Distal attention is better?

[bernard]

Hi Somasimplers,

I read on Pubmed many abstracts saying that internal focusing give less results than focusing on the goal (distal) to reach.
I tried it out with some patients with arms problems and it is true that if they focus on hand and goal, it works finer than to be attentive to the realization of movement.

They are able to move in a better way and with less pain.

Did you encounter such difference?

[nari]

Certainly, Bernard.

If you ask someone with a sore shoulder to reach for a towel on a hook to dry themselves, especially if they were cold and wet, they might have little problem.
If you ask the same person to 'lift your arm as high as you can' - much more difficult to do.

It may be similar to the imagery of movement which is very popular at present - ask someone to imagine a certain action, and let them act out the movement.

Mostly, our objective examinations requesting people to endlessly turn this or raise that, leave a great deal to be desired and tell us nothing.


Nari

[ian s]

Nari,
what our objective tests are more likely telling us is a persons 'willingness' to move not real 'physical' dysfunction? Simple physical thoughtless movements that are meaningful work best ......if people are overly cautious or fearful just breaking task down seems to work best ?
If one is working at a more elite level or trying to change habbitual postural habits as I am it is necessary to employ visualisation and postural awareness .......I use things I have learnt from Alexander technique and tai chi .....if you strip away the esoteric jargon and philosophy these things have a lot to offer most people in daily life.
Ian

[Diane]

A poster on Rehabedge had this to say.. I think it is exactly to do with what this thread is talking about. It also makes me think that we probably "get in the way" of our patients more than we realize, with our conceptualized and analyzed ideas about movment.

Just an experience that I feel like relates in here, esp. in the teaching stability, kinesthetic awareness part. I was seeing a head injury pt. at home. Sometimes he would be alone a few hours, and like a child, he would forget he wasn't supposed to leave the house. He had gone down the long driveway to go to his Mother's house across the county road, and had fallen down. He couldn't remember how to get up, and fire ants were on him. They will kill animals and humans that can't get away, one pt. in a power w/c turned his chair over and was killed by fire ants. Luckily for this fellow his school teacher wife found him on her way home in time. We had absolutely no success teaching remembrance of step-by-step movements of standing from the floor. On the next to last session, Feldenkrais teaching came to mind. He was on the floor and I told me picture a string from his head to a point in the air at standing height, and when I tell you, think up, and follow the string. He did and stood up as naturally as you please. Now, I know this question is coming and I wish I had an answer. It was consistent, his body could stand at any time he thought up, once the concious how-to thoughts were suppressed. The question, of course, is could he remember to think up, by himself, when he needed to, especially in a state of panic. Any one able to think of a way I could have tested that? Despite this case not being a normal brain, having done a little Feldenkrais, I think bodies have learned normal movement, and that often it is what we have done to them, that interferes. Sometimes we can bypass these things that have been done, and relearn it, and sometimes not, at least fully. Obesity, or scarring in tissues, being examples of interfering factors. I agree Randy "too complex for me to understand" but anyway, there's an example of "impose the right stimulus, and the body, or 'mind', handles the rest.

Here is the link to the whole thread..
http://www.rehabedge.com/cgi-bin/forums/ultimatebb.cgi?ubb=get_topic;f=1;t=000446
Diane

[nari]

ian

Our standard objective tests and 'interrogations' still look at how a limb dysfunctions, (measured in degrees!) not why.
Which is why some of the functional tests are somewhat more useful, as improvement is visible to the patient. All my grumblings aside on our inadequate objective testing, I agree with Diane that sometimes we impose what we think is the right way to do something, and actively interfere with recovery -and sometimes we do not. Once again, it is finding the right way to approach pain and dysfunction for each person as he/she presents, that is so tricky.


Nari

[bernard]

if you strip away the esoteric jargon and philosophy these things have a lot to offer most people in daily life.

I think bodies have learned normal movement, and that often it is what we have done to them, that interferes. Sometimes we can bypass these things that have been done, and relearn it

If you ask someone with a sore shoulder to reach for a towel on a hook to dry themselves, especially if they were cold and wet, they might have little problem.
If you ask the same person to 'lift your arm as high as you can' - much more difficult to do.

Which is why some of the functional tests are somewhat more useful, as improvement is visible to the patient.

I have just boldlined some of your phrases and one more time, we must concentrate our minds on normality and functions which of course are not easy to see in an objective way?