[EMERGING] Theories in Physical Therapy Practice

According to the APTA (2009), this serves as a guide and tool for practice.

Theory

Where should the selection of interventions and anticipated outcomes be derived from?

Follow Up Question (True or False): A theory can no longer change throughout the physical therapy process, from examination to interventions.

Physical therapy theory

False; theory can still be evaluated and reviewed

Fill in the Blanks: Theory can be substituted for ______.

Theory can be substituted for professional judgement.

What are the main traditional theories in physical therapy practice?

1. Biomedical model

2. Psychosocial model

This model states that diseases are caused by internal and external injuries to the body. Development of medical techniques is based on knowledge of cells, tissues, and organs.

Follow Up Question: What are examples of internal and external injuries to the body?

Biomedical model

• Internal: assault, falls, etc.

• External: stroke, MI, etc.

Fill in the Blanks: The Biomedical model focuses on the ______ more than the ______.

The Biomedical model focuses on the disease more than the patient.

Read: The 7 Principles of the Biomedical Model

1. Reductionism

2. Cartesian Dualism

3. Specific Aetiology

4. Germ Theory

5. Normalization

6. Objectivity and Experimentation

7. Body as Machine

This states that the body is composed of various systems and parts ranging from the cellular level to the systemic level.

Reductionism

This states that they body and mind are separate. It describes the body as imperfect and prone to insanity and disease, and the mind as God-like, pure, and perfect.

Cartesian Dualism

Who proposed the concept of Cartesian Dualism?

Rene Descartes

This states that the goal is to determine the origin or root cause of the illness and focus on curing the underlying cause.

Specific Aetiology (i.e. PD occurs due to Lewy bodies)

This states that germs are the cause of the disease, not the foul air and evil spirits.

Germ Theory

Sir Tope: If there is germs, it is germ theory na agad; if there are no germs, it is specific aetiology

This emphasizes the distinction between normal and abnormal.

Normalization (i.e. when someone only has one foot, they are considered “abnormal”)

This states that rationally conducted experimentation should be done to verify what we believe to be true.

Objectivity and Experimentation

This compares the body to simple and complex machines.

Body as Machine (i.e. joints are similar to screws, neurons are similar to telephone wires)

What are the theories that have emerged from the Biomedical model?

1. Systems theory

2. Dynamic fiction theory

This states that movement is achieved due to the interaction of the body and the systems (i.e. the body moves because of the musculoskeletal and neurological systems). It states that the body is a mechanical system with a large number of joints and muscles that need to be controlled in any movement task.

Systems Theory

This states that movement is achieved due to the interaction of the person and his environment. It describes motor control as an organizing system, meaning that movement emerges based on the system's demands rather than being controlled by higher centers.

Dynamic Fiction Theory

This theory focuses on the interaction of a person with another person. It focuses on the nature of self-understanding, social relationships, and the mental processes that support connections between the person and his/her social world.

Psychosocial model

According to the Psychosocial model, this is the product of the ongoing interaction between individuals and their social environments.

Development

What are the theories that have emerged from the Psychosocial model?

1. Social Cognitive Theory

2. Health Belief Theory

3. Erik Erikson’s Developmental Theory

This theory states that a person has self-efficacy and can do the task with or without motivation. It focuses on achieving self-efficacy to acquire behavior and eventually sustain behavior, or interactive deliberative tasks foster self-efficacy and lead to increased engagement.

Social Cognitive Theory (i.e. being able to study regardless of if you are motivated or not because you know you can study)

This is the term used for the belief that you can do something.

Self-efficacy

This theory states that there should be motivation to start behavior and that behavior does not need to be sustained. It states that the presence of motivation leads to self-engagement, but sustained behavior is not needed. It highlights the presence of sufficient motivation for health to be relevant.

Health Belief Theory

This states that the progress of each life stage is determined by the success or lack of success in all the previous stages

Erik Erikson’s Developmental Theory

What are the emerging theories in physical therapy practice?

1. Transformative Learning Theory

2. Connectivity Theory

This is the process of affecting change to our habitual ways of doing things to make our practice more inclusive and truthful through reflection and action.

Transformative Learning Theory

What are the three types of reflection in the Transformative Learning Theory?

1. Content Reflection — examination of the description of the problem; what went wrong? (i.e. the patient did not get better)

2. Premise Reflection — questioning the problem; why did the problem happen (i.e. why didn’t the patient get better?)

3. Process Reflection — checking the problem-solving strategies; what do I do? (i.e. read on CPGs to try better interventions)

Enumerate the 10 Phases in the Transformative Process.

1. Disorienting dilemma

2. Self-examination- with feelings of guilt, anger, shame

3. Critical assessment of assumptions

4. Recognition that one’s discontent and the process of transformation are shared

5. Exploration of options for new roles, relationships, and actions

6. Planning a course of action

7. Acquiring knowledge and skills for implementing the plan

8. Provisional trying of new roles

9. Building self-confidence and competence in new roles and relationships

10. Reintegration of one’s life on the basis of conditions dictated by one’s new perspectives

The theory refers to any assemblage, interaction, or linkage between one ‘self’ and another (others).

Connectivity Theory

What are the four Philosophical Basis of Connectivity Theory?

1. Phenomenology

2. Symbolic Interactionism

3. Structural Embodiment

4. Postmodernism

This emphasizes that movement is personal, expressive, relational, specific, experiential, and personal. This can encourage the individual to move further and create an attitude where people can come to trust that they can perform movements regardless of age, ability, or situation. It describes that the world is not an external reality, independent of our consciousness, but rather a product of our “being-in-the-world”, and that intersubjectivity is one part of our always-situated existence.

Phenomenology (i.e. elderly stroke patient is not allowed to do any chores following her condition, leading her to rely on others instead)

It states that:

• Human beings act toward things based on the meanings those things hold for them.

• The meaning of things is derived from or arises out of the social interaction that one has with one’s fellows.

• Meanings are handled and modified through an interpretation.

Human beings do not respond directly to objects, but attach meaning to them instead.

Symbolic Interactionism (i.e. relationship between a paraplegic and his wheelchair)

This states that our experiences of the world are framed by external forces that cause us to act and think in certain ways. This perspective challenges physiotherapists to acknowledge the political and social circumstances of the people we work with and integrate this into how we work.

Structural Embodiment (i.e. the relationship between a paraplegic patient and a ramp)

This debunks normalism and states that we are all ‘normal’. Recognizes human connectedness's complexity, diversity, and multiplicity and the endless transition or becoming rather than the being that animates our subjectivities. It proposes that all world elements are profoundly connected and move in and out of various temporary “assemblages” of human and non-human elements.

Postmodernism