Phys ther 1986-purtilo-372-4

Proposing 6 Dimensions Within the Construct of
Movement in the Movement Continuum Theory
Diane D Allen
PHYS THER. 2007; 87:888-898.
Originally published online May 15, 2007
doi: 10.2522/ptj.20060182

The online version of this article, along with updated information and services, can be
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Movement
Continuum Theory

Proposing 6 Dimensions Within the
Construct of Movement in the
Movement Continuum Theory
Diane D Allen
DD Allen, PT, PhD, is Adjunct As-
sociate Professor, Department of
Physical Therapy, Samuel Merritt
Background and Purpose
College, Oakland, Calif, and Post- The Movement Continuum Theory (MCT) provides a potential basis for movement
Doctoral Fellow, Health and Dis- assessment and intervention, but “movement” lacks specificity. The purposes of this
ability Research Institute, Boston study were to propose and evaluate a subdivision of movement into multiple
University, Boston, Mass. Address
all correspondence to Dr Allen at:
dimensions.
allendianed@gmail.com.
Subjects
[Allen DD. Proposing 6 dimen-
sions within the construct of A convenience sample of 318 adults completed a 24-item self-report measure of
movement in the Movement Con- movement ability.
tinuum Theory. Phys Ther.
2007;87:888 – 898.] Methods
© 2007 American Physical Therapy A multimethod approach was used to identify, operationalize, and test a multidimen-
Association sional model of movement. Data analysis included a comparison of the fit of uni-
dimensional and multidimensional models using item response theory methods and
inspection of response patterns.

Results
A model specifying 6 dimensions—flexibility, strength, accuracy, speed, adaptability,
and endurance—fit respondent data significantly better than the unidimensional
model, even with high pair-wise correlations between dimensions. Response patterns
showed large differences rather than uniform scores across dimensions for over half
of the respondents.

Discussion and Conclusion
Subdividing movement into the proposed dimensions fits the data and potentially
strengthens the usefulness of the MCT as a theoretical foundation for managing
movement effectively.

Post a Rapid Response or
find The Bottom Line:
www.ptjournal.org

888 f Physical Therapy Volume 87 Number 7 July 2007

Dimensions of Construct of Movement in the Movement Continuum Theory

T
he Movement Continuum The- identify appropriate interventions. level on the continuum) and for iden-
ory (MCT),1 first published in The purposes of this study were to tifying physical, psychological, so-
1995, establishes links among propose a multidimensional model cial, and environmental factors that
movement sciences, the movement of movement as an extension of the influence the movement,1 these as-
capability of individuals, and the role MCT and to perform an initial evalu- pects of observable behavior do not
of movement specialists in maximiz- ation of this new model of require redundant description. Only
ing people’s movement capability. movement. the movement itself requires further
The MCT1 presents movement as the specification.
central unifying construct for the as- Literature Review
sessment and management of move- The MCT presents 3 general and 6 The specification of multiple subdi-
ment and movement disorders in- physical therapy principles that link visions or dimensions of movement
stead of the common clinical movement science with movement has support in the movement sci-
practice of focusing on function or capability and clinical practice.1 In ence and clinical literature. Clinical4
disability.2 Its authors proposed it as essence, movement, defined as an and motor control5 sources present
a possible grand theory of physical actual change in position, occurs at strength, flexibility, proprioception,
therapy,1 but the MCT and its prin- multiple interacting levels along a and coordination as candidates for
ciples can enhance the understand- continuum from microscopic to the intervention following orthopedic or
ing of movement and potential inter- level of a person acting in society. neurologic pathology. Some of these
ventions by other professions as Each level is influenced by physical, sensorimotor aspects overlap with
well. social, psychological, and environ- the list that Hedman et al6 compiled
mental factors. Physical agents and as the “components of movement”
Despite broad relevance and a need therapeutic exercise generally have or that Majsak7 identified as con-
for theoretical foundations for clini- entry points at the tissue level or straints delineating the “range of
cal practice,1,3 the MCT has inspired higher, but because the levels inter- movement behaviors.” Additional
little empirical research since its in- act, these interventions can affect overlap and alternative ways of spec-
troduction. In a search of CINAHL molecular and cellular movement as ifying aspects of movement appear
and MEDLINE databases as of August well as body part and person move- in Craik’s discussion of issues for de-
2005, none of the 24 articles refer- ment. The MCT specifies that each fining normal motor behavior8 and
ring to the MCT since its publication person has maximum, current, and the classification that Scheets et al9
contained accounts of prospective preferred movement capabilities. If a formulated for diagnosing impair-
testing of the MCT or any hypothe- movement specialist successfully ad- ment of the movement system. Each
ses stemming from it. dresses movement problems with a of the movement aspects and com-
patient or client, then current move- ponents mentioned in these sources
This study initiates testing of the ment capability will increase and the could contribute to a multidimen-
MCT in a direction that could ease gap between current and preferred sional model of movement.
the application of this theory to em- movement capabilities will narrow.1
pirical research. In this study, the Phases of Study
construct of movement is subdivided Testing the principles presented by This article describes 3 phases of a
into multiple components or dimen- the MCT requires an assessment of multimethod study. The purposes
sions that may prove more readily people’s current and preferred were to formulate and evaluate a
measurable than the singular generic movement capabilities and the effect multidimensional model of move-
movement construct presented in of intervention on them. The con- ment to extend the MCT. In the iden-
the MCT. A multidimensional model struct of movement as presented in tification phase, components of
such as the model proposed here the MCT, however, is too generic for movement from the literature were
may stimulate both the generation of clinical assessment. Specifying subdi- evaluated on the basis of a set of
testable hypotheses and the associa- visions or dimensions of movement criteria for inclusion into an econom-
tion of current evidence of effective- may assist in identifying clinically ical model. In the operation phase,
ness with a unified theory. A multi- measurable constructs that have a the set of dimensions and the MCT
dimensional model of movement definitive relationship to the move- formed the basis of a new measure
also may promote the characteriza- ment capabilities presented in the constructed to incorporate both ge-
tion of people’s different movement MCT. Because the MCT already pre- neric and multidimensional con-
abilities, enhancing the specificity sents a framework for identifying structs of movement. In the test
with which clients and movement what part of the person moves (eg, phase, data were collected with the
specialists can pinpoint deficits and at the tissue, body part, or person new measure. The proposed multi-

July 2007 Volume 87 Number 7 Physical Therapy f 889


dimensional model then was com- A comparison of possible movement Operation Phase:
pared with a unidimensional model dimensions with the criteria led to Method and Results
of movement and with a multidimen- the addition, modification, or elimi- The next step in determining the
sional model with randomly attrib- nation of candidates. Tables 1 and 2 usefulness of this set of dimensions
uted dimensions. Because the phases show comparisons of the first 4 cri- was to construct or locate measures
necessarily occurred sequentially, teria with the proposed (Tab. 1) and for assessing movement. If the same
the results follow the method for some of the rejected (Tab. 2) candi- measure could evaluate both generic
each phase in sequence. dates for movement dimensions. The and multidimensional movements,
fifth criterion implies that people then it would facilitate the direct
Identification Phase: can differentiate among and use the comparison of a generic or overall
Method and Results various dimensions in their observa- idea of movement with the dimen-
Generating the set of potential move- tions and descriptions of movement. sions of movement proposed in the
ment dimensions consisted of setting Testing this implication or otherwise model. In addition, because the MCT
evaluative criteria, identifying from providing evidence of understanding and the proposed model apply to a
literature sources common features of any of the movement dimensions broad range of ability levels and to
of movement to propose as candi- will require empirical data. the movements of people with or
dates, and comparing those candi- without pathologic conditions, the
dates with the criteria to ensure The resulting set of dimensions in- ideal measure for comparing generic
alignment. The criteria for potential cludes flexibility, strength (force ex- and multidimensional constructs
dimensions of movement to extend erted), accuracy, speed, adaptability, would apply to a similar range. Many
the MCT included the following: and endurance. These 6 dimensions measures of movement exist for test-
describe observed movement com- ing individual dimensions, specific
(1) Descriptive: The complete set of prehensively and efficiently (criteria diagnostic groups, or particular body
dimensions, with an added refer- 1 and 2). The proposed dimensions parts exist, but few existing mea-
ence to the body parts or sub- of flexibility, strength, and speed ap- sures assess generic movement abil-
stances doing the moving, ply to all human movement; accu- ity or apply to multiple groups or
should fully describe normal hu- racy applies specifically to purpose- across the proposed dimensions.
man movement, a series of ful movement; and adaptability and
movements, or actively holding endurance apply to movement when Generation of the self-report Move-
a position against a force. encountering unexpected obstacles ment Ability Measure (MAM) opera-
or when approaching the limits of a tionalized the MCT and the proposed
(2) Efficient: The set of dimensions person’s capacity. All of these dimen- model and facilitated direct compar-
should describe movement effi- sions have direct relationships with ison of unidimensional and multi-
ciently, subsuming related con- but remain distinct from the physi- dimensional models of movement.
cepts, with the fewest number cal, psychological, social, and envi- For addressing a generic or uni-
of separate dimensions while ronmental factors that influence dimensional construct of movement,
completely describing movement. movement (criterion 3). Each candi- all items in the MAM were given a
date dimension can be measured similar item construction and stan-
(3) Distinct: The dimensions should clinically (criterion 4). Although fur- dard levels of item responses. If peo-
identify observable features of ther research may justify modifica- ple marked every item with the same
movement distinct from the part tion of this set, these 6 dimensions level of response, then a generic
of the body doing the moving or provide a starting point for charac- movement construct could specify
different physical, psychologi- terizing movements readily observed their movement ability quite ade-
cal, social, or environmental fac- by movement specialists and their quately. For addressing a multi-
tors that influence movement. patients or clients (toward criterion dimensional construct of movement,
5). In addition, these 6 dimensions variations in the wording of items in
(4) Measurable: The dimensions present interesting possibilities for the MAM referred specifically to the
should be measurable. categorizing movement abilities 6 proposed dimensions of move-
maximized by athletes or performing ment. If people marked items associ-
(5) Understandable: The dimensions artists or diminished in people with ated with one dimension quite differ-
should make sense to both a particular pathologic condition ently from items associated with
movement specialists and their (Tab. 3). other dimensions, then specification
patients or clients. of their ability on that dimension



Table 1.
Proposed Movement Dimensions Aligned With 4 Criteria

Dimension Descriptive (eg, Efficient (Summarizes Distinct (Requires, But Measurable (Can Be
Ascending and Subsumes These Is Distinct From, Each of Assessed With These
Stairs) Related Concepts) These Physical Factors) Clinical Measures,
Among Others)
Flexibility4 Extent and ease of Extent of linear or angular Appropriate muscle stiffness, Range of motion (goniometer
movement at displacement, range of muscle tone,6,7 and or electrical potentiometer)
joints to reach motion,8,9 amplitude, muscle length7; joint and and extent of movement
next step ease of movement, and ligament integrity; and (video or optoelectric
mobility6 skin and connective tissue systems)
integrity
Strength4 Force to propel or Force behind Appropriate number, size, Myometry, manual muscle
withstand displacement, force and type of muscle fibers; testing, force transducer,
against forces to generation,6,8 and muscle integrity and and electromyographic
lift mass tension generation recruitment7; and neural amplitude (relative to
integrity maximum)
Accuracy Attainment of Direction and timing of Cerebellar integrity and Distance between result of
target position displacement, neuromuscular integrity movement and target; error
on each coordination,6,7,9 timing scores; distance or number
subsequent step and sequencing,7,9 of deviations from target
fractionating or trajectory; and synchrony
isolating movement,9 with a timing target,
and selective capacity6 cadence, and
electromyographic timing
Speed6,8,9 Velocity of ascent Speed of displacement Neuromuscular integrity and Distance divided by time and
of steps and velocity biomechanical integrity cinematography
Adaptability Change when Adjustment during Sensory integrity, reflexes,7 Sensory integration tests and
unexpected displacement, and integrity of reaction times following
step height or adaptation to sensorimotor cortical areas encounter of unexpected
texture is environmental and pathways stimuli
encountered changes,5 adaptive
capacity,6 and
sensorimotor
interaction7
Endurance6–8 Persistence of Continuation through Cardiopulmonary health and Duration plus extent of
ascent up all completion of vascular integrity movement, perceived
steps without displacement, exertion, and change in
flagging persistence, and cardiopulmonary measures
perseverance or vital signs

could enhance the description of The MAM was developed and tested would like to be able to move. Three
their movement ability. for reliability and for content and sample items and instructions are
construct validity with procedures shown in Figure 1. The MAM in-
The self-report format allowed sub- recommended by Wilson10; evi- cluded 4 items for each of the 6 di-
jects to interpret movement as a dence of reliability and validity is pre- mensions, for a total of 24 items. The
whole or differentiate movement di- sented elsewhere (see the article by same instructions applied to all
mensions within the context of their Allen on the validity and reliability of items. Consistency of responses
own lives. The MAM placed minimal the Movement Ability Measure in across items was high, with person
constraints on subject interpreta- this Special Series).11 Each item in separation reliability ranging from
tion. In avoiding the specification of the MAM consisted of 6 statements .92 to .96 for the 6 dimensions and
tasks that may have limited relevance indicating levels of movement abil- equaling .98 for the whole measure.
across groups, the MAM also applied ity. Respondents were instructed to
to a broad range of subjects across choose the statement that most Test Phase: Method
movement ability levels and with or closely matched how they thought For the test phase, a heterogeneous
without pathologic conditions. they moved now and how they sample of people completed the



Table 2.
Representative Movement Features Not Aligned With Criteria

Feature of Movement Unmet Criteria
Posture6,7 Efficient and distinct: posture, when active, as during holding of a
position against a force such as gravity, can be described
adequately with a combination of other dimensions; when
passive, it influences but does not describe subsequent
movement
Balance6 Efficient: balance is a complex set of sensorimotor activities that
can be described with a combination of the proposed
dimensions, such as adaptability, strength, and flexibility
Cognitive capacity,6 psychological capacity,6 ability to learn,9 Distinct and descriptive: these psychological factors influence
and motivation and alertness7 movement and the intention behind movement but do not
describe movement itself
Pain6 Distinct and descriptive: pain, perhaps a physical or psychological
factor influencing movement, does not describe movement
itself
Alignment, center of mass, and base of support7 Distinct and descriptive: these physical (biomechanical) factors
influence movement but do not describe movement itself
Proprioception,4 sensory modalities,9 perception of vertical,9 Distinct and descriptive: sensation and perception are physical
perception of motion,9 and sensory information6 and psychological factors that influence the ability to learn
movement or to adapt to an environment but do not describe
movement itself

MAM. The expectation was that multidimensional model would fit tain a heterogeneous representation
most people who move normally the data better than a unidimensional of movement abilities. Adults volun-
might perceive themselves to have model. The proposed multidimen- teered from religious and commu-
about the same level of movement sional model was compared with a nity groups, personal contacts, a col-
ability on all 6 dimensions; therefore, unidimensional model and with a lege sports team, physical therapy
a unidimensional model would fit multidimensional model in which outpatient clinics, and a senior day
the data very well. If people perceive items were randomly assigned to activity event. In addition to the
differences in the effects of different dimensions. MAM, respondents completed a
dimensions on their movement abil- cover sheet of information about
ity, then they might respond quite Recruitment of volunteers to re- health status and any movement
differently to items associated with spond to the MAM targeted a broad problems. Respondents were in-
those dimensions. In this situation, a spectrum of groups in order to ob- formed that completing and return-
ing the questionnaire constituted
consent for their (anonymous) re-
Table 3. sponses to be included in the study.
Proposed Dimensions and Sample Activities or Pathologies Relevant to Each

Dimension Sport or Activity Pathology The data were analyzed with item
Flexibility Gymnastics, ballet Arthritis, Parkinson disease response theory (IRT) methods12
and ConQuest13,* software, and only
Strength Weight lifting, moving furniture Muscular dystrophy, stroke, peripheral
nerve injury
the “now” responses to items were
analyzed. Two models were com-
Accuracy Archery, tap dancing Cerebellar disease
pared. One model assigned all items
Speed Sprinting, piano playing Parkinson disease, other diseases of to 1 dimension in a unidimensional
the basal ganglia, loss of fast-twitch construct; the other assigned items
muscle fibers
to the 6 dimensions in a multidimen-
Adaptability Skiing, tennis, juggling, reactive Sensory or perceptual loss from sional construct. Fit was analyzed on
balance auditory, visual, vestibular, or
the basis of the differences in the
somatosensory systems
Endurance Running a marathon, singing an Cardiovascular or pulmonary diseases
* Australian Council for Educational Research,
opera
Hawthorn, Victoria, Australia.



deviances and the numbers of pa-
rameters (obtained from ConQuest)
by use of the G2 likelihood ratio sta-
tistic. For a more complex (multidi-
mensional) model to fit better than
a simpler nested (unidimensional)
model, it must result in a lower de-
viance (a measure of lack of fit of the
data to the model) than can be ac-
counted for simply by the greater
number of parameters estimated.
The difference between the devi-
ances for the 2 models functions like
a chi-square distribution with the dif-
ference in the number of parameters
as the degrees of freedom. Correla-
tions also were obtained for each pair
of dimensions in the multidimensional
model.

To assess whether any multidimen-
sional model would fit better than
the unidimensional model for these
data, a random multidimensional
model was generated, with items as-
signed randomly, but without repli-
cation, to generic dimensions. That
is, no more than one item from any
proposed dimension was allowed
per generic dimension. This random
multidimensional model also was
compared with the unidimensional
Figure 1.
model with the G2 likelihood ratio Example of 3 Movement Ability Measure items directed toward the dimensions of
statistic as described previously. flexibility, speed, and strength. Respondents were instructed to choose the one state-
ment within each box that most closely described their usual ability to move now, this
In addition to the comparisons of week, and the one statement that most closely described the ability that they would like
models with the G2 statistic, the pat- to have even if they had to work hard for it. They were instructed to mark one number
on the left (Now) and one number on the right (Would Like) for each set of 6
terns of responses of individual re-
statements.
spondents were examined. Examin-
ing uniform or uneven patterns of
responses across dimensions might
provide insight into the constructs in dimensions (d) for each person p, as movement ability on at least one of
the proposed model. A sum of follows: the dimensions to be quite different
squares indicator, DI, was calculated from the average of the rest. Repre-
sentative respondents with low and
͸ ͓͑␪៮ Ϫ ␪ ͒ ͔
to indicate the sizes of the differ- 6

ences in responses across dimen- DI p ϭ d
2 high DI values were selected; move-
sions.14 For this calculation, move- dϭ1 ment ability plots (MAPs) depicted
ment levels and respondent abilities the asymmetry of dimensions for
(␪) were examined in logits, the log If the sum of the squared deviations these selected respondents with low
of the odds of choosing the state- from an average estimate is low, then and high DI values. Designation of
ment indicating a given level of that person perceives his or her low and high DI values within any
movement ability within each item. movement to be about the same particular study is arbitrary.15 For
The DI sums differences from move- across all 6 dimensions. If DIp is this study, the lowest and highest
ment ability estimates across the 6 high, then that person perceives average logits for any dimension



side of their respective 98% confi-
dence intervals (standard errors for
average dimension estimates were
about 1 logit), and the spread signi-
fied at least 0.5 and up to 1.25 move-
ment ability level differences be-
tween the dimensions. At a DI value
of 5.3, 165 (52%) of the respondents
showed differences between the di-
-6 mensions of movement rather than a
uniform average across dimensions.
-11 Movement ability plots of sample
cases (Figs. 2, 3, 4, 5, 6, and 7) cho-
sen to represent low and high DI
values depict dimensional abilities in
logits along 6 respective axes in a
hexagon (range for all axesϭϪ11 to
ϩ9 logits). Greater asymmetry indi-
cates larger differences between di-
mensions. Demographic information
is provided when known from re-
sponses and comments on com-
pleted questionnaires.
Figure 2.
Respondent 201 reported low movement ability (low logit values) on all dimensions. Discussion and Conclusion
This respondent was an 86-year-old woman who reported that she was “clumsy” and The 3 phases of this study resulted in
had low back problems. The sum of the squared deviations from an average dimen- a proposed set of dimensions to ex-
sional logit value, DI201ϭ0.47 logit2.
tend the construct of movement
within the MCT. The proposed di-
mensions included aspects of move-
were inspected for each respondent; tidimensional model fit significantly ment that were described in the lit-
the DI cutoff was assigned to the better than the unidimensional erature and that were aligned with
value above which all respondents model (␹225ϭ280.9, PϽ.0001), even evaluative criteria. Testing the pro-
had differences from their lowest to with high internal consistency across posed dimensions required the con-
their highest dimensions that were all items (Cronbach ␣ϭ.94) and high struction of a new measure targeting
large enough to be outside of a 98% correlations between pairs of dimen- these movement constructs along
confidence interval. tions (rϭ.87–.99). In contrast, when with a generic movement construct.
items were randomly assigned to 6 Model comparisons carried out with
Test Phase: Results generic dimensions, the multidimen- data obtained with the new measure
A total of 318 adults completed the sional model fit no differently than showed that the proposed multidi-
MAM. Respondent ages ranged from the unidimensional model (␹225ϭ mensional model fit better than a
18 to 101 years, with modes (10 23.3, Pϭ.56). unidimensional model.
each) at ages 49 and 76. Women con-
stituted 206 (65%) of the respon- When response patterns were exam- Despite the dimension-specific
dents; 178 (56%) acknowledged at ined with the DI statistic (meanϭ wording of the MAM, many respon-
least a little movement difficulty in 9.25 logits2, standard deviationϭ dents provided no discernible indica-
the previous week. Forty-six respon- 11.62), 5.3 logits2 was designated as tion that their movement was differ-
dents (14%) indicated that they were the cutoff between low and high. No ent across dimensions. For them,
starting or undergoing physical ther- person who had a DI value above responses across the dimensions in-
apy at the time of responding to the this cutoff had less than 2.5 logits dicated about the same level of
MAM. between the lowest and the highest movement ability, although that
average dimension estimates. At 2.5 movement ability might have been
With items specifically assigned to 6 logits, the lowest and highest aver- low or high, as shown in Figures 2
corresponding dimensions, the mul- age dimension estimates were out- and 3. The associated demographic



data indicated that symmetry in re-
sponses across dimensions might
have been associated with debilita-
tion or physical capability in general. 4

For more than half of the respon-
-1
dents in this study, MAM responses
were different across dimensions.
Some respondents showed excep-
-6
tionally low levels of ability on some
dimensions (Figs. 5 and 7), and
others showed exceptionally high -11
levels of ability on 1 or 2 dimensions
(Fig. 6). These responses imply suf-
ficient understanding of the dimen-
sions in the MAM to reflect con-
sistent differences (with person
separation reliability ranging from
.92 to .96) across designated groups
of items. This is initial evidence that
this set of dimensions may meet cri-
terion 5. Determining whether such
differences across dimensions have
clinical meaning depends on future Figure 3.
research. Comparing the demo- Respondent 244 reported high movement ability on all dimensions. This respondent
graphic data to the MAPs suggested a was a 72-year-old man who was healthy. The sum of the squared deviations from an
link between responses and respon- average dimensional logit value, DI244ϭ3.15 logits2.
dent characteristics rather than ei-
ther uniform or random responses to
items.
4

Although these results provide some
initial evidence supporting the sub-
-1
division of the movement construct
of the MCT into the 6 proposed di-
mensions, validation of the proposed -6
model requires further research. For
example, the MAM deliberately al-
-11
lowed respondents to interpret
items without specifying standard
tasks; this property increased its ap-
plicability across individuals with dif-
ferent experiences of functional ac-
tivities but restricted the absolute
comparison of one individual with
another or of MAM responses with
instrumented measures. To deter-
mine whether differences in per-
ceived movement ability correlate
with measurable differences in di-
Figure 4.
mensions, future research might ex-
Respondent 39 reported higher movement ability on flexibility, strength, and endur-
amine the association between MAM ance and lower movement ability on accuracy, speed, and adaptability. This respondent
responses and performance-based was a 65-year-old man. The sum of the squared deviations from an average dimensional
measures or clinicians’ judgments of logit value, DI39ϭ28.22 logits2.



movement ability. To determine
whether the magnitude of perceived
movement ability has meaning, fu-
ture research might examine group
data for each dimension and com-
pare healthy control subjects with
subjects who have identified defi-
ciencies. To explore the possible
clinical meaning of the proposed di-
mensionality, future research might
examine people before and after
-11
therapy to determine whether those
who respond well to therapy started
with a generic lack of movement
ability across all dimensions or a spe-
cific and predictable lack of move-
ment ability in one dimension or a
few dimensions. Further research
also might indicate that MAPs reveal
identifiable patterns of asymmetry
for certain clinical groups.

Asymmetry across different dimen- Figure 5.
sions should follow predictable pat- Respondent 186 reported moderate movement ability on adaptability and much lower
terns according to the proposed mul- movement ability on the other dimensions, especially flexibility. This respondent was a
76-year-old woman who had had a stroke. The sum of the squared deviations from an
tidimensional model of movement. average dimensional logit value, DI186ϭ68.34 logits2.
For example, athletes should test
higher in predictable subsets of
these dimensions, depending on the
requirements of their specific sport-
ing events, as proposed in Table 3.
Likewise, patients should test lower
in predictable ways if they have di-
agnoses affecting 1 or several desig- -1
nated dimensions. Furthermore, if
these dimensions extend the MCT, -6
then patients should improve in af-
fected dimensions upon successful
completion of a clinical intervention. -11

If research confirms predictable pat-
terns among the dimensions related
to athletic ability or pathology-
related disability, then characteriza-
tion of movement ability along the
dimensions may prove useful in de-
termining prognosis and planning
for client intervention.

A common alternative statistical
method for determining dimension-
Figure 6.
ality, factor analysis, proved unhelp-
Respondent 316 reported higher movement ability on endurance and moderate move-
ful in this study. Exploratory or con- ment ability on the other dimensions. This respondent was a 25-year-old woman who
firmatory factor analysis of an was a long-distance runner. The sum of the squared deviations from an average
instrument relies on a lack of corre- dimensional logit value, DI316ϭ29.35 logits2.



lation between groups of items or
dimensions to determine whether
different factors are represented. For
perceived movement ability as as-
sessed with the MAM, the dimen-
sions had an extremely high pair-
wise correlation that negated
confirmation of factors with factor
analysis. Choosing IRT methods to
test dimensionality proved more use-
ful in this study because these meth- -11
ods estimate item and respondent lo-
cations on the same (logit) scale on
the basis of all of the recorded re-
sponses to all of the items. Thus, IRT
methods retain the distinctions be-
tween items and groups of items
made by individual respondents
rather than subsuming all of those
differences in pooled correlation
data across a sample.

Although the MCT describes move- Figure 7.
ment at all levels, from the molecular Respondent 309 reported low movement ability on flexibility and strength and mod-
and cellular levels to the level of a erate movement ability on the other dimensions. This respondent was a 40-year-old
person acting in society, the MAM man with limited neck and arm function because of impingement. The sum of the
squared deviations from an average dimensional logit value, DI309ϭ123.02 logits2.
incorporates the 6 dimensions of
readily perceivable movement only.
Further research is needed to deter-
mine whether these 6 dimensions study will promote discussion of potheses, however, the MCT will
apply to the molecular and cellular movement and all of its possible fail to provide a foundation for as-
levels of the continuum described by dimensions. sessment and intervention. The pro-
the MCT or whether separate move- posed multidimensional model may
ment descriptors are more applica- The subjects in this study were not a promote hypothesis generation be-
ble for these levels. randomized sample; subjects who cause the specificity of the dimen-
volunteered to complete the self- sions makes measuring movement
Although numerous discussions with report measure may have self- with the MCT more concrete.
professional informants helped re- selected either because they thought Strength, for example, as a dimen-
fine the set of dimensions described they moved well or because they sion within the movement con-
here and although these dimensions were conscious of movement prob- struct of the MCT, has links among
met the evaluative criteria, the liter- lems. Neither of these motivations the assessment of strength in the
ature search for movement dimen- was thought to bias the results par- laboratory, the problems of weak-
sion candidates was neither exhaus- ticularly, as this study focused on di- ness, and the intervention used to
tive nor systematic. Further research mensionality and not the level of improve current ability to gener-
may provide support for the exclu- movement ability. ate force. Characterizing movement
sivity of these dimensions or provide capabilities across dimensions and
some other criteria for accepting dif- An alternative to the disablement testing any narrowing of the gap be-
ferent dimension candidates. Re- models described as the basis of tween current and preferred move-
search also may modify the concepts the Guide to Physical Therapist ment capabilities as a result of inter-
of these dimensions, splitting some Practice,2 the MCT1 presents a po- vention become possible.
into smaller subdivisions or merging tential grand theory of physical
others on the basis of some alterna- therapy3 that also could be relevant If the research suggested in this dis-
tive criteria. It is hoped that the iden- to movement specialists in other cussion further supports the MCT
tification of the 6 dimensions in this professions. Without testable hy- and the proposed dimensions of



movement, it will have implications odology of testing. The author also thanks 7 Majsak MJ. Consolidating principles of mo-
Rick Allen for support and editing advice tor learning with neurologic treatment
affecting research, education, and techniques in a professional physical ther-
throughout the process of conceptualizing,
clinical practice. In research, the apist program. Neurology Report. 1996;
testing, and writing. 20:19 –27.
MCT and dimensions of movement
A version of this study was presented as a 8 Craik RL. Abnormalities of motor behav-
could provide a framework for re- ior. In: Lister MJ, ed. Contemporary Man-
poster at the Combined Sections Meeting of
vealing relationships among flexibil- agement of Motor Control Problems: Pro-
the American Physical Therapy Association; ceedings of the II-Step Conference.
ity, strength, and speed, for exam- February 1–5, 2006; San Diego, Calif. This Alexandria, Va: Foundation for Physical
ple, providing a needed unification study was completed as part of the author’s Therapy; 1991:155–164.
for effectiveness evidence. In educa- doctoral dissertation at the University of Cal- 9 Scheets PK, Sahrmann SA, Norton BJ. Di-
ifornia, Berkeley. agnosis for physical therapy for patients
tion, a focus on movement dimen- with neuromuscular conditions. Neurol-
sions provides a natural link between The Committee for the Protection of Human ogy Report. 1999;23:158 –169.
basic and movement sciences and Subjects at the University of California, 10 Wilson M. Constructing Measures: An
Berkeley, designated this study exempt from Item Response Modeling Approach. Mah-
the movement deficits associated wah, NJ: Erlbaum; 2005.
further review.
with particular pathologic condi- 11 Allen DD. Validity, Reliability, and Re-
tions, perhaps improving student This article was received June 27, 2006, and sponsiveness of the Movement Ability
was accepted March 1, 2007. Measure, a New Instrument Proposed for
understanding of assessment and in- Assessing Physical Therapist Competence
tervention relationships across diag- DOI: 10.2522/ptj.20060182 [dissertation]. Berkeley, Calif: Graduate
School of Education, University of Califor-
nostic groups. In clinical practice, nia; 2005.
the dimensions of movement may References 12 Adams RJ, Wilson M, Wang W. The multi-
help patients and movement special- 1 Cott CA, Finch E, Gasner D, et al. The
dimensional random coefficients multino-
mial logit model. Applied Psychological
ists more readily specify and focus movement continuum theory of physical Measurement. 1997;21:1–23.
therapy. Physiother Can. 1995;47:87–95.
assessment and intervention on the 13 ACER ConQuest: Generalised Item Re-
2 Guide to Physical Therapist Practice. 2nd
dimensions having the most diffi- ed. Phys Ther. 2001;81:9 –746.
sponse Modelling Software [computer
program]. Version 2.0. Hawthorn, Victo-
culty. Across all areas, dissemination 3 O’Hearn MA. The elemental identity of ria, Australia: ACER (Australian Council for
and use of the MCT and dimensions physical therapy. Journal of Physical Educational Research) Press; 2003.
Therapy Education. 2002;16:4 –7.
of movement could enhance effec- 14 Briggs DC, Wilson M. An introduction to
4 Tomberlin JP, Saunders HD. Evaluation, multidimensional measurement using Ra-
tiveness in investigating and manag- Treatment and Prevention of Musculo- sch models. Journal of Applied Measure-
ing movement. Although this study skeletal Disorders. Vol 2. 3rd ed. Chaska, ment. 2003;4:87–100.
Minn: The Saunders Group; 1994.
addressed only the initial testing 15 Allen DD, Wilson M. Introducing multidi-
5 Shumway-Cook A, Woollacott MH. Motor mensional item response modeling in
of the proposed multidimensional Control: Theory and Practical Applica- health behavior and health education re-
model of movement and the MCT, tions. 2nd ed. Philadelphia, Pa: Lippincott search. Health Educ Res. 2006;21(suppl
Williams & Wilkins; 2001. 1):i73–i84.
the potential usefulness of this
6 Hedman LD, Rogers MW, Hanke TA. Neu-
theory makes further research rologic professional education: linking the
worthwhile. foundation science of motor control with
physical therapy interventions for move-
ment dysfunction. Neurology Report.
1996;20:9 –13.
The author acknowledges Mark Wilson for
sparking the original idea of dimensions of
movement and for his direction in the meth-


Proposing 6 Dimensions Within the Construct of
Movement in the Movement Continuum Theory
Diane D Allen
PHYS THER. 2007; 87:888-898.
Originally published online May 15, 2007
doi: 10.2522/ptj.20060182

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