Practical course. Dr. Ulrike Van Daele. Artesis University College Antwerp - Belgium

Size: px

Start display at page:

Download "Practical course. Dr. Ulrike Van Daele. Artesis University College Antwerp - Belgium"

Katrina Wiggins
5 years ago
Views:

1 Practical course Dr. Ulrike Van Daele Artesis University College Antwerp - Belgium

2 Motor Control clinical evaluation PROPRIOCEPTION COÖRDINATIE POSITION SENSE MOTION SENSE POSTURAL CONTROL REPOSITIONING TASK PELVIC TILTING

3 PROPRIOCEPTION COÖRDINATION Palpation M transversus abdominis Palpation M multifidus Waiters Bow Pelvic tilt One leg stance Sitting knee extension Bent knee fall out Leg Lowering test POSTURAL CONTROL

4 Motor Control clinical evaluation Score A Good Score B PROPRIOCEPTION Score C COÖRDINATION (Van Daele et al.) Score D Bad (Brumagne et al.) POSTURAL CONTROL

5 Spinal stability Diafragma Disfunctions in low back pain patients! Multifidus Transversus Abdominus Muscles of pelvic floor

6 Motor Control clinical evaluation Evaluation with stabilizer change in pression = movement Knee Lift Abdominal Test

7 Motor Control clinical evaluation Adapted Sahrmann Active Straight Leg Raise Bent Knee Fall Out

8 Motor Control clinical evaluation Prone instability test

B Not correct Angle hip Fx without low back movement less than 50 or Flexion occurring in the low back.

9 Test protocol "Waiters bow". Flexion of the hips in upright standing without movement (flexion) of the low back. A. Correct -Forward bending of the hips without movement of the low back (50 70 Flexion hips). B Not correct Angle hip Fx without low back movement less than 50 or Flexion occurring in the low back. Rating protocol: As patients did not know the tests, only clear movement dysfunction was rated as "not correct". If the movement control improved by instruction and correction, it was considered that it did not infer a relevant movement dysfunction.

B Not correct Pelvis doesn't tilt or low back moves towards Ext./No gluteal activity/compensatory Fx in Thx.

10 Test protocol Dorsal tilt of pelvis. Actively in upright standing. A Correct Actively in upright standing (Gluteus activity); keeping thoracic spine in neutral, lumbar spine moves towards Fx. B Not correct Pelvis doesn't tilt or low back moves towards Ext./No gluteal activity/compensatory Fx in Thx. Rating protocol: As patients did not know the tests, only clear movement dysfunction was rated as ''not correct''. If the movement control improved by instruction and correction, it was considered that it did not infer a relevant movement dysfunction.

Not more than 2 cm difference between sides. B Not correct Lateral transfer of belly button more than 10 cm. Difference between sides more than 2 cm.

11 Test protocol -One leg stance. From normal standing to one leg stance: measurement of lateral movement of the belly button. (Position: feet one third of trochanter distance apart). Correct The distance of the transfer is symmetrical right and left. Not more than 2 cm difference between sides. B Not correct Lateral transfer of belly button more than 10 cm. Difference between sides more than 2 cm. Rating protocol: As patients did not know the tests, only clear movement dysfunction was rated as ''not correct''. If the movement control improved by instruction and correction, it was considered that it did not infer a relevant movement dysfunction.

Correct Upright sitting with corrected lumbar lordosis; extension of the knee without movement of LB (30 50 Extension normal).

12 Test protocol Sitting knee extension. Upright sitting with corrected lumbar lordosis; extension of the knee without movement (flexion) of low back A. Correct Upright sitting with corrected lumbar lordosis; extension of the knee without movement of LB (30 50 Extension normal). B Not correct Low back moving in flexion. Patient is not aware of the movement of the back. Rating protocol: As patients did not know the tests, only clear movement dysfunction was rated as "not correct". If the movement control improved by instruction and correction, it was considered that it

13 Motor Control Results clinical studies Measurements are reliable BUT Patients use different compensation strategies 1. Lumbopelvic movement 2. Change of respiration 3. Trunk stiffness

14 Motor Control - training Fase 1: local segmental control Fase 2: closed chain segmental control Fase 3: open chain segmental control Fase 4: Progression into function Richardson, Hodges and Hides

15 artesis

16 Fase 1

17 Fase 1

18 Fase 1 Adapted Sahrmann

19 Fase 2

20 Fase 2

21 Fase 2

22 Fase 2

23 Fase 2

24 Fase 3

25 Fase 3

26 Fase 3

27 Fase 3 artesis

28 Fase 4 Make it functional Think of patients profression / Hobby / Sports

Core Stability Exercises

Core Stability Exercises Static Floor Exercises The plank Hold a straight body position, supported on elbows and toes. Brace the abdominals and set the low back in the neutral position. Hold this position