The Sensitive Nervous System

David S. Butler

• Publisher: Noigroup Publications
• Year: 2000
• Print ISBN: 9780975091029
• eBook ISBN: 9780987342621
• Edition: 1
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

Table of contents

• CONTENTS
• PREFACE
• Chapter 1 - Introduction - Painting on a bigger canvas
• 1.1 Introduction
• 1.2 Some History
• 1.2.1 Key points from the history
• 1.3 Historical reflections - Neurodynamics
• 1.4 References chapter 1
• Chapter 2 - A bird's eye view of the nervous system
• 2.1 Introduction
• 2.1.1 The associative, distributed, plastic, reactive and representational nervous system
• 2.2 The complex signalling capability of the nervous system
• 2.2.1 Hardware and big numbers
• 2.2.2 Wetware
• 2.2.3 Ion channels and receptors
• 2.2.4 Resting potential, generator potential and the spike
• 2.3 Putting it together - The nervous system as a distributed system
• 2.3.1 Parallel processing
• 2.3.2 Bilateral processing
• 2.3.3 Motor control areas as part of the distributed pain experience
• 2.3.4 Active and passive movement
• 2.4 Receptive fields and homonculi
• 2.4.1 Concept of receptive field
• 2.5 Plasticity in the central nervous system
• 2.5.1 Representations are dynamically maintained
• 2.5.2 A variety of inputs can alter representations
• 2.5.3 The messages of phantom limb pain
• 2.5.4 The mechanisms behind cortical plasticity
• 2.6 The ultimate representational device
• 2.7 Clinical repercussions of the plastic representational nervous system
• 2.7.1 The bird's eye view and therapy
• 2.8 Models to engage pain and sensitivity
• 2.9 Metaphors for the nervous system
• 2.10 How does it actually work? - Conclusion
• 2.11 References chapter 2
• Chapter 3 - Pain mechanisms and peripheral sensitivity
• 3.1 Introduction
• 3.2 Pathobiological mechanisms in injured and diseased tissues
• 3.2.1 Limitations of the tissue injury model
• 3.3 Pathobiological mechanisms in pain perception
• 3.3.1 Current categorisation
• 3.3.2 Why focus on pain?
• 3.3.3 Pain mechanisms
• 3.4 Pain from tissues - nociceptive pain
• 3.4.1 The apparatus and stimuli for nociceptive pain
• 3.4.2 Nociceptive pain and inflammation
• 3.4.3 Nociceptive pain with minimal inflammation
• 3.4.4 A suggested pattern of nociceptive pain
• 3.4.5 Some thoughts for clinicians
• 3.5 Peripheral neurogenic pain
• 3.5.1 Modern concepts
• 3.5.2 Abnormal impulse generating sites (AIGS)
• 3.5.3 Proposed symptom pattern for peripheral neurogenic pain
• 3.5.4 Some thoughts for clinicians
• 3.6 Peripheral input to the CNS
• 3.7 Chapter summary
• 3.8 References chapter 3
• Chapter 4 - Central sensitivity, response and homeostatic systems
• 4.1 Introcution - central sensitivity concept
• 4.1.1 Process of sensitivity changes in the dorsal horn
• 4.1.2 Changes in the brain
• 4.1.3 Descending control systems
• 4.1.4 A proposed pattern of central sensitivity
• 4.1.5 Clinical thoughts
• 4.2 Immune, endocrine, motor and sympathetic systems as response and background systems
• 4.2.1 Introduction
• 4.3 Autonomic/neuroendocrine system
• 4.3.1 The hypothalamus-pituitary-adrenal axis (HPA)
• 4.3.2 Sympathetic neural axis and sympathetic adrenal axis
• 4.3.3 Sympathetic nervous system and pain
• 4.3.4 The parasympathetic nervous system
• 4.3.5 Motor system as an output system
• 4.4 Immune system
• 4.4.1 Basic apparatus
• 4.5 Thoughts for clinicians
• References chapter 4
• Chapter 5 - Neurodynamics
• 5.1 Links between systems
• 5.2 Introduction - neurodynamics
• 5.2.1 Neurodynamics - operating definitions
• 5.3 Gross movements and the nervous system
• 5.4 The continuum of the nervous system
• 5.5 Dynamic neuroanatomy
• 5.6 Neural connective tissues - fabulous design for movement
• 5.6.1 The meninges
• 5.7 Connective tissues of the nerve root complex
• 5.7.1 Peripheral nerve connective tissues
• 5.7.2 The connective tissu/neural tissue relationships in a nerve
• 5.7.3 Attachments and surroundings of the nervous system
• 5.7.4 Sensitivity and the neural connective tissues
• 5.8 Spaces and fluids
• 5.8.1 Epidural space
• 5.8.2 Subarachnoid space and cerebrospinal fluid
• 5.8.3 Axoplasm
• 5.9 Bloodthirsty neurones require a mobile blood supply
• 5.10 Neurones unfold, unravel and stretch
• 5.10.1 Brain and spinomedullary angle
• 5.10.2 Spinal cord
• 5.10.3 Nerve roots and peripheral nerves
• 5.11 Clinical neurodynamics
• 5.11.1 Relationship to joint axes and neural container
• 5.11.2 Extent of movement and strain
• 5.11.3 Order of movement and the accumulation of load
• 5.11.4 Effect of elongation and pressure on blood supply
• 5.11.5 Variable directions
• 5.11.6 Best neural rest position
• 5.11.7 Changes in damaged nervous systems
• 5.12 Summary
• 5.13 References chapter 5
• Chapter 6 - Clinicians and their decisions
• 6.1 Introduction
• 6.2 Reasoning and experts - the current state of affairs
• 6.2.1 Clinicians, scientists and evidence
• 6.2.2 Clinician/scientist relationships
• 6.2.3 The grey zones of manual therapy practice
• 6.3 Clinical reasoning science
• 6.3.1 Introduction
• 6.3.2 Modern reasoning
• 6.3.3 Declarative knowledge
• 6.3.4 A critical look at current declarative knowledge
• 6.4 A clinical reasoning model to include pain
• 6.4.1 Clinical decision making requires hypothesis making
• 6.4.2 Pathobiological mechanisms
• 6.4.3 Dysfunction/impairment - the patient's problems
• 6.4.4 Sources
• 6.4.4 Contributing factors
• 6.4.5 Prognosis
• 6.4.6 Precautions
• 6.4.7 Management
• 6.5 The process of reasoning
• 6.6 Chapter summary
• 6.7 Chapter 6 references
• Chapter 7 - Assessment, with a place for the nervous system
• 7.1 Introduction
• 7.2 Assessment and the stakeholders
• 7.3 Bio-psycho-social assessment
• 7.3.1 Bio-psycho-social assessment in general
• 7.3.2 Talking about pain and disability
• 7.4 Collecting information and categorising it
• 7.5 Pathobiological mechanisms
• 7.5.1 Tissue mechanisms/processes
• 7.5.2 Pain mechanisms/processes
• 7.6 Dysfunction
• 7.6.1 General physical dysfunction
• 7.6.2 Specific physical dysfunction
• 7.6.3 Mental dysfunction/level of distress
• 7.6.4 So what? - Critical decisions are needed about the relevance of dysfunction
• 7.7 Sources
• 7.8 Contributing factors
• 7.8.1 Psychosocial yellow flags
• 7.8.2 Physical factors
• 7.9 Prognosis
• 7.10 Precautions and contraindications
• 7.10.1 Precations with physical neural examination
• 7.11 Management
• 7.12 General physical assessment
• 7.12.1 Reasons to perform a physical evaluation
• 7.13 Assessment of physical dysfunction of the nervous system
• 7.14 References chapter 7
• Chapter 8 - Palpation and orientation of the peripheral nervous system
• 8.1 Introduction
• 8.2 Anatomy and physiology of peripheral nerve palpation
• 8.2.1 Neurones and nerve sheath relationships
• 8.2.2 Physiological responses to palpation
• 8.2.3 Anomalies
• 8.2.4 Palpation and peripheral nerve pathobiology
• 8.3 General techniques of palpation
• 8.3.1 The 'feel' of a nerve
• 8.3.2 General techniques
• 8.4 Specific areas - orientation and palpation
• 8.4.1 Nerve roots and the spinal cord
• 8.4.2 The head and the cranial nerves
• 8.4.3 The trunk
• 8.4.4 Upper limb nerves
• 8.4.5 Lower limb sciatic tract
• 8.5 The femoral, saphenous and anterior thigh nerves
• 8.6 Chapter 8 references
• Chapter 9 - Manual assessment of nerve conduction
• 9.1 Manual assessment of nerve conduction
• 9.2 Introduction
• 9.3 The value of a neurological examination
• 9.4 Mental status
• 9.5 Sensory examination
• 9.5.1 Introduction
• 9.5.2 Language of the sensory examination
• 9.5.3 Use of dermatomes and peripheral nerve innervation fields
• 9.6 Sensory examination performance
• 9.6.1 Skin sensations - light touch
• 9.6.2 Skin sensations - superficial pain
• 9.6.3 Skin sensations - hot and cold
• 9.6.4 Deep sensations - pain
• 9.6.5 Deep sensations - proprioception
• 9.6.6 Deep sensation - vibration sense
• 9.6.7 Cortical sensory function
• 9.7 Manual tests of motor function
• 9.7.1 Muscle wasting
• 9.7.2 Tremor and fasciculation
• 9.7.3 Muscle power - general comments on technique
• 9.7.4 Commonly performed tests of muscle power
• 9.7.5 Upper limb
• 9.7.6 Lower limb
• 9.7.7 Quick/functional muscle tests
• 9.7.8 Use the muscle innervation map
• 9.8 Reflexes
• 9.8.1 The skill of muscle-stretch reflex testing
• 9.8.2 Specific muscle-stretch reflexes
• 9.8.3 Analysis and recording of reflex behaviours
• 9.8.4 Other reflexes
• 9.9 The cranial nerves
• 9.10 Tests of autonomic function
• 9.10.1 The eye and horner's syndrome
• 9.10.2 Observation and palpation of the skin
• 9.11 Appendix 9.1
• 9.12 References chapter 9
• Chapter 10 - Neurodynamic tests in the clinic
• 10.1 Introduction
• 10.2 The base test system
• 10.2.1 Relationship between base tests
• 10.3 Conceptually, it is a dynamic examination
• 10.4 Active and passive movements
• 10.5 A clinical categorisation
• 10.6 Concept of structural differentiation
• 10.6.1 Analysis of structural differentiation - care needed
• 10.6.2 Taking the base tests further - go 'jazzy' in the clinic
• 10.6.3 When and how much neurodynamic assessment to do
• 10.6.4 Recording
• 10.7 Analysis of neurodynamic test findings
• 10.7.1 A sensitive movement doesn't provide much information
• 10.7.2 Determining the relevance of the test
• 10.7.3 Identification of source
• 10.7.4 Unexpected responses
• 10.8 The art of good handling
• 10.9 References chapter 10
• Chapter 11 - Neurodynamic testing for the spine and lower limb
• 11.1 Introduction
• 11.1.1 Manual handling
• 11.2 Handling guidelines for all neurodynamic tests
• 11.3 Straight leg raise
• 11.3.1 SLR performance
• 11.3.2 Thoughts on SLR performance
• 11.3.3 Normal responses
• 11.3.4 Sensitising tests
• 11.3.5 Other straight leg raises
• 11.3.6 Indications of some clinical thoughts
• 11.3.7 A quick reminder of the bigger picture
• 11.4 Passive neck flexion
• 11.4.1 PNF performance
• 11.4.2 Variations and links to the SLR
• 11.4.3 Normal response/research
• 11.4.4 Clinical use
• 11.4.5 Lhermitte's sign
• 11.5 The slump test
• 11.5.1 Introduction
• 11.5.2 Performance of the slump test
• 11.5.3 Frequently used variations
• 11.5.4 Normal responses
• 11.5.5 Precautions related to the slump test
• 11.6 Slump test in long sitting
• 11.6.1 Performance of the test
• 11.6.2 Refined testing
• 11.6.3 Slump LS normal responses
• 11.6.4 Do it yourself
• 11.7 Prone knee bend
• 11.7.1 Performance of the test - PKB
• 11.7.2 Normal responses and analysis
• 11.7.3 Variations
• 11.8 References chapter 11
• Chapter 12 - The upper limb neurodynamic tests
• 12.1 Introduction
• 12.1.1 What's in a name?
• 12.1.2 Concept of ULNT
• 12.2 ULNT1 (median) base test - performance
• 12.2.1 ULNT1 (median) - active test
• 12.2.2 ULNT1 (median) - passive test
• 12.2.3 ULNT1 - Alternative handling
• 12.2.4 General ULNT1 handling comments
• 12.2.5 ULNT1 (median) - normal responses
• 12.2.6 Indications and special care
• 12.2.7 Adaptations, sensitising additions
• 12.2.8 Analysis of inputs
• 12.2.9 The reverse ULNT1 (median) - test variation
• 12.3 ULNT2 (median) performance
• 12.3.1 ULNT2 (median) - active test
• 12.3.2 ULNT2 (median) - passive test
• 12.4 Performance of the ULNT2 (radial)
• 12.4.1 ULNT2 (radial) - active test
• 12.4.2 ULNT2 (radial) - passive test
• 12.4.3 Handling comments and variations for the ULNT2 tests
• 12.4.4 Normal responses
• 12.5 ULNT3 (ulnar) - performance
• 12.5.1 Introduction
• 12.5.2 ULNT3 (ulnar) - active test
• 12.5.3 ULNT3 (ulnar) - passive test beginning distally
• 12.5.4 ULNT3 - passive test beginning proximally
• 12.5.5 Handling comments/normal responses/further sensitisation
• 12.6 Musculocutaneous nerve test
• 12.6.1 Musculocutaneous nerve - active test
• 12.6.2 Musculocutaneous nerve - passive test
• 12.6.3 Handling comments/normal responses/further sensitisation
• 12.7 Other upper limb tests
• 12.7.1 Axillary
• 12.7.2 Suprascapular nerve
• 12.8 Chapter 12 references
• Chapter 13 - Research and Neurodynamics - Is neurodynamics worthy of scientific merit?
• 13.1 Introduction
• 13.2 A critical analysis of neurodynamics
• 13.3 Support from anatomical and physiological evidence
• 13.4 The efficacy of neurodynamic tests
• 13.4.1 Operational definitions of neurodynamic tests
• 13.4.2 Reliability of neurodynamic tests
• 13.4.3 Validity of neurodynamic tests
• 13.5 The emerging new construct in neurodynamics
• 13.6 Research related to treatment effects
• 13.7 Future research into neurodynamics
• 13.8 Appendix A
• 13.9 References chapter 13
• Chapter 14 - Management strategies - integration of neurodynamics
• 14.1 Introduction
• 14.2 "Big Picture" evidence based approach
• 14.3 Incorporation of neurodynamics into management
• 14.4 Use as a reassessment tool
• 14.5 Explanation
• 14.5.1 Introduction
• 14.5.2 Explaining neurodynamic test findings and peripheral neurogenic pain
• 14.5.3 Explaining neurodynamic test findings and central sensitivity
• 14.5.4 Nerve images can be scary
• 14.6 Neurodynamics and passive mobilisation
• 14.6.1 General comments
• 14.6.2 Guidelines for techniques for more peripheral neurogenic/nociceptive mechanisms
• 14.6.3 Passive movement techniques for more central disorders
• 14.6.4 Passive technique conceptualisation
• 14.6.5 Neurogenic massage
• 14.7 Active mobilisation and neurodynamic tests
• 14.7.1 Introduction
• 14.7.2 Movement breakdowns
• 14.7.3 Order of movement variations and 'trick movements'
• 14.7.4 Slider/tensioner
• 14.7.5 Active movements - use of meaningful activity
• 14.7.6 Pacing
• 14.7.7 Warm up/warm down manoeuvres with a focus on the nervous system
• 14.8 Postural advice and neurodynamics
• 14.9 Summary
• 14.10 Chapter 14 references
• Chapter 15 - Clinical aspects of neurodynamics
• 15.1 Introduction
• 15.2 Conservative decompression of the nervous system
• 15.3 Carpal tunnel syndrome
• 15.3.1 Extended physical evaluation
• 15.3.2 Active CTS mobilisation based on sliders, tensioners and altered order of movement
• 15.3.3 Thoughts on the local biological effects of these exercises?
• 15.4 Nerve root complex
• 15.4.1 Importance of the container and pinching forces
• 15.4.2 Neurobiology and the nerve root complex
• 15.4.3 Minor nerve root disorders
• 15.5 Double crush - review of an old friend
• 15.5.1 Some history
• 15.5.2 Current thoughts on double crush
• 15.6 The foot and neurodynamics - the place to start
• 15.6.1 Spained ankles and the peroneal nerves
• 15.6.2 Heel spurs
• 15.7 Neurodynamics and the thorax
• 15.7.1 Techniques and the slump long sitting (slump LS)
• 15.7.2 Thoughts on the sympathetic chains
• 15.7.3 Notalgia paraesthetica
• 15.8 Chapter summary: What's in a technique?
• 15.9 References chapter 15
• Chapter 16 - Epilogue
• 16.1 Epilogue
• INDEX
• Other NOI resources