doi: 10.2522/ptj.2006.0182.0197.0198.ic12007; 87:925-926.PHYS THER. 

Cheryl A Cott and Elspeth FinchSpecial SeriesInvited Commentary on the Movement Continuum

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Invited Commentary Cheryl A Cott, Elspeth Finch

The Movement Continuum Theory(MCT), published in 1995,1 builton Hislop’s notion of pathokinesiol-ogy.2 Our intent was to stimulate dis-cussion and debate about theory inphysical therapy. Although the MCThas received international attention,most notably as an influence on theWorld Confederation for PhysicalTherapy’s international definitionof physical therapy,3 there has notbeen much academic response orfurther theoretical development inthe physical therapy profession, un-like the occupational therapy4,5 andnursing6,7 professions, both of whichhave given considerable attention totheory over the years. A theoreticalframework is an important indicatorof an evolving clinical science,8 andthe arguments we put forward in1995 for the need for a theory ofphysical therapy remain relevant to-day. Allen’s work on further devel-oping the MCT is very welcome, andhopefully her work and this specialseries will encourage others to enterand continue the debate. The follow-ing comments are made in this spiritof advancing debate on physicaltherapy theory.

Perhaps one of the reasons that theMCT has not inspired much empiri-cal research on movement is that theMCT is not actually a theory of move-ment; rather, it is a theory of howphysical therapists conceptualizemovement and approach problemsolving and decision making withtheir clients. We identify movementas the central unifying concept ofphysical therapist practice and at-tempt to distinguish what makesphysical therapy different from othermovement sciences. We put forwardthe MCT as a grand theory of physi-cal therapy, that is, a theory that pro-vides broad conceptualizations andforms the basis for middle-range the-

ories that are more concrete and ad-dress specific problems and issues.We originally intended to write aclinical version of the MCT, but—despite the best of intentions—thisnever transpired. We were very ex-cited, therefore, to see Allen’s pro-posed dimensions that expand theconstruct of movement in the MCTand are consistent with grand the-ory. Her Movement Ability Measure(MAM) is an important step in mov-ing the theory to a more clinical,applied level.

Allen contends that the 6 proposeddimensions of movement (flexibility,strength, speed, accuracy, adaptabil-ity, and endurance) can be appliedbeyond the levels of movement ofthe body part or body to the personin his or her environment. Using amore familiar model, the Interna-tional Classification of Functioning,Disability and Health9 (ICF), theselevels correspond to the levels of im-pairment and activity limitations. Shepresents examples of sports and ac-tivities and of pathologies that can belinked to 1 of the 6 specific dimen-sions (eg, gymnastics, ballet, andflexibility). However, movement atthe level of the person in his or herenvironment, we believe, is too com-plex to be categorized as being rele-vant to only one of the movementdimensions. One could just as easilyargue that accuracy, adaptability,and endurance are key to ballet andgymnastics. This does not diminishthe value of the proposed dimen-sions; rather, it suggests that the fur-ther one moves along the movementcontinuum, the more necessary it be-comes to incorporate all 6 dimen-sions when analyzing movement.Certainly, at the level of the personin society (or participation asdefined by the ICF9), the 6 proposeddimensions are probably inadequate

to capture the complexity and intri-cacies of, for example, the move-ment involved in working for aliving.

The initial identification of the 6 di-mensions does not appear to haveincluded the client’s perspective.The dimensions certainly resonatewith the physical therapy perspec-tive and as such are important con-tributions to a grand theory of phys-ical therapy. Allen, herself, statesthat many respondents rate all di-mensions similarly, and, for some,this may be because they are notdescribed in terms that are meaning-ful to them. It would be very inter-esting to conduct qualitative workwith clients to explore how they un-derstand movement and then to tryto reconcile their perspectives withthe physical therapy view in order todevelop dimensions that incorporateboth perspectives. For example,rather than strength and flexibility,clients might talk about ease ofmovement, as they may not differen-tiate among strength, weakness, stiff-ness, and lack of range of motion,particularly if their impairments aremoderate. In a similar vein, the cli-ents for the psychometric testing ofthe MAM were sampled from a rela-tively healthy population with fewmovement impairments. It will beimportant to validate the tool withclients with physical impairmentsprior to its utilization in research andpractice.

These considerations reflect a no-ticeable change in physical therapistpractice since the publication ofthe MCT—the rise of a discoursein rehabilitation about client-centeredness.10 The MCT is consis-tent with this discourse. For exam-ple, when goal setting using theMCT, the starting point is to identify

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the client’s goals, specifically, the cli-ent’s preferred movement capacity(PMC).11 Despite our reservations asto the extent to which the 6 pro-posed dimensions represent the cli-ent’s or the therapist’s perspective,the exciting thing about Allen’s workis that her measure captures informa-tion about both the PMC and thecurrent movement capacity (CMC)and, as such, may allow for the mea-surement of the PMC/CMC differen-tial. Figures 2 through 7 in the firstarticle in the Movement ContinuumSpecial Series nicely illustrate thePMC/CMC differential in differentclients and emphasize the im-portance of considering the client’sperspective when goal setting. Forexample, on a purely objective basis,the 72-year-old man may have lessmovement ability than the 25-year-old athlete. However, in terms ofexpectation of movement, the olderman appears quite satisfied withhis movement in the 6 dimensions,whereas the young athlete identifiesa quite significant PMC/CMC differ-ential. Unfortunately, Allen does notsuggest how she proposes to use thePMC data or further develop themeasurement of the PMC. A discus-sion of how the MAM might be usedto measure the PMC/CMC differen-tial and of the further work neededto achieve this would be welcome.

Another major change in physicaltherapist practice since the publica-tion of the MCT has been the rise ofevidence-based practice and the useof outcome measures. Most of theoutcome measures currently in usefocus on measuring the CMC or us-ing normative data12 to help predicta client’s potential (eg, maximumachievable movement potential).There are fewer available measuresthat capture the client’s perspectiveon achievement of outcomes. Allen’s

measure has the potential to fill animportant measurement gap in phys-ical therapist practice where the fo-cus is often on the acquisition ofmotor skills to improve functionalabilities, with little attention on en-abling the client to regain formerroles and meaningful activities.11,13

For example, whereas clients follow-ing stroke define recovery in termsof returning to the life they livedbefore their stroke14 and the activi-ties that give them identity and con-trol,13 physical therapists tend to fo-cus on improvements in physicalfunction and the ability to performbasic care tasks.13,15 This disparitybetween what is important to clientsand to physical therapists needs tobe addressed if we are to truly be aclient-centered profession.

In closing, we believe the MCT re-mains relevant as a grand theory ofphysical therapy. As such, it maynot readily lead to the developmentof specific hypotheses and proposi-tions at the clinical level, but itcan be used to guide research andeducation around physical therapistpractice. We are excited aboutthe possibilities inherent in Allen’swork, both in expanding our under-standing the construct of movementwithin the MCT and in the develop-ment of a measure that has the po-tential to explore the PMC and thePMC/CMC differential.

CA Cott, PT, PhD, is Associate Professor, De-partment of Physical Therapy, Faculty ofMedicine, University of Toronto, 160-500University Ave, Toronto, Ontario, CanadaM5G 1V7. Address all correspondence to DrCott at: cheryl.cott@utoronto.ca.

E Finch, BScP&OT, MHSc, is Assistant Profes-sor, School of Rehabilitation Science, Mc-Master University, Hamilton, Ontario,Canada.

DOI: 10.2522/ptj.2006.0182.0197.0198.ic1

References1 Cott CA, Finch E, Gasner D, et al. The

movement continuum theory of physicaltherapy. Physiother Can. 1995;47:87–95.

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

3 World Confederation for Physical Thera-py. Declaration of Principle and PositionStatements. Available at: http://www.wcpt.org/common/docs/WCPTpolicies.pdf.

4 Canadian Association of OccupationalTherapists. Enabling Occupation: An Oc-cupational Therapy Perspective. Ottawa,Ontario, Canada: CAOT Publications ACE;1997.

5 Law M, Cooper B, Strong S, et al. ThePerson-Environment-Occupation Model:a transactive approach to occupationalperformance. Can J Occup Ther. 1996;63:9–23.

6 Watson J. Nursing—Human Science andHuman Care: A Theory of Nursing. Sud-bury, Mass: Jones and Barlett Publishers;1999.

7 Parse RR. Illuminations: The Human Be-coming Theory in Practice and Research.Sudbury, Mass: Jones and Barlett Publish-ers; 1999.

8 Richards CL. Enid Graham Memorial Lec-ture: Physiotherapy and the rehabilitationsciences. Physiother Can. 2005;57:34–47.

9 International Classification of Function-ing, Disability and Health: ICF. Geneva,Switzerland: World Health Organization;2001.

10 Cott CA. Client-centred rehabilitation: cli-ent perceptions. Disabil Rehabil. 2004;26:1411–1422.

11 Cott CA. Goal setting. In: Pickles B, Comp-ton A, Cott CA, et al, eds. PhysiotherapyWith Older People. Philadelphia, Pa: WBSaunders Co; 1995:189–196.

12 Finch E, Brooks D, Stratford PW, Mayo N.Physical Rehabilitation Outcome Mea-sures II. Toronto, Ontario, Canada: Cana-dian Physiotherapy Association; 2002.

13 Tyson S, Turner G. Discharge andfollow-up for people with stroke: whathappens and why. Clin Rehabil. 2000;14:381–392.

14 Doolittle ND. A clinical ethnography ofstroke recovery. In: Benner P, ed. Inter-pretive Phenomenology: Embodiment,Caring and Ethics in Health And Illness.Thousand Oaks, Calif: Sage; 1994:211–229.

15 Ellis-Hill C, Payne S, Ward C. Self-bodysplit: issues of identify in physical recoveryfollowing a stroke. Disabil Rehabil. 2000;22:725–733.

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doi: 10.2522/ptj.2006.0182.0197.0198.ic12007; 87:925-926.PHYS THER. 

Cheryl A Cott and Elspeth FinchSpecial SeriesInvited Commentary on the Movement Continuum

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