Facilitation of movement: New perspectives provide expanded insights to guide clinical practice

Hands-on therapeutic interactions are essential to neurological physiotherapy. Facilitation of movement is a particular aspect of such interactions that potentiates self-initiation of movement. This process involves interactions between the physiotherapist and the patient through three integrated phases: (1) "make movement possible;" (2) "make movement necessary;" and (3) "let movement happen," in which communicative aspects are considered important. The purpose of this paper is to explore a theoretical foundation for this approach by utilizing an extended framework. Dynamic systems theory clarifies the physiotherapist's handling as the adjusted manipulation of the patient's constraints upon movement complemented by tailoring of the specific attributes of the task and environment; however, this theory provides inadequate coverage of the involved communicative aspects. Phenomenology, which perceives the body as the center of experience and expression, offers a path to understanding such hands-on interactions as a form of communication. Enactive theory clarifies these physical interactions of the physiotherapist and the patient as essential in co-construction of meaning that evolves as an interactive and dynamic process within a specific context. This extended framework, in which neuro- and movement sciences are integrated, provides an appropriate theoretical anchoring of facilitation of movement that is beneficial for guiding clinical practice and training.