In a recent study, Frost et al discovered that knowledge of scoring criteria improved FMS scores in a group of firefighters, leading them to question whether the FMS or any other whole body general movement screen can be used to capture “dysfunction”. Click here for the abstract: http://www.ncbi.nlm.nih.gov/pubmed/26502271
I am rather pleased to see this, as it opens up the discussion as to what, as clinicians, we might be expecting from assessing movement.
Let’s say that you choose a movement to test. We will assume that it is relevant to the functional or environmental demands upon the patient. This is quite a big assumption, as commonly we see the same battery being used for footballers, golfers or firemen, and while there are some commonalities, there are also some glaring differences in their needs, so the chosen movements may really miss the mark in terms of identifying functional problems e.g. Lockie et al 2015. Click here for the abstract: http://www.ncbi.nlm.nih.gov/pubmed/?term=FMS+multidirectional+sports
So, you’re ready to start. The first basic question to answer is simply whether the movement you are seeing indicates the patient’s capability, or simply their habit. The answer to this question will take you in two completely different directions in your treatment.
When you initially test a movement, you will observe the patient’s spontaneous strategy, or at least their ability to physically express their understanding of what you are asking for. This shows you which physical assets they can readily access to solve your movement challenge, and what is most likely habitual for them.
Tempting though it is to leap to conclusions at this point, you do not yet know what you need to work on, however.
The next step is to add a modifier. In the above paper, the subjects were informed about the scoring criteria, but not coached. A modifier of this nature provides additional information to improve understanding of the task. A performance cue could also be considered to be a modifier in this category. They work through different mechanisms, but they both offer the opportunity to see whether the subject has assets that they are not currently accessing.
If the movement does not improve with this new information, there is a strong possibility that the patient does not currently have the capability to perform the movement challenge in any other way. A bit of differentiating will now occur to find out what you will need to do to increase the patient’s capability. Factors to consider may for example be available mobility, through range strength, kinematic sequencing, balance or even sensory processing. Once you have identified the relevant factor(s), your initial clinical focus will be on restoring or improving capability.
However, if the assessment movement improves with the extra information or instruction, it demonstrates that the patient has the capability, but does not spontaneously use it. This may be because they have not previously made this sensory motor connection, or that their nervous system has simply chosen other movement options to meet the force demands upon them.
Treatment will therefore have a completely different focus – you don’t need to work on what they already have! The focus will be on engaging the new motor coordination pathway, and using a range of tasks to increasingly make it more readily accessible, more sustainable, and more likely to emerge under a range of conditions, which may include fatigue or complexity of task or environment.
This distinction is rarely made, leading to patients who spend years working on capability factors for no appreciable benefit.
A movement test is a start point, a launch pad from which clinical reasoning and differentiation can be applied so that appropriate individualised treatment planning can emerge. It’s positive to see papers like this pop up, to shake up the prescriptive direction that movement assessment is taking and remind us to investigate the needs of individuals, not just the behavior of study cohorts, in order to treat relevantly.