8- Movement Analysis

Purposeful movement is:

-complex

-requires a series of tasks directed toward a goal behavior (ex. STS)

-occurs within a specific context (influenced by social, environmental, and personal factors)

PTs are responsible for:

Evaluating, managing, diagnosing, interventions

reasons PTs perform movement analysis

treatment efficacy, provide person-centered care, focus intervention, treatment strategies, avoid pathoanatomical diagnosis, justify skilled intervention

What is the big picture of movement analysis?

• Observe the movement

• Describe the movement, noting abnormalities

• Hypothesize cause(s) of any abnormalities

• Test your hypotheses

• Treat the problems you identify

• Re-assess

• Modify and repeat as needed

Motor control framework steps

movement examination, movement analysis, plan of care to address movement dysfunction, outcome

Motor control framework step: __________________

- What is the problem?

- Where in the movement continuum does the problem occur?

- How is the pt CURRENTLY performing the specific movement tasks - observe and describe the movement (seeing/hearing, how can it be qualitatively described, quantitatively?)

- How does movement compare with premorbid or expected performance?

movement examination

How long a pt takes to do an exercise is an example of

Quantitative description of movement

Review slides 18-24: motor control framework...

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Within the movement continuum, what is one thing you look at during the termination phase?

Timing of stopping, balance or stability

Which component of the movement continuum corresponds to the time period when the movement is being organized (mental processes)?

Preparation

Motor control framework: ________________

- Hypothesize the underlying determinants of the problem (test/measure to rule in and rule out)

- Develop hypotheses for why the movement dysfunctions exist (consider ICF, what DOMAIN is the problem occurring?)

- CLINICAL COMPONENTS of movement

- ultimately leads to PT DIAGNOSIS (Dx)

Movement Analysis

Medical Dx vs. PT Dx?

Medical Diagnosis: Causes of diseases, disorders, injuries
Physical Therapy Diagnosis: Consequences of diseases, disorders, injuries (Movement system impairments, activity limitations, and participation restrictions)

What are examples of Medical Dx?

Stroke, TKR, adhesive capsulitis

What are examples of PT Dx?

Muscle weakness, difficulty walking, shoulder pain

What are the 4 Domains of movement?

Neural, Biomechanical, Physiological, Behavioral

neuronal structures, pathways, and processes that participate in the control of the movement

Neural domain

Weakness due to stroke, or lack of sensation due to peripheral neuropathy from diabetes, are examples of problems with what domain?

Neural

structure and properties of muscles, joints, and soft tissues and the physical laws governing movement

Biomechanical domain

This is an example of problems with what domain?

Muscle tightness limiting joint range of motion or Ligamentous laxity affecting joint stability

Biomechanical

mechanisms of various systems of the body that contribute to the production of movement

physiological domain

This is an example of problems with what domain?

Impaired cardiopulmonary endurance or decreased metabolic efficiency, or skin is too tight after burn (integumentary system)

Physiological

cognitive, motivational, perceptual, and emotional processes, & the outcome of movement in terms of either solving a motor problem or satisfying a goal in a particular environmental context

behavioral domain

Impaired attention and cognition, or Fear of falling are examples of problems with what domain?

Behavioral

What are the clinical components of movement?

Mobility, force generation, muscle tone, sensory information, pain, speed, endurance, posture, balance, coordination, selective capacity, adaptive capacity, cognitive and psychology

Identify the difference between medical diagnosis and PT diagnosis?

Medical: causes of disease

PT: consequences

Abnormal movement patterns due to a leg length discrepancy would be categorized under which domain of movement?

Biomechanical

Motor control framework: _________________

How do we treat this pt? What does the evidence say?

- Aim to optimize movement and minimize activity limitations and participation restrictions (ICF)

- Identify interventions linked to underlying determinants

- directly target underlying determinant (assistive devices, pt education, referrals)

Plan of care to address movement dysfunction

Motor control framework: ___________

What is the result? Did we achieve the desired pt goal?

- Re-eval to assess effectiveness of interventions

- Goals achieved?

- Return to movement examination if needed

outcome

Identify the big picture: How does the motor control framework help you to get from what you observe to how you design your plan of care?

Identify where in the movement continuum they have dysfunction, try to identity the cause of the problem, and design the plan of care, reevaluate, refer if needed

10 min walk gait analysis

IC: posture standing upright with cane, leaning towards the cane, left arm IR (muscle tension), BOS is narrow but normal, environment: in hallway, flat surface

Preparation: pt understood directions well, no modification needed

Initiation: cane moves first, movement initiated at the hip

Execution: stomping more weight the left foot leading, eye gaze on the ground, toe in posture of the right foot, no excessive leaning, left arm in flexed position, knee in extension, leg circumducts)

Termination: ends in same position as start, elbow ended in flexion, elevated shoulder