The future of PT is here: read this incredible article by Dr. Jennifer Hauskey, PT, DPT, FEMG. In this study, Dr. Hauskey notes, “For this specific patient with a diagnosis of chronic demyelinating sensorimotor neuropathy of the median nerve, we altered his treatment plan to use nerve gliding/sliding neuromobilization techniques with loading at the site of injury. The patient carried out their newly designed plan of care for five weeks. Follow-up EMG/NCS testing indicated all signs of neural injury had been resolved.”
IMPLEMENTING NEURODIAGNOSTICS INTO PT THERAPY CLINICAL CARE
By Dr. Jennifer Hauskey, PT, DPT, FEMG
In a perfect world of Physical Therapy, all patients would see improvements with the prescribed plans of care we set for them.
As clinicians, we strive to set the most accurate plans to help them succeed. However, some of the diagnoses we encounter can yield negative or inconclusive test results, therefore not fully alleviating the patients’ conditions.
Fortunately, Electrodiagnostic Testing has given far greater specificity, sensitivity, and accuracy compared to traditional diagnostic tests such as Phalen’s or Spurlings. For example, in patients with Carpal Tunnel Syndrome (CTS), Phalen’s sign generally yields sensitivity of levels of 51% and specificity levels of 76% (Kuhlman and Hennessey 1997). This compares with Electromyogram/Nerve Conduction Studies (EMG/NCS), which delivers 86% sensitivity and 98% specificity (American Association of Electrodiagnostic Medicine, American Academy of Physical et al 2002).
As the Clinical Director of One to One Physical Therapy and Aquatics — and Vice President of Operations for One to One Diagnostics — quickly onboarding my clinicians to new Electrodiagnostic Testing was important.
As a team, we fully embraced the chance to use this testing with patients with nerve-related symptoms. Also, we put in place neurofascial techniques to support our EMG/NCS work. We were spurred by a Hands-On-Seminars course titled “Neurofascial Revealed” by Dr. Dimitrios Kostopoulos; so we deeply embraced the techniques to treat patients according to the specific diagnoses related to the peripheral nervous system and neuromuscular injuries.
Now through diagnostic testing we can identify, for example, not only a Tarsal Tunnel Syndrome (TTS), but more specifically a primarily sensory-axonal version of TTS. Diagnostic testing, in this case, allowed our team to accurately treat based on the specific type of axonal injury (contralateral tensioner with unilateral limb in mild tension followed by unilateral relaxer), which we may have treated differently if the patient had been diagnosed demyelinating nerve injury (neural glides/slides). Though our clinic has begun to bridge the gap between diagnostic findings and applying these focused techniques, the understanding amongst the therapists and patients has enhanced the overall symptom-management of our clients.
Simply said, our PT treatment plan and PT treatments are decided not only based on the results of our physical examination but also guided by EMG/NCS testing results.
To get the most of the new techniques, we place our patients into what we call a Diagnostic Progress Board, a tool to check the progress of patient care from the initial evaluation to discharge. Upon initial evaluation, we use an Assessment Tool screen and evaluate patients by assessing symptoms, leading to candidates for the diagnostic testing.
As an example, a patient came in recently with Carpal Tunnel Syndrome and marked on our Assessment Tool that he was having numbness and tingling in his fingers; we placed him on the Progress Board as “in need” of diagnostic testing. We then checked his insurance coverage and obtained a doctor’s referral. Once we learned the patient was authorized, we set a test date and completed the EMG/NCS test. His results showed a chronic sensorimotor demyelinating neuropathy of the median nerve at the Carpal Tunnel. At that point, the next step on the Progress Board was to schedule a diagnostic follow-up visit with the evaluating therapist to revise the plan of care based on the more accurate findings. For this specific patient with a diagnosis of chronic demyelinating sensorimotor neuropathy of the median nerve, we altered his treatment plan to use nerve gliding/sliding neuromobilization techniques with loading at the site of injury. The patient carried out their newly designed plan of care for five weeks. Follow-up EMG/NCS testing indicated all signs of neural injury had been resolved.
We now aggressively set appointments with patients to review their Electrodiagnostic Tests, advise them with even more confidence, and enhance their treatment plans. The Patient Diagnostic Progress Board clearly identifies which patients are to get specific testing, tracks the review steps, and helps us adapt our treatments properly. Our commitment as therapists is to provide the most effective, accurate diagnoses and treatments possible: Electrodiagnostic Testing gives our team another huge step toward that goal.