Evidence Based Practice and Maitland Flashcards
1
Q
Study by Hoving et al: Tested patients with non-specific neck pain and placed them into what three groups?
A
1: Manual therapy (once per week)
2: Physcial therapy (twice per week)
3. Continued care by a general practioner
2
Q
Hoving study- which group tx is being described: Specific mobilization techniques, soft tissue, and strengthening exercises?
A
Manual therapy group
3
Q
Hoving study: which group tx is being described- decompression and exercise therapy
A
Physical therapy group
4
Q
Hoving study findings: at 7 weeks the success rates were _% for Manual therapy, _% for physical therapy, and _% for continued care? Which therapy in daily practice has the favorable treatment option (*)?
A
- 3% for manual therapy* (is favorable treatment option)
- 8% for physical therapy
- 9% for continued care
5
Q
Hoving study: which treatment was the most cost effective? Which was the most expensive?
A
Most cost effective was- Manual therapy
Most expensive was- Physical therapy
6
Q
Cochrane review of manipulation/ mobilization for mechanical neck disorders: what was the most beneficial treatment? When done alone manipulation and/or mobilization were _ _ _. When compared _ was superior. There was _ _ to make conclusions for neck disorder with Radicular findings (arm pain).
A
Mobilization and/ or manipulation when used with exercise was most beneficial
When done alone manipulation and/ or mobilization were NOT AS BENEFICIAL
When compared NEITHER WAS SUPERIOR
There was INSUFFICIENT EVIDENCE to make considerations for neck disorder with arm pain
7
Q
According to Boyles study: inclusion or exclusion of cervical thrust manipulation into the manual PT treatment plan _ _ _ the _.
A
DID NOT INFLUENCE THE RESULTS
8
Q
Cleland study: _ to _ _ of mobilizations resulted in the best outcomes when directed at the thoracic spine in patients with neck pain.
A
2 to 3 MINUTES
9
Q
Cleland study: Subjects who received thrust mobilization/ manipulation experienced _ _ in disability in the short term. What on the GROC (global rating change scale) was considered a success in this study? (3)
A
Those who received thrust mobilization/ manipulation experienced GREATER REDUCTIONS in disability . . .
GROC measure of success:
- A very great deal better (7)
- A great deal Better (6)
- Quite a bit better (5)
10
Q
Forbush study: In geriatric population with degenerative cervical radiculopathy (cervical spondyloarthritis) a _ _ approach was used. Included? (3) Results?
A
A MULTIMODAL CONSERVATIVE APPROACH was used
Included: manual therapy (mobilization/ manipulation) of the upper thoracic and cervical spine, intermittent mechanical traction, and home program including deep cervical flexor strengthening
RESULT: all but one had NO PAIN AFTER DISCHARGE
11
Q
According to Dunning: cervical manipulation and mobilization received what grade of evidence?
A
A
12
Q
According to study by Wainner: Looked at 4 clinical examination findings (+ Spurling’s, + distraction, + UNLT- median nerve, and less than 60 degrees of cervical rotation to involved side) for cervical radiculopathy- 4 out of 4 had specificity of _%, 3 out of 4 had specificity rating of _%, and the best screening test was?
A
4 out of 4- 99% specificity
3 out of 4- 94% specificity
Best screening test for radiculopathy was UNLT1
13
Q
Ghasemi study: In addition to using Upper limb tension tests for screening of cervical radiculopathy what 2 other tests are good diagnostic tests for comparison between acute and chronic CR?
A
Shoulder Abductin test and Spurling’s test
14
Q
According to Snodgrass: study shows that _ # of traction will result in a change in pain level, _# of traction will not.
A
20# will result in change
6.7# will not
15
Q
According to EBP if you are _ _ with cervical manipulation or it is _, adding thoracic spine thrust manipulations to the cervical spine mobilizations and AROM exercises results in _ _ outcomes.
A
If you are NOT COMFORTABLE with cervical manipulation or it is CONTRAINDICATED, adding thoracic spine thrust manipulations to the cervical spine mobilization and AROM exercises results in SUPERIOR TREATMENT OUTCOMES
16
Q
According to study by Young: There appears to be no relationship between the amount of traction _ used and _ _ due to ceiling effect however it may affect?
A
No relationship between the amount of TRACTION FORCE used and PERCEIVED RECOVERY due to ceiling effect, however it may affect PATIENT SATISFACTION
17
Q
According to Young study: addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields _ _ _ _ to pain, function, or disability in patients with cervical radiculopathy
A
NO SIGNIFICANT ADDITIONAL BENEFIT
18
Q
What are the 3 proposed mechanisms as to why manipulations work so well? What is most supported by research*?
A
1 Mechanical effects
2 Neurophysiological effects* (most supported)
3 Biochemical changes (changes in blood chemistry)
19
Q
What percent of cardiovascular output goes to the nerves?
A
25%
20
Q
What is the new name for traction used by chiropractors as a marketing tool?
A
Spinal decompression therapy
21
Q
What angles are recommended for traction for upper versus lower cervical spine?
A
Upper cervical spine: 0 degrees
Lower cervical spine: 60 degrees
22
Q
According to Aguino and Schumacher: If you deliver mobilization/ manipulation treatment within - _ of the painful facet you will still improve symptoms. Why is this helpful?
A
Within 3-4 LEVELS of the painful segment/ facet
It is helpful to know because if the painful facet is too irritable moving up or down 3-4 levels may be more tolerable for the patient and still will have the same result
23
Q
According to Ronnie et al: _% increase in outcomes if patient has _ out of the _ clinical prediction rules
A
90% increase if patient has 4 out of the 5 clinical prediction rules present
24
Q
_, _, _ and _ pain often occur together
A
THROACIC, SHOULDER, NECK AND ARM pain often occur together
25
According to Maitland what scenario would be the ideal response to treatment? What would be the worst? (Improved- quick response, completely resolved, improved-slow response, increase in symptoms/ worsening, or no change)
Ideal response: Improved- quick response to treatment
Worst: No change
26
What is the sequence and selection of techniques (maitland) for unilateral sypmtoms in the cervical spine? (4)
Unilateral PA pressures
- Neutral (push on painful side)
- Rotation (away from painful side)
Traction
Transverse Vertebral pressures (push towards side of pain)
27
What is the sequence and selection of techniques (maitland) for bilateral cervical spine sypmtoms? (4)
```
Central PA pressure
Bilateral PA pressure
Traction
-upper cervical in neutral (0 degrees)
-lower cervical spine in flexion (60 degrees)
```
28
With unilateral PA pressures (for unilateral cervical sypmtoms) pressures should be at a _ degree _ _ on the side of pain with a _ or _ inclination.
Pressures should be at a 30 DEGREE MEDIALLY INCLINED on the side of pain with a CEPHALAD OR CAUDAL INCLINATION
29
With cervical spine rotation (unilateral PA pressures) you should start with the neck in _/ _ _ position and then move towards?
Start with the neck in a NEUTRAL/ OPEN PACKED position and then move towards the angle of rotation that reproduces the patient's symptoms/ position of restriction
30
According to Hoving study: What form of patient intervention resulted in the best outcomes at the lowest cost?
Manual therapy performed by a PT
31
According to Cochrane Review: There was strong evidence of benefit favoring multimodal care (manipulation/ mobilization plus exercise) for _ and _ _ neck disorders with or without _.
Strong evidence of benefit favoring multimodal care for SUBACUTE AND CHRONIC MECHANICAL neck disorders with our without HEADACHE
32
In cochrane study: What were the 3 types of thrust manipulations that were applied? Which were applied to the involved side?(*)
Opening restriction*
Closing restriction
Upslope*
33
Lohman study: what was the main difference between the novice v. Expert hands when applying thoracic spine manipulations? Why?
Novice's hands have different amounts of pressure applied
Experts hands have more equal distribution of pressure
Why: expert has better body mechanics
34
According to Cochrane report (2004) cervical manipulation was _ _ mobilization. According to Dunning (2012) cervical manipulation was _ _ mobilization. How many studies were each based on?
Cochrane: cervical manipulation was EQUAL TO mobilization
- based on 33 studies
Dunning: cervical manipulation was SUPERIOR TO mobilization
- based on 1 study
35
Walker study, 2008: Study was to assess the effectiveness of _ _ _ and _(_) for mechanical neck pain with or without _ _ _ _, as compared to a _ _(_) approach
Assess the effectiveness of MANUAL PHYSICAL THERAPY AND EXERCISE (MTE) for mechanical neck pain with or without UNILATERAL UPPER EXTREMITY SYMPTOMS, as compared to a MINIMAL INTERVENTION (MIN) approach.
36
Walker study: Allowed for subjects with and without UE symptoms but still falling under mechanical neck disorder umbrella by excluding those subjects with _ _ _ _ _ on the same nerve root level. Limited their intervention to _ _ in an attempt to replicate realistic reimbursement practice patterns.
Excluding those subjects with MORE THAN 2 NEUROLOGICAL SIGNS on the same nerve root level.
Limited their intervention to 6 SESSIONS
37
Walker study: The impairment based _ program resulted in clinically and statistically _ _ and _ _ improvements in _, _ and _ _ _ compared to _.
The impairment based MTE program resulted in clinically and statistically SIGNIFICANT SHORT AND LONG TERM improvements in PAIN, DISABILITY and PATIENT PERCEIVED RECOVERY compared to MIN.
38
Walker study: MIN program comprised of _, a _ exercise, and _ _.
Comprised of ADVICE, a _ MOBILITY exercise, and SUB-THERAPEUTIC ULTRASOUND
39
Walker study found that _ group sought additional care _ as often as the _ group
MIN group sought additional care TWICE as often as the MTE group
40
Childs study: proposed classification system for patients with neck pain that included _ _, _, _, _ and _
PC CMH
PAIN CONTROL, CONDITIONING, CENTRALIZATION, MOBILITY and HEADACHE
41
Child study: Those in the mobility category received and intervention to treat either a _ or _ _
Intervention to treat either a OPENING OR CLOSING DSYFUNCTION
42
Child study: Centralization group received intervention treatment consisting of _ exercises/ _ technique
Consisting of DIRECTIONAL EXERCISES/ MCKENZIE TECHNIQUE
43
Child study: Pain control group proposed intervention included: gentle _ within pain _, _ exercises for _ _, physical _ as needed, and _ _ to control _. Interventions based on the "_ patient"
Intervention included: gentle AROM within pain TOLERANCE, ROM exercises for ADJACENT REGIONS, physical MODALITIES as needed and ACTIVITY MODIFICATION to control PAIN
Interventions based on the "IRRITABLE patient"
44
Childs study: Patients in the conditioning group matched intervention included: _ and _ _ for the the muscles of the neck and upper quarter, and _ _ exercises. Patient defined as the _-_ chronic _ patient
Intervention included: STRENGTHENING AND ENDURANCE EXERCISES for the muscles of the neck and upper quarter and AEROBIC CONDITIONING exercises.
Patient defined as the NON-IRRITABLE CHRONIC PAIN patient
45
Child study: proposed matched intervention for headache group included: cervical spine _/_, _ of neck and upper quarter muscles and _ education.
Intervention included: cervical spine MANIPULATION/ MOBILIZATION, STRENGTHENING of neck and upper quarter muscles and POSTURAL EDUCATION
46
Fritz study: purpose was to develop _ _ for _ _ to subgroups of patients to _ _ (less _ and decreased _ and _)
Purpose was to develop CLASSIFICATION METHODS for MATCHING INTERVENTIONS to subgroups of patients to IMPROVE CLINICAL OUTCOMES
(Less VISITS, and decreased DISABILITY AND PAIN)
47
Fritz study: Outcome variables used were _ _ _ (_), _ _ rating, and _ of _.
Variable used were NECK DISABILITY INDEX (NDI), NUMERIC PAIN rating, and NUMBER OF VISITS
48
Fritz study: Results showed patient receiving _ _ was associated with _ _ in the _ than receiving _-_ _.
Patients receiving MATCHED interventions was associated with GREATER IMPROVEMENTS in the NDI than those receiving NON-MATCHED INTERVENTIONS.
49
Fritz study: Conclusion was the development of _ _ for patients with _ _ may improve the outcomes of _ _ _.
Conclusion was the development of CLASSIFICATION METHODS for patients may improve the outcomes of PHYSICAL THERAPY INTERVENTIONS
50
Fritz study: Which two classifications consistently showed the biggest improvements to matched treatment intervention?
Centralization and Conditioning/ exercise
51
Fritz study: Which two classifications showed (highest percentages of) minimal detectable change?
Mobility and Pain control
52
Cleland study, 2007: Clinicians have greater accuracy when determining the likelihood that a patient with neck pain will exhibit a _ response to thoracic spine _ _ when using _ out of _ variables.
A patient with neck pain will exhibit a RAPID response to thoracic spine THRUST MANIPULATION when using 3 OUT OF 6 variables.
53
Cleland, 2007: Random manipulation of the thoracic spine will be successful in patients with neck pain approximately _% of the time.
Will be successful approximately 50% of the time
54
Sillevis and Cleland study, 2010: looked at immediate effects of the thoracic spine thrust manipulation on the _ _ _ (_)
On the AUTONOMIC NERVOUS SYSTEM (ANS)
55
Sillevis and Cleland, 2010: Results found _ _ change in pupil diameter with high thrust manipulation, which indicates there was _ _ to the _ or _ _ _- aka _.
Results found NO SIGNIFICANT change in pupil diameter with high thrust manipulation, which indicated there was NO CHANGE to the SYMPATHETIC (dilator muscle) or PARASYMPATHETIC (constrictor muscle) NERVOUS SYSTEMS- aka ANS
56
Sillevis and Cleland: Also found that thoracic thrust manipulation was _ _ effective in reducing _ in _ _ _ subjects. Grade for T-S HVLA thrust?
Thoracic thrust manipulation was ALSO NOT effective in reducing PAIN in CHRONIC NECK PAIN subjects.
Grade: C
57
What was Cleland's inclusion criteria for thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: symptoms duration of _ _ _ _, No symptoms _ to the _, looking up _ _ _, low FABQ- _ _(less than _), decreased _ _ (_-_ spinal level) and extension ROM _ _ _.
Symptom duration of LESS THAN 30 DAYS
No symptoms DISTAL TO THE SHOULDER
Looking up DOES NOT AGGRAVATE
Low FABQ- PHYSICAL ACTIVITY (less than 12)
Decreased THORACIC KYPHOSIS (T3-T5 spinal level)
Extension ROM LESS THAN 30 DEGREES
58
Neck disability rating scale: mild disability _-_, moderate disability _-_, severe disability _-_, complete disability above _.
Mild: 5-14
Moderate: 15-24 (some say 12)
Severe: 25-34
Complete: above 34
59
Cleland thoracic versus cervical manipulation: which group had higher scores on the NDI? Which had higher scores on the numeric pain rating scale? Which had higher scores on the Fear Avoidance Beliefs Questionnaire- Physcial activity (FABQ-PA)?
THORACIC scored higher on NDI AND NUMERIC PAIN RATING SCALE
CERVICAL scored higher on the FABQ-PA
Higher score= greater perceived disability/ pain
60
Puentedura et al 2012: development of clinical prediction rule for patients with neck pain likely to benefit from _ _ manipulation and _ _.
Likely to benefit from CERVICAL SPINE manipulation and ROM EXERCISES
61
Puentedura et al: Clinical prediction rules considered: duration of symptoms _ _ _ days, _ _ that manipulation _ _, difference in cervical ROM to either side of _ _ _ _, and _ with spring test/ central PA's to the _ _ _.
Duration of symptoms LESS THAN 38 DAYS
POSITIVE EXPECTATION that manipulation WILL WORK
Difference in cervical ROM to either side of AT LEAST 10 DEGREES
PAIN with spring test/ central PA's to the MIDDLE CERVICAL SPINE
62
Puentedura: # of clinical prediction rules and associated probability of success: All 4? 3 present? 2 present? 1 present?
All 4: 100%
3 present: 90%
2 present: 68%
1 present: 43%
63
Puentedura belives that _ _ should get _ and _ unless _.
ALL PATIENTS should get MANIPULATION AND EXERCISE unless CONTRAINDICATED.
64
Ragonese study, 2009: performed study comparing manual PT to ther-ex to a combination of therapies for the treatment of _ _
For the treatment of CERVICAL RADICULOPATHY
65
Ragonese study: 4 parts of the inclusion criteria
MS NC
+ Spurling's test
+ Median Nerve test (UNLT 2a)
+ Neck Distraction test
Cervical AROM of less than 60 degrees
66
Ragonese study: 3 PT intervention groups
1: Manual PT only
2: Ther-Ex only
3: Manual PT and Ther-Ex
67
Ragonese study: which group is described- Cervical lateral glides (grade III and IV 30-45 sec each), Thoracic passive accessory mobilizations (central PA's, grade III and IV 30-45 sec each) and Median Nerve mobilizations (UNLT 2A sliders/ flossing- increased elbow extension and decreased wrist extension)
Group 1- Manual PT only
68
Ragonese study: which group intervention is being described: deep neck flexor (DNF) strengthening (hold for 10 repeat 10X), Lower and Mid trap strengthening (2 sets of 15 reps), Serratus Anterion push ups plus (2 sets of 15 reps).
Group 2: Ther-Ex only
69
Ragonese study: Which group intervention is being described- cervical lateral glides, thoracic passive accessory mobilization, median nerve mobilization, DNF strengthening, low and mid trap strengthening, and serratus anterior push up plus?
Group 3- manual PT and ther-ex combo
70
Ragonese study results: When treating patients with dx of cervical radiculopathy a _ approach of _ _ _ _ appears to be superior to _ _ _.
A COMBINED approach of MANUAL PT AND THER-EX appears to be superior than EITHER TREATMENT ALONE
71
Cellany, Seyda et al, 2016: comparison of the effects of _ _ plus _ _ to those of _ _ alone in patients with non-specific mechanical neck pain.
Comparison of the effects of STABILIZATION EXERCISES plus MANUAL THERAPY to those of STABILIZATION EXERCISES ALONE in patients with non-specific mechanical neck pain
72
Cellany et al study: _ _ _ _ was more effective than _ _ _ _ _. More effective at reducing _ (_), Reducing _ _ _ _ (_), improving cervical _ _ (_), and improving _ of _ (_)
STABILIZATION EXERCISES PLUS MT was more effective than STABILIZATION EXERCISES OR MT ALONE
More effective at reducing DISABILITY (NDI), reducing PAIN INTESITY AT NIGHT (NPRS), improving cervical ROTATION ROM (INCLINOMETER), and improving QUALITY OF LIFE (SF-36)
73
Young study: looked at _ _, _ and _ for patients with cervical radiculopathy
Looked at MANUAL THERAPY, EXERCISE, and TRACTION for patients with cervical radiculopathy
74
Young study: Inclusion criteria- ages _-_; unilateral UE _, _ or _; _ or greater out of _ tests with positive result.
Inclusion criteria-
Ages 18-70
Unilateral UE PAIN, PARESTHESIA, or NUMBNESS
3 or greater out of 4 tests
75
Young study: what 4 tests did he consider for inclusion criteria?
Use IUDS when your YOUNG
Ipsilateral cervical rotation of less than 60 degrees
ULNT1 (median nerve)
Distraction test
Spurling's test
76
Young's study: Exclusion criteria included- history of previous _ or _ _, _ UE symptoms, medical "_ _", cervical spine _ in the past 2 weeks, or current use of _ _.
History of previous CERVICAL OR THORACIC SURGERIES
BILATERAL UE symptoms
Medical "RED FLAGS"
Cervical spine INJECTIONS in the past 2 weeks
Current use of STEROID MEDICATION
77
Langevin study: Comparison of _ _ _ and _ _ for cervical radiculopathy (difference between exercises that open the _ _ versus _ _ exercises)
Comparison of 2 MANUAL THERAPY EXERCISES and EXERCISE PROTOCOLS for cervical radiculopathy
Difference between exercises that open the NEURAL FORAMEN versus NON-SPECIFIC exercises
78
Langevin study: results suggest that _ _ and _ are effective in improving pain, function and ROM in patients with cervical radiculopathy. The addition of manual therapy techniques and exercises thought to _ the _ _ yielded _ _ _ benefits.
Results suggest that MANUAL THERAPY AND EXERCISES are effective. . .
The addition of manual therapy techniques and exercises thought to INCREASE THE INTERVERTEBRAL FORAMEN yielded NO SIGNIFICANT ADDITIONAL benefits
79
Jull study: purpose was to determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when _ _ or in _, as compared to a _ _.
Effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when USED AONE OR IN COMBINATION, as compared to a CONTROL GROUP
80
Jull study: what are the four groups that were compared?
1- manipulative therapy alone
2- exercise therapy only
3- combined manipulative and exercise therapy
4- control group
81
Jull study: at 12 month follow up both _ _ and _ _ had _ _ headache frequency and intensity, and the neck pain effects were maintained. But _% more patients gained relief from?
Both MANIPULATIVE THERAPY and SPECIFIC EXERCISE had SIGNIFICANTLY REDUCED headache frequency . . . .
But 10% more patients gained relief from the combination of both
82
Dunning* 2016: _ _ and _ _ versus _ and _ in patients with cervicogenic headache
UPPER CERVICAL and UPPER THORACIC versus MOBILIZATION and EXERCISE in patients . . .
83
Dunning study: What areas of the spine where targeted for manipulations? How many attempts were made?
Transition zones (C1-C2 and T1-T2)
With both 1 attempt, and then if no cavitation occurred a 2nd manipulation was performed
84
Dunning study: Mobilization and exercise group included- mobilization was done with _ _ on the _ and _ at _-_, and a _ _ was performed at _-_. _ _ _ (_) were performed with a 10 sec hold and a range of 22mmHG-30mmHG. _ _ and _ _ exercises were performed via Progressive resistive exercises with a _.
Mobilization
- UNILATERAL PA'S on the RIGHT AND LEFT at C1-C2
- CENTRAL PA's at T1-T2
CRAINIOCERVICAL FLEXION EXERCISES (CCFE) were performed with a 10 sec hold and range of 22mmHG-30mmHG
LOWER TRAP AND SERRATUS ANTERIOR exercises were performed via PRE with a THERABAND
85
Dunning, 2016: Results suggest _-_ sessions of _ over _ weeks, directed at the _ _ and _ _ spine results in _ _ in headache intensity and frequency, disablility, headache duration and medication intake than _ _ with _. How long were the effects maintained?
Suggests 6-8 sessions of MANIPULATION over 4 WEEKS, directed at the UPPER CERVICAL AND UPPER THORACIC spine resulted in GREATER IMPROVEMENTS in headache . . . . Than MOBILIZATION COMBINED WITH EXERCISE
Effects were maintained at 3 MONTH FOLLOW UP
86
Associated fields: "law of the nerve"? "Law of the artery"? "Law of the facet"?
Nerve- Chiropractors
Artery- Osteopaths
Facet joint- PT
87
Raney study, 2008: Development of _ _ _ to identify patients with neck pain likely to benefit from _ _ and _.
Development of CLINICAL PREDICTION RULES to identify patients with neck pain that would likely benefit from CERVICAL TRACTION AND EXERCISE
88
Raney study: Patients completed _ sessions of _ _ _ and _ _ _ twice weekly for _ weeks.
Completed 6 sessions of INTERMITTANT CERVICAL TRACTION and CERVICAL STRENGTHENING EXERCISES twice weekly for 3 WEEKS
89
Raney study: What was the GROC (global rating of change) criteria that was used to assess outcomes?
6 or greater (1-7) scale, very high standard
90
Raney study: 5 clinical prediction rules that were developed: _ testing of _-_ with + _ symptoms, + _ _ test, + _ (_ _) test, + _ _ test, and age _ or _
```
MOBILITY testing of C4-C7 with + PERIPHERAL SYMPTOMS
+ SHOULDER ABDUCTION test
+ UNLT (MEDIAN NERVE) test
+ NECK DISTRACTION test
Age 55 OR OLDER
```
91
Raney study: If patient met 4 out 5 criteria what was the percentage of success with ICT and CSE? 3 out of 5? 2 out of 5? 1 out 5? Random application?
```
4/5: 94.8% success rate
3/5: 79.2%
2/5: 53.2%
1/5: 47.6%
Random app: 44%
```
92
Raney study (random intermittent traction) versus Cleland study (random t spine manipulation)- both had _ _. Percentages?
Both had SIMILAR OUTCOMES
Intermittent traction: 44%
T-spine manipulation: 54%
93
Borghouts study found: patients with _ _ symptoms may be more responsive to a different treatment approach such as _ _ and other _ _ interventions.
Patients with MORE DISTAL symptoms
More responsive to CERVICAL TRACTION AND OTHER DISTRACTION ORIENTED INTERVENTIONS
94
Coppieters and butler study: Findings of the study _ the beneficial effects of _ _ _ on neuropathological processes and may assist the clinician in electing more appropriate _ _ _ in the conservative and post-op management of common Neuropathies.
Findings of the study SUPPORT the beneficial effects of NERVE GLIDING EXERCISES on neuropathological processes and may assist the clinician in selecting more appropriate NERVE GLIDING EXERCISES . . . .
95
Coppieters and butler: Which technique (sliding versus tensioning) had higher effect (more strain= less excursion) on the Median nerve (at wrist) and the Ulnar nerve (at elbow)?
SLIDING TECHNIQUES:
Median nerve (UNLT1)
- 12.6 mm (LOWER STRAIN) with SLIDING technique
- 6.1 mm (HIGHER STRAIN) with TENSIONING technique
Ulnar nerve (UNLT3)
- 8.3 mm (HIGHER STRAIN) with SLIDING technique
- 3.8 mm (LOWER STRAIN) with TENSIONING technique
96
Coppieters and Butler: stretching a nerve more than _-_% is enough strain to stop _ _ _
Stretching a nerve more than 7-8% is enough to STOP VENOUS BLOOD FLOW
97
A peripheral nerve is approximately _% connective tissue
50% connective tissue
98
What 3 things do nerves need to be healthy and happy? Grade for neurodynamics as therapy?
MB'S
-Movement, Blood, Space (roomy container)
Grade: B
99
What are the treatments steps for restoring neurodynamics: 1- prepare the _(_), 2- peripheral nerve _, 3- active _ (_ prior to _) and 4- passive _ (_ becomes the treatment)
1- prepare the CONTAINER (SPACE)
2- peripheral nerve MASSAGE
3- active NEURODYNAMICS (SLIDERS prior to TENSIONERS)
4- passive NEURODYNAMICS (TEST becomes the treatment)
100
Née study: Impact of _ of _ on _ _ and _ _: a biomechanical study with implications for neurodynamic test sequencing.
Impact of ORDER OF MOVEMENT ON NERVE STRAIN AND LONGITUDINAL EXCURSION . . . .
101
Nee study: The strain and excursion is _ based on the _ but the _ _ is _. The movement applied _ is _ _ and more _.
The strain and excursion is DIFFERENT based on the SEQUENCE but the END POINT is SIMILAR
The movement applied FIRST IS STRESSED FIRST and more RAPIDLY
102
Née study: Clinical applicability- for Acute neurogenic pain add the _ _ _. For subacute and chronic neurogenic pain add the _ _ _.
Acute- add the PAINFUL SEGMENT LAST
Subacute and Chronic- add the INVOLVED SEGMENT FIRST
103
Louw research shows that for chronic pain patients _ is therapy. Grade of evidence?
EDUCATION is therapy
GRADE OF EVIDENCE: A
104
Puentedura 2012: Are adverse events _ and are _ being performed _?
Are adverse events PREVENTABLE and are MANIPULATIONS being performed APPROPRIATELY
105
Puentedura: What are the 4 most common adverse events in order of highest occurrence?
Arterial dissection
Disc herniation
CVA
Vertebral fracture or dislocation
106
Puentedura: what profession has the highest incidence of adverse effects? Lowest 2?
Highest- chiropractors
Lowest- naturopath and then PT
107
Puentedura: What was the total number and percentage of appropriate vs. inappropriate/ preventable incidents?
Appropriate 108, 80.6% of cases
Inappropriate/ preventable 26, 19.4%
108
Puentedura: if all contraindications and red flags were ruled out there was the potential for a clinician to prevent _% of adverse events associated with cervical spine manipulation
Potential for a clinician to prevent 45% of AE's
109
Puentedura: _ of the adverse events were unpredictable, suggesting that there are some inherent risk associated with cervical spine manipulation after a thorough _ and _ _ _.
10% were unpredictable
Some inherent risk associated with CSM even after a thorough PHYSICAL EXAMINATION and PROPER CLINICAL REASONING.
