Foundations of movement

analysis
Background
• Human movement is a marker of development and has been associated
with the maturation and interdependence of various systems including
the neuro muscular system, metabolic, cardio vascular systems,
cognitive processes, emotion and social functioning.
• Analysis of movement was historically restricted to the physical domains
but increasingly the role of psycho-social and environmental factors on
movement is being understood.
• Analysis can be undertaken using no technology or using sophisticated
technology. The use of technology is predominantly useful in the fields of
sports and ergonomics.
Background
• For routine physiotherapy or rehabilitation requirements, a
systematic method of analysis based on the person’s
requirements using the skills of a trained person is
considered adequate.
• The use of video analysis makes this systematic method
easier because it affords the ability to view the same
movement multiple times as compared to real time
observation which is fleeting and hence inherently flawed..
Background
• The role of neurophysiology is an important aspect of movement
analysis.
• Motor learning has a crucial role in the maturation of coordinated
movements.
• When considering whole body locomotor movements this includes
postural stability, planning organisation of movement sequences,
judgement of distance, force and other functions mediated by the
cognitive systems.
• These aspects take on greater finesse when it comes to analysis
of movements of the upper limb dealing with precision, dexterity
and parsimony of effort.
Background
•While considering movement analysis, the limits of “ normal”
or “typical” is often difficult to define due to the various self
selected movements that are adopted by individuals.
•Social factors such as defined gender roles or what is
deemed “appropriate” dictate movement selection and
performance.
• Psychological factors such as fear and anxiety may affect
the performance during formal testing .
Background
•Movement analysis is essential to assess the role of
interventions in patient groups, to mediate movement
development in children, to put in place safety and preventive
strategies in the case of elderly individuals at risk of falling and
in a variety of occupational settings.
Background
• Tools of movement analysis are part of research and in the
development of assistive technology.
• Another area where movement analysis can be utilised effectively
is in occupational health settings where a standard method of
analysis can make a valuable contribution in early identification of
risk and prevention of work-related and other overuse injuries.
• Movement analysis is a suitable tool in a systematic scientific
analysis of the risk factors related to occupational injuries and in
the evaluation of the effectiveness of recommended remedies.
Background
•Historically, the term movement analysis has been considered
to be synonymous with gait analysis in a laboratory setting.
•The limitations of this are very evident.
• While considerable emphasis has been given to gait
evaluation methods, other domains of movement have largely
been ignored.
•With the availability of sophisticated technology consisting of
high definition video recording and wearable technology, focus
on other tasks which are relevant for daily life of the individual,
e.g. grasping and manipulation is now possible.
Background
•Individuals choose optimal movement strategies that meet the
demands of the task under their current abilities and limitations.
•Movement analysis provides the opportunity to evaluate the
differences in movement under various conditions- a fact defined
by the international classification of functioning as performance
and capacity.
•Capacity is the optimum way a task can be done when all other
factors are controlled while performance is the natural way that the
movement is done under the influence of environmental factors.
Background
•A laboratory setting provides the opportunity to evaluate
capacity while; wearable technology provides the opportunity to
observe the person in his natural environment.
Background
•Systematic observation of movement under the two different
conditions allows for theorization of underlying reasons for particular
movement patterns and differences between laboratory and home
settings if any, and may ultimately lead to a method for making
movement system diagnoses that can drive evidence-based
treatment decisions.
•Activities that seem intuitive to analyse include static (sitting and
standing) and dynamic tasks (sit to stand, walking, step up/down
and reach/grasp/manipulate, lying to sit; throwing a ball) reaching,
squatting, although the variety of tasks is unlimited eg manipulating
a mobile phone which is now an integral part of daily life.
Background
•Therefore, a general framework which can be tweaked for
particular tasks must be framed. Literature suggests that these
consist of observable aspects of motor control; in other words,
those that can be seen or reported during movement.
•These constructs are symmetry, speed, amplitude,
alignment, verticality, stability, smoothness, sequencing, timing,
accuracy, and provocation of fatigue/ pain.
Background
•These can be grouped within two broader motor control
concepts of postural control and coordination.
•To engage in movement analysis, a concept of the whole
person and not limited to biomechanics must be considered,
albeit biomechanics being the core of movement analysis
concerning the physiotherapist.
Background
•Movement analysis methods have used various tools.
•These include movement notation which was popularised by stalwarts such
as Rudolf Laban, Joan Benesh and Eshkol and Wachman to name a few.
•Free body diagrams were used by dividing movement into phases and still
continues to be a method of analysing movement.
• Any purposive movement generally can be divided into phases the most
simplistic of which will consist of a preparation, execution and return phases.
•This can further be subdivided into sub phases depending on the
movement being analysed.
Background
• As currently defined, the “movement system” represents the
collection of systems (cardiovascular, pulmonary, endocrine,
integumentary, nervous, and musculoskeletal) that interact to
move the body or its component parts. In this interplay of
systems, the unique role of a physiotherapist is in diagnosing
and determining interventions for movement system disorders,
with an emphasis on the biomechanical aspects of movement.
• This is not to say that the other systems be ignored during
analysis but rather that the biomechanical aspects must be
considered within the overall human functioning
Background
• Movement analysis has been considered important from
historical times and the knowledge in this is evolving at a rapid
pace.
• As physiotherapists it is necessary for us to keep pace with the
times while understanding our unique role in this field.
Why movement analysis is important
• Despite the burgeoning advances in technology, optical observation
remains the most prevalent method for movement analysis.
• Optical observation consists of both real time screening methods
and a more standardised and controlled method of retrospective
video footage analysis.
• For relatively straightforward or slower functional movements,
specifically the static ones, naked eye real time observation may be
adequate.
• However in dynamic movements that consist of a complex interplay
of several joints and movements, the value of real time analysis is
questionable.
• Despite the human eye’s acute ability to detect deviations from
what it perceives as typical, the finer aspects of the deviations
cannot be captured reliably during real time observation.
Why movement analysis is important
• Moreover, during real time visualisation, the perception is coloured by
the observer’s impressions, point of focus, prior knowledge and myriad
other aspects which contribute to observer bias and hence poor
reliability.
• During real time observation, the observer does not necessarily excel
in recognizing fundamental issues or compensatory strategies. In
actuality, the genuine attributes of movement are minimally visually
discernible to us without a framework against which it must be
compared.
• During real time observation, we may perceive that something is
different, yet understanding what it is, and its underlying causes often
remains an enigma.
Movement analysis – importance
• While experience might play a role, a critical limitation is that the
human eye does not detect movements occurring in less than
0.25 seconds.
• For example, the stride duration in running, is <0.6 s and
alterations cannot be perceived in real time. Another challenge
is that motion occurs in three different anatomical planes, while
we can only study one plane at a time.
• The same applies to the ‘level’ of motion – we can either
examine the overall pattern or focus on a specific joint.
Movement analysis – importance
• Analysing both simultaneously is nearly impossible, just as we
are incapable of visually estimating the degree of variability in
someone’s movement.
• Thus at best real time observation is useful as a screening tool
to identify if there is “something wrong” but not what is wrong.
Movement analysis – importance
• It is essential necessary for a variety of situations including functional
activities in patients who may be dysfunctional or disabled , physical
activity for fitness to predict and prevent injury and in occupational
settings for the same reasons.
• While the association between movement quality and injury risk has
been inconclusive, these assessments can provide rehabilitation
practitioners with valuable information regarding areas of muscular
weakness, tightness, and movement dysfunction in specific
environments and the reasons behind it.
• This information can therefore play an important role in guiding
exercise prescription or assistive technology recommendations to
meet the individual needs of the patient or client.
Tools
• The increasing understanding of the importance of movement
quality has spawned a variety of screening tools for use in clinical
and research settings.
• These tools have largely been developed for use in specific
populations with relatively specific objectives, although their
overreaching goal is to assess movement quality through the
appraisal of an individual's capacity to perform specific
fundamental movements.
• Fundamental movement skills include: balance skills –
movements where the body remains in place but moves around
its horizontal and vertical axes.
Tools
• Locomotor skills – running, jumping, hopping, and galloping.
• Ball skills – catching, throwing, kicking, underarm roll and
striking.
• Aspects of fundamental movement skills are the building blocks
of all movement and these assessment tools are generally
made using a curated set of movements extracted from
fundamental movement skills.
Uses
•The assessment of movement quality has the capacity to
provide professionals with valuable information that can advise
the development and application of exercise interventions.
•There has been a rapid increase in the number of
assessment tools used in practice, although many do not have
evidence of their reliability.
•Reliability is the degree to which the result of a
measurement, can be relied upon to be accurate.
Uses
•These include the ability of the measurement to give the
same results every time it is applied so long as the person’s
capability has not changed.
•One of the reasons for poor reliability is the psycho-social
underpinnings of movement.
• Through movement, humans act upon and perceive the
world.
•Beyond its direct relationship with the surface/ environment,
movement conveys intention and emotion.
Uses
•This expressive and communicative aspect is studied in
artistic domains such as dance and music, in the field of non-
verbal communication, and as a means of symbolic
communication e.g. through sign language.
• The movement notations systems, originally developed in the
context of performing arts has been applied in numerous fields
due to this interaction of emotion and movement.
• However, due to the requirement for specialised training, these
notation systems are not popular in physiotherapy for routine
usage
Uses
• Having a framework which can be used to focus movement analysis
or an algorithm approach is likely to improve the reliability of
retrospective analysis of video footage.
• This kind of system provides the opportunity to observe multiple task
repetitions and gauge the monotony or variability.
• Moreover, , task and environmental variations can be used to
evaluate movement capabilities and observe changes in strategies or
performance with different constraints, supports, or verbal instructions.
• If an individual is unable to complete a task as instructed, we can
alter the task or environmental conditions to promote optimal
performance.
• This provides an opportunity to gauge the person’s intention and
emotion related to movement.
Uses
• A systematic framework to alter environmental and task
constraints, using an adaptation model would provide guidance.

• The actual modifications must also be applicable and

acceptable to the patient/ client (emotional aspect).
• Simplifying a task or breaking up a task into components allows
the therapist to observe individual movement in someone who
is unable to perform a composite task.
• Compensations can include modifying the environment, tools or
speed.
Uses
• Examples of task modifications may include planning and
breaking down into sub tasks.
• Examples of environmental modifications include altering the
surface type or height; providing cueing (auditory or visual) ,
physical assistance, or external support; or altering environment
through adaptations or assistive technology. .
• The choice of assistance or cueing depends on many factors,
including the individual’s physical and cognitive abilities;
however, the general order is : (1) verbal cue, (2)tactile cue,
and (3) physical assistance
Tools
•Movement Analysis Worksheets are useful to provide
students with a structured format for conducting movement
analysis.
•Quality of movement can be assessed through worksheets
and the necessity for quantitative assessments identified.
•Thereafter the system wise assessments can provide
additional information on the areas for interventions.
Tools
• Movement analysis can be done both as a developing strategy and as a
regressing strategy.
• Developing strategy involves the evaluation of body structure and function
aspects and moving on to function or composite movement analysis.
• This method is useful in straightforward musculoskeletal pathology.
• In complex neurological conditions with no expectation of complete
recovery, a regressive strategy might be able to provide greater information.
• This would involve analysing the composite movement first and then
identifying the components that need to be addressed.