Movement Analysis & Production (PDF) - University of St. Augustine for Health Sciences

Movement Production and Analysis Introduction 1 Objectives At the completion of this unit, the learner will be able to: CLO 2 Analyze typical (normal) movement patterns and basic functional activities (tasks) in varying environments across the lifespan. 2. 1 Describe...

Movement Production and Analysis Introduction 1 Objectives At the completion of this unit, the learner will be able to: CLO 2 Analyze typical (normal) movement patterns and basic functional activities (tasks) in varying environments across the lifespan. 2. 1 Describe the quality of 2. 2 Analyze selected whole- 2.3 Compare variations in typical movement patterns at body movements (e.g., sitting, selected movement parameters selected body regions, e.g., forward reach / grasp / resulting from normal aging shoulder, upper extremity, head manipulate, sit to stand, squat, and body structures and neck, trunk, pelvis, and step up/down), applying lower extremity, using selected parameters of movement characteristics including: a. Symmetry, Speed, Amplitude, Alignment b. Postural Control c. Coordination 2 1  Recall from Previous Units Movement is the result of the interaction of  Task to be performed Interaction  Capacities of an individual results in Task Movement  Constraints of the environment Individual Environment 3 Individual Capacities Task Multiple systems involved  Cognitive ideation of the purpose of a movement C Cognitive or task Individual Environment  Sensory/perceptual INPUT M/A SP  Motor OUTPUT Motor Sensory Action Perception 4 2  Why Emphasize Movement? Movement is at the heart and center of physical therapy practice 5 Central to Physical Therapy Practice  2013 Vision Statement: "Transforming society by optimizing movement to improve the human experience."  Physical Therapists are movement ‘experts’.  Analyzing movement is a key component of APTA’s Patient and Client Management Model. 6 3  Patient and Client Management Model EXAMINATION includes: History Review of Systems Movement System Movement Analysis Source of Image: APTA, 20232 7 Elements of Patient and Client Management Model EAMINATION EVALUATION/ PROGNOSIS INTERVENTIONS OUTCOMES DIAGNOSIS Measure joint Apply skilled Develop goals to Create plan of Assess whether ROM, mobility, judgment to improe care to improve interventions muscle length identify movement and movement resulted in tests, strength impairments that function improved affecting altar movement movement movement 8 4  Elements of Patient and Client Management Model Examination Evaluation Prognosis Interventions Outcomes Measure Apply skilled Develop Create plan Assess joint ROM, judgment to goals to of care to whether mobility, identify improve improve interventions muscle impairments movement movement resulted in length tests, that impact and function improved strength movement movement affecting movement 9 Up Next: Movement Production How does movement occur?  Role of the Central and Peripheral Nervous System  Reciprocal Innervation and Inhibition  Role of force couples and the Agonist – Antagonist relationship in producing movement 10 5  Summary  Movement is the result of the interaction of the Individual, Task and Environment  Movement analysis is central to the role of the physical therapist in maximizing movement and function in patient management  Subsequent presentations introduces frameworks to describe and analyze movement and tasks 11 References 1. Shumway-Cook A, Woollacott MH, Rachwani J, Santamaria V. Motor Control: Translating Research into Clinical Practice. Sixth edition. Wolters Kluwer; 2023. 2. APTA Guide to Physical Therapist Practice 4.0. American Physical Therapy Association. Published 2023. Accessed November 13, 2023. https://guide.apta.org 12 6  Science of Movement Movement Production 1 Objectives  Upon successful completion of this unit, the learner will be able to:  Describe the anatomical structures, pathways and selected end-organs of the Nervous System responsible for normal movement production  Identify and describe the function of the sensory and motor components of the Nervous System involved in movement production 2 1  Review: Movement Production Movement Task Environmen Individual t 3 Individual Capacities Include: Nervous System functions: Cognitive  Cognitive ideation of the purpose and movement or task  Sensory/Perceptual INPUT Sensory / Motor / Action Perception  Motor OUTPUT 4 2  A Broader View of Movement  In earlier course(s) you learned about the anatomy and structure of individual muscles and their resulting individual actions contributing to movement  In this course we start with observing and describing the whole movement Moore, Dalley and Agur, 20181 5 Cognitive Input to Movement c  Attention  Planning  Problem-solving  Motivation  Emotional aspects of motor control 6 3  Motor Output  Movement begins in the precentral gyrus of the cerebrum  Brain ‘sees’ or controls movement of a body segment, not individual muscles 7 Descending Motor Pathways Conscious movement ‘messages’ travel from the primary motor cortex downward through multiple pyramidal tracts:  Corticospinal and Corticobulbar tracts Unconscious or reflexive responses originate in the brainstem and do not pass through the pyramids  Extrapyramidal tracts  Reticulospinal  Rubrospinal  Vestibulospinal  Tectospinal 8 4  Descending Motor Pathways Conscious movement ‘messages’ travel from the primary motor cortex downward through multiple pyramidal tracts:  Corticospinal and Corticobulbar tracts Unconscious or reflexive responses originate in the brainstem and do not pass through the pyramids  Extrapyramidal tracts  Reticulospinal  Rubrospinal  Vestibulospinal  Tectospinal 9 Sensory/Perceptual Systems Input  Sensation and perception are essential in the control of movement  Perception is the integration of sensory input  Sensory input includes somatic sensation  Light touch  Vibration  Pressure  Proprioception (joint  Pain position)  Temperature  Kinesthesia (movement)  Also, visual vestibular input 10 5  Ascending Sensory Pathways  While motor messages are traveling down from the brain, sensory input/messages are traveling UP to the brain by multiple sensory tracts including:  Spinothalamic  Dorsal column medial lemniscal pathway  Spinocerebellar 11 Formation of Spinal Nerve Roots  Motor neuron in anterior horn exits spinal cord  Sensory neuron enters posterior horn of spinal cord  ‘Mix’ of sensory and motor nerves = a single spinal nerve root 12 6  Peripheral Nerves  Examples: Combination of portions of multiple spinal nerves e.g., Femoral n. L2-4, Axillary n. C5-6.  Comprised of a mix of sensory and motor nerves 13 Muscle ‘Activation’  Motor component of peripheral nerve connects to (innervates) a muscle at the neuromuscular junction at multiple sites 14 7  Types of Muscle Activation Concentric Eccentric Isometric Meaning: “Coming to the center” Meaning: “Away from center” Meaning: “Equal length” or unchanging length Shortening contraction Lengthening contraction Contraction with no change in muscle length Internal force of the muscle overcomes Internal force of the muscle is overcome Internal force of the muscle is equal to an external force (weight or gravity) by an external force (weight or gravity) the external force Example: Biceps curl - Elbow flexion Example: Elbow extension produced by Example: Elbow held in flexed position produced by shortening of Biceps lengthening of Biceps brachii against (no motion), produced by contraction of brachii against gravity or external gravity or external weight Biceps brachii against gravity or weight external weight 15 Muscle Activation: Reciprocal Innervation  While motor neuron is stimulating the Agonist to contract (in this case the Biceps brachii), a sensory/afferent nerve feeds back to the spinal cord.  Feedback results in inhibition of the opposing (Antagonist) muscle (the Triceps brachii), allowing Agonist to work unopposed 16 8  Muscle Activation: Force Couples  Force couple – a pair of forces equal in magnitude, oppositely directed.  Force couples are the actions of 2 or more muscles on opposite sides of a joint working together to stabilize a joint, or to produce movement. 17 Muscle Activation: Force Couples at Work  Deltoid produces upward and outward force on humerus  3 Rotator cuff mm. (Infraspinatus, Teres minor, and Subscapularis) create a downward and inward force to maintain position of humeral head  Supraspinatus pulls humeral head inward 18 9  Muscle Activation: Movement Synergies  Movement synergy = coordinated movements produced by the simultaneous activation of multiple muscles, muscle groups (e.g., force couples) at multiple joints, and in multiple planes of movement.  Normal synergies produce coordinated movement and are efficient  Functional human movement occurs in synergies 19 Normal Synergies at Work Video Credit: [gorodenkoff]/[Squad of Fully Equipped and Armed Soldiers Running in Single File in the Desert. ]/[iStock/Getty Image Plus] 20 10  Normal Synergies at Work - Contrast Video Credit: [jamesbenet]/[Toy Soldiers marching with Alpha]/[iStock/Getty Image Plus] 21 Muscle Activation: Movement Synergies at Work Video Credit: [simonkr]/[Tennis Player Serving On The Clay Court - stock video]/[iStock/Getty Image Plus] 22 11  Movement: A Continuous Process  The Cognitive system initiates the idea of movement and transmits the idea via the descending motor pathways to spinal and Cognitive peripheral nerves Sensory / Motor Activity / Perceptual Input Output 23 Movement: A Continuous Process  The motor neuron stimulates the muscle at neuromuscular junction repeatedly to Cognitive Motor produce a muscle contraction and movement Planning Sensory / Motor Activity / Perceptual Input Output 24 12  Movement: A Continuous Process  Sensory end organs detect movement within muscles, providing local feedback (at the level of Cognitive Motor the spinal cord) to inhibit antagonists Planning  Sensory receptors in joints, skin and muscles also send information up to the brain, where Cognitive systems modify motor plans to refine movement Sensory / Motor Activity / Perceptual Input Output 25 Movement: A Continuous Process  At any moment during a movement the 3 components are simultaneously and Cognitive continuously acting and modifying their Motor Planning activity to refine movement Sensory / Motor Activity / Perceptual Input Output 26 13  Example of the Continuous Process  Cognitive: ideation to reach for object  Motor: muscle contraction to initiate movement  Sensory: visual and proprioceptive input with movement  motor refinement 27 Summary The Individual’s Capacities are responsible for producing movement in response the required Task and in the context of the Environment The Individual Capacities include the Cognitive, Motor/Action (Output) and Sensory/Perceptual (Input) Systems Descending motor pathways facilitate contraction of the Agonist muscle and inhibit contraction of the Antagonist through reciprocal innervation and inhibition 28 14  Summary Movement is the result of multiple muscles groups working together at a single joint (force couples), and at multiple joints (movement synergies) Motor output is refined at both spinal cord and the brain Movement is a continuous cycle of motor output, sensory input and cognitive planning and integration 29 References Moore KL, Agur AMR, Dalley AF. Clinically Oriented Anatomy. Eighth edition. Wolters Kluwer; 2018. Blumenfeld, Hal. Neuroanatomy Through Clinical Cases. 3rd ed., Sinauer Associates/Oxford University Press, 2021. Silverthorn, DU. Human Physiology: An Integrated Approach. Pearson Education, Inc; 2019. Neumann, DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation, 3rd Edition Mosby; 2016. ISBN-13: 978-0323287531 30 15  1/30/25 Movement Analysis Science of Movement 1 Objectives Upon successful completion of this unit, the learner will be able to: § Define terms used to describe movement as proposed by APTA’s Academy of Neurologic Physical Therapy (2021) § Analyze typical movement at selected body regions using the proposed terminology § Analyze selected whole-body movements applying selected terms of movement 2 1  1/30/25 Why ‘Measure’ Movement? § If you cannot measure it, you cannot improve it. (paraphrased from Lord Kelvin) § “You can’t manage what you can’t measure.” (Peter Drucker) 3 Why ‘Measure’ Movement? § Restoring/maximizing function essential to physical therapy practice § Functional activities are built on movement § Establishing ‘baseline’ movement is necessary to assess improvement § Measuring joint mobility, Active and Passive ROM, muscle length and muscle strength are not enough 4 2  1/30/25 Patient Management Starts with Movement Analysis Hypothesize underlying cause/ Perform Task/ Identify Key (Movement) contributing factors to Movement Analysis Impairment(s) movement impairments Create a therapeutic Determine most Formation of appropriate exercise(s) to improve appropriate form of intervention to improvement the movement/task resistance impairment; Look back at the movement 5 Hypothesize underlying Perform Task/Movement Identify Key Movement cause/Contributing factors Methods Analysis of Movement Impairment(s) to movement impairments Assessment Create a therapeutic Determine most Formation of appropriate Exercise(s) to improve appropriate form of Ther Ex; Look back at the task/movement resistance movement performance 6 3  1/30/25 How to ‘Measure’ Movement? Computerized Motion Analysis Visual Analysis of Movement 7 Photo credit (left to right): [SolStock]/[A shot of two people orchestrating a Photo credit (left to right): [JMichl]/[Male Athlete Speed Skating on a sport science experiment at a university in Perth, Australia. They are tracking Cold Winter Day. - stock photo./[iStock/Getty Image Plus] the movement of an athlete./[iStock/Getty Image Plus] 8 4  1/30/25 A Framework for Movement Analysis of Tasks: Recommendations From the Academy of Neurologic Physical Therapy’s Movement System Task Force Task force proposed and developed 2 important tools for movement analysis § A glossary of terms containing 10 terms to describe movement § A chronological framework to describe movement, based on Hedman et al (1996) 9 10 Constructs Describing Movement 1. Symmetry Postural Control Coordination 2. Speed 5. Verticality 7. Smoothness 3. Amplitude 6. Stability 8. Sequencing 4. Alignment 9. Timing 10. Accuracy 10 5  1/30/25 Glossary of Terms for Movement Analysis Observable Definition Measurement Examples Construct Agreement of the external kinetics and Symmetry Symmetry index or ratios kinematics of movement (e.g., left vs right) Rate of change or velocity of segment or body Speed or movement time, walk speed, Speed displacement from start to finish of a task 6MWT, 2MWT The extent or range of movement used to Range of motion, step length, stride Amplitude complete a task length, reach distance Biomechanical relationship of body segment to Orientation of body segments (e.g., Alignment one another, as well as to the base of support, anterior, posterior, lateral) with respect to and environment, to achieve the task other limb segments 11 Examples of Terms - Symmetry § Symmetry: Agreement of the external kinetics and kinematics of movement (e.g., left vs right) § Observe the equal or symmetrical movement of the man’s arms as he performs shoulder horizontal adduction and abduction Video Credit: [mack2happy]/[Asian man working out his inner chest in gym.]/[iStock/Getty Images Plus] 12 6  1/30/25 Examples of Terms - Speed § Speed: Rate of change or velocity of segment or body displacement from start to finish of a task § In the video, the boxers lead with a slower speed ‘jab’ followed by a faster punch 13 Video Credit: [Edwin Tan]/[Extreme sport asian male muay thai boxesr punching sandbag in a row practicing in health club together.]/[iStock/Getty Images Plus] Examples of Terms - Amplitude § Amplitude: The extent or range of movement used to complete a task § Watch the dancer’s shoulder movement change from small to larger amplitude movements 14 Video Credit: [KenanQigun]/[Fire performer.]/[iStock/Getty Images Plus] 7  1/30/25 Examples of Terms - Alignment § Alignment: Biomechanical relationship of body segment to one another, as well as to the base of support, and environment, to achieve the task § Watch the dancers’ arm position in relation to their trunks, hips, and legs Video Credit: [wundervisuals]/[Two male ballet dancers spinning together in studio - 15 stock video]/[iStock/Getty Images Plus] Glossary of Terms for Movement Analysis Observable Definition Measurement Examples Construct POSTURAL CONTROL Verticality Ability to orient the body to the line of Body segment anterior/posterior/lateral to a gravity (upright) (vertical) plumb line Stability Ability to control the body’s center of Amount of sway; center of pressure mass (COM) in relation to the base of support (BOS) under static and dynamic conditions 16 8  1/30/25 Examples of Postural Control § Verticality: Ability to orient the body to the line of gravity (upright) § As the woman assumes the yoga pose, she maintains her head upright and the weight-bearing leg upright 17 Photo credit: [Motoyuki Kobayashi]/[Young woman in tree pose]/[iStock/Getty Image Plus] Examples of Postural Control § Stability: Ability to control the body’s center of mass (COM) in relation to the base of support (BOS) under static and dynamic conditions § The woman’s COM is located over the BOS 18 Photo Credit: [Cheschhh]/[Young woman doing yoga]/[iStock/Getty Image Plus] 9  1/30/25 Glossary of Terms for Movement Analysis Observable Definition Measurement Examples Construct COORDINATION Smoothness Movement occurring in a continual fashion, Measures from kinematic analysis without any interruptions in velocity or reflecting acceleration or ‘jerk’ trajectory Sequencing Specific order of motor output required to Order of joint of segment movement achieve the intended goal or action (Kinetic and kinematic analysis) Timing Temporal structure of movement that Reaction time, stance and swing time in includes relative percentage (%) or time gait devoted to movement segments Accuracy The ‘closeness’ of a movement to a standard Spatial or variable errors in obtaining value or intended target; freedom from error. target 19 Examples of Movement Coordination § Smoothness: Movement occurring in a continual fashion, without any interruptions in velocity (speed) or trajectory (pathway) 20 Video Credit: [pigprox]/[A bodybuilder performs a shoulder push with dumbbells]/[iStock/Getty Image Plus] 10  1/30/25 Examples of Movement Coordination § Sequencing: Specific order of motor output required to achieve the intended goal or action § Where does the movement start? § When does the body’s center of mass (COM) start moving? 21 Video Credit: gorodenkoff]/[Professional Trainer Explaining Exercise,.]/[iStock/Getty Image Plus] Examples of Movement Coordination § Timing: Temporal structure of movement that includes relative percentage (%) or time devoted to movement segments § Example: Time spent in stance or swing on right leg Video Credit: PeopleImages]/[A Young business man drinking coffee while 22 walking.]/[iStock/Getty Images Plus] 11  1/30/25 Examples of Movement Coordination § Accuracy: The ‘closeness’ of a movement to a standard value or intended target; freedom from error. 23 Video Credit: [TommL]/[A man carrying a basket and reaching To the top shelf to take an item while grocery shopping in a local supermarket ]/[iStock/Getty Image Plus] Examples of Movement Coordination § Accuracy: The ‘closeness’ of a movement to a standard value or intended target; freedom from error. 24 Video Credit: [thaiview]/[Close up of baby hands reaching a toy from mother for playing - stock video]/[iStock/Getty Image Plus] 12  1/30/25 Application § Active learning activities: can be completed independently, in class, and/or in Integrated Lab o Start with applying concepts and definitions from 4.2 and 4.3 o Progress to movement analyses: § Describing motion using APTA Task force terminology § Identify key muscle groups involved in producing motion § Identify types of muscle contraction: concentric, eccentric, isometric 25 Summary § There is no universally accepted terminology to describe movement § APTA’s Academy of Neurologic Physical Therapy has proposed a glossary of terms to standardize movement description: § Movement descriptors: symmetry, speed, amplitude and alignment § Postural control § Coordination § The proposed terminology is not diagnosis-specific. Can be applied across ages and diagnoses. § The terminology will be incorporated into Task Analysis in the next unit 26 13  1/30/25 References Quinn L, Riley N, Tyrell CM, et al. A Framework for Movement Analysis of Tasks: Recommendations From the Academy of Neurologic Physical Therapy’s Movement System Task Force. Physical Therapy. 2021;101(9):pzab154. doi:10.1093/ptj/pzab154 27 14