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TechnoPalooza: Integration of Technology intoSpecialty Practice 1
February 4 7, 2015Indianapolis, IN
www.aptahpa.orgHPA The Catalyst is the Section on Health Policy & Administration
of the American Physical Therapy Association
Speaker(s): Ryan Balmes, PT, DPT, OCS, SCS, FAAOMPT; Beth Ennis, PT, EdD, PCS, ATP; Sheryl Flynn, PT,PhD, Founder/CEO; Robert Latz, PT, DPT, CHCIO; John Meyer, PT, DPT, OCS, FAFS; DanielVreeman, PT, DPT, MSc; Steven Wilkinson, PT, PhD
Session Type: Educational SessionsSession Level: Intermediate
This information is the property of the author(s) and should not be copied or otherwise used without theexpress written permission of the author(s).
Page 1 of 34 total pages
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Integration of Technology into Sports Physical Therapy
John Meyer, DPT, OCS, FAFSUniversity of Southern CaliforniaDepartment of Athletic Medicine
ISportsPT
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
APTA Combined Sections Meeting 2015Indianapolis, IN
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Disclosures
• I have no actual or potential conflict of interest in relation to this program/presentation
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
When Can I Return to Sport?
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Video
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Video
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Objectives for our Time
• Share 3 new technologies that assist in the
AssessmentTreatment ProgressionReturn to Sport Decision
• Demonstrate their application to multiple aspects of physical therapy care
• Understand the benefits and challenges related to current and future utilization
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Fundamental Sports Movement Skills
• Balance• Walking• Running• Lateral agility• Cutting• Jumping• Throwing • Hitting
• Can technology assist in the assessment
• Simplify objective measurements
• Speed up diagnosis• Guide treatment
progressions• Assist Return to Sport
decision
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Capacitive Sensor Treadmills
• Accurate systems for pressure and gait analysis
• Pre-calibrated capacitive sensors built into the treadmill's deck
• Allows analysis of force and pressure distribution during
standing, walking, and running
• Completed in less than 30 seconds
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Quickly Quantify!
• All pressure, spatial, and temporal parameters are compared in an easy-to-read report
• Provides side-by-side comparisons• PDF format for easy transmission and sharing
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Single Leg Balance
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Pressure plot s
0 2 4 6 8 10 12 14 16 18 20 N/cm²
Single suppor t , average St ance, average St ance, max imum
Separat e foot pr int s
1 2 3 4
5 6 7 8
9 10 11 12
13
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Gait param et ers
Geom et ry
Foot rotation, degreeL
R
3.4±1.0
10.6±1.1
-14° 14°
Step length, cmL
R
71±2
69±1
180 cm
Str ide length, cm 140±2
Step width, cm 19±2
Phases
Stance phase, %L
R
61.6±0.8
63.1±0.7
100 %
Load response, %L
R
12.1±0.6
12.7±0.7
Mid stance, %L
R
36.9±0.7
38.3±0.6
Pre-Swing, %L
R
12.7±0.6
12.1±0.6
Swing phase, %L
R
38.4±0.8
36.9±0.7
Double stance phase, % 24.8±1.0
Tim ing
Step t ime, secL
R
0.6±0.0
0.6±0.0
1.4 sec
Str ide t im e, sec 1.1±0.0
Cadence, steps/min 107±2 140 steps/min
Velocity, km/h 4.5±0.1 6 km/h
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Walking 3.5 mph
Asymmetrical step length and slight ER/toe out of the right foot secondary to lack of plantar flexion strength and stability
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Force curves
left1800
0
500
1000
1000 10 20 30 40 50 60 70 80 90
N
%
right1800
0
500
1000
1000 10 20 30 40 50 60 70 80 90
N
%
Force par am et er s
Maximum force1, NL
R
1392.5
1366.3
1800 N
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
As seen in walking am asymmetrical step length and foot rotationAlso max pressure on the forefoot is also diminished on the right due to lack of plantar flexion strength and stability
Running 11.0 mph/5.5 min mile
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Clinical Motion Analysis
• Try to identify the biomechanical cause of dysfunction
Faulty movement patternsAvoid just treating the symptoms
• Balance betweenData quality and practicabilityDaily routine in a clinical environment?
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Clinical Motion AnalysisComputer Based
• Simi Aktisys• Laptop• 1-2 high speed
cameras• 500 frames per sec
• Active LED Markers
Tablet Based
• Simi Move
• Spark Motion
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Clinical Motion Analysis
• Direct biofeedback• Immediate movement data
AnglesDistances
• Choice of predefined protocols and built in normative data
• Quick comparative reports and analysis
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
2.7 degree Plantarflexion on Left 10.3 degree Dorsiflexion on Right
13 Degree Difference in Push Off Phase
Running 11.0 mph/5.5 min mile
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
2.7 degree Plantarflexion on Left 3.2 degree Plantarflexion on Right
No Significant Difference in Push Off Phase
Running 11.0 mph/5.5 min mile
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Acceleration: Stance Get Off R &L
Significantly reduced ankle PF lever with excessive compensatory subtalar eversion and midfoot pronation.
Right Left
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Lateral Agility Movement
• Video
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
• Adequate intensity• Multidirectional• 3 dimensional• Replicate true sport demands• Identify movement and biomechanical deficiencies
Are the Assessments & Return to Sport Tests appropriate?
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
• Total distance covered% of forward/backward vs. right/left
• Player load• % of high intensity running• Max velocity
% of forward/backward vs. right/left
• Heart rate variables
Do we truly understand the demands of the sport?
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Movement Tracking Analytics
• Microtechnology• Physiological and GPS monitoring devices
• Inertial Movement SensorsAccelerometersGyroscopesMagnetometersMicrotechnology
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
What really happens during a practice or game?• Distance• Acceleration • Deceleration• Change of direction• Velocity• Speed zones
• Player Load• Jumps• Collisions• Position• Heart Rate• Repeat high intensity
efforts
Aughey RJ. Int J Sports Physiol Perform. 2011
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Soccer Game Analytics
• Total distance covered 10,300m Approx. 6.4 miles
• High-intensity running (HIR) accounting for 1031 km: 125 bouts
• Average and peak HR in a game was 167 bpm and 186 bpm
• 87% - 97% of HRmax
Lacrosse Game Analytics: yards-m
• Walk: 30 yards-m
• Jog: 30 yards-m
• Run: 33 yards-m
• Sprint 6 yards-m
• Player load: 9.9 min-1
Polley, C et al: J Strength Cond Res 2014
Krustrup, P et al: Med Sc Sport Ex 2005
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Movement Breakdown in Soccer
Clemente FM et al: J Hum Kinet. 2013
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Movement Breakdown in Soccer
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Football Practice Analytics
1.4
9.4
7.1
10.3
4.2 4.6
1.9
12.5
2.5
16.0
2.1 2.1 1.8
Exe
rtio
n &
Vel
oci
ty C
han
ge/
min
Dis
tan
ce/m
in (m
/min
)
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University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Football Practice Analytics
• Understanding the demandsRiskReadinessReturn to play
Position Load %HIR Max Velocity MPH
Dist > 12mph
Dist > 16mph
Dist > 18mph
Total COD Left
Total COD Right
WR #1 424 3.8 18.3 581 361 156 55 83
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
Challenges of Athlete Tracking
• Compliance of Athlete• Lack of consistency in the definition of
speed zonesactivity descriptors
• Data processing, distribution, analysis• Reaction to the Data• Changing technology
GPS coverageAccelerometer speed
Cummins, C et al :Sports Med. 2013
University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine University of Southern California Division of Biokinesiology and Physical Therapy Department of Athletic Medicine
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Hangar Hustle
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4 main products, 20+ mini games: Cost effective, scalable, precise, agnostic software platform
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Private PracticeRyan Balmes, PT, DPT
Disclosure
Dr. Balmes has no actual or potential conflict of interest in relation to this presentation
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Utilizing website creation for private practicesWISIWYG programs (what-you-see-is-what-you-get)squarespace.comwix.comwordpress.com
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Changes can be seen immediately and tested for useWebsite is made ultimately to create leads and new sales (new patients)
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Potential usesclinic websitePT blogevents
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