[1.1] Manual Techniques Flashcards
what is VBI? what is CAD?
VBI = vertebrobasilar insufficiency CAD = cervical artery dissection/disfunction
what are some contraindications of manual techniques
Multi-level nerve root pathology Worsening neurological function Unremitting, severe, non-mechanical pain Unremitting night pain (preventing person from falling asleep) Relevant recent trauma Upper motor neuron lesions Spinal cord damage
precautions to be aware of with manual techniques
Ligament laxity/hypermobility (Transverse ligament test, Alar ligament test) Rheumatoid arthritis Long term corticosteroid use Osteoporosis/-penia Down’s Syndrome Local infection or inflammatory disease Active cancer or history of cancer Connective tissue disease
tests & signs to address when considering manual techniques
[test]
- vertebral artery test (active & passive) (0% sensitivity, .67-.90% specificity)
- CN testing
[sign]
- subjective history (family history, family pathologies, genetic makeups, etc.)
- physical signs (pain @ face/eyes, droopy eyelid, neck EXT adds pain, malaise)
what happens if you conduct a vertebral artery test and it’s positive?
what happens if you conduct a vertebral artery test and it’s negative?
[positive] you would not treat
[negative] N/A, doesn’t say anything then
- Quality medical history and screening (BP, HR, neurologic)
- Active movement (how pt moves/reacts into EXT, rotation)
- Passive movement (VAT, understand that EXT is most important)
- Positional testing (Pre-manipulation/mob or traction hold)
- Informed Consent
generally speaking, where do you see the adverse events of manual techniques
you’d see it in patients with a high number and/or severity of risk factors of getting hurt, as the risk(s) heavily outweigh the benefits
what does clinical prediction rules (CPR) mean?
CPR is used to describe the likelihood of the presence or absence of a condition, assist in determining patient prognosis, and help the classification of patients for treatment
explain the CPR process
Three step process:
[1] Derivation
[2] Validation
[3] Impact Analysis
what is the derivation phase of CPR
- first stage
- figure out what factors may be predictive of benefit from a treatment
- laundry list of multiple factors regarding the patient, provide treatment, then go through a process to help predict an outcome
what is the validation phase of CPR
- second phase
- now we know these predictive factors, we need to see how applicable they are
what is the impact analysis phase of CPR
- third stage
- cost efficiency, time efficiency, etc.
how many predictor variables need to be present to determine if cervical traction for mechanical neck pain would be beneficial?
3 or more predictor variables need to be present
list some of the predictor variables need to be present to determine if cervical traction for mechanical neck pain would be beneficial
Age > 55 y/o
Positive Shoulder Abduction Test
Positive Upper Limb Neurodynamic Test 1
Symptoms peripheralize with C4-C7 central PA motion testing
Positive Neck Distraction (reduction in symptoms)
how many predictor variables need to be present to determine if Prone Lumbar Mechanical Traction in Patients with Signs of Nerve Root Compression would be beneficial?
what are they?
at least 1 of the following:
- Peripheralization with repeated lumbar extension
- Positive Crossed SLR
