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Head and Cervical Spine Presentation in HSD/EDS

presented by Heather Purdin, MSPT, CMPT and Patricia Stott, PT, DPT, ATC, CHT, CYT

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Financial: Heather Purdin receives compensation from MedBridge for the production of this course. She is also a presenter for EDS Society and Providence Health System and is a coauthor of Taming the Zebra—It’s Much More than Hypermobility: The Definitive Physical Therapy Guide to Managing HSD/EDS.

Financial: Patricia Stott receives compensation from MedBridge for the production of this course. She is also a presenter for EDS Society and Home CEU and is a coauthor of Taming the Zebra—It’s Much More than Hypermobility: The Definitive Physical Therapy Guide to Managing HSD/EDS.

Nonfinancial: Heather Purdin is the president of the Oregon Area Ehlers-Danlos Society (nonprofit). She has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Nonfinancial: Patricia Stott has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 159 Minutes, Learning Assessments: 52 Minutes

The cranial bones are connected by sutures, which are fibrous joints. The brain is covered with dura, a type of connective tissue. For patients with an underlying connective tissue disorder, the cranium can be a source of chronic issues if the cause is not identified and treated effectively. This course will cover commonly seen issues throughout the cranium and discuss ideas for treatment strategies and referrals to improve outcomes. Recognition of these conditions is imperative to overall wellness; therefore, the information is applicable to all allied health professionals in all settings.

Meet Your Instructors

Heather Purdin, MSPT, CMPT

Heather Purdin has been a practicing PT in an outpatient setting for 26 years and has a special interest in chronic pain, fibromyalgia, and connective tissue disorders. She is president of the Oregon Area Ehlers-Danlos Society. She is also president of Good Health Physical Therapy & Wellness, a private practice specializing in connective tissue disorders…

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Patricia Stott, PT, DPT, ATC, CHT, CYT

Patricia Stott treats primarily those with HSD/EDS and those considered highly sensitive patients at her own practice, Elevation Wellness, outside the Denver metro area in Colorado. Also trained in functional and herbal medicine, she works on health and wellness through holistic strategies with these patients, both in person and through telehealth appointments. With an extensive…

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Chapters & Learning Objectives

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1. Structural Differences in the Head and Cranial Base With HSD/EDS

In this chapter, we will review the reported structural and functional differences in the brain and cranium in those with HSD/EDS. Knowing these differences can expedite the healing process and improve outcomes.

2. Headaches and Migraines in HSD/EDS

Headaches and migraines are more commonly seen with HSD/EDS. The cause may be driven by some of the associated underlying comorbidities. Understanding these contributing factors can direct treatment more efficiently.

3. Postconcussion Syndrome

The composition of the dura is different in those with HSD/EDS. This, combined with potential altered cranial suture integrity and underlying inflammatory conditions more prevalent in HSD/EDS, can lead to the appearance of postconcussion syndrome or delayed recovery with minor injury. Knowing what is contributing to the delayed healing response in an individual with HSD/EDS can improve treatment outcomes.

4. Identify the Presentation of UCI in HSD/EDS

Upper cervical instability (UCI) in HSD/EDS is not uncommon, but there is a wide spectrum of severity the patient may present with. AAI and/or CCI may be present with or without a predisposing injury. These conditions are frequently overlooked in the HSD/EDS community.

5. AAI Versus CCI

Craniocervical instability (CCI) indicates instability at C0–C1, while atlantoaxial instability (AAI) represents instability at C1–C3. One or both conditions may be present in a patient with HSD/EDS. Identifying the specific dysfunction can help guide treatment strategies for the patient and provider.

6. Determining Severity of Presentation

UCI presents with a range of severity in those with HSD/EDS. This chapter will review the signs and symptoms associated with different levels of severity to drive a more appropriate treatment plan.

7. Evaluation of UCI Based on Severity Suspected

Patients with HSD/EDS may be hyperresponsive to manual interventions and evaluation techniques. This chapter will review the appropriate evaluation strategies recommended based on the level of severity suspected.

8. Treatment Paradigm for Mild UCI

Treatment strategies will vary for this population based on the severity of instability suspected in the patient. Applying the appropriate treatment plan in this population will create improved long-term outcomes.

9. Evaluation of the Mid to Lower Cervical Spine in HSD/EDS

Red flags to screen for will be reviewed to inform the safety of the cervical spine exam. Specific palpation findings will be correlated with potential causes, which will inform treatment.

10. Treating the Mid to Lower Cervical Spine

Specific interventions will be reviewed and demonstrated, including strategies to address soft tissue, bony alignment, and tracking while reviewing clinical decision-making. Examples of exercises and home programs will be shared.

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