Faculty

Dissecting Movement: Which Came First? Associated Impairments vs. Movement Faults

A question recently landed in our inbox from a faculty member, sparked by a student inquiry within the Orthopaedics app. The student, curious and eager to learn, posed the question: Are associated impairments and movement faults the same thing? Let's delve deeper and untangle the cause-and-effect relationship between associated impairments and movement faults. In the realm of orthopaedics, pinpointing the root cause of a patient's limitations is crucial for effective treatment. Our Orthopaedics app tackles this by differentiating these two key concepts.

Associated Impairment:

  • Definition: An associated impairment is a measurable limitation in a physiological system, such as weakness, stiffness, or balance deficits. 

  • Think of it as: A consequence of the injury/pathology or a preexisting impairment or set of impairments that may be contributing to the cause or maintenance of non-optimal movements, leading to tissue stress and production of symptoms. It's the "what" - the measurable dysfunction.

  • Example: A patient with a knee ligament injury might demonstrate quadriceps weakness (associated impairment) on a strength test, or a patient with uncoordinated or weak scapular muscles contributing to the onset of shoulder impingement during shoulder abduction during a tennis serve.

Movement Fault:

  • Definition: A movement fault is an observable deviation from optimal movement patterns during functional activities. 

  • Think of it as:  A faulty "how" - the way the body compensates for the impairment or moves as a result of impairments. This could be due to pain avoidance, limitations in mobility or improper movement coordination.

  • Example: A patient with a weak gluteus medius might exhibit adduction of the femur and excessive valgus collapse (inward knee buckling) during squats. These movement faults may result in significant tissue stress over time, resulting in patient complaints of pain and loss of function.

Squat with femoral internal rotation and corrections

The Chicken 🐔 or the Egg 🥚?

The question of which comes first - the impairment or the fault - is often complex. Here's a breakdown:

  • Injury often leads to impairment: The initial injury (e.g., ligament tear) directly causes the impairment (e.g., quad weakness).

  • Impairment can lead to faulty movement: To compensate for the weakness, the patient might adopt a faulty squat pattern (movement fault).

Importance of the Distinction:

Understanding the difference is critical for treatment planning:

  • Addressing impairments: Techniques like strengthening exercises can target the quad weakness (impairment).

  • Correcting faulty movement: Movement re-education can address the faulty femoral adduction squat pattern (movement fault).

By effectively differentiating between associated impairments and movement faults, your students can develop a more holistic approach to patient care.

Bonus Tip: The Orthopaedics app can be a valuable tool for students to practice identifying these concepts in real-world scenarios.

Miller's Pyramid: Building Clinical Reasoning in Physical Therapy Students

Physical therapists rely on strong clinical reasoning skills to effectively assess and treat patients. Miller's Pyramid of Clinical Competence (1990) provides a framework for developing these skills by going beyond rote memorization of knowledge.

Here's a look at Miller's Pyramid and how it can be applied in physical therapy education:

  • Knows (Knowledge): This is the foundation of the pyramid, encompassing the factual knowledge base of physical therapy. For example, knowledge of anatomy, physiology, pathology, and therapeutic interventions.

  • Knows How (Competence): Here, students develop the ability to apply their knowledge to solve problems. This involves clinical scenarios, case studies, simulations, and other problem-based learning exercises.

  • Shows How (Performance):  Next, students demonstrate their competence in simulated settings. Learning experiences like practicing techniques in a lab or role-playing patient interactions are appropriate at this stage.

  • Does (Action): The pinnacle involves applying knowledge and skills in real-world situations during supervised clinical placements. Students become proficient and autonomous practitioners capable of making sound clinical judgments independently.

Pyramid graphic from Ramani, S., & Leinster, S. (2008). AMEE Guide no. 34: teaching in the clinical environment. Medical Teacher, 30(4), 347–364.

How to use Miller's Pyramid of Clinical Competence with PhysioU to build clinical reasoning:

  • Build the “Knows” level through video-based lectures/handouts and assess factual recall through MicroLearning.

  • Elevate students to “Knows How” with Case Studies and other problem-solving activities.

  • Allow students to “Show” their knowledge through clinical simulations found in MiniSIMS using standardized patients.

  • Provide the crucial “Does” experience through MacroSIMS to augment students’ supervised clinical placements.

By integrating Miller's Pyramid into physical therapy education, educators can create structured learning experiences that gradually build students' clinical reasoning skills from foundational knowledge (“Knows”) to advanced clinical practice (“Does”). This approach fosters a deep understanding of clinical concepts and prepares students to excel as competent and confident physical therapists.

Ready to transform your classroom? Schedule a meeting with our Education Lead, Dr. Tracy Moore, PT, DPT, ONC.

References:

  1. Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9 Suppl), S63-67.

  2. Ramani, S., & Leinster, S. (2008). AMEE Guide no. 34: teaching in the clinical environment. Medical Teacher, 30(4), 347–364.

Improve Classroom Learning with PhysioU ROM/MMT Simulations

Elevate your classroom experience with the dynamic and interactive ROM/MMT Simulations from PhysioU! This webinar is tailored for educators who are eager to enhance their teaching of Range of Motion and Manual Muscle Testing concepts.

Dr. Tracy Moore, PT, DPT, ONC, Education Lead at PhysioU, will guide you through the effective integration of these simulations into your curriculum. Discover innovative ways to visualize and practice ROM and MMT procedures, making complex concepts accessible and engaging for students. This session will provide practical strategies to boost student interaction engagement, track progress, and scaffold clinical experiences into the classroom in a low stakes and highly reproducible format.

00:00 Improving Classroom Learning With Simulations

04:55 Addressing Skill Application in Clinical Practice

10:10 Tracy Demonstrates New Web App Features

18:25 Mastering Knee Extensor Testing Procedures

22:32 Integrating Educational Simulations in Ortho Course

26:40 Maestro Approach for Enhanced Learning

31:48 Simulations, Integration, and Ortho App Discussion

Helpful Links: Complimentary Educator access | Educator resources | Set up a Demo

The Future of Muscle Testing: Exploring Handheld Dynamometry in Classroom Education

There’s a new kid on the block! Introducing an easier way to teach handheld dynamometry content with our popular ROM, MMT, and Palpation app and our new device.

Join Dr. Tracy Moore, PT, DPT, ONC, Education Lead at PhysioU, to explore the integration of handheld dynamometry in classroom settings, compare traditional manual muscle testing and handheld dynamometry, and see how this content can seamlessly integrate into your course layout. We will also feature comments from industry experts and fellow faculty members.

Learn effective teaching strategies to enhance student engagement and understanding, and see how Dr. Moore and other faculty are already using this with their students. Join us to embrace the future of muscle testing in entry level education. Register now to transform your classroom experience and equip your students with this new innovative technology.

Featured Speaker: Tracy Moore, PT, DPT, ONC Dr. Moore excels as a clinician, product manager, and educational leader, seamlessly integrating clinical research, curriculum design, and app development to bridge the gap between the student experience and clinical expertise.

00:00 Our Mission Statement

07:35 Handheld Dynamometry in the ROM, MMT, & Palpation App

13:13 Classroom Resources and Comparison to Traditional MMT

20:36 Practical Applications in the Classroom and Faculty Feedback

31:01 A Word From our CEO's and Closing Remarks

Helpful Links: Complimentary Educator access | Educator resources | Set up a Demo

A Mile in Your Shoes: Transform Your Gait Lab With the PhysioU Gait App

Join Dr. Tracy Moore, PT, DPT, ONC, Education Lead at Clinical Pattern, for a 30-minute overview and collaborative discussion about the Gait app. Explore the best practices for including and deploying video-based resources to encourage proper gait analysis skills in your classroom and easily integrate technology into your labs.

00:00 PhysioU Gait App: Enhancing Classroom Learning

05:13 Gate App Introduction and Features

07:33 Gate App Introduction and FeaturesDeveloping Educational Tool for Range of Motion

12:22 Clinical Examples and Educator Roles in Health Education

15:38 Gate App in Teaching and Learning

31:25 Enhancing Clinical Reasoning Education

37:19 Classroom Improvement and Technological Tools

Helpful Links: Complimentary Educator access | Educator resources | Set up a Demo