Professor Roberta Shepherd, a pioneer in the field of physiotherapy, graduated with a Diploma of Physiotherapy in 1956.

She was awarded a Master of Arts in 1986 and a Doctor of Education in 1991, both from Columbia University.

In 2014 she was named as an Honoured Member of the APA, in 2016 she received an honorary degree of Doctor of Health Sciences from the University of Sydney and in 2018 she was awarded an Order of Australia (AO).

Roberta has published more than 60 articles and eight textbooks cited as gold standard in rehabilitation. She continues to contribute by running workshops, developing new research collaborations and publishing articles.

Speaking at the 2019 World Confederation for Physical Therapy Congress in Geneva, Roberta cultivated a strong sense of progressive learning by encouraging communal insights and shared experiences inherent to the Indaba format.

An Indaba is ‘a meeting and inspirational zone’ inspired by the traditional gatherings and meetings of African culture. An Indaba possesses an element of informality that is able to facilitate comfortable and fluid participation.

This is a format that is very suited to Roberta, who thrives on the open sharing and discussing of ideas.

Later in 2019, she was invited by the APA Neurology group to discuss these ideas in a similar format in Sydney.

Here are some concepts that Roberta discussed during these Indabas.

Understanding biomechanics

Roberta challenged current education and practice of physiotherapy for its lack of knowledge and application of biomechanics.

‘It’s about analysing the action, describing what moves, how fast and how effective in achieving a goal,’ Roberta said.

She questioned: ‘How you can be a physiotherapist if you don’t understand biomechanics?’.

Task and context specificity

‘Basically, exercise and training should be task and context-specific so the individual can learn to move effectively to achieve a goal in different and relevant environments,’ Roberta said.

Beyond this, Roberta suggested exercise is only effective in improving independent, functional performance when specific actions are practised in their natural contexts, for example, reaching to pick up and drink from a glass of water and returning the glass to the table.

‘The major environmental context throughout all our actions is of course gravitational, hence the significance of balance training in different contexts.

'Investigations of sit-to-stand show that there may be little or no carryover from lower limb strength training exercises to balancing the body mass while standing up from a seat without using the hands,’ Roberta said.

During the Indaba sessions, Roberts asked: ‘If someone has had a stroke and they need to be able to perform a physical task like standing up, how are we going to help a person do that?’

Roberta indicated that by understanding the biomechanics of the action, applying the information about the major features of standing up, and getting the patient to practise the action, you give them the chance to learn again how to be successful.

‘If it’s too difficult, the action can be modified by increasing seat height for example,’ Roberta said.

Interestingly, Roberta postulated that although muscle strength may increase as a result of exercise, sit-to-stand performance may not improve; that is, there may be little carry over from non-specific exercise to stand-up performance.

Drawing on evidence-based conclusions, Roberta suggested that there may be little or no carry over from simple exercises to improved functional performance without context-specific practice.

‘Task-and-context-specific exercise and training enable an action to be learned by affecting the neuromuscular system’s basic plasticity (ie, training is specific to the action, the goal and the environment).

It involves meaningful tasks and not just random exercise,’ Roberta said.

She quoted recent research which validated a successful training program of task and environmental variability, repetitive practice and augmented feedback (Rensink et al 2009).

This included the citing of another effective task-related training program wherein patients worked on a specific, self-driven and goal-directed activity in a position where weakened muscles were required to function (Dean & Shepherd 1997).

Here, Roberta stated that task- and context-oriented training improves coordination of muscles and muscle extensibility and flexibility while balancing body mass.

This increases the control of synergistic muscle groups that contract in different actions concentrically, eccentrically, and isometrically (Safavynia et al 2011).

She drew upon a study of repetitive and high-intensity walking training which demonstrated improvements in walking competence in the first year following stroke (Cauraugh & Kim 2003).

She also referenced research showing effective outcomes of playing electronic games in standing to increase postural stability and balance, and independence (Blennerhassett & Dite 2004; Morone et al 2014).

Best practice

Roberta exposed a growing shift away from interventions based on early 20th century theoretical concepts.

Here, she discussed the development of clinical research post-1980s that has been used and will continue to be used to develop best practice.

As Roberta continued her Indaba, one message became clear: physiotherapy fundamentally contributes to the rehabilitation of motor performance.

Such rehabilitation is achieved by a combination of exercise and the practice of specific actions to increase muscle strength and extensibility, endurance, power, and motor control.

She emphasised the capacity for such methods to benefit task performance, and ultimately aid a person to achieve their individual goals in specific contexts.