Mobilization and Stimulation of Neuromuscular Tissue (MaSoNT)

By Dimitrios K. Athanasiadis

Mobilization and stimulation of neuromuscular tissue (MaSoNT) is a "hands-on" treatment technique which is applied in neurorehabilitation and aims to enhance and facilitate muscle activity. At MaSoNT, the therapist applies several maneuvers in order to bring nerve and muscle fibers into contact as this elicits recovery responses for stroke patients in terms of both facilitation and inhibition.

 

  In this course, details with regards to physiology is given at the first part. There, some analysis is provided on physiology of how the generated signal is triggered and travels all the way to the higher centers of the central nervous system in healthy individuals. Moreover, there is some emphasis on how stroke changes it all and then focus on what is the physiological response on the "bottom-up" somatosensory techniques we therapists apply in every-day clinical practice. To that end, you will find interesting to learn how motor learning works and offers the principles upon which us therapists choose to guide the procedures of cortical reorganization inside stroke patient's brain towards functional recovery. To sum up, in this part you will learn why we use MaSoNT in stroke recovery.

• Language: English
• Publisher: Dimitrios K. Athanasiadis
• Release date: Feb 20, 2023
• ISBN: 9798215828540

Dimitrios K. Athanasiadis

I studied physiotherapy in Greece, did my MSc in Neurological Physiotherapy at Keele University, UK, and have about a decade of experience in neuro and orthopedic cases from several rehabilitation clinics. Moreover, I'm the founder of the MaSoNT concept® and owner of the Dimitrios K. Athanasiadis Private Physiotherapy Practice. I review or have reviewed articles for the jounals: Advances in Rehabilitation. Physiotherapy Quarterly and the journal of the Panhellenic Physical Therapy Association. Furthermore, I teach courses for both physical and occupational therapy assistants at the Public Vocational Training Institute of Kavala. In my free time I like playing and writing music on my guitar, ukulele and keyboards, read and write books, watch documentaries and TV series as well as jog. My clinical catchphrase is that, ''I  don't know how to treat every patient's problem but I know that I won't sleep all night unless I come up with some kind of solution''.

Book preview

Contents

Chapter 1

1.1 Introduction

1.2 Normal physiology before stroke

1.3 Physiology of stroke

Chapter 2

2.1 Physiology underpinning recovery model hypotheses for MaSoNT

2.2 The brain-derived neurotrophic factor generation hypothesis

2.3 The reflexive hypothesis

2.4 Cortical reorganization enhancement by sensory input as a way of motor recovery

Chapter 3

3.1 The literature review on physiology

3.2 The clinical research

3.3 The case study

Chapter 4

4.1 Before applying

4.2 Basic facilitatory technique for the upper limb

4.3 Basic facilitatory technique for the lower limb

4.4 Alternative facilitatory technique for the lower limb

4.5 Basic inhibition technique for the upper limb

4.6 Basic inhibition technique for the lower limb

4.7 Twisting for the upper limb

4.8 Twisting for the lower limb

4.9 Finger swiping

4.10 Patient’s education

4.11 How to use the techniques (case studies)

Chapter 5

5.1 The initial thought

5.2 The APRAHL algorithm

Reference list

Preface

I discovered Mobilization and Stimulation of Neuromuscular Tissue (MaSoNT) when taking a course as an undergraduate student on trigger point’s stimulation. Trying to press a trigger point on a muscle band of the extensors of the upper extremity, a small contraction appeared. However, no trigger point existed. What I initially thought was a local twitch response, turned out to be something inexplicable to me. I started applying on many other patients after that and the inexplicable grown even more. It lured me into further exploring. The whole concept based on this exploration is what will be elaborated as briefly, concisely and comprehensively as possible in this textbook.

One of the scarce times that I turned on my TV, I watched a BBC documentary on the psychology interventions of Afghanistan. There was a moment where a psychologist was narrating a story of how the people of a certain city punished a thief in order to later focus on the effect this event might have on the psychology of those watching. It was said that the people punished the thief by cutting his hand off his body and throwing it on the air for everyone to see. When the hand laid on the ground, it was said that they could see the fingers of the hand still moving. Why shall the fingers of the hand still be moving since the hand had no connection with the body?

I know it was a very macabre way to realize anything - and even more macabre for the people who actually saw that - but that incident made me understand how strangely the human body acts. Thinking of this incident as if it was a stroke patient, the query still applies. Before and early after stroke, the neuromusculature of the upper and lower limp remains mostly as is. Similar for the axoplasm, the nerves/nerve endings, the axoplasm etc. In a time-lapse of a few hours, before and after a CVA, everything on the upper and lower extremity keeps on being in the exact same state. Yet everything is different.

In my attempt to give a reason for applying MaSoNT, to give the physiological perspective of MaSoNT’s application, many difficulties arose. With all the support provided to me by Keele University and for which I will be eternally thankful, I came to hypothesize at least seven different reasons for why this concept might be of help for stroke patients. I strongly believe that this handbook would be of great help for any neuro-physiotherapist worldwide, a perfect companion for the dozens who undertake MaSoNT’s Udemy course as well as all those who wish to have their understanding of this concept built upon a solid basis. May it broaden your horizons, just like it did to me!

Chapter 1

1.1 Introduction

Mobilisation and stimulation of neuromuscular tissue (MASONT) is a hands-on facilitatory technique which is applied in neurorehabilitation and aims to enhance and facilitate muscle activity. At MASONT, the therapist applies several manoeuvres in order to stretch across the muscle belly. The application procedure for all the MASONT manoeuvres will be elaborated in details later on the chapters to follow. However, it was considered more helpful to first analyse deeper the effects that the application might have on a local, spinal and central level and then inform on the theory behind the application of MASONT.

Before more deeply analysing the background of MaSoNT’s application, it is necessary to know that the peripheral nerve has a space to move within its course through the surrounding tissue but some of its parts are more attached than others (Butler, 1991). To be specific, for the radial nerve at the upper extremity, the most attached areas are at the radial head and at the carpal tunnel where the nerve branches, as figure below shows (Butler, 1991). This means that, given that the nerve has some more attached and less attached sites and also that the most attached for the radial nerve are at the radial head and the carpal tunnel means that the less attached sites are placed between those two areas. The vulnerable injury sites for that specific nerve are mentioned to be the soft tissue tunnels, the branching sites, the fixed points and the tension points (Butler, 1991). As a result, MaSoNT could possibly take advantage of the aforementioned less attached areas of the nerve without potentially causing any damage to it, given that MaSoNT stays away from the aforementioned vulnerable to injury sites. When a transverse stretch and a little compression are applied in an intermittent manner to the periphery (as in MaSoNT), the therapist possibly mobilizes one fascicle against the other (Butler, 1991).

Following the application of MaSoNT, the observed result is a brisk muscular contraction. A similar result, named local twitch response (LTR), is observed after the therapist applies a snapping palpation to a taut band of muscle fibres and it may indicate the existence of a myofascial trigger point (MTrP) (Hong & Simons, 1998). LTR can possibly be triggered when the finger pinches strongly across a tangible band of muscle fibres in a way similar to when plucking a violin string, it may be either seen or felt or rarely both, it is common when the therapist quickly pushes hard at the MTrP and its justification is that the nociceptors of the MTrP cause sensory afferent discharge which passes to the SC and initiates a reflexive activity of the motor efferent (Baldry, 2005, p. 86) though there is also mechanical deformation of muscle and the effect of the stretch on the muscle spindle. Thus, there are some main differences between LTR and MaSoNT’s observed response: firstly, MaSoNT’s framework of use is deployed to and for