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  • 2018 NEXT: Movement System Finding Its Way Into Education and Research

    As far as Paula Ludewig, PT, DPT, PhD, is concerned, the idea of anchoring physical therapy's identity in the movement system is, to put it simply, a big deal. "This is a huge opportunity for our profession," said the University of Minnesota professor and researcher. "We're at the doorstep of making significant change."

    The question is, just how does the profession get the door open?

    That was the idea at the heart of a presentation on incorporating the movement system into curriculum and research offered at APTA's 2018 NEXT Conference and Exposition in Orlando. Presenters offered 3 distinct perspectives: one from a physical therapist education program that has been infusing movement system concepts into its curriculum and other programs for years, one from a program that more recently accomplished what might be called a retrofit of its curriculum to create stronger links to the system, and one from a researcher and teacher who recounted her own transition away from the "pathoanatomic" perspective. The common thread: embracing the movement system concept can lead to stronger education programs, more useful research, and more effective practice.

    In her presentation on the longstanding incorporation of movement system concepts at Washington University in St Louis (WUSTL), professor Gammon Earhart, PT, PhD, outlined an approach that is now "the seat of everything we do in our department," informing not just education, but research and practice.

    According to Earhart, the first practical application of movement system concepts at WUSTL began with continuing education offerings. From there the concept expanded to residencies and fellowships, and finally worked its way into entry-level DPT training. Movement system concepts are now a part of every course offered in the program, she said.

    Likewise, the university's research efforts underwent a shift toward a more integrated system, resulting in the Department of Physical Therapy's Movement Science Research Center, a centralized facility that allows multiple disciplines to take a team approach to research.

    Eventually, the ripple effect touched the program's practice-related activities, making movement "the primary outcome and primary intervention," Earhart said. For example, patients who presented with back pain were offered another avenue of treatment: rather than focusing solely on exercises aimed at addressing a condition, PTs worked with patients to modify the ways they move in their everyday activities, such as loading a dishwasher or moving a vacuum cleaner.

    Sara Scholltes, PT, PhD, FAPTA, is a graduate of the Washington program and well-versed in the movement system approach, but she found herself teaching at the University of Montana's physical therapy program—which wasn't. Faculty in the program agreed that the school's curriculum needed to make a change, but where to start?

    In the end, it boiled down to tearing down silos, Scholtes said. Rather than structuring curriculum around isolated coursework (first semester, basic sciences; second semester, more of the same; second and third years, subjects seemingly cut off from each other), faculty began thinking about how movement system concepts and critical reasoning skills could be infused throughout the program. Classes were structured in ways that incorporated knowledge gained in other classes—and instructors were free to evaluate that combined knowledge. "The question 'is this exam cumulative?' didn't really matter anymore, because everything is cumulative," Scholtes said.

    For Ludewig, the transition to a movement system approach was personal. As a researcher focused on shoulder issues, Ludewig was driven by what she described as a pathoanatomic approach—"first I get the diagnosis, then I look at the impairment."

    The problem with this approach, Ludewig pointed out, is that it doesn't square with reality: patients don't present in homogenous groups that are cleanly identified within certain diagnostic buckets. They do present with various movement impairments that may share similar characteristics. Those perspectives make a difference. "When you address it from the pathoanatomic perspective, approaches [and] clinical reasoning are all over the place," Ludewig said.

    Instead, Ludewig began looking at impairment first, getting a bead on how patients were moving and associating those movement patterns with hypermobility, hypomobility, or what she termed "aberrant motion." It's a concept anchored in the movement system, and though use of the concept hasn't fully caught on at her school, Ludewig sees a transition happening, calling the shift a "work in progress."

    "We still care about pathoanatomy," Ludewig said. "But it's further down the food chain in how we think about it."

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