Indications, Benefits and Barriers of 2D Motion Analysis

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Top Contributors - Thomas Longbottom, Kim Jackson, Jess Bell and Tarina van der Stockt  

Introduction

The observation, analysis and management of movement are necessary elements in addressing movement system impairments.  While the use of 2D slow motion video can facilitate this process, this technique is underutilized.  Damien Howell, a physical therapist based in Richmond, Virginia, in the United States, provides a guide to the indications, benefits and barriers related to the use of 2D motion analysis in this first of a four-part series.

1. Module 1: Indications, Benefits and Barriers of 2D Motion Analysis
2. Module 2: Tactics and Techniques of Recording, Analyzing, Storing and Retrieving 2D Slow Motion Video Data
3. Module 3: Using 2D Slow Motion Video to Identify Deviant Movement
4. Module 4: Integrating 2D Slow Motion Video Analysis with Symptom Modification Procedure, Intervention and Telehealth

Applying 2D Video to the Movement System

Physiotherapists are movement specialists. The ability to observe and analyse movement is important in the management of movement system impairment syndromes. Progress has been made in defining a framework to accomplish this in a systematic way, around a set of core movement tasks.A specific challenge has been in maintaining a consistent approach, using a common language around movement constructs related to aspects of motor control such as symmetry, speed, alignment and amplitude. Movement system diagnostic labels and classifications will continue to be developed. The application of 2D slow motion video analysis is a technique and a tactic that can facilitate this process. Despite the usefulness of this form of motion analysis, it is an underutilized technique with more than half of surveyed orthopaedic physiotherapists not using the technique in clinical practice.A survey of 261 American Academy of Sport Physical Therapy members found that while over 70% of them did use video motion analysis in their practices, 84% of those members did so with 25% or less of their caseloads.

This course will show how 2D slow motion video analysis can accomplish the following goals:

• Improve communication with clients, referral sources, and third parties
• Simplify treatment and get to the heart of the matter more quickly
• Facilitate a higher level of engagement by the patient or client
• Facilitate obtaining second opinions on complex patients
• Quickly show the patient or client that they have control of their symptoms

Benefits of 2D Motion Analysis

The use of slow motion video has the potential to increase the accuracy of the physiotherapist's analysis of movement. Slow motion, frame-by-frame analysis dramatically increases the ability to observe the details of movement. The ability to slow down the movement and to even freeze the motion at key moments increases observational powers, leading to improved accuracy and validity of the physiotherapist's observations.

Incorporating 2D motion analysis into clinical practice also has the potential to increase engagement with the client. A high degree of engagement between the provider and client can lead to better outcomes, lower costs, and higher levels of client/clinician satisfaction. Increased self-awareness can facilitate engagement, boosting acceptance and aiding the client to see a different perspective. This can then facilitate decision processes and communication. The client and provider can see what movements and specifically what direction of movements are causing symptoms, leading to an understanding of how altering those movements can decrease or even eliminate those symptoms.

Video and image analysis can improve communication, facilitating the conveyance of complex concepts and information not only to the client but to third parties as well. Comprehension can be improved by reinforcement of the information, helping the clinician and the client engage in reflective learning. Videos and images can grab attention and provide inspiration, and they can help overcome language barriers. The visual evidence and resulting validation can be provided to clients, referral sources, and third parties. When a client is sceptical and has not reached the contemplation stage of affecting change, the use of videos and images can be helpful in the client's understanding of what is occurring with movement and how it relates to their symptoms. In cases where the client may be magnifying their symptoms, video analysis can be used to validate the clinician's judgment. In other words, when the clinician is suspicious of the credibility of the patient's reports, video can help distinguish between symptom magnification and credible complaints.

Indications for 2D Motion Analysis

Slow motion video and image analysis can aid the shift from ambiguity to accuracy and understanding. The technique can be useful for the clinician who may be lost or confused when trying to understand a complex and/or unusual client. If the clinician thinks atypical movement is observed but is not certain, or if more time and data is needed to observe the movement where clear diagnosis or classification is lacking, 2D motion analysis may be indicated. In cases where the client or perhaps the clinician is sceptical of the movement abnormality, or in legal cases where more rigorous documentation of the movement is needed, the clinician may opt to use this technique. The clinician may also want to use this method when performing case studies or other research endeavors with goals of publication or other dissemination.

From a clinical standpoint, when there aren't resources such as full-length mirrors available, potentially due to the client interaction taking place in a home health setting versus in the clinic, use of video may be useful in providing visual feedback of movement performance. Highlighting atypical movement in the video can aid prevention of injury and also improve performance. The clinician may also find it beneficial to provide the client with personalized video, recorded on the client's own device, of the client performing the exercises as instructed in order to enhance the home exercise programme. This could include audio instructions as well as video demonstration.

Finally, the clinician should consider the benefits of storing the visual data of a wealth of patient experiences and thereby providing details for reflective learning and professional development. Dr. Arlan Cohn, writing under the pseudonym of Oscar London, considered the conundrum of experience without a record of learning. "The more patients a doctor sees, the fewer journals he has time to read. If he isn't careful, he can end up after forty years with a wealth of experience and a poverty of intellect."

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