Humans are intrinsically and dynamically tied to the environment. Not only do we shape the environment that we inhabit, but the environment also shapes our behaviours. Of particular relevance to physiotherapists, the environment influences human motor behaviour.
J.J. Gibson, a central figure in the development of ecological psychology, proposed that the environment provides possibilities for action, or affordances (Gibson, 1979). Based on an individual’s capabilities, what an environment does or does not afford will differ. Take for instance a toddler approaching a stair step. Depending on the developmental stage and individual characteristics of the toddler, the step may afford “climb-ability.” For another toddler with different characteristics (e.g., differing leg length, past experiences), the same step may afford “crawl-ability,” not “climb-ability.” The same is true for the movement of individuals with disabilities. There is an accumulating body of evidence to suggest that the movement patterns employed by individuals with disabilities are not context-independent pathological manifestations (e.g., Figueiredo et al., 2015; Holt et al., 1996; Schwab et al., 2020). Rather, movement patterns are intimately linked to the environments in which they occur (Vaz et al., 2017). An individual with a disability may explore new (extraordinary) ways to use their body to achieve the desired effect given what affordances are available to them.
Fundamentally, we as physiotherapists cannot understand the full nature of human movement without an understanding of the environment and the interaction between an individual and their environment. One of the key principles of ecological psychology is that the individual-environment system should be considered the irreducible unit of analysis, rather than considering an individual in isolation from their environment (Chiel & Beer, 1997; Turvey, 2009; Turvey & Fonseca, 2009). In many cases (not all instances, but many), physiotherapy reduces movement to mechanical structures, seeking to address individual impairments and component functions removed from the environment (Nicholls & Gibson, 2010). This practice risks treating disability as a problem within the individual to “fix” or “normalize” through rehabilitation, disconnected from the physical, social, cultural, and political environments that meaningfully give rise to movement (Gibson, 2016; Nicholls, 2022).
Sarah Schwab
PhD cand, University of Cincinnati
Photo by Fionn Claydon on Unsplash.
How can we bring the environment more strongly into physiotherapy practice?
Physiotherapy faculty who pursue training beyond the health sciences or biomedical fields may represent one step toward addressing current knowledge-practice gaps in physiotherapy related to the environment.
Imagine a potential future for the profession wherein a physiotherapist with training in philosophy can instruct physiotherapy students in philosophies that incorporate the environment (e.g., enactivism). Or, a physiotherapist trained in ecological psychology can facilitate the instruction of an ecological-dynamics approach to movement, placing equal emphasis on the individual, task, and environment. Such an understanding may promote counter-narratives of disability by recognizing that disability experiences are not located only in the individual, but in their intersection with the various contexts in which they are situated.
In short, physiotherapy faculty with training outside the health sciences may promote the ongoing evolution of the profession by thinking beyond the somewhat narrow confines of orthodox rehabilitation and biomedicine. In doing so, we may be able to leverage knowledge and lessons from different disciplines to push forward a more inclusive and environmentally focused future for our profession.
For more information on the content covered in this blog, please check out our new article: Schwab, S.M., Andrade, V., Santos Moreira, T., Cavanaugh, J. T., Vaz, D. V., & Silva, P. L. (2022) Narrowing the physiotherapy knowledge-practice gap: faculty training beyond the health sciences, Physiotherapy Theory and Practice, https://doi.org/10.1080/09593985.2022.2027585
Photo by Polina Skaia on Unsplash.
References
Header image credits: Photo by Jukan Tateisi on Unsplash
Chiel, H. J., & Beer, R. D. (1997). The brain has a body: adaptive behavior emerges from interactions of nervous system, body and environment. Trends in Neurosciences, 20(12), 553-557.
Figueiredo, P. R. P., Silva, P. L., Avelar, B. S., da Fonseca, S. T., Bootsma, R. J., & Mancini, M. C. (2015). Upper limb performance and the structuring of joint movement in teenagers with cerebral palsy: the reciprocal role of task demands and action capabilities. Experimental Brain Research, 233(4), 1155-1164.
Gibson, B. (2016). Rehabilitation: A post-critical approach. CRC Press.
Gibson, J. J. (1979). The ecological approach to visual perception. Psychology Press.
Holt, K. G., Obusek, J. P., & Fonseca, S. T. (1996). Constraints on disordered locomotion a dynamical systems perspective on spastic cerebral palsy. Human Movement Science, 15(2), 177-202.
Nicholls, D.A. (2022). Physiotherapy otherwise. Tuwhera Open Access Books.
Nicholls, D. A., & Gibson, B. E. (2010). The body and physiotherapy. Physiotherapy Theory and Practice, 26(8), 497-509.
Schwab, S. M., Grover, F. M., Abney, D. H., Silva, P. L., & Riley, M. A. (2020). Children and adolescents with cerebral palsy flexibly adapt grip control in response to variable task demands. Clinical Biomechanics, 80, 105149.
Turvey, M. T. (2009). On the notion and implications of organism-environment system. Ecological Psychology, 21(2), 97-111.
Turvey, M. T., & Fonseca, S. (2009). Nature of motor control: perspectives and issues. Progress in Motor Control, 93-123.
Vaz, D. V., Silva, P. L., Mancini, M. C., Carello, C., & Kinsella-Shaw, J. (2017). Towards an ecologically grounded functional practice in rehabilitation. Human Movement Science, 52, 117-132.
This new blog post is based on an excellent article by Sarah Schwab et al.
Congratulations to all the authors who suggest that in order to PROMOTE ECOLOGICALLY GROUNDED PHYSIOTHERAPY and NARROW the PHYSIOTHERAPY KNOWLEDGE-PRACTICE GAP for current and future faculty and students, FACULTY TRAINING needs to EXTEND BEYOND the HEALTH SCIENCES through
POST-PROFESSIONAL EDUCATION in a NON-BIOMEDICAL FIELD (e.g. psychology, education, and philosophy).
The goal is to prepare faculty “to provide students with tools for dealing with complex social issues facing their clients” together with “a deeper theoretical and philosophical understanding of practice”.
In addition to this excellent suggestion which promotes interdisciplinary influences, we can take a further step towards humanizing physiotherapy by embracing all stakeholders to create inclusive Trandisciplinary teams and work towards an environmentally focused justice centered system.
Including clinical therapists and the patient population in the team can be used to help faculty and students alike understand the ‘practicalities of practice’ and learn about the significance of the quality of communication and collaboration in interactive relationships in practice.
“J.J. Gibson, a central figure in the development of ecological psychology, proposed that the environment provides possibilities for action, or affordances.” What a wonderful concept. “Based on an individual’s capabilities, what an environment does or does not afford will differ”.
True but as therapists who engage with our clients in a therapeutic relationship we need to understand we are an important part of the challenged person’s enviroment and as such we need to take responsibility for the ‘Affordances’ or ‘Possibilities for Action’ we present to others and how we do so.
Rehabilitation possibilities can easily be presented as an invitation to participate in a series of ‘adventures’ as we deal with challenges of daily living through collaborative goal directed problem solving in different outdoor settings rather than a series of repetitive exercises in a gym.
Big adventures and small ones are equally meaningful. I had been a physiotherapist for 58 years when I broke my neck & became a quadriplegic at 75. Imagine my joy when I was able to re-enter the ocean as an adaptive surfer 9 months later after much preparation in the hospital pool with my physiotherapist.
Thanks to the team of 12 who carried me into the waves much like the medieval waiters carrying the roast into the banqueting hall on a plank.
Family members, school children, business people, physiotherapists, National Sea Rescue Institute members and surf coaches were all part of the 12 member team who carried me lying prone propped on my elbows with a rolled up life vest under my chest to keep me in position on the surfboard.
And the small adventures? A driver friend took me for a walk seated in my chair bumping along the short board walk (good for activating sitting balance reactions) running along the Hout Bay Coastline over looking the entire bay. While we paused to enjoy the magnificent view we experienced an adfitional moment of awe as a glorious double-collared sunbird alighted on the grey green leaves of a fynbos plant only a metre in front of us and stayed with us posing elegantly for a while.
“One of the key principles of ecological psychology is that the individual-environment system should be considered the irreducible unit of analysis, rather than considering an individual in isolation from their environment.”
So true, particularly if we expand the “Irreducible of analysis” to include “Individual+Team+Environment”
The authors conclude that “experiences are not located only in the individual, but in their intersection with the various contexts in which they are situated.
Best wishes for your ongoing research
Pamela,
Thank you so much for sharing your experiences. Such great insights!
I completely agree that therapists are a critical part of the disability context and need to take responsibility for the affordances provided to those with whom we interact. There is some really interesting work starting to come out about the importance of engaging with mutual affordances (what two people afford to each other) during an interaction. How well we engage with those mutual affordances is crucial in creating positive experiences and interactions for people with disability. More coming soon!
You might be interested in this excellent paper that describes mutual affordances and some early findings in this area:
Toro, J., & Martiny, K. (2020). New perspectives on person-centered care: an affordance-based account. Medicine, Health Care and Philosophy, 23(4), 631-644.