The Pneu-Back™ Program

1. The Pneu-Back™ Program Level I

2. The Pneu-Back ™ ProgramSeven Steps to a Healthy Back • Assessment • Measure Analyze Posture • Pneu-Weight Pain Free Warm Up • Back System III • Pneu-Weight and Pneu-Back Chair • Pneu-Back Chair Specific Recruitment • Home Maintenance Program

3. The Pneu-Map™ Pg 6 • Quantitate posture curves • AP and Lateral • Measure Spinous Process • Measure lean • Show patient progress

4. Computer GeneratedDocumentation and Protocols Pg 6 • Patient understanding and compliance • Documentation • Computer generated protocols

5. Using The Pneu-M.A.P.™ Pg 9 • Level M.A.P • Patients in a gown so wheel can run on the spinae process. • Stand patient in front of MAP heels against base.

6. Pg 9 • Adjust height so wheel reaches the sacrum. • Line patient up with wheel on spinae process at lumbar apex. • Run wheel down patients lumbar apex to make sure you are on spinae process.

7. Pg 11 • Patient--hands at sides, relax, stand normally and focus on point at eye level. • Tell patient you will put a finger on their forehead to prevent movement. • Move wheel from the lumbar to patient’s cranial apex. • Note:If wheel is off center of head, check the patient for Scoliosis or lateral shift.

8. Pg 11 • With thumb and index finger on wheel, run wheel with constant pressure down center of spine. • Start at cranial apex, run down to the sacrum. • The pen on the bar will trace contours of spine.

9. How to Read a Screening Pg 13 • Locate 6 points: • cranial apex • cervical apex (approx.. C4) • 4 lines down from cervical apex (approx. C7) • thoracic apex • lumbar apex • sacral apex

10. Pg 13 • Apex is furthest point out on curve. • If apex covers more than one point, pick center point. • If you have two points the same, choose lower of the two Exception: If cervical apex covers more than one point, choose points 4 lines up from C7 transition point. Palpate to find the sacrum before letting patient move. Place the wheel on that point. Make a mark on M.A.P. grid.

11. Each point will have a • Horizontal (x value) • Vertical (y value) • When reading points: • Stand directly in front of tracing. • Put mark on left side of the line • Read from right of line Pg 13

12. Pg 17 • Enter Patient • First Name • Last Name

13. Pg 19 Enter Screening Be sure to select Posture Enter Points Use Tab Key to move

14. Exercise Display Pg 21 The computer evaluates data and calculates curves and lean.

15. View Protocols Pg 21 • To view the exercise protocols click on the radio button at the top right of the Posture Analysis box

16. New Sessions Pg 23 • Select Visit • Select Billing • Select Screening • Enter New Points • Select Graph • Select Post Screening New protocols will be generated based on values entered into initial screening

17. Pg 39 The Pneu-Weight™ Buoyancy Without Water Unweighting is defined as applying vertical support to a patient in order to lessen weight bearing stress.

18. Pg 39 Benefits • Balance mode prevents falling. • Patients can exercise without fear. • Lumbar & cervical spine Unweighting.

19. Using the Pneu-Weight Pg 42 Key Benefits • Orthopedic Patients • Knee, Hip, & Ankle Injury • Back Problems • Gait Training • Cardiovascular • Overweight Patients • Respiratory Ailments • Neurological Patients • Assist in lifting wheelchair Patients • Cervical/Upper Thoracic

20. Pneu-Weight Components Pg 42 • The Pneu-Weight™ Unweighting system uses pneumatic power and the Pneu-Vest™ to support the patient. • The Pneu-Weight’s™ 1 to 360 lb. Unweighting range allows the patient to perform low-impact kinetic exercises in an upright, functional position • The center of the Unweighting system is the Pneu-Vest ™. This Unweighting harness fits the patient like a snug vest with leg straps.

21. The Pneu-Vest ™ Pg 43 • Fits all sizes • Supports comfortably • Allows confidence

22. Unweighting Pg 45 • Exercise Mode • Neurological or spinal cord injury • Post surgical • Sciatica • Balance Mode • Show the patient they cannot fall • Treadmill activities will be done in the balance mode.

23. Treadmill Walking Pg 47 • Forward • Lateral • Retro

24. Gait Analysis & Enhancement Pg 49 In working with patients in various stages we discover many of them have in common various strength imbalances, range of motion restrictions, and incorrect firing and recruitment patterns.

25. First Test Pg 49 • The first of these tests is forward walking on the treadmill while unweighted. • We are looking for any irregular stride patterns. • Our speed will be at a normal to challenging level.

26. Observation Pg 49 The most common things we will observe: • A tendency to toe in (internally rotate) • Toe out (externally rotate) • Poor pelvic stability • Circular gait pattern • Lack of coordination and support between upper and lower extremities. (Minimal arm swing, having to hold treadmill etc.)

27. Second Test Pg 51 • The second test we utilize is lateral side stepping at a normal to challenging level • Subject beginning facing to one side and then rotating 180° and doing the same thing facing the opposite side.

28. Observations Pg 51 The most common things we see: • A marked contrast in ability between one side and the other. • Toeing out • Inability to maintain balance at set speed. (The patient should maintain parallelity between the foot and the treadmill). • Important-the stabilizing leg is usually the one to look at in the case of improper recruitment, strength or fatigue.

29. Third Test Pg 51 The third test we will utilize is retro walking again at a normal to challenging level..

30. Observations Pg 51 Observing this test we typically see: • Minimal hip extensions one side or the other or both • Poor pelvic stability when attempting additional extension • Poor coordination and support between upper and lower extremities while conducting test

31. Recommendations Pg 51 • Aggressive ankle mobilization and strengthening program where indicated • Use the gait straps in various fashions • Utilize the treadmill in conjunction with the Unweighting system, the stretching program and the gait straps to get the subject to desired strength, endurance recruitment and flexibility levels.

32. Primary Gait Conditions Pg 53 External Rotation– With external/internal rotation each leg is independent and needs to be evaluated that way. Opposite leg may be externally rotated, straight or internally rotated. In externally rotated or internally rotated each leg may be treated concurrently. Often times with external rotation circumduction will also be present. The strap placement works for circumduction.

33. Pg 53 Internal Rotation–With external/internal rotation each leg is independent and needs to be evaluated that way. Opposite leg may be externally rotated, straight or internally rotated. In externally rotated or internally rotated each leg may be treated concurrently.

34. Pg 55 Varus & Valgus With both varus & valgus both sides will be done concurrently. The effect of the tensioning will be to bring the person out and begin establishing a new neuromuscular recruitment and gait pattern. Over-stridingWith excessive forward foot strike usually both sides will be done concurrently. The effect of the tensioning will be to reduce flexion and begin establishing a new neuromuscular recruitment and gait pattern.

35. Testing Balance Neurological Obesity Spondylolsis Stenosis Unweighting on Treadmill Pg 57 • Warm-up Acute & Chronic • Retrain Neuro patterns • Post Orthopaedic

36. Warm up Pg 57 The most effective program in working with and acute and chronic low back patient begins with a 10-12 min treadmill session while unweighted. We will employ the same steps as discussed in the unweighted assessment section: • 6 min forward walking • 2 min right lateral • 2 min retro • 2 min left lateral

37. Stretching Program Pg 57 At the conclusion of the warm up we will employ a self or assisted stretching program

38. Hamstring Pg 57

39. Psoas Pg 57

40. Piriformis Pg 57

41. Indicators for Unweighting Pg 59 • Break muscle spasms leading to acute / chronic discomfort • Limited Range of Motion • Changing lean patterns more aggressive than normal • Bulge / Herniation • Scoliosis • Spondylolysis • Post Surgery • Osteoporosis

42. Treatment Protocol Pg 61 Treating a patient with an acute or chronic low back problem • Put the patient in a vest and stabilize them in a Pneu-back chair • Unweighted position, whether in extension, neutral, or flexion, will be determined by: • Patient tolerance • Initial evaluation • What you are trying to accomplish

43. Pg 61 NOTE: A general rule of thumb on this is that you will take the patient opposite to what they are presenting. • Impingement with referral and anterior lean, normally distract in extension with thoracic pad all the way down. • Distraction in extension over pad will tend to maximize lumbar vertebral spacing.

44. By distracting in a certain postural attitude with a stabilized pelvis, a very effective lumbar distraction technique is accomplished and the erectors begin loosening up. By firing the abdominals to accomplish mobilization, further messages are being sent to the antagonist muscles to relax. By accomplishing active mobilization through the region with muscles in a distracted and relaxed state, a compression and decompression activity is initiated and a normal balance and circulation through the affected region is facilitated. Results Pg 61

45. Lumbar Unweighting Pg 61 • Unweight 50% of body weight for 6-8 minutes,then begin active recruitment • For anterior (forward) lean, Unweight in extensionapproximately 6 - 10” forward • For posterior (backward) lean, Unweight in flexion approximately 0 – 4” backIf patient does not tolerate extension or flexion unweight in neutral position

46. Active Recruitment inUnweighting Pg 63 Be very specific on what you are trying to accomplish • Acute - place pad at affected area approximately 20-25 psi 10-15 times, one set maximum range of motion • Chronic - same as acute • Excessive anterior (forward) lean if acute /chronic - may help to do all exercises Unweighted/in extension • Negative lean - same as excessive w/ positioning in flexion. • Limited range of motion unweight in extension - do protocols Unweighted

47. Pg 63 • Scoliosis - Unweight in extension • Use scoliosis pad on convex side to get unilateral recruitment. • Work multiple levels as necessary on convex side. • Spondylolysis - Unweight in flexion • Herniation/Rupture - Unweighting based on patient tolerance and specific area of herniation • Post surgical - same as acute • Osteoporosis - repetitions at therapist’s discretion

48. Cervical/Thoracic Unweighting Pg 65 Unweight6-8 lbs for 6-8 minutes, then begin active recruitment. Early stage resistance is often done by hand. • Excessive kyphosis (extension) • Limited range of motion (extension) • Forward lean when upper thoracic in balance (extension) • Further down on thoracic column (flexion or neutralposition) • Shoulder mobilization • Specific stabilized mobilization • Muscle Energy Techniques

49. Pneu-Angle Adjuster Pg 66 It provides the ability to unweight in any vertical direction. e.g. neutral, flexion, extension, in combination with neutral, right or left.