Proprioceptive Training

Transcription

1 This book combines 5 of our best selling books in one convenient piece. The course description and course content of each module can be found on the following pages. Proprioceptive Training Course Description Course Objectives Proprioceptive training is integral to nearly all daily life functions. An injury whether due to repetitive stress, disease or soft tissue damage affects proprioception. Proprioception affects work, sports, household and leisure activities, it is paramount to have a thorough knowledge of the current research on proprioceptive training. Such a framework lends itself to designing treatment plans that increase patient lifestyle satisfaction while improving clinical outcomes. This course will cover the fundamental principles of proprioception. The book will present the architectural framework of proprioception as the basis for treatment interventions designed to improve func tion. Improving patient outcomes will be facilitated through increasing your knowledge of the different treatment techniques to improve proprioception. Several effective strategies will be examined for the young population, juvenile rheumatoid arthritis patients, Parkinson's patients, Alzheimer's patients and many more Define proprioception and identify body systems that affect proprioception. 2. Identify the stages of proprioception and how it affects childhood and adulthood. 3. Devise Treatment Techniques to improve proprioception 4. Choose the best treatment protocol for your neuromuscular impaired patients 5. Incorporate proprioceptive training in your practice

2 Nerve Mobilization of the Upper extremity Course Description The nervous system is a complex arrangement of the nerve cells and tissues. It regulates the body responses to external and internal stimuli. The peripheral nervous system is responsible for the transfer of information between the motor and sensory neurons and their effectors in both directions. Injuries to the peripheral nervous system often result in significant deterioration of the regular activities. Many of the peripheral nerve injuries in the upper extremity are often a result of traction injury to the brachial plexus. Such injuries are commonly associated with altered shoulder postures and functional imbalance in the arm, forearm and hand due to pain in the related nerves and muscles. Brachial plexus neuropathy is one of the commonly noted upper extremity pain syndromes. The involvement of the peripheral neuropathies and cervical spine pathologies can complicate the diagnosis of brachial plexus neuropathy. Most of the nerve injuries are believed to arise due to influence of the physical factors that alter the mechanical abilities of the nerve fibers. Nerve mobilization has been projected as an efficient therapy to treat the pathologies of the nervous system. It is essential to know about the basics of the nervous system, the neuropathology, the transmission of pain and movement dysfunction before initiating nerve mobilization procedure. The movements of the nerves or nerve fibers can result in changes in the internal nerve physiology by altering the neural tension. Neural mobilization aims at relieving such changes in the nerve physiology to relieve the symptoms of pain and restriction of mobility. It is also vital to have a clear idea about the principles, guidelines, precautions and contraindications of nerve mobilization for better utilization of this procedure. Course Objectives 1. Implement techniques of Upper Limb Tension Testing (ULTT ) to rule out proximal pathology from hand symptoms 2. Apply nerve gliding and muscle re-education, in the treatment of common upper quadrant problems 3. Design a home exercise program for the client with upper quadrant problems 4. Describe the common entrapment sites and pain mechanisms in the cervical spine, shoulder, wrist and hand 5. Identify the most common anatomical sites of upper extremity compression 6. Examine the neural system continuum and its relationship to musculoskeletal problems using Upper Limb Tension Testing (ULTT) to rule out proximal pathology from hand symptoms 7. Demonstrate upper limb tension tests with a bias toward the median, ulnar and radial nerves 8. Use proven techniques including neural milking, muscle stripping, nerve sliding and nerve tensioning to safely and effectively treat the median, ulnar and radial nerves

3 Advances in Stroke Interventions Course Description Approximately 730,000 first-ever strokes occur in the United States each year. Stroke is the third leading cause of death in the United States and in most Western countries. However, approximately 80-90% of patients survive their stroke, often with substantial motor dysfunction that comprises ability to perform valued activities. Stroke is the most frequent cause of permanent disability in adults worldwide. Average survival following stroke is 8 years; in the United States, this calculates to a stroke survivor prevalence of 5.7 million persons. A recent review of randomized controlled trials in therapy treatment alternatives (in over 1000 stroke patients), indicates that therapy provide improvement in function when compared to no treatment or control. Yet, superiority of one type of therapy over another could not be distinguished, and therefore the specific choice of therapy was difficult to justify over another type of treatment. Consequently there are reservations in the medical community concerning the benefit of various types of therapy. So, although we have progressed from do nothing to do something is the solution to do anything? Despite evidence suggesting that therapy may be useful in brain restoration and in the therapy of patients with stroke, there is little information available describing the precise nature of interventions provided by therapy therapists. Little evidence determines which patients with stroke should receive motor therapy, what elements those therapies should contain, or when they should be implemented. In addition, results are limited and functional gains after stroke are often minimal. Thus, identifying interventions that can improve motor function remains a priority. This book will provide an overview of the current understanding of modern rehabilitation therapies and the effects on plasticity and recovery of motor function in stroke. Course Objectives 1. Identify the cause of cerebrovascular accident 2. Implement interventions that are evidencebased which would help in promoting recovery in patients with stroke 3. Assess the effectiveness of constraint-induced movement therapy based on side of stoke, time since stroke, age of the patient and current ambulatory status 4. Create treatment programs that would include balance retraining after stroke such as limb loading and overground ambulation 5. Review other restorative therapies to improve cognition such as mental practice and non-invasive brain stimulation.

4 Current Evidence Based Protocols on the Use of Therapeutic Modalities Course Description This book summarizes the effectiveness of several therapeutic modalities in the treatment of neurologic and musculoskeletal disabilities and the challenges faced by the health practitioners in selecting the most appropriate treatment. Numerous guidelines recommend therapeutic modalities for the management of musculoskeletal conditions. However, specific recommendations are lacking concerning which adjunct modalities to employ. This book will discuss current evidence-based clinical practice guidelines have been developed in the treatment of neurologic and musculoskeletal conditions. Clinicians use a variety of modalities to reduce pain, improve mobility and treat neuromusculoskeletal injuries and disabilities. Examples of therapeutic modalities include: hot-packs, cold-packs, whirlpools, TENS (Transcutaneous Electrical Nerve Stimulation), ultrasound, traction, electrical stimulation, and joint and spine mobilization/manipulation that can help strengthen, relax, and heal muscles and expedite recovery in the orthopedic setting. Specific recommendations are lacking concerning which adjunct modalities to use. This review will summarize the effectiveness of several therapeutic modalities in the treatment of neurologic and musculoskeletal disabilities and the challenges faced by the health practitioner in selecting the most appropriate treatment. Course Objectives 1. Understand how ultrasound benefits in fracture healing. 2. Identify the mechanisms of action of iontophoresis, low-level laser therapy, electrical stimulation and spinal decompression therapy. 3. Choose the best modality for osteoarthritis and rheumatoid arthritis 4. Prescribe the best treatment protocol for knee pain, neck pain, and shoulder pain based on evidence based guidelines 5. Differentiate high intensity ultrasound versus low intensity ultrasound

5 Myofascial Trigger Point Release of the Upper Extremity Course Description This course will teach myofascial trigger point release concepts. By utilizing the trigger point techniques, patients make rapid improvement in their status. Outcomes have reflected reduced therapy sessions with permanent improvement as well as the patient s ability to self-manage their condition with the home exercise programs. Methods for locating and deactivating trigger points using a variety of techniques and modalities will be explored. Myofascial release involves sustained pressure and graded stretch applied to the soft tissue which is guided entirely by the feedback obtained from the patient s body. The feedback felt by the therapist while applying the stretch determines the direction of the stretch, its duration, and the amount of force applied. From shoulder disorders to elbow injuries to debilitating hand and wrist problems, quicker improvement and more favorable outcomes are unquestionably dependent on proper rehabilitation technique and indi vidualized, forward thinking concepts and application. What were previ ously considered complementary therapeutic methods are now proven, evidence-based techniques and modalities that care for the total patient and are imperative for today s therapist. Myofascial release can benefit individuals of almost all age groups wherein the release of the muscle tightness (as a result of fascial involvement) facilitates the maximal elongation of the muscles leading to a decrease in the constant pull being experienced by the tendons and other associated structures.. Course Objectives 1. Demonstrate how to identify and correct for the most common factors that precipitate and perpetuate myofascial trigger points 2. Identify techniques for deactivating trigger points including trigger point pressure release and myofascial release 3. Interpret client history and assessment findings to ascertain irritability 4. Utilize self-care techniques for deactivating trigger points 5. Demonstrate trigger point palpation using STAR palpation

6 Table of contents/course Outline Part 1: Current Evidence Based Protocols on the use of Therapeutic Modalities Chapter 1 Introduction Introduction 5 Evidence-Based Clinical Practice Guidelines 5 Musculoskeletal Conditions 7 Therapeutic Modalities 8 Therapeutic Exercise 10 Chapter 2 Ultrasound Ultrasound 11 Benefits in fracture healing 12 Mechanism of action 15 Fracture healing 16 Cellular reaction 17 Benefits in osteoarthritis 19 Benefits in soft tissue shoulder disorders 19 High-intensity ultrasound 21 Factors affecting the transmission of acoustic energy 21 Sonophoresis/phonophoresis 23 Chapter 3 Other Therapeutic Modalities Iontophoresis 25 Low-level laser therapy 27 Electrical stimulation 29 Spinal decompression therapy 31 Current Models in the Market 33 DRX 9000

7 VAX-D Chapter 4 Evidence Based Clinical Practice Guidelines Low Back Pain 37 Osteoarthritis 38 Rheumatoid Arthritis 41 Knee Pain 47 Neck Pain 48 Shoulder Pain 50 Fibromyalgia 51 Conclusion 52 References...54 Part two: Myofascial Trigger Point Release of the Upper Extremity Chapter 5 Introduction Brief history and some definitions 64 Anatomy of a skeletal muscle 66 Types of muscle contraction 68 Laws affecting muscle tissues 69 Chapter 6 Trigger Points Mechanism of injury 71 Myofascial Trigger points 72 Clinical Symptoms 72 Physical Findings 73 Classification of Myofascial Trigger Points 74 Rehabsurge, Inc.

8 Chapter 7 Diagnosis of Myofascial Trigger Point Syndrome History 75 Diagnostic Criteria 76 STAR palpation 76 Chapter 8 Myofascial Release Trigger Point Acupuncture 80 Vapocoolant spray 81 Modalities for Myofascial Trigger Point Release 81 Myofascial Stretching 82 Precautions and Contraindications 83 Chapter 9 Specific muscles Deltoid 85 Biceps Brachii 85 Triceps 86 Brachioradialis 86 Supinator 87 Pronator Teres 87 Flexor Carpi Ulnaris 88 Flexor Carpi Radialis 88 Extensor Carpi Radialis 89 Extensor Carpi Ulnaris 89 Extensor Digitorum 89 Extensor Indicis Proprius 90

9 Abductor Pollicis Brevis 90 Flexor Pollicis Brevis 91 Adductor Pollicis 91 Levator Scapulae 92 Upper trapezius 92 Chapter 10: Other Techniques Muscle Energy Technique 93 Postisometric Relaxation Postfacilitation stretch method Reciprocal Inhibition Effect of Breathing Positional Release Technique 97 Strain-Counterstrain Technique Application guidelines Integrated Neuromuscular Inhibition Technique 100 Application guidelines Instrument Assisted Myofascial Release 100 Effects of manual loading on soft tissue Benefits of Cross fiber massage Graston Technique Augmented Soft Tissue Mobilization (ASTYM) Chapter 11: Review of Current Research 8-week calf myofascial treatment programs 107 Home Program of Ischemic Pressure and Sustained Stretch for Myofascial Trigger Points 107 Ease of technique reproducibility 108 Rehabsurge, Inc.

10 Myofascial pain and fibromyalgia: thorough history necessary 109 Effect of myofascial release on an adult with idiopathic scoliosis 110 Changes in active mouth opening following a single treatment of latent myofascial trigger points in the masseter muscle involving post-isometric relaxation or strain-counterstrain 111 Sympathetic facilitation of hyperalgesia evoked from myofascial tender and trigger points in patients with unilateral shoulder pain 112 Proximal hamstring rupture, restoration of function without surgical intervention 113 Trigger points in tension-type headache 114 Active fascial contractility: Fascia can influence musculoskeletal dynamics 114 Conclusion 115 References Part three: Nerve Mobilization of the Upper Extremity Chapter 12 anatomy and Physiology of the Nerves Introduction 126 Importance of proper evaluation 127 Anatomy and physiology of the nerves 127 Neurodynamics 128 Common causes of reduced nerve gliding 129 Pain Responses and Definitions 132

11 Nerve Injuries Classification 133 Chapter 13 Evaluation Using Neural Tension Tests Slump Test 136 Upper Limb Tension Test 137 Signs and Symptoms 141 Chapter 14 Extremity The 3 Main Nerves of the Upper Median Nerve 143 Ulnar nerve 145 Radial nerve 146 Chapter 15 Exercises to improve nerve gliding Median Nerve Exercises 148 Ulnar Nerve Exercises 149 Radial Nerve Exercises 151 Chapter 16 Treatment Techniques Stage I Symptom Control 152 Behavior modification 152 Workplace modification 154 Stage II Restorative Procedures 155 Soft tissue mobilization/ Muscle Stripping 155 Joint mobilization 156 Deep massage and stretch 156 Neural Milking 156 Stretch Tight Muscles 157 Stage III Rehabilitative Processes 158 Rehabsurge, Inc.

12 Chapter 17 review of Current Research and Concluding Remarks 159 References PARt 4: Proprioceptive training Chapter 18 Proprioception Introduction 171 Definition of Proprioception 171 Body Systems that Control of Proprioception 173 Chapter 19 development of Proprioception Introduction 175 Stages in the Ontogenesis of Proprioception 175 Proprioception and Early Childhood 177 Proprioception and Rehabilitation 178 Geriatric Stages and Proprioception 178 Chapter 20 Intervention Therapies Introduction 179 Is Proprioceptive Training Essential? 179 Susceptibility to Injuries 181 Training Techniques Popular Proprioceptive Training Techniques Such as One Leg Stand, Forward-backward Leg Swings, Toe Walking, Heel Walking 184 Case Specific Therapies. Juvenile Rheumatoid Arthritis 186 Oriental Methods of Physical Training 191

13 Tai Chi and Qigong as an Alternative Proprioceptive Training Technique 194 Chapter 21 Proprioceptive Exercises for Patients with Neuromuscular Impairments Introduction 197 Can exercise enhance brain functions? 198 Exercise and Alzheimer s Disease 200 Can you teach and Alzheimer s patient to exercise? 201 Exercise and Parkinson s Disease 204 Is exercise beneficial for Parkinson s patients? 204 Chapter 22 Concluding Remarks 207 References Part 5: Advances in Stroke interventions Chapter 23 Cerebrovascular Accidentt Introduction 217 What Causes Stroke? 219 Ischemia/reperfusion injury 220 Brain plasticity 221 Spontaneous Behavioral Recovery After Stroke 222 Molecular and Physiological Events 223 Chapter 24 restorative Therapies Setting the Stage for Rehabilitation 225 What can be done for Stroke Patients? 226 Rehabilitation Interventions 227 Restorative Therapies for Promoting Behavioral Rehabsurge, Inc.

14 Recovery after Stroke 229 Chapter 25 Constraint-Induced Movement Therapy Repetitive Training and Task Oriented Based Interventions 233 Constraint-Induced Movement Therapy (CIMT) 233 Who Benefits from Constraint-Induced Movement Therapy 237 Combined Botulinum Toxin Type A and Modified CIMT in Upper Limb Spasticity 239 Approaches to Reducing Visual Neglect 241 Repetitive Task Practice and Robotic Therapy 243 Chapter 26 Improving Balance and Proprioception Balance Retraining After Stroke 245 Limb Loading 246 Body Weight Support Treadmill and Overground Ambulation 248 Chapter 27 Other Therapies Device Based Therapies 250 Cognitive Training 251 How Does Mental Practice Work? 253 Non-Invasive Brain Stimulation 255 Chapter 28 Conclusion Time Window for Restorative Therapies 258 Measuring Impairment and Disability in Stroke 258 Conclusion 260

15 References Appendix Examination 269 Survey questions 295 Answer sheet 296 Afterword Rehabsurge, Inc.