Dynamic Neuromuscular Stabilization (DNS) is a rehabilitation strategy based on developmental kinesiology, viewing movement and posture through the lens of infant neurodevelopment to assess and treat musculoskeletal and neurological conditions.
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dear colleagues we are pleased to
introduce the rehabilitation concept
that includes neuromuscular functional
assessment and treatment called dynamic
neuromuscular stabilization
dynamic neuromuscular stabilization
in short dns is a unique rehabilitation
strategy based on the principles of
developmental kinesiology
and the neurophysiological and
biomechanical aspects of the maturing
postural locomotor system
dns defines posture breathing patterns
movement and joint function from a
neurodevelopmental perspective
normal early progress
during the first year of life leads to
the development of an optimal postural
locomotion function
dns assessment is based upon the
comparison between the patient's
stabilizing motor pattern and that of a
healthy infant
the treatment approach is based on
ontogenetic postural locomotor patterns
optimizing the distribution of internal
forces of muscles that act on each
segment of the spine
and or any other joints is the primary
goal of this treatment approach
one of the most important
neurophysiological principles dns
applies is the relationship between the
cns control mechanism
muscle function and the anatomical
parameters of the skeleton
the correct central program that is the
physiological development
enables balanced muscular coordination
which ensures an optimal movement
strategy resulting in optimal formative
influences on skeletal structures and
thus ideal morphology
here is an example
what are the differences in shape
between the newborn and adult femur
the newborn has a femoral neck shaft
angle of 150 degrees
whereas the norm for an adult is 125 degrees
degrees
during human development the muscles are
used differently in specific
developmental positions forming the
maturing bone as it grows
if the brain develops physiologically
optimal muscle coordination occurs and
the child presents with physiological
movement patterns ensuring optimal
skeletal function generally
generally
we can say
the function forms the structure
and the structure then serves the function
function
under pathological conditions we can
observe not only abnormal postural
locomotion function
you can see that the patient is not able
to stand or walk independently and
require support from the use of crutches
furthermore bone and joint deformities
occur as well
generally stated dysfunction deforms the structure
structure
this rule is very evident in infants
when the skeleton develops rapidly but
we can also observe such close
relationships between structure and
function in the adult population
suboptimal postural development is
imprinted into the morphology of the
adult skeleton and muscular system here
here
you can see hypertonic paraspinal
musculature related to lower ribcage flaring
flaring
or abnormal position of shoulder blades
dysfunctions can be presented in static
but even more in a dynamic situation
meaning during movement
generally we can describe three basic
types of global postural movement
patterns that occur during child
development in everyday life activities
and also during sports
first we present an undifferentiated
symmetrical movement pattern where both
upper or lower extremities work
symmetrically either in an open or in a
closed kinematic chain
in the upper pictures we can see that
both the infant and the adult activate
all four extremities in phasic function
which means in an open kinematic chain
squatting as can be seen in the bottom
pictures represents the situation when
both lower extremities work in closed
kinematic chains serving for support
while both upper extremities are phasic
working in open kinematic chains
secondly we present the ipsilateral
pattern which occurs when the same side
extremities work in a closed kinematic
chain serving for support
meanwhile extremities on the other side
of the body are phasic
working in open kinematic chains
we use the ipsilateral pattern whenever
our body rotates
and finally we use contralateral
patterns whenever we want to move our
body forward for example when we creep
run walk or climb
in this pattern the opposite side
extremities for example right upper and
left lower limb both work in an open
kinematic chain stepping forward meanwhile
meanwhile
the left upper and the right lower limbs
work in a closed kinematic chain
the ipsy and contralateral pattern
develop simultaneously
during the first year of human life
all three global motor patterns
undifferentiated symmetrical
differentiated ipsilateral
and contralateral patterns are each
fully dependent on trunk stabilization
trunk stabilization is a prerequisite
for all movements developmentally trunk
or core stabilization is completed
at the age of three months
the cervical and upper thoracic spine
is stabilized
via well balanced
coordination between deep neck flexors and
and
cervical spine extensors
diaphragm pelvic floor and abdominal
wall musculature regulate
intra-abdominal pressure which
stabilizes the lower thoracic spine
and lumbar spine from the front
paraspinal musculature stabilizes the
perfect stabilization synergy
keeps the chest and pelvis in a parallel position
position
trunk stabilizers must be active
before the phasic movement starts
it is a feed forward mechanism which
this animation demonstrates how the core
needs to stabilize
and maintain the neutral spine during
hip movement
when trunk stabilization fails we can observe
observe
ribcage and pelvic instability
especially during movements resulting in
lumbar and cervical spine compression
and overload
permanent suboptimal stabilization may
result in repetitive strain injuries of joints
joints ligaments
ligaments
and intervertebral discs
in assessment we always compare the norm
defined by physiologically developing
children with the quality of postural
stabilization presented by the client
for example
this child presents with a perfect
spinal elongation
while in the adult we can observe
cervical spine collapse from a rigid
thoracic kyphosis
the supine child
demonstrates perfect neutral position of
the trunk
while the patient's flaring of the
ribcage can be seen
in dns any developmental position can be
used in treatment training and self-treatment
self-treatment
at first the clinician manually assists
to achieve ideal stabilization
later the patient continues with
self-treatment making the exercise more
challenging by adding the movements load
resistance and any other kind of stimulation
dynamic neuromuscular stabilization
serves numerous purposes
it is a functional diagnostic concept
dns assessment is based upon the
comparison of the patient's stabilizing
pattern to that of a healthy infant
developmental kinesiology helps us to
explain and understand the etiology of
various musculoskeletal disorders [Music]
[Music]
the treatment goal is to achieve
functional joint centration
global muscle coordination and optimal
trunk stabilization
ideal respiratory patterns
because dns is based on
neurophysiological principles
we can apply the concept in the
assessment and treatment of various
patients or clients
such as developmental problems in infants
infants
poor posture and scoliosis in kids
to prevent and treat repetitive strain
injuries in the athletic population
to treat common musculoskeletal disorders
disorders
neurological and orthopedic patients
and senior clients as well
in women an important topic is pelvic
floor dysfunction
pregnancy or problems after labor and delivery
what exactly can we do for our clients
let us introduce the most important
topics we cover in dns courses
it is critically important to recognize
any sub-optimal development in infants
especially during the first year of life
in pathological cases it is necessary to
start with treatment as soon as possible
before any abnormal movement patterns
have become
established therefore in dns pediatric
courses we teach course attendees how to
distinguish normal and abnormal
development during the first year of life
life
applying dns principles in infants
during the first year of life we can
stimulate the achievement of important
developmental milestones at appropriate times
times
we can stimulate symmetrical development
we can improve the quality of movement
we can educate the parents how to
properly handle infants
and what appropriate tools to use
when applying baby handling
therapeutically we stimulate the child
to reach the position that is typical
for the infant's developmental age in
those instances when the child cannot
adopt it spontaneously
the proprioceptive information resulting
from proper positioning
and approximation
stimulates the infant's brain
and allows it to learn and establish the position
position
the ultimate goal is to make the child
integrate the newly learned position as
spontaneous motor behavior
our educational system called dns fit
kid is a program for younger school-aged children
children
six to 10 years of age
who suffer from poor posture
need to improve core stability and or to
be better in sports
the program consists of exercises based
on five developmental positions it
serves as a home exercise program for
children aimed at both the treatment and
prevention of musculoskeletal pain
these exercises can also be used as a
fundamental dynamic warm-up for not only
common recreational play but also youth
athletic training
the dns exercise app and dnx exercise
journal explains the developmental
exercise positions to children in a fun
relatable manner
comparing them
with the way animals characteristically
move and pose
the concise text and colorful
illustrations help to explain not only
how the child ought to move but also
what they should feel during exercise
movement or position details about how
to detect and correct the common errors
and movement faults typically seen with
each exercise are included
to incorporate speech development while
also helping train exercise transitions
movement therapy
mimicry and team exercise
the dns has included a variety of
rhythmic songs to be sung by the user
why to apply dns in sport optimal
posture is a prerequisite for top
athletic achievements and safe sports performance
performance
every sport has different training
methodology strategies and tools however
trunk stabilization is a cornerstone for
every motion
please compare the two exercising individuals
individuals
the lady performs with the poor quality
of intra-abdominal pressure stabilizing
mechanism while lifting her legs
as a result she increases spinal
lordosis and overloads the lumbar spine
on the contrary the exercising gentleman
demonstrates an example of excellent
trunk stabilization
and optimal intra-abdominal pressure
control even when lifting the legs while
exercising with the load in his hands
his back adheres to the floor due to
increased intra-abdominal pressure which
stabilizes the spine ventrally
preventing hyperlordosis and lumbar overloading
overloading
demonstrating command and control over
each sport position and the transitions
from each position is the goal of the
entire movement
in sport training dns emphasizes
functional joint centration
quality of movement
full body awareness
appropriate breathing stereotypes
sufficient stabilization for speed endurance
endurance strength
strength
and increased quality of
movement dns can also be applied in
neurological patients with various
central and peripheral nervous system disorders
disorders
it is important to analyze neurological
symptoms in detail and set up optimal
treatment strategies based on clinical
neurological assessment
cns disorders are analogous to
ontogenesis reversed that is to say the
greater the brain lesion the more the
patient's posture resembles that of the
neonate but sensory and motor cortex
organization can be changed with
appropriate exercise the dns goal is to
restart that organization and
rehabilitate postural locomotion
function toward higher developmental
positions and better movement
neurological patients frequently lose
their independence and the ability to
perform activities of daily living thus
suffering from reduced quality of life
cns treatment goals are to address the
clinical symptoms
that can be influenced by postural
training and sensory motor integration
the ultimate goal is to achieve the
highest level
of motor function
verticalization and locomotion
allowing for maximum independence
depending on the level of disability and
available postural locomotor function
the condition of patients with
neurological deficits can be compared to
the developmental stages
the dns therapeutic goal is to achieve
the highest possible developmental stage
which means the highest possible degree
of locomotion even with reduced posture
and movement quality
neurological patients with different
types of diagnoses may present with
similar problems for example
shoulder dysfunction may occur after stroke
stroke
peripheral nerve injury
in a patient with muscular dystrophy
or after spinal cord injury
in all of them we aim to evoke maximum
compensatory capacities
allowed by present morphological limits
and neurological deficits
in order to achieve the best function
here is an example of how we work with
the patient with a c7 t1 spinal cord lesion
lesion
we train trunk stability in a
developmental position called low
oblique sit
which corresponds with the developmental
age of seven months
trunk stability is critical for safely
sitting in a wheelchair
transferring from the wheelchair to a
bed or bath
as well as for breathing and for communication
communication
here you see dns training in a stroke
patient suffering from right-sided
paralysis typical symptoms following strokes
strokes
involve disturbed gait disturbed balance
and sensory motor deficits on the
paretic side of the body the first goal
is to stimulate sagittal core
stabilization and appropriate breathing stereotypes
stereotypes
for such purposes the three-month
developmental position can be used
exercising in the low oblique sit again
corresponding with seven months
developmentally the therapist controls
trunk stabilization and supporting
function on the paretic side in order to
achieve optimal body awareness and
postural locomotion function
pain and range of motion must be
simultaneously respected and controlled
the modern population is aging on a
daily basis seniors must deal with
various signs of functional and
structural involution such as decreased
maximum aerobic capacity
general fatigue sarcopenic muscular weakness
weakness
reduced sensory processing due to
limited sight
hearing and balance
and many other disturbances
some symptoms may be positively
influenced by dns training
endurance and difficulty of the
modifications must be adjusted to meet
the individual clients capacities
when exercising the movement needs to be
slow the client must be fully aware of
appropriate weight bearing of support
segments and phasic movement performance
the goal is to maintain or increase
range of motion and to maintain muscle strength
strength
the exercise also has a positive effect
on cardiovascular conditioning and
cognitive function
we must always respect the individual
limits of a particular client
when working with the aging population
it is essential to integrate stretching self-mobilization
self-mobilization
core stabilization strengthening
strengthening endurance
endurance
and sensory stimulation within each
series of exercises
dns strategies can serve all of these purposes
purposes
all the programs should be integrated
into daily life activities
dns assessment and treatment follows the
same principles regardless of what kind
of patient we work with
this is because dns is not a technique
again it is a general
neurophysiological principle
for more information please visit the
dns website and subscribe to the dns
online library
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