For the physical therapy community to gain respect as human movement system experts, we need to assume the role of a lifespan practitioner, one that sees individuals over the years, not as separate, unrelated episodes of care.

    Included in that is development of a standardized movement system exam, bringing in common language that facilitates communication. "By having a rubric that allows us to describe the situation, we can communicate with others," Cyndi Zadai, PT, DPT, MS, FAPTA, explained.

    There are obstacles to integrating a defined "movement system" into practice, education, and research, the panelists agreed, but cost shouldn't be one of them. While expensive monitoring systems in the clinic are nice, PTs can use their observational skills, noted Sue Whitney, PT, DPT, PhD, NCS, ATC, FAPTA. "We see things other providers don't. And you have to see it to fix it."

    A simple cell phone can capture video of the patient moving. That said, PTs need to be aware of limitations—facilities may prohibit use of video because of HIPAA regulations, for example. It was suggested that using the patient's phone may be an alternative.

    Turning to obstacles in physical therapist education, panelists noted that if movement is integrated into the other more-established systems such as musculoskeletal and neurological, then current teaching approaches need to change, as they compartmentalize students by addressing those systems separately.

    Andrew Guccione, PT, DPT, PhD, FAPTA, addressed the movement system and research. "Research oriented toward the human movement system will have a visual component," he said, indicating that visual analysis of movement will come to the fore of research.

    The bottom line for Guccione is that there is a set of determinants of optimized movement. These are: ideation, initiation, execution, regulation, equilibrium, and sustainability. "These are ‘buckets' of knowledge, within which are huge bodies of literature. The brilliance of this profession is our ability to look across these buckets," he said. To do so, however, he cautioned that "we must stop being orthopedic or neurologic or cardiopulmonary PTs and be movement PTs."


    Wondering if you have any idea about the extent of person trainers crossing the line with their clients and *acting* as physical therapists. There are a number of courses being taken across the USA, (NeuroKinetic Therapy, and Anatomy In Motion to name but a couple) where the trainers are *diagnosing* movement disorders, using tools such as DMS (deep muscle stimulators) and then using corrective exercise to *treat* pain and dysfunction. The APTA has been notably silent on this, but as patients are increasingly dissatisfied with traditional PT practice (3-4 patients per hour, too much utilization of modalities, minimal focus on ther ex, limited number of visits, insurance hassle, etc) this is only likely to become more of an issue. In my area, these trainers command up $150-$200 per hour for a one-on-one session, and patients/clients are happy to pay to see their trainer, who, to be honest, is actually being more effective with many people than a PT in a crammed schedule could possibly be. I have left my insurance-based PT practice and now operate only 60' sessions, fee-for-service, but am increasingly worried about the gradual *creep* of extended scope of "practice" of these trainers, who do not have any licensure requirements, or to be fair, legal support for their practice. Would love to know your take on this, perhaps a survey is in order? Perhaps a DPT-in-training would take this on as a study? Perhaps you could elucidate APTAs perspective on this and a national education campaign would be in order.
    Posted by sinead fitzgibbon on 6/8/2015 10:42:27 AM
    This was a great presentation. I work in a setting where this will definitely help set us apart from our allied healthcare group KT. Thanks so much, this was right on time.
    Posted by Kim Williford on 6/8/2015 11:41:59 AM
    We need to get more younger therapists involved in this movement...pun intended. It is essential for our profession to educate "the world" on our role and how we do need to be interaged across the lifespan. I have encountered many new graduates that do not grasp the concepts above. Thank you
    Posted by Darren Smith on 6/8/2015 12:57:23 PM
    I agree that our profession needs to become sustainable partners with our clients and this relationship should also benefit fit pain free clients. We need to become a solution in the prevention of disease affecting the mobility and function of individuals. We need a strong body of experts who can be quick but not in a hurry if we want to be a bigger part of the healthcare arena. Going slow with indecision is costly.
    Posted by Scott Colombo on 6/8/2015 2:13:52 PM
    When I read this article, I said to myself, "Really? REALLY?". I sent the following to a number of fellow therapists, all very sharp people. "Is it just me or is this recent APTA article asinine? APTA is obviously on a new jargon kick with "human movement system" (as if this is a new concept). I guess they're getting bored with "evidence based". Most agreed. Why is APTA focusing on what, for most savvy therapists, is an old concept integral to what they do as PTs while the phenomenon described above by Sinead Fitzgibbon is sweeping the country unchecked. And APTA's response to this threat? Crickets chirping. I'm getting increasingly disenchanted by APTA's apparent detachment from reality. This obsession with polishing the brass and rearranging the deck chairs as the Titanic slips under the waves is disturbing. Goals instead should be: (1) Protect the profession and, thereby, protect the public. (2) Protect reimbursement to preserve the profession. Instead they're fretting about "evidence based" and "human movement system" while everyone from personal trainers to massage therapists are increasingly doing what we do without limitation or restriction and while reimbursement sinks lower and lower.
    Posted by Brian Miller on 6/9/2015 8:42:33 PM
    Well said Mr. Brian Miller, totally agree! You have nailed the two goals! human movement system was one of PT's objective focus back in the early 90's. Then we combined HMS with functional mobility, after that, evidence based with neuromusculoskeletal and now we are back to HMS again, nice!
    Posted by Iris Liou on 6/10/2015 8:13:50 PM

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  • Last Updated: 6/8/2015
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