This keynote presentation was captured during the Physiotherapy New Zealand Conference in Auckland in September 2014 and outlines key features of the ISM approach to illustrate how all regions of the body are connected and how to determine which region is creating a kink in the linked chain.


In clinical practice, it is common to see complex patients with a combination of impairments in the musculoskeletal, urogynecological, respiratory and posture/equilibrium systems and there is little scientific evidence to guide clinicians for these complex, yet common, patients. Clinical reasoning remains the recommended approach for determining best treatment for the individual patient.

The Integrated Systems Model (ISM)  is a framework to help clinicians organize knowledge and develop clinical reasoning to facilitate wise decisions for treatment. A key feature of this approach is Finding the Primary Driver. In short, this involves understanding the relationships between, and within, multiple regions of the body and how impairments in one region can impact the other. Specific tests are used to determine sites of non-optimal alignment, biomechanics and control (defined as failed load transfer (FLT)) during analysis of a task. Subsequently, the timing of FLT, as well as the impact of correcting one site on another, is noted. Clinical reasoning of the various results determines the site of the primary driver, or the primary region of the body, that if corrected will have a significant impact on the function of the whole body/person. Further tests of specific systems (e.g. articular, neural, myofascial, visceral) then determine the underlying impairment causing the non-optimal alignment, biomechanics and/or control of the primary driver for the specific task being assessed.

Course Reviews


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  1. Profile photo of jane wilkinson

    The Clinical Puzzle

    Creating space..finding the primary driver…using individual skills and collaborating thoughts and tests….I want more knowledge bombs from D Lee…onto the next one…thank YOU!!

  2. Profile photo of HollyHerman

    Introduction to The Integrated Systems Model

    So many pearls of wisdom.
    The clinic is the place to be to learn from those we help and those whom we are not able to help
    The lecture, videos, lab reflect years of Experience, Innovation,Functional Relevance, Thinking Outside the Box, Individualized Approach
    Tremendous amount of humor, the key to getting everyone hooked and remembering what is said
    Could watch it over and over again and learn more each time

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