The Voices of Physical Therapy Education: Orchestrating Timbre, Tempo, and Dynamics

Abstract

BACKGROUND AND PURPOSEOliver Sacks believed that is the profoundest non-chemical medication for our patients1 Music has the power to heal, to create change, and set every journey off on the right track.2 Such journeys, including our professional journeys, have the same rhythm, flow, and patterns that characterize music.3 In my view, the voices that speak to us about purpose and change in physical therapy are a form of music that also can move us, and our profession, forward. My use of a musical analogy is aimed at illustrating the origin and impact of the voices that speak to us about our work, help us understand the urgency to make change, and guide us to organize meaningful action. In essence, we orchestrate change in physical therapy just as a conductor orchestrates a musical performance. It is through this analogy that I will address the origin and impact of the voices that speak to us about our profession and how change must proceed to meet contemporary imperatives for physical therapy. Not only will we enjoy some musical interludes, but we will have time for reflection and incubation of new ideas to catalyze change in physical therapy education.Why Speak About Voices?Voices calling for change in physical therapy education are heard from a myriad of sources - leaders whose insights are built on academic rigor,4-6 innovators who seek new ways to explore change,7'8 payers, and perhaps most importantly, our clients and patients whose health is influenced by what physical therapists (PTs) provide.9 In one sense, voice is simply sound. In a broader sense, however, voice receives meaning from the context of the speaker and the listener and becomes distinctive, just as one musical instrument is distinctive from another. One's voice is a musical instrument of its own! Dilemmas always arise in listening to many voices when they speak at once, in interpreting the essence of the messages received, and in trying to prioritize response(s) to the voices we hear. Clearly, there is a need to organize the sounds we hear from various voices into an orchestrated whole that provides meaning for change in physical therapy education.Why the Musical Analogy?Music is very much like human movement. It flows, has order (otherwise it is just noise), occurs in sequence, and has timing and energy. Creating musical compositions is much like creating human movement. A note is analogous to a muscle or muscle fiber. Many notes are like many muscles (or fibers) working synchronously to produce increasingly complex movement. A melody (instead of just a noise) occurs when many notes are organized and united to communicate a story or feeling. But, it all starts with one note.Then, just as musical compositions arise from joining many, many notes in different patterns and unique styles, human movement results when many muscles join together in a particular pattern to enable unique movements. On a larger scale, symphonies are comprised of groups of compositions named movements, just as functional activities are comprised of complex combinations of motor skills supported by the individual components of the movement system. So, thinking about the characteristics and meaning of the music produced by voices in our work can be helpful in managing the maze of complications associated with moving our profession forward. That will be paramount if we are to meet the vision of the American Physical Therapy Association (APTA) of Transforming society by optimizing movement to improve the human condition.10 Let us now proceed to consider the timbre, tempo, and dynamics of change that will enable that vision!What About Timbre, Tempo, and Dynamics?Making change in our work has parameters that are analogous to music and to the voices that speak, sing, and shout at us. Three of these musical parameters (timbre, tempo, and dynamics) capture what I believe are relevant parameters of change in our professional lives. …