Practical course Dr. Ulrike Van Daele Artesis University College Antwerp - Belgium
Motor Control clinical evaluation PROPRIOCEPTION COÖRDINATIE POSITION SENSE MOTION SENSE POSTURAL CONTROL REPOSITIONING TASK PELVIC TILTING
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
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
Spinal stability Diafragma Disfunctions in low back pain patients! Multifidus Transversus Abdominus Muscles of pelvic floor
Motor Control clinical evaluation Evaluation with stabilizer change in pression = movement Knee Lift Abdominal Test
Motor Control clinical evaluation Adapted Sahrmann Active Straight Leg Raise Bent Knee Fall Out
Motor Control clinical evaluation Prone instability test
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.
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.
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.
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
Motor Control Results clinical studies Measurements are reliable BUT Patients use different compensation strategies 1. Lumbopelvic movement 2. Change of respiration 3. Trunk stiffness
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
artesis 2008 15
Fase 1
Fase 1
Fase 1 Adapted Sahrmann
Fase 2
Fase 2
Fase 2
Fase 2
Fase 2
Fase 3
Fase 3
Fase 3
Fase 3 artesis 2008 27
Fase 4 Make it functional Think of patients profression / Hobby / Sports