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Editor's Notes |
Most physical therapists and physical therapist assistants didn't intend to become teachers, but teaching is what clinicians often spend much of their time doing. We teach patients motor skills and home exercise programs, and we try to teach them to make lifestyle changes to enhance their well-being and prevent problems in the future. We teach parents, family members, and others to care for patients and to promote their abilities and health, and, on behalf of patients and people who might become patients one day, we teach employers, agency personnel, and the general public. The role of "teacher" is evident even in the way that clinicians share information about patient management; for example, in Case Reports, such as Peterson's "The Use of Electrical Stimulation and Taping to Address Shoulder Subluxation for a Patient With Central Cord Syndrome," authors describe examination and intervention in such a way that procedures and specific interventions can be replicated by other clinicians and by researchers who want to address clinical questions.
The Guide to Physical Therapist Practice1 strongly emphasizes the teaching role of physical therapists, with patient/client-related instruction included as 1 of the 3 components of physical therapy intervention. Teaching also is a part of consultation and education, which the Guide lists among the 4 professional roles of the physical therapist that are not related to individual patient/client management.
Although physical therapists have taught patients since the profession began, widespread knowledge and application of learning principles and research results are a relatively recent development. Many of us learned little or nothing in our education programs about how to teach effectively, and we received our first major dose of learning theory and research when we attended the II STEP conference in 1990. Sponsored by APTA's Neurology Section and Section on Pediatrics, II STEP: Contemporary Management of Motor Control Problems2,3 was an intensive and exciting experience, with the topics and discussions as hot as the July days in Norman, Oklahoma, where the conference was held. II STEP followed the tradition of NUSTEP (Northwestern University Special Therapeutic Exercise Project), which was held 24 years before in Chicago. II STEP focused on contemporary theories, research, and clinical practice related to motor learning, motor development, and motor control, and, like NUSTEP, it was a catalyst for a major shift in physical therapy for people with neurological conditions. During II STEP, many of us felt a sense of welcome liberation from neurofaciliation approaches that had dominated practice since NUSTEP, and we were eager to learn more about motor learning, systems approaches, and newer theories of motor development and motor control. We looked forward to rapid expansion of research that would help us to put the theories into practice.
An article in this month's issue of the Journal helps to expand our knowledge about one of the most common motor teaching tasks in physical therapy—the teaching of home exercise programs. In "Effects of Live, Videotaped, or Written Instruction on Learning an Upper-Extremity Exercise Program," Reo and Mercer raise important questions about the value of the ubiquitous home exercise program handouts, and their study supports motor learning research on the effects of models for motor teaching and learning.
The research that Ropponen and colleagues report in this issue contributes to our knowledge of topics covered during II STEP. One principle of systems approaches and motor learning is that movement is a result of the interaction among an individual's personal characteristics, the environment, and the task. In their research, Ropponen et al showed that the relative contributions of genetic factors and environmental factors vary with the task. The tasks in their study were isokinetic lifting, psychophysical lifting (participants' perceptions of acceptable loads), and isometric trunk extension tasks. Although these tasks may not be relevant to many types of patients, the study is important because it supports the principle and the potential of future research to identify relationships among a variety of personal characteristics, environmental factors, and tasks that are of relevance to many patients. Knowledge of such relationships is key to the pursuit of effective evidence-based interventions.
"Evidence-based" is not a term that I remember hearing in 1990, but at the end of the II STEP conference, Ann VanSant, PT, PhD, conference co-chair, urged participants to read. She said, "Our increased professionalism brings increased responsibility to keep abreast of new ideas and to incorporate research findings into our professional body of knowledge. Keeping abreast of new ideas is not accomplished just by attending continuing or graduate education courses. Our own professional development depends on reading."2(p261)
At the time, only the most visionary and computer savvy among us could have imagined today's online access to databases, abstracts, and full-text articles. (Just imagine how much more difficult searching the literature for an Update such as "Aerobic Exercise Dysfunction in Human Immunodeficiency Virus: A Potential Link to Physical Disability" by Cade et al [pages 655–664] would have been in the days before online literature databases.) The professional mandates for evidence-based practice have greatly increased the need for clinicians to have not only the access to literature but the skills to find and interpret research evidence. In their article "Challenges for Evidence-Based Physical Therapy: Accessing and Interpreting High-Quality Evidence on Therapy," Maher and colleagues described current barriers to finding and using research evidence. They also provided useful suggestions for overcoming the barriers, finding resources, and engaging in evidence-based practice.
On the last day of II STEP, Marylou Barnes, PT, FAPTA, predicted, "The impact of this meeting on our thinking and actions will exceed that of any other single event in our professional history."2(p265) II STEP challenged us to radically change how we thought about and managed children and adults with neurological problems. No doubt III STEP * will take us several steps beyond, challenging us with the advances in research, theory, and practice that have been made over the past 15 years. Practice in pediatrics and neurology—and in all areas of physical therapy—needs to reflect an increasing body of knowledge and a greater sophistication among clinicians and educators. What kind of teachers do we need to be in the 21st century? What do we need to teach, and how can we teach it the most effectively?
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