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).
PhD cand, University of Cincinnati
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
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.