Physical Assessment & Interventions

physical exam

focus on global, functional movements

enhance therapuetic relationship

assessment of general fitness

testing for sensitive NS if appropriate

may introduce PNE

graphesthesia

ability to recognize writing on skin purely by sensing touch

perform on affected body part

80% accuracy aim

manipulate speed & pressure to make more challenging

grid localization

printed/written copy of defined grid for patient to visualize

20 areas & calculate percentage score

decrease # of squares if too challenging

2 point discrimination

start at 0 mm & increase until 2 points felt

low back - change 5 mm each time

if unsure= report one

average 5 ascending and 5 descending measurements (start 30 mm above for asc)

dermatome or pain area

at home paper clip 2 point discrimination

3 clips= TPD, smaller, wider

educate regarding nature of problem

PNE= metaphors, examples, pictures

reconceptualize pain experience

objectve to shift from marker of tissue damage/pathology to perceived need to protect body tissue

de educate prior to re educating

discuss psychosocial barriers

reduce fear by gaining a better understanding in itself can reduce pain

what should PNE be billed as?

Neuro re-education w

what is most effective approach for intervention?

biopsychosocial model

PNE pillars

pain education

aerobic exercise

sleep hygiene

goal setting

PNE combined with physical intervention is superior

how many exercises to do at home?

4-5

principles for exercise prescription

treatment expectations

baseline of activity

discuss activity pacing

provide patient education

utilize activity tracker/diary

consequences of increased pain during/following 1st session

erode confidence with movement/exercise

strengthen relationship b/t movement and pain

decrease patient motivation for participation

negative sleep affects

increased rates of pain, obesity, depression, increased risk for cancer, etc

HEP

questions

exercise

aerobic exercise program

goals

traditional therapy

manual therapy, soft tissue techniques, diaphragmatic breathing, modalities, neurodynamic exercises, stretches and conditioning

left/right discrimination

ID left or right body parts

magazines, flash cards, apps

>80% accuracy

neck/back = 1.6 secs

hands, feet, shoulder, knees = 2 secs

maintain above parameters for at least a week & despite stress

less accurate at 90-180 *

train under calm and stressful situations

repeat 4-5 times per day

explicit motor imagery

imagined movements

begin with unaffected body part

goal= visualize yourself moving

perform in many different places

mirror therapy

use of mirror for cortical remapping

remove anything covering limb

what is impaired with chronic pain?

left right discrimination

predetermined training load

patient should NOT exceed m

multidisciplinary approach

use for chronic LBP

medical aspects, exercise/hands on treatment, education, mental health