Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.
Butler’s Neurodynamics
Concept
Saurab Sharma, MPT
Lecturer, KUSMS
History
• The concept of the
continuum of the nervous
system
• ALF BREIG
– founder of Neurodynamics
2
Neurodynamics
• Encompasses the interactions between
mechanics and physiology of the
nervous system.
M. Shacklock, Physiot...
Functional Anatomy
and Physiology
4
The dynamic nervous system
• The central nervous system is a dynamic
organ like muscle, joint or any other
involved in mov...
Transection of a nerve
6
mesoneurium
Blood supply of a nerve
7
Cross section of nerves
8
Sites of peripheral nerve vulnerability
1. Tunnels: Carpal tunnel, tarsal tunnel
2. Branches: medial and lateral plantar n...
Stages of nerve injury
• Hypoxia
• Edema
• Fibrosis
10
What happens after nerve injury?
Sequel
• Intraneural fibrosis’
• Alterations in the conduction
Sunderland, 1976
• Loss o...
Mechanical interface (MI)
• Tissue most anatomically adjacent to the
nervous system that can move
independently to the sys...
Neurodynamics
• Encompasses the interactions between
mechanics and physiology of the
nervous system.
M. Shacklock, Physiot...
Neurodynamics
15
• Median nerve can withstand 20-30% of tensile
force before failure (70-220N).
Mechanical responses
1. Neural movement
2. Tension
3. Intraneural pressure changes
4. Alterations in cross sectional shape...
Physiological responses to movement
• Viscoelasticity- improves
• Thixotropy- axoplasm viscosity reduces
• Intraneural blo...
Examination
18
Examination
1. Assessment and Clinical reasoning
2. Examination of nerve conduction
3. Nerve palpation
4. Neurological exa...
Neurodynamic tests
24
Indications
• Disorders suitable for mobilization can be
classified into those whose origins may result
from:
1. Any infla...
Precautions
1. Other structures involved in testing like discs
2. Irritability related to nervous system
3. Worsening diso...
Contraindications
1. Recent infection, malignancy of nervous system
2. Recent onset of, or worsening neurological signs
3....
Neurodynamic testing
• Straight leg raise test (SLRT)
• Slump test
• Upperlimb neurodynamic tests (ULNT)
• Passive neck fl...
Neurodynamic testing
• Used for non-irritable condition
1. Symptom response: P1= range at which symptom
starts; P2= sympto...
Neurodynamic testing
30
Analysis of Neurodynamic testing
• Normal response
– Resistance/ pain or both bilaterally
– Is it relevant to patient’s pr...
Further testing
• Nerve Palpation: direct/ indirect
– Median nerve
– Ulnar nerve
– Radial nerve
– Sciatic nerve
– Common p...
Treatment
34
General consideration
• Nervous system cannot avoid being mobilized
• Analytical assessment (Maitland, 1986) is
cornerston...
Treatment approach
Q. How can we treat a problem related to
neural mobility?
1. Direct mobilization of nervous system by
n...
Basic principles of mobilization
1. Maitland Concept: treatment based on
severity, irritability and nature of disorder.
2....
Movement diagram for SLR
38
Butler D. Mobilization of nervous system, 1991
Irritable disorder: Guidelines
• Start with remote (distant) technique
• Non-provoking
• Under-treat
• Large amplitude gra...
Non-irritable disorder
Pathomechanical dominance
• Chronic problem
• Into the resistance:
– Grade III: for extraneural dis...
Recent advance
• Addition of sciatic nerve mobilization in slump
position (both by tensioner and sliders) can
improve hams...
Summary
• Nervous system – a continuum
• Neurodynamics – mechanical and physiological
benefits
• Management principles
48
References
• Butler DS. Mobilization of the nervous system. 1991
• Butler DS, Tromberlin JS. Structure, function, and
phys...
Nächste SlideShare
Wird geladen in …5
×

von

Neurodynamics, mobilization of nervous system, neural mobilization Slide 1 Neurodynamics, mobilization of nervous system, neural mobilization Slide 2 Neurodynamics, mobilization of nervous system, neural mobilization Slide 3 Neurodynamics, mobilization of nervous system, neural mobilization Slide 4 Neurodynamics, mobilization of nervous system, neural mobilization Slide 5 Neurodynamics, mobilization of nervous system, neural mobilization Slide 6 Neurodynamics, mobilization of nervous system, neural mobilization Slide 7 Neurodynamics, mobilization of nervous system, neural mobilization Slide 8 Neurodynamics, mobilization of nervous system, neural mobilization Slide 9 Neurodynamics, mobilization of nervous system, neural mobilization Slide 10 Neurodynamics, mobilization of nervous system, neural mobilization Slide 11 Neurodynamics, mobilization of nervous system, neural mobilization Slide 12 Neurodynamics, mobilization of nervous system, neural mobilization Slide 13 Neurodynamics, mobilization of nervous system, neural mobilization Slide 14 Neurodynamics, mobilization of nervous system, neural mobilization Slide 15 Neurodynamics, mobilization of nervous system, neural mobilization Slide 16 Neurodynamics, mobilization of nervous system, neural mobilization Slide 17 Neurodynamics, mobilization of nervous system, neural mobilization Slide 18 Neurodynamics, mobilization of nervous system, neural mobilization Slide 19 Neurodynamics, mobilization of nervous system, neural mobilization Slide 20 Neurodynamics, mobilization of nervous system, neural mobilization Slide 21 Neurodynamics, mobilization of nervous system, neural mobilization Slide 22 Neurodynamics, mobilization of nervous system, neural mobilization Slide 23 Neurodynamics, mobilization of nervous system, neural mobilization Slide 24 Neurodynamics, mobilization of nervous system, neural mobilization Slide 25 Neurodynamics, mobilization of nervous system, neural mobilization Slide 26 Neurodynamics, mobilization of nervous system, neural mobilization Slide 27 Neurodynamics, mobilization of nervous system, neural mobilization Slide 28 Neurodynamics, mobilization of nervous system, neural mobilization Slide 29 Neurodynamics, mobilization of nervous system, neural mobilization Slide 30 Neurodynamics, mobilization of nervous system, neural mobilization Slide 31 Neurodynamics, mobilization of nervous system, neural mobilization Slide 32 Neurodynamics, mobilization of nervous system, neural mobilization Slide 33 Neurodynamics, mobilization of nervous system, neural mobilization Slide 34 Neurodynamics, mobilization of nervous system, neural mobilization Slide 35 Neurodynamics, mobilization of nervous system, neural mobilization Slide 36 Neurodynamics, mobilization of nervous system, neural mobilization Slide 37
Nächste SlideShare
What to Upload to SlideShare
Weiter

105 Gefällt mir

Teilen

Neurodynamics, mobilization of nervous system, neural mobilization

This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.

Ähnliche Bücher

Kostenlos mit einer 30-tägigen Testversion von Scribd

Alle anzeigen

Ähnliche Hörbücher

Kostenlos mit einer 30-tägigen Testversion von Scribd

Alle anzeigen

Neurodynamics, mobilization of nervous system, neural mobilization

  1. 1. Butler’s Neurodynamics Concept Saurab Sharma, MPT Lecturer, KUSMS
  2. 2. History • The concept of the continuum of the nervous system • ALF BREIG – founder of Neurodynamics 2
  3. 3. Neurodynamics • Encompasses the interactions between mechanics and physiology of the nervous system. M. Shacklock, Physiotherapy, 1995 3
  4. 4. Functional Anatomy and Physiology 4
  5. 5. The dynamic nervous system • The central nervous system is a dynamic organ like muscle, joint or any other involved in movement. • Possesses plastic and elastic properties • Mechanically and physiologically continuous 5
  6. 6. Transection of a nerve 6 mesoneurium
  7. 7. Blood supply of a nerve 7
  8. 8. Cross section of nerves 8
  9. 9. Sites of peripheral nerve vulnerability 1. Tunnels: Carpal tunnel, tarsal tunnel 2. Branches: medial and lateral plantar nerves 3. Hard Interface: radial nerve in spiral groove 4. Proximity to surface 5. Where nerves are fixed to interfacing surface: common peroneal nerve at fibular head 9
  10. 10. Stages of nerve injury • Hypoxia • Edema • Fibrosis 10
  11. 11. What happens after nerve injury? Sequel • Intraneural fibrosis’ • Alterations in the conduction Sunderland, 1976 • Loss of elasticity • Mechanosensitivity (Shacklock, 2005) 11
  12. 12. Mechanical interface (MI) • Tissue most anatomically adjacent to the nervous system that can move independently to the system Butler , 1987 • Pathology at the MI can give rise to abnormalities in the nerve movement & cause increases in tension within the nerve Butler, Gifford , Physiotherapy, 1989 12
  13. 13. Neurodynamics • Encompasses the interactions between mechanics and physiology of the nervous system. M. Shacklock, Physiotherapy, 1995 13
  14. 14. Neurodynamics 15 • Median nerve can withstand 20-30% of tensile force before failure (70-220N).
  15. 15. Mechanical responses 1. Neural movement 2. Tension 3. Intraneural pressure changes 4. Alterations in cross sectional shape 16
  16. 16. Physiological responses to movement • Viscoelasticity- improves • Thixotropy- axoplasm viscosity reduces • Intraneural blood flow – improves • Axonal transport- increases • Sympathetic response 17
  17. 17. Examination 18
  18. 18. Examination 1. Assessment and Clinical reasoning 2. Examination of nerve conduction 3. Nerve palpation 4. Neurological examination- Subjective and objective 19
  19. 19. Neurodynamic tests 24
  20. 20. Indications • Disorders suitable for mobilization can be classified into those whose origins may result from: 1. Any inflammatory reaction i.e. irritable disorders (with patho-physiological dominance) 2. Biomechanical compromise i.e. non- irritable disorders (with patho-mechanical dominance) 25
  21. 21. Precautions 1. Other structures involved in testing like discs 2. Irritability related to nervous system 3. Worsening disorder 4. Presence of neurological signs 5. General health problems 6. Dizziness due to cervical spine pathology 7. Circulatory disturbances 26
  22. 22. Contraindications 1. Recent infection, malignancy of nervous system 2. Recent onset of, or worsening neurological signs 3. Cauda equina lesions 4. Injury to the spinal cord 27
  23. 23. Neurodynamic testing • Straight leg raise test (SLRT) • Slump test • Upperlimb neurodynamic tests (ULNT) • Passive neck flexion test • Prone Knee bend test (PKBT) 28
  24. 24. Neurodynamic testing • Used for non-irritable condition 1. Symptom response: P1= range at which symptom starts; P2= symptom at limit of range 2. Resistance encountered: R1= Resistance first encountered; R2= resistance stops any further movement 29
  25. 25. Neurodynamic testing 30
  26. 26. Analysis of Neurodynamic testing • Normal response – Resistance/ pain or both bilaterally – Is it relevant to patient’s problem? • Positive test – If test reproduces patient’s symptom – If response is altered by movement of distant body part 31
  27. 27. Further testing • Nerve Palpation: direct/ indirect – Median nerve – Ulnar nerve – Radial nerve – Sciatic nerve – Common peroneal nerve – Posterior tibial nerve 33
  28. 28. Treatment 34
  29. 29. General consideration • Nervous system cannot avoid being mobilized • Analytical assessment (Maitland, 1986) is cornerstone of the concept • No recipe treatments- treatment based on clinical reasoning 35
  30. 30. Treatment approach Q. How can we treat a problem related to neural mobility? 1. Direct mobilization of nervous system by neurodynamic exercises (sliders & tensioners). 2. Treatment of the interface and related tissues. 3. Indirect treatment by postural advice and ergonomic design. 36
  31. 31. Basic principles of mobilization 1. Maitland Concept: treatment based on severity, irritability and nature of disorder. 2. Maitland’s Grades of Mobilization 3. Movement diagram may be used 37
  32. 32. Movement diagram for SLR 38 Butler D. Mobilization of nervous system, 1991
  33. 33. Irritable disorder: Guidelines • Start with remote (distant) technique • Non-provoking • Under-treat • Large amplitude grade II- slow and rhythmic • Progress to grade IV to P1 42
  34. 34. Non-irritable disorder Pathomechanical dominance • Chronic problem • Into the resistance: – Grade III: for extraneural disorder – Grade IV : for intraneural disorder • Start by technique not provoking pain 45
  35. 35. Recent advance • Addition of sciatic nerve mobilization in slump position (both by tensioner and sliders) can improve hamstring flexibility than static stretching alone to hamstrings. 47 Sharma et al. Physical Therapy in Sport. 2015
  36. 36. Summary • Nervous system – a continuum • Neurodynamics – mechanical and physiological benefits • Management principles 48
  37. 37. References • Butler DS. Mobilization of the nervous system. 1991 • Butler DS, Tromberlin JS. Structure, function, and physiology of the nervous system. Chapter 8; page 175- 189 • Shacklock M. Clinical neurodynamics 2005 49
  • RebekahMartyres

    Sep. 22, 2021
  • AjithPhysio

    Sep. 15, 2021
  • LalithaKrishnan9

    Sep. 15, 2021
  • AliMubashir1

    Aug. 24, 2021
  • TarannumNisha3

    Jul. 11, 2021
  • AleenaNaaz6

    Jul. 7, 2021
  • AYKhandelwal

    Jun. 22, 2021
  • MuktiMourya

    Jun. 1, 2021
  • ssuser9e5a57

    May. 19, 2021
  • ForamPanchal7

    Mar. 18, 2021
  • BidishaDevi1

    Feb. 25, 2021
  • santhohsri1293

    Feb. 25, 2021
  • GowsalyaGanesan1

    Feb. 18, 2021
  • ArunimaDamu

    Feb. 4, 2021
  • MehiTha

    Feb. 3, 2021
  • Salehmahmoode

    Jan. 20, 2021
  • ShrijaShetty

    Jan. 7, 2021
  • 17SarveG

    Jan. 7, 2021
  • vermouthsherry

    Jan. 6, 2021
  • TanveePathak

    Dec. 23, 2020

This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.

Aufrufe

Aufrufe insgesamt

18.070

Auf Slideshare

0

Aus Einbettungen

0

Anzahl der Einbettungen

3

Befehle

Downloads

109

Geteilt

0

Kommentare

0

Likes

105

×