PTJ -- Rapid Responses for Scheets et al., 0 (2007) 200503491-0

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Focus on Diagnosis:
Patricia L Scheets, Shirley A Sahrmann, and Barbara J Norton
Use of Movement System Diagnoses in the Management of Patients With Neuromuscular Conditions: A Multiple-Patient Case Report
PHYS THER 2007; 0: ptj.20050349v1-0 [Abstract] [PDF]

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Rapid Responses published:

One clinician's initial reactions: David J. Smyntek (11 July 2007)

One clinician's initial reactions 11 July 2007

David J. Smyntek,
physical therapist
none
Send rapid response to journal:
Re: One clinician's initial reactions

davesmyntek{at}yahoo.com David J. Smyntek

So far, I have only read the introduction and first case report. As a clinician in acute rehabilitation, I am interested in a cross-section of patient "types," particularly severity. The 3 individuals described seem to reflect that, and that is much of the appeal of the article. Many articles describe cases that are rare or simply unlike the "typical" patient seen by my colleagues and me.
The second appealing aspect of the article--and I am curious if it will be mentioned in the discussion--refers, at least indirectly, to the quality and quantity and applicability of the "evidence" supporting whatever intervention is chosen. I was intensely pleased that the authors had the courage to specify "logic" as part of the basis for choosing the intervention. Duh! Given the nature of current evidence, logic seems to be a strong rationale, coupled with clinical experience (also mentioned) and awareness of fundamaental principles of exercise, physiology, pathology, and motor learning.
Finally, I wonder about the unavoidable effect/impact of spontaneous recovery. Particularly regarding the first case report, I strongly suspect that the individual might/would have recovered uneventfully without physical therapy. I do commend what was done as appropriate and beneficial, but I just do not know how to value its impact when blended with the body's own recovery processes.
I am hopeful that the remainder of the article meets my expectations as a realistic portrayal of patients with a reassuring and clear approach to how and why to intervene.
Dave Smyntek, PT