Skill, Understanding and Juggling

[Barrett Dorko]

At the bottom of this post is a link for a juggling video sent me by our friend Sebastian in Toronto. I have been sent this several times this week from others who are aware of my interest in juggling as a hobby and I hear from my friends in the juggling community that Chris Bliss’ performance has spread massively across the Internet during the past month. Before you view it I’d like to make a point about this activity and connect to something else done manually that we all share.

I say to my classes, “Your patient will never be helped by your skills nearly so much as they will be by the depth of your understanding.” For some this is welcome news. They have many doubts about their coordinative ability and are convinced that the sensitivities displayed by veteran therapists are beyond their reach. But they really want to know what is necessary to understand and interpret their patient’s response to handling and movement and if study will be enough then they’re glad to do it.

For others what I say is bad news. They tell me quite flatly that they don’t like to read and that even if they did their life would never allow them the time to do what I and several others here obviously have done for years. All they want is to be shown what to do. When I show them how to “do nothing” while understanding the deep model the neurobiologic revolution has created and continues to create, well, sometimes they’re not very happy. Not uncommonly they direct their frustration and disappointment at the messenger – that would be me.

The video shows us a juggler who has created a remarkably entertaining routine that takes just over 4 minutes to complete. Believe it or not, what Chris Bliss actually does here takes only a moderate amount of skill. Among jugglers this is understood though there’s no way for the general public to know that. Even I can do most of this easily and would estimate I could get the rest of it down with a couple of week’s practice. In fact, there is a backlash of criticism in the community led by a particularly skillful and technically brilliant juggler who seems rather upset at Bliss’ recent celebrity. I suppose you can figure out where that comes from.

I’ve more to say about the distinctions between skill and understanding, about the difference between ease and simplicity and about where truly skillful genius lies in the clinic but that can wait. In the meantime, enjoy the video.

http://youtube.com/watch?v=z965UUEmdB8

[flaviovitor]

A good video for activating mirror neurons and perhaps, to rehabilitate neurological patients.


Flávio.

[Bas]

Being a 100% non-juggler, I was very impressed with Chriss Bliss performance - hence my sending it to Barrett. In the mean time, I have found that other jugglers have made similar videos of their performances that make Chris efforts pale in comparison, as well as those who use electronic tricks to make them look better than they are (juggler dropping balls on a floor keyboard, supposedly making the music one hears...). Furthermore, I am very impressed that Barrett can do stuff like this...

One of the issues with learning a different approach to handling patients is that there is NO specificity to the hands-on technique. NO sidebend, left-rotation 'lock" before the short thrust - no one-hand-holding-the-distal-radio-ulnar-joint-while-the-other-thumb-and-index-finger-mobilises-the-scaphoid-at-grade 4 stuff, NO 10 reps in 3 sets 3 times a week.... There are simply NOT enough instructions to follow minutely. When learning something, many seem to need the play-by-play of all kinds of precise parameter applications - which are lacking in any gentle handling technique.

Juggling obviously takes time to learn, but cannot be transferred by show-and-tell type of indstruction - I doubt that someone stands over Barrett and says, "throw the blue ball 6 inches higher and flex your left wrist 20 degrees more". It seem a skill that can only be gained by dogged practise within loose parameters: catch the things in good patterns. Period.

This leads me to believe that many PTs would not make good jugglers, even if they tried...

[Barrett Dorko]

Flavio,

I agree. According to the NOI group, Bliss himself shouldn't be having any pain either because, as they say, he has "juggled it away." It helps that he never seems to drop anything. Just like me.

At every course I speak of the distinction between "easy" and "simple" and tell the story of how I came to understand this while listening to NPR one day. Here I'll just say that when you're talking about "easy" you're referring to the task itself. When you use the word "simple" you're referring to the thought processes behind the task.

What Bliss does here is easy for anyone who has devoted a certain amount of time to the craft. But how he has combined these movements with the music is by no means simple. You could spend a great deal of time analyzing the connections he's formed with the rhythm and the lyrics, but even more important is his knowledge of what will impress and entertain. This is genius.

In my younger days I performed with a troupe occasionally and did a solo act with three bowling balls. Though this bit only contained 25 throws with a few tricks in the midst of them I was actually capable of doing 90 consecutive catches. I kept this a secret from the audience and feigned near complete exhaustion after about 18 catches, finding that this pumped up the applause.

Show biz.

The connection to manual technique is this: Much of what is taught within the coercive community by therapists like Kaltenborn and Paris (and I taught with these men) is presented as if it required the kind of skill needed for technically brilliant juggling though the effect of the handling and the thought behind it was relatively simple. Long ago I switched to a manual method that is very easy to do while contending that its effect is complex, to say nothing of how much thought must precede it. In other words, I'm the Chris Bliss of manual care.

One more thing. Watch the video again and notice the space he allows for the audience. When done at the right moment and for enough time, the audience's reaction becomes the main part of the show - even when they sit in rapt silence while witnessing the beauty of these "easy" movements and listening to these common words sung in just the right way.

Sounds like what I seek to achieve each day.

[flaviovitor]

Barret,

the impressiveness of the combination between music and juggling really is fantastic. That man does know how to make money. And it is this way the world is and always has been since long time ago. It is a good thing, because while some entertain themselves, the entertainer gets a job.

Well, some questions have been done by neuroscientists:


Where is located the intelligence in the brain?
Why do we like music?


But, a question which regards directly me, you, Diane, Bernard, Shacklock, Moseley, Richardson, Nari, Newman and many other PTs, and perhaps, mainly those which work in neurological situations and some kinds of pain, the question can be that:


Why do we like so much to see a sport performance or a dance?


The answer can be several, but, can be also, MIRROR NEURONS. And all I know is that, we have a possibility of, in a near future, to have some new kinds of therapy, based on or stimulating these Mirror Neurons seeing a show like that or a dance / sport performance coined byt this purpose. Who knows? That is not a bad idea. It is just one more technique for us... how good it is.


Flávio.

[Barrett Dorko]

Flavio,

I agree entirely.

Here's a link sent me recently by our friend Ian Stevens.

http://www.interdisciplines.org/mirror/papers/1

Here's a great line: "The same functional logic that presides over self-modeling is employed also to model the behavior of others: to perceive an action is equivalent to internally simulating it. This enables the observer to use her/his own resources to experientially penetrate the world of the other by means of a direct, automatic, and unconscious process of simulation."

Two things here: Handling another with acceptance (Simple Contact) is much more likely to reveal how your patients actually exist than any typical examination or coercion ever would and it is essential for the therapist to display healthful, authentic behaviors so that the patient has the right thing to model.

[PTPete]

Barrett,

This thread really struck a chord with me, as lately I've been feeling that I have a very solid understanding of chronic painful problems, but very little skill in treating them. SC has worked for me with a moderate degree of success in the short term, but I've no idea what my patients go through once they leave me. I also have yet to abandon all of the leeches stuck to me during my education.

I'm currently away from practice, caring for my 8 month old daughter which allows for alot of time for thought, but no physical practice. The longer I'm away from the clinic, the more I can't stomach the idea of returning to an environment plagued with memes in which I've lost faith. The option that I continually toy with is doing some solo private practice, but fear my lack of skill and experience despite some solid evidence that new and experienced practicioners have little difference in outcomes.

I guess the question I keep coming back to is: Is knowledge enough when for many patients you intend to "do nothing".

P.S. - It has been awhile since I've been on the PT sites. It is good to see your all still out there thinking out loud for my benefit:)

[nari]

Flavio

My mirror neurons must be deficient, as I neither watch sport (except maybe the Olympics for a couple of hours) nor do I like watching dancing. Performing these activities is OK up to a point, but watching...is just plain boring.
I guess the aficionados of both could give a dozen reasons why this is so.
I await diagnoses of my terminal condition.

PTPete

I think Bas said it all neatly:
There is no specificity with the hands-on technique.
and because PTs like to be specific in technique (learning and application)....I agree also that they would probably make bad jugglers.
They more specific one is, the more mechanically-minded is the brain that seeks specificity.
The environment which is plagued with memes of all sorts is the environment that I had difficulty with over the last 5-6 years. The complicated, tail-chasing details of approaching some poor patient with a crook back was disheartening as well as unnecessary. And after attending Barrett's class, that environment became worse. Thanks Barrett!:) :)

Nonetheless, Pete I am sure you can handle those memes. Though in our free-to-choose environment here in Oz, it is easy for me to say that.

Nari

[Diane]

"The option that I continually toy with is doing some solo private practice, but fear my lack of skill and experience despite some solid evidence that new and experienced practicioners have little difference in outcomes."

In the end, that is the only solution. It will be easier if you openly embrace the idea that it is pain you are really treating, the usual sort that people get, people who are buried under the same faulty memes: e.g. patients who say, "it feels like my back is out; my rib gets stuck, this one right here; I get really tight calves, I need to stretch more; My shoulder feels weak, what can I do to strengthen it? I get this pain in my hip, right here, when I run.. why just this one side?" Those are their own kinesthetic perceptual fantasies (and that as practitioners we have subscribed to! Have designed complete mythical treatment systems to "detect" and "treat"). Solution; educate, help them unload the nervous system, teach them how to keep from loading it again.

Don't worry, you'll probably never get rich but you'll always have lots of patients.

[Jon Newman]

Hi PTPete,

I hope you find the courage to pursue what you think is right. I don't believe the true barriers are your skills and experience as you intellectually already know.

[Barrett Dorko]

Jon,

Perfectly true. I wrote something for Juggler's World magazine years ago titled Juggling Courageously that I think addressed this issue. It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express.

I express at every course my frustration with our community's ignorance of the most basic aspects of modern neuroscience. Actually, many therapists are ignorant of many things that are no longer even modern. This is the "interrogation of reality" that any fierce (read productive) conversation must begin with and, as has been discussed here in the past, that interrogation requires courage to pursue. As I've said to others when teaching them how to juggle: "I know you're going to leap about in an effort to catch the ball. What we'll find out about is whether or not you have the courage necessary to throw it."

Recently a student demanded a refund for my course. She made it clear that the information was valuable and that the objectives had all been met. She wanted her money back for only one reason - she disliked me so intensely. She said she felt that in the first few minutes of my first lecture.

What I have to ask myself before I head out there again to give the same lecture in the same way I have so many times before is this: Do I possess the courage necessary to throw that ball up again?

PTPete,

Perhaps you're asking yourself the same question about what you might be willing to say at your next job. Good luck with that.

[Diane]

"She wanted her money back for only one reason - she disliked me so intensely. She said she felt that in the first few minutes of my first lecture."

Hmmnn.. so she thinks the world should revolve around her "subjective well being", her SWB as in Jon's article (http://www.somasimple.com/forums/showthread.php?t=2251) on hedonics and eudaimonics? She hasn't made it into PWB yet, apparently.

Barrett, our little dream facility/faculty (Querencia or SIMPLER or whatever we toyed with calling it) will definitely have to teach reams and reams of neurology. "I express at every course my frustration with our community's ignorance of the most basic aspects of modern neuroscience." This just won't do; the issue of ignorance and the subsequent fact that your frustration with the issue would appear to create/broadcast a more static-y rather than a more clear signal, must be addressed.

[christophb]

I had a patient that was telling me about changing methodology of teaching in the school systems (he is a semi-retired principal). He reference some research (couldn't exactly remember.. I asked) and talked about his personal experience of trying to implement new methods of teaching based on new research and understanding. His conclusion was that the vast majority of people are horribly afraid of change. The findings of the research indicated that the new methodology had to be taught and modeled 4 times (imagine attending Barrett's course and working with him in the clinic on 4 separate occasions) in order for 10% of the people to start using the new method. In order to get the majority of people to change (not sure about the actual percentage), the method had to be taught and modeled 28 times. He has a few MD friends in the medical community he talked to about this and they all reported about the same experience.

Chris

[Diane]

Chis, what depressing news.
We'll have to make at least four readings of Butler's SNS book mandatory, in that case, as a prerequisite. ;)

[christophb]

Depressing? I find it consoling... now I know it's not me that's an idiot:D

[Diane]

Gee, I wish I could get a refund for every time I felt an instructor was behaving in an "unprofessional" manner.. :rolleyes:.. I'd have my whole education for free by now.. all the cont. ed too.

[Jana OT]

The option to take another Cross Country course was the suggestion of the individual I spoke to at Cross Country..... there seems to be a great deal of censorship on this site... is there some reason for that?

[Barrett Dorko]

Posts that progress the discussion and do not contain personal attacks are always welcome.

[Jana OT]

So, Barrett the posts that you place that do contain personal attacks misrepresentations are fine... any post in response to that is not? I have simply replied to references you have made.

[Jon Newman]

Jana, please demonstrate where this board has allowed anyone to post a personal attack of another through misrepresentations and where responses to those posts were not allowed.

[Jon Newman]

Jana,

In this particular thread I saw Barrett mention a student. Apparently that student was you (how were we supposed to know this?). There are no quotation marks in his post, just the general idea that the student (you) thought the material was ok but that the presenter was not. It would seem to me that that is an accurate portrayal as I have access to the deleted post you wrote (in this thread). Although I could be misunderstanding you also. Are you trying to say that you actually like Barrett and the material he presented?

[Jana OT]

Jon,
Once again, as I try to express my thoughts my posting (@3:16pm) seems to be, yet again, pulled. I cannot imagine why the content was determined to be inappropriate as I was simply responding to your remarks. I don't know that either one of us will be inviting the other to Sunday brunch, however, as I have said repeatedly I do appreciate his knowledge. If that were not the case I would not waste my time here. I do see a unique group of patients that I have posted about. I have questions about SC in that setting and feel I need to consider its use with my patients due to potential contraindications. Barrett encouraged us to discuss clinical issues and thoughts here. Here I am. If my postings are continually pulled I am left to assume that I am not welcome here due to Barrett's growing dislike for me personally.

[nari]

Chris, that is a very interesting thought - I am surprised, but shouldn't be, that 10% will change if a course/ method is repeated x4. Yikes.

No wonder restructuring an organisation takes so long and loses faith along the way before it actually takes place. (I have been through two restructurings of physiotherapy).

Perhaps those 80% of school teachers who don't 'take', have their personality too tied up in their profession. They value their own perceptions of themselves and how they fit into the scheme of things, including the students' perceptions. Any move to alter that carefully molded course is a threat to integrity. Unfortunately it doesn't need to be like that..

Chris, I couldn't wait to chuck the endless permutations and computations baggage of clinical practice...I was too much the other way! Similar to you, but in the other direction.

Nari

[Jon Newman]

Jana,

I have yet to see Barrett make any direct or degrading comment naming you. The same cannot be said for your posts that have been deleted.

[Diane]

the vast majority of people are horribly afraid of change. The findings of the research indicated that the new methodology had to be taught and modeled 4 times (imagine attending Barrett's course and working with him in the clinic on 4 separate occasions) in order for 10% of the people to start using the new method. In order to get the majority of people to change (not sure about the actual percentage), the method had to be taught and modeled 28 times. Is this what constitutes "institutional inertia"?

[Jana OT]

Diane,
I think having children and working with them, providing educational opportunities as a family, and living with them tends to keep those occassional leanings toward subjective well being in check. Psychological well being is a continual process for myself as well as the kids. I am blessed with insightful and amazing little ones.
Jana

[Jana OT]

Jon,
Are you saying that if you were reading along and discovered that someone was referring to a conversation you had engaged in and falsely represented your comments or thoughts... you would not respond and clarify your intention? I guess I'm not sure what the groups expectation is. The references may not have named me personally but they were derogatory.
Jana

[Jon Newman]

Jana,

Is this the post you are referring to?

Recently a student demanded a refund for my course. She made it clear that the information was valuable and that the objectives had all been met. She wanted her money back for only one reason - she disliked me so intensely. She said she felt that in the first few minutes of my first lecture.

What I have to ask myself before I head out there again to give the same lecture in the same way I have so many times before is this: Do I possess the courage necessary to throw that ball up again?

If so what about that post is personally derogatory or inaccurate?

[nari]

Jana

I read the post by Barrett as a statement of what happened. It is an objective statement, and also quite anonymous to anyone who happens to read it.
Perhaps you could look at it again with less subjectivity?

Nari

[Jana OT]

I see no need to continue this on the site. I welcome comments or questions via private message.

Jana

[Jon Newman]

Happy trails (http://www.gladstonebowl.com/cowboystars/sounds/happytrails.wav) anyhow.

[nari]

Looks like I hit a sensitive spot with her. Oh well....

Nari

[Jana OT]

Maybe I wasn't clear. It seems as though postings I have left and responses I have provided are not furthering the intent of the forum. My comments above to choose not to continue them is not intended as a goodbye to the forum. Nor was it stated from a position of sensitivity. I merely felt that I should not continue this issue as it has been. If my comments have sidetracked the forum from its intent you have my apologies. If there are issues with me personally or questions regarding any comments I have made feel free to send a private message.

[Jon Newman]

Well in that case Welcome back (http://tvland.classictvhits.com/WelcomeBackKotter/Sounds/WBKTheme.wav)

[nari]

Jana
Sorry for a misunderstanding. Welcome back.

Nari

[PTPete]

Barrett, Jon, Diane and Nari,

Just wanted to say thanks for the supportive comments. I am not sure when I'll return to practice as caring for my daughter is becoming my new vocation. However, when I do I am grateful for the advice and support recieved directly and indirectly from your postings here and elsewhere. Courage...courage...just need to confront the man behind the curtain I suppose and then move off in my own direction, to a new home so to speak.

Thanks all,
Peter Randall, PT

[flaviovitor]

Hi Nari.


Ok, YOU (I mean, your MIND with its own desires, etc.) do not like or matter in watching a dance or sport. But, what about your neurons?

Are you capable of decreasing their activities while seeing a sport performance? Well, maybe YES! Why not? But, would it be necessary a bit of training? Maybe, if you make use of NEURO-BIOFEEDBACK you could become a master in making "mirror neurons" to sleep.

But, there are some questions that still need to be answered:


What you be the solid situations in which "mirror neuron therapy" could be applied?
Is there any association between mirror neurons and the pleasure of seeing a sport / dance performance?
And other questions...

Is there any association between mirror neurons and limbic system (which is activated during listening to a music)?



For example, I what know is that if you like capoeira (a braziliand dance) more than jazz, your mirror neurons will fire more vigorously in watching the capoeira dance instead of jazz. OK? That is a good begining.

Sorry of making so much questions. Just trying to learn with all of you.


Flávio.

[nari]

Flavio

I need to do some reading before I can accurately answer your questions.

The instinct/meme/tendency which people display when watching sport is probably the result of upbringing - early and constant exposure, so it is perceived as something everyone likes and does.
We love to copy, and so do the mirror neurons/memes.
Presumably most people enjoy sport-watching; I do not, and never take any notice of it.
The only dancing I would watch with real 'limbic' activation is flamenco. It is full of what other dancing lacks; natural energy, strength and rhythm, intense emotion.
I know what music I don't like, if that is any assistance.
Presumably the mirror neurons activate with watching only people, I don't know.
Rock hunting and watching is great fun...does that comply with your theories on mirror neurons?;) ;) :)

Nari

[Barrett Dorko]

While waiting in the Memphis airport on Monday on my way to Arkansas I came across the latest issue of Scientific American Mind and saw that the cover article is about the discovery and implications of mirror neurons.

The article is titled "Human See, Human Do" and it's pretty good, especially in the section regarding aberrant functioning in the absence of these neurons.

[nari]

It is a good article. Scientific American Mind rarely misses a beat.

Nari

As a bit of a rider...does anyone know anything about NLD?
(Nonverbal Learning Disability) Doesn't appear to have much study done on it. My niece's daughter has just been diagnosed with it and it looks a scary condition.

[flaviovitor]

I think this issue of SCIAM my be fantastic.

But... I do not have it ofr sale in Brazil. I must import it, but I do not know it is worth buying it.

If anyone has it in a electronic format, I would accept it. :-)


Flávio.

[bernard]

Flavio,

After I read the advice from Barrett, I decided to buy the electronic version of the cited paper.
I put the article in The Sound Of Silence.
A Revealing Reflection (http://www.somasimple.com/forums/showthread.php?t=2270)

[flaviovitor]

Dear Bernard, thank you.


I have already downloaded it. I just need to read it now.


Flávio.

[Barrett Dorko]

I read this recently and this thread came to mind. From Self University by Charles Hayes

"When you decide to push away from the shore and embark on a journey in search of knowledge, remember that you must continually be able to distinguish between belief and understanding in order to keep from getting lost. Many people who begin this journey make the critical mistake of requiring belief to be a condition of understanding. If you do this, your ship will sail in circles and never get far from the shore. It is a mistake often made when people use religion as a substitute for thinking."

I also took the time to listen to the podcast Jon posted recently that contains a presentation by Ramachandran on Synesthesia. It's astounding, and I believe it explains a whole lot about how those of us who handle others thoughtfully are affected centrally by this repeated experience.

You can find the podcast here (http://www.nyas.org/snc/podcasts.asp?PartnerCD=iTunes&TrackCD=pcast)

[Jon Newman]

Hi Barrett, thanks for reposting that. I just listened to it again. I don't think the "enhanced" version was available when I first posted it. I would recommend that anyone who listened to it before do so again, the images used in the podcast were helpful (to me).

[Barrett Dorko]

Jon,

Not having the ipod with a screen for such images I've not seen them, but my imagination seems to have been sufficient so far. I presume that when he gets to the part about different styles of art (impressionism, abstract, cubism etc.) that he puts up some examples. Fortunately, I have several of each on my internal screen.

I was especially impressed with his insights regarding the power of an incomplete image that nevertheless possesses the most important aspects of the thing it hopes to depict. Picasso's few, spare lines defining the female shape for instance. And how such a thing becomes more provocative than any photograph with all its clutter. Because the brain functions in this way it makes more sense to evaluate our patients less and not more as I commonly suggest. Gladwell makes the case for this in Blink and Buchanan does the same in Ubiquity.

Bliss' juggling performance is similar with its deemphasis on technique and complexity. If there isn't too much to see the audience is invited (if not actually compelled) to fill in the gaps and thus add their own "internal juggling" to the performance. In a sense, Bliss "juggles" the audience as much as he does his props.

Each time I teach I try to show therapists that they are perfectly capable of handling their patients as I do and that the requisite skills amount to little or nothing. I make it clear that success is dependent upon how well they get their patient (the audience) to participate and that in order to get that they must stop interfering with that participation (ideomotion). On my web site there's an essay titled One Hand Clapping that begins with this line: "I was recently listening to the poet David Whyte speak of this Zen question and what it has come to mean to him. He had previously been talking about how we become an individual by meeting the world, by reaching out toward it with attention and awareness. If you don’t take the time to quietly observe the world in all its dimensions, he says, “The world can’t find you.” I think this fits here.

In class they prove over and over that this works but when they return to their clinics so full of strife or conflict or concerns with productivity or the egos and superstitions of their colleagues it disappears.

Today I feel that it always will.

[Jon Newman]

Hi Barrett,

I was able to "watch" the podcast on my computer screen as I don't have that video feature on my gizmo either. Unfortunately and quite frankly I simply haven't taken the time to educate myself about much of the world of art and so my internal screen was a bit blank to put it in terms that are not too self depreciating. Either that or maybe I was dropped on my left angular gyrus as a child.

Not surprisingly, Ramachandran seemed to follow his own advice and only used approx. 16 images over his 50 min lecture. The images that seemed to help me the most were the "kiki" versus "boo-bah" portion of the presentation during which he claims we are all "synesthetes in denial" and then goes on to make a case for this. Also, his visual examples during the "laws of aesthetics" helped me for the reason cited earlier.

An association that I drew, perhaps incorrectly, was that the law of aesthetics were not unlike the characteristics of correction in terms of the function they serve.

I was about to ask how one might go about enhancing this feature we have but then realized you already addressed it.

[Barrett Dorko]

Jon,

The law of aesthetics also relates directly to the "vitals of pain" and "the four corners of Simple Contact" as they have evolved over the years. This minimalist approach to teaching is necessary for the six hour window I'm allowed these days but I think it's a good thing.

Ironically, this all plays into my increasing tendency to speak less. For all I know, that's the reason I came up with some of this. Then too, I seem to following my brain's natural tendencies.

Yea, that's it. I'm not too lazy to come up with 15 intermediate courses and an advanced certification - I'm just letting my cingulate gyrus take over.

[Mike Terrell]

I have the strong feeling that PTPete and I have many of the same feelings. Dissatisfaction with current treatment practices, growing knowledge in neuroscience, and a desire to change.

I will freely admit that I am not good at change. I like smooth water and a steady boat. I am like the cowardly lion. The ability to roar is there, but I just can't let it out (I've never been truly found of loud noise!).

During the drive home from Barrett's course, I had many hours to consider and ponder all that I had absorbed. My head was filled with fabulous ideas and wonderful plans. Most of these died quickly once I stepped back into the real world. A good part of this was my fault but my clinical enviornment was not helpful.

I know that I will eventually pluck up the courage to speak what I know. Why not now? Not much of a rumble in the throat quite yet.

mike t

[christophb]

Mike, I can appreciate where you are coming from. The transition from Barrett’s course into the clinic was perhaps one of my most courageous acts to date (along with the willingness to look foolish posting on this site).

Yesterday we had the president of our national corp. and some of his cronies hold a meeting to chat about the business of PT. All in all I would say they are nice enough guys, but their loyalty is to the business and not the profession of PT. That being said, as long as a treatment is bringing in patients and $$$, all is good. The comment was made that if the schedules of the therapist are full and the clinic is busy, then the treatment must be effective. Yes, if only it were that easy to judge the effectiveness of what we do.

I had to speak up against this in a room full of fellow PT's and co-workers. When I saw most of their jaws drop in disbelief, I knew I was in trouble. I haven't yet decided if this was an act of courage or stupidity. It's a slow road but you are in the right place for support. The people on soma are wonderful.

Chris

[Barrett Dorko]

Mike,

Great post. As I recall, you drove to St. Louis from Grand Rapids to take the course so it must have been a long drive back. I remember as well that you expressed a concern about what would happen when you returned to work at lunch. Three hours of instruction to go and you could already see what was going to happen if you roared.

I wrote an essay titled When Dorothy Touched the Lion (http://www.barrettdorko.com/articles/lion.htm) about Bert Lahr awhile ago that might provide some insight here for you. I was always struck by this comedian's comment to his son; "I don't know what's funny - the audience tells me."

Your patients know what's therapeutic and what isn't. Problem is, they're as scared as The Lion.

One thing. I can understand your boss and your colleagues ignoring me, of course. But what makes them think they can ignore the greatest minds in neuroscience?

[Barrett Dorko]

Chris,

Courage or stupidity. I know the answer to this but would appreciate it if you didn't ask me until about twenty years have passed. By then we'll both know.

Maybe thirty.

[christophb]

I was reflecting on the drive home from the meeting how I tend to speak out with passion instead wisdom, one day they'll combine, hopefully.

I'll know in thirty years, maybe.

How’s that for confidence? ;)


Chris

[Barrett Dorko]

Chris,

In the movie Office Space there's a perfect example of how subversive speech can get you promoted but it must be said in a certain way. I'm sure you know what I'm talking about, but if not, your assignment is to watch this movie.

[Mike Terrell]

Barrett & Chris,

Thanks for the support. I may be changing jobs soon, more out of a desire to not drive so far than anything else. One thing I will consider is what kind of "productivity" will be required as well as how much oversight of my pt. care.

I will be looking for a quieter and calmer clinic where I can actually talk to my pts. for a few minutes.

Will I actually find this? Hopefully.

mike t

[Mike Terrell]

I didn't have time to say much with the last post, so I will finish.

Barrett,

Yes, it was a long drive home and if I recall correctly, I thought about SC and what you had discussed the whole way home (about 6.5 hrs).

At my clinic, I feel we are fairly progressive, at least in comparison to many other clinics I have heard of. What I am beginning to see as the main drawback is that we are essentially an "orthopaedic" clinc. The CNS is essentially left out of the picture in any truly meaningful way. Sure, we do neuromuscular re-ed for muscle dysfunction, but we have no consideration for the influence of anything above the foramen magnum. Seeing pts. with their heads full of "no pain, no gain", "I've always had neck trouble", "the Dr. said I had arthritis", and "the MRI showed...." is frustrating to say the least. When your boss is quick to slap on the microcurrent ES or hand out the TENS unit and then does posterior GH mobs because "it's always tight", you want to beat your (literal) head against the wall while you watch her beat her (metaphorical) head against the wall.

The odds I will find something different at another clinic are slim, I realize, but a change of enviornment would be good.

You know, I started this post with the intent of letting you know my clinic is probably not as bad as I have let on. As I review what I have already written, you wouldn't think that.

mike t

[Barrett Dorko]

Mike,

I take it your boss didn't attend my course in Grand Rapids a couple of months ago? There were over 40 PTs there from your town. What happened after they walked out the door? Again, I have to wonder about my influence beyond this BB.

It sounds like your clinic has also forgotten the peripheral nervous system. I still think were necessary (and most useful) when orthopedic problems go bad. In my opinion, this includes almost all spinal pain that endures and recurs.

We can't change our profession. Today I don't even think we can fix it. We're stuck changing ourselves.

Sounds like you're on your way.

[nari]

Chris and Mike,

We have all been against the brick wall; you are in good company.

Last week I went to a reunion of PTs whom I have known for years; comfortable surroundings in a lovely house. We each were asked to tell the group, very informally, of things that have happened over the past year.

I started to talk about Simple Contact and above-the-foramen-magnum stuff; then two of us did a little demo on a very willing PT. When she started to go forward, someone laughed and said: "She's going to fall out of the chair!!" and it ended there. Despite this,there was great attention and the comments were:

"Oh, that's Bowen therapy"
"Much more pressure is needed to get to subdermal structures"
"Is the person actually conscious? Or hypnotised?"
"Where is the evidence that it works?"
"Don't you feel a bit guilty not doing anything? Is that ethical?"

These were all hard-lined orthopaedic-thinking physios, who have been doing what they have been taught by orthopaedic gurus.

End of story. No encores - I was thought a bit weird, which is true, but not when it comes to neuroscience. At least that is my belief...;)

Nari

[Barrett Dorko]

Nari,

I feel very uncomfortable in a situation such as this. If asked, I think I'd decline any opportunity to explain my method and what I've come to understand about what we can't see. I know I'd offend most of them, no matter how gently I put it. I imagine trying a few questions, hoping to sound a little Socratic. Soon they'd want to beat me to death - I'm sure of this.

When I spoke at Cleveland State's PT program in '04 (video on my site) an instructor came up to me afterward and said, "In the middle of your talk I felt as if I was being scolded. (long pause) But, you're right."

I never heard a thing from anybody there since that evening.

[nari]

Barrett,

I nearly did not say a word about it - then my evangelical streak surfaced; it could be that my explanation either made no sense or was inadequate. Or both.

Since September last year, there has not been a single PT whose brain has moved out beyond mere passing interest in a new topic such as ideomotion, skin contact, the brain, corrective movement and so on. It seems to be firmly placed in the "alternative" box of tools.

I think you're right - we can't change the profession, it will continue on its merry way becoming more and more complex and possibly unstable as the sand pile grows.

One day I might realise that fact...

Nari

[Barrett Dorko]

Nari,

I used to be infected by the same evangelical meme and so I made the same speech that you did. The antidote is the silence and/or irrelevant comments such a speech elicits. Several you mentioned reveal more ignorance than anyone would be comfortable hearing from a colleague, especially one your own age. Knowing all of this, I feel I'm doing others a favor by not speaking in an informal setting.

This thread is largely about watching another perform, and I know a thing or two about placing myself in front of others. I know that what fascinates some bores/angers the daylights out of others. There is a specific alchemy of movement, timing, ambient sound and environment that magnifies the message as well. If I don't like what I'm given in that regard and find I can't alter it I hesitate to move forward with anything of substance. When pushed to deliver despite my misgivings, I do so. Others find that my essential feelings and opinions about my work are carefully considered and solid to an unusual degree. I'm not "open minded" when it comes to therapeutic approaches, as you and others who read my writing know.

[Diane]

Speaking of juggling, I found this amazing video (http://www.glumbert.com/media/juggle) and decided to land it on some thread to do with juggling.

Check out the symphony of movement and the no-mistake, leisurely way the forces of nature (gravity and self and weight/trajectory/timing of the dropping of the balls) are effortlessly handled. Is this not good juggling?

Apologies to whoever may have originally posted this, if it has been posted here already somewhere.. I feel like I may have seen it here already, but in keeping with the theme of the last part of this thread, I may not have had the "hooks" to truly appreciate it until now.

[EricM]

This guy is too good not to revive this old(er) thread. Michael Moschen: Juggling rhythm and motion (http://www.ted.com/index.php/talks/view/id/260).

[Barrett Dorko]

Thanks Eric.

I've been a Moschen fan for years, and though I still have the sense that the hardest part of juggling is in letting go of the prop, he proves that there's a lot to be said about never actually releasing it at all.