This letter discusses a study that examined the false positive rates of two neurodynamic tests - the upper limb neural tension test and seated slump test. The author takes issue with how the study defined a positive test result, as being based solely on structural differentiation, rather than also considering symptoms, bilateral comparisons, and other clinical information. The author argues this led to an underestimation of the false positive rate in healthy subjects. The response from the original study authors defends their methodology and definitions, noting they aimed to isolate the validity of the individual tests. Both discuss the need for further research on the diagnostic validity of neurodynamic tests.
1. Neural tissue mobilization (NTM) is a clinical technique that applies the mechanics and physiology of the nervous system and how it relates to and integrates with the musculoskeletal system.
2. NTM uses specific movements and positions to assess nerve mobility and elicit symptoms in order to determine the source of a patient's pain. Common tests include the median, ulnar, and radial nerve tests.
3. A positive NTM test is indicated by reproduction of the patient's clinical symptoms that change with structural differentiation. NTM can help diagnose neurogenic causes of pain and guide effective treatment.
This document discusses various neurodynamic mobilization techniques used to assess and treat neural tension. It begins by defining neurodynamics and describing principles of neural mobilization including applying gentle oscillatory movements when tension is detected. Several upper and lower extremity neural tension tests are then described in detail, including the upper limb neurodynamic test for the median, radial and ulnar nerves, the straight leg raise for the sciatic nerve, slump-sitting maneuver, prone knee bend for the femoral nerve. Precautions for each technique are provided. The document concludes by briefly defining carpal tunnel syndrome.
The document discusses neurodynamics and summarizes key points in 3 sentences:
Neurodynamics examines the nervous system as a continuum that can withstand tension or sliding longitudinally and transversely. Proper sequencing and structural differentiation of movements is important for neurodynamic testing to isolate neural responses from musculoskeletal influences. Abnormal neurogenic responses on testing can be overt, reproducing symptoms, or covert, evoking different symptoms, and determining the relevance of the response guides clinical decisions.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
This document discusses neurodynamic testing and neural mobilization. It begins by outlining the objectives of determining neurodynamic restrictions, evaluating neurodynamics through testing, and selecting neural mobilizations based on test findings. It then reviews neural anatomy, neurodynamics, types of neural injury, and examples of common neurodynamic tests. The document concludes by summarizing evidence that neural mobilization can reduce pain, improve flexibility and range of motion, and enhance performance.
The document discusses neuropathodynamics and neuromobilization techniques. It covers:
- Flexion and extension of the spine and their effects on neural tissues, producing tension and sliding.
- Lateral flexion and its effects of increasing tension on the convex side and reducing tension on the concave side.
- Various mechanical interface and neural dysfunctions that can occur.
- Objectives, clinical tests, and techniques used in neuromobilization to restore normal neuromechanical function.
- Contraindications for neuromobilization include acute injuries or infections of the nervous system.
- Different levels of neurodynamic testing based on symptoms and neurological status.
Nerve Gliding Exercises - Excursion and Valuable Indications for TherapySarah Arnold
This document discusses nerve gliding exercises and their benefits for therapy. It describes how nerve glides can help increase nerve mobility and blood flow. Specific nerve glides are presented for common nerve entrapment syndromes like cubital tunnel syndrome (ulnar nerve) and carpal tunnel syndrome (median nerve). The document emphasizes performing glides symptom-free and using sliding techniques over tensioning. Nerve glides are recommended to prevent nerve adhesions after injuries or surgery.
Comprises of assessment and diagnostic techniques of neurodynamics.
it includes both the mechnaical interface and neurological aspect, along with the level of application of diagnostic as well as treatment part of neurodynamics
1. Neural tissue mobilization (NTM) is a clinical technique that applies the mechanics and physiology of the nervous system and how it relates to and integrates with the musculoskeletal system.
2. NTM uses specific movements and positions to assess nerve mobility and elicit symptoms in order to determine the source of a patient's pain. Common tests include the median, ulnar, and radial nerve tests.
3. A positive NTM test is indicated by reproduction of the patient's clinical symptoms that change with structural differentiation. NTM can help diagnose neurogenic causes of pain and guide effective treatment.
This document discusses various neurodynamic mobilization techniques used to assess and treat neural tension. It begins by defining neurodynamics and describing principles of neural mobilization including applying gentle oscillatory movements when tension is detected. Several upper and lower extremity neural tension tests are then described in detail, including the upper limb neurodynamic test for the median, radial and ulnar nerves, the straight leg raise for the sciatic nerve, slump-sitting maneuver, prone knee bend for the femoral nerve. Precautions for each technique are provided. The document concludes by briefly defining carpal tunnel syndrome.
The document discusses neurodynamics and summarizes key points in 3 sentences:
Neurodynamics examines the nervous system as a continuum that can withstand tension or sliding longitudinally and transversely. Proper sequencing and structural differentiation of movements is important for neurodynamic testing to isolate neural responses from musculoskeletal influences. Abnormal neurogenic responses on testing can be overt, reproducing symptoms, or covert, evoking different symptoms, and determining the relevance of the response guides clinical decisions.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
This document discusses neurodynamic testing and neural mobilization. It begins by outlining the objectives of determining neurodynamic restrictions, evaluating neurodynamics through testing, and selecting neural mobilizations based on test findings. It then reviews neural anatomy, neurodynamics, types of neural injury, and examples of common neurodynamic tests. The document concludes by summarizing evidence that neural mobilization can reduce pain, improve flexibility and range of motion, and enhance performance.
The document discusses neuropathodynamics and neuromobilization techniques. It covers:
- Flexion and extension of the spine and their effects on neural tissues, producing tension and sliding.
- Lateral flexion and its effects of increasing tension on the convex side and reducing tension on the concave side.
- Various mechanical interface and neural dysfunctions that can occur.
- Objectives, clinical tests, and techniques used in neuromobilization to restore normal neuromechanical function.
- Contraindications for neuromobilization include acute injuries or infections of the nervous system.
- Different levels of neurodynamic testing based on symptoms and neurological status.
Nerve Gliding Exercises - Excursion and Valuable Indications for TherapySarah Arnold
This document discusses nerve gliding exercises and their benefits for therapy. It describes how nerve glides can help increase nerve mobility and blood flow. Specific nerve glides are presented for common nerve entrapment syndromes like cubital tunnel syndrome (ulnar nerve) and carpal tunnel syndrome (median nerve). The document emphasizes performing glides symptom-free and using sliding techniques over tensioning. Nerve glides are recommended to prevent nerve adhesions after injuries or surgery.
Comprises of assessment and diagnostic techniques of neurodynamics.
it includes both the mechnaical interface and neurological aspect, along with the level of application of diagnostic as well as treatment part of neurodynamics
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
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.
This document discusses neural tissue mobilization of the upper limb. It defines neurodynamics as the clinical application of nervous system mechanics and physiology as they relate to musculoskeletal function. Neurodynamic tests are described to assess the median, ulnar, and radial nerves. The tests involve moving the associated joints in specific positions and directions to apply tension or sliding movement to the nerves while monitoring for symptoms. Structural differentiation is used to identify the level of nerve involvement. Contraindications for neural tissue mobilization include certain nervous system disorders or areas of instability. The goal is to assess nerve mobility and produce tension or gliding of the nerves for non-irritable neurogenic or neuropathic conditions.
1) The study measured the longitudinal excursion and strain in the median and ulnar nerves during different types of nerve gliding exercises commonly used to treat carpal tunnel syndrome and cubital tunnel syndrome.
2) It found that "sliding techniques" which involve alternating movements at two joints resulted in substantially larger nerve excursion with much smaller increases in nerve strain, compared to "tensioning techniques" which simply elongate the nerve bed.
3) The findings demonstrate that different nerve gliding techniques have different mechanical effects on the peripheral nervous system, and may influence neuropathological processes differently. Clinicians should consider these effects when selecting exercises for conservative or post-operative treatment of common neuropathies.
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
This document summarizes a presentation given by David López Sánchez on spinal osteopathic manipulative therapy. It provides an overview of osteopathic philosophy which views the body as a single unified system. It describes assessment techniques for somatic dysfunction including asymmetry and tissue changes. Mechanisms of spinal manipulation are discussed such as restoring range of motion and reducing nociception. The document concludes that osteopathy aims to optimize health and stimulate self-regulation rather than simply treat diseases.
1. Spasticity is a motor disorder characterized by increased muscle tone and exaggerated reflexes caused by hyper-excitability of the stretch reflex due to loss of inhibitory pathways in the spinal cord.
2. The pathophysiology of spasticity involves denervation supersensitivity, axonal sprouting, and loss of descending inhibition resulting in disinhibition of segmental reflexes. Changes in muscle properties also contribute to increased tone.
3. Spasticity is assessed using measures of physiology like reflexes, muscle tone, and stiffness scales; measures of voluntary movement; and functional measures of activities and quality of life.
This document provides an overview of peripheral nerve anatomy and physiology, mechanisms of nerve injury, and neurodynamic testing and treatment approaches. Key points include:
- The perineurium creates a closed compartment around nerve fibers and positive endoneural pressure can cause edema to spread longitudinally.
- Nerve injuries can range from neuropraxia to neurotemesis depending on the severity of the ischemic insult such as compression, elongation, or disruption.
- Neurodynamic testing involves assessing nerve mechanics and sensitivity through passive and active movements while monitoring for barriers, pain responses, and altered symptoms. Treatment aims to improve nerve gliding and decrease intraneural pressures.
This document discusses the management of spasticity through pharmacological, surgical, and physiotherapy approaches.
Pharmacological management includes medications like baclofen, tizanidine, and diazepam which can help reduce spasticity but have side effects like sedation. Botulinum toxin injections target specific muscles to weaken them.
Surgical options are neurostimulation or neuroablative procedures like peripheral neurotomies. Physiotherapy includes sustained stretching, positioning, serial casting, orthotics, strength training, Roods approach, and modalities like TENS, heat, and cold therapy. Studies show these approaches can effectively reduce spasticity without increasing weakness. Management must be tailored to
The term Spinal Cord Injury is used to refer to neurological damage of the spinal cord
Any lesion involving the spinal cord result a syndrome called a “myelopathy”
Spinal cord injuries are defined as complete or incomplete according to the International Standards for the Neurological Classifification of SCI and the American Spinal Injuries Association Impairment Scale (AIS)
Complete lesions are defifined as AIS A, and incomplete lesions are defifined as AIS B, AIS C, AIS D or AIS E (Harvey, 2016)
Recognising features (contracture and spasticity)Richard Baker
This document discusses contractures and spasticity in individuals with neuromuscular impairments. It defines contracture as a shortening of the muscle belly through atrophy or loss of fascicles and increased muscle stiffness from an enlarged extracellular matrix. Spasticity is described as a velocity-dependent increase in muscle tone due to hyperreflexia of the stretch reflexes following an upper motor neuron lesion. The Modified Ashworth Scale and Modified Tardieu Scale are presented as clinical measures of tone and spasticity, respectively, with the latter assessing the angle at which a joint catches during a rapid stretch.
Spasticity is a motor disorder characterized by velocity-dependent increase in muscle tone and exaggerated reflexes resulting from hyper-excitability of the stretch reflexes as part of the upper motor neuron syndrome. It is caused by interruption of descending inhibitory pathways and alteration of central inhibitory commands leading to rearrangement of spinal cord circuitry and peripheral changes in the muscle over time. Spasticity is not a single symptom but part of a movement disorder defined by features like hypertonia, abnormal reflexes, dystonia, resistance to movement, and abnormal posturing affecting coordination and mobility. A multifaceted approach is needed for management including prevention, physiotherapy, pharmacological and surgical interventions to address both neural and non-neural factors.
This document discusses spasticity, including its pathophysiology, assessment, and management.
Spasticity is characterized by velocity-dependent increases in muscle tone and exaggerated reflexes due to hyper-excitability of the stretch reflex. It is caused by loss of inhibitory descending pathways in the spinal cord from upper motor neuron lesions. Management includes identifying triggers, passive stretching, exercises, medications like baclofen and botulinum toxin injections, and in severe cases nerve blocks or neurolysis using phenol or alcohol. The goal is to reduce spasticity-related pain and impairments while preventing complications like contractures.
This document discusses spine mobilization and manipulation techniques. It defines mobilization and manipulation as skilled passive movements applied to joints and soft tissues. Manipulation involves high velocity, low amplitude movements while mobilization can involve oscillations of varying amplitudes. The effects of manipulation include mechanical, neurophysiological, and psychological impacts. Mechanical effects involve restoring tissue extensibility and range of motion. Neurophysiological effects occur through stimulation of mechanoreceptors and descending pain pathways in the central nervous system. Psychological effects involve reducing pain and anxiety through reassurance. Clinical decision making involves considering factors like joint mobility, pain response, and targeted treatment effects when selecting techniques.
An Internet questionnaire to predict the presence or absence of organic patho...Nelson Hendler
The Pain Validity Test, developed by a team of physicians from Johns Hopkins Hospital, is available over the Internet, at www.MarylandClinicalDiagnostics.com. The test can predict, with 95% accuracy, which patient will have abnormalities on medical tersting, i.e. who has a valid complaint of pain. The test takes only 5 minutes to set up a patient, 15 minutes for a patient to take the test, and results are available immediately after completion. The test has been admitted as evidence in court cases in over 30 cases in 8 states.
The document provides a critical analysis of claims made in a 2012 study by Lozano et al regarding the rationale for selecting the subcallosal cingulate gyrus as a target for deep brain stimulation to treat treatment-resistant depression. The analysis finds that the evidence cited by Lozano et al. to support the involvement of the subcallosal cingulate gyrus in processing acute sadness is insufficient. Several of the cited studies do not specifically implicate this brain region or have limitations such as small sample sizes that weaken their conclusions. The analysis concludes the evidence presented is not adequate to definitively support targeting the subcallosal cingulate gyrus with deep brain stimulation.
1) The document discusses a scientific workshop focused on changing paradigms for understanding chronic pelvic pain.
2) It notes that the traditional biomedical model of focusing only on medical/surgical therapies has failed many patients, and the workshop aimed to develop alternative conceptual frameworks.
3) A key topic was the role of the nervous system in pain perception and the potential for central and peripheral sensitization to chronic pain independent of the initial cause. Alterations in nerve receptors and neuroendocrine mediators noted in sensitization might provide treatment targets.
Discriminative Validity of Metabolicand Workload MeasurementAlyciaGold776
Discriminative Validity of Metabolic
and Workload Measurements for
Identifying People With Chronic
Fatigue Syndrome
Christopher R. Snell, Staci R. Stevens, Todd E. Davenport, J. Mark Van Ness
Background. Reduced functional capacity and postexertion fatigue after physical
activity are hallmark symptoms of chronic fatigue syndrome (CFS) and may even
qualify for biomarker status. That these symptoms are often delayed may explain the
equivocal results for clinical cardiopulmonary exercise testing in people with CFS.
Test reproducibility in people who are healthy is well documented. Test reproduc-
ibility may not be achievable in people with CFS because of delayed symptoms.
Objective. The objective of this study was to determine the discriminative validity
of objective measurements obtained during cardiopulmonary exercise testing to
distinguish participants with CFS from participants who did not have a disability but
were sedentary.
Design. A prospective cohort study was conducted.
Methods. Gas exchange data, workloads, and related physiological parameters
were compared in 51 participants with CFS and 10 control participants, all women,
for 2 maximal exercise tests separated by 24 hours.
Results. Multivariate analysis showed no significant differences between control
participants and participants with CFS for test 1. However, for test 2, participants
with CFS achieved significantly lower values for oxygen consumption and workload
at peak exercise and at the ventilatory or anaerobic threshold. Follow-up classification
analysis differentiated between groups with an overall accuracy of 95.1%.
Limitations. Only individuals with CFS who were able to undergo exercise
testing were included in this study. Individuals who were unable to meet the criteria
for maximal effort during both tests, were unable to complete the 2-day protocol, or
displayed overt cardiovascular abnormalities were excluded from the analysis.
Conclusions. The lack of any significant differences between groups for the first
exercise test would appear to support a deconditioning hypothesis for CFS symp-
toms. However, the results from the second test indicated the presence of CFS-related
postexertion fatigue. It might be concluded that a single exercise test is insufficient
to reliably demonstrate functional impairment in people with CFS. A second test
might be necessary to document the atypical recovery response and protracted
fatigue possibly unique to CFS, which can severely limit productivity in the home and
workplace.
C.R. Snell, PhD, Department of
Sport Sciences, University of the
Pacific, Stockton, California, and
Workwell Foundation, Ripon,
California.
S.R. Stevens, MA, Workwell
Foundation.
T.E. Davenport, PT, DPT, OCS,
Department of Physical Therapy,
University of the Pacific, 3601
Pacific Ave, Stockton, CA 95211
(USA), and Workwell Foundation.
Address all correspondence to
Dr Davenport at: [email protected]
pacific.edu.
J.M. Van Ness, PhD, Department
of Sport Scienc ...
Neurodynamics, mobilization of nervous system, neural mobilizationSaurab Sharma
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.
This document discusses neural tissue mobilization of the upper limb. It defines neurodynamics as the clinical application of nervous system mechanics and physiology as they relate to musculoskeletal function. Neurodynamic tests are described to assess the median, ulnar, and radial nerves. The tests involve moving the associated joints in specific positions and directions to apply tension or sliding movement to the nerves while monitoring for symptoms. Structural differentiation is used to identify the level of nerve involvement. Contraindications for neural tissue mobilization include certain nervous system disorders or areas of instability. The goal is to assess nerve mobility and produce tension or gliding of the nerves for non-irritable neurogenic or neuropathic conditions.
1) The study measured the longitudinal excursion and strain in the median and ulnar nerves during different types of nerve gliding exercises commonly used to treat carpal tunnel syndrome and cubital tunnel syndrome.
2) It found that "sliding techniques" which involve alternating movements at two joints resulted in substantially larger nerve excursion with much smaller increases in nerve strain, compared to "tensioning techniques" which simply elongate the nerve bed.
3) The findings demonstrate that different nerve gliding techniques have different mechanical effects on the peripheral nervous system, and may influence neuropathological processes differently. Clinicians should consider these effects when selecting exercises for conservative or post-operative treatment of common neuropathies.
This document provides an overview of neural mobilization including:
1. It discusses the anatomy and physiology of the nervous system as a continuous tissue tract including the central and peripheral nervous systems.
2. Key concepts in neurodynamics are introduced such as tension, sliding, compression and how nerves move with joint movements.
3. Physiological events related to neural mobilization techniques like intraneural blood flow and its maintenance during movement are covered.
4. Examples of specific neural mobilization techniques like neurodynamic sliders and tensioners are given as well as how the spine moves in flexion, extension and lateral flexion.
This document summarizes a presentation given by David López Sánchez on spinal osteopathic manipulative therapy. It provides an overview of osteopathic philosophy which views the body as a single unified system. It describes assessment techniques for somatic dysfunction including asymmetry and tissue changes. Mechanisms of spinal manipulation are discussed such as restoring range of motion and reducing nociception. The document concludes that osteopathy aims to optimize health and stimulate self-regulation rather than simply treat diseases.
1. Spasticity is a motor disorder characterized by increased muscle tone and exaggerated reflexes caused by hyper-excitability of the stretch reflex due to loss of inhibitory pathways in the spinal cord.
2. The pathophysiology of spasticity involves denervation supersensitivity, axonal sprouting, and loss of descending inhibition resulting in disinhibition of segmental reflexes. Changes in muscle properties also contribute to increased tone.
3. Spasticity is assessed using measures of physiology like reflexes, muscle tone, and stiffness scales; measures of voluntary movement; and functional measures of activities and quality of life.
This document provides an overview of peripheral nerve anatomy and physiology, mechanisms of nerve injury, and neurodynamic testing and treatment approaches. Key points include:
- The perineurium creates a closed compartment around nerve fibers and positive endoneural pressure can cause edema to spread longitudinally.
- Nerve injuries can range from neuropraxia to neurotemesis depending on the severity of the ischemic insult such as compression, elongation, or disruption.
- Neurodynamic testing involves assessing nerve mechanics and sensitivity through passive and active movements while monitoring for barriers, pain responses, and altered symptoms. Treatment aims to improve nerve gliding and decrease intraneural pressures.
This document discusses the management of spasticity through pharmacological, surgical, and physiotherapy approaches.
Pharmacological management includes medications like baclofen, tizanidine, and diazepam which can help reduce spasticity but have side effects like sedation. Botulinum toxin injections target specific muscles to weaken them.
Surgical options are neurostimulation or neuroablative procedures like peripheral neurotomies. Physiotherapy includes sustained stretching, positioning, serial casting, orthotics, strength training, Roods approach, and modalities like TENS, heat, and cold therapy. Studies show these approaches can effectively reduce spasticity without increasing weakness. Management must be tailored to
The term Spinal Cord Injury is used to refer to neurological damage of the spinal cord
Any lesion involving the spinal cord result a syndrome called a “myelopathy”
Spinal cord injuries are defined as complete or incomplete according to the International Standards for the Neurological Classifification of SCI and the American Spinal Injuries Association Impairment Scale (AIS)
Complete lesions are defifined as AIS A, and incomplete lesions are defifined as AIS B, AIS C, AIS D or AIS E (Harvey, 2016)
Recognising features (contracture and spasticity)Richard Baker
This document discusses contractures and spasticity in individuals with neuromuscular impairments. It defines contracture as a shortening of the muscle belly through atrophy or loss of fascicles and increased muscle stiffness from an enlarged extracellular matrix. Spasticity is described as a velocity-dependent increase in muscle tone due to hyperreflexia of the stretch reflexes following an upper motor neuron lesion. The Modified Ashworth Scale and Modified Tardieu Scale are presented as clinical measures of tone and spasticity, respectively, with the latter assessing the angle at which a joint catches during a rapid stretch.
Spasticity is a motor disorder characterized by velocity-dependent increase in muscle tone and exaggerated reflexes resulting from hyper-excitability of the stretch reflexes as part of the upper motor neuron syndrome. It is caused by interruption of descending inhibitory pathways and alteration of central inhibitory commands leading to rearrangement of spinal cord circuitry and peripheral changes in the muscle over time. Spasticity is not a single symptom but part of a movement disorder defined by features like hypertonia, abnormal reflexes, dystonia, resistance to movement, and abnormal posturing affecting coordination and mobility. A multifaceted approach is needed for management including prevention, physiotherapy, pharmacological and surgical interventions to address both neural and non-neural factors.
This document discusses spasticity, including its pathophysiology, assessment, and management.
Spasticity is characterized by velocity-dependent increases in muscle tone and exaggerated reflexes due to hyper-excitability of the stretch reflex. It is caused by loss of inhibitory descending pathways in the spinal cord from upper motor neuron lesions. Management includes identifying triggers, passive stretching, exercises, medications like baclofen and botulinum toxin injections, and in severe cases nerve blocks or neurolysis using phenol or alcohol. The goal is to reduce spasticity-related pain and impairments while preventing complications like contractures.
This document discusses spine mobilization and manipulation techniques. It defines mobilization and manipulation as skilled passive movements applied to joints and soft tissues. Manipulation involves high velocity, low amplitude movements while mobilization can involve oscillations of varying amplitudes. The effects of manipulation include mechanical, neurophysiological, and psychological impacts. Mechanical effects involve restoring tissue extensibility and range of motion. Neurophysiological effects occur through stimulation of mechanoreceptors and descending pain pathways in the central nervous system. Psychological effects involve reducing pain and anxiety through reassurance. Clinical decision making involves considering factors like joint mobility, pain response, and targeted treatment effects when selecting techniques.
An Internet questionnaire to predict the presence or absence of organic patho...Nelson Hendler
The Pain Validity Test, developed by a team of physicians from Johns Hopkins Hospital, is available over the Internet, at www.MarylandClinicalDiagnostics.com. The test can predict, with 95% accuracy, which patient will have abnormalities on medical tersting, i.e. who has a valid complaint of pain. The test takes only 5 minutes to set up a patient, 15 minutes for a patient to take the test, and results are available immediately after completion. The test has been admitted as evidence in court cases in over 30 cases in 8 states.
The document provides a critical analysis of claims made in a 2012 study by Lozano et al regarding the rationale for selecting the subcallosal cingulate gyrus as a target for deep brain stimulation to treat treatment-resistant depression. The analysis finds that the evidence cited by Lozano et al. to support the involvement of the subcallosal cingulate gyrus in processing acute sadness is insufficient. Several of the cited studies do not specifically implicate this brain region or have limitations such as small sample sizes that weaken their conclusions. The analysis concludes the evidence presented is not adequate to definitively support targeting the subcallosal cingulate gyrus with deep brain stimulation.
1) The document discusses a scientific workshop focused on changing paradigms for understanding chronic pelvic pain.
2) It notes that the traditional biomedical model of focusing only on medical/surgical therapies has failed many patients, and the workshop aimed to develop alternative conceptual frameworks.
3) A key topic was the role of the nervous system in pain perception and the potential for central and peripheral sensitization to chronic pain independent of the initial cause. Alterations in nerve receptors and neuroendocrine mediators noted in sensitization might provide treatment targets.
Discriminative Validity of Metabolicand Workload MeasurementAlyciaGold776
Discriminative Validity of Metabolic
and Workload Measurements for
Identifying People With Chronic
Fatigue Syndrome
Christopher R. Snell, Staci R. Stevens, Todd E. Davenport, J. Mark Van Ness
Background. Reduced functional capacity and postexertion fatigue after physical
activity are hallmark symptoms of chronic fatigue syndrome (CFS) and may even
qualify for biomarker status. That these symptoms are often delayed may explain the
equivocal results for clinical cardiopulmonary exercise testing in people with CFS.
Test reproducibility in people who are healthy is well documented. Test reproduc-
ibility may not be achievable in people with CFS because of delayed symptoms.
Objective. The objective of this study was to determine the discriminative validity
of objective measurements obtained during cardiopulmonary exercise testing to
distinguish participants with CFS from participants who did not have a disability but
were sedentary.
Design. A prospective cohort study was conducted.
Methods. Gas exchange data, workloads, and related physiological parameters
were compared in 51 participants with CFS and 10 control participants, all women,
for 2 maximal exercise tests separated by 24 hours.
Results. Multivariate analysis showed no significant differences between control
participants and participants with CFS for test 1. However, for test 2, participants
with CFS achieved significantly lower values for oxygen consumption and workload
at peak exercise and at the ventilatory or anaerobic threshold. Follow-up classification
analysis differentiated between groups with an overall accuracy of 95.1%.
Limitations. Only individuals with CFS who were able to undergo exercise
testing were included in this study. Individuals who were unable to meet the criteria
for maximal effort during both tests, were unable to complete the 2-day protocol, or
displayed overt cardiovascular abnormalities were excluded from the analysis.
Conclusions. The lack of any significant differences between groups for the first
exercise test would appear to support a deconditioning hypothesis for CFS symp-
toms. However, the results from the second test indicated the presence of CFS-related
postexertion fatigue. It might be concluded that a single exercise test is insufficient
to reliably demonstrate functional impairment in people with CFS. A second test
might be necessary to document the atypical recovery response and protracted
fatigue possibly unique to CFS, which can severely limit productivity in the home and
workplace.
C.R. Snell, PhD, Department of
Sport Sciences, University of the
Pacific, Stockton, California, and
Workwell Foundation, Ripon,
California.
S.R. Stevens, MA, Workwell
Foundation.
T.E. Davenport, PT, DPT, OCS,
Department of Physical Therapy,
University of the Pacific, 3601
Pacific Ave, Stockton, CA 95211
(USA), and Workwell Foundation.
Address all correspondence to
Dr Davenport at: [email protected]
pacific.edu.
J.M. Van Ness, PhD, Department
of Sport Scienc ...
Discriminative validity of metabolicand workload measurementAMMY30
This study examined the ability of cardiopulmonary exercise testing (CPET) to distinguish between women with chronic fatigue syndrome (CFS) and sedentary control women. 51 women with CFS and 10 sedentary control women underwent two maximal exercise tests on a stationary bike 24 hours apart. No significant differences were found between the groups for the first test, but the second test found significantly lower oxygen consumption and workload values at peak exercise and ventilatory threshold for the CFS group, accurately differentiating the groups 95.1% of the time. This suggests a single exercise test is insufficient and that post-exertion fatigue unique to CFS is better demonstrated on a second test.
The near death experience scale. Construction, reliability, and validityJosé Luis Moreno Garvayo
En este artículo se expone un criterio de demarcación para las experiencias cercanas a la muerte conocido como “escala de Greyson”: se trata de un cuestionario formado por 16 preguntas agrupadas en cuatro bloques (componentes cognitivo, afectivo, paranormal y trascendental) en las que el entrevistado debe marcar la respuesta que más se acerque a la experiencia vivida (con un 0 si no la ha experimentado, un 1 si lo ha hecho de forma poco intensa, o un 2 si ha sido muy intensa). El análisis de los resultados sirve para evaluar si el sujeto vivió una ECM (alcanzado una puntuación mínima de 7 según los postulados de Greyson), permitiendo descartar un síndrome orgánico del cerebro o una respuesta no específica al estrés sufrido por el “miedo a morir”. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
Neurological and genetic basis of PTSD in a female populationJohn G. Kuna, PsyD
This study investigated the genetic basis of PTSD in women by analyzing data from 68,518 women in the Nurses' Health Study II. Researchers screened participants for trauma exposure and PTSD, then conducted diagnostic interviews with 3,000 women. They genotyped 1,000 women diagnosed with PTSD and 1,000 controls. The study implicated three neurological systems in PTSD etiology: the hypothalamic-pituitary-adrenal axis, locus coeruleus-noradrenergic system, and limbic-frontal neurocircuitry. However, the study was limited by its large sample size increasing the risk of Type I errors, and PTSD diagnosis conducted via phone by non-experts. Nonetheless, the study provided insights
Electromyography (EMG) and nerve conduction studies (NCS) provide physiological information about nerves and muscles. They are important diagnostic tools but only provide one piece of the puzzle, and must be interpreted along with other clinical information. EMG and NCS can help establish diagnoses, determine appropriate treatment, and provide prognostic information. They are generally safe when performed by a skilled clinician but have small risks like infection, bleeding, or tissue injury that should be weighed against the potential benefits for any given patient.
Cranial electrotherapy stimulation by Ray B. Smith, Ph.D.Liza Volv
A Summary Look at Studies of Cranial Electrotherapy Stimulation by Ray B. Smith, Ph.D. Cranial Electrotherapy Stimulation provides small pulses of electric current across the head of patients for the FDA recognized treatment of depression, anxiety and insomnia. CES has been in clinical use in the U.S.A. since 1963 and in Europe since 1953. Hundreds of thousands of patients have been treated with CES over the years, and thousands presently use these prescription devices in their homes.
A Summary Look at Studies of Cranial Electrotherapy Stimulation by Ray B. Smith, Ph.D. The mechanism of action, research... Cranial Electrotherapy Stimulation provides small pulses of electric current across the head of patients for the FDA recognized treatment of depression, anxiety and insomnia. CES has been in clinical use in the U.S.A. since 1963 and in Europe since 1953. Hundreds of thousands of patients have been treated with CES over the years, and thousands presently use these prescription devices in their homes.
This document discusses using patient behavioral data from rehabilitation records to inform medical treatment. It presents a case study of a patient (Mr. C) whose sodium levels fluctuated and participation in therapy declined as hyponatremia worsened. Correcting the hyponatremia by discontinuing suspected medications (citalopram, tamsulosin) led to improved sodium levels, mood, and greater participation in therapy. The document argues that closely tracking behavioral outcomes can provide insights into medical conditions and responses to interventions that traditional lab tests may miss.
Concussion guidelines article. Carney et al. Neurosurgery 2014brwjam004
This document summarizes the methodology and initial findings of a project to develop an evidence-based definition of concussion. The project used a systematic review and quality assessment of published literature from 1980 to 2012 to identify the most prevalent signs, symptoms, and cognitive deficits within 3 months of a potential concussive event. Sixty-two studies of medium or high quality were identified. The findings suggest consistent deficits in reaction time, memory, attention, processing speed and working memory within days of injury. Disorientation or confusion immediately after injury and slower reaction times or impaired verbal learning within 2 days were the most prevalent indicators. The studies mainly examined athletic populations and could not distinguish between evidence of concussion versus just a potential concussive event.
The document discusses the epidemiology of convulsive status epilepticus (CSE) in children. Key points:
1) The incidence of CSE in children is approximately 20 per 100,000 children per year in developed countries, though it varies depending on factors like socioeconomics and ethnicity.
2) The incidence is highest in children under 1 year old, with febrile CSE being the most common cause. Around 40% of children will have previous neurological abnormalities and less than 15% a history of epilepsy.
3) Outcome depends mainly on the underlying cause of CSE. However, the role of CSE itself, as well as factors like age, duration, and treatment, on
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
The document summarizes a study that examined the impact of gender and age on the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder (MDD). The study analyzed data from 157 patients who received ECT and found that neither gender nor age significantly influenced treatment outcomes. Specifically, gender did not affect the rate of response to ECT or patient receptivity to treatment, and age was also not related to these measures of efficacy. The study had some limitations but provides initial evidence that gender and age may not be determinants of ECT effectiveness for MDD.
Artigo (4) importante para a preparação para o curso de dor lombar crônica. "Características sensoriais da dor lombar crônica inespecífica: uma investigação de subgrupos."
This study examined relationships between subjective and biological stress responses in youth undergoing MRI scans and a social stress test. The study found:
1) Children's cortisol levels during MRI were correlated with their cortisol levels in response to a social stress test, suggesting consistent individual stress responses.
2) Children's self-reported anxiety during MRI was correlated with their cortisol response during MRI, indicating they could accurately report their biological stress.
3) Self-report measures of inhibition and distress were correlated with measures of anxiety in youth.
This meta-analysis reviewed 16 randomized controlled trials comparing the effectiveness of motor control exercises (MCE) to other treatments for chronic or recurrent low back pain. The analysis found that MCE was superior to general exercise in reducing both disability in the short, intermediate, and long term, and pain in the short and intermediate term. MCE was also superior to minimal interventions like advice or placebo for both pain and disability outcomes at all time periods. Compared to spinal manual therapy, MCE demonstrated superior results for reducing disability but not pain. The studies varied in quality but provided evidence that MCE can better improve pain and disability for low back pain over the short to long term compared to other common treatments.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Outbreak management including quarantine, isolation, contact.pptx
Neurodynamic testing
1. [E104] THE JOURNAL OF MANUAL & MANIPULATIVE THERAPY n VOLUME 17 n NUMBER 3
LETTER TO THE EDITOR
Re:“Upper Limb Neural Tension and Seated Slump
Tests: The False Positive Rate Among Healthy Young
Adults without Cervical or Lumbar Symptoms”
Daves et al. J Man Manip Ther 2009;16:136–141
I
t was of great interest that I read the
recent article by Davis et al1
which
questions the clinical validity of the
seated slump test and upper limb neural
tension test (median nerve), two com-
monly used clinical neurodynamic tests1
.
What ignited my interest was that this
study employed a methodology which
attempted to determine the ratio of false-
positive test findings with definitions
that do not adequately reflect the true in-
tention of these neurodynamic tests.
Clinically neurodynamic tests assess
the mechanosensitivity of neural tissue2
.
Neurodynamic tests utilize established
sequences of movements to either stress
or relieve the nervous system in such a
way as to alter, albeit temporarily, the me-
chanics (i.e. ability of the nerve to with-
stand compression, glide, stretch) and/or
physiology (i.e. localized ischaemia, al-
terations in intra-neural pressure) of that
particular neural tissue2,3
. Each test has a
number of options of ‘sensitizing move-
ments’ which are a “test component that
preferably has no direct structural link
with the symptomatic area except by
means of the nervous system”4
. These
sensitizing movements therefore attempt
to differentiate whether the symptoms
that are reproduced during the test occur
through provocation via alteration of the
nervous system versus other, related and
neighboring soft tissues3-9
. This concept
of neural sensitization, and therefore
structuraldifferentiation,hasbeenwidely
explored in the literature.
It is important to note that although
neurodynamic tests can provide infor-
mation regarding mechanosensitivity
and differentiation between neural and
non-neural tissues, the definition of a
positive neurodynamic test, clinically,
should not be made on structural differ-
entiation alone. Butler3
defines a positive
neurodynamic test if “it reproduces
symptoms, plus structural differentiation
supports a neurogenic source, plus there
are differences left to right and to known
normal responses, plus there is support
from other data such as history, area of
symptoms,imagingtests”. Shacklock8
has
developed a clinical algorithm to attempt
to simplify and add clarity to the inter-
pretation of neurodynamic tests. Integral
to his algorithm is the distinction be-
tween normal neurodynamic responses
and abnormal neurodynamic responses.
As they deliberately load the neural tis-
sue, it is to be expected that neurody-
namic tests will evoke a neural response.
In the absence of what Shacklock8
refers
to as overt neurodynamic symptoms (i.e.
those symptoms that the patient com-
plains of which are present on testing)
any neural symptoms that are elicited in
routine testing would be considered a
normal neurodynamic response. These
symptoms are often similar to that of the
contralateral limb and as such should not
be considered to be indicative of neuro-
dynamic pathology and therefore should
not be rated as a positive neurodynamic
test. This is in support of the previous
definition from Butler3
.
Although Davis et al1
have acknowl-
edged the distinction that Shacklock8
makes between an overt abnormal neuro-
dynamic response and a normal neurody-
namic response, they go onto define a
positive test for their study “using struc-
tural differentiation as the criterion”1
. Es-
sentially the authors are happy to assign a
positive finding to a neurodynamic test
that shows structural differentiation. It is
surprising that, based on this definition
of a positive test and given the healthy
subject population, the rate of false-posi-
tives was not 100% given that normal
neurodynamic responses are to be ex-
pected when progressive load is imposed
on the neural tissues, such as that with
neurodynamic testing.
It is vital that the interpretation of
neurodynamic testing must take into ac-
count the symptoms and presentation of
the patient. Many experts in the field of
neurodynamics have clearly stated the
importance of the reproduction of a per-
son’s symptoms, which implies the pres-
ence of pathology3, 8, 10, 11
. Therefore clini-
cally, it would be flawed to suggest that a
neurodynamic test is to be judged either
as positive or negative based on struc-
tural differentiation. Unfortunately this
is exactly what Davis et al1
have done in
defining a positive neural tension test,
based solely on structural definition.
The other feature which is vital to the
interpretation of any neuromusculoskel-
etal clinical measure is the comparison
between sides (i.e. for neurodynamic
testing,comparisonbetweenlimbs). This
study sought only to assess the left side.
During neurodynamic assessment no in-
ference can be made as to whether a clin-
ical test is positive or negative unless bi-
lateral comparison is made. This lack of
comparison would surely increase the
likelihood of a false-positive test for any
clinical measure, particularly in light of
the fact that healthy subjects were exam-
ined. Davis et al1
do acknowledge that
this situation is a limitation of the study.
Further to this point, if claims are to be
made about the clinical validity or useful-
ness of neurodynamic tests, then the fact
that bilateral comparison was not made
should have forced the methodology to
be changed to incorporate this very im-
portant process. This being the case any
claims regarding clinical validity must be
debated.
The use of the term false-positive
would imply that a clinical test is found to
2. THE JOURNAL OF MANUAL & MANIPULATIVE THERAPY n VOLUME 17 n NUMBER 3 [E105]
LETTER TO THE EDITOR
be positive, thus implicating the pres-
ence of a condition or diagnosis, where
in fact the condition does not exist. To
conduct a study to specifically assess the
ratio of false-positive findings for a clin-
ical test in a population of healthy sub-
jects appears to be an unfair witch-hunt.
Surely a study conducted to try to estab-
lish true-positive results and therefore
attest to the strength of clinical validity
in a symptomatic group (compared even
to a healthy population) would seem a
much more robust methodology. With
this type of design, the ratio of false-
positive rates to true-positive findings
could still be assessed.
I think the negative comments that
Davis et al1
make in respect to the clini-
cal validity and usefulness of neurody-
namic tests require further debate, espe-
cially when the working definition that
they have used to judge a positive or
negative test is not complete. As a newly
emerging field of neuromusculoskeletal
therapy, neurodynamics has been asso-
ciated with many different terms and
definitions. Leading authorities, like
David Butler and Michael Shacklock ac-
tively try to promote clear terms and
definitions to avoid confusion for clini-
cians. This study has the potential to
undermine this effort. It is vital that
there is a universal adoption of clear and
concise terms and definitions within
neurodynamics, particularly in respect
to interpretation of neurodynamic tests.
There is no gold standard measurement
or clinical test for neurodynamic dys-
function. In respect to clinical validity
or neurodynamic tests, measurement of
construct and content validity is per-
haps the best assessment available.
Clearly more research needs to concen-
trate on the true underlying physiologi-
cal and biomechanical underpinnings of
neurodynamic pathology before a gold
standard measurement exists. While we
are waiting, Shacklock’s8
clinical algo-
rithm presents the most simple and
user-friendly method of interpretation
or neurodynamic tests.
Richard Ellis, B. Phty, Post Grad Dip
Lecturer
School of Physiotherapy
Auckland University of Technology
Auckland, NZ
REFERENCES
1. Davis DS, Anderson IB, Carson MG, Elkins
CL, Stuckey LB. Upper limb neural tension
and seated slump tests: The false positive
rate among healthy young adults without
cervical or lumbar symptoms. J Man Manip
Ther 2009; 16(3):136–141.
2. Coppieters MW, Stappaerts KH, Janssens K,
Jull G. Reliability of detecting ‘onset of pain’
and ‘submaximal pain’ during neural provo-
cationtestingoftheupperquadrant.Physio-
ther Res Int 2002;7(3): 146–156.
3. ButlerDS.TheSensitiveNervousSystem.Ad-
elaide: Noigroup Publications, 2000.
4. Coppieters MW, Stappaerts KH, Wouters
LL, Janssens K. The immediate effects of a
cervical lateral glide treatment technique in
patients with neurogenic cervicobrachial
pain. JOSPT 203;33(7):369–378.
5. Butler DS. Mobilisation of the Nervous Sys-
tem. Melbourne: Churchill Livingstone,
1991.
6. Coppieters MW, Stappaerts KH, Wouters
LL, Janssens K. Aberrant protective force
generation during neural provocation test-
ing and the effect of treatment in patients
with neurogenic cervicobrachial pain. J Ma-
nipulative and Physiol Ther 2003;26(2):99–
106.
7. Herrington L. Effect of different neurody-
namic mobilization techniques on knee ex-
tension range of motion in the slump posi-
tion. J Man Manip Ther 2006;14(2):101–
107.
8. Shacklock MO. Clinical Neurodynamics: A
New System of Neuromusculoskeletal Treat-
ment. Oxford: Butterworth Heinemann,
2005.
9. Butler DS. Adverse mechanical tension in
the nervous system: a model for assessment
and treatment. Aust J Physiother 1989;
35(4):227–238.
10. Elvey RL. Physical evaluation of the periph-
eral nervous system in disorders of pain
and dysfunction. J Hand Ther 1997; 10:122–
129.
11. GiffordL.Neurodynamics.In:Pitt-BrookeJ,
ReidH,LockwoodJ,KerrK,eds.Rehabilita-
tion of Movement. London: WB Saunders
Company Ltd, 1998:159–195.
3. [E106] THE JOURNAL OF MANUAL & MANIPULATIVE THERAPY n VOLUME 17 n NUMBER 3
AUTHOR RESPONSE
W
e appreciate the opportunity to
reply to the comments provided
by Mr. Ellis regarding our inves-
tigation, which examined the false posi-
tive rate of the upper limb neural tension
test (ULNTT) and seated slump test
(SST) among healthy young adults.1
In
his letter, Mr. Ellis calls for further debate
regarding the validity of these neurody-
namic tests. We support his desire for not
only debate but more importantly addi-
tional research in this area. However, the
debate should be based on science and
conducted with professional decorum.
Mr. Ellis identified three primary
concerns with the methodology used in
our investigation. Each of these concerns
relate to the operational definition of a
positive test. Mr. Ellis stated that “neuro-
dynamic testing must take into account
the symptoms and presentation of the pa-
tient.” He also stated “a positive neurody-
namic test, clinically, should not be made
on structural differentiation alone.” He
suggests that additional information is
needed from the “history, area of symp-
toms, and imaging tests.” Mr. Ellis also
stated that “no inference can be made as
to whether a clinical test is positive or
negative unless bilateral comparison is
made.”
It should be noted that our investiga-
tion was purposefully conducted on a
sample of individuals who were without
pathology, thus these subjects did not
have any neural mediated symptoms that
could be used for comparison. While a
composite examination may offer greater
diagnostic validity, we sought to examine
the stand alone validity of these tests. Ad-
ditionally, we clearly stated that the tests
were conducted on the left upper and
lower extremities and identified this as a
limitation of the study.
Complete examination of diagnostic
validity requires the testing of subjects
with and without the condition or dis-
ease. Our investigation only examined
the false positive rate among subjects
without the condition or disease. Using a
clearly defined and reproducible opera-
tional definition of a positive test, we
found a high false positive rate among
these tests. Our investigation made no at-
tempt to offer data relative to sensitivity,
positive predictive value, false negatives,
prevalence, or post-test odds. We wel-
come future investigations that examine
the full spectrum of diagnostic validity of
the ULNTT and SST.
While a debate regarding the opera-
tional definition of these tests is wel-
comed, it should be conducted with pro-
fessional discord. To suggest that our
investigation was an “unfair witch-hunt”
is presumptuous and portends a superfi-
cial review of the article. In addition to
offering data regarding the false positive
rate, we suggested possible cutoff values
that may enhance the diagnostic validity
of these tests.
The tone of Mr. Ellis’ letter does not
foster collegial dialogue and offers little
evidence to advance our understanding
of the diagnostic validity of these neuro-
dynamic tests. If we are to move forward
as evidence based practitioners we must
be willing to critically examine evidence
in an unbiased manner and be willing to
recognize potential limitations of our
clinical tests and measures. In an elo-
quent editorial, the late Jules Rothstein2
,
Editor-In-Chief of Physical Therapy,
wrote . . . “All evidence has limitations,
but whatever those limitations may be,
data are far better than debates that are
more about theology than they are about
health care.”
We invite Mr. Ellis and other re-
searchers to replicate our investigation
and improve upon the methodology
where it is deemed necessary. We have
come a long way toward Dr. Rothstein’s
dream of becoming an evidence based
profession.Ratherthanbecomingmarred
by dogma and rhetoric, let us instead add
to the body of evidence and learn from
our limitations so that we can become
better health care providers.
REFERENCES
1. Davis DS, Anderson IB, Carson MG, Elkins
CL, Stuckey LB. Upper limb neural tension
and seated slump tests: The false positive rate
among healthy young adults without cervical
or lumbar symptoms. J Man Manip Ther
2009;16:136–141.
2. Rothstein JM. Disciples, Demigods, and
Data. Phys Ther 1998;78:1044–1045.
D. Scott Davis PT, MS, EdD, OCS
Associate Professor and Director of Pro-
fessional Education
Division of Physical Therapy
School of Medicine
West Virginia University
8312 HSS, PO Box 9226
Morgantown, WV 26506