Unit 3 Flashcards
Nervous System Viscoelasticity
Nervous tissue connective tissue
- Accepts tensile + compressive loads + transferring loads
- Adaptability through passive movement
–> elongate
–> longitudinal movment of nerve trunk
–> Level of relaxation of tissue at nerve trunk
- Can stretch up to 2cm or 10%
What are the Tension sites?
- Tether points
- Stabilizes the spinal cord
C6
T6
L4 - Movement at tension sites depends upon the location of the stress and the order in which it is applied
What are the peripherial tension sites?
Elbow
Shoulder
Knee
Neurodynamic dysfunction
- compromise of nerve and microcirculation
- Adherent duram thethered unable to glide and stretch
- limited movement of body segment
- predispose nerve injury –> cascasde inflammatory process–> fibrosis tissue formation btw nerve and sheath
- motor, sensory, sympathetic
Precautions to Neurodynamic
- recognize irratibility
- monitor response
- screen for active disease affecting nervous system
- Watch for signs of vascular compromise
Contraindications for neurodynamic
- acute or ubstable neurological signs
- cauda equina symptoms related to the spine
- spinal cord injury or ysmptoms
- neoplasm
- infection
Neurodynamic Tests
Upper limb tension test 1-4
Slump
Stright leg raise
Prone knee bend
4 ULTTs
- ULTT 1- median nerve, anterior interosseous C5,C6,C7
- ULTT 2- Median nerve, musculocutaneous, axillary
- ULTT 3- radial nerve
- ULTT 4- Ulnar nerve C8 & T1 nerve roots
Slump test is for diagnosising
Lumbar ridculopathy or disk herniation
- High false positive rates in asymptomatic individials
- Very high sensitivity
- CUtoff scores symptoms 22 degrees from terminal knee extnesion
SLR neurodynamic assessments what are the different positions for each nerve
- DF + Eversion + great toe extension = tibial nerve
- DF + inversion = sural nerve
- PF + inversion = fibular nerve
Positive Findings of SLR
- Stresses the sciatic nerve
- back pain alone is not a positive finding
- <70 degrees considered postivie reproducing sciatica symptoms pain radiates below knee neurological in nature
- 0-30 degree range may indicate serious pathology or malingering
- 30-70 degree range L4-S2 tissues are stretched 2-6mm
- > 70 degrees other structures become stretched
- Non-neural confounders: SIJ , hamstring length, lumbar facets, connecctive tissues, hip joint
- COrelate with other findings from evaluation
Prone Knee Bend
- stretches the femoral nerve
- 80-100 degrees dura is stretched L2,L3,L4
Prone Knee Bending Findings
Postive= reproduction of symptoms
- >100 degrees rectus femoris stretch and lumbar spine motion
- sensitivity 84%
What is the goal of neurodyanmic interventions?
- restore normal mobillity and extensibility to nerve tissues- prevent adhesion formation after acute injury or surgery
Alleviate mechanical stimuli:
–> reduce mechnical stimuli
–> reduce traction/tension forces
–> reduce inflammation
–> modify enviornmental contributors
–> reduce intinsic pressures and improve nerve conduction velocity
General principles of dosing for neurodynamic assessment
Intensity
–>irritability of the tissue
–> patient response
–> change in symptoms
- Greater irratibility –> gentler the technique
- graual approach : surrounding tissues–> neural tissues
- Neurological symptoms of tingling or increased numbness should not last when the stretch is released
- Once the patient has shown improvement–> the self-mobilization can be taught
Neural Tension Technique
- Take limb to point of neural tension –> actively or passively move one joint in the pattern
- Hold 15 seconds then release and repeat (stretch)
- Oscillations into symptomatic range 15-30 seconds bouts (glides)
- Observe patients response
- reassess comparable sign repeat tension test, ROM
Nerve Flossing Technique
- Take the limb to the point of tension
- moving two joints actively or passively
- ONe joint will move into position of increased tension the other into slack
- this maintains a constant tension on the nerve while it flosses back and forth through the surrounding tissues
- position can be held for 15 to 20 seconds released and repeated several times or performed with rhythmic oscillations of the movement
Precautions to Tension/Flossing neurodynamic technique
- recognize irratibility
- monitor response
- screen for active disease affecting nervous system
- watch for sign sof vasuclar compromise
What is the classic view of pain model?
Cartesian Model
- Bottom up view of pain
- That pain is a direct measure of tissue damage and the brain is a passive recipient of pain signal, stright through channel from the pain nerve to the pain center in the brain
What is the specificity theory?
- Specific nerve to specific pathay to specific pain center within the brain
Pattern Theory of pain
Generic nerves and the signal of pain is based on the coding of sensation or impulse
- How a frequency or intensity of the nerve signal is what actually creates the sensation of pain
Affect theory of pain
- Pain is viewed as an emotion not a sensation
- Affective as a parallel process to or product of sensory process of pain
Gate Control Theory of Pain
- Pain is the product of imbalnce of small and large fiber input
- INcludes central control system and process of descending control over sensory inputs
- Looking at a 2 way process going on through pain nerve impulses and that also the brain itself can controll/centrally control pain sensation
Current Theories of Pain: Neuromatrix Theory of pain
- The brain and spinal cord are what produce pain, not tissue damage
- Various parts of the central nervous system work together to produce pain
Neuromatrix of Pain Theory
- Multiple inputs to different parts of the brain happening at once
- produces pain as an output in addition to other outputs
- genetically determined and enviornmentally shaped
Neuromatrix View of Pain
Nociception (noxious stimulus/tissue damage) + Threat ( perception of danger) = Pain (phenomena of the brain)
Biopsychosocial Perspective
Looking at the person as a whole
- pain is a component of the interplay between sensory info + emotion + context
Mature organism Model
- Views pain as a survival tool
- Humans as a mature organizm sample the enviornment/scrutinize the input and then respond
- pain perception = sensory dimension
- altered thoughts= cognitive dimension
- altered feelings= affective dimension
–> all of which alter outputs = behavior/physiology
- altered feelings= affective dimension
- with pain there is either some negative noxious stimulus coming from the neviornment/tissue inputs the brain scrutinizes it
- Inputs are brought in and pain/nociception is just another input thats put in and procesed by the brain in order to improve our survival
Fear Avoiding Model
- pain input - threat level- so if percieved as a low threat what will happen is they will give priority to their life goals over the perception of pain which is helped by positive affect and optimism they then cope and revoer from the pain
- If the person percieves pain in the context of high threat then they are going to give priority to the pain —> pain control over their life —> feed into by negative affect/harm representation of pain and then end up doing the outward behavior will be —> fear of pain/avoiding pain and interfere with recovery which leads to a negative affect —-> more ppor negative bad emotions which feeds back into pain/threat loop
Pain Catastrophizing
(FEAR)
- Tendency to explain pain experience in more exaggeration terms than average person
- Increases pain through altered attention, anticipation, and emotional response
Pain Catasrophizing Scale
Rumination: Attenion
Magnification: Exaggeration
Helplessness: Low self affect
What are the 4 stages of Stress
Stage 1 = Stimuli form one or more of the five senses are sent to the brain
Stage 2= The brain deciphers the stimulus as either a threat or non-threat
Stage 3= The body stays activated or aroused until the threat is over
Stage 4= The body returns to homeostasis, a stage of phsyciological calmness once the threat is gone
Stress and the HPA Axis
- Hypothalamus Pituitary Adrenal Axis
- Stress involves perception of threat and pain itself can be a stresso and stress can exacterbate the pain and there are broad long term effects with having chronic stress that are similar to some of the things we see in centralized pain
Stress Response
- 1st stimulus and brings it through your senses and the info is then processsed by the amygadala and judged as stressful and does this with some consultation with the hippocampus (our memories)
- If the amygadla decides it is a threat it sends that info to the hypothalamus
- Hypothalamus is in charge of the stress response—> so the hypothalamus is goin got send a signal to the adrenal medulla
- Adrenal medulla will then release epineprine / norepinephrine and this will work in cases of short term stress response, fight/flight/HR/RR and will also send a signal to the pituitary
- Pituitary will respond to that signal from the hypothalamus by producing adrenal corticotrophic hormone that will stimulate the adrenal cortex
- Adrenal cortex is going to produce cortisol which will enable our body to maintain blood sugar levels throughout the stress response
What is the long regulator of stress?
HPA Axis
Chronic Stress
- Long tern stress- negative feedback loop
- Cortisol inhibits hypothalamus and pituitary
- Overtime the over used glands become less effective and then not able to function as well in actual stressful situations
- Lower cortisol levels impair ability to conrol inflammation (immunosuppression)
- Reduced growth factors in the brain (rpair and make new neurons will be reduced)
- Decreased function and size of hippocampus (needed for memory and mood and it can be negatively effected)
Health Effects of Chronic Stress
HTN
DM
Heart disease
Insomnia
Muscle Pain
Digestive Disorders
Excretory dysfucntion
Weak immun system
Reproductive dysfunction
Exisiting conditions get worse
Anxiety
Mood disorders
Overwhelm
Burnout
Maladaptive behaviors
Effects of Stress on The Brain
- The more stressed you feel the more susceptible you are to feeling stress
- Well worn path from the amygdala to the hypothalamus
- Amygdala calling the shots
- Put the prefrontal cortex back in charge to try and get rig of threat signals
