SPECIAL INTEREST ARTICLES
White Paper: Movement System Diagnoses
in Neurologic Physical Therapy
Lois D. Hedman, PT, DScPT, MS, Lori Quinn, PT, EdD, Kathleen Gill-Body, PT, DPT, NCS, FAPTA,
David A. Brown, PT, PhD, FAPTA, Myla Quiben, PT, PhD, DPT, MS, GCS, NCS,
Nora Riley, PT, PhD, NCS, and Patricia L. Scheets, PT, MHS, DPT, NC
Background and Purpose: The APTA recently established a vision
for physical therapists to transform society by optimizing movement
to promote health and wellness, mitigate impairments, and prevent
disability. An important element of this vision entails the integra-
tion of the movement system into the profession, and necessitates
the development of movement system diagnoses by physical thera-
pists. At this point in time, the profession as a whole has not agreed
upon diagnostic classifications or guidelines to assist in developing
movement system diagnoses that will consistently capture an individ-
ual’s movement problems. We propose that, going forward, diagnostic
classifications of movement system problems need to be developed,
tested, and validated. The Academy of Neurologic Physical Therapy’s
Movement System Task Force was convened to address these issues
with respect to management of movement system problems in pa-
tients with neurologic conditions. The purpose of this article is to
report on the work and recommendations of the Task Force.
Summary of Key Findings: The Task Force identified 4 essential
elements necessary to develop and implement movement system di-
agnoses for patients with primarily neurologic involvement from ex-
isting movement system classifications. The Task Force considered
the potential impact of using movement system diagnoses on clinical
practice, education and, research. Recommendations were developed
and provided recommendations for potential next steps to broaden
this discussion and foster the development of movement system di-
agnostic classifications.
Northwestern University, Chicago, Illinois (L.D.H.); Teachers College,
Columbia University, New York (L.Q.); Newton-Wellesley Hospital, New-
ton Massachusetts and MGH Institute of Health Professions, Charlestown,
Massachusetts (K.G.B.); University of Alabama at Birmingham (D.A.B.);
University of North Texas Health Science Center, Fort Worth, Texas
(M.Q.); St Ambrose University, Davenport, Iowa (N.R.); and Infinity Re-
hab, Wilsonville, Oregon (P.L.S.).
The work of the Movement System Task Force was supported by the Academy
of Neurologic Physical Therapy.
The authors presented the Task Force’s work in a poster at the IV STEP meeting
in July 2016 and in an educational section at the 2017 Combined Sections
Meeting of the APTA.
The authors declare no conflict of interest.
Supplemental digital content is available for this article. Direct URL citation
appears in the printed text and is provided in the HTML and PDF versions
of this article on the journal’s Web site (www.jnpt.org).
Correspondence: Lois D. Hedman, PT, DScPT, MS, 645 N. Michigan Ste
1100, Chicago, IL 60611 (l-hedman@northwestern.edu).
Copyright C 2018 Academy of Neurologic Physical Therapy, APTA.
ISSN: 1557-0576/18/4202-0110
DOI: 10.1097/NPT.0000000000000215
110
Copyright © 2018 Academy of Neurologic Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
Recommendations for Clinical Practice: The Task Force proposes
that diagnostic classifications of movement system problems need
to be developed, tested, and validated with the long-range goal to
reach consensus on and adoption of a movement system diagnostic
framework for clients with neurologic injury or disease states.
Video Abstract available for more insights from the authors (see
Video, Supplemental Digital Content 1, available at: http://links.lww.
com/JNPT/A198).
Key words: movement system, movement system diagnosis, stan-
dardized tasks
(JNPT 2018;42: 110–117)
INTRODUCTION
T he APTA House of Delegates adopted a new vision for the
profession in 2013— “transforming society by optimiz-
ing movement to improve the human experience.”1 One of the
guiding principles associated with the vision is that the move-
ment system, defined as “the collection of systems (cardio-
vascular, pulmonary, endocrine, integumentary, nervous, and
musculoskeletal) that interact to move the body or its compo-
nent parts,”2 would become the core of physical therapist (PT)
practice, education, and research (Figure 1). With this vision
statement and accompanying identity statements, we extend
an over 40-year discussion3-7 about our professional identity
as experts in the movement system.
Incorporating the movement system into clinical prac-
tice will require clinicians to evaluate and diagnose movement
dysfunction.8 While this practice may be inherent for many
PTs, the profession lacks a consistent approach to movement
analysis and, importantly, lacks the terminology to describe
movement dysfunction in a standardized manner.
Diagnoses identified by physicians that are based on a
person’s health condition are not particularly helpful in guid-
ing rehabilitation because they typically do not link the health
condition with specific movement impairments.9-12 Instead,
movement system diagnoses that are created and used by PTs
will be composed of clinical findings from the PT’s exam-
ination to create classifications that are relevant to patient
management.
The APTA has previously attempted to develop patient
classifications, named Practice Patterns (PPs), in the Guide
to Physical Therapy Practice Part II (1999). The PPs were
JNPT r Volume 42, April 2018
JNPT r Volume 42, April 2018
Figure 1. The APTA’s movement system diagram that
illustrates the interaction of all the body systems that
comprise the movement system (used with permission from
American Physical Therapy Association).
organized around pathology/health condition and included de-
scriptions of management for each pattern. These PPs were
never validated13 and were not included in the 3.0 revision
of the Guide. Some concerns raised about the PPs were that
no rationale was provided for sorting by pathology,14 the lan-
guage of the PP labels was potentially burdensome,7 and the
PPs lacked the specificity necessary to be helpful in prescrib-
ing interventions3,7,14 and fostering intervention effectiveness
research.3
Achieving success with the profession’s new vision re-
quires the development of a framework for movement system
diagnoses that will be useful in clinical practice, education,
and research.15 The concept of diagnosis by PTs has been
most notably influenced in recent years by the Diagnosis Di-
alog groups,16,17 and in 2015 the APTA endorsed “the de-
velopment of diagnostic labels and/or classification systems
that reflect and contribute to the physical therapist’s ability to
properly and effectively manage disorders of the movement
system.”8 Accordingly, the Academy of Neurologic Physical
Therapy (ANPT) appointed a Movement System Task Force
in 2015 to explore this issue for individuals with primary neu-
rologic dysfunction.
The purpose of this white paper is to report on the current
ideas and recommendations generated by the ANPT Move-
ment System Task Force as a result of 21 months of reviewing
existing literature and resources, and discussing the movement
system and approaches to patient classification. Specifically,
the purpose of this article is to (1) identify the essential ele-
ments necessary to develop and implement movement system
diagnoses for patients with primary neurologic involvement
along with examples of existing movement system classifica-
tions from the literature, (2) discuss the potential impact of
using movement system diagnoses on clinical practice, ed-

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White Paper
ucation, and research, and (3) provide recommendations for
potential next steps to broaden this discussion and foster the
development of diagnostic classifications based on the move-
ment system. Although the focus of the Task Force’s work has
been on movement system diagnoses relevant for patients with
primary nervous system involvement, we expect that these
ideas and recommendations may also apply to other areas of
PT practice.
ANPT MOVEMENT SYSTEM TASK FORCE
PROCESS
The ANPT Board of Directors invited ANPT members
to apply for a position on the Movement System Task Force
in March 2015. Subsequently, the authors of this article were
chosen to serve on the Task Force. Task force members have
a mean of 30.7 years of experience working with individu-
als with neurologic disorders (range = 22-39 years). They
represent different geographic regions of the United States
(3 Midwest, 2 Northeast, 1 Southeast, and 1 Southwest),
and varied primary roles (3 academician/researchers, 2 aca-
demician/clinicians, 1 clinician/administrator, and 1 academi-
cian/clinician/researcher). Of the 7 Task Force members, 3 are
American Board of Physical Therapy Specialties (ABPTS)–
certified neurologic clinical specialists, and 1 is dual certified
by the ABPTS as a clinical specialist in both geriatric and
neurologic physical therapy. The Task Force was convened in
June 2015 and was charged to (1) develop expertise in the
conversation regarding the movement system and diagnosis
of movement system problems by reading, studying, and dis-
cussing relevant writings, lectures, and professional materials,
and (2) develop examples of content (eg, terminology, de-
scriptions, and labels) that may be used to describe human
movement system problems. The group conducted monthly
phone conferences and one 2-day face-to-face meeting over
the 21-month period. The group presented their ideas in an
education session at the 2017 Combined Sections Meeting of
the APTA.
Figure 2 depicts the Task Force’s process to develop
expertise in the movement system and diagnosis. Task Force
Figure 2. Literature review process that led to the
development of 4 critical characteristics for developing a
movement system diagnosis framework.
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Hedman et al JNPT r Volume 42, April 2018

members initially read a series of seminal papers about the
professional dialogue regarding the movement system, move-
ment system diagnosis, and physical therapy.3,4,6,7 To under-
stand the variety of approaches used to categorize patients into
meaningful groups, members reviewed articles related to pa-
tient classification across physical therapy and other disciplines
even if this was not the primary intent of the article. Over time,
members narrowed the focus of the review to articles specific
to neurologic conditions. By the end of this process, the Task
Force identified 16 articles that represented varied approaches
to patient classification and/or movement analysis. The group
then identified 13 characteristics that we thought would be im-
portant to consider when assessing the utility of a diagnostic
classification framework. These characteristics are embedded
in a set of questions that were used to conduct paired reviews
of each of the 16 articles to determine the presence of these
characteristics (Table 1). Two task force members separately
reviewed the same articles and reached consensus when they
disagreed. The results from this review are presented in the
Appendix (see the Appendix, Supplemental Digital Content 2,
available at: http://links.lww.com/JNPT/A199).
Through this process, the Task Force gained an under-
standing of the movement-related classifications that have been
developed and how the logic used in these approaches might
apply to a diagnostic framework. Based on our comparative
analysis of these classifications, the Task Force then distilled
4 characteristics that provide a foundation for moving forward
in developing movement system diagnoses relevant to patients
with primary neurologic involvement. The Task Force recom-
mends that movement system diagnoses should (1) be based on
a sound, evidence-based theoretical framework, (2) emphasize
movement observation and analysis of core standardized tasks
as central to the clinical examination and evaluation, (3) repre-
sent a unique cluster of movement observations and associated
examination findings that can impact a variety of tasks, and (4)
provide unique and nonambiguous labels for each movement
system diagnosis. While none of the 16 articles we reviewed
Table 1. Questions Developed by the Task Force to Guide
Article Reviews
1. Did the article describe classifications of patients for one health condition
or across health conditions?
2. Did the article describe one classification of patients or more than one?
3. Did the article describe a classification system related to a single task or
could it be used for a variety of tasks?
4. What is the theoretical framework used and/or purpose of the
classification system?
5. Are the included classifications related to impairments, activity
limitations, and participation restrictions?
6. Have the authors provided labels for the classifications? Do they use
standard movement language?
7. Did the article provide a guide to clinical reasoning/decision-making?
8. Was an examination process for identifying the patient classifications
described? Does the clinical examination lead to movement system
diagnoses?
9. Are the classifications linked to prognosis?
10. Do the classifications lead to evidence-based interventions?
11. Does the classification system include a behavioral component?
12. Will the classifications be useful for research?
13. Have the concepts of the classification system been validated?
demonstrated all 4 of these characteristics, we did find exam-
ples of each of these characteristics, as shown in Table 2. More
details about the characteristics are provided in the second Task
Force recommendation at the end of this article.
The Task Force recognizes that the development and use
of movement system diagnoses will have significant effects
on physical therapy clinical practice, education, and research.
The following sections summarize these anticipated effects
and identify likely implications for these areas.
CLINICAL PRACTICE
Clinical reasoning, the thinking and decision-making
processes used in clinical practice,18 is a cornerstone of the
physical therapy profession. The Patient-Client Management
Model13 identifies the iterative process used by PTs to make

Table 2. Examples of Critical Characteristics for Movement System Diagnoses

Characteristic
1. Based on sound, evidence-based theoretical
framework(s).
2. Emphasize movement observation and analysis of core
standardized tasks as central to the clinical examination.
3. Comprise a set of movement system diagnoses that each
represents a unique cluster of movement observations
and associated examination findings that can impact a
variety of tasks.
4. Provide unique and nonambiguous labels for each
movement system diagnosis.
Abbreviation: BESTest, Balance Evaluation Systems Test.
Example of Each Characteristic
Horak et al:55 The BESTest is a science-based approach derived from research around the
motor control of balance in nonimpaired and neurologically-impaired individuals
associated with a variety of health conditions. It describes an interactive set of
constructs around the control of the center-of-mass relative to a stable or moving base
of support. Each construct has been reduced to specific tests and measurement variables
that can be used to generate hypotheses about why an individual may be experiencing
loss of balance.
Scheets et al:56 This case illustrates how a diagnosis framework guided the clinical
examination process and led to the identification of 3 movement system diagnoses for a
patient after hip fracture. The appendices describe a detailed clinical examination
including movement observation of selected tasks.
Quinn and Busse:52 This categorization was developed to characterize movement
problems identified in people with Huntington’s disease. The authors identified
task-independent motor control issues such as exercise capacity and performance and
planning and sequencing of tasks that can be identified with appropriate examination
tools.
Hedman et al:57 A consensus-driven Delphi process resulted in expert consensus on the
labels and descriptions for requirements for successful locomotion. The study’s
methodology provides a model for the initial development of diagnostic classifications.

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JNPT r Volume 42, April 2018
clinical decisions and manage each patient/client; it consists
of the following elements: examination, evaluation, diagnosis,
prognosis, intervention, and outcomes. The Task Force iden-
tified 4 of these elements in which use of a movement system
diagnosis can inform and strengthen clinical reasoning and
decision-making in neurologic physical therapy: examination,
evaluation, diagnosis, and intervention.
Examination
Physical therapists gather a range of multidimensional
information during the patient examination. The Guide to
Physical Therapist Practice13 describes examination as includ-
ing patient history, body systems, and review tests and mea-
sures of body structure and function, activity and participation
(based on the International Classification of Functioning, Dis-
ability and Health). However, movement observation and anal-
ysis are not mentioned in the Guide and may not be a routine
part of clinical practice.
The Task Force proposes that movement observation
and analysis are critical to understanding why a patient is ex-
periencing a movement problem and how one might label the
movement problem. Movement observation entails observing
and describing the way a person moves spontaneously or while
performing a task or activity. Importantly, this description is
far more detailed than a label of a patient’s level of indepen-
dence. Movement analysis is the synthesis of the movement
observations based on knowledge of motor control and taking
into consideration all other patient data (eg health condition
and impairments in body function). The observation/analysis
process is iterative, and we believe it is at the center of assign-
ing a diagnostic label or movement system diagnosis (see the
Evaluation and Diagnosis subsection).
Although there are well-described examples in the lit-
erature that demonstrate the usefulness of movement/task ob-
servation and analysis for clinical reasoning,19-21 there are
currently no validated tools that can be used across a range
of tasks to reliably detect movement system problems. The
Task Force recommends that key tasks be identified and used
to systematically observe patients, as they perform each task
in a standardized manner. The Task Force used a consensus
process to identify core standardized tasks (Table 3) that, when
observed in a systematic manner, can provide insights about
motor control impairments. The tasks listed in Table 3 place
differing demands on the movement system and are likely to
be useful across a broad range of patient types.
In addition to recommending a core set of standard-
ized tasks, the Task Force identified existing literature to in-
form future efforts to standardize movement observation. The
movement continuum, as described by Hedman et al,22 is an
Table 3. Recommended Core Tasks for Movement
Observation
Sitting
Standing
Sit-to-stand, stand-to-sit
Walking
Step up/down
Reach, grasp, and manipulation

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example of a useful framework to organize and describe move-
ment observations in a standard manner across all tasks. The
6 stages of the movement continuum consider movement from
its preparation to outcome on the task goal and environment.
The stages and the key movement attributes associated with
each stage are described in Figure 3. Descriptive and quan-
titative analyses of various functional tasks23,24 will also be
instrumental in identifying the critical aspects of movement
that characterize each stage of a task. Identifying such critical
aspects of movement for each core standardized task25 could
lead to the development of a standardized approach to move-
ment observation that can then be tested for reliability, validity,
and clinical utility. Such a standardized approach could include
visual observations and analysis as well as use of instrumented
technology to quantify and describe movement.
Evaluation and Diagnosis
The evaluation and diagnosis steps of clinical reasoning
are closely linked. The goal of the evaluation is for the PT to
arrive at an understanding of why a person is experiencing a
movement system problem so that interventions can be specif-
ically directed at that problem. Synthesis and interpretation of
movement observations of standardized tasks is a critical step.
Movement observations that are linked to particular stages of
movement22 can lead to hypotheses about how motor control is
affected. This knowledge, in conjunction with other informa-
tion gained during the patient examination, provides a strong
foundation for the therapist to hypothesize what may under-
lie different movement strategies. In arriving at the evaluation,
the therapist needs to consider all possible sources from across
the movement system (from Figure 1, nervous, cardiovascu-
lar, pulmonary, integumentary, musculoskeletal, and endocrine
systems) when determining possible underlying contributors
to the movement problem.22 We believe that this iterative diag-
nostic process is currently a standard component of practice,
although explicit movement observation and analysis of tasks
are not routinely included.
At the conclusion of the diagnostic process, a diagnostic
label or movement system diagnosis should be assigned. This
is another potential missing component of practice that must
now be addressed by agreeing on and standardizing movement
Figure 3. The movement continuum is composed of
6 stages of movement that are identified in the figure along
with movement-related parameters to consider with each
stage (used with permission from Hedman et al22 ).
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Hedman et al
system diagnoses. We posit that each movement system diag-
nosis needs to be associated with a clear description of a unique
cluster of movement observations and associated examination
findings. The clinician will need to interpret all patient ex-
amination data including movement observations to recognize
these clusters that align with one or more movement system
diagnoses. This process of linking the clusters seen in each
patient’s clinical presentation to known descriptions of move-
ment system diagnoses25 represents a key and novel advance
in the decision-making processes used in practice.
Intervention
Determination of a diagnostic label should guide the
practitioner’s plan of care, which may include a specific inter-
vention or a defined set of intervention options. The movement
system problem should be identified within the diagnostic la-
bel to allow clinicians to more clearly state the “bottom line”
about each patient from a movement system perspective. This,
in turn, may advance clinical reasoning regarding how to select
or apply elements of intervention.
Using a shared set of movement system diagnoses across
physical therapy practice will enable clinicians to more effi-
ciently identify and select the most effective interventions re-
lated to specific movement system problems. Currently, there
are no validated movement system diagnoses that organize
intervention selection. From the large array of intervention
options available in practice, more defined sets of evidence-
based interventions related to each specific movement system
diagnosis will emerge.
Despite proliferation of practice guidelines, there is still
considerable variability in neurologic PT practice.26-29 Un-
warranted variability in practice or “differences in care that
cannot be explained by illness, medical need, or the dictates
of evidence-based medicine”30 undermines the integrity of PT
practice and is associated with an increased cost of care and less
favorable outcomes.31-33 The expectation is that development
and use of movement system diagnoses such as the ones that
have been developed and tested for individuals with primarily
orthopedic34-41 and urogenital conditions42 may foster a con-
sistent level of neurologic PT practice through the development
of associated treatment planning algorithms, clinical pathways,
and clinical practice guidelines. Tools such as these may help
clinicians sort through evidence more efficiently and can facil-
itate reduction in unwarranted variability in clinical practice.
EDUCATION
An “in depth, integrative knowledge of the movement
system and its component elements (anatomical structures
and physiological functions)”2 is needed for clinicians to in-
tegrate the movement system into practice. This requirement
will necessitate that the movement system be the centerpiece of
entry-level PT preparation. We therefore wholeheartedly sup-
port Deusinger’s43 recent call for the profession to adopt the
human movement system as a common philosophy of physical
therapy education programs’ (PTEP) curricula.
The Task Force recommends that PTEP curricula link the
development of clinical reasoning and decision-making with
knowledge of the movement system. Examples from the liter-
ature illustrate how movement science can be integrated into
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JNPT r Volume 42, April 2018
neurologic curricula22 and an entire curricular design.44 PTEP
curricula will also need to incorporate movement system diag-
noses, as they foster student development of clinical reasoning
and decision-making. It will be critical that clinical faculty are
included in the process of changing curricula so that they are
able to mentor students during their clinical education. The
Task Force expects that these changes in curricula will ensure
that entry-level therapists have the expertise needed to under-
stand, implement, and further develop movement system diag-
noses including the standardized movement observation and
analysis. The profession cannot, however, place the responsi-
bility of this paradigm shift on new graduates. All clinicians
need to understand the importance of movement system diag-
noses and how to implement them in their clinical practice. We
anticipate that the Academy can help foster these outcomes by
engaging as many clinicians as possible in the process of creat-
ing and testing the movement diagnoses, sponsoring ongoing
continuing education opportunities, and setting up mentoring
networks.
RESEARCH
While the concept of movement system diagnoses has
been discussed in our profession for many years, the research
supporting the development and use of such diagnostic labels
has been limited. In 2011, the APTA recognized the need to
develop classification systems as a means to improve patient
outcomes; their updated research agenda included the charge
to develop and evaluate effective patient/client classification
methods to optimize clinical decision-making for PT manage-
ment of patients/clients. In addition, in 2015-2016, the Na-
tional Center for Medical Rehabilitation Research, part of the
National Institutes of Health/National Institute of Child Health
and Human Development, developed new priorities for reha-
bilitation research that included developing methods that may
predict rehabilitation treatment response and tailor interven-
tions to individual patients.45 These 2 important agendas for
rehabilitation and physical therapy research each place impor-
tance on research that facilitates optimal clinical reasoning and
decision-making to maximize patient outcomes. Development
of movement system diagnoses and classification systems is
central to these research strategies.
Recent randomized controlled trials of rehabilitation in-
terventions for patients with neurologic health conditions have
demonstrated significant variability in participant responsive-
ness to the target intervention, even in patients with the same
health condition.46,47 At times, there is an effort to explain this
variance by examining other factors in the study data such as
patient age, gender, time since onset of condition, and extent
and location of damage. Importantly, there has been a shift in
thinking about factors other than medical diagnosis that may
contribute to patient outcomes, such as a patient’s underlying
movement system problem. To understand which interventions
are effective, patients should be categorized, in part, according
to movement system problems, and not solely on the health
condition.
The Task Force suggests that specific diagnostic la-
bels must be validated and tested empirically to move the
concept of movement system diagnoses forward in the pro-
fession. This process can utilize a data-driven approach, in

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JNPT r Volume 42, April 2018
which researchers utilize large data sets that are created with
standardized observations, outcome measures, and/or inter-
ventions to look for patterns among patient groups. Using a
data-driven approach, Bland et al48 identified 4 clusters of
individuals poststroke based on their sensorimotor, cognition,
language, and activity-level impairments. While the primary
goal of their study was to identify categories to guide posta-
cute discharge recommendations, such groupings based on
large data sets are a first step to developing diagnostic classi-
fications that can use prognostic indicators to guide physical
therapy intervention. Another approach to validating diagnos-
tic labels is to use an experience-based approach, in which cat-
egories or classifications are developed based on clinical data.
An experience-driven approach has been employed by sev-
eral clinician-researchers utilizing clinical experience to iden-
tify patterns of patient characteristics across different health
conditions.25,49,50 Experience-driven approaches could inform
data analysis plans for data mining when large data sets are
available. Such data sets will become ubiquitous for physical
therapy researchers in the upcoming years, particularly with
the development registry data, such as APTA’s Physical Ther-
apy Outcomes Registry.51 The Task Force recommends mov-
ing forward by creating movement system diagnoses based on
clinical experience, initially testing them for face validity and
subsequently using large data sets to further test their validity.
Regardless of the health condition, a patient’s movement
system problem may be a critical factor predicting respon-
siveness to rehabilitation intervention. Alternatively, within a
given health condition, classification of patient problems based
on movement system diagnosis may help better direct inter-
ventions and ultimately affect outcomes. Such classification
systems are just beginning to be developed and empirically
tested.52-54
SUMMARY AND RECOMMENDATIONS
The development and adoption of a coherent move-
ment system diagnostic framework is an important step in
fully integrating the movement system concept into physical
therapy education, research, and clinical practice. Gaps exist
in our understanding of the best way to develop and inte-
grate movement system diagnoses into our profession, and we
look forward to further dialogue on this topic. Since ideas on
movement system diagnosis are at an early stage of develop-
ment, time and financial resources must be dedicated by the
leadership and members of the Academy. To assist with next
stages of the process, the Task Force puts forth the following
recommendations:
1. Develop and test a systematic process for movement ob-
servation and analysis of standardized tasks. This will in-
volve applying the literature to determine key attributes of
each task to construct a standardized movement observation
scheme that can be tested for validity and reliability.
2. Clinicians and researchers should work together to develop
a set of movement system diagnoses that address the identi-
fied attributes using both experience-based and data-driven
approaches. The Task Force developed a set of 4 charac-
teristics that are expected to form the foundation for the

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development of clinically meaningful movement system di-
agnoses. Movement system diagnoses should:
A. Be based on a sound, evidence-based theoretical frame-
work. This theoretical framework should be based in
movement science and offer clear operational defini-
tions, theoretical constructs, measurable variables, and
can lead to predictable hypotheses.
B. Emphasize movement observation and analysis of core
standardized tasks as central to the clinical examination
and evaluation. Once core standardized tests are devel-
oped and tested, they will become an essential part of
the clinical examination to inform the selection of the
appropriate movement system diagnosis.
C. Represent a unique cluster of movement observations
and associated examination findings that can impact a
variety of tasks. Defining the diagnostic categories of the
movement system will require synthesis of the essential
elements, including both movement observations and
associated examination findings, which occur together
as a cluster across tasks and health conditions.
D. Provide unique and nonambiguous labels for each move-
ment system diagnosis. The labels should be descriptive,
unique, and nonambiguous. These labels should be ap-
plicable across a number of health conditions and tasks,
allowing for the identification of movement system prob-
lems that are typically found in patients with primary
neurologic dysfunction.
3. Test movement system diagnoses for their validity (includ-
ing their ability to predict outcomes and responsiveness to
intervention), their clinical utility, and their relationship to
clinical practice guidelines. Importantly, any publications
related to the development of these diagnoses should in-
clude the search term “movement system diagnosis.”
4. Promote the movement system and movement system di-
agnoses as the core of entry-level curricula through publi-
cations, continuing education, mentoring, and modification
of Commission on Accreditation in Physical Therapy Edu-
cation (CAPTE) criteria. This fundamental change in PTEP
education will require multifaceted and ongoing education
of all stakeholders including academic and clinical faculty
and CAPTE.
5. Promote the establishment, dissemination, utilization, and
refinement of movement system diagnoses as priorities of
the ANPT. This can be accomplished by reporting on the
work related to movement system diagnoses in ANPT publi-
cations, educational opportunities, research initiatives, and
communications. Surveys of practice can help identify uti-
lization of movement system diagnoses over time, and re-
veal barriers to their adoption that need to be addressed.
The transition to using movement system diagnoses will
be challenging, and a commitment to clear communication
from the ANPT will be critical.
ACKNOWLEDGMENTS
The authors are grateful for the support of the Academy
of Neurologic Physical Therapy for the Task Force. We also
acknowledge Dr Barbara Norton for providing feedback on an
earlier version of this article.
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Hedman et al
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