Monday, January 16, 2017

Innovations in Movement - Blending Movement Science with Technology - Part III

Last week, we discussed various technologies that could be leveraged clinically to assist us in assessing human movement.  During last week's post, we looked at apps, 2D technologies and 3D technologies that could assist us in efficiently and reliably assessing human movement.  With the advent of technology, simply relying on the human eye has been shown to be less efficient, less accurate and less reliable.  As such, we can now leverage technologies to do what we use to through simple observation.  This provides us much more accurate and objective measures of progress and current status.

As we continue this series, we now want to start investigating what technological advancements has there been that can aid us in the treatment of human movement.  Keep in mind, throughout this discussion, the goal is not to simply use the snazziest advancement on the market but more importantly to incorporate technologies that can allow us to efficiently and reliably correct movement dysfunction and which can be easily implemented with the lowest cost barrier to entry.  To use technology that leverages the latest in movement science with the latest advancements in movement technology.  That said, we will approach this section from four perspectives.
  • 2D video
  • Biofeedback
  • Resistance bands & product innovations
  • Tracking & compliance
2D Video:

2D video provides us a great tool to provide visual feedback to the athlete.  When assessing high level athletes, some are very receptive to your interpretation of movement and some are not as receptive, especially if they are a high level athlete (or they perceive themselves as high level athlete).  Therefore, the ability to show the athlete how they move is instrumental part of getting the athlete's psychological buy in to what you are trying to achieve.  Video based software and apps allow us a medium which we can not just describe the movement we see, but actually show the athlete the motion.  From this visual feedback, we can then help them make corrections in, correlate that movement to injury risk and how that movement impacts athletic performance.

One of the most widely used video technologies is Dartfish.  This technology offers a lot of advantages for assessing movement and for treating movement.  In a systematic review by Agresta et al - J Orth Sport Phy Ther 2015 the authors showed that video feedback provided to runners by using real time feedback (via Dartfish) during their run was very effective tool at helping runners address their running movement dysfunctions.  Dartfish is one of the few technologies that allows you the ability to do live video feedback that can be used during live training with an athlete and is extremely helpful in helping them correct their movement dysfunction.   

In addition to 2D video software based technologies, there are also several apps that are offered out there that can be used to provide video feedback.  One major limitation of all of these is the inability to do live feed to a television or projector.  Where Dartfish allows the athlete to see this live, correct as they go and see the immediate results, most Apps do not allow.  With Apps, this information is recorded and then provided to the athlete after the fact.  Therefore the ability to correct that movement on the fly is not easily obtained.  Although providing feedback after and then having them correct still works, the training impact is more immediate with live feed.  

Some of the most common Apps are listed below and have the ability to function on IOS and Android.  

  1. Hudl - this is a 2D app that offers some versions for free and some upgraded versions offered at minimal cost.  This app allows you to capture movement and perform slow motion.  This allows you to show the athlete motions which occur at a high rate of speed at a speed which they can see.  
  2. Dartfish Express - this comes to us from Dartfish and includes some of the capabilities that
    are available in the software.  It allows some of the same functionality of the others but the quality and functionality of this app seems to have a step ahead.  It is available for minimal cost.  Videos can also be saved to Dartfish TV which you can then give access to the athlete to see and download in media books.
  3. Coaches Eye - this is another 2D app that initially started as a tool for coaches to assess players motion during athletic competition or practice.  The application to the treatment of movement is obvious and it also offers some of the same functionality of the previous two.  

With advancements in technology, we now have several technologies that can be used for biofeedback.  Some of the most commonly used include:

  • DorsaVi - as mentioned in the previous blog, DorsaVi is a "true" 3D motion analysis system that uses an IMU (inertial measurement unit) to provide 3D data and feedback.  DorsaVi has a module that is available within the system that provides the subject real time feedback on motion. So the athlete will use the sensors during treatment to provide them real time data on where their body is in space and the system will use this to challenge them through a series of tests and exercises.  Although the current application is for balance and lumbar spine, I suspect that lower kinetic chain training will be available in the future.  In addition, there is the ability to attach the sensors to the athlete and have them go for a 1 hour, 2 hour or 4 hour run while collecting data or reporting the data during the live run.  This allows you to make adjustments to their running and see the direct impact on IPA (initial peak acceleration) and ground reaction forces. 

  • Tecnobody Isofree - has a system coming out on the market that uses the XBox One and time of flight technology combined with a force plate to provide feedback of joint position and weight distribution.  This is a great tool for providing proprioceptive retraining for the athlete.  With this device, the athlete stands on the device and the system tracks their body in space while taking them through a series of challenging, fun and interactive games.  Although there is nothing on the website about, based on their other systems, I suspect this will be in the $20K range.

  • Motion Guidance - this is a relatively simple and inexpensive device that was developed by two physical therapists.  This system uses a small laser strapped to the lower extremity and target.  This is a great tool for use in jump training and while performing single leg activities that will provide instantaneous feedback to the athlete if they are able to maintain stability of the knee in the frontal plane as well as pelvic stability.  These kits also come with a patient HEP pack that the athlete can take home for their home exercise program.

This is by no means an exhaustive list but more at list of products that we have used and have some familiarity with.  Next week we will continue this discussions as we look at some product innovations which can be used in the the treatment of movement dysfunction.

Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >3000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 

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