Any PT or PT student that knows me has heard me say “experts do the basics extraordinarily well.” In fact, this is the motto of my teaching approach for entry-level students, guiding students through foundational psychomotor skills such as the neuromotor screen (dermatomes, myotomes, reflexes), manual muscle testing and goniometric measurement. I harp on doing these in a standardized and confident fashion with intent and purpose. I preach to them that these foundational skills pave the way for other psychomotor skills that involve our hands. The students, as they get more reps in performing these skills, become confident and feel prepared to apply these in the clinical realm.
Have I created an ivory-tower world view?
Let’s now shift from the entry-level environment to the clinical trenches. A PT is performing an evaluation on a patient who has a condition effecting her lower extremities and is performing a neuromotor screen. As the PT is running through the exam, he is performing distal dermatomal assessment with the patient’s shoes on. Better yet, in non-accurate locations. In the next room, the PT is performing myotomal screening, yet is documenting findings as a numeric grade (i.e. 3, 4+, etc.). Then there is the therapist who is measuring hip flexion ROM and slaps the goniometer on the lateral hip without any fine tuning of the distal and proximal landmarks. These are not examples of experts doing the basics well. Students and new graduates, coming into the trenches with their slates blank, are now subjected to this lackluster performance. I can only imagine what they might be thinking – that this is another example of a “perfect world” picture of what happens in the clinic.
The Current State of Affairs
This quite honestly makes me sad and frustrated. It seems we all too often work to refine our manual skills or go through hours of continuing education to learn some specific type of intervention, yet we can’t even perform a manual muscle test through a standardized procedure with any reliability or validity. Is Florence Kendall rolling in her grave?
The last thing we all want to do in any continuing education course or program is review a neuro screen or goniometric measurements, but maybe we should? Maybe we should start taking blood pressures without using a machine. Maybe we should start caring about the difference between a manual muscle test and myotomal screening. Maybe we should take the time to refine those landmarks during goniometric assessment.
The current state from my point of view is that we are not doing the basics well. This is a call for us to bring our attention to the basic skills that are foundational to the very skills that we spend the most time working on. Maybe if we did, we wouldn’t have to spend as much time trying to refine them.