observing movement

What is the purpose of observational movement analysis (OMA)?

To understand how a person moves and the movement strategies they use.

Why is OMA important in physiotherapy?

Physiotherapists use movement analysis to understand normal movement, identify deviations, generate hypotheses about contributing impairments, and design evidence-based interventions.

What factors interact to determine movement patterns?

Individual, task and environmental factors.

What can OMA help physiotherapists identify?

Deviations from typical movement patterns and potential movement problems.

What are 'hypothesised contributing factors'?

Hypotheses about impairments that may be contributing to a movement disorder, such as reduced joint ROM, muscle strength/length or pain.

What is the clinical reasoning process using OMA?

Observe movement → identify deviations → hypothesise contributing impairments → prioritise hypotheses → assess impairments → confirm or eliminate contributors → design intervention.

What can visual OMA be supplemented with?

Instrumented measurement systems and other objective measurements.

What can video capture systems measure?

Kinematics.

What do force plates measure?

Kinetics/ground reaction forces.

What does EMG measure?

Muscle activation.

What is often considered the 'gold standard' for movement analysis?

Instrumented systems such as video capture, force plates and EMG.

What are smartphone-based movement-analysis apps like?

They are increasingly available, generally less accurate than laboratory systems, but many have acceptable validity; the field is rapidly developing.

What is the key principle when preparing for OMA?

Assess the person's self-selected movement pattern while minimising interference, without compromising safety.

What should be standardised before OMA?

The environment and starting position should be selected and standardised where possible.

Why should instructions be standardised?

To reduce variation caused by differences in how the task is explained and make observations more consistent.

How many repetitions should you observe at minimum?

At least 2 repetitions.

When should you observe additional repetitions?

When interested in changes with practice or fatigue.

What should you assess during the first observation?

Whether the person understood the instructions, could perform the task, used physical assistance/aids, moved safely, and achieved the task goal.

What aids should you note during the first observation?

Gait aids, chair arms, objects used for stabilisation, and braces such as ankle or knee braces.

What is the focus of the second observation?

Narrow attention to the essential movement components of the skill.

How are essential movement components used in OMA?

They provide a template for comparison so deviations from expected movement patterns can be identified.

Why divide motor skills into phases?

Phases make complex movement patterns easier to observe and describe.

What 3 general phases can be used when a skill has no named phases?

Initiation, execution and termination.

What are key components of rolling in lying?

Head turn, shoulder-girdle rotation, trunk rotation and pelvic rotation.

How might you organise observations during gait analysis?

Observe each joint/segment during each gait phase, or follow one joint through every phase before moving to the next joint.

Can OMA be conducted distal-to-proximal or proximal-to-distal?

Yes. Both approaches can be used depending on clinician preference and the task.

What is a movement compensation?

A new movement adopted in an attempt to achieve the goal of a task, often in response to injury or illness.

Give the sit-to-stand example of a movement compensation.

Restricted knee flexion limits foot positioning underneath the body, so the person uses greater trunk flexion to generate momentum and compensate for increased lower-limb force demands.

How is a primary movement problem different from a compensation?

A primary movement problem is the original movement limitation; a compensation is an additional movement adopted to achieve the task despite that limitation.

Why is it important to distinguish the primary problem from compensation?

Treating the compensation rather than the primary problem is unlikely to improve the person's ability to complete the movement.

What does a primary movement problem often look like kinematically?

A decrease or loss of expected movement.

What does a movement compensation often look like kinematically?

An additional movement, which may appear as an increase compared with expected kinematics.

What should you do if a patient cannot complete the movement?

Regress the task by modifying task requirements and/or the environment; verbal cues or prompts may also help.

How can you regress sitting for someone unable to maintain sitting?

Provide more thigh support and/or increase the base of support by allowing use of the arms.

How can you modify sit-to-stand for someone unable to perform it?

Observe or practise the movement from a higher chair.

How can verbal cues help?

They provide specific prompts about how to modify the movement, e.g. pulling the feet further underneath before standing.

How can environmental support simplify upright standing?

Ask the person to stand close to a wall that can provide support if needed.

What should you do if no movement problem is observed after ≥2 repetitions?

Progress the task difficulty to determine whether a movement deviation appears under greater demands.

How can task difficulty be increased?

Modify task requirements and/or the environment.

How could you challenge gait if no gait disorder is observed?

Walk faster than preferred, walk with head turns, walk while completing a cognitive task, or walk while carrying an object.

Give an example of a secondary cognitive task during walking.

Walking while counting backwards.

Give an example of a secondary physical task during walking.

Walking while carrying an object.

How do OMA observations inform predictions about contributing factors?

Observed movement deviations are used to generate hypotheses about impairments that may explain the deviations.

What should you do if the list of possible contributing impairments becomes very long?

Use clinical reasoning to prioritise the most likely impairments for physical examination.

What happens after prioritising hypothesised contributing factors?

Assess the most likely impairments to determine whether they are present and contributing.

If movement amplitude is reduced, what impairments might you hypothesise?

Restricted joint ROM, restricted muscle length, reduced muscle strength, pain around the joint, or other relevant impairments.

If movement is not smooth or is inaccurate, what might you hypothesise?

Altered/reduced proprioception, impaired motor control, reduced muscle strength, or other relevant impairments.

If the sequence of movement is altered, what might you hypothesise?

A motor-control impairment.

How are movement hypotheses tested?

Use impairment-based physical assessments to confirm or eliminate possible contributing factors.

What is the key purpose of hypothesis testing after OMA?

To determine which impairments are actually present and likely contributing to the observed movement problem, guiding treatment selection.