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Through observation, palpitation, and touch, the therapist uses knowledge and skill to assess the patients’ functional ability.

In this Chapter

  • Setting expectations

  • Driving the show

  • Observing and engaging

  • Drawing on the past

  • Reengaging with life


Following the initial development of the Clinical Recognition Program at Massachusetts General Hospital (MGH), members of the Professional Development Committee met with members of their respective disciplines to validate and amend the criteria to better reflect their discipline’s practice. When members from Occupational Therapy and Physical Therapy met, for example, they discovered that, given the nature of their practice, another major theme emerged: movement. The Occupational Therapists and Physical Therapists found that movement was so prominent in the discussions, separate from clinical knowledge and decision-making, that they advocated that it be pulled out as a separate and unique theme.

Narratives—Entry Level of Practice

Entry or Advanced Beginner therapists are developing their skills in being able to facilitate the desired movement pattern, while being able to facilitate patients’ functional activities. This requires them to understand, through consultation with more experienced colleagues, normal patterns and responses—versus the abnormal response—and the appropriate intervention to address them.

Narratives—Clinician Level of Practice

Competent or Clinician-level therapists effectively use their palpation and manual skills to facilitate the patient achieving the desired movement. They demonstrate confidence in their ability to translate what they are seeing and feeling into a diagnosis and treatment plan. The narratives allow for a more in-depth, detailed, and nuanced discussion.

Narratives—Advanced Clinician Level of Practice

With continued practice, reflection, and supervision, therapists at the proficient or Advanced Clinician level of practice are able to efficiently use their palpation and manual skills to select interventions and continuously adapt them to meet patients’ changing motor responses. The therapists integrate information from their sensory, visual, and cognitive systems at an automatic level.

Narratives—Clinical Scholar Level of Practice

At the expert or Clinical Scholar level, the therapists have a highly refined ability to palpate, observe, and guide the patient at an intuitive and subconscious level. This allows for a high degree of treatment specificity and creativity. Their treatments are highly focused and designed. Their narratives allow for discussions that promote reflection and understanding of challenging patients, ethical situations, or system concerns.

The narratives that follow describe the movement theme of practice across the physical therapy and occupational therapy discliplines and across the four levels of expertise, as described in Chapter 1. The unbundling through reflective questions, which follows a brief commentary on the narrative, allows you to reflect on your own practice or that of a colleague.



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