Gunn Kristin Øberg

Embodied-enactive clinical reasoning in physical therapy

Abstract Clinical reasoning is essential in physical therapy practice. Instrumental approaches and more recent narrative approaches to clinical reasoning guide physical therapists in their understanding of the patient’s movement disturbances and help them to plan strategies to improve function. To the extent that instrumental and/or narrative models of clinical reasoning represent impairments as mere physical disturbances, we argue that such models remain incomplete. We draw on a phenomenologically inspired approach to embodied cognition (termed “enactivism”) to suggest that the dynamics of lived bodily engagement between physical therapist and patient contribute to and help to constitute the clinical reasoning process. This article outlines the phenomenologically informed enactive perspective on clinical reasoning, with special reference to clinical work that addresses impairments as sequelae of neurological diseases.

Therapeutic encounters with preterm infants: interaction, posture and movement.

Abstract Background and purpose: Physiotherapy is a common intervention for preterm infants with motor disorders. There is a limited knowledge on how individual and contextual actions influence what is created and achieved in clinical encounters between physiotherapists and infants born preterm. In this theoretical paper the aim is to open a discussion for clinicians in pediatrics to take into consideration that patient interaction might have a significant impact for the outcome. Through introducing theoretical principles based on the phenomenology of the body and enactive intersubjectivity the paper provides a framework for better understanding the contribution that the interactional components in physiotherapy with preterm infants may have. Conclusion: The elaboration shows how social interaction and intentional actions influence each other in therapy. Accordingly, a fundamental driving force for effective physiotherapy intervention in preterm infants may involve a dynamical process of embodied interaction with the generation of meaning between physiotherapist and infant. Clinical implications: Our elaboration suggests that a coordinated process of embodied interaction with preterm infants can enhance motor performance during therapeutic encounters.

Parents' Perceptions of Primary Health Care Physiotherapy With Preterm Infants: Normalization, Clarity, and Trust.

Having a preterm infant is a life-altering event for parents. The use of interventions intended to support the parents is recommended. In this study, we investigated how parents’ perceptions of physiotherapy in primary health care influenced their adaptation to caring for a preterm child. We conducted 17 interviews involving parents of seven infants, at infants’ corrected age (CA) 3, 6, and 12 months. The analysis was a systematic text condensation, connecting to theory of participatory sense-making. The parents described a progression toward a new normalcy in the setting of persistent uncertainty. Physiotherapists can ameliorate this uncertainty and support the parents’ progression toward normalization, by providing knowledge and acknowledging both the child as subject and the parent–child relationship. Via embodied interaction and the exploration of their child’s capacity, the parents learn about their children’s individuality and gain the confidence necessary to support and care for their children in everyday life.

Innovative Physiotherapy and Continuity of Care in People with MultipleSclerosis: A Randomized Controlled Trial and a Qualitative Study

Background: Individuals with Multiple Sclerosis (MS) frequently present balance and walking problems; in which reduced trunk stability, often termed core stability, is one essential aspect. A new group-based, individualized core stability training (GroupCoreSIT) is developed and will be evaluated in terms of effects, users’ perceptions, performance and coordination of care. Methods: The study consists of two related parts: 1) a prospective randomized controlled trial (RCT), and 2) a qualitative study. The RCT will be conducted in six municipalities to evaluate the effects of GroupCoreSIT on people with MS compared to standard care. The intervention addresses movement quality in core and balance training highlighting the following elements: dynamic stability, sensory stimulation, specificity, individualization, intensity, and teaching. GroupCoreSIT will be offered three hours per week for 6 weeks, complemented with unsupervised home exercises, with a 6-month follow-up. Seventy-to ambulant people with MS will be included, baseline tested and randomized to intervention and control group. Assessor blinded standardized outcome measurements will be carried at 1-week, 3-month and 6-month post-intervention. The qualitative study will include: i) qualitative interviews conducted twice with 12 participants from each group, at 1-week and 6-month post intervention, aimed to increase the knowledge about short and long-term experiences with GroupCoreSIT and standard care; ii) 12 observations and 12 qualitative interviews with physiotherapists conducting GroupCoreSIT, aimed to identify essential aspects of physiotherapy performance and perceptions related to delivery of intervention; and iii) qualitative interviews conducted twice with 16-20 health professionals in hospital and municipalities, focusing on intensive programs in the coordination of care for people with MS. Conclusion: Evaluation of the efficacy of GroupCoreSIT, participants’ perceptions, physiotherapists’ performance and reflections, and health professionals’ deliberations regarding coordination of intensive programs will provide information for evidence based selection of physiotherapy in ambulatory people with MS.

Physical therapy with newborns and infants: applying concepts of phenomenology and synactive theory to guide interventions

Abstract Physical therapy involving newborns and young infants is a specialized area of practice reserved for therapists who have advanced training and the competence to help newborns, young infants and their families meet their goals. Beginning at birth, infants apply a significant amount of effort to actively participate in and shape their world. Infants make their intentions and requests for support known through their behaviors during social and physical therapy encounters. The therapeutic encounter viewed from the infant’s perspective has received limited attention in the physical therapy literature. The purpose of this article is to discuss concepts related to phenomenology and synactive theory that are relevant to physical therapy with newborns and young infants during the first few months of life after birth.

Test–retest reliability of the Test of Infant Motor Performance Screening Items in infants at risk for impaired functional motor performance

OBJECTIVE To examine test-retest reliability of the TIMPSI in infants at risk for impaired functional motor performance. METHODS The TIMPSI was administered twice to 51 infants from two different hospitals in Norway. RESULTS The intra-class correlation coefficient was 0.99. CONCLUSION Test-retest reliability of the TIMPSI was excellent.

Somatosensory impairments and upper limb function following stroke: Extending the framework guiding neurological physiotherapy

Abstract Disturbances in the somatosensory system are common following stroke but are often neglected during the rehabilitation of upper limb function. Physical therapists’ theoretical understanding of the body, including somatosensory capacities, is important for clinical decision making. In this article, we introduce theoretical notions based on phenomenology of the body to provide subjectivity status to the body and argue for the application of this understanding to improve clinical practice. Subjectivity status to the body implies a conception of the body as the centre of experience and expression simultaneously with it being a biological mechanism. Somatosensory modalities are considered as integral aspects of the experiencing and expressing body (the embodied self) and therefore need to be studied as integrated rather than isolated neurophysiological events. These body functions support intentionality, ownership and the sense of being in control of ones own movement to enable interaction with the surroundings and other people. Disturbances of the somatosensory system affect vital aspects of the embodied self, and training in these capacities may strengthen the experiencing and expressing body. We apply this framework to clinical examples and discuss the implications of a deeper understanding of somatosensory disturbances following stroke; we also discuss the potential of this framework to influence clinical decision making to further develop neurological physiotherapy.

Does a parent-administrated early motor intervention influence general movements and movement character at 3 months of age in infants born preterm?

BACKGROUND Studies of preterm and term-born infants have shown absent fidgety movements and an abnormal movement character to be related to brain lesions and unfavourable neurological outcomes. AIMS The present study examines what effect a parent-administered early intervention program applied to preterm infants in a randomised control trial (RCT) between 34 and 36weeks gestational age has on their fidgety movements and overall movement character at three months of age. STUDY DESIGN The study was part of the RCT in an early intervention programme including preterm infants born between 2010 and 2014 at three Norwegian university hospitals. SUBJECTS 130 preterm infants participated in the study, with 59 of them in the control group and 71 in the intervention group. OUTCOME MEASURES Fidgety movements and overall movement character at three months corrected age. RESULTS No difference was found between the intervention group and the control group in terms of fidgety movements or movement character. Approximately half of the infants in both groups showed an abnormal movement character. CONCLUSION No evidence was found in this RCT to suggest that an intervention at 34 to 37weeks gestational age has a significant effect on the fidgety movements or overall movement character of preterm infants. This is in line with the assumption that absent fidgety movements and an abnormal movement character are due to permanent brain injury and are therefore good predictors for later neurological impairments.

Efficacy of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy: a systematic review:

Objective: To systematically review the evidence on the effect of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy. Data sources: Seven electronic databases (Cinahl, Cochrane Library, EMBASE, Ovid MEDLINE, PEDro, PsycINFO, PubMed) were searched from database inception through December 2016. Methods: A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Standardised mean differences (effect sizes) were calculated for each study and outcome. Results: Nine studies met the eligibility criteria. All studies provided level II evidence. Methodological quality was high in two studies, moderate in four studies and low in three studies. The methodology, participant and intervention characteristics were heterogeneous. The participants’ ages ranged from 1.5 to 16 years. Their initial hand function ranged from Manual Ability Classification System Level I to Level III. The total intervention dose ranged from 24 to 210 hours and duration from one week to ten weeks. The studies measured outcomes assessing unimanual and bimanual hand and arm function, participation and attainment of individualised goals. Overall, the effect sizes did not favour one of the interventions at short- or long-term follow-up. The 95% confidence intervals were broad, indicating inaccurate precision of the effect sizes. Pooling of the data for a meta-analysis was judged to be of little clinical value owing to heterogeneity. Conclusion: It is not possible to conclude whether constraint-induced movement therapy or bimanual intensive training is more effective than the other in children with unilateral cerebral palsy.

Parents’ perceptions of administering a motor intervention with their preterm infant in the NICU

Abstract Background: Giving birth prematurely challenges bonding, optimal parent-child interactions and parental confidence in the early care of their preterm infants. In this study we explored the short-term impact of a parent administered motor intervention programme on parents’ perception of competency and relationship building with their preterm infant. Methods: We conducted 11 interviews at infant age term and three months corrected age, involving parents of seven preterm infants who had performed the functional movement intervention programme in the Neonatal Intensive Care Unit. A phenomenological-hermeneutical analysis was conducted. Results: After implementing the intervention, the parents were no longer fearful of moving their babies and expressed heightened awareness of their infant’s responses and competency. The parents enjoyed the infants’ positive responses to handling and movement and this reinforced attachment between the parent and the child. The parents felt empowered by taking control of decision-making and by being more interactive with their child. Their role in contributing to the infant’s development was empowering in itself. Conclusion: Overall, the parent administered intervention programme had a substantial positive impact on parent-infant bonding and parents’ perceptions of empowerment and competency.