This blog is intended to discuss the overall concept of the Motion Guidance system.
Motion Guidance was created to bring a valuable and affordable visual feedback system that any clinic or rehabilitation specialist can use with ease. It is as simple as adding the visual feedback tool to a limb, adjusting the aim where you want it, and creating an exercise based on your patients' need. The concept behind the product is to offer more engaging cues toward rehab goals, create a superior learning environment, reveal body awareness and skill in ways that are easy to understand and allow real-time feedback for movement range, skill, and control.
To start with, lets discuss some relevant background research regarding proprioception, injury, learning, and how all this ties into the unique visual feedback system that your clinic can incorporate to help assist patients.
When considering how people learn, let’s look at some general information about auditory, experiential, and visual learners. According to Bradford et al, “Verbal learners, a group that constitutes about 30% of the general population, learn by hearing. They benefit from class lectures and from discussion of class materials in study groups or in oral presentations, but chafe at written assignments. Experiential learners - about 5% of the population - learn by doing and touching, and clinical work, role-playing exercises, and moot court are their best instructional modalities. Visual learners - the remaining 65% of the population - need to see what they are learning”
Although this research relates to a classroom setting, we can extrapolate these results and apply them to the context of rehabilitation and motor learning; people benefit from visulaziation as a learning style. In lieu of this information, if goals in rehabilitating your patient are directed at teaching your patient about body awareness, movement, and understanding their movement strategies or position, we may be missing a crucial part of our education by not using visual feedback. Are we missing out by not making movement and exercise more "visual" for our patients???
Research has also noted that the use of “external cues” for motor-learning (ie mirrors, targets, etc) are superior to the use of “internal cues” (ie instruction on how to move during a task). Visual feedback with the Motion Guidance laser device offers the potential of incorporating and external focus of attention to any movement or exercise. The feedback is immediate and the cue is something the person can directly follow and understand without the potential “confusion” of giving too many unnecessary verbal instruction: instead, they see it.
There has been much conversation on the need for compliance during home exercise programs, and during rehab in general as well. What might increase compliance? For a start, the activity needs to make sense as in what the purpose of doing it is, as well as be stimulating. Visual feedback with a laser covers both these areas: it offers an instant assessment of movement, while instantly allowing the visualization of progress and movement control. This may be especially important among those who are more likely to view exercise with laser visual feedback as a game, and become competative with the results they see. However, the concept applies to everyone, as the majority of persons across all age groups are visual learners.
Our bodies have inherent mechanisms to allow us to know where we are in space. This includes vision, tactile sensation, and proprioceptive sensation. Laser guided visual feedback rehabilitation covers all grounds, to create a learning experience that is all encompassing of these mechanisms. Research has shown that our brain’s representation of our body undergoes changes when we are injured. This has been labeled “cortical smudging” or “altered-body mapping” by educators on the topic. We can influence these changes through skilled movement and awareness, just as they are influenced negatively by maladaptive non-use in the injured state. Visuals assist by bringing an additional dimension to learning to improve motor performance by promoting an External Focus of attention and body awarness that requires skill and coordination in real-time. After injury, our discrimination of the injured body part may be diminished or altered. (This phenomenon has also been noted in lower back pain patients, knee pain, whiplash as well as shoulder pain patients.) This includes 2-point discrimination (being able to accurately feel and discern pin-prick sensation), as well as “joint positional awareness.” A more in depth read on positional awareness can be found here, and on proprioception here.
Joint Positional Awareness (JPE) is our ability to understand where our body is in space. Trevelean et al. have conducted numerous studies concluding that after whiplash, subjects have difficulty discerning their head position when tested with visual feedback from a laser pointer. Balke et al. has done the same for the shoulder.
Here is an example of using the Motion Guidance laser pointer device with cervical JPE
There are numerous ways to influence proprioception, but it is pertinent to consider the most reasonable interventions (as well as how the client is interpreting the intervention). These may include manual therapy (tactile afferent input), taping, exercise etc. The research seems to conclude that, despite what we think or intend to do to tissues, beneficial results exist due to a change in how patients (their brains) “view” the body part under the influence of a novel stimuli. A further read can be found here. Any means in disrupting a pain full habitual experience can be beneficial to the person physically and psychologically. Introducing novel movement, or improved movement skill, under the right educational context, is an important part of rehab. We can influence maladaptive movements or low performance levels (thus initiating cortical reorganization) by applying specific exercises that emphasize joint positional awareness, and specific neuromuscular control, such as attempting to move a body part guided by visual feedback with a laser pointer, with the goal of precision and accuracy. It is as simple as practicing these tasks. The visual external cues just change the level of interaction, engagement, and type of information yielded during the task.
The Motion Guidance concept is, by nature, a creative concept that can be applied to any body part, to yield instant positional awareness. Functions may include “static functions”, where the laser is kept centered while the body moves (such as keeping the laser centered while performing a tassk or exercise), or dynamic (such as attempting to track the laser in a desired range, or direction). But really, you can be as creative as you want!
Below are examples of static uses of visual feedback:
Static Balance Application
Static Cervical Application
Static Thoracic Application
Below are examples of dyamic uses of visual feedback:
Dynamic Cervical Application
Dynamic Knee Application
Dynamic Shoulder Application
For further video examples of applying the concept to the head and neck, the shoulder, the lumbar spine and trunk, the hip and knee during squatting, and general balance applications, brows our YouTube Channel
More information regarding the Motion Guidance Patient Pack and Clinician Kit, as well as our other rehab products, visit the Motion Guidance Shop.
- Treleaven, et al. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med. 2003 Jan: 35(1):36-43
- Balke et al. The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability. Arch Orthop Trauma Surg (2011) 131:1077-1084
- Brumagne et al. The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine (Phila Pa 1976). 2000 Apr 15; 25(8):989-94.
- Wulf et al. Frequent external-focus feedback enhances motor learning. Front Psychol. 2010 Nov 11;1:190
- Schabrun et al. Smudging of the Motor Cortex is Related to the Severity of Low Back Pain. Spine, Oct 22, 2015.