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).

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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

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

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

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

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

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

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

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

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

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

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

)

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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RESET

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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Potential usesclinic websitePT blogevents

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