Analyzing Functional Movement

(Editor's note: I wrote this several years ago and it just never made it to be posted. I think that it's still valid, but that will explain some of the references to my commute and we'll blame any errors on that too)

One of the skills learned in occupational therapy school is how to analyze functional movement, both in patterns and specific observations. While this is a skills that is taught in refined in school, you may have already intuitively noted some analyses of your own. Therapists are rather notorious for noting differences in movement patterns while out at the mall or other public spaces, but before schooling, people often notice when they spot a task occurring in an odd or different way. 

For example, I am frequently amused during my morning commute. There are 5-7 escalators that I take each day, and I usually walk up them to save time and musculature. But the amusing part comes in watching people step on and off the escalator. Some people pause in their usual cadence to get the timing right, but others come to a dead stop near the edge of the steps. Others take small, short steps and keep their pace the same. 

There is also a mechanical door that is on my path, and watching people either learn the pattern and change their pace (faster or slower) to appropriately interact or fail to learn the pattern and end up stopping the door is notable, if annoying (hey, who wants to be stuck in a mechanical door, even if you are studying movement?).

Everyone has their own movement quirks that they're likely unaware of. Maybe not as  involved as Robert Barone's food to chin behavior (video), but there nonetheless. Until we had our functional movement class and had to watch each other perform different tasks, I was unaware that every time I pour a liquid or focus intently, I tilt my head to the side of the movement. Do I subconsciously think that tilting my head as the liquid flows will keep me from spilling? I don't know, but it is what I do. 

The analysis of movement is a skill, and not just a fun party trick. If you don't know HOW a person goes about a movement, how can you expect to return them to their normal functioning? (Obviously WHY is also important, but that's another entry) Because each person is unique in their movements, you have to individualize the treatment they get so that it is relevant to their situation. 

One example is a woman I have seen multiple times on the orthopedic floor. Unfortunately, she has required multiple washouts and revisions of her LE joint replacements. She also has severe Rheumatoid Arthritis in all extremities. Typically, therapists approach a pt. s/p a hip or knee surgery with a walker, however, this lady is unable to use a walker due to her wrists and hands. So she usually throws new therapists with limitations in ROM, strength and weight bearing in all extremities. But with crutches and modified technique, she was able to transfer effectively.

Another great example of this was a wonderfully pleasant gentleman that I worked with after his hip fracture for several weeks on the transitional care unit. He had Parkinson's Disease, and several adaptations to achieve movement when he was un-injured. Prior to his hospitalization, he needed arm rails on his chairs and a lot of rocking to be able to stand up. This need didn't disappear after his injury, and in fact he had greater difficulties with movement not just because he now had a broken hip with lots of pain, but because his medication schedule got messed up in the hospital. So we needed to coordinate a.m. ADLs with pain and other medications, needed to use the toilet in the shower room across the hall instead of his room to allow better placement of grab bars, shoes before standing (NOT socks) and extra time to complete all tasks. If we hadn't carefully individualized his treatment and looked for solutions that fit his abilities, he likely would have required a much longer stay and been frustrated by the lack of independence.

Movement analysis and activity analysis are key to basic occupational therapy practice. Have you noticed a unique movement pattern on yourself or someone else? Feel free to share.