Movement Analysis

Lecture 3

What are the phases of the Movement Continuum?

1. Initial Conditions

2. Preparation

3. Initiation

4. Execution

5. Termination

6. Outcome

List and describe the 3 Movement Constructs.

1. postural control - verticality and stability

2. coordination - smoothness, sequencing, timing, accuracy

3. other - symmetry, speed, amplitude, alignment, symptom provocation

Define Symmetry.

agreement between kinematics and external kinetics of movement

Define Amplitude.

the extent or range of movement used to complete a task

What are the 3 principles of movement analysis?

1. standardized environment and instructions

2. minimal assistance, observe natural strategy

3. regressions and progressions

What are the 4 Task Changes?

1. BOS

2. Speed

3. Perturbations

4. Cognitive Demand

What are the 5 Environmental Changes?

1. Surface type or height

2. cueing

3. physical assistance

4. external support

5. environmental inputs

What are the steps to link analysis to treatment?

• generate hypothesis

• select tests/measures

• match tx to deficits

observation → diagnosis → intervention

Describe the Integrated Framework.

• movement system is at the core of PT practice

• shared decision-making as a foundation

• applicable across the lifespan and conditions

• organizes reasoning based on the Patient/Client model

What does the Integrated Framework combine?

• ICF

• movement science

• hypothesis-oriented decision-making

What are the Revisions of the Framework?

• applies to all health conditions

• shared decision-making focus

• episode of care framed around participation goals

• integration of movement analysis into patient management

What does OARS stand for?

Open-Ended questions

Affirmations

Reflective listening

Summarize

What are the components of shared decision-making?

• partnership begins at history and review

• explore pt’s goals, perceptions, resources, and constraints

• motivational interviewing, readiness to change

What are the 5 categories of questions PTs should be asking when performing shared decision-making?

• why are you seeking care?

• goals

• pt’s role in society

• pt’s resources and constraints

• pt’s preferences for solutions

What are the 6 systems involved in the Systems Review?

1. Cardiovascular

2. Pulmonary

3. Integumentary

4. MSK

5. Endocrine

6. Nervous

What are the components of the minimal dataset when performing a systems review?

1. vitals

2. orientation

3. communication

4. learning style

What are the components of the examination process?

• dissect participation goals (component activities)

• movement analysis of tasks (initiation, execution, termination)

• blend ICF activity/participation + movement science constructs

What is hypothesis generation based on?

• observed movement patterns

• pt history and goals

• systems review findings

When does hypothesis generation occur?

at each step of patient/client management

What should Interventions include?

• address impairments

• be task-specific to participation goals

• include progression/regression

• incorporate shared decision-making in planning

What does the Integrated Framework encourage?

• consistency between clinicians

• patient partnership

• integration of movement science + ICF

Why does gait matter?

• gait and posture - essential for independence and QOL

• predict morbidity and mortality

• fear of losing the ability to walk = major patient concern

Why does gait need classification?

• many prior classifications = anatomy or pathology

• challenge: gait is multi-system

• goal is clear and clinically useful system

What are the continuous gait disturbances?

• ataxia

• spastic

• bradykinetic/hypokinetic

• dyskinetic/choreic/dystonic

• paretic

• truncal

• antalgic

• higher-level

What are the Episodic gait disturbances?

• freezing of gait

• festinations

• falls/disequilibrium

What does Quinn et al say about using movement constructs to observe?

• provides structured observation tools

• key constructs: symmetry, amplitude, speed, sequencing, verticality

• use in case: identified impaired initiation, reduced step length, instability

What are takeaways of the Giladi et al study on Gait Classification?

• differentiates between continuous and episodic gait disturbances

• helps link prognosis and treatment focus

What are the 3 components of holistic care?

• observation

• reasoning

• classification

How should you treat a patient with both continuous and episodic gait disturbances?

treatment should address both impairments

What are the steps to Patient-Focused Education?

1. normalize and clarify the problem

2. connect to function and goals

3. describe treatment approach simply

4. involve spouse

5. encourage hope and partnership

What are the components of the Stance Phase of Gait?

1. initial contact

2. loading response

3. midstance

4. terminal stance

5. pre-swing

What are the components of the Swing Phase of Gait?

1. initial swing

2. midswing

3. terminal swing

What are the critical events of Initial Contact?

heel strike creates the first point of contact for weight acceptance

Which muscles are involved in Initial Contact?

• tibialis anterior

• glute max

• hamstrings

What are the common deviations seen in Initial Contact?

• foot drop (weak dorsiflexors)

• knee hyperextension (weak quads or instability)

What are the critical events of the Loading Response?

• controlled knee flexion

• ankle plantarflexion

• hip stabilization

What are the common deviations seen during Loading Response?

• foot slap (weak dorsiflexors)

• forward trunk lean (weak quads)

• lateral trunk shift (weak hip abductors)

Which muscles are involved in the Loading Response?

• eccentric quads

• glute max

• tibialis anterior

What are the critical events in Midstance?

controlled tibial advancement and frontal plane hip stabilization

Which muscles are involved in Midstance?

• ecc calf

• glute meds

Which impairments are commonly seen during Midstance?

• trendelenburg (weak hip abductors)

• excessive pronation (foot instability)

• knee valgus (foot instability)

• early heel rise (tight calf)

What are the critical events during the Terminal Stance Phase of Gait?

controlled ankle dorsiflexion with heel rise and trunk progression

Which muscles are involved in Terminal Stance?

ecc calf muscles

What impairments are commonly seen during Terminal Stance?

• lack of heel rise (weak plantarflexors)

• shortened step length (hip flexor tightness or pain)

What are the critical events of the Pre-Swing Phase of Gait?

passive knee flexion and plantar flexion for push-off

Which muscles are involved in Pre-Swing?

• minimal active muscle role

• passive recoil of stored energy

• hip adductors assist limb positioning

What impairments are commonly seen during Pre-Swing?

• insufficient push-off (weak plantarflexors)

• limited knee flexors (tight quads or weak hammies)

What are the critical events of the Initial Swing Phase of Gait?

hip flexion, knee flexion, and foot clearance

Which muscles are involved in Initial Swing?

• iliopsoas and sartorius

• hamstrings

• tibalis anterior

What impairments are commonly seen during Initial Swing?

• toe drag (weak dorsiflexors)

• hip hiking or circumduction (compensatory for poor foot clearance)

What are the critical events of the Midswing Phase of Gait?

continued hip flexion and ankle dorsiflexion for clearance

Which muscles are involved in Midswing?

• hip and ankle flexors

• tibialis anterior

What impairments are commonly seen during Midswing?

• toe drag

• vaulting on opposite limb

What are the critical events of the Terminal Swing Phase of Gait?

full knee extension and ankle neutral for heel strike

Which muscles are involved in Terminal Swing?

• ecc hamstrings

• quads

• tibialis anterior

What impairments are commonly seen in Terminal Stance?

• knee snaps into extension (weak hamstrings)

• foot slap at contact (weak dorsiflexors)

Which gait impairments are weakness-related?

• foot drop

• poor push-off

• knee buckling

Which gait impairments are due to spasticity/rigidity?

• equinovarus

• scissoring

• early heel rise

• knee hyperextension

Which gait disturbances are due to coordination/balance deficits?

• ataxia

• poor limb placement

• festination

• FOG

Which gait disturbances are due to compensations?

• hip-hiking

• circumduction

• vaulting

• trunk lean