Sørvoll Marit, Obstfelder Aud, Normann Britt, Øberg Gunn Kristin
a Department of Health and Care sciences , UIT - The Artic University of Norway , Tromsø , Norway.
b Centre of Care research , NTNU - Norwegian University of Science and Technology , Gjøvik , Norway.
Physiother Theory Pract. 2019 May;35(5):427-436. doi: 10.1080/09593985.2018.1453003. Epub 2018 Mar 20.
Physiotherapy from an early age is considered important for children with cerebral palsy (CP). In preschool, dedicated aides are responsible for the daily follow-up and training under the supervision of a physiotherapist (PT). Knowledge is sparse regarding what is created and achieved in clinical practice involving triads (i.e. the PT, aide, and child) with respect to the enhancement of practical skills in dedicated aides. The study purpose was to explore form and content in supervision.
Nonparticipating observations were performed on a purposive sample of seven triads, including seven PTs, seven dedicated aides, and seven preschool toddlers with CP with function level III-IV of the Gross Motor Function Classification System. Each triad was video-recorded once. Data consisted of 371 minutes of video recordings analyzed using content analysis and enactive theory on participatory sense-making.
From the analysis, three supervision approaches emerged: (1) the Cognitive Supervision approach; (2) the Joint Action Supervision approach; and (3) the Embodied Supervision approach. Each approach gives rise to different types of sense-making processes, ranging from merely reflective ways of knowing through verbal and visual conveyance to mutual embodied ways of knowing through joint actions and physical interplay. To make use of all approaches, PTs require incorporated handling skills and action competence.
Supervision is an emergent process where knowledge is transformed through interactions and shared sense-making processes.
Clinicians should be aware of the context-dependent and interactional factors that drive the supervision process.
从幼儿期开始进行物理治疗被认为对脑瘫（CP）儿童很重要。在学龄前阶段，专门的助手在物理治疗师（PT）的监督下负责日常随访和训练。关于在涉及三人组合（即物理治疗师、助手和儿童）的临床实践中，为提高专门助手的实践技能所创造和达成的成果，相关知识匮乏。本研究的目的是探索监督的形式和内容。
对七个三人组合进行了非参与性观察，这些组合包括七名物理治疗师、七名专门助手以及七名患有脑瘫且粗大运动功能分类系统功能水平为III - IV级的学龄前幼儿。每个三人组合被录像一次。数据由371分钟的录像组成，使用内容分析和关于参与式意义建构的具身理论进行分析。
通过分析，出现了三种监督方法：（1）认知监督方法；（2）联合行动监督方法；（3）具身监督方法。每种方法都会引发不同类型的意义建构过程，从仅仅通过言语和视觉传达的反思性认知方式，到通过联合行动和身体互动的相互具身认知方式。为了运用所有方法，物理治疗师需要具备综合的处理技能和行动能力。
监督是一个知识通过互动和共享意义建构过程得以转化的涌现过程。
临床医生应意识到驱动监督过程的情境依赖和互动因素。
