Sub-classification Based Profiling for Specific Neuromuscular Rehabilitation
Course Overview
Sub-classification is about applying the best treatment for an individual patient at any given point in their rehabilitation. There are many rehabilitation options available for therapists. This concept has evolved considerably from early days. It better represents 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-classifications
- Comprehensive: more subgroups to address known deficits in patients
- Individual characteristics of patients are addressed facilitating patient centered care
- Functional causation of each subgroup is considered facilitating more precision in 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.
On this course we cover the various facets of “Motor Behavior”. We use this as a foundation for understanding the patient in front of you as well as integrating other techniques and strategies you have learned.
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?
- Motor Fitness (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?
- 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?
- 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?
- Kinetic Chain Error (e.g. a patient may have extreme movement patterns and not use an aspect of their kinetic chain sequence and this contributes to the loading on tissues). Why does a patient move like this?
- 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?
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 dysregulation
- Patho-anatomical
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.