A Non-Pharmacy Approach to Neurological Patient's Pain and Spasticity
A Non-Pharmacy Approach to Neurological Patient's Pain and Spasticity
  • Total Seat(s): 50
  • Left Seat(s): 50

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.

Speaker biography

Annie O’Connor, PT, 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 Pain and Hypertonia clinical practice. In addition, she is a Physical Therapy Manager for Anthem AIM Specialty Health Back Pain Guide Program. Annie has co-authored 2020, Pain Mechanism Classification Chapter, Rehabilitation of The Spine: A Patient Center Approach 3e, Liebenson C (ed). Wolters Kluwer Philadelphia publisher. She has co-authored 2021 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 treating 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 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 framework 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, 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 and spasticity to achieve the best life possible through her Chicago based private practice.

Melissa Watson, MSPT, Cert. MDT is Vice President of the World of Hurt, LLC and assistant instructor for the World of HURT six training courses. She received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago Burr Ridge Outpatient Center with 20 years of clinical experience in neurological rehabilitation. Melissa is a Master Clinician and certified clinical instructor with the Shirley Ryan Ability Lab 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 is leads other Day Rehab clinicians on research supported pain science education group that are focused on pain science education and active care treatment for patients with centrally dominated pain throughout 6 sites of care facilitating a standard for education through inpatient and outpatient clinicians in a large system of care. She certified in Mechanical Diagnosis and Treatment – McKenzie Method. She is an instructor of the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” and uses both sub grouping methods exclusively in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.

Course Objective(s)

Upon completion of the course, participants will be able to apply the principles directly into their clinical practice.
At the conclusion of this course, participants should be able to:

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.

Course Outline

Saturday, October 22, 2022
7:45 Registration / Continental Breakfast
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

Sunday October 23, 2022
7:30 Continental Breakfast
8:00 Lecture: Central Nervous System (CNS) Subgroups Subjective and Objective Characteristics 
8:45 Lecture: CNS Intervention Patient Education and Active Care Exercise Prescriptions 
9:30 Workshop: CNS Paper Cases Classification Exercise
10:00 Break
10:15 Words Workshop / Patient Demonstration: Yellow Flag Risk Form; Pain Science Education; 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; Dynamic Neuromuscular Stabilization (DNS) Approach to Hypertonia Treatment
2:30 Break
2:45 Workshop: DNS Exercise Progression
4:15 Questions / Answers
4:30 Adjourn


Providence St. Vincent Medical Center

Souther Classrooms

9155 SW Barnes Rd.

Portland, OR 97225

**This location is subject to change if COVID guidelines require using a facility outside the hospital.**

A Non-Pharmacy Approach to Neurological Patient's Pain and Spasticity
Registration Information

Registration: Registration is on a first-come, first-served basis. Space is limited.  Masks will be required for the entirety of the course.  

Registration Fee: The registration fee is as follows: 

$299 for Providence employees, $595 for all other participants. An additional $50 early bird discount is available to participants who register prior to October 1, 2022.   Registration fees cover electronic certificate of attendance and course handout. 

Refund Policy: Full refunds less a $25 administrative fee will be granted if cancellation is requested by October 8, 2022. No refunds will be made after that date unless the course is cancelled by Providence Rehabilitation Services, in which case full refunds will be issued.

Contact Hours: This course qualifies for 14.75 contact hours for Physical Therapists and Physical Therapy Assistants, Occupational Therapy and Occupational Therapy Assistants in Oregon and Washington.  Certificates of attendance will be issued to all participants completing the CEU requirements.  This course may qualify for continuing education in additional states.  Please contact joanna.mullett@providence.org to see if continuing education is available in your state.