Dissecting Movement: Which Came First? Associated Impairments vs. Movement Faults
A question recently landed in our inbox from a faculty member, sparked by a student inquiry within the Physical Disability: Musculoskeletal app. The student, curious and eager to learn, posed the question: Are associated impairments and movement faults the same thing? Let's delve deeper and untangle the cause-and-effect relationship between associated impairments and movement faults. In the realm of orthopaedics, pinpointing the root cause of a patient's limitations is crucial for effective treatment. Our Physical Disability: Musculoskeletal app tackles this by differentiating these two key concepts.
Associated Impairment:
Definition: An associated impairment is a measurable limitation in a physiological system, such as weakness, stiffness, or balance deficits.
Think of it as: A consequence of the injury/pathology or a preexisting impairment or set of impairments that may be contributing to the cause or maintenance of non-optimal movements, leading to tissue stress and production of symptoms. It's the "what" - the measurable dysfunction.
Example: A patient with uncoordinated or weak scapular muscles (associated impairment) contributing to the onset of shoulder impingement during shoulder abduction during a tennis serve.
Movement Fault:
Definition: A movement fault is an observable deviation from optimal movement patterns during functional activities.
Think of it as: A faulty "how" - the way the body compensates for the impairment or moves as a result of impairments. This could be due to pain avoidance, limitations in mobility or improper movement coordination.
Example: A patient with weak scapular muscles might exhibit scapular winging (the scapula is internally rotated) during posture assessment. These movement faults may result in significant tissue stress over time, resulting in patient complaints of pain and loss of function.
Scapular postural assessment anterior tilting, abduction and winging
The Chicken 🐔 or the Egg 🥚?
The question of which comes first - the impairment or the fault - is often complex. Here's a breakdown:
Injury often leads to impairment: The initial injury (e.g., shoulder impingement) directly causes the impairment (e.g., scapular muscle weakness).
Impairment can lead to faulty movement: To compensate for the weakness, the patient might adopt a scapular winging posture (movement fault).
Importance of the Distinction:
Understanding the difference is critical for treatment planning:
Addressing impairments: Techniques like strengthening exercises can target the scapular muscle weakness (impairment).
Correcting faulty movement: Movement re-education can address the faulty scapular position (movement fault).
By effectively differentiating between associated impairments and movement faults, your students can develop a more holistic approach to patient care.
Bonus Tip: The Physical Disability: Musculoskeletal app can be a valuable tool for students to practice identifying these concepts in real-world scenarios.