World of Hurt: A Non-Pharmacy approach to neurological patient's pain and spasticity

COURSE DESCRIPTION

  This two-day course focuses information critical to clinical reasoning principles for the selection of non-pharmacy pain science patient education and therapeutic exercise interventions for the problems of spasticity and pain involving neurologically impaired patients.  Recent literature review for pain and spasticity in neurologically impaired patients suggest a need for new thinking toward interventions with a focus on non-pharmacy interventions. A taped patient testimony, in addition to live patient demonstrations (when available) and video cases promote a more thorough understanding and illustrate the clinical importance of providing non-pharmacy spasticity and pain management interventions. Spasticity is often an expression of peripheral nerve irritation in the neurological impaired patient and found to respond to a Pain Mechanism Classification System (PMCS) for treatment and management. Applying the principles of a PMCS to diagnosis of the dominating mechanism for spasticity and pain can help the clinician determine specific patient education and active care exercise interventions.  This course provides workshops in Spine Repeated Movement Testing, Neurodynamic Evaluation and Exercise selection, and Developmental Staging to address skills necessary for classification of dominating PNS and CNS mechanisms. This classification allows for greater specificity in pain science patient education and therapeutic exercise for spasticity and pain interventions. Participants will learn clinical reasoning skills using subjective and objective characteristics for classification of trapped, tight, and centrally mediated spasticity and pain. Participants will also learn the specific pain science patient education and active therapeutic exercise associated with each classification. Scientifically tested pain science education group model class structure and scripts outlined along with validated outcome measures. Documentation guidelines outlined along with goal setting for the neurological patient.

SPEAKERS

Annie O’Connor, MSPT, OCS, Cert. MDT is Founder and CEO of a World of Hurt, LLC a dedicated consulting, teaching, telehealth and research company for the application of Pain Mechanism Classification System into MSD & Neurological clinical practice. In addition, she is a Manager at Anthem AIM Specialty Health Back Pain Guide Program.  Annie has co-authored 2019, Pain Mechanism Classification Chapter, Rehabilitation of The Spine: A Patient Center Approach 3e, Liebenson C (ed). Wolters Kluwer Philadelphia publisher. She has co-authored 2020 and 2017, Therapeutic Exercise Chapter, Orthopedic Knowledge Update Spine 6 & 5, American Academy for Orthopedic Surgeons publisher. This chapter specifically is dedicated to helping Medical Doctors understand pain mechanism classification and the importance in therapeutic exercise selection. She has co-authored 2015 book “A World of Hurt: A Guide to Classifying Pain” and September 2016 Journal Article in JMMT “Validation of a pain mechanism classification system (PMCS) in physical therapy practice”. Both publications offer a research supported “paradigm shift” in managing Musculoskeletal Pain promoting effective and efficient outcomes with significant cost savings.  She is an Orthopedic Clinical Specialist (OCS) of the American Physical Therapy Association and has a Certification in Mechanical Diagnosis and Therapy in the McKenzie Method (Cert. MDT). She teaches nationally and internationally the World of Hurt training courses, a six course training series designed for interdisciplinary application of the PMCS into clinical practice. She lectures nationally and internationally on musculoskeletal pain mechanism classification and intervention, neurodynamic evaluation and treatment, mechanical diagnosis and therapy of spine and extremities, kinetic chain evaluation, functional manual therapy and exercise prescription. She was instrumental in establishing the Pain Mechanism Classification System approach for musculoskeletal pain and neurological spasticity at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. She is a member of American Physical Therapy Association in the orthopedic section and canine special interest group, the North American Spine Society (NASS) serving on the Exercise Committee, and McKenzie Institute. She continues to treat orthopedic, neurological patients, and canines with pain to achieve the best life possible through her Chicago based private practice.

Melissa Watson, MSPT, Cert. MDT received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan AbilityLab formerly known as the Rehabilitation Institute of Chicago Burr Ridge Outpatient & DayRehab Center with 21 years of clinical experience in neurological rehabilitation. Melissa is a Master Clinician and certified clinical instructor where she mentors other clinicians and students on their professional and clinical development. She is a recognized mentor in utilizing Pain Mechanism Classification System for Neurological Patients with pain and spasticity. She is practicing clinically in the Day Rehabilitation setting with a research interest in pain and applying both pain classification and MDT principles within the neurological population for spasticity. She is currently leading a Day Rehab Pain Group Committee where she leads other Day Rehab clinicians on a pain science education group that is focused on pain science education and active care treatment for patients with centrally dominated pain throughout multiple sites of care. She is certified in Mechanical Diagnosis and Treatment – McKenzie Method. She is an assistant instructor of the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” and uses both subgrouping methods in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.

AGENDA

Day 1


 8:15                 WoH Course Introduction

8:30                 Lecture: Pain Mechanism Classification System (PMCS) – Definitions and Research

9:00                 Lecture: Shift Happens: What does the evidence and innovation say about hypertonia?

10:00      Break

10:15               Lecture: Peripheral Nervous System (PNS) Hypertonia Mechanisms Subjective, Objective Clinical Characteristics

10:45                Workshop: Active and Passive Neurodynamic Exercise Upper & Lower Extremity

12:00      Lunch   

1:00                  Lecture: PNS Intervention Patient Education & Active Care Exercise Prescriptions

1:45                  Workshop:  Preferred Direction Active, Manual Therapy Cervical & Lumbar Spine           

3:15        Break

3:30                  Workshop: PNS Paper Cases Classification Exercise  

4:30                  Case Study: Video or Live Patient Demonstration - PNS

5:30        Adjourn



Day 2


8:00                  Lecture: Central Nervous System (CNS) Subgroups Subjective and                                                            Objective Characteristics [WoH: pg 222-223; 202-203; 260; 327-328]

8:45                  Lecture: CNS Intervention Patient Education and Active Care Exercise Prescriptions                      [WoH: pg 236; 206-218; 264-265, 269-271,276-277, 281; 335-339, 343]

9:30                  Workshop: CNS Paper Cases Classification Exercise


10:00      Break

10:15                Words Workshop / Patient Demonstration: Yellow Flag Risk Form [WoH: pg 258]; Pain Science Education [WoH: pg ix, 39-40, 82-83]; Documentation Guidelines and Goal Setting for Central Sensitivity and Affective Mechanisms

11:30                Workshop: Role-playing clinician and patient pain science topic scenarios: Explaining CNS mechanisms, Traffic Light Guide to Movement Safe Pain, Pain Journal, Battery Assessment

12:00      Lunch

1:00                  Lecture/Patient Demonstration: CNS Motor / Autonomic Mechanism – Motor & Sensory Evaluation & Treatment [WoH pg 328-335]; Dynamic Neuromuscular Stabilization (DNS) Approach to Hypertonia Treatment

2:30     Break      

2:45                  Workshop: DNS Exercise Progression               

4:15                  Questions / Answers

4:30        Adjourn

1. Differentiate subjective and objective clinical characteristics for peripheral and central nervous system pain and hypertonia symptoms
2. Apply pain mechanism classification system clinical reasoning approach to neurological patient case studies to identify pain and hypertonia mechanisms, spine directional preference, tight peripheral nerve and centrally mediated
3. Classify pain and hypertonia dominant mechanisms to prescribe individualized patient education and active care intervention
4. Administer, interpret and clinically reason Yellow Flag Risk Form along with pain and hypertonia mechanical and functional baselines to determine classification, effectiveness of patient education and active care intervention
5. Demonstrate application of common cervical and lumbar spine directional preference active, passive and manual therapy procedures for the neurological patient
6. Demonstrate median, ulnar and sciatic nerve neurodynamic active, passive procedures for the neurological patient

$250 for general registrants.

A. OhioHealth Cancellation: OhioHealth reserves the right to cancel or delay a course due to any unforeseen circumstances. In the event a course is cancelled, OhioHealth will refund all registration fees. OhioHealthis not responsible for any travel, hotel or other costs incurred.
B. Participant Cancellation: If a participant cancels, a refund of the conference fee minus an administrative charge of 25% of the registration fee will be made if written notice of cancellation is received no later than one week prior to the event. Exceptions may be approved on a case-by-case basis.
C. Inclement Weather: If a participant is unable to attend due to inclement weather (Level 3 Snow Emergency), refund of the registration fee minus 25% administrative charge will be issued.
D. Exceptions: Exceptions are considered at the discretion of the primary activity planner on a case-by-case basis.