IPHREHAB: APPROACH FOR NEUROGENIC DISORDER TREATMENT

IPHREHAB

APPROACH FOR NEUROGENIC DISORDER TREATMENT

Approach for neurogenic disorder treatment 

With the above in mind, I felt the need to produce an approach that is in some ways uniquely useful to the clinician. 

The approach is therefore characterized by the following:

1. links between mechanics and physiology of the nervous system

2. integration of neurodynamics with musculoskeletal functions

3. a new movement diagram that enables the clinician integrate musculoskeletal and neural mechanisms

4. a new system for determining the kind and extensiveness of examination and treatment based on

neurodynamics and neuropathodynamics

5. the concept of neurodynamic sequencing and various options in assessment and treatment

6. new diagnostic categories of specific dysfunctions based on neuropathodynamics

7. treatment progressions derived from the above.

Nevertheless, it is common for therapists to diagnose more frequently the problems they have recently learned about, which raises the possibility of false diagnosis due to raw enthusiasm. At all times, the reader will realize that clinical neurodynamics is only one aspect of management of the person in pain and all other relevant information should be included in clinical decision making. For instance, the existence of a neural problem does not necessarily mean that a treatment with a neurodynamic technique is warranted. This could be because other treatments may attack the causative mechanisms more effectively or neurodynamic application may be contraindicated. Clearly, the biopsychosocial approach to neural problems will place this

book in its rightful place as just a modality of treatment that will be effective in some patients and not in

others.

Clinical neurodynamics is for clinicians dealingwith musculoskeletal disorders with peripheral neurogenic pain mechanisms, including those of the nerve root and peripheral nerve. There is no assumption that all problems are as such, or that the treatments presented in this book act only on peripheral mechanisms. The clinician will naturally and responsibly establish that it is appropriate to treat patients with clinical neurodynamics before doing so.

IPHREHAB: NEUROGENIC DISORDER TREATMENT

IPHREHAB

NEUROGENIC DISORDER TREATMENT

Neurogenic disorders are common and their incidence is probably underestimated (Bennett 1997).

With many recent developments in their management, it is merciful that they can now be treated with non-invasive physical methods.

The notion of adverse neural mechanics has been present for many

years and probably longer than we know. 

Wittingly or unwittingly, the first known description of a neurodynamic

test was on the Edwin Smith Papyrus by Imhotep in 2800 BC, in which a leg straightening manoeuvre was performed in the diagnosis of low back pain in workers injured whilst building the Egyptian pyramids (Beasley 1982; Dyck 1984).

However, between then and now, much has happened and it is fascinating to note that, in addition to the neurodynamic tests for the lower quarter, the three major tests for the upper limb nerves (median, radial and ulnar) had been documented and illustrated

pictorially by the 1920s and 1950s (Bragard 1929; Von Lanz & Wachsmuth 1959). Their antitension counterpart postures were also illustrated

next to these neurodynamic tests.

In the context of therapy, neural mobilization has undergone massive development, particularly in the last thirty-five years since Gregory Grieve, Geoffrey Maitland, Robert Elvey and David Butler published

their work. Such an awareness of mechanical function of the nervous system has developed to the point where, for therapists dealing with pain and the musculoskeletal system, proficiency in neurodynamics has become a standard requirement. 


Nevertheless, an author whose work passed relatively unnoticed was Grieve (1970). The reason this paper is important is that in it Grieve commented on, for the first time that I am aware of in the physiotherapy literature, the notion of sensitivity of neural tissues being a key factor in whether they produce symptoms. He remarked on the possibility that inflamed neural tissues may well be more likely to produce abnormal neurodynamic tests as opposed to those on which pressure was exerted by pathologies such as disc bulges. He also alluded to the possibility that nervous system processing could be a means by which neurodynamic tests might change with spinal manual therapy. These aspects have undergone somewhat of a renaissance and they turn out to be key facets of current thinking in clinical neurodynamics.

IPHREHAB : HYPOTONIA AND ETIOLOGY

IPHREHAB

HYPOTONIA


Disorders of muscle tone Hypotonia

• Hypotonia is a condition of abnormally low muscle tone, often involving reduced muscle strength.
• Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. 
• Recognizing hypotonia, even in early infancy, is usually relatively straightforward, but diagnosing the underlying cause can be difficult and often unsuccessful.

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• The long-term effects of hypotonia on a child's development and later life depend primarily on the severity of the muscle weakness and the nature of the cause.  
• Some disorders have a specific treatment but the principal treatment for most hypotonia of idiopathic or neurological cause is physical therapy to help the person compensate for the neuromuscular disability .

Etiology of Hypotonia

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• Congenital - i.e. present from birth (presenting within 6 months) 

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• Genetic disorders are the most common cause

Down's syndrome - most common

3-Methylcrotonyl-CoA carboxylase deficiency

Achondroplasia

Aicardi syndrome

Canavan disease

Centronuclear myopathy

Familial dysautonomia

Infantile spinal muscular atrophy

Krabbe disease

Leigh's disease

Marfan's syndrome

Menkes syndrome

Methylmalonic acidemia

Nonketotic Hyperglycinemia (NKH) or Glycine Encephalopathy (GCE)

Prader-Willi syndrome

Tay-Sachs disease

Trisomy 13

22q13 deletion syndrome

FG Syndrome

Developmental Disability

Cerebellar ataxia (congenital) 

Dysfunction in Sensory Integration (DSI) 

Developmental Dyspraxia 

Hypothyroidism (congenital) 

Hypotonic Cerebral palsy 

Teratogenesis from in utero exposure to Benzodiazepines 

Acquired

Genetic 

1. Muscular dystrophy (including Myotonic dystrophy) - most common 
2. Metachromatic leukodystrophy 

• Infections 

Encephalitis

Guillian-Barre syndrome

Infant botulism

Meningitis

Poliomyelitis

Sepsis

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• Autoimmunity disorders  

Myasthenia gravis- most common

Abnormal vaccine reaction

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• Metabolic disorder

Hypervitaminosis

Kernicterus

Rickets

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• Neurological

Traumatic brain injury, such as the damage that is caused by Shaken Baby Syndrome

Lower Motor Neuron Lesions

Upper Motor Neuron Lesions

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• Miscellaneous  

Central nervous system dysfunction, including Cerebellar lesions

Hypothyroidism

Other names for hypotonia

• Low Muscle Tone 
• Benign Congenital Hypotonia 
• Congenital Hypotonia 
• Congenital Muscle Hypotonia 
• Congenital Muscle Weakness 
• Amyotonia Congenita 
• Floppy Baby Syndrome 
• Infantile Hypotonia