What is FNOR (Functional Neuro-Orthopedic Rehabilitation)?
More than a Rehabilitation system… FNORTM is an ongoing exploration of the Opportunities in Modern Healthcare and Clinical Neuroscience.
Functional Neuro-Orthopedic Rehabilitation (FNORTM ) is a modern rehabilitation system that is based on evidence and advances in neuroscience, musculoskeletal rehabilitation, biotechnology and pain science. The emergence of FNORTM is in part a positive response to the various opportunities and challenges of the modern healthcare environment, which demand new clinical approaches that are cost-effective, efficient, safe and most of all, highly efficacious. We believe that the FNORTM system’s innovative contributions in each of these areas will continue to garner growing interest by stakeholder, including, patients, clinicians, health systems, and payers. More than just a highly effective rehabilitation system, FNORTM is an ongoing exploration of opportunities surrounding the union of modern orthopedic rehabilitation and innovative, clinical neuroscience.
Where did FNORTM begin?
FNORTM began as a multi-year project that was aimed at developing non-invasive solutions to one of the greatest, evolving, tragedies in modern medicine – Failed Back Surgery Syndrome (also known as FBSS, or failed back syndrome). FBSS is a condition whereby patients who have undergone spine surgery experience chronic disabling low back pain and leg pain, often after a well-performed surgery, which is generally resistant to physical therapy and pharmacologic treatment. It is estimated that around 20-50% of lumbar surgeries result in FBSS (Manchikanti et al, 1999). The condition exacts a tremendous toll in human suffering and staggering economic loss, typically associated with real disability and loss of quality of life on the part of the sufferer. This was a challenging place to start!
In developing innovative treatment approaches for this complicated population, the FNORTM development team, predominantly based in the orthopedic rehabilitation setting, soon realized that solutions developed for FBSS appeared to be transferable to other forms of post-surgical pain, likely owed in large part to the commonalities in pain generating mechanisms across different post-surgical pain populations (e.g. post- hip replacement, knee replacement, labral repairs, rotator cuff repairs etc.) In our search for more effective solutions to chronic post-surgical pain, our team attempted to trace the typically complex and multi-faceted pain contributing mechanisms back to a common origin (an objective frustrated and subsequently abandoned thanks in most part to the complexity and individuality of the human nervous system). This said, an almost fortuitous benefit began to emerge as the project crossed into the unexpected domains such as biomechanics, neurology, vestibular rehabilitation and even psychology. The team found that using lessons learned from the most stubborn, chronic forms of pain, we were better equipped to treat other forms of pain, even those completely unrelated to surgery. After several years, we realized that what started as an orthopedic, pain management-focused project had evolved into a network of pathways, which ultimately served as the integrative, therapeutic foundation for the FNORTM system of assessments, clinical processes and therapeutic techniques.
Today, FNORTM hardly resembles the pain-focused project that it originated from. While lessons learned in treating stubborn pain are far from forgotten (on the contrary, evolving innovative pain management strategies are an FNORTM priority), the current day FNORTM approach might be characterized as a cohesive, efficient merging of orthopedic physical therapy, pain management, neurorehabilitation, manual therapy, and modern psychology. The FNORTM system is applied across a range of common orthopedic conditions beyond joint and spine pain, including movement dysfunction, gait abnormalities, musculoskeletal injury of various forms and even non-somatic conditions such as traumatic brain injury (incl. concussion) and stroke.
FNORTM for Pain & Motor Abnormalities
Musculoskeletal injury is frequently associated with neurophysiological changes occurring across distributed areas of the nervous system. The development of the pain process is associated with re-organization in brain chemistry and changes in nervous system function. Pain and motor abnormalities typically occur together in varying patterns, attributable to their shared substrate of the brain and nervous system. As well supported as these current clinical concepts are, most physical rehabilitation specialists still employ physical interventions alone (e.g. motor training or manual therapy) in their therapeutic approach to orthopedic rehabilitation. Others, arguably slightly more current in approach, erroneously assume that pain can be addressed through motor interventions, such as therapeutic movements and corrective exercises aimed at correcting observed deviations from normal movement.
While it is true that changes in the nervous system can be induced by repeated, therapeutic movements, these applications can be markedly enhanced by an understanding of the brain. Furthermore, the unimodal approach of rehabilitating abnormal movement with corrective movement is flawed when held to the standard of maximal clinical efficiency and optimal effectiveness. The high volume therapy environment in which the FNORTM system was developed soon revealed the limitations of this approach. If we are to effectively treat pain and rapidly restore function, we must take a multimodal, systematic approach.
The multimodal FNORTM approach is based in part on the premise that the brain is best stimulated by therapies that are tailored to the individual’s unique nervous system and by directing this therapies at affected areas of the nervous system. Additionally, the FNORTM system prioritizes rapid reduction of pain, which in the FNORTM system, involves addressing pain-generating changes in the peripheral- and central nervous systems (PNS and CNS respectively) through non-invasive but highly effective analgesic procedures. For these reasons the FNOR approach to any orthopedic presentation involves an assessment of the PNS, CNS, involved and remote joints and tissues, motor function, and cognitive and behavioral components. This assessment leads to an integrative rehabilitation approach that serve to distinguish FNORTM from other current rehabilitation methods.
Emerging Neuroscience + Innovative Technology + Interdisciplinary Collaboration =
Unique Solutions & Better Results!
In parallel with the burgeoning field of non-invasive neuromodulation, the innovative FNORTM system is rapidly and continually evolving around its core growth drivers of application-based, clinical neuroscience, professional collaboration and emerging clinical technologies.
By emphasizing the nervous system’s role in function and dysfunction, the FNORTM system approaches common clinical challenges, such as joint injury, chronic pain, joint instability, motor dysfunction, post-surgical pain and associated cognitive and behavioral sequelae, through the therapeutic window of the brain and nervous system.
What does FNORTM application of Neuroscience matter to you?
By understanding the nature of the brain and nervous system’s roles in injury, better rehabilitation of even the most stubborn “orthopedic cases” becomes accessible and way more efficient. Pain, a dominantly nervous system phenomenon becomes easy to understand and predict and infinitely easier to treat. The “neuro-” element in Functional Neuro-Orthopedic Rehabilitation is more than an enhancement to orthopedic rehabilitation, it is a pillar at the foundation of an entirely new approach to musculoskeletal and pain rehabilitation.
Smartly applied technology broadens diagnostic and therapeutic capabilities. While, much of the FNORTMsystem consists of effective yet simple and “low-tech” applications, we do introduce the practitioner to the use of technology in the areas of diagnosis, therapeutic applications, and care plan implementation and management. Diagnostically speaking, being able to visualize and respond to the “frames between the frames”, the otherwise unseen world of function that occurs beyond the abilities of the human eye, provides an undeniable clinical advantage, creating a range of unique therapeutic opportunities. This said, cost (to patient and practitioner) are always of important to our group. While we do present a range of new technologies, our courses always offer alternatives that might be employed to, for example, reduce costs or ease the process of adoption and implementation.
What does FNORTM application of clinical technology mean to you?
Smart use of technology will allow you to see more, do more and even enjoy more! Expect to be exposed to applications of modern technology to assess dynamic changes in nervous system, biomechanics, movement, endurance, physiology and overall function in an enjoyable, easy-to-apply format. You will become a better, more current practitioner through technology!
Why Interdisciplinary Collaboration?
Introspective, systemic evaluations of modern healthcare, ranging from prevailing opinions to formal, systemic investigations, are all but unanimous in a resounding call for interdisciplinary collaboration. The FNORTM system is not only developed in an interdisciplinary environment but it is constantly being improved by a team of professionals with differing professional backgrounds and approaches. We believe that one of the greatest causes of poor recovery, excess healthcare costs and prolonged human suffering in modern healthcare is the fragmentation of care. In the current, healthcare environment it is not unusual for a patient to see a variety of specialists, for the same condition, receiving a variety of differing opinions and ultimately making the frustration-driven decision to give up hope for any real recovery. Contributing substantially to the solution of this problem is one of the primary motivators at “the soul” of our group.
What does FNORTM interdisciplinary collaboration mean to you?
Understanding each other is the first step to better cooperation. The FNORTM leadership team is made up of practitioners with a range of different backgrounds and experiences. FNORTM will teach you a rehabilitation system that is influenced by different approaches from the professional fields of physical therapy, medicine, psychology, chiropractic, nursing, complementary and alternative medicine (CAM) and even surgery. Furthermore, FNORTM will give you a foundation of understanding in different approaches to common musculoskeletal complaints, facilitating meaningful collaboration with other specialists in your area. This will be driven in no small part by an understanding of how the unique service that you provide may help to complement the skills of other healthcare professionals.