Sub-classification Based Profiling for Motor Behavior Therapy
Motor Behavior Therapy is a clinical reasoning framework for the personalized management of musculoskeletal pain. The key themes are:
- Modern Sub-classification
- Causation is targeted
- Individualization
Sub-classification is about applying the best treatment for an individual patient at any given point in their rehabilitation. A category can be a sub-group if it:
- describes the underlying mechanisms driving the disorder
- provides a diagnosis
- predicts a response to therapy
- provides a prognosis
The Sub-classification concept has evolved considerably from early days. Modern Sub-classification is best considered as a clinical reasoning tool in rehabilitation. Major differences from early days:
- Parallel: multiple subgroups can be classified and treated concurrently
- Hierarchical: one subgroup can be considered more important at any point in time;
- Adaptable: treatment can switch between subgroups depending on the patient presentation
- Progressive: within and between sub-groups
- Comprehensive: more subgroups to address known deficits in patients
- Precise: Functional causation of each subgroup is considered facilitating more precision in care
- Profile: Individual characteristics of patients are addressed facilitating patient centered care
Musculoskeletal pain is complex and it can be challenging to sort through everything and decide what is best for your patients. It is also challenging when starting your career to develop a strategy to approach patients. Sub-classification is often the first tool we use to direct our clinical reasoning, assessment and treatment. This is made more precise by understanding the causation of each sub-classification. Individual factors complete a patient profile and allow the treatment to be tailored to the person.
On this course we cover the various facets of “Motor Behavior”. We use this as a foundation for understanding why this patient is presenting in front of you as well as integrating other techniques and strategies you have learned.
Motor Behavior focuses on
- Skill acquisition (e.g., motor skill learning, cognitive therapy)
- Behavior change (e.g., movement behavior, lifestyle, cognitive)
- Functional integration
- Self management and disability prevention
Understanding how motor behavior links to tissue loading mechanisms (with possible patho-anatomical diagnoses) and pain mechanisms is a central feature of Motor Behavior Therapy.
Some aspects of Motor Behavior include:
- Movement Pattern (e.g. the way in which a person naturally moves contributes to the loading on tissues). What is the cause of this movement pattern?
- Spinal Control or Joint Control (e.g. the joint control contributes to the loading on the tissues). Why is there increased or decreased joint control?
- Biomechanical loading exposures. Work, sport and home demands place forces on the body that influence musculoskeletal loading. These are often, but not always, combined with the above influences. How do we understand the complexity of which is most important?
- Motor Fitness Deficits (e.g. muscle fatigue or weakness is present contributes to loading on tissues). Why can’t this person’s central and peripheral nervous systems produce sufficient motor unit recruitment?
- Kinesiophobia (e.g. a patient has fear and avoids movement which contributes to the loading on tissues, sensitization or both). Why is the patient experiencing these thoughts?
- Motor competence (e.g., why does a person have poor coordination? Is this in all movements or in some movements and not others. What are the implications of poor motor competence?)
- Mobility dysfunction (e.g., why does pain or a physical restriction influence functional range of motion?)
As these skills are solidified, more advanced knowledge can be added. To further understand a patient’s presentation, we need to consider the causal pie of the relevant aspect of Motor Behavior as well as a number of individual characteristics the patient presents with. Along with Motor Behavior, we can further develop a patient profile by understanding other subgroups and their characteristics as they relate to the patient.
Other sub-classification categories include:
- Minor Neurological Factors
- Pain Mechanisms
- Behavioral Factors
- Neuro-immune-sympathetic-endocrine (NISE) dys-regulation
- Patho-anatomical Diagnosis
With this, clinical priorities can be made and a management plan put in place with the patient. An understanding of this sub-classification model allows you to develop a management plan for all musculoskeletal pain patients.