This is a revised reprint of an article published in the TAMO newsletter Vol (3). 1997 pp 5-6. It was originally written for parents and case managers of children receiving TAMO therapy. It has also been used as an introduction to TAMO for therapists and therapy students.

Traditional therapy concepts are based on the assumption that the brain controls motor behavior similar to a computer. Motor programs and standardized movement patterns are stored in the brain and are activated under the direction of the highest brain centers that are functionally mature. Some of these traditional neurophysiological assumptions have been challenged in recent years and have been, in part, experimentally disproved. Current Movement Science concepts suggest that biological systems are far less static and much more adaptable. We are usually able to spontaneously adapt movement patterns to the numerous challenges we face when performing even 'simple' every day activities, such as dressing or getting out of bed.

Current theories propose that the brain is not prescribing nor directing every aspect of a coordinated movement pattern; instead, many components and forces collaborate spontaneously to produce a specific posture or movement. Such collaboration follows specific rules of coordination (defined by laws of modern physics and, in part experimentally proven by 'Dynamic Pattern Theory'). The detailed activation pattern of most movements are therefore new and have not been practiced before. This contradicts the concept of established, fundamental movement patterns that are stored like programs in a computer.

According to current understanding of motor control, coordinated movements require the collaboration of forces and conditions generated by the body itself (for example, muscular forces, motivation, emotions, sensory information, etc.) and outside forces and conditions that act on the body (for example, gravity, counter force from the support, demands of the task, etc.). The interaction between all components is uniquely adapted to each activity (task), such as taking off a sock, and to each situation (context), such as walking on a tile floor. A different movement coordination is required when task and context are changed; for example, when taking off the other sock or when walking on the beach. With so many forces acting on a body with so many movable segments, it is easy to see that we are faced with an enormous variety of situations and demands when it comes to controlling our movements.

Changing just one of the numerous components may pose a different challenge for balancing, such as walking on a tile floor versus walking on the beach sand. Another example would be the difference between standing on an incline versus standing on a level surface; while both standing postures look quite similar, the patterns of muscle activation needed to counteract gravity, the exact joint positions and the distribution of neurons firing are quite different for the two situations.

Considering how many joints, muscles, neurons, etc. the brain would have to control during every phase of a movement, and how incredibly many movement patterns the brain would have to store, it becomes clear that the previous neurophysiological model is not helpful for explaining the coordination and control of movement. Instead of learning and storing every individual movement pattern, it is assumed that we may learn general rules of coordination which can be applied to a wide variety of skillful movements.

For example, pressure distribution through the thighs and the "sitting bones" of the pelvis determine sitting posture and sitting balance. Focusing on how to change this pressure distribution before and during reaching or while turning the head ensures balance. Associated postures and movements follow automatically and do not have to be actively monitored. In contrast, patients with movement disorders often try to balance and move from the top of the body without actively changing the pressure distribution at the contact area with the support surface: this always leads to poor alignment and poor balance.

Changing the theoretical model requires that the therapy approaches also change. TAMO is a new therapy approach to movement disorders that was developed in agreement with current concepts of Movement Science. Current theories of movement coordination and control are reflected in the following TAMO Treatment Principles¹.

1. In TAMO, movement skills are practiced in the respective functional situation. In TAMO we do not perform artificial exercises, such as balancing on therapy balls, since this would require a different movement coordination than the functional skill(s) the patient tries to learn. Also, so called simple every day activities are indeed very complex and require many perceptual and motor skills. This holds true especially when these activities are slightly changed with each repetition, as happens during TAMO treatment and in real life situations. Simple everyday activities can therefore offer challenging learning opportunities.

2. In TAMO, we teach patients to better utilize all components that contribute to a coordinated movement. Very often, this means to show the patient how to gather information that is important for the action. One example is the above description of sitting posture and sitting balance. Patients are also taught how to make better use of external forces, such as gravity or the counter force from the support surface. This results in a better movement strategy which may make a previously unattainable movement skill possible -- with a minimum of muscle force.

3. TAMO handling always applies forces associated with independent movements; that is, the therapist does not support nor move the patient; instead, the patient plans and generates the movement in response to the therapist's 'loading', which accentuates appropriate gravitational influences. That loading force is almost always directed through the patient's body to the support surface. The exact direction of this loading force constantly changes with movement. However, the observer cannot see that. You should ask your child's therapist to apply that 'loading force' to you! TAMO handling feels good; it gives a sense of security (stabilizing to the support surface and moving from the support surface) and it allows you to move with ease. Careful, it's easy to get hooked on TAMO treatment! This type of handling requires a good knowledge of the relation between pressure distribution at the contact with the support surface and the associated body posture and movement.

Please discuss any questions, concerns or ideas you may have in regard to therapy with your TAMO therapist!

TAMO was developed by Ingrid Tscharnuter, who is a Physical Therapist, Lecturer, Author, Adjunct Instructor at New York University (Masters Program) and the founder and director of the Tscharnuter Akademie for Movement Organization (TAMO^TM). Before developing the TAMO therapy approach, Ingrid was internationally known as teacher and author in the Neuro-Developmental Treatment approach.

TAMO workshops, 3 week long certification courses and various advanced courses have been taught throughout this country and overseas since 1991. TAMO is also taught at various Universities in undergraduate and graduate programs.

1. For a more detailed description see Ingrid Tscharnuter: A New Therapy Approach to Movement Organization. Physical & Occupational Therapy in Pediatrics, Vol 13(2):19-40. 1993.