Eye-Closing, the APTA Movement Screen, and the Mirror System
The documents below are the most current version and an older version of the APTA Movement Screen.
apta-movement-screen new.docxapta-movement-screen old.docxIn the newer version, some descriptors in the "Quality of Movement to Observe" have been removed. One of those entries is "eye-closing." "Eye-closing" as a phenomenon, based on my experience, is a negative prognosticator which negatively impact medically-complex patients when performing tasks on command. When a therapist "stands" this patient up, the therapists effort and attention is completely in just holding the patient up against gravity to maintain standing. Observing for "eye-closing" is the least of their problems. I have always wondered why eye-closing is a negative prognosticator.
ASSUMPTIONS:
Two things might be negatively impacting patient progress with eye-closing.
We use vision to guide our movement by using it as feedback before or during movement. For example, when reaching for an object, our vision directs us to the object. When the object is moved, our vision provides some of the information necessary to re-calibrate the trajectory of our reach. Related to this is the use of vision to compensate for impaired balance and/or proprioception necessary to keep the body upright.
There has been an explosion of interest and research done on the mirror system recently. The mirror system has been used to regain movement among individuals who have had a stroke or who have chronic movement dysfunction. The mirror system are neural substrates which are activated by watching movement . If some individuals are using vision to regain movement, then people who exhibit eye-closing do not get the benefits of using some of the same neural substrates in the mirror system to regain movement.
The only reason why I have been able to consistently recognize eye-closing, and appreciate its significance in physical therapy, is because I have used ASSISTED PRIMING IN SUPINE (APS) exercises. In the supine position, I have been able to consistently observe the presence of this phenomenon which consistently result in poor patient outcomes. I do not think anything has been published about this phenomenon.
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