FMT overview Flashcards
Functional Manual Therapy
Approach each patient from the perspective that all have the existing potential and that potential is achieved by treating each person with a whole body approach.
Seamlessly integrates evaluation and treatment for mechanical capacity, neuromuscular function, and motor control.
Established from pnf by Maggie knot and dr. Kabbott
Functional Efficiency
- Utilizes sufficient mechanical capacity (M), Neuromuscular function (N), and motor control (M) to allow for options of strategies in the performance of any given action or task.
- Promotes the establishment of functional efficiency for the accomplishment of independence in functional skills with coordinated purposeful movement.
Change from pain and pathology of the patient to how pain and pathology impact their functional capacity and efficiency
Mechanical Capacity
The quality and excursion of movement and the ability to attain functional postures. Includes mobility of joints (arthrokinematics, Osteokinematics, and accessory motions) and soft tissues (skin, muscles, connective tissues, neurovascular structures, and viscera).
*Unrestricted movement
Characteristics of Mechanical Capacity
- Springy end feel
- indicative of efficient state of mechanical capacity. A hard end feel is indicative of an inefficient mechanical capacity - Inefficient end feels include hypomobility and hypermobility
-Get as specific as possible for hypermobility NMRE - Assessment of joint mechanical capacity is performed three dimensionally to assess the surrounding connective tissue which typically limits joint mobility.
- Three dimensional assessment applies to all anatomical structures - Efficient mechanical capacity supports functional efficiency of the human movement system.
Springy end feel definition
the presence of an elastic recoil at the end motion of a joint or soft tissue
Neuromuscular Function
Neurophysiological ability of synergistic muscles to initiate a contraction with proper strength and endurance for the given task, including ability to return to a state of muscular relaxation
*ability to activate muscles
Assessment of active neuromuscular function
ability to isometrically initiate appropriate synergistic muscle contractions
Motor Control
The ability to learn and perform the skillful and efficient assumption, maintenance, modification, and control of voluntary movement patterns and posture
*Efficient (coordinated movement)
Efficient Motor Control
- Requires
- Efficient mechanical capacity and neuromuscular function
- presence of an integrated sensory and motor homunculus which can effectively recognize sensory input and activate effective motor output for any given automatic or volitional movement
- Presence of CoreFirst Strategies (proper synergistic activation of local and global muscles) to promote smooth and coordinated patterns of movement. - Allows for appropriate anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA) to best adapt to external input or control intentional movement
- Optimum MC provides the flexibility of automatically selecting one of numerous learned motor strategies which most effectively (least energy expenditure and least degradation to the system) achieves a desired task, given the individual’s structure and pathology
Efficient Movement
- Most adaptable
- Most # of degrees of freedom
Alignment + Coordination =
Efficiency
Reduced compensation
- mobilize mechanical restrictions
- Re-Educate with PNF (activate core muscles)
- Teach/Relearn motor control using CFS and PNF
VC tests for
Alignment/postural assessment
VC testing note
Tuck thumb in with fingers using only carpal bridge
-to not pull patinet backwards
Cobra with the arms
“Relax everything but your knees”
EFT tests for
ACE
EFT testing notes
Can test from above or below
Can do with arms in neutral (thumbs up) if unable to fully supinate
Pt not bracing arms to side
Remove everything from the wrists
“Don’t let me straighten your arms out”
Hand positioning for LPM
on corticoid processes
PA- Scapula and costothoracic cage
LPM testing with dowel
Test without facilitation
Quick test for initiation
Low and slow for strength
Hold for endurance
Can test different heights (overhead, chest, stomach)
“Match my force; don’t be pushy”
Posterior view assessment
- general view
- regional and specific locations
- relationship of segments
- vertical and horizontal alignment
- calcaneus and foot positioning
- horizontal alignment at malleoli, head of fibula, knee fold, gluteal fold, head of femur, sacrum, PSIS, iliac crest, lower border of ribs, spine of scapula, occipital ridge, ears
- Spinal alignment to Cranium for verticality and rotational changes. note spinous processes and adjacent groove
- rib cage symmetries and horizontal alignment
- Shoulder girdle positioning and arm positioning
- Soft tissue symmetry/proportions and contour
a. verticality of Achilles tendon, calf positioning
b. relationship calves, hamstrings, contours of hamstrings
c. holding patterns in glutes
d. Lumbar spine
e. thoracic spine and scapula soft tissues - structure function with movement
- folding, elongating, ROM, side comparisons, sequencing FB/SB/pelvic shear)
- visual memory
Anterior view evaluation
Lateral view evaluation
Types of dysfunction
Acute
Subacute
Sustained pain strategies
Acute treatment strategies
a. gentle oscillations to soft tissues and articulations in non-weight bearing
b. Tone reduction
c. Decrease inflammation, swelling, edema
d. STM to associated ST restriction
e. note pain related to associated dysfunction
f. STM shortened range
g. Train self care and pain reducing exercises
Subacute treatment strategies
a. decrease tone and inflammation, improve soft tissue and articular mobility
b. more aggressive STM and more direct; progress from shortened to lengthened range
c. promote healing, initiate rehabilitation, exercises, and training in efficient posture and movement
