Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064 (USA).
Ability Occupational Therapy Services, LLC, Anchorage, Alaska.
Phys Ther. 2019 Jun 1;99(6):748-760. doi: 10.1093/ptj/pzz026.
Clinical assessment of movement and posture guides the decision-making process in designing interventions for infants and children with movement disorders. Clinical reasoning is influenced by the therapist's understanding of developmental processes. The views of development grounded in perception-action, dynamic systems, and neuronal group selection theories are well recognized in current literature and supported by a large body of research. Based on the available evidence, intervention must be task-specific, repetitive, and highly salient to the child. Furthermore, it must honor spontaneous exploration and active problem-solving, enhance the child's ability to perceive environmental affordances, and target optimal variability and adaptability of movement and posture. However, a neuromaturational approach to developmental assessment and intervention that relies on "teaching" motor milestones and emphasizes the importance of correcting movement patterns in infants and children developing atypically is still prevalent in the clinic. This perspective paper will: (1) examine evidence in support of a paradigm shift from neuromaturational views toward bringing the concepts of grounded cognition, variability, complexity, and adaptability to the forefront of clinical reasoning; and (2) introduce the Perception-Action Approach as a method of assessment and intervention that may serve as an agent of such a shift by augmenting knowledge translation for the clinician.
临床对运动和姿势的评估指导着设计运动障碍患儿干预措施的决策过程。治疗师对发育过程的理解影响临床推理。基于感知-动作、动态系统和神经元群选择理论的发展观在当前文献中得到广泛认可，并得到大量研究的支持。基于现有证据，干预必须具有任务特异性、重复性和高度突出性。此外，它必须尊重自发探索和主动解决问题，增强儿童感知环境可能性的能力，并针对运动和姿势的最佳可变性和适应性进行目标定位。然而，一种依赖于“教授”运动里程碑并强调纠正运动模式重要性的神经成熟发育评估和干预的方法，在临床上仍然很普遍。本文将：（1）检查支持从神经成熟观向以认知基础、可变性、复杂性和适应性为重点的临床推理范式转变的证据；（2）介绍感知-动作方法作为一种评估和干预方法，通过增强对临床医生的知识转化，可能成为这种转变的推动者。
