Clinical Reasoning by Expert Bobath Instructors

Background: Clinical reasoning, a complex clinical skill, is central to professional accountability but currently invisible in the rehabilitation sciences evidence base with an associated under-development of underpinning theory. Understanding and minimizing movement problems is a focus of rehabilitation. Movement performance is a key aspect of Bobath clinical practice, the most widely used neuro-rehabilitation approach. To date there are no publications addressing the clinical reasoning process or the conceptualization of movement by Bobath therapists despite considerable investigation of the effectiveness of this rehabilitation approach. Purpose: To address this research gap, this dissertation aimed to develop an interpretive understanding of the clinical reasoning process of expert Bobath therapists. Methods: To accomplish this aim, a modified e-Delphi method was used to define a Bobath Clinical Framework. A qualitative research approach was adopted for the second study using Interpretive Description methodology to explicate a conceptual understanding of movement and the clinical reasoning process of expert Bobath therapists. Results: Eight statements representative of the conceptual framework, and three assumptions and eight principles representing key aspects of clinical practice reached consensus in the modified e-Delphi successfully identifying a Bobath Clinical Framework. Twenty-two IBITA instructors participated in the Interpretive Description study identifying three key elements integral to the instructorsâ conceptualization of movement specifically the integration of postural control and selective movement, and the unique role of visuo-spatial kinesthetic perception, an aspect of practical wisdom, in the clinical reasoning process. Conclusions: The development of a Bobath clinical framework and explication of the Bobath therapistsâ conceptualization of movement formed a practice epistemology exposing and illustrating the critical role of phronesis (practical wisdom), in the clinical reasoning process. This thesis highlights the need for a multi-dimensional knowledge base, procedural and conditional knowledge, in addition to declarative knowledge, necessary for clinicians to make wise judgments with respect to individual clients, the clinical reasoning process.Ph.D.2018-11-30 00:00:0