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Advanced Spine > M4 Reading Guide 1 > Flashcards

M4 Reading Guide 1 Flashcards

1
Q

When is neurodynamic treatment indicated?

A

Absence of improvement related to non-neural techniques

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2
Q

What other interventions should be addressed prior to initiating neurodynamics?

A
  • neurodynamic and neurobiology education
  • non-neural tissue intervention
  • hip mobility
  • NDTs
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3
Q

What are the two categories of neurodynamic treatment?

A
  • neurodynamic mobilization

- tensile loading techniques

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4
Q

What are the 3 primary classifications of chronic low back pain

A
  1. Adaptive or protective altered motor response to an underlying disorder
  2. Altered motor response and centrally mediated pain secondary to dominant psychosocial factors
  3. Maladaptive motor control patterns that drive the pain disorder
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5
Q

What characterizes pts with adaptive or protective altered motor responses to an underlying disorder?

A
  • high pain level
  • disabilities
  • movement and/or control impairments 2˚ and adaptive to an underlying pathological process
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6
Q

What characterizes pts with altered motor response and centrally mediated pain 2˚ to dominant psychosocial factors?

A
  • high levels of disability
  • altered central pain processing
  • enhanced constant pain
  • movement and MCIs
  • psychosocial traits that are the dominant coexisting, precipitation, or agg factor
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7
Q

What are some of those crazy psychosocial traits?

A
  • pathological anxiety
  • fear
  • anger
  • depression
  • negative beliefs
  • emotional issues
  • poor coping strategies
  • negative social influences
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8
Q

What characterizes pts with maladaptive motor control patterns that drive a pain disorder?

A
  • ongoing pain, disability, and distress

- commonly have psychological and neurophysiological factors as contributes to the pain

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9
Q

What, if any, pathological processes are likely to be present for the adaptive or protected altered motor response to underlying disorder group?

A
  • red flag conditions
  • symptomatic pathologies
  • neuropathic disorders
  • centrally or sympathetically mediated pain disorders
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10
Q

What, if any, pathological processes are likely to be present for the altered motor response and centrally mediated pain 2˚ to psychosocial factors group?

A

pathological processes cannot be found

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11
Q

What, if any, pathological processes are likely to be present for the maladaptive motor control patterns group?

A
  • may have specific pathoanatomical dx or are classified as nonspecific LBP
  • may also have psychological and neurophysiological disorders
  • may have central sensitization
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12
Q

What general approaches to PT intervention are most indicated and what is the likely response?

adaptive/protective altered motor response with underlying disorder

A
  • treat underlying cause first
  • sx should resolve
  • some pts may benefit from PT mgmt in conjunction with 1˚ medical and/or surgical intervention
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13
Q

What general approaches to PT intervention are most indicated and what is the likely response?

altered motor response and centrally mediated pain 2˚ to psychosocial factors

A

interdisciplinary care

  • CBT
  • psychological intervention
  • graded exposure to functional activities
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14
Q

What general approaches to PT intervention are most indicated and what is the likely response?

maladaptive motor control patterns driving pain disorders

A
  • address movement and control deficits

- added intervention for 2˚ cognitive influences

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15
Q

For all categories of pts, what should happen?

A

If you address the underlying issue, the sx should resolve

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16
Q

What are the 2 subgroups of the 3 rd classification of chronic low back pain?

maladaptive motor control patterns

A
  • movement impaired classification of pain avoidance behavior (MI)
  • motor control impairment classification of pain provocation behavior (MCI)
17
Q

pt characteristics: movement impaired classification of pain avoidance behavior

A
  • painful loss or impairment of AROM/PROM in one or more directions
  • associated with high levels of mm guarding and co-contraction when moving in impaired rang
  • fear moving in direction of pain
  • perceive pain as damaging
18
Q

pt characteristics: motor control impairment classification of pain provocation behavior

A
  • no MI or painful loss of movement in direction of pain
  • loss of functional control around neutral zone of motion segment due to specific motor control deficits
  • mm guarding in some pts of the spinal stabilizing muscles in primary direction of pain
19
Q

pt characteristics: motor control impairment classification of pain provocation behavior

arc of motion

A
  • demo through range pain or painful arc
  • end range pain

during both static and dynamic tasks potentially stressing pain sensitive tissue

20
Q

pt characteristics: motor control impairment classification of pain provocation behavior

compensation

A
  • develop compensatory strategies to stabilize motion segment toward an end range position (flex, ext, lat shift)
  • adopt provocative postures/mvts but have no awareness that they are assuming them
21
Q

pt characteristics: motor control impairment classification of pain provocation behavior

Why might these pts adopt provocative postures without being aware of it?

A
  • poor proprioceptive awareness of lumbopelvic region

- gradual onset of pain and absence of withdrawal reflex

22
Q

What general approaches to PT intervention are most indicated and what is the likely response?

MI

A
  • educate that pain isn’t harmful and that compensation strategies help maintain disorder
  • desensitize nervous system and reduce fear of mvt in painful direction
  • graded movement
  • address fear avoidance
  • manual therapy
  • relaxation, breathing control, postural training, graded exposure, cardio, etc
23
Q

MI

relaxation, breathing control, postural training, graded exposure, cardio, and graded functional restoration are done to

A

normalize motor control

24
Q

What general approaches to PT intervention are most indicated and what is the likely response?

MCI

based on

A

CBT model that aims to change movement behavior through physical and cognitive learning process

25
Q

What general approaches to PT intervention are most indicated and what is the likely response?

MCI: desensitization

A
  • desensitize nervous system by educating pt to control posture and movement patterns to avoid repetitive strain to painful tissue
  • reduce peripheral nociceptive drive
  • improve function
26
Q

What general approaches to PT intervention are most indicated and what is the likely response?

motor learning

A

motor learning interventions using SSE’s

Advanced Spine (50 decks)

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