Håkstad Ragnhild B, Øberg Gunn Kristin, Girolami Gay L, Dusing Stacey C
Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States.
Front Rehabil Sci. 2022 Oct 11;3:994804. doi: 10.3389/fresc.2022.994804. eCollection 2022.
In pediatric physical therapy, there is an ongoing debate about the use of therapeutic handling and its potential effects on motor learning. In this study, we build on enactive theoretical perspectives to explore the role of therapeutic handling in connection to children's sensory-motor play, engagement, and performance during a single physical therapy session.
This is a qualitative study based on video observations of therapy sessions and interviews with 15 physical therapists (PTs) each treating two different children aged 0-3. The authors utilized a framework of co-reviewing, discussing, and reflecting on the sessions. Themes were identified and used to describe the ways by which PTs' therapeutic handling unfolds, with connections to theories on sensory-motor play and learning, along with enactive perspectives on embodiment, experience, mutual incorporation, and sense-of-agency.
The characteristics and purposes of therapeutic handling are presented in two main themes: (1) position and support, and (2) directing movement. We found that position and support promoted sensory-motor improvement when the PTs' handling aligned with the child's play interests and engagements. As part of play, the children used new and additional support surfaces to self-initiate better posture and movement solutions and reach play goals. The PTs' ways of directing movements varied. To awaken curiosity and induce a child's self-driven motor exploration the PT needs to be subtle, flexible, and precise in the directing of movement. This entails responsiveness to the child's signals and bodily know-how in the placing of hands and direction of pressure to enable the child to actively participate in and eventually self-drive movement.
Therapeutic handling that is mutually incorporated between PT and child can enrich the child's playing-to-learn-to-move process by providing novelty and facilitating the child's sense-of-agency in the self-initiated exploration and refinement of movement possibilities. In the PTs' effort to merge therapeutic handling with children's play, the momentum of interaction can open new therapeutic windows of movement experience and learning opportunities.
在儿科物理治疗中，关于治疗性手法的使用及其对运动学习的潜在影响一直存在争论。在本研究中，我们基于具身理论视角，探讨在单次物理治疗过程中，治疗性手法在儿童感觉运动游戏、参与度及表现方面所起的作用。
这是一项定性研究，基于对治疗过程的视频观察以及对15名物理治疗师的访谈，每位治疗师治疗两名0至3岁的不同儿童。作者运用了共同审查、讨论和反思治疗过程的框架。确定了主题，并用以描述物理治疗师的治疗性手法展开的方式，以及与感觉运动游戏和学习理论的联系，同时还有关于具身、体验、相互融合和能动感的具身理论视角。
治疗性手法的特点和目的呈现为两个主要主题：（1）姿势与支撑，以及（2）引导运动。我们发现，当物理治疗师的手法与儿童的游戏兴趣和参与度相契合时，姿势与支撑能促进感觉运动能力的提升。作为游戏的一部分，儿童利用新的和额外的支撑表面来自我启动更好的姿势和运动解决方案，以实现游戏目标。物理治疗师引导运动的方式各不相同。为了激发好奇心并促使儿童进行自我驱动的运动探索，物理治疗师在引导运动时需要巧妙、灵活且精准。这需要对儿童的信号和身体技能做出反应，以确定手的放置位置和施压方向，从而使儿童能够积极参与并最终自我驱动运动。
物理治疗师与儿童之间相互融合的治疗性手法，通过提供新颖性并促进儿童在自我启动的运动可能性探索和完善过程中的能动感，能够丰富儿童从游戏到学习再到运动的过程。在物理治疗师努力将治疗性手法与儿童游戏相结合的过程中，互动的契机可以打开运动体验和学习机会的新治疗窗口。
