Guidance strategies and motor modelling in physiotherapy

Abstract

Patient education is an important aspect of physiotherapy. Supporting and developing patients' self-motivation and activity requires efficient education during the practice period. Physiotherapists use predominantly verbal instruction and demonstration in their teaching activities. The aim of this study was to investigate how physiotherapists organise their therapeutic interventions in order to facilitate patients' learning. This was done by studying the ways in which physiotherapists provide their patients with the mental and motoric imagery pertaining to the action to be performed using verbal, visual and manual guidance. The study was undertaken at three hospitals in southern Finland. Five physiotherapists and seven patients with a variety of disorders were studied. Systematic observation was used to determine the physiotherapists' verbal, visual and manual guidance and the patients' verbal and physical responses. The results show that the physiotherapists made extensive use of verbal and manual guidance. The main means of instructing patients was to name the next exercise and to ask them to assume the correct position for starting the movement. The physiotherapists hardly ever discussed with the patients the goal of the therapy or the importance of a partial exercise in the context of the total rehabilitation programme. Visual modelling was rarely used. Observational learning was usually carried out during a demonstration, with the physiotherapist modelling the exercise for the patients either just before the exercise session began or together with the patients during the session. It would appear that physiotherapists require more education about motor modelling and learning and that more research is needed into different guidance strategies.