Lab 2: Intro to Observational Movement

What is observational movement analysis?

The process of observing the performance of a specific task and recording results. It can be comprised of both objective & subjective elements.

Movement analysis of task(s) framework consists of?

1. Subjective

2. Analysis of task(s)

3. Progression/ regression

4. Tests & Measures

5. Plan of care

What is the subjective portion?

Use patient/ client history to guide selection of relevant goal directed tasks to observe

What is the analysis of tasks portion?

Have patient/ client performa a patient-focused task. While viewing, generate hypotheses about contributing factors to any deviations in observable constructs of motor control

What is the progression/ regression portion?

Modify the task and/or the environment to enable independent performance (regression) or challenge performance (progression) to better understand the capacity of the movement system and better inform your hypothesis

What is the tests & measures portion?

Perform tests & measures (MMT, ROM, coordination, etc) to confirm or reject hypotheses made in Steps 2 and 3 regarding factors impacting movement

What is the plan of care portion?

Combine data from patient/ client history, movement analysis, and tests & measures to develop diagnoses and PT plan of care

What are the movement constructs?

• Coordination

  • Sequencing & Timing

  • Smoothness

• Postural Control

  • Verticality

  • Stability

• Alignment

• Amplitude

• Speed

• System Provocation

Sequencing & Timing definition

The spatial organization and temporal structure of different body segments to complete a task

• Including: Initiation, execution, & termination

• Ex: Delayed initiation, delayed stepping strategy, 180° phasing for arm swing

Smoothness definition

The ability to complete a task in a continual fashion without interruptions in velocity or trajectory

• Ex: Hesitancy during reach, jerkiness of limb advancement during swing phase, intention tremor

Verticality definition

The ability to orient the body in relation to the line of gravity

• Ex: Lateral trunk lean, head tilt

Stability definition

The ability to control the body’s COM in relation to the BOS

• Ex: Increased sway, loss of balance during reach

Alignment definition

Biomechanical relationship of body segments to one another as well as to the BOS, in order to achieve the task

• Ex: Elevated shoulder, genu varus/valgus, retracted pelvis, scoliosis

Amplitude definition

The extent or range of movement, either whole body or body segments, used to complete a task

• Ex: Low amplitude arm swing, asymmetric step length

Speed definition

Rate of change or velocity of segment or body displacement for task execution

• Ex: Time to walk 10 meters, turn, and walk back, time to complete reaching task

Symptom Provocation definition

An observation or patient report of symptoms; movement that evokes a particular response

• Ex: Change in O2 sat, heart rate, patient-reported measures of pain, dizziness, fear

Task variations for progression & regression

• BOS

• Speed

• Perturbation

• Cognitive demand

• Vision

How to progress & regress BOS?

Progression:

• Decrease BOS (feet closer together)

Regression:

• Increase BOS (widen feet)

How to progress & regress speed?

Progression:

• Encourage faster completion of task

Regression

• Allow slower completion of task

How to progress & regress perturbation?

Progression:

• Add internal perturbation (head turns, carrying loads)

Regression:

• Remove perturbations if present

How to progress & regress cognitive demand?

Progression:

• Add cognitive task to movement (reciting alphabet, math facts)

Regression:

• N/A

How to progress & regress vision?

Progression:

• Remove vision

Regression:

• Add vision if not part of the original tasks

Environmental variations for progression & regression

• Surface

• External cues

• Physical assistance

• External support

• Sensory inputs

How to progress & regress surface?

Progression:

• Decrease BOS (placing feet closer together)

Regression:

• Decrease demand (decrease step height, increase seat height)

How to progress & regress external cues?

Progression:

• Remove verbal, visual, or physical cueing if present

Regression:

• Add verbal, visual, or physical cueing (use of mirror)

How to progress & regress physical assistance?

Progression:

• Remove physical assistance if present

Regression:

• Provide physical assistance by therapist or family member

How to progress & regress external support

Progression:

• Remove external supports if present

Regression:

• Provide external support (orthoses, assistive devices)

How to progress & regress sensory inputs?

Progression:

• Vary auditory or visual inputs (add environmental motion)

Regression:

• Vary auditory or visual inputs (remove sound, increase light)

What are the 3 challenges the postural system must meet?

1. It must maintain a steady state (balance) in the presence of gravity

2. It must generate adjustments that anticipate self-initiated goal-directed movements

3. It must be adaptative during these movements in response to external perturbations

________ forms the foundation for all voluntary motor skills

Balance

Biomechanical task definition

The overall goal or purpose of the movement (ex. sit-to-stand, supine-to-sit)

Movement strategy definition

The plan or approach used to accomplish the movement.

Movement pattern definition

The actual kinematics or motions used during the task.

Deviation definition

• An atypical movement pattern; describes HOW movement differs, not the underlying cause OR

• A change or variation in the normal pattern, path, or execution of a movement from an established standard or expected biomechanical pattern

Movement schema/ Coordination mode definition

The requirements for successful completion of the movement. (Example: for sit to stand, we need to translate our COM from a BOS of the pelvis to over the feet and maintain it there as we extend our knees)

What are the steps in the movement continuum?

1. Initial condition/ Postural set

2. Preparation

3. Initiation

4. Execution

5. Termination

Initial condition/ Postural set definition

Starting posture & readiness for movement

Preparation definition

Internal motor planning & response preparation

Initiation definition

How movement begins

Execution definition

Performance of movement & core movement tasks

Termination definition

Ability to stop or end movement appropriately

Typical movement is ________, ________, ________, ________, ________, & ________

Fluid, Efficient, Symmetrical, Adaptable, Reliable, Goal-oriented

Typical movement includes ________ & ________ between body segments

Rotation, Dissociation

Neurologic movement often demonstrates ________, ________, ________, ________, & ________

Reduced dissociation, Asymmetry, Excessive effort, Jerky motion, Limited adaptability

________ is a hallmark movement impairment after stroke

Hemiplegia

What are the postural control concepts?

• Postural stability

• Postural control

• Postural adjustments

Postural stability definition

Ability to maintain COM within BOS

Postural control definition

Mechanisms used to maintain balance (hip/ankle strategies)

Postural adjustments definition

Responses used to rgain or maintain stability

Balance systems must maintain ________, respond to ________, and adapt to ________

Steady-state balance, Perturbations, Environmental demands

Primary impairment definition

Signs and symptoms that are a direct result of a patient’s disease or pathology

• Weakness, sensory loss

Secondary impairment definition

Changes in structure or function of a given system that may occur as a consequence of the patient’s initial pathology and related impairments and/or as a result over time of some other influence (aging/lifestyle choices/etc). “Sequela”

• Reduced endurance, contracture