Clinical Judgement:


making the best clinical decisions

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Course Outline

In the real world, by the time a patient has a chronic or recurrent pain disorder there are multi-factorial competing issues to manage.

This course makes 3 diagnoses:

  • Movement Control Impairments - (identify the site and direction control impairments)
  • Symptoms - (identify the various pain sensitive tissues)
  • Pain mechanisms (identify combinations of mechanical nociceptive pain, central and peripheral neurogenic pain, along with the influence of behavioural and contextual factors

Many people with chronic and recurrent pain present with:

  • multiple sites and directions of uncontrolled movement
  • multiple pain sensitive tissues
  • more than one pain mechanism

The course explores how to prioritise - where to start and how to best manage these competing interests. Treatment options and priorities are presented, emphasizing the management of multiple movement control impairments

The course will explore and explain:
  • where to start and where not to start;
  • what you can fast-track and what to hold back on;
  • how to develop appropriate strategies to use movement to influence neurogenic pain

Key Features

This course reviews the concepts of the uncontrolled movement theory. It uses patient demonstration to highlight how movement control assessment and rehabilitation compliments other therapeutic approaches. This details a logical clinical reasoning approach to integrate assessment and correction of dysfunction in the articular, myofascial and neural systems. It develops rehabilitation strategies to facilitate clinical problem solving and common areas of clinical difficulty are reviewed.

 

Learning Outcomes

At the end of this course the participant should be able to:
  • Make 3 clinical diagnoses for patients with complex musculo-skeletal pain
    • Tissues / Structures; Movement Dysfunction; Pain mechanisms
  • Discuss the differences in clinical presentations of dysfunction in different tissues
    • Articular structures; Myofascial tissues; Connective tissues; Neural tissues
  • Understand the development of Un-Controlled Movement (UCM) and analyse the relationship between restrictions and compensation
  • Assess for and develop strategies to manage different pain mechanisms
  • Identify clinical indicators for possible presence of sensitisation & neurogenic pain and discuss management options for issues of neuro-dynamic sensitivity
  • Understand and discuss how clinical presentations determine priorities in management strategies
  • Recognise the clinical indications and discuss management options for:
    • low threshold training of the local system as a clinical priority
    • low threshold training the global system as a clinical priority
    • Indications for high threshold training the global system as a clinical priority
  • Develop an understanding of using outcome measures and re-assessment tools to evaluate the effectiveness of interventions to manage symptoms, dysfunction, disability and demonstrate how these tools can help to guide the rate of progression of an individual patient through their rehab programme
The participant should demonstrate the ability to apply principles of assessment and motor control retraining to:
  • Use clinical reasoning to prioritise initial management and plan a progression of rehab
  • Demonstrate an understanding of the clinical reasoning behind the choice of therapeutic exercise options

Programme Outline

  • Movement system assessment: Inter-related systems
    • Articular structures assessment
    • Myofascial tissues assessment
    • Connective tissues assessment
    • Neural tissues assessment
    • Behavioural / psychosocial issues
  • Tissue systems as a source of pain Pain mechanisms and clinical indicators
  • Diagnostic frameworks:
    • 3 diagnoses
    • Tissues / Structures - more than one
    • Movement Dysfunction (site and direction) - more than one
    • Pain mechanisms - more than one
    • Mechanical subgroups of neuro-musculo-skeletal pain
  • Clinical judgement
  • Clinical reasoning
  • Physiology: Motor Control Update
  • Movement health
  • Outcome measures: is treatment making a difference?
  • Update: Principles of ‘motor control’ rehab
  • Therapeutic Exercise: Decision-making Framework
  • Clinical scenarios
  • Case reviews

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Kinetic Control courses are designed for medical health professionals such as physiotherapists, osteopaths, chiropractors, podiatrists etc registered with the HPC. In exceptional circumstances experienced non medical health professionals may be allowed to attend Kinetic Control courses but these participants MUST be able demonstrate that the course material is within their scope of practice and that they have appropriate professional liability insurance to cover them for their attendance at the course and the course content.

This course has both theortical and practical elements. Please come prepared for the practical work.