1B - neuroprovocation testing

Question 1

how does nerve tissue respond to movement?

Answer 1

• gliding
• lengthening
• compression (from surrounding tissues)

Question 2

3 tension sites

Answer 2

C6, T6, L4

where dura is tethered to bony canal

Question 3

spinal dural abnormal mechanisms

Answer 3

• excessive stress produced in areas around adhesions
• increased tension 2/2 ↑ length of dura outside normal limit

Question 4

sites of peripheral n. + nerve root vulnerability

Answer 4

• tunnels
• branches
• hard interfaces
• proximity to surface
• adherence to interfacing structures

Question 5

how can posture affect neural tension?

Answer 5

sustained postures → adaptive shortening of neural structures

Question 6

how can direct trauma affect neural tension?

Answer 6

damage from direct blow or 2/2 injury at adjacent structures

Question 7

how can extremes of motion affect neural tension?

Answer 7

certain movements of extremities could place traction on the nerve

Question 8

permanent injuries occur in nearly ___ of electrocuted patients

Answer 8

1/4

Question 9

how can compression affect neural tension?

Answer 9

• occurs during muscle contraction
• result of tight fascia, neoplasms, and bony protuberances

Question 10

3 signs of a (+) NTPT

Answer 10

1. reproduces pt’s symptoms (concordant pain)
2. test responses altered by movement of distant body parts
3. test differences from L/R side or from normal

must have ALL 3 to be (+)

Question 11

slump test

Answer 11

• simulate extremes of spinal motion associated w/ symptom-provoking activities
• for sciatic n.

Question 12

research suggests that a relationship may exist b/w ___ and adverse neural tension of ___ (+) slump test

Answer 12

• repetitive hamstring strains
• sciatic n.

Question 13

slump stretching may be beneficial in short term for improving ___, ___, and ___

Answer 13

• disability
• pain
• centralizing sx’s

Question 14

ULTT 1

Answer 14

C-spine neutral → shoulder depression → GH abduction (> 90°) → wrist/finger extension, forearm supination → GH ER → elbow EXTENSION → C-spine contralateral SB

median n.

Question 15

use of median n. glides to improve nerve excursion in pts w/ ___

Answer 15

carpal tunnel syndrome

Question 16

ULTT 2

Answer 16

C-spine neutral → shoulder depression → GH abduction (∼ 45°) → GH IR → wrist/finger flexion, forearm pronation → elbow extension → further GH abduction → C-spine contralateral SB

radial n.

Question 17

ULTT 3

Answer 17

C-spine neutral → shoulder depression → GH abduction (> 90°) → GH ER → forearm pronation, wrist/finger extension → elbow FLEXION → C-spine contralateral SB

ulnar n.

Question 18

condition composed of neurologic dysfunction due to compressive pathology at multiple sites

Answer 18

double crush injury

may impair nerve’s ability to withstand compression at distal site
treat proximal sx’s first

Question 19

___ (+) ULTTs rules in cervical radiculopathy

Answer 19

≥ 3 (+)

Question 20

___ (+) ULTTs rule out cervical radiculopathy

Answer 20

all (-)

Question 21

neurodynamic mobilization ex’s in order of aggressiveness

Answer 21

glides (least) → tensioners → stretches (most)

Question 22

gliding (technique)

Answer 22

load 1 end of nerve while relieving stress on opposite end, repeat in oscillatory fashion

on/off, off/on
good for high irritability … START HERE

Question 23

tension (technique)

Answer 23

load opposite ends of nerve in oscillatory fashion

on/on, off/off
progress to these after glides/less irritable

Question 24

stretching (technique)

Answer 24

load NS + sustain for 10-15 seconds at sensitized position (3-5 reps)

does NOT physiologically lengthen nerve … only attenuates it to prolonged stress

Question 25

example dosing of neurodynamic mobilizations

Answer 25

- high irritability → 2x10 - low irritability → 3x10-20