theories of motor development

[estherderu]

dear bobby,

I must say, my first personal feeling is to follow the theories based on neurological knowledge.
I am very much a practical person. The theoretical background to explaining motor behaviour in infants by mrs Mijna hadders-Algra in her Dutch book on infant motor development was an eye opener for me at the time. She was explaining the theory to what I had expierenced so often without knowing exactly why. Making me very curious to know more. At the same time the DST was being introduced.

By nature I am also a person who is willing to work without a theoretical background, using an open mind and common sense. Variability in motor behaviour motor performance, the sensory information capacity, the hyper-hypomobility, brain plasticity......there are so many interesting variables.... and I am comfortable with that. Not one child is the same, so why should their treatment be?

Am very happy if I find a hypothesis to explain why something works, but am especially busy trying to make "something work".
I have been in the health "business" (in various professions) long enough to be sceptical of "evidence based" and statistics.

Am looking forward to the book about posture.

kind regards

Esther de Ru

[Bobby Nabeyama]

Esther de Ru,

Postural Control: a key issue developmental disorders by Hadders-Algra should be released any day now. The release supposed to be Oct 08. I'm excited to get to read it as well.
So you're skeptical of evidence-based practice and statistics as you should. But, do you practice evidence-based?

Regards,
Bobby Nabeyama

[estherderu]

dear Bobby,

as much as possible.... and
as far as real evidence based theories can tell me what to do...

In Holland we have been very lucky to have people like the Bobaths across the Channel and Vojta around the corner ( long ago). In the last 15 years people like dr Prechtl, dr Mijna Hadders Algra and mrs Marjolein Ketelaar ( functional physiotherapy in CP), colleagues Eva Bower, Ann-Christin Eliasson (MACS) Olaf Verschuren ( physical fitness in CP) Raoul Engelbert (connective tissue- JRC) around the corner, and the European Academy of Childhood Disability,EACD -an active organisation promoting research. European Academy of Childhood Disability
Our NVFK ( pediatric group of our National Society) has strict rules about the education of paediatric physios... for more information look at our site NVFK; Nederlandse Vereniging voor Fysiotherapie in de Kinder- en jeugdgezondheidszorg (sorry most is in Dutch- a factsheet is in English). A 4 yrs part time education (used to be 3) covering all aspects of all childhood disabilities. Protocols and guidelines for various childhood diseases are used and being created.
The www.cebp.nl is "made in Holland"!
Look up... NetChild | homepage
Gait labs are working with video analysis, I can send my video to various Gait Labs and have colleagues + rehab specialists "look at my childs problems"

We are lucky....

We are probably one of the only countries with an electronic patient file system specifically for PPTers.

So being an older bird, I can say I was trained in many "old methods" , had to comply to the new regulations and recieved extra education in order to obtain knowledge of current evidence based work. To be registered and to stay in our paediatric physiotherapy register, ongoing postgraduate education was and is mandatory.

Being the clinician, it was nice to finally know the evidence behind the practice.
This sometimes meant changing things and like always.... everytime you hear something new ( in course- book- conference) you always know a patient you definitely want to "try this" with.


and... how about you?

Esther

[Bobby Nabeyama]

Esther,

Yes it can be very difficult to discriminate the mass information across multiple theories. You demonstrated the complexities with your attached summary. Seems your document was greatly influenced by Hadders-Algra (2000) in Developmental Medicine & Child Neurology.

Anyway, it seems as you have “come along with the times” well. It’s always interesting to find how different clinicians change or don’t change with the paradigm shifts of motor control models and neurologic rehabilitation models. As many clinicians still proclaim the efficacy of Bobath/NDT and Vojta. When in fact they should not, relative to the evidence.

Also, we should tread lightly in accepting many of the current motor control models since they better explain typical/normal development and not otherwise. You might find interesting that Neuronal Group Selection Theory (NGST) is not spoke of much in the States. We appear to reference Dynamic Action Theory or Systems Theory much more. The geographical science preference is pretty overt. I would like to hear more of NGST since it appears to function closely with Evolutionary Theory and Behavioral Learning Theory (which are empirically validated “theories”).

So again, do you have a strong preference towards a specific model?

Oh and I only practice evidence-based.

I would love to hear others speak of theories and the applicability. Guess clinicians avoid the chatter.

Thank you Esther.

Bobby Nabeyama

[estherderu]

dear Bobby,

Sorry for not answering this post earlier. I have been busy translating and correcting a manual for a colleague.

The answer to your last question So again, do you have a strong preference towards a specific model? has to be....

I do not really know enough about the "models"
I suppose that is probably the reason why so many "older experienced physio´s" will not, or cannot go into discussion with the young thoeretically "better" educated colleagues.

Last year, at the AECD conference in Groningen Holland, one of the keyspeakers Diana Damiana, reflected on the differences in the way PTers work and she told us that in the USA there are currently "two camps" These colleagues are in discussion, but both groups are still persuing their own way.

I would very much like to try understand and fill this "gap- communication problem?" and try reach consenses on what "the best" treatment is today and why!
Lets try!
Tell me....
what theories are currently "in" at the moment?

Does the fact that the Dutch have tried to integrate the ICF into their daily practice count for something?

Does the fact that I read a lot and still go to- and have always been- to numerous postgraduate courses ( problem being, they have always been in Europe)make me a "good candidate" for such a discussion?

Is it possible that I might not "remember" the theoretical explanations given, but concentrate on what is being said and seeing the practical implications??

Is it possible, that - being an old bird- I have heard so many explanations, hypothesis, so many people telling me this was "it", "the best therapy for..." that I have become a little sceptical???

Is it possible that some young colleagues have problems believing what older coleagues say because they percieve to have all the wisdom?

Should we not always try to stay open-minded and not just believe what some guru is telling us, even if it is so-called EBM?

Help me understand please!

Hope others join this discussion!

What is your opinion.... do we need to duplicate this discussion on more forums, such as the wcpt forum and the myphysicalspace forum?????


Esther

[linbin]

hi esther
most of the theories mentioned are discussed under the title of"theories of motor control". i agree that they will definitely be overlapping.in the book "reflex and vestibular aspects of motor control,motor development and motor learning" by marylou r barnes,carolyn a crutchfield etal they discussed 3 theories of motor development

[Bobby Nabeyama]

Hello Esther,

Sorry for such a delay. You bring up some good points regarding communication challenges between therapists. As far as age as being a constraining variable- it does seem so at times. However, in my experience both “younger” and “older” therapists may or may not know much about motor control or development. To be quite honest, I do at times jokingly stereotype older therapists as not knowing much of modern physical therapy. That they might still be so greatly influenced by Bobath/NDT, not be able to apply research to practice, being easily duped by fad treatments, and are really just practice as technicians. That being said, I’ve discriminated the same for new graduates or other younger therapists!

Theories and conceptual frameworks are vital in PT practice. If not how does one know what to do with a patient in front of oneself? You can’t know. You could defiantly guess. I find too much guessing going on and it’s disturbing. In clinical practice we should attempt to discriminate right and wrong practice, correct or incorrect, best or worst. Now if these terms are too moralistic or absolute let’s at least maintain an emphasis on objectivity and discriminate practices as more effective or less effective. Let’s get away from this sort of open minded and eclectic practice where everything goes and you can never be wrong because everything works because every patient is different.

What to you think?

Anyway, we’ll chat more about motor control theories and clinical conceptual frameworks.

Bobby

[Bobby Nabeyama]

So has anyone read Postural Control: a key issue developmental disorders by Hadders-Algra?

Guess we either don't care much of research or are fearfull of chatting about it.

[estherderu]

Hi Boby,
Am in the middle of it.....
Have made sure two of my spanish colleagues have bought it as well...

Do not have much time (no time in fact) at the moment, am busy with preparing a course and going on a BIG holiday. Will be back to really dig into it in october....... isn´t that horrible

Esther

[Bobby Nabeyama]

I see Esther is still by herself here on this site. Do pediatric therapists even care about advancement of discussions?