Are we missing opportunities to improve clinical practice using 3D motion analysis in the upper-limb?
Advances in technology, both hardware and software, have improved our ability to measure and understand human movement. A better understanding of how people, with and without injury, move and control their limbs has resulted in less unnecessary surgery and better targeted care.
Clinical gait analysis in children with Cerebral Palsy is a good example of this. 3D movement technology is routinely used to measure how children walk, then based on the information collected, clinicians are better able to make decisions around surgery or rehabilitation.
Why do you have to use 3D motion analysis, can’t you just watch the child walk or use video?
This is a question we get asked a lot. The reality is that when we observe movements as they happen with our eyes, or replay them on video, we are only getting part of the information we need to make good decisions. Regular camera’s only allow us to see things in 2D. This means we can ‘see’ things moving across the the image very well, but if they get closer or further away (by a small amount) it’s much harder to see all the things we are interested in. By using multiple cameras at the same time, we can ‘see’ in 3D. In our previous blog-post we also discussed how ability to trust and describe what we are seeing becomes less when the movement patterns or features we are trying to observe vary a lot between people or are complex. Whilst walking may seem simple, there’s actually a lot going on ‘under the hood’ if you like.
Okay. I thought you were to talk about arms though?
I am, but the point I am trying to make is that 3D motion analysis is not widely used to inform clinical decision making in the upper limb. This is somewhat surprising, given how effective it has been in the lower limb. Arguably upper-limb movements are more complex and there are some conditions that affect people’s movements which are not well understood. 3D motion analysis could potentially improve our understanding and help improve care, for example, planning for shoulder surgery in patients with whose shoulders keep dislocating or people living with Facioscapulohumeral muscular dystrophy (FSHD).
Hmmmm, that is interesting. Why isn’t it used as much in the upper-limb then?
Well that’s what we wanted to know. To help us answer this question we did some research looking at how many movement analysis laboratories are doing upper-limb clinical assessment and what the current barriers to more widespread use of upper-limb motion analysis were. We surveyed laboratories who were accredited with the Clinical Movement Analysis Society of UK and Ireland (CMAS).
They sound like an interesting bunch.
Yes, they are! CMAS was set up in the early 2000’s and is responsible for setting national clinical practice standards and accrediting motion analysis laboratories. Basically they make sure laboratories are set up correctly and that any information about patients using 3D movement analysis is collected and reported properly. There are currently 13 CMAS accredited laboratories and all of them responded to our survey (100% response rate).
And what were the results?
So, out of all the labs, only 4 (31%) reported doing any upper-limb assessment for clinical or research purposes. All 4 labs carried out upper-limb assessment for clinical purposes but only 2 labs carried out upper-limb assessment for research purposes.
Out of the labs who did upper-limb analysis, patients with Cerebral Palsy (adults and children) were the the most frequently seen patient group. This was true for both clinical and research purposes. Labs also collected information about people without injury or illness to act as a comparison group.
Each lab used different measurement methods and outcome measures when assessing the upper limb. These have summarized these in the graphs and pictures below.
Several barriers to the use of more routine upper limb motion analysis were also identified…
So what does it all mean?
Essentially, very few labs are doing clinical upper-limb motion analysis, and whilst there are some similarities in practice, different labs are doing different things. This isn’t necessarily a bad thing but does highlight the need to try and develop some common practice.
Results from this research support that there is a clinical need for upper limb-motion analysis. Neurological patients (Cerebral Palsy) were the most seen group and 3D movement analysis was used. Given that people with Cerebral Palsy are seen across all CMAS laboratories, arguably the use of upper-limb motion capture should be more prevalent. Some of the barriers identified may explain why this is.
Cost, lack of funding and laboratory time were identified as the main barriers to upper-limb motion analysis. We assume similar challenges were present when 3D motion analysis was introduced to measure walking, however initial effort and financial costs were offset by the benefits of minimised harm, cost and improved confidence in clinical decision-making. There are patient groups with upper-limb pathologies, who fit a similar model used to justify the use of motion analysis in the lower-limb. It may be that current clinical workloads, clinical pressures and inherited practices are limiting adoption and wider integration of 3D movement analysis into management of upper-limb conditions.
And what’s next?
We have presented our results to the CMAS labs in order to share and inform practice. This research provides a summary of whats currently being done nationally and may inform standards which progress the the use of motion analysis in a clinical setting.
We hope that by identifying and raising awareness around barriers to upper-limb motion analysis, we could see it being more widely used with the aim of ultimately helping patients.
We are looking to expand on the research we have already done and include motion analysis labs across Europe. This will provide us with more information and allow us to compare national and international practices around clinical motion analysis for the upper limb.
