Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Maitland mobiisation
1.
2. Central theme or core
Particular mode of thinking
Examination
Techniques
recording
3. THE CENTRAL THEME OR CORE
•Making sense of the information the patient
provides
•Listening and believing the patient without any
prejudging
•using the patient own terminology
•Having skill in understanding and using verbal and
non verbal communication
•Encouraging a feeling of confidence and trust in us
the clinicians
4. THE THINKING MODE IS THE STRENTH OF THE CONCEPT
AND THE SECURITY AND THE THERAPIST
THEORETIC
AL
CLINICAL
PATHOLOGY
NEUROPHYSI
OLOGY
ANATOMY
DIAGNOSIS HISTORY
SYMPTOMS
SIGNS
5. It’s a symbolic permeable brick wall which guides therapists
in their mode of thinking
By this mode of thinking therapist can keep their thoughts
reflections, impressions, hypothesis and knowledge in two
separate compartments
One compartment contains all theoretical information,known
and speculative including the precautions and contraindications.
The other compartment should contain all the
clinical evidence
The main core of this mode of thinking states that we must not
get diverted by the theoretical aspects of the patient disorder
because there are enormous events which we do not know
8. Examined in loose pack position
At the end of limited ranges or
In painful positions of a free range of movement
It is closely related to patient symptoms
10. TO know the origin of patient symptoms from joint surface
abnormality compression performed in following circumstances
when usual test movements do not show patient symptoms
,compression applied through range assessing the smoothness and
matching pain response
If pain response much greater than when surfaces compressed,the
indication is that the disorder associated wih [joint surface
abnormality]
NOTE Common joints require examination by compression are
Tarsometatarsal joint of big toe
Patellofemral jint
Carpometacarpal joint of the thumb
The hip and
The glenohumeral joint
11. Specially when pain rather than
stiffness is the disability .
Subject demonstrates the
particular movement.
12. Used when a passive test
movement causing
simultaneous movement of at
least two joints, reproduces a
patient symptoms
13. To note whether it is [through range pain or end
range pain ]
Does the behavior of the pain with the movement
match the behavior of the resistance with that same
movement within its available range?
NEVER THINK OF RANGE WITHOUT
THINKING OF PAIN
NEVER THINK OF PAIN WITHOUT
THINKING OF RANGE
14. Normal if a very firm pressure can be applied
without provoking anything more than the expected
normal stretch response.
When the stretch response is normal and the
overpressure is with adequate firmness the
movement recorded with two ticks.
1 TICK over pressure is applied and the range is
normal
2 TICK stretch response to over pressure has been
normal.
15. To draw a diagram representing the
findings on examining a particular
movement forces he clinician to
analyse the relationship of pain
stiffness muscle spasm which may
be present
17. Analytical assessment used during a
treatment programme and at the completion of
programme .
The mental process involves .
Vertical thinking.
Lateral thinking.
Inductive thinking.
Deductive thinking.
18. The basic treatment techniques must include every
movement of which the joint is capable[Both
Physiological movements and accessory movements
] and possible combination of them.
The techniques are never ending and NEVER
should have ending.
The clinicians mind must always be open ; the
teacher must never be dogmatic.
19. The techniques are never ending
and NEVER should have an ending
The clinicians mind must always be
open
20. Physiological movementsaccessory
movementscombinations
Small amplitudelarge amplitudesustained
Early in range late in rangewithin range
Smoothlystaccatosustained
Without compression with compression
Short of discomfortinto discomfort into pain
Short of resistanceinto resistance respecting
paininto resistanceup to bite
21. Pain [at rest or with movement ]
Stiffness [due to contracted structure or adhesion
Muscle spasm
the above may occur in combinations
Eg painless spasm painful and stiff joint
22. Treatment for pain treatment for stiff treatment for pain and
stiff
group 1 group 2 group 3
pain and stiff stiff and pain
23. The joint is placed in pain free position .
The accessory movements started of large amplitude without
discomfort
If discomfort persists then mild distraction applied while
performing the technique
If improvement occurs the amplitude of movements is
increased and move to range that is painful
Continue to grade 3
At stage where grade 3+without discomfort occurs grade 2
will start.this results in improvement of about 60percent.
Gradually amplitude increase till grade 3+physiological
movement performed without pain .
24. Joint is taken to physiological limit of range
Grade 4 is given for nearly2 minutes.
Started from 4 increase to 4+ and even
4++strength
Holding at limit therapist performs accessory
movements at grade 4
Physiotherapist repeats the above movements 3 or
4 times
If technique produce soreness then relieve it by
performing physiological movements
25. Patient opinion of effect of treatment [a
comparison statement]
Execute treatment plans by planning and reasoning
process which has to be recorded.
The treatment and effect record next .it involves
treatment technique ,its grade ,its rhythm and its
symptomatic response.
Commit thoughts about how the treatment
techniques need to be modified next .