The Sensitive Nervous System Chapter XIV: Management Strategies: Integration of Neurodynamics

This is a summary of chapter XIV of “The Sensitive Nervous System” by David Butler. The Big Picture Evidence Based Approach Here is the step by step patient care process that Butler advocates. 1)      Identify red flags and manage accordingly. 2)      Educate on the whole problem to include tissue health status, the nervous system’s role, and test results. 3)      Provide prognosis and make realistic goals. 4)      Promote self-care, control, and motivation. 5)      Decrease unnecessary fear and manage catastrophization. 6)      Get patients moving as early as possible. 7)      Help patients identify success and sense of mastery of a problem. 8)      Perform a skilled exam. 9)      Acknowledge that biopsychosocial inputs combine with the nervous system to produce pain and disability. 10)   Use any measures possible to reduce pain. 11)   Minimize number of treatments and contacts with all medical personnel. 12)   Chronic pain may need a multidisciplinary approach. 13)   Manage physical function and dysfunction. 14)   Assess and assist in improving general fitness. 15)   Assess how injury affects creative outlets and assist the patient with regaining creativity and discovering new creative outlets. Incorporating Neurodynamics There are several ways to incorporate neurodynamics into the patient’s plan of care which will be outlined below. Reassessment. Explanation. Passive mobilization. Active mobilization. Posture and ergonomics. Reassessment There are many evaluation protocols that warrant constant reassessment after applying an intervention. Be it a comparable sign or audit, neurodynamic tests can be utilized well within these systems. A word of caution with instant reassessment, as quick changes could merely be

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The Sensitive Nervous System Chapter XIII: Research and Neurodynamics: Is Neurodynamics Worthy of Scientific Merit?

This is a summary of Chapter XIII of “The Sensitive Nervous System” by David Butler. Intro Research has demonstrated that often evidenced-based medicine is low on the list for why clinicians choose a particular treatment. From an ethical standpoint, it is important to consider evidence. This chapter is very short so I will just provide the highlights that I got from it. Appraising a New Theory or Approach There are six criteria that a new theory should be evaluated by: 1)      Support from anatomical and physiological evidence. 2)      Designed for a specific population. 3)      Studies from peer-reviewed journals. 4)      Include a well-designed randomized controlled trial or single experiment. 5)      Present potential side effects. 6)      Proponents discuss and are open to limitations. Agreement Here are some definitions of different ways research measures agreement. –          Cohen’s Kappa: Measures nominal data reliability. >0.75 is excellent agreement. 0.40-0.75 is fair to good. <0.40 is poor. –          Pearson product movement correlation: Measures interval/ratio data. –          ICC: Measures continuous data. The closer to 1, the better. Validity There are also many different validity types defined throughout this chapter. The first two are proven through logic and have the least evidence support. –          Construct Validity: Valid relative to a theoretical foundation. –          Content Validity: Can I use this measure to make an inference? The next two are higher up on the evidence support hierarchy. –          Convergent Validity: The test shows a correlation between two variables. –          Discriminant Validity: The test shows a low correlation between two variables.

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The Sensitive Nervous System Chapter XII: Upper Limb Neurodynamic Tests

This is a summary of Chapter XII of “The Sensitive Nervous System” by David Butler. Intro Today we will take a look at assessing upper limb neurodynamic tests (ULNT). These assessments used to be called tension tests, but that terminology is now a defunct mechanical description. We now describe these as neurodynamic tests to better appreciate the neurophysiologic aspects of mechanosensitivity and upper limb homunculi stability. These tests are numbered based on the movement sensitizer, which are as follows: 1 – Shoulder abduction. 2 – Shoulder depression. 3 – Elbow flexion. ULNT1: Median Nerve Here is the quick test first. Here is how to do the manual test. A quick heads up regarding head motions. Sidebending away increases symptoms in 90% of people. Sidebending toward decreases symptoms in 70% of people. ULNT2: Median Nerve Here is the manual test ULNT2: Radial Nerve Here is the active test. And the manual test. ULNT3: Ulnar Nerve Here is the active test And the manual test. Musculocutaneous Nerve Here is the active test And the passive test. Axillary Nerve Here is the passive test. Suprascapular Nerve Here is the test. Final Words Have some fun with these tests, and be mindful that you are not too aggressive. Thanks to Scott and Sarah for your videotaping help. You guys rock.  

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Course Notes: Graded Motor Imagery

I recently attended another great course through the NOI Group called “Graded Motor Imagery” (GMI) taught by Bob Johnson. These guys are the industry leaders in all things pain so please check them out. It was great connecting with Bob and learning what I think will be an excellent adjunct to what I am currently doing. So here is the run down on GMI. Overview GMI is a three-pronged sequential process of establishing early, nonpainful motor programming. Johnson calls this synaptic exercise to limit negative peripheral pain expression. GMI is a 3 step process: 1)      Laterality reconstruction (Implicit Motor Imagery). 2)      Motor imagery (Explicit Motor Imagery). 3)      Mirror Therapy. The Neuromatrix Paradigm & Pain States Before delving into the neuromatrix, we first must define pain. Pain is a multiple system output or expression by an individual-specific pain neuromatrix that activates when the brain concludes that body tissues are in danger and action is required. The neuromatrix, like I talk about in this post here, is the nervous system’s coding space and network. It is first and foremost affected by genetics, sculpted by experience, and constantly evolving. It is the entity that makes us who we are—the self. The neurosignature, or neurotag, is an output’s representation in the brain. For example, regions in the brain will activate in response to produce the pain output. This sequence is the neurosignature. Some common activated areas when pain is expressed include both primary and secondary somatosensory cortices, insula cortex, anterior cingulgate cortex, thalamus, basal

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The Sensitive Nervous System Chapter XI: Neurodynamic Testing for the Spine and Lower Limb

This is a summary of Chapter XI of “The Sensitive Nervous System” by David Butler. Intro For today’s chapter, I have decided that the best way to learn these tests is to show you. I will write in any pertinent details you need for a good test performance. The Straight Leg Raise (SLR) SLR hacks. Add sensitizers (dorsiflexion, plantarflexion, etc) to determine nervous system involvement. Add cervical flexion or visual input to enhance responses. Be mindful of symptoms before and after pain responses. If this test is positive post-operation, it will likely be inflammatory in nature. You can preload the system further with cervical flexion or sidebending the trunk away from the test side. Here are some other ways to perform the SLR with sensitizers first. (I apologize for the way the camera shot in advance). For tibial nerve-bias. For fibular nerve bias. For sural nerve bias. Passive Neck Flexion (PNF) Here is how to perform the test. PNF Hacks. Add SLR to further bias the test. Be mindful of Lhermitte’s sign, which is an electric shock down the arms or spine. This is a must-refer sign as there is potential spinal cord damage. Slump Test Here is how to perform the slump. Slump Knee Bend In the book itself, Butler uses the prone knee bend as his base test. However, NOI does not teach this motion as much and now favors the slump knee bend. This movement allows for much more differentiation to be had. And the saphenous nerve

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