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Athletic development specialists dedicated to the art and science of excellence in movement

Dynamic Neuromuscular Stabilization (DNS) Course "B": Notes and Recap

Some notes from Dynamic Neuromuscular Stabilization Course "B" taught by Magalena Lepiskova and Clare Frank...

For previous DNS course reviews see:

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*Reflex locomotion = ultimate movement jumper cables (but you don't use them every time to start your car!)

*DNS offers just a very small sampling of Vojta therapy. Don't think you become a Vojta expert just by taking DNS...

*Why does developmental kinesiology matter? How does the individual interact with environment. Certain responses from developmental stages offer cues on how best to optimize treatment.

*Never force treatment response on patient; guide them to more effectively interact with environmental stimuli

*In Prague, DNS is only one fraction of the treatment approach. That's a key point that many new DNS practitioners often overlook. Don't forget the basics of what you already do (this applies to learning any new approach)

*Understanding planned movement is most important treatment fundamental in DNS. I think I write this after every course (one reason why taking Exercise I/II is so valuable before Course A and why self practice of developmental sequence is so valuable for all practitioners)

*Trigger points never occur in isolation. Relates to overall pattern of movement. Trigger points aren't necessarily bad. They provide valuable information on how the brain is perceiving external stimuli

*"Search and destroy" is not always the best approach to managing trigger points

*Trigger points = intramuscular incoordination. Think of treatment as a means to encourage intramuscular coordination, whether through exercise, manual therapy, environmental modification, etc. All goes back to how the brain is perceiving input

*Patient must be active participant in care

*Breathing is an audit on the nervous system

*Train the ability to breathe through different intensities of diaphragm engagement

*Common error in DNS treatment is impatience...insufficient time on breathing, not waiting long enough for changes via reflex locomotion, progressing too rapidly to more upright postures

*But don't wait forever with reflex locomotion. Some patients won't respond or may respond better to different position

*Not every response to reflex locomotion is a good one.  Some patients may increase kyphosis (not desirable). Important to understand anticipated movement so you don't assume treatment is working merely by presence of motion

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*Appreciation of subcortical movement properties is a way to "backdoor" into the sensorimotor system. This is consistent with contemporary literature on motor learning

*^^This is why we care about how babies move reflexively.  The programming is there; the next step is how do we access it and work with it (meet the patient where they are!)

*Pain is based on perception of threat. Ability to access subcortical, nonthreatening movement via "pre downloaded" patterns can accelerate the process toward pain resolution 

*Muscles should have the ability to function as both movers and stabilizers

*Management of support zones is one of the most powerful cueing options we have (very consistent with ideas of Feldenkrais...also FMS 4 x 4 matrix, progressing from grounded to standing postures...)

*Precision of alignment - change in one place leads to change elsewhere

*The more effective your treatment setups, the less you need to rely on verbal cueing

*But verbal cueing plays different role with babies as with adults (importance of face + voice recognition in infants, language development at young ages)

*When you dial something down, you must dial up someplace else (match mobility with stability)

*If you can't handle a load with good form, you can still function with bad form but there is a price to be paid...(not necessarily pain, could be increased stress...this is what we see in many developmental disabilities)

*Muscle tone is an expression of the brain's perception of the environment

*Assess movement quality in regressed postures, not only "most functional" upright postures. Reveals how brain chooses to interact with ground/support zones

*Note hand position/behavior during elevation tasks

*Importance of precise and repeatable commands during assessment

*Kyphosis can be strategy to assist breathing. Can offer more stable position. Always a subconscious drive to breathe. Not merely a structural issue...in other words, telling people to sit up straight is insufficient if you haven't corrected breathing issue

*Learn to see every "dysfunction" as a neurological strategy. Sometimes voluntarily chosen, but more often involuntary (thus, importance of appreciating different layers of nervous system)

*Kyphosis can hide scap winging

*Parts of pelvic floor can be weak. "Pelvic floor dysfunction" should not be used as all encompassing term

*What if "proper" breathing is provocative for disc pain patient? Cue breathing up to point where pain onsets but don't go into pain

*Connect scap to chest when sitting in car. More efficacious cue than "pinch shoulder blades back"

*"Maintain ground contact pressure" - simple cue for many exercises. Teaches nervous system to interact with external environment

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*Best for patients to get out of lordosis themselves. Only use external supports for pain. Play with body position (supine, prone, oblique sit, 1st position, etc) to find right environment to facilitate change. Can sometimes facilitate change without exercise (sets, reps).  Just get there and let the position marinate 

*Set up patient to be successful. Consider whole body position for mobilizations. Finding the right position to minimize perception of threat can make mobilization easier (=patient more accepting of intervention) 

*Finding right grounded developmental posture can obviate need for certain treatments. Ability to find these postures encourages self management by patient and creates better flow into movement program

*Lateral sway during quadruped is developmental analog to upright Trendelenberg

*Elongate spine to produce segmental rotation. Body perceives advanced developmental position and can disinhibit rotational restrictions ("taking off the brakes")

*During unilateral reaching tasks (especially 4.5 mo position), the main problem may be the support arm, not the reaching arm

*^Very similar to troubleshooting a heavy Turkish getup. Another good example "hard" and "soft" training existing along treatment continuum

*Parents are unable to assess quality of movement - difference between "falling from one position" versus stereotypical rolling

*ATNR is not pathological if it is the result of following object. Occurs after onset of optical fixation.  Presents as hand open + arm extenstion and rotation

*Plantar reflex disappears when stereognosis of foot appears. Palmar grasp disappears with onset of purposeful grasp

*Hand stereognosis first occurs on ulnar side of hand.  Ulnar grasp occurs before radial

*Galant disappears when segmental rotation of spine occurs

*Spontaneous motor -> Postural reactivity -> Primitive reflexes

*Importance of optical fixation for musculoskeletal stability. Musculoskeletal reveals state of nervous system.

*Pathological tongue = tongue only goes forward and backward (expect 4-5 month onset for lateral tongue)

*Primitive reflex presentation can be asterisk sign for effectiveness of treatment (kids and adults). Integration is signal of higher level motor control accessibility

*Postural reaction is baby's answer to environmental situation. Treat by modifying the environment to facilitate change, not by forcing change upon the patient

*Effect of vertical postures on treatment - Don't always need to follow a linear developmental sequence. Sometimes higher level postures will elicit the most desirable response. Nothing wrong with working backwards 

*Common flaw in supine treatments (ie. 90-90 setup) is insufficient loading of T/L junction.

*Proper loading of T/L junction engages abs more than hip flexors

*Social bipedal locomotion -need to stop to turn around at 12 months; turns should be continuous at 14-16 months

*Assess how many steps required after stop and how big was turn radius (similar to on-field assessment for athletes turning/cutting)

*Review of ipsilateral versus contralateral patterns: turns are progression from rolling patterns

*Rocking back and forth during crawling indicates inability to differentiate between tonic and phasic

*Build movement into treatment, build treatment into play. Developmental kinesiology creates framework to interject appropriate interventions along preexisting neurological framework

General Observations

*Heavier into pediatrics than Course A (in part because Course A is structured to provide the first exposure to clinicians who did not take the Exercise courses).

*Only learn two additional reflex locomotion sequences (RT2 and 1st position)...but extremely valuable review on RT1 and RC1.

*Realize how many nuances you can miss in RT1 and RC1, which leads to a greater appreciation of the basics and understanding of when RL is appropriate