RAT 4: ND,Chronic Pain, and PGP Flashcards Preview

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Flashcards in RAT 4: ND,Chronic Pain, and PGP Deck (81)
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1

When is neurodynamic treatment indicated? (3)

  1. ND mobilization is indicated under the lumbar stenosis category pg 119
  2. Altered neurodynamics are identified during exam pg 250
  3. For algorithm of LBRLP, if LANSS scale is below 12 and there are no hard neuro signs 

2

What is teh goal of neurodynamic mobilization? 

reduce neural tissue mechanosensitivity and restore its movement capabilities 

3

What other interventions should be addressed prior to initiating neurodynamics? (3)

  1. joint or soft tissue mobilization

  2. motor control training

  3. neurobiology education- role of nervous system in movement and pain related to mechanical loading

4

What are the two categories of neurodynamic treatment?

  1. Non-provocative gliding techniques

  2. Tensile loading techniques

5

Are non-provocative gliding techniques passive OR active movement?

Both

6

Who is contraindicated for Tensile loading techniques? (3)

Patients with hard neurological signs of impaired conduction like:

  • weakness
  • impaired sensation
  • diminished DTRs  

7

Nonprovocative gliding techniques are thought to result in __________

a larger longitudinal excursion with minimal increase in strain and to produce sliding movement between neural and adjacent non-neural tissue

8

How are the gliding neurodynamic mobilizations performed? 

In an on/off manner or oscillatory manner

Not to be performed as a stretching technique 

9

What are the 3 primary classifications of chronic low back pain?

  1. Adaptive or Protective Altered Motor Response to an Underlying Disorder

  2. Altered Motor Response and Centrally Mediated Pain Secondary to Psychosocial Factors

  3. Maladaptive Motor Control Patterns that Drive the Pain Disorder

10

What characterizes patients in the Adaptive or Protective Altered Motor Response to an Underlying Disorder category?

  • high pain levels
  • disability
  • movement and/or control impairments that are secondary and adaptive to an underlying pathological process

11

What, if any, pathological processes are likely to be present in patients with Adaptive or Protective Altered Motor Response to an Underlying Disorder? (9)

  1. red flag conditions
  2. pathology of the disc
  3. stenosis
  4. radiculopathy
  5. spondylosis
  6. spondylolisthesis
  7. inflammatory disorders
  8. neuropathic
  9. centrally or sympathetically mediated pain disorders

12

What general approaches to PT intervention are most indicated and what is the likely response for patients with Adaptive or Protective Altered Motor Response to an Underlying Disorder?

PT management in conjunction with the primary medical or surgical intervention

13

What additional types of intervention might be warranted for patients with Adaptive or Protective Altered Motor Response to an Underlying Disorder?

 

CLBP management (for a small group of them)

14

What characterizes patients into the Altered Motor Response and Centrally Mediated Pain Secondary to Psychosocial Factors category? (6)

  1. Pain disorder is driven by nonorganic factors
  2. high level of disability
  3. altered central pain processing
  4. enhanced, constant pain
  5. movement and MCIs
  6. pathological anxiety, fear, anger, depression, negative beliefs, emotional issues, poor coping strategies , negative social influences

15

What, if any, pathological processes are likely to be present in patients with Altered Motor Response and Centrally Mediated Pain Secondary to Psychosocial Factors?

None

16

What general approaches to PT intervention are most indicated and what is the likely response for patients with Altered Motor Response and Centrally Mediated Pain Secondary to Psychosocial Factors? (3)

Interdisciplinary care:

  1. Cognitive Behavioral Therapy (CBT)
  2. psychological intervention
  3. graded exposure to functional activities

17

What additional types of intervention might be warranted for patients with Altered Motor Response and Centrally Mediated Pain Secondary to Psychosocial Factors?

 

  • clinical psychology or psychiatry
  • exercise ALONE is unlikely to cure

18

What characterizes patients in the Maladaptive Motor Control Patterns that Drive the Pain Disorder category? (5) 

  1. the largest group
  2. maladaptive movements and poor coping strategies produce chronic abnormal tissue loading with reduced or excessive spinal stability
  3. ongoing pain, disability and distress
  4. MI (movement Impairment) presenting with pain avoidance behaviors or MCI presenting with pain provocation behaviors
  5. central sensitization

19

What, if any, pathological processes are likely to be present in patients with Maladaptive Motor Control Patterns that Drive the Pain Disorder?

may have a specific diagnosis or classified as nonspecific CLBP

20

What general approaches to PT intervention are most indicated and what is the likely response for patients with Maladaptive Motor Control Patterns that Drive the Pain Disorder?

 

PT intervention to address the movement and control deficits (most likely to respond to PT intervention as primary intervention)

21

What additional types of intervention might be warranted in patients with Maladaptive Motor Control Patterns that Drive the Pain Disorder?

Cognitive behavioral approach

22

2 subgroups of Maladaptive Motor Control Patterns that Drive the Pain Disorder

  1. Movement Impairment Classification of Pain Avoidance Behavior
  2. Motor Control Impairment Classification of Pain Provocation Behavior

23

What characterizes patients in the subgroup: Movement Impairment Classification of Pain Avoidance Behavior? (5)

  1. painful loss or impairment of active and passive physiological movement associated with high levels of muscle guarding and co-contraction when moving in the impaired range
  2. mvmt restriction or rigidity (excessive stability)  
  3. fear moving into the painful direction and perceive pain as damaging
  4. beliefs of harm, anxiety and hypervigilance
  5. poor coping strategies

24

What general approaches to PT intervention are most indicated and what is the likely response for patients in subgroup: Movement Impairment Classification of Pain Avoidance Behavior? (5)

 

  1. education that pain is not harmful or damaging , but avoiding mvmts help to maintain the disorder
  2. desensitization through graded mvmt strategies (cognitive desensitization and central pathway)
  3. + mobs, manips, STM (soft tissue mobilization) to restore motion, which reduces their fear of those movements.
  4. relaxation, breathing control, postural training, graded exposure exercises and functional activities
  5. cardiovascular xercise

*Reduction in fear and MI results in less pain and disability

*Focus on pain and stabilization tend to reinforce avoidance

 

25

What characterizes patients into subgroup: Motor Control Impairment Classification of Pain Provocation Behavior? (8)

  1. demonstrate P through range pain or painful arc
  2. end range pain during static or dynamic tasks (in all directions)
  3. develop compensatory strategies to stabilize the motion toward the end range
  4. adopt postures and mvmt that are provocative without being aware of it
  5. poor proprioceptive awareness of the lumbopelvic region
  6. gradual onset of pain and absence of withdrawal reflex
  7. have mvmt related fear
  8. fail to respond to general exercise programs

26

What general approaches to PT intervention are most indicated and what is the likely response for patients in subgroup: Motor Control Impairment Classification of Pain Provocation Behavior? (4)

  1. Cognitive behavioral training model
  2. desensitization
  3. educate pt to control posture and mvmt patterns to avoid repetitive strain to painful tissues
  4. motor learning interventions using SSEs

27

What are the typical components of a cognitive behavioral approach to chronic low back pain? (3)

  1. Strategies: education, graded exposure, graded exercise, confrontation of negative beliefs, which are likely to be effective at reducing threat and fear-avoidance beliefs (research- most effective at least 100 hours of treatment)
  2. may include imagery and motivational self-talk, relaxation or biofeedback, coping strategies such as assertiveness, and reduction of negative cognitions, changing maladaptive beliefs and personal goal setting
  3. use quotas or goals for gradual return to activities, family involvement, reframing of affective and cognitive responses, introduction of positive coping and relaxation skills

28

What is graded exposure? 

  • engagement in hierarchy of feared activities
  • confronts/challenges person's beliefs until harmful appraisals reduced or eliminated while progressing through fearful activities
  • may benefit people with chronic pain and high levels of fear avoidance behavior 

29

What is graded exercise?

  • operant conditioning to improve exercise and activity tolerance and reinforce healthy functional behaviors.
  • quota driven, pt must reach intensity/rep count/ etc prescribed by the PT
  • pain reduction is not the primary goal of graded exercise.

30

What is the main goal of pain education?

Decrease the threat value associated with pain by increasing patient understanding