How to Classify Complicated Movement in 3 Easy Steps

As physical therapists, part of our culture is watching people move. 

It’s in our blood.  We can’t help ourselves!  We scan through crowds of people analyzing their movements and make mental notes about what might be the root cause of their dysfunction.  If you have a partner who is also a PT like me, this is fun for you both.  If you don’t, I’m sorry. 

 

With the 4th of July holiday coming up, there is sure to be plenty of people moving in all kinds of ways for you to watch and analyze! 

 

All kidding aside, with all of the types of movements out there in the neurologic population, it can be really tricky to find a great way to describe it for ourselves and our colleagues. 

 

Having a common language about movement is really important for strengthening our stance as the Movement Experts. 

 

With this post, my intent is to propose a common language and structure that we can use to describe the movements we see in our clients so that their physicians and other health care providers can get an accurate picture of what might be going on even without video or seeing it in person. 

 

Before we get into the concepts, I want you all to self-rate how comfortable you feel with movement analysis on a scale of 0-10 with 10 being the ultimate expert! 

Can you think of a patient or client that you have right now whose movement is difficult to characterize?  Keep that person in mind as we go through this exercise.

 

For your background knowledge, this framework was adapted from this article by Wilson F Abdo, et al. and was the focus of a Schmidt Fellowship Movement Disorder learning module recently held at re+active physical therapy & wellnessIn this module we clinicians took the opportunity to practice watching videos of movement disorders and describing them without actually naming what the disorder was.  This was a fun exercise and helped us to become very clear about what we were seeing so it could be clearly communicated.  The article is aimed specifically at movement disorders but the framework could easily be applied when working with other neurologic populations to describe a movement clearly and in a more standardized way. 

 

STEP 1:

When approaching movement characterization, the first thing you want to ask yourself is:

Is this person moving different than expected? Yes or No.

 

STEP 2:

Next you want to ask:

Is it insufficient movement or too much movement?

If it is too much movement, is the movement jerky or non-jerky?

 

STEP 3:

Then finally, how do we characterize the movement? 

This includes the body part, rhythmicity, speed, amplitude, etc.

 

Use this figure to help you see how movement disorders would be categorized and to get to a possible movement diagnosis. 

 

Now let’s practice!

Watch the videos and follow along!

Video 1

 

Is the person moving different than expected? YES

 

Is it insufficient movement or too much movement? TOO MUCH

Is it jerky or non-jerky? This one can be tricky, but it looks pretty rhythmic, so NON-JERKY

 

Characterization:

Position observed: SITTING

Body part(s) involved: HANDS

Rhythmicity: RHYTHMIC

Speed: FAST

Amplitude: SMALL

Duration: CONTINUOUS

Pattern: REPETETIVE

Stimuli Induced: NO

Suppressible: NO

At Rest, With Action, Both: AT REST

 

With this process we can now make a sentence about the movement to describe it:

The client demonstrates a non-jerky, small, continuous, fast, rhythmic movement of bilat hands at rest. 

BRAVO!

 

What does that sound like?

What does that look like?

A: RESTING TREMOR

Excellent job!

 

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LET’S TRY ANOTHER ONE!

 

Video 2

 

Is the person moving different than expected? YES

Is it insufficient movement or too much movement? TOO MUCH

Is it jerky or non-jerky? This one can be tricky, because it looks like a dance but it is really a series of small jerks put together into a pattern, so – JERKY

(Don’t worry; this is why we are doing this one together!)

 

Characterization:

Position observed: STANDING/WALKING

Body part(s) involved: FULL BODY

Rhythmicity: IRREGULAR

Speed: MODERATE

Amplitude: LARGE AND SMALL

Duration: CONTINUOUS

Pattern: FLOWING, IRREGULAR, UNPREDICTABLE

Stimuli Induced: NO

Suppressible: NO

At Rest, With Action, Both: BOTH

 

With this process we can now make a sentence about the movement to describe it:

The client demonstrates irregular, jerky but flowing and unpredictable, continuous movements with large and small amplitude through the full body during standing, walking and rest.

 

What does that sound like?

What does that look like?

A: CHOREA

 

Excellent work!!

Now you can try with your clients! Go through the steps.  Ask yourself the questions.  Then put together a statement about the movement.  You can also do what we did and make a template to add to your evaluation where you can go through the list of movement descriptions.

 

If you liked learning about this or have more questions because you can’t get enough – post your comments below! 

 

Join our online community for more support and a platform for your questions! Click to link to our Facebook group NeuroCollaborative Professionals!

 

Thanks again and let me know what you thought of the movement characterization framework!

 

Keep on movin' and evaluatin' movement!

Erin Caudill, PT, DPT, NCS