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Assessment and plan for
intervention
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Examination and Evaluation

careful examination and evaluation of

impairments, activity limitations, and
participation restrictions enable the therapist
to identify movement deficiencies to target
during rehabilitation(plan of care)

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Movement observation and task analysis

 Mov analysis is the process of breaking an activity down into its component parts to
understand and evaluate the demands of the task.
 It begins with an understanding of normal movements and normal kinesiology associated
with the task.
 The therapist examines and evaluates the patient’s performance and analyzes the
differences compared with “typical” or expected performance.
 Early in the treatment process, the therapist needs to identify what activities are
important to the patient as determined by the patient’s own interests, roles, and living
environments. The patient’s interest in the activity and motivation to complete the activity
successfully can influence the level of performance observed.

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:Stages of movement analysis

 A: Initial condition, Preparation and initiation

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B:Movement execution

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D: Movement outcome

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:Categories of activities

• basic activities of daily living or BADL (self-care tasks such as dressing, feeding,
and bathing
• instrumental ADL or IADL (home management tasks such as cooking, cleaning,
shopping, and managing a checkbook).
• Functional mobility skills (FMS) are defined as those skills involved in moving
by changing body position or location. Examples of FMS include rolling, supine-
to-sit, sit to-stand, transfers, stepping, walking

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Use of Movement System Diagnoses

in the Management of Patients With
Neuromuscular Conditions:

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Diagnosis: Force Production Deficit

 The primary movement system problem is weakness. The origin of the weakness
may be muscle, neuromuscular junction, peripheral nerve, or central nervous
system dysfunction.

 The presentation may be focal (one joint), segmental (generalized to an

extremity or body region), or related to fatigue (of skeletal muscle rather than
cardiopulmonary capacity.

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 Strength: less than 3/5 to 4/5 muscle strength throughout a limb or
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Task Analysis:

Sit-to-stand:
Failure during initiation phase, typically requiring assistance or accommodation
Extension of knees before hips during first half of
Execution

Gait:
May need manual assistance or an assistive device to bear
weight and maintain upright posture

Reach and grasp:

Difficulty or failure with reach above 60° of shoulder flexion or with sustaining
reach position
Unable to maintain force for gripping objects, especially during transport

Initiation movement and increase ROM/stability

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Facilitatory techniques

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:Technique

 Rhythmic initiation
 Replication (Hold relax active motion)
 Repeated stretch, contraction

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Impairment base

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Rolling or Rocking

 Rhythmical movements can be performed passively or actively in various ways, such as

rolling repetitively from supine toward prone, rotating the lower trunk in hooklying, or
rocking in a chair, over a large ball, or even rocking in the therapist's arm.
 Slow, repetitive, rhythmical rocking movement appears to produce reflexive autonomic
changes, regardless of the plane in which it is applied.
 Adaptive input from the vestibular system may playa role in the calming response.
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Rhythmic rotation

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 Brunnstrom techniques (movement therapy)

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 Lederman E 2005 Science and Practice of
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Manual Therapy, Elsevier.

Skills

Composite abilities
Balance, motor relaxation,
coordination, fine control,
Motor complexity

reaction time, transition rate

Synergetic abilities
Co-contraction reciprocal activation
(Stability, dynamic / static) (Movement)

Contraction abilities
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:COMPOSITE ABILITIES B

 reaction time: Reaction time is how long it takes between the onset
of a stimulus and the individual's response to it.
 fine control (control precision)
 Transition rate: speed and flexibility at which the patient can move
from one ability to another: Rhythmic hand and stop

 Coordination: the harmonious and synchronous control of two or

more joints

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 Slow reversal
 Agonist reversal (Combination of Isotonics)

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:Position test

 The therapist passively moves one arm to an angle that

has to be matched by other arm. In comparison, run the
same test with the arm straight in front of the body (with
eyes shut).
 Re- abilitation Treatment is by using the same
methodology as testing, but with an increase in the
duration of the test t.
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Spatial orientation

 Spatial orientation is similar to movement sense but involves a whole limb or

trunk movement. It is the ability to determine the position, direction and
force during movement of the limb or trunk in space.

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Test

 Test Instruct the patient to shut the eyes. Take the affected limb, say the arm, and move it slowly in
space in different directions.
 The patient has to actively follow these movements with the affected arm. Another test

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:Treatment

 increase in the afferent stimulation: Skin mechanoreceptors can be maximally

stimulated by dynamic events on the skin, for example massage, rubbing and vibration.
 reducing the visual feedback.

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