Objectives: Manual and physical therapists incorporate neurodynamic mobilisation (NDM) to improve function and decrease pain. Little is known about the mechanisms by which these interventions affect neural tissue. The objective of this research was to assess the effects of repetitive straight leg raise (SLR) NDM on the fluid dynamics within the fourth lumbar nerve root in unembalmed cadavers. Methods: A biomimetic solution (Toluidine Blue Stock 1% and Plasma) was injected intraneurally, deep to the epineurium, into the L4 nerve roots of seven unembalmed cadavers. The initial dye spread was allowed to stabilise and measured with a digital calliper. Once the initial longitudinal dye spread stabilised, an intervention strategy (repetitive SLR) was applied incorporating NDMs (stretch/relax cycles) at a rate of 30 repetitions per minute for 5 minutes. Post-intervention calliper measurements of the longitudinal dye spread were measured. Results: The mean experimental posttest longitudinal dye spread measurement (1.1 ± 0.9 mm) was significantly greater (P = 0.02) than the initial stabilised pretest longitudinal dye spread measurement. Increases ranged from 0.0 to 2.6 mm and represented an average of 7.9% and up to an 18.1% increase in longitudinal dye spread. Discussion: Passive NDM in the form of repetitive SLR induced a significant increase in longitudinal fluid dispersion in the L4 nerve root of human cadaveric specimen. Lower limb NDM may be beneficial in promoting nerve function by limiting or altering intraneural fluid accumulation within the nerve root, thus preventing the adverse effects of intraneural oedema.

A learner's development of orthopaedic manual physical therapy (OMPT) psychomotor skills may be influenced by selected intrinsic and extrinsic factors. The purposes of this study were to identify the factors that influence learners' development of manual physical therapy competencies and to define each factor as intrinsic or extrinsic. A 3-round Delphi method survey and a retrospective review of the data were used to develop composite scores and rankings. Eighty manual physical therapy educators participated in the 3 rounds. Thirty-six factor descriptor statements associated with manual physical therapy competency were established and further categorized as intrinsic (19 total), extrinsic (10 total), or conceptual outliers (7 total). Cognitive Processing ranked as the most important factor influencing manual physical therapy competency development. Adaptation ranked second, followed by Science Knowledge. This study is the first to establish manual physical therapy educational factors associated with attainment of competency. The majority of the factors distill into the theory of extrinsic and intrinsic factors identified by Schmidt and Lee. The outcomes of this study identify the factors to which OMPT educators should give particular attention when developing and executing the learning experiences for their learners. Keywords:Competency-Based Education, Curriculum, Delphi Technique, Factors, Motor Learning, Musculoskeletal Manipulations, Psychomotor Performance. S pecific manual and/or movement-based competencies are emphasized by physical therapy educators during learners' development of psychomotor skills. Psychomotor skill acquisition is a product of psychomotor learning, which is a set of processes associated with practice or experience leading to relatively permanent changes in the capability for responding to stimuli 1 . As a consequence of psychomotor learning, individuals gain greater movement efficiency, develop more complex movement control strategies, optimize movement behaviors, and develop movement expertise 2 . Schmidt and Lee identified five extrinsic and four intrinsic factors that influence psychomotor learning factors are 1) practice, 2) feedback, 3) task classification, 4) instruction format, and 5) movement context. Factors such as practice, which involves cognitive processing 3,4 , accentuate learned abilities through the processing of sensory information 5 . The use of quantitative feedback and concurrent feedback in manual physical therapy learning has provided both favorable [6][7][8] and unfavorable results 9 . Visual instructional formats incorporate observation to facilitate psychomotor skill acquisition 10 , while kinesthetic instruction uses the learner's sensory system by physically moving the learner through the task 11 . Finally, movement context appears to influence psychomotor skill acquisition 12 . The intrinsic factors include 1) attention, 2) memory, 3) motivation, and 4) psychomotor learning stage 13 . These factors are less tangible and more difficult to measure t...