Sub-Classification & Clinical Prediction Rules for Neuromuscular Rehab

1 Day

Course Description
This module is a pre-requisite for many SMARTERehab courses, but is recommended for all courses.  It is primarily for musculoskeletal physiotherapists.

The common problem: a client presents with multi-factorial pain, recurrent or ongoing, and has not responded to various forms of treatment from various practitioners. What can we do to help?

Current sub-classification and rehabilitation strategies do not address the diverse range of motor, sensory, neurological, cognitive (learning and psychological) and psychosocial problems that clients present with.  In this very informative module we present the need for more specific sub-classification as evidenced from the research.  We then build on this to present our five category diagnostic sub-classification approach. This includes diagnosing (1) patho-anatomical (2) motor function (3) pain mechanisms (4) psychosocial factors and (5) CNS coordination, each of which will make up the overall picture in the client to a greater or lesser extent.

Clinical prediction rules are presented to help you with the diagnosis and rehabilitation of each sub-classification. This clearly identifies which individual should receive what therapy. Each sub-classification is described in detail making diagnosis of each straight forward, with an easy to use decision tree to show which sub-classification is the rehab priority.  The Functional Performance Evaluation © is then discussed which provides a clinical problem solving strategy to allow you to identify the client’s functional requirements and design an exercise program specific to match their needs. 

The relevant physiology required to understand motor control rehabilitation is covered along with the concepts of graded exercise therapy.  The importance of understanding the learning process, learning styles and neuroplasticity for motor control training are highlighted along with appropriate strategies we can apply clinically. 

This course will allow you to start using the evidence based clinical reasoning, the sub-classification process and clinical prediction rules for your rehab of clients right away.

This is an evidence based course.
This module may alternatively be taken as a home study course.

Course Objectives: After the course the participant will be able to:
 

  • Utilize clinical prediction rules for making five types of sub-classification and choosing the right rehabilitation strategies
  • Prescribe functional exercise programs with the Functional Performance Evaluation©
  • Appreciate the importance of assessing movement patterns, sensory motor function and the nervous system
  • Be aware of the normal time frames for rehabilitation and factors that influence this
  • Understand the clinical reasoning process and how to apply evidence based practice
  • Apply the relevant physiology and learning strategies for motor control rehabilitation
  • Use our universal problem solving model for prescribing and progressing exercise
Program & Pre-course Reading

Suggested pre-course reading

Revision of the Clinical Reasoning or Key Concepts course

Gibbons SGT, Comerford M J 2001 Strength versus stability Part I; Concepts and terms. Orthopaedic Division Review, March/April: 21-7 (see www.smarterehab.org/resources/publications)

Gibbons SGT, Comerford M J 2001 Strength versus stability Part II; Limitations and benefits. Orthopaedic Division Review. March/April:28-33 (see www.smarterehab.com/resources/publications)

Free articles available at: http://www.ncbi.nlm.nih.gov/sites/gquery

Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. Hannu Luomajoki, Jan Kool, Eling D de Bruin, and Olavi Airaksinen. BMC Musculoskelet Disord. 2008; 9: 170. Published online 2008 December 24. doi: 10.1186/1471-2474-9-170. PMCID: PMC2635372

The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. James S. Thomas and Christopher R. France. Eur Spine J. 2008 January; 17(1): 97–103. Published online 2007 October 31. doi: 10.1007/s00586-007-0532-6. PMCID: PMC2365523
 

Various Time Options
Morning Start

Program
Day 1
8:00 – 8:30 Background & SMARTERehab System
8:30 – 9:00 Need for sub-classification
9:00 – 9:30 Evidence based practice & key issues in clinical reasoning
9:30 – 10:30 Sub-classification
10:30 – 10:45 Break
10:45 – 11:45 Clinical prediction rules
11:45 – 12:15 Motor learning & neuroplasticity
12:15 – 12:45 Fundamentals of exercise prescription & Motor control
12:45 – 1:00 Summary

 

Afternoon Start

Program
Day 1
2:00 – 2:30 Background & SMARTERehab System
2:15 – 2:30 Need for sub-classification
2:30 – 3:30 Evidence based practice & key issues in clinical reasoning
3:30 – 4:00 Sub-classification
4:00 – 4:30 Break
4:30 – 5:00 Clinical prediction rules
5:00 – 6:00 Motor learning & neuroplasticity
6:00 – 7:00 Fundamentals of exercise prescription & Motor control
7:00 – 7:30 Problem solving
7:30 – 8:00 Summary


 

2 Day Course

Course Description
This module is a pre-requisite for many SMARTERehab courses, but is recommended for all courses.  It is primarily for musculoskeletal physiotherapists.

There is a diverse range of motor function, sensory motor, cognitive (learning and psychological), autonomic, neurological and personal factors that are dysfunctional in clients with chronic pain. These are described from a detailed literature review.  Current sub-classification and rehabilitation strategies do not address the spectrum of problems that clients present with.  In this very informative module we present the need for more specific sub-classification as evidenced from the research.  We then build on this to present our five category diagnostic sub-classification approach. This includes diagnosing (1) patho-anatomical (2) motor function (3) pain mechanisms (4) psychosocial factors and (5) CNS coordination, each of which will make up the overall picture in the client to a greater or lesser extent.

Clinical prediction rules are presented to help you with the diagnosis and rehabilitation of each sub-classification. This clearly identifies which individual should receive what therapy. Each sub-classification is described in detail making diagnosis of each straight forward, with an easy to use decision tree to show which sub-classification is the rehab priority.  In the retraining of motor function we teach you to use The Functional Performance Evaluation©. This provides an easy to use clinical problem solving strategy to allow you to identify the client’s functional requirements and design a program specific to match their needs.  This tool can be used to design a functional and graded exercise program when specific motor control retraining is not a priority. The foundations of how to assess motor control are introduced based on how altered motor control or psychosocial factors can contribute to musculoskeletal dysfunction.  The importance of understanding the relevant neurophysiology, the learning process and learning styles are covered in detail so that you can apply appropriate individualized rehabilitation options with suitable starting points and progressions. You are taught how to monitor your intervention with suitable outcome measures.

In this two day comprehensive course there is considerable reference and attention paid to the relevant research evidence. And to facilitate effective learning of the concepts there is valuable time given to group workshops and discussion.  Practical sessions and workshops are used throughout the course to demonstrate the sub-classification method, the clinical prediction rules, functional exercise and the clinical reasoning process.  This course will allow you to start using the evidence based clinical reasoning, the sub-classification process and clinical prediction rules for your rehab of clients right away.

This is an evidence based course.
This module may alternatively be taken as a home study course.
 
Course Objectives: After the course the participant will be able to:
  • Utilize clinical prediction rules for making five types of sub-classification and choosing the right rehabilitation strategies with immediate clinical application following workshop learning.
  • Prescribe functional exercise programs with the Functional Performance Evaluation©
  • Appreciate the importance of assessing movement patterns, sensory motor function and the nervous system
  • Interpret evidence based outcome measures and screening questionnaires
  • Be aware of the normal time frames for rehabilitation and factors that influence this
  • Understand the clinical reasoning process and how to apply evidence based practice
  • Apply the relevant physiology and learning strategies for motor control rehabilitation
  • Use our universal problem solving model for prescribing and progressing exercise
  • Be aware of extensive research literature to underpin your clinical reasoning and deepen your understanding of rehabilitation
     
Program
Day 1
8:30 – 9:00 Background & SMARTERehab System
9:00 – 9:30 Need for sub-classification
9:30 – 10:00 Evidence based practice & key issues in clinical reasoning
10:00 – 10:30 Break
10:30 – 11:00 Sub-classification: Patho-anatomics
11:00 – 12:00 Sub-classification & Clinical prediction rules: Motor Function
12:00 – 1:00 Break
1:00 – 3:00 Sub-classification & Clinical prediction rules: Motor Function
3:00 – 3:15 Break
3:15 – 4:30 Sub-classification & Clinical prediction rules: Motor Function
Day 2
8:30 – 10:00 Sub-classification & Clinical prediction rules: Pain mechanism
10:00 – 10:30 Break
10:45 – 12:00 Sub-classification & Clinical prediction rules: Psychosocial Factors
12:00 – 1:00 Lunch
1:00 – 2:30 Sub-classification & Clinical prediction rules: CNS Coordination
2:30 – 3:00 Motor learning & neuroplasticity
3:00 – 3:15 Break
3:15 – 3:45 Fundamentals of exercise prescription & Motor control
3:45 – 4:30 Problem solving & questions
4:30 – 5:00 Summary

 


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