Every once in awhile a great paper comes along, one that reads as though a mountain climber has stopped struggling for a little while, sits and admires the view, then shares what they notice about it - what it looks like, how it smells and feels; but not just what they perceive - also what they think about what they perceive.
This paper is like that. It didn't just resonate, it jangled every neuron in my brain in a most pleasant way. I read it through, once, and it held my attention right to the last sentence. Not every paper can do that, and frankly, most PT papers are so boring to me I can't get beyond the title. Not this one. Wow. It's absolutely captivating, exciting, scholarly and elegant. I feel another blog series coming on, like the one I did with Melzack and Katz' paper a couple years ago, in 20 parts each with many posts included.
Here is the abstract:
Clinical reasoning is essential in physical therapy practice. Instrumental approaches and more recent narrative approaches to clinical reasoning guide physical therapists in their understanding of the patient’s movement disturbances and help them to plan strategies to improve function. To the extent that instrumental and/or narrative models of clinical reasoning represent impairments as mere physical disturbances, we argue that such models remain incomplete. We draw on a phenomenologically inspired approach to embodied cognition (termed “enactivism”) to suggest that the dynamics of lived bodily engagement between physical therapist and patient contribute to and help to constitute the clinical reasoning process. This article outlines the phenomenologically informed enactive perspective on clinical reasoning, with special reference to clinical work that addresses impairments as sequelae of neurological diseases.
It's about a lot of things, including intersubjectivity.
I have tried to write about that, could only express a fraction of what swirls around inside my head, about how important it is to realize that's as good as we can ever get. But that it is enough. The closest I ever got was delineating interaction as opposed to operative approaches or models. (This paper even has a section titled "Interaction".)
I'll see how much energy I have... I start teaching again in a couple weeks, plus I'm trying to complete the manual and send it away to see if someone will publish it. It's been all uphill, I must say.
Yet I hear this paper calling: I want to devour it one line at a time, digest it into my brain cells like the amazing food for thought it is.
