Carrick Institute

CITV Technology Review: Motion Guidance

In this episode of CITV, we meet with Dr. Eric Dinkins from Motion Guidance to talk about leveraging their technology in your office.

This month, Motion Guidance is offering a special 20% off discount to all Carrick Institute scholars. For more information, visit https://carrickinstitute.com/store/motion-guidance-clinician-kit/

#carricktrained #carrickinstitute #motionguidance #visualfeedback #lasers #brainhealth #neurology #movementtraining #neuroscience

 

Transcription:

– Hello, welcome to CITV, my name is Dr. Freddy Garcia. Today we’re joined by Eric Dinkins and we’re doing a product review on the Motion Guidance Clinician Kit coming up next. Eric, thank you so much for coming on the show. Today we’re going to be taking a look at the Motion Guidance Clinician Kit, which is a device that is very popular for a lot of our Carrick Institute Scholars. But you may be new to a lot of our scholars, Can you tell us a little about yourself?

– Absolutely. Thank you for having me on today.

– Our pleasure.

– A pleasure to be here. My background is, I’m a physical therapist. I have a Board Certification in Orthopedics. And a Post Graduate Certificate in Manipulative Therapy, and I’m also credentialed as a Clinical Instructor through the American Physical Therapy Association, and I’m an owner of Motion Guidance, which is a product that we’re talking about today.

– Awesome, so a lot of our scholars use this for many different reasons, but what I want to know first is how did you guys arrive to this device? I mean, they haven’t even seen it yet for some of them, but what were you guys trying to solve? What was going on?

– Sure. So in my clinic, we have a primary specialty in Sports Orthopedics and Rehabilitation, but we also have an eclectic mix of some neuro and soe vestibular patients that come through. And what we are finding in the clinic, was we use a lot of auditory and kinesthetic cues for our patients to try to have them understand movement, and what was happening, and that doesn’t tie into some primary learning models, and how people understand what’s going on in space. So we needed a visual feedback tool, so people could understand what they were doing in real time.

– Right, and that makes a lot of sense. Right, so you guys were kinda talking about one, the internal versus external cuing aspect.

– Absolutely.

– And the literature’s out on that. But also having that visual feedback. So what are you finding when you give somebody visual feedback to their movement? What are you guys seeing?

– So we’re seeing an immediate representation of what they didn’t understand before. So it’s hard to sometimes internalize what people are truly feeling, and that’s when we try to give those kinesthetic and auditory cues, but they don’t have that understanding and meaning for their movement. And that’s what this application does for them.

– So do they have faster corrections to that movement? Is that what you’re seeing?

– Absolutely. With less cues from the clinician.

– Right.

– So we don’t need to get in there and tell them what’s going on, they can see it. And when they see it, they can feel it. And when they can feel it, they can transition over to permanent changes.

– Alright, so this is kinda like the whole, maybe you’re fixing a hinge pattern. You know, squeeze your glutes versus, actually no, just bring this body part to this target.

– Correct.

– Excellent, exactly.

– That makes a lot of sense. This sounds fantastic. Can you show us the device?

– Absolutely, I’ve brought some examples with us here. Our main device is this ball and socket mounted laser. And this is what makes our device different from others, is we have two different mounts to help acquire any angle necessary with your patient, and you can put it on any body part. The laser has the socket side, and you just pop this on and that creates a mobile, but pretty solid surface, to create any angle representation, that movement. It’s a rechargeable push button laser and you just project it wherever the clinician needs it from there. This mount has teeth behind it to go into a series of belts that comes with our kit. These belts have a hygienic, wipeable side to them that also allows for a grippy, sticky surface to prevent migration of the application area.

– Right, so what I’ve seen before, is other units haven’t had the versatility in regards to attaching it to their body. So I think you guys did a really good job with the different mounts. And also, another kind of feature that I really liked, is the fact that you do get to attach it to any body part. So I, when I use it clinically I’m doing a lot of head. I’m doing a lot of wrist and shoulder, so I end up putting it on the upper arm or the wrist. I’m also doing a lot of lower extremity, and I think it’s really underused in regards to that, because sometimes you can’t attach it there. They don’t make that little mental leap. So I think you guys did a really great job with that.

– Yeah, thank you very much. We also have another feature with one of our lasers and that’s a remote switch. So our red laser offers an on-off capability, for you to remotely turn the laser on and off, without having to fiddle with the head cradle or worry about changing the angle that you originally established. And you can also give this remote to the patient, for them to execute their own rehab.

– I think that was one of the biggest improvements that you guys made, ’cause you guys just came out with that laser, was it earlier this year?

– Correct?

– Yeah, the ability to turn that laser on and off I thought was absolutely game-changing. We immediately put it into some of our pain reset protocols that we’re teaching out here at the Carrick Institute. It’s been received really, really well. Well listen, is one thing to just look at the device, another thing is to show people how to use it. Why don’t we go to the treatment room, and give them some examples of how Carrick Institute Scholars are using this both for Musculoskeletal Rehab, and, Neurological Rehab. Do you want to do that?

– That sounds great.

– Let’s do it.

– Let’s go do it.

– One example we’re going to review today of using the Motion Guidance Device is for joint position error sense assessment. In this example, Doctor Garcia is going to be sitting on the table and we assume that clinically he’s a chronic right shoulder pain patient. So, we’re going to apply the Motion Guidance Device to the right wrist. Typically in clinic, we would assess some proprioceptive inputs by having him bring both arms up to my hands, establishing that he’s maybe at 90 degrees, and say, okay Dr. Garcia, I want you to bring your hands back down, now close your eyes, and return to where you thought your shoulders were. And we’re looking for some type of drift, some type of undershoot. Maybe he pops up into my hand on one side, and we consider that to be a potential deficit that we want to assess further, or maybe start treatment. If we put the Motion Guidance Device on his wrist, we can turn the laser on. I can have him come back up 90 degrees. I can turn this laser on, and say don’t move your arm, but I am going to establish a form of a standard deviation or at least a base line criteria, of where his shoulder is in space represented by the laser. Now go ahead and come back down. And go ahead and bring your arm back up a few times to that same spot for me, with the same representation over, and over. Okay, come back down. Good. So now I can have him train this by bringing his arm down. I can take the laser off with the remote switch. And now come back up to where you think that same position is. I can turn the laser on, and we can see he’s outside of that yellow bullseye. Come back down. I can take the laser away with the off switch. Where do you think you are? And turn it back on. Very well done. Our next example would be if he were doing that with his eyes closed. So go ahead and close your eyes for me. Come back up to that same position, and then open your eyes and make an adjustment. And we want you to learn from that adjustment. So go ahead and come back down. Close your eyes and return to that 90 degree position. And he opens. Very well done. Then come back down. So from using this immediate visual feedback, we can start establishing not only a deficit, but also a plan of care for this patient, moving forward.

– Another area where our Carrick Institute Scholars are leveraging this Motion Guidance technology, is in vestibular rehabilitation. So in this example lets have Eric. Eric, we’re going to be doing one times viewing exercise in the horizontal plane. So your job is to keep your eyes fixed on this center dot. Okay. He’s going to be moving his eyes in the horizontal plane in a no-no head movement. He’s going to shake his head horizontally. His eyes are to stay centered on that dot, and what this allows him to do is a couple things. I’m going to turn the laser on, and adjust it so it’s right in the middle there. Perfect. So his eyes are locked on the laser. Now I’m going to him a specific cue. I’m going to control the amount of excursion that he has. So I’m going to say Eric, I want you to go to this dot and then this dot, when you turn your head to the right and the left. So can you just do that? Super. Now that’s his excursion. Now, the second part is you have to maintain gaze fixation here. Now this gives me a couple things that I can do. One, I can assess the quality of him having the gaze stabilization. Are his eyes staying on the target? Two, I can look at the laser when I need to and assess the quality of his cervical spine movement because two things that you’re looking at. One, are his eyes on target? Two, how is cervical spine and the motion being generated? Is it stable? Are there any titubations? Does he have any other tremors that are coming out when he’s doing this movement? It is not just the practice that makes it perfect, it’s perfect practice makes perfect. Now we can control several of the variables. Is he holding the target? Is he maintaining the excursion? Is the quality of the cervical spine movement appropriate? This is what’s possible when you have such technology. Another area where clinicians leverage this type of technology a lot, is in regards to assessing the quality of a saccadic eye movement, and any compensation that happens at the cervical spine. So what does that look like in practice? Let’s have Eric, I’m going to turn the laser on here, and I want you to put your eyes on this center dot for me now.

– Okay.

– And we’ll just line this up. So we know where his head is right now. So we know his heads looking straight ahead. We know his heads not moving, it’s staying right on that target. So we know his heads not moving, that’s great, but in a moment I’m going to say, what I want you to do is, I want you to jump your eyes to this upper-right target, and not yet. I’ll tell you when.

– Okay.

– When I snap my fingers again, you’re going to jump your eyes to the second target. When I snap my fingers again, your going to jump your eyes to the third target. His goal is to jump his eyes to the target, be on target, and not move his cervical spine. So, typically what I’ll do, is I’ll set up a mirror behind him so I can look at two things at once. I can look at the quality of his eye movement, and I can very quickly see if the laser moved or deviated in any way. So when I snap my fingers you’re gonna jump your eye up to that target. Jump. Nice job. And jump. Nice job. And jump. Excellent. So I see his eyes are moving very, very well. Also, since I’m not having the mirror in this scenario, I could do it again. Which is going to be there. And I’m going to snap my fingers and he’s going to jump. Super. He’s going to jump. Super. Now in this scenario he deviated a little bit. Right? Very, very common to see that. You’ll have some patients generate saccade, and they don’t do it well enough, so what they do is the compensate and move their head. You need to be able to catch that, and there are some rehabilitative procedures which would teach under the function of neurology paradigm versus how to fix that. So again, another very powerful assessment and rehabilitative procedure using a laser for saccade assessment and treatment. So we’ll stay within the concept of vestibular rehabilitation. Another way that I love using these flags that you get in the clinician kit, is the fact that you have all these different patterns. So why don’t you turn that laser on for me? Now, a simple way to do this would say, all right, Eric, I want you to trace this blue butterfly pattern, and I want you to follow the green laser as you do it. So go ahead and give that a go, and I can asses the quality of his movement. Now in receptor based essentials and pain reset, we started talking about the different planes of movement and how that correlates to this patient’s nervous system. You can see if they have a difficulty in one diagonal versus another diagonal. Another way you could do this, is let’s have you reset right here. Is, I want you to keep your eyes fixed here, but then move your cervical spine still in that same target, which then is a different level of difficulty for him. Now I want you to pay attention to this flag, you can see the quality of the movement, we also have all these other flag patterns that we could use. I find it very, very powerful for some of our athletes and clients that we do rehabilitation on. Okay, we’ll do one last one. Another way that I really like using this is let’s say we’re doing saccades, and the patient is constantly hypometric when they do a saccade to the left side. So, you’re going to be jumping your eyes from this target to this target when I snap my fingers, but at the same time, because he’s hypometric to the left, I’m going to have him do a right head turn. A quick, right head turn at the same time. So I want you to jump your eyes from here to here, but I want you to move your head rotation from here to here. When I snap my fingers it’ll be a very quick movement. Let’s see it. The entire time I’m going to watch his eyes to see if he’s metric. Meaning does he move his eyes accurately from here to here, when I snap my fingers. Are you ready Eric?

– Yes.

– And, go. Super. Back to center. And lets see how he does with the laser, ’cause he should be moving the laser from here to here ’cause that’s his target. Again, your eyes are moving from here to here. When he rotates his head to the right, we’re using a reflexive mechanism to push his eyes leftward. Sometimes necessary when you’re doing this type of rehabilitation. Lets give it a go. And go. Super. That’s actually pretty good movement wise. Excellent. Another powerful way to use this tool. Eric, thank you so much for taking time out of your busy schedule to film some of those demonstrations, as to how our scholars are leveraging the Motion Guidance Kit in their practice. That was a lot of fun.

– That was a lot of fun.

– Can you show us what’s in the full kit now?

– Absolutely. So your kit comes in a zip up container like this, and inside the kit you have three different flag options with different designs. You also have mobile targets that you can put on the floor or hang on the wall. It comes with hangers to put on any surface, as well as four different style mounts, four different sized belts, with the hygienic strap on all of those, and a rechargeable laser in your kit. And you can build on extras during checkout.

– I mean, it’s obvious and very clear to me why our scholars are such big fans of this technology. It’s very versatile, and you’re really only limited to your own creativity in regards to how you can use it rehabilitativly. So it makes it a lot of fun, in my opinion.

– Absolutely.

– So, hey, if people want to learn more about Motion Guidance or where to get one, where do they go?

– They can go to motionguidance.com and that’ll take you to our home web page.

– Excellent. Eric, thank you very much for joining us here today. Hope you guys enjoyed the video. I’m your host, Dr. Freddie Garcia on another episode of CITV and until next time.

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