Movement Analysis II

1. Life/Death
2. Walking
Mobility = bed mobility, transfers, ambulation
Many neurological diagnoses have typical patterns that change mobility.
Impairments associated with a specific diagnosis drives the pattern

Mobility - Our identity

1. Primary impairment: weakness/paresis
a. Causes secondary impairments: musculoskeletal issues
i. Decreased ROM....lead to contractures
ii. Anticipatory control
iii. Reactive control
iv. Fitness/endurance/participation

Mobility - Impairments that Drive Abnormal Patterns

• Primary impairment: weakness/paresis

  • plantarflexors

  • quadriceps

  • hip flexors swing

  • hip extensors

  • hip abductors

Mobility - Impairments that Drive Abnormal Patterns

plantarflexors ?

i. Reduced propulsion
ii. Reduced hip flex pre-swing (ipsilateral)
iii. Increased knee hyperextension (stance)

quadriceps ?

i. Reduced loading (ipsilateral)
ii. Forward lean
iii. Difficulty with knee flex (swing)

hip flexors-swing

i. Decreased knee flex (ipsilateral)
ii. Impairs toe clearance

Hip extensors- postural stability, gait velocity?

i. Compensation - backward lean
ii. Must increase Tibialis Ant to compensate

Hip Abductors - trendelenburg?

i. Contralateral hip drop
ii. Lateral shift over stance LE
iii. Loss of stability

a. Inappropriate muscle activation
b. Increased muscle stiffness
c. Quadriceps-stiff leg
d. Hamstrings-excessive knee flexion
e. Hip adductors-scissoring
f. Synergies:
i. ankle/knee extensors
ii. hip/ankle flexors reduces knee extension

Impairment: Spasticity

• Increased muscle activation unrelated to spasticity pattern

  • More in cerebral palsy

• Abnormal coordination of segments during multi-joint movement

  • inability to control timing and scale of muscle activity

    • Ataxia,

    • PD

• Agonist/antagonist co-activation

  • May be due to need to increasing postural support

Impairment: Coordination

• Primary impairment: weakness/paresis

  • Causes secondary impairments: musculoskeletal issues

    • Decreased ROM....lead to contractures and reduced power

      • Tibial advancement, toe clearance, recurvatum, hip extension

    • Anticipatory control

    • Reactive control

    • Fitness/endurance/participation

Mobility - Impairments that Drive Abnormal Patterns

what is anticipatory control?

hanging conditions, obstacles, turns, speed

what is reactive control?

Instability in stance and walking, trip/slip - lack of stepping reaction

/what is Fitness (endurance)/participation?

declines

Other Considerations: for mobility impairments that drive abnormal patterns?

◆ Perception
◆ Pain
◆ Cognition
● executive function (awareness, attention)
● dual-task

Hedman, 1996

Ok, So How Do We Analyze Movement? chart?