Concepts Learned in 2013: Why Video Should Be Used In Your Practice
As the year winds down, we all take stock of how 2013 went
and what’s to come in the New Year.
[re+active] has undergone a lot of changes in the last year – as I’m
sure you’ve all experienced changes as well.
With this year coming to a halt and the excessive stimulation of the
holiday season ending, it is nice to take a moment to reflect on what we’ve
learned and what we plan to change or implement for the next year.
Over the past year, I spent approximately 186 physical hours
in education courses. That is about 23
workdays – over 3 weeks – spent learning in one year! As I try to reflect on all of the knowledge
I’ve gained this year, it is hard to rate one experience over another. However, the course that really made the most
impact on my practice was not technically a neuro
course, but an ortho one! I completed the 6-month series on Advanced Functional
Biomechanics of the Lower Quarter by Dr. Chris Powers in December. This was a course recommended by Julie, who
took it last year. This course focuses
on the use of video and technology to analyze movement and determine possible
sources of dysfunction during activities including walking, running, cutting,
cycling, and jumping. Despite the fact
that this is an ortho course, and I was the only “neuro” there, I found the
approach and the information extremely applicable to the neurologic
population. I think we neuro PTs are
used to taking concepts for impairment-based treatment and tweaking them to suit
our population and our unique patients’ needs.
Using video to capture movement seems like a simple concept
yet it is rarely implemented in the clinic.
I understand that there are barriers to doing this in many clinics, but
I have to say the results and knowledge gained from using video and showing it
to patients is worth the extra steps to get it going. Video helps you see things the naked eye is
too slow to detect, and it also helps show a person exactly what his body is
doing during movement. This knowledge is
helpful for those with and without sensory dysfunction. Have you ever seen a video of yourself
running or performing an athletic task such as swinging a baseball bat? What about giving a speech? If you have, chances are there are things in
the video that you had no idea you were even doing! (Did I really say “um” 10 times?!) Using video is an extremely objective and
holistic way to dissect movement and piece together a list of hypotheses to
explain the cause of the dysfunctional movement. It doesn’t matter what types of patients you
work with, all of our patients need
to be better at movement. With the video
to show the movement and our PT knowledge to evaluate it, we can create a list
of possible impairments to assess what may be contributing to the dysfunction. Once this is performed, we can work both on
the impairments and also re-train the dysfunctional movement using neuroplastic
principles. Video provides useful and
objective feedback needed to make the changes that will create improved
alignment, increased flexibility and strength, and, ultimately, more normal
movement strategies!
It doesn’t have to be scary or overwhelming. Even movements that you think seem so
straightforward may have something you did not even notice! Start small – video
your patient doing a sit to stand.
Steps to performing a video movement analysis:
1)
Obtain a camera, ipad, iphone or other device (You’ll
need a high frame per second rate for high speed movements such as
running).
2)
Video your patient performing a sit to stand
from the front and the side views
3)
Use an app like Ubersense to help slow down the
video and break apart the phases of the movement – initial conditions, preparation,
initiation, execution, termination. Look
at the quality of the movement, the alignment of the joints, and the center of
mass
4)
Review the video with your patient pointing out
the movement strategies (both good and bad)
5)
Create an impairment list based on what could be
causing the movement dysfunction. This
could be a range of impairments from deficits in strength, pain, tightness,
poor postural awareness and sensory organization, impaired executive
functioning/planning, inattention or neglect, etc
6)
Test your impairments and treat using principles
of neuroplasticity and motor control – repetition, intensity, time, salience, variability,
functional training
7)
Re-evaluate and compare before and after videos (note:
this may be done within a session but may also take several weeks, depending on
the impairment(s) involved)
In our practice – where movement analysis is the first form
of evaluation performed – we (and our patients) find the video feedback to be
both enlightening and monumentally helpful in their rehabilitation. It is also motivating for them to see the
difference the training makes in their movements upon reassessment. Do not be overcome by whatever obstacles may
make using video difficult for you. Start
the New Year with a new outlook. Try
filming a sit to stand with one of your patients and show it to them. Remind yourself of how seeing the excessive
hand gestures in the video of you giving a speech drove you to become a more
composed and articulate speaker thereafter.
IPAD apps we like:
ubersense
Simi Move
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