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Unit B – Hong Kong | 3 – 5 Apr 2021
April 3 @ 8:00 am - April 5 @ 5:00 pm$1920
UNIT B | MODULE 3 + 4
– motor control & progression
– general /ageing/ neuro / sporting cohorts
– programme based management
– healthcare 2020 & health reform
As clients improve, clinicians require a broader repertoire to progress patients safely. This module teaches programme progression and indicators to determine if/when client pathologies are stable & suitable to progress.
Clinical applications & pathology management
• problem solving co-existing pathologies
• prioritising between primary & secondary problems
• identifying/ manage multi directional/ global instabilities
• linking neuro research to differentiate motor learning from a pathology management approach
• managing neuro patients with Clinical Pilates and identifying links with normal patients
• managing the ageing population like athletes
• improving sporting/athletic performance with a non-sport specific approach
• Advanced case studies to develop individualized programmes with a strong clinical pathway & reasoning.
Module 4 links the Clinical Pilates program to the current health reform strategies being implemented by government. consolidates all levels to update the knowledge base, while further extending the exercise repertoire.
Clinical applications & pathology management
• additional clinically relevant exercises
• developing suitability for surgery / prehab programmes
• solving problems not just treating symptoms
• complex case studies for advanced clinical reasoning
• developing clinical pathways
• using outcome measures to quantify efficacy
• costing programmes for better financial returns
• Clinical Pilates cost reduction role in the current health
reform & primary care models
• how to integrate tele-medicine into patient care
• updates on the Clinical Pilates research faculty projects
• preparation for Clinical Pilates certification process
UNIT B-MODULE 3
Progressing patients requires a broader repertoire of techniques. As patients improve they will find exercises
and movement strategies easier. Using “load” to progress will lead to a strengthening/muscle hypertrophy
process that can compromise rather than enhance motor control. Instead, Clinical Pilates exercises are
progressed on a co-ordination/proprioception model that increases motor challenge and feed forward
planning (Hurd 2008).
The “stability” of a patient’s pathology can be tested by progressing from their specific subgroup into a multidirectional programme. If there is no degradation of their functional tests or outcome measures then the clinician can be confident of further improvement and a change in threshold of provocation. Proprioceptive deficits are more indicative predictors of injury than strength (Hurd 2008).
Patients will all differ on their ability to tolerate programme changes, as progression is not suitable for everyone. A heterogenous/patient specific approach is still key and the decision to, or not to, progress is based on the response to outcome measures & validated tests of function (Tulloch 2012). Outcome measurements will also be extended to incorporate a greater repertoire of measures of function. Progression to self-management can also be determined by the effect of measured treatment breaks.
The potential of co-morbidities requiring a more complex approach is also covered in this stage of the programme. A patient may have co–existing pathologies, such as a disc protrusion and a spondylolisthesis, which will require a multi directional approach, biased 80%–20% between primary & secondary problems (e.g. in this case disc as primary, spondylolisthesis the secondary problem).
Neurological patients are also showing strong preference to a directional exercise approach, further strengthening the indication there is a strong sub cortical process in proprioceptive training & function. Pilot studies on Traumatic Brain Injury & Hemiplegia are showing positive results. This has implications in both the neuro population and the ageing population, where there is a growing need for developing further
approaches managing this growingly complex & expensive group (Benjaminse 2011).
Similarly, the sporting population often lacks the higher levels co-ordination/proprioception to improve performance & prevent injury. Strength & conditioning training has a threshold of effect and proprioceptive deficits are often more to blame for injury than lack of strength (ACL injuries etc.).
Case studies looked at in this stage will further expand participants ability to develop individualized programmes for challenging presentations, using a simple clinical reasoning basis.
• Hurd,WJ ,Axe,M, Snyder-Mackler,L (2008) A 10-Year Prospective Trial of a Patient Management Algorithm and Screening Examination for Highly
Active Individuals With Anterior Cruciate Ligament Injury Pt 1 Am J Sports Med 2008 36: 40
• Long, A; Donelson, R; Fung,T (2004) Does it Matter Which Exercise?: A Randomized Control Trial of Exercise for Low Back Pain. Spine.
• Benjaminse A, Otten E (2011) ACL injury prevention, more effective with a different way of motor learning? Knee Surg Sports Traumatol Arthrosc
This final stage in the Clinical Pilates programme updates the knowledge base of previous levels with the most recent relevant literature. The treatment exercise repertoire is also further extended.
With the current focus on global health reform and cost vs outcome, the aim is to be able to provide a cost effective service that can be measured for both cost efficacy and positive outcomes.
Advanced clinical reasoning is heightened, with the focus moving to using the Clinical Pilates approach
within the current health reform models being established globally. As focus moves to hospital substitution
and simplification of processes to minimize and prevent surgery, there is significant scope for cost effective
programme based management.
In the UK, the NHS reform model has highlighted the need for “get it right first time” management and a
move toward primary care and hospital substitution. The focus on outcome measurement has sharpened to
ensure better treatment models. In Australia the mood is similar, with the shift towards Primary Health Hetworks
and hospital substitution further opening the door for physiotherapy, which is comparatively cost effective
and relatively cheap. Introduction of physiotherapists in extended scope programmes has shown significant
savings and this can be carried into the private system where costs of surgical interventions are rising at
unsustainable rates (www.phiac.gov.au).
The current private health insurance “death spiral“ (Grattan Report 2019) is increasing the load on our
already overstretched public system. While discussions of novel funding models to address the heavy skew
towards surgery & hospitalization, the scene is set for implementation of primary sector programs that can
reduce surgery and hospital admissions, particularly in the ageing population.
Pre-surgery physiotherapy programmes have the ability to reduce surgical costs and need for interventions,
screening for patients that will respond to conservative management rather than surgical approaches.
Development of partnerships with private & public funding bodies by providing a licensed programme
model, with trained and certified clinicians delivering Clinical Pilates treatment programmes, has the
potential to fulfill the needs of government policy. The cost of an ageing population and the need to keep
an active approach to management is fundamental. There now exists an approach that is more patient
specific than general exercise and can take into account the effect of structural degradation on
neurological & physical function.
Fritz J (2009) Clinical Prediction Rules in Physical Therapy: Coming of Age? J Orthop Sports Phys Ther 2009;39(3):159-161
Feldman, A (2008). Does Academic Culture Support Translational Research? CTS: Clinical and Translational Science;1(2):87-88
Goldblatt EM, Lee WH. (2010) From bench to bedside: the growing use of translational research in cancer medicine. Am J Transl
NHS ( 2011) www.dh.gov.uk/health/tag/white-paper/
Grattan Report (2015) http://grattan.edu.au/report/questionable-care-avoiding-ineffective-treatment/
Nicholson C (2012) The Evolution of a Primary Health Care System in Australia S25 JABFM March–April 2012 Vol. 25 Supplement
Grattan Report (2019) https://grattan.edu.au/report/the-history-of-private-health-insurance/
Grattan Report (2019) https://grattan.edu.au/a-blueprint-to-rein-in-doctors-bills-reduce-hospital-costs-and-cut-private-health-insuranceOn Completion of UNIT B you will be eligible to enter the Clinical Pilates certification process.