Have you ever had the difficult experience of conveying an idea, notion or concept to someone? This may be a challenge in itself to a patient but to colleagues in the same profession who are talking about the same thing it can still be tough. You only have to experience a clinical debate online on twitter to get a sense of this using only 140 characters. Understanding the context, frame of reference and technical language are all exaggerated on this platform but it can be highly compelling and potentially misinforming! If all of this occurs in professional discourse, what happens in clinical research? If physiotherapists value clinical research highly as a form of evidence in evidence based practice (EBP) then is there a risk of exploring or evaluating something that is inaccurate in reference to the focus of the study? Or believing that it is indeed correct and then perhaps misinforming clinicians who then use this ‘evidence’ in a clinical setting inappropriately or out of context?
What I am talking about is concepts and the understanding of them. It is not only the use of language that needs consideration but the basis of understanding the phenomenon that the concept exists within. This may step into a philosophical arena but has to be acknowledged in its deeper understanding.
Where has this come from you may ask? For me it has stemmed from the concept of ‘Motor Control’ specifically but I am sure that there are other areas in physiotherapy that this applies to. Have you noticed that when talking about movement the term ‘Motor Control’ can mean one thing to one person and be something else to another? Stability might be used synonymously with mobility in some explanations. Or the ‘appropriate balance of stability and mobility in response to afferent input from the extrinsic environment and intrinsic mechanisms?’ I am sure you have…so the use of opposites to describe the same phenomena or the use of vague language can be interpreted in numerous ways. This is exemplified in the following paragraph:
“Currently, movement science is filled with loose terminology. Textbooks and papers operate with expressions such as motor program, schema, muscle tone, synergy , internal model, etc. Typically, none of these is provided with a clear and unambiguous definition. Well-established notions from physics and mathematics such as, for example, stiffness and dynamic system are used in a fuzzy, imprecise way. Such texts create an impression of the author winking at you and saying “Certainly, you understand what I am talking about, right?” It is very difficult to answer no, in particular, if you are a student reading a book or a paper by an established professor. It is tempting to accept the rules of the game, to start juggling the same terms, and to join the club.” (Latash, 2008)
Concept clarification or analysis has been around since the 1970s in nursing literature but there does not appear to be much in physiotherapy literature, perhaps it should be? Concept analysis has been described as the building blocks of theory and/or provide direction for future research (Rogers and Knalfe, 2000) and I can see why! But first of all we should examine what are the foundations of concepts:
The diagram above is attempting to demonstrate the diversity of perspectives that a number of authors and philosophers have on the topic. Three main themes emerge from the literature in regards to health science. They are viewing concepts as an empirical reality, a cognitive idea or image and it’s use in language.
Empirical reality is the notion that concepts are focused on observable reality and the relationships that they have in the world. An example is how “words that describe objects, properties, events and relations amongst these are called descriptive terms or concepts” (Jacox, 1974) or that concepts are “labels…the dimensions, aspects or attributes of reality which interest the scientist” (Becker, 1983). Although viewing concepts in this way may show some relationships and attributes it may not be adequate to describe its demonstrable effect or describe its constituents. In terms of motor control we can observe movement and see how elements of it relate to others but it does not necessarily demonstrate how this is done.
The notion of cognition in respect of concepts place an emphasis on how they are constructed in the mind and therefore are a “mental picture” or “image, a word that symbolises ideas and meanings and expresses an abstraction” (Watson, 1979). In reference to motor control, the concept of movements could be seen both within the conscious and sub-conscious mind and the construction of hypotheses to the interaction of mind and body appears complex and intangible.
Some authors describe concepts simply in terms of language where “simply a word to which a meaning has been attached through formal definition or common usage” (Diers, 1979) however as is demonstrated in the concept of ‘Motor Control’ it can change meaning dependent on the understanding of the individual using it in various contexts. As a social construct the emphasis of the concept is subject to social and contextual variability.
Philosophers who have debated and discussed the nature of concepts emerge into two theories. Entity and dispositional theories of concepts and overlaps between the two.
Entity theories of concepts are characterised by their primary emphasis on concepts as specific things. Typically, this has been in the view that concepts consist of universal essences such as described by Aristotle focusing on all the characteristics or attributes that are in common and categorising them as various aspects of reality. An example of this is Aristotle’s development of taxonomies to categorise classes of biological species on their essential features which could be seen as a reductionist approach.
Rene Descartes theorised that there was a distinct difference in substance between the mind (soul) and the body (physical reality) and was instrumental in an idealist sense of enquiry towards an inner mental realm and an outer physical one. This was then moved forwards by John Locke who saw concepts as private entities that reside purely in the mind and therefore challenges of appropriately expressing them were met. This was complicated by the idea that concepts could only be developed through experience which would develop them into more complex constructs making concept analysis near impossible. Immanuel Kant, however, did not view concepts as a result of experience but existed in the mind in order to gain experience. Gottlob Frege felt that concepts that were constructed in the mind was just that…mental!! He revolted against this idealism and focused purely on logic and language as there was too much confusion on what came first in terms of experience or the mind/body confusion of essentialism. He identified two primary category of words: proper names and predicates. This basically means that concepts have strict boundaries in the context of language that is unchangeable over time and context.
The entity theories mainly had limitations with how a concept changes with time, the boundaries of concept definition, the context a concept can lie within and how evolution effects concepts!
Then a dispositional philosophical perspective came along, championed by a chap called Ludwig Wittgenstein who previously advocated a logical positivist approach. He recognised these limitations and concentrated on the ‘use’ of language rather than its description and focused on the resemblances and commonalities in the use of a word or concept. Therefore, concept clarity was seen as the ability to formulate comparisons and to see what is common.
Stephen Toulmin recognised the process of of conceptual change and the relationships between concepts, scientific discovery, contextual variation and development and therefore concepts were underpinned by a social construct. This becomes very helpful in regards to the enquiry of concept analysis and its methodology which, as you could imagine, could be extremely difficult in viewing concepts as ideas only!
So after all of that are you any the wiser?
Basically, concepts are challenging to understand but recognising these foundations makes it easier to come to terms with and, in view of ‘Motor Control’ and other concepts in physiotherapy practice, it might be helpful to clarify them as just describing it may not be enough. Also, when listening to people who describe ideas and concepts, I feel more at ease with not necessarily having a strict ideology and boundary surrounding it but if one is to truly get to grips with a concept topic it may not be enough to do a literature review and build on what we previously have thought. We may need to strip everything back and get to the foundations of the topic and clarify it in light of new findings from a host of perspectives in order to make effective progress in clinical research and practice.