1986; 66:364-365.PHYS THER. Jules M Rothstein

A Name for Our Times?−−Pathokinesiology

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PATHOKINESIOLOGY.

The purpose of publishing this series of articles is to document a few current concepts and viewpoints related to the topic of pathokinesiology. The opinions expressed here are of some of the invited speakers from "A Symposium on Pathokinesiology: Theory, Research, and Practice" held at the Sixtieth Annual Conference of the American Physical Therapy Associ­ation, Las Vegas, NV, June 17-21, 1984. The Associate Editors and the Editor invited all the speakers of that symposium to adapt their presentations for publication so our readers can ponder and, perhaps, debate one of the most important issues of our times.

The symposium critically addressed the following questions: • Does pathokinesiology have the potential for becoming the basic science of physical

therapy and the source of theory in physical therapy? • What is pathokinesiology? • Why is the concept of pathokinesiology becoming so central to our profession's identity? • What kinds of research questions are being addressed by research in pathokinesiology? • What are the implications of pathokinesiology for our body of knowledge? • What might theory in pathokinesiology be? • What is theory, and what is the role of theory in science? • What are the implications of theory and research in pathokinesiology for the practice of

physical therapy?

Pathokinesiology—A Name for Our Times?

JULES M. ROTHSTEIN

Key Words: Pathokinesiology, Physical therapy.

In a Las Vegas room that could have fit easily into a Boeing 747, a remarkable number of physical therapists took time from other activities of the Sixtieth Annual Conference of the American Physical Therapy Association to listen to a sym­posium on pathokinesiology—its definition and whether the term could be used to describe the profession of physical therapy. I say a remarkable number because, despite the outstanding reputations of the speakers, there was little ad­vanced publicity about the session and, in the midst of the research papers, clinical sessions, and inevitable socializing, it would have been easy to avoid going to what promised to be a philosophical session.

As the session co-moderator along with Sandy Burkart, I looked at the cavernous meeting room and anticipated feeling quite lonely. The several hundred therapists who attended the session showed me that I had misjudged the interests of my peers and that something was going on in our profession that I did not quite understand. For some reason, therapists were taking time to listen to papers on a relatively esoteric subject. Almost all of those papers have been somewhat reworked and are now offered here to a larger audience. Where once I

thought the content of these papers might be of only parochial interest, I now hope that all physical therapists will take the time to read and contemplate these papers and the issues they raise. One effect of the symposium was to convince me that the topic was neither esoteric nor as remote from the everyday practice of physical therapists as I had imagined.

To understand why the topic is of importance, one needs to consider the historical context of the symposium. Nearly a decade earlier in her 1975 Mary McMillan lecture, Helen Hislop had suggested that physical therapy was then in an identity crisis, one that she felt could be lessened if we could collectively accept the idea that pathokinesiology was the distinguishing clinical science of physical therapy.1

Since that lecture, pathokinesiology has become what I consider a professional buzzword. An analogy, perhaps, will make clear what I mean. When a therapist administers passive range of motion one day and decides on another day to call it "basic implementation of manual therapy procedures," he is using the buzzword as a form of elevating jargon. Similarly, when teaching progessively more difficult activities of daily living skills becomes "implementation of a developmental sequence for life skills," a therapist also may be resorting to jargon to create an aura of change that is in reality only a change in name and not in substance.

If one reads the Hislop lecture, it is clear that she gave considerable thought to the meaning and implications of the term "pathokinesiology." Unfortunately, many who have used the term since have not. And that is one reason why the symposium was so important. Clearly, Hislop's intent was not

Dr. Rothstein is Assistant Professor, Department of Physical Therapy, School of Allied Health Professions, Medical College of Virginia, Virginia Common­wealth University, Box 224, MCV Station, Richmond, VA 23298 (USA). Dr. Rothstein and Dr. Sandy Burkart moderated "A Symposium on Pathokinesi­ology: Theory, Research, and Practice" at the Sixtieth Annual Conference of the American Physical Therapy Association, Las Vegas, NV, June 17-21, 1984. This paper was not presented at that symposium; rather, it has been written as an introduction to the revised papers of the participants that are published in this issue.

364 PHYSICAL THERAPY

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PATHOKINESIOLOGY

for schools to change course names so that pathokinesiology could be said to be in the course content but to cause educators to rethink what and how they were teaching. She also meant for pathokinesiology to be a focus for research. In a very real sense, she contended that it could be the center around which our profession organizes all of its activities.

In 1982, the APTA House of Delegates even considered endorsing the term pathokinesiology so that it would have been our official raison d'être. Ironically, this symposium, with its invited speakers bringing their scholarship, pragma­tism, clinical orientations, and biases followed what may be considered the House's political consideration of the topic. Interestingly, one of the prime movers in bringing the motion before the House suggested after the symposium that she then realized that pathokinesiology could no more define physical therapy than pathophysiology could define the medical profession. One may now ponder how the business of the House might in the future be expedited by symposia that deal with critical issues before, rather than after, votes.

So, one of the reasons why all therapists should read the papers presented here is that they reveal something about the decision making process used within our profession. But I suggest there is a more vital reason. The identity crisis Hislop saw a decade ago has worsened. We, as a profession, may be doing more things, but in no way have we developed a true sense of who and what we are. All too often, we are defined by the tasks we do, and, as a result, only those who have seen therapists in practice have the vaguest notion of who and what we are. We have many faces to those who know us and no singular image that we can present to those who do not. My bias is that this is not good, but as can be seen in some of the papers, this concern is not universal.

The papers that follow this essay are a divergent lot. Schlegel urges that we take a pragmatic approach in defining ourselves. Zadai cautions against exclusionary definitions that could splinter us. Because both are primarily clinicians, they speak from the "trenches" and with a conviction that they manifest through the commitment they have to the specialties they practice. That they have no simple solutions means that they have exemplified the perseverance that Purtilo calls for when she warns in her paper that, "The concept of pathokinesiology surely will become chillingly vacuous or be reduced to simply a shrill slogan if physical therapists neglect to engage in a diligent search for its roots and appropriate shape in today's practice of physical therapy."

Smidt, if I may interpret, suggests that, as he has "walked the trail of physical therapy research," he has observed that we have begun to evolve a sense of self that will lead eventually toward an acceptance of terms that can be used to define our profession. Furthermore, he suggests a framework that already

exists. This, in many ways, is in contrast to Rose, who also offers a theoretical framework based on a historical perspec­tive, but who suggests that the process of physical therapy growing into what Kuhn might call a "mature science"2 can be expedited by immediate action. Specifically, he suggests a conference that would develop a Nomina Pathokinesiologica that would unify terminology and give an orienting center to a divergent body of knowledge. On the other hand, Walker suggests that this, to some extent, has begun through the research course taken at the University of Southern California.

Readers can judge for themselves whether the papers that follow show that someday we can collectively define ourselves or whether they indicate that we are not even close to that goal. For that matter, the reader may even determine that definition, now or in the future, is not necessarily a good thing. But because we, as a profession, define our competen­cies, accredit our schools, and judge our ethics and profes­sional standards, this is an issue that will not go away. The ideas presented must be examined critically, rhetoric and unrealistic thinking must be identified, and parochial con­cerns should be noted—but that is your task.

No physical therapist with a sense of history can deny that we have seen fundamental change in our profession in the decade since Hislop's speech. Clearly, that is why so many people came to the symposium. Hislop called her address "The Not-So-Impossible Dream," and in it she described the basis for her dream in the words Pericles spoke to the Ath­enians:

Fix your eyes on the greatness of your profession as you have it before you day by day; fall in love with her; and when you feel her greatness, remember that her greatness was won by people with courage, with knowledge of their duty, and with a vision that all things are possible.1

Ten years later, we still may be inspired to believe that all things are possible. But how can we dream together when the visions are divergent? How can we follow a vision when we do not know what it is? We must realize that our collective task as members of a great profession is to identify those with the visions worth following so that we might be a profession with a face to the world, rather than a consortium of practi­tioners loosely tied together by historical accidents. The pur­pose of the papers that follow is to reflect on this issue that goes to the very heart of whether tomorrow will be ours to shape or merely a recapitulation of yesterday.

REFERENCES

1. Hislop HJ: Tenth Mary McMillan lecture: The not-so-impossible dream. Phys Ther 55:1069-1080,1975

2. Kuhn TS: The Structure of Scientific Revolutions. Chicago, IL, University of Chicago Press, 1962

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1986; 66:364-365.PHYS THER. Jules M Rothstein

A Name for Our Times?−−Pathokinesiology

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