UTTERANCES USING TRAINING AID INTERPRETATION “

16) so you don’t have any referred symptoms didn't have any particularly dermatomal pattern didn’t have any pins and needles anaesthesia didn’t have latent things « they didn’t increase on weight bearing ‘cos they were already there in the morning weren’t they and then they got better when you were moving around = reflexes are fine no muscle weakness no tension signs so it’s not a neurological problem

Hypothesis 1.1

IF <theæ am no naurdogical signs & symptoms>fA E N {the problem Is not n e u r o g e n i c } - KS [neural pattern] " ^ PATTERN

" I ) ' r

17) arthogenic any local symptoms yes do they increase on static postures yes on sitting any early morning stiffness

Diag n o svc Cues

<Local symptoms>

increased on static postures>

19) OK does active movement reproduce your symptoms yes extension = passive testing wasn’t tested « accessory palpation = does produce your symptoms on L4 and L5 PA and unilaterals does active movement look stiff = yes yes any stiffness on passive testing any resistance on accessory palpation yes on the unilaterals on the right side = any abnormality of quality of movement

Diagnostic Cues

<Symptoms reproduced on active and passive tests> <Active movement looks stiff>

21) any abnormality so 1,2,3,4,5,6,7, so 1 think there’s an arthrogenic abnormality

Hypothesis 2.1 |

IF <data>THEN {problem has arthrogenic component}

KSlom tpattem ] SYMPTOM

22) well I’m not sure why she’s lost her lordosis whether that’s part of her posture and that's causing the problem or whether it’s the stiffness and soreness in her back that’s caused her to do that 1 mean it’s obviously a joint problem that’s caused her to do that 1 think to do with L4 & L5

Hypothesis 2.2 »

IF <possible jo in t problem, decreased lordosis, pain & e

stiffness>THEN {problem is postural} BUT symptoms are coming from joints (L4/5)

KS [posture] [joint pattem] PATTERN

23) 1 think maybe I’m not sure OK there’s no active passive mismatch there’s possibly some muscle imbalance ’cos her posture’s a bit unusual and she’d got poor abdominals

Hypothesis 3.1 ¥

IF <mascle weakness (abdominals) & postural abnorm ality>

THEN {could be attributable to muscle im balance} KS [muscle dysfurtctionjs PATTERN

25) do symptoms increase on stretching = no you didn’t have any pain on all that so is there any soft tissue tightness there is 1 think yes at L3 any symptom reproduction on palpation yes = on accessory movements but not on actual just on palpation = do tissues feel abnormal on palpation

Diag n o svc Cue

<Soft tissue tightness at L3>

27) any muscle tightness # but obviously with the tightness there obviously is some kind of problem with the muscles and soft tissues so I’ve got to go back to this what do 1 think has happened to it L4 & 5 = they w eren’t stiff on PA they’re only sore = is it possible that they’ve moved back 1 don’t know that they’ve got 1 can’t remember what it’s called 1 don’t know they’ve got her posture’s kind of well 1 don’t know actually

Hypothesis 3.2 "

IF <tissue tightness & possible muscle imbalance w idi (puscle weakness> THEN {the tight soft tissues are contributing to the problem}

Chapter 8: Testing the Model Page 137

Figure 8.1: Final Model for S4^

Methodological Knowledge

d a ily a ctivitie s: area o f sym p to m s; b e h a v io u r o f sym ptom s; kind o f problem ; d a ily p a tte rn ; spe cia l q u e s tio n s ; X -ray; ra n g e o f m o v e m e n t testin g; p a lp a tio n testin g; o b s e rv a tio n ; n e u ro lo g ic a l te stin g ; m u s c le testin g

Object L evel KSs

P o stu re ; n e u ra l p a tte rn ; jo in t pa ttem ; fa scia l p a tte rn ; m u scle d y s fu n c tio n BLACKBOARD P IC T U R E 23 P A T T E R N 22 2 7 S Y M P T O M \ ■ ■■ 1 _\ s y m p to m s re p ro d u c e d o n a c tiv e an d p a s s iv e te s ts (1 9 ) s o ft tis s u e tig h tn e s s a t L 3 (2 5 ) L o c a l s y m p to m s (1 7); In on s ta tic p o s tu re s (17); m o v e m e n t lo oks s tiff (1 DIAGNOS icrea sed a c tiv e 9 TIC CUES

The subject’s initial hypothesis was modelled on the blackboard as an entry at the pattern level produced by triggering of KS [n e u r a lp a t t e r n] , HypothesiSp, concerned the joint dysfunction and was

subsequently extended to state the structures but not the pathology. These utterances are represented on the blackboard as entries at the symptom and pattern level respectively, following triggering of KS [p o s t u r e] and [j o i n t p a t t e r n] . Hypothesis^] (which was the basis for the proposed

treatment plan) showed a, top down reasoning. The utterances identified a possible diagnosis and then extended it by adding,interpretation of symptoms. This subject failed to generate any hypotheses relating to symptom severity, such as were identified in the unaided protocols. Consequently, KS