unwise to treat a damaged, compressed or oedematous nerve root or peripheral nerve trunk with neural stretching techniques. (Elvey & Hall, 2005)

Transkript

1 unwise to treat a damaged, compressed or oedematous nerve root or peripheral nerve trunk with neural stretching techniques. (Elvey & Hall, 2005)

2 Præsentation Præsentation Terminologi Smertemekanismer Undersøgelses-protokol Fysioterapeutisk interevention

3 Diagnostisk gruppe Central sensitivering Denervation Perifer neural sensitivering Muskuloskeletal Classification Neuropatisk Neuropatisk Neuropatisk / nociceptiv Nociceptiv Symptomatisk struktur Neural Neural Neural Muskuloskeletal Mekanisme CNS sensitivering Disinhibering Korticale processser Strukturel skade af perifere nerverødder Inflammation Sensitivering af neurale nociceptorer Konvergens Effekt Forstærket respons på afferente input Nedsat konduktion de-afferentation Øget mekanosensitivitet i perifere nerverødder Mental perception af smerte/symptomer er relaterede til UE Symptomer Distal smerte Hyperaesthesia Hyperalgesia Paraesthesia Allodynia Segmental distal smerte Hypoesthesia, nedsat kraft/lammelse Smerte lokaliseret i alle dele af OE/UE Øget sensitivitet for mekanisk stimuli Referet OE/UE smerte Smerte; proksimalt > Normal neurologiskfunktion Fund LANSS score > 12 Ofte S/S der ligner denervation og mekanosensitivitet Positive neurologisk undersøgelse; Minimal tegn på mekanosensitivitet LANSS < 12 Normal konduktion Mekanisk mekanosensitivitet for tryk og stræk Positive test for mekanosensitivitet LANSS < 12 Ingen af fundene fra andre kategorier LANSS < 12

4 Perifer sensitivering / mekanosensitivitet Smerteteori KORT! Neurale nociceptorer Inflammatorisk sensitiveret Forsimplet; immun / AIGS NR disponeret - Beskyttelse - Placering (disc/zj) unwise to treat a damaged, compressed or oedematous nerve root or peripheral nerve trunk with neural stretching techniques. (Elvey & Hall, 2005)

5 1. Posture 2. Aktiv ROM (AROM) 3. Passiv ROM (PROM) 4. Nerve Tissue Provocation Test (NTPT) 5. Neural palpation 6. Tegn på lokal patologi Undersøgelsesprotokol Elvey & Hall (Grieve, 2005)

6 Posture Beskytte nervevævet mod mekanisk stimuli Forkorte anatomisk distance DDx = Ipsilateral LF Plexus brachialis (C6) Cx ipsilateral LF scapula elevation GHJ Add/IR, Albue/wrist F Plexus lumbalis; ipsialteral LF hip/knee F, TCJ PF

7 AROM AROM forårsager mekanisk stimuli på sensitiveret neuralt væv = SMERTE Quick test; - DDx GHJ S/S (lokal / refereret) Ax ROM og S/S anvendelig som FOM

8 PROM PROM = AROM ifht påvirkning af neurale strukturer Differentiering - muskulære problematik / neuralt

9 Nerve Tissue Provocation Test (NTPT) Provokation IKKE tension Formål = vurdering af neural sensitivitet - SLR, Slump, BPPT Generelle principper; - Information - Forsigtig - Bilateral sammenligning (obs CS) Ax Symptomer ROM Modstand (R1) (Muskler beskytter neuralt væv) - Præcision (struktur specifik)

10 Nerve palpation Kendskab til PNS anatomisk Sensitivitet Forsigtighed (skade) Fx - C4-6 nerver - n. medianus, n. ulnaris, n.ischadicus sv.t gluteal region

11 Lokal patologi Mekanosensitivitet bør være Dx UQ = Make Pattern fit Manuel Ax; - identificer lokal (artikulær) dysfunktion der matcher S/S Obs; - Røde flag

12 Intervention Cause (korrektion af vedligeholdende og disponerende faktorer) Externe /Interne - info, TR, MT Source = smerte-struktur Rx; PROM; - Cx = LG - Lx = LF Effekt; Fysiologisk Mekanisk; neurodynamik Principper; Aldrig smerte R1 = Rx barriere Progression; OE / UE position + mobilisering

13 Husk / Take Home Nerver har nociceptorer Neurogen inflammation (irritation) = nerve sensitiv for mekanisk stimuli Kompression = +ve neurologisk test (ikke nødvendigvis smerte) Diagnostik; undersøgelseprotokol - Posture, AROM, PROM, NTPT, neural palpatoin, lokal patologi Intervention; - IKKE STRÆK - cause, source

14 Kritik Kombination af Sub-gruppering ifht Schäfer et als klassifikation - Gifford case (ipsilateral CX LF = S/S) Refereret og/eller lokal patologi Smerteteori

15 Referencer Butler, D. (2000). The sensitive nervous system. Adelaide, Australia: Noigroup Publications. Butler, D. & Nee, R. (2006). Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics and clinical evidence. Physical Therapy in sport, 7, Gifford, L. (2001). Acute low cervical nerve root conditions: Symptom presentations and pathobiological reasoning. Manual Therapy, 6, Greening, J.(2004). In J. Boyling & G. Jull (Eds.), Grieve s modern manual therapy: The vertebral column (3rd ed., pp ). Edinburgh Churchill Livingstone Hall, T., & Elvey, R. (1999). Nerve trunk pain: Physical diagnosis and treatment. Manual Therapy, 4, Hall, T., & Elvey, R. (2004). Management of mechanosensitivity of the nervous system in spinal pain syndromes. In J. Boyling & G. Jull (Eds.), Grieve s modern manual therapy: The vertebral column (3rd ed., pp ). Edinburgh Churchill Livingstone. Schäfer, Hall et al (2007), Sterling, M., Treleaven, J., & Jull, G. (2002). Responses to a clinical test of mechanical provocation of nerve tissue in whiplash associated disorder. Manual Therapy, 7, Sterling, M. (2007); Noter fra Master program, UQ Woolf, C., & Mannion, R. (1999). Neuropathic pain: Aetiology, symptoms, mechanisms, and management. Lancet, 353(June 5),

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18 Forberedelse; - x-ray + vaccinationer - Engelsk test - Visum - Optagelse på Uni; senest novmber - Opdateret førstehjælp Forberedelse Faglig forberedelse; - Maitland - Univisitets specifikt; - UQ; Grieve, MC, artikler - Perth; Peter O Sullivan, Elvey / Hall Økonomi ; ca Aus$ for Master - Andre omkostninger; fly, forsikring, kost / logi, bøger - SU + legater undgå at regne med at tjene penge undervejs

19 Program Rules for the Master of Physiotherapy 1. Enrolment requirements: To enrol, a student must (a) (i) hold an approved degree in physiotherapy; and (ii) have completed 2 years full-time relevant professional experience, or equivalent; and (iii) produce evidence of continuing professional education to the satisfaction of the head of school; or (b) satisfy the head of school that the student s qualifications and experience are equivalent to the requirements in rule 1(a). 2. Field of study: A student may undertake the program in a field of study approved by the executive dean. 3. Program requirements: #16 from the MPhty list for the chosen field. 4. Special rules: 4.1 Continuous enrolment: A student must undertake the program without interruption. 4.2 Supplementary examinations: (1) The executive dean, after considering advice from the school board of examiners, may award a supplementary examination only to a student who gains a grade of 2 or 3. (2) The executive dean may award supplementary examinations to a student for up to #8 in an academic year. (3) Despite subrule (2), the maximum number of units in each semester is Immunisation schedule: (1) Before commencing a course in which, in the opinion of the executive dean, the student may be at risk of contracting or passing on a blood-borne virus or other disease, the student must complete a schedule of immunisations approved by the executive dean. (2) The requirement under subrule (1) may be waived only if (a) the student provides evidence of his or her status with respect to immunity against blood-borne viruses or other diseases prescribed in the schedule; or (b) approved by the executive dean.

20 Master by course work Opbygning - Midt februar midt november - 2 semestre a 13/52-3 fag på hvert semester - 3 x 6/52 kliniske praktikker (3/7 eftermiddage) - Ca 1/12 vinterferie

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22 Master- fag Semester 1 PHTY7101 Advanced Studies in the Basic, Behavioural & Medical Sciences A - advanced knowledge of the medical management of musculoskeletal disorders - detailed understanding of the structure and function of the musculoskeletal system - gain understanding of pain.. PHTY7103 Theory & Practice of Musculoskeletal Physiotherapy - theoretical knowledge and clinical skills in manipulative and musculoskeletal physiotherapy - emphasis on the integration of skills and knowledge with specific disorders - encouraged to incorporate all aspects of learning from the course into their clinical practice. PHTY7111 The Scientific Basis of Advanced Therapeutic Exercise - provides the scientific basis, practical skills and clinical application of therapeutic exercise - advanced understanding of motor control, and the physiology of exercise as a basis for the rehabilitation of muscle function. - practice of therapeutic exercise will develop the selectivity and specificity of reeducating muscle function/control

23 Master- fag Semester 2 HRSS7809 Evidence-based Practice in Allied Health - introduce the principles, methods, and skills for evidence-based practice - litterature PHTY7018 Directed Research Project - research = include making a critical analysis of the literature, conduct an experiment, to present results clearly and concisely and to draw logical conclusions. PHTY7102 Advanced Studies in the Basic, Behavioural & Medical Sciences B (7101) PHTY7106 Theory & Practice of Manipulative Physiotherapy (7103) 9&acad_plan=MUSTHX5221

24 Hvorfor tage afsted 1) Hvorfor tage afsted 1) Fuldtidsstudie 2) Teori / praktik 1) CR / Maitland ( Make pattern fit ) 2) Ax / Dx / Rx 3) UQ = NMC Mekka 3) Eventyrlyst 4) Forskermiljø 5) Karriere-åbner 6) Undervisere

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