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Posted by Eric Matheson<script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,13,8,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> (Member # 2368) on 13-07-2005 15:23<noscript>July 13, 2005 08:23 AM</noscript>:
From Arch Phys Med Rehabil. 2005 Jul;86(7):1349-55
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,13,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-07-2005 20:23<noscript>July 15, 2005 01:23 PM</noscript>:
Two days and no reply from Barrett? He must be busy.
mike t
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,16,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-07-2005 23:36<noscript>July 15, 2005 04:36 PM</noscript>:
Mike,
I figured anybody who can read and reason can see that the deeply imbeded memeplex first planted by Kendall over fifty years ago had again been challenged powerfully on the Seringetti of the collective mind of the therapy community. As it goes, however, this animal/meme of Kendall's remains remarkably resilient and we shouldn't forget that it's being nurtured regularly by thousands of academics who still hold it up and ask their students to admire it. It remains King of the Jungle in the Darwinian sense offered us by Edelman in his original work on neuronal patterning.
Despite this wonderful reference in opposition, I don't think this thing will die in my lifetime-not without support from the schools. I don't think that's going to happen.
If Sahrmann were to see this study would she say, "Ah well, I'm going to examine posture and relate it to pain anyway. Some day I'll be proven right about this."
Is that what you're looking for?
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,16,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-07-2005 23:52<noscript>July 15, 2005 04:52 PM</noscript>:
Eric
A very odd study. Who would really WANT to know about interobserver reliability on scapular positioning? And when we discover it's OK...so what? Someone must have been feeling bored and decided to do a study or two....
Nari
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,19,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 02:25<noscript>July 15, 2005 07:25 PM</noscript>:
Nari, they were either bored or they were forced to do it (PT students). But either way, proving the null hypothesis is just as valuable to research as proving the hypothesis. Not that this study really proves anything, it is just one link in the chain....
Don't you think we need a little debate here? Are the lines so clearly drawn in this forum that no one bothers to challenge anyone else because we've "been there, done that?" (except Wags and Jason of course, but I don't even know what that was about). I'm sure the majority of people reading this forum treat people with shoulder pain by strengthening the scapular stabilizers and rotator cuff, stretching the pecs and lats, and mobilizing the capsule. I know I do. Should we really throw all this out the window? Mobilizing, strengthening and stretching is what physical therapists do....it's in our schools because it is what physical therapy is....look at the APTA Guide to Physical Therapy Practice. It's what we get paid for, why should we be ashamed of it? There is certainly a place for traditional physical therapy for musculoseletal injuries.
Geesh, I get the impression that this forum has become a dysfunctional marriage where neither side is really talking to the other anymore, just giving them the silent treatment. Whatever happened to interrogating reality??
Ok, I'm done ranting.
Sarah (aka Anakin)
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,20,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 03:26<noscript>July 15, 2005 08:26 PM</noscript>:
Sarah
I loved your rant. Should be more of it.
Sure we can continue with scapular stabilising and RC work plus capsular stretches (whatever they are supposed to do); if we get good results, that's fine. If we don't - what next? Do we simply say that physical therapy doesn't work for some shoulder pain? Probably it doesn't, but we should offer more than protocol exercises if progress is poor. Neurodynamically-based movements may just do that, though no guarantee - as with everything.
I also think the situation in the USA is quite different; there seem to be certain expectations (correct me if I'm wrong)that a PT will perform certain routines given a rough diagnosis from the doctor. We don't operate that way; we assess and treat according to what we find. The medical diagnosis here is so often inaccurate and based on imaging findings; the doctors generally accept we will sort it out and manage, and they are only too glad to hand over.
Sometimes a GP might say -"but the US showed SS tendonitis" or "..a 2x3 tear in the SS" - and we explain that it was not relevant to restoring function and resolving pain. OK, I should say "I" and not "we"..as we approach things differently from one PT to another.
Who is who in the opposite sides that you mention in this forum? I thought it was a matter of differing opinions/beliefs/clinical practice, which is a positive way of looking at PT in general.
I did notice that there was a deafening silence after Pablo posted the info on CRPS; I can't explain the lack of interest, unless CRPS is not a familiar condition in PT practices...?
Sarah, launch into Fierce Conversations forum...I think you have a lot to offer.
Nari
<hr> Posted by Eric Matheson (Member # 2368) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,22,24,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 05:24<noscript>July 15, 2005 10:24 PM</noscript>:
Nari, an odd study indeed, in part. Have to admit I haven't read any more than the abstract yet. Hope to get to it this weekend. I have a pdf version I'm happy to forward on if anyone's interested.
Eric
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,16,9,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 16:16<noscript>July 16, 2005 09:16 AM</noscript>:
Sarah,
I think using the word "ashamed" is inappropriate. It implies that those who differ with you are saying you should be so, and that certainly isn't true of me. As far as I know, the difference between shame and guilt is this: guilt means you feel you've done something wrong-shame means you think there's something wrong with you. People who practice in certain ways might be guilty of poor reasoning, but I doubt there's something fundamentally wrong with them as people.
PTs can practice any way they want, but if they only do it because "that's what PTs do" I have to wonder how this is justified given new knowledge. Can you think of another profession that would say this? Do engineers still use slide rules? Do doctors still bleed people?
If what you do "works" you are obligated to explain that and defend your method-nothing less. This forum has been over that issue many times, and when people aren't interested in doing that with anything more than platitudes I can certainly grow quiet. Don't mistake that for acceptance. I'm shaking my head as I read their words.
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,16,20,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 03:19<noscript>July 16, 2005 08:19 PM</noscript>:
Nari,
I was re-reading some of my PT school textbooks such as Hertling & Kessler, and they state that joint mobilizations don't actually stretch the capsule, but instead provide some kind of neuromodulation that isn't yet well understood. That book also had a whole chapter on pain with an introduction by Melzack (as I stated in another thread). So, I think it is possible to read between the lines and figure out that there is more going on with what we traditionally do, than just simple strengthening and stretching (a topic that has been beaten to death here lately).
My point in the previous post was based on a concern that people reading the forum lately would not feel welcome to contribute if they did not completely fit into one or the other camps which seem to be forming. I am welcoming a healthy exachange of ideas and friendly debate.
Barrett, yes "ashamed" was probably not the correct word. Maybe I should have said, are we too "intimidated" to speak up for what we do?
Unfortunately, Nari, there is nothing going on over in the Fierce Conversations thread, or I would be there in a flash. I'm afraid I killed it with my lobster story....or maybe it's just too obscure to understand. I know SJ has been waiting for a response from Barrett. And though I know some of the answers to her questions from being at his course, I was hoping he would dignify her with a response. (hint, hint).
Sarah
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,1,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 08:46<noscript>July 17, 2005 01:46 AM</noscript>:
Sarah,
I've definitely noticed the two camps, and have asked pretty much the same thing. Why? It's like Democrats and Republicans, they all want the same thing, just take a different approach on how to get there. Where there should be 90% agreement and 10% difference the opposite happens because people generally seemed entrenched in their own perspective. I've only seen a few who actually regularly contribute equally to both. Jason is one of the few who seems to have accepted new ideas and perspectives.
We've discussed this before of course, my theory is much of it has to do with personality/learning styles. Notice the conceptual and metaphorical style of the posts in the Bullypulpit as compared to the others.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,1,47,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 08:47<noscript>July 17, 2005 01:47 AM</noscript>:
Sarah
I can understand how a capsular stretch can result in neuromodulation; it surprises me that someone would need to do a posterior capsular stretch when, given normal circumstances, that part of the capsule would be posturally stretched most of the time anyway..
I don't think the lobster metaphor killed the thread...probably my terminally boiling frog might have!!
Nari
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,6,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 13:42<noscript>July 17, 2005 06:42 AM</noscript>:
I think that different points of view are what have significantly increased my learning experience here on rehabedge. It sure would be dull if everyone's post after the leading post or the first responding post said, "I agree". That said, I'd like to inquire, because inquiring minds want to know, what are the two "camps" that Sarah and Randy are seeing?
jon
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,8,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 15:16<noscript>July 17, 2005 08:16 AM</noscript>:
Shh.. did I just slip into the Bullypit? I won't let the door hit me in the behind as I leave... LOL
There will never be a discussion or a debate until questions are answered. I refuse to go any further on that joke of a "firece converation" thread. What's the point?
I can kick and scream and throw a tantrum, but no one will hear it. LOL I don't know if there are 2 camps... but there is definitely imbalance. When my husband and I get 2 posts deleted... that right there speaks volumes. The person in control would rather choose to delete versus debate. Remember when there was a bit of talk about cults... uh, huh... I view that kind of action as cultish. Only allowing thoughts that are in agreement with the "leader" so to speak creates a situation of total control. Why waste my time to question and disagree with some things when the post will be deleted? When the person in control begins to either have fear or take things too personally, then those that don't have control definitely won't be heard.
In my opinion it is flat out ridiculous and irresponsible to believe that only one approach will be the best approach for patients. I believe it is best practice to know what approach to use for which patient and at what time in their episode of care, combined with what the patient wants and has available as resources. There is no "one way" and to believe that each theory is right in all situations is wrong. Look at all the research coming out on the importance of classifying patients... you get better results using the appropropriate approaches on the appropriate patient. That is kind of common sense...
In regard to the slam against Sahrmann... well, in her defense, at least her theory is beginning to be published in peer-reviewed literature. She believes in her approach enough to do the extra work to have papers submitted and accepted and published. I don't know, but actions speak more than words to me. There are a lot of words in some people's beliefs, but no "actions" to support those words. Is it because of fear that the belief is wrong? Is it because of fear that the results aren't as great as believed? Is it because those that speak the theory do not believe that anything else is needed to support the theory?
And, hey, I'm not saying that all the neurodynamic stuff is wrong... I just don't believe that it needs to be utilized on every single patient and that the time and presentation of when that approach should be used needs to be defined along with the expectation of results after the technique is used.
And.. I'm out.. I did copy this so that if it is deleted... I will repost it. It pisses me off whenever my posts get deleted. That type of control of what people get to read is unfair... ah, but I'm anonymous and questioning the one in power... bad Bird, bad Bird... And, I guess I have learned that the world isn't fair, so I should quit complaining...
And, in regard to the actual article... scapular positioning... Bournephysio would definitely have an excellent critique of the study. He's done 3 dimensional measurements with high tech equipment... Eric, if you wanted any feedback on that study, you could repost the abstract in the ortho section and you might snag Bournephysio's attention - I don't believe he generally posts in this section... after a while that door slamming your hinney gets a little old...
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,9,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 16:52<noscript>July 17, 2005 09:52 AM</noscript>:
The comment about Sahrmann’s attitude is not a “slam,” it is in fact a simple restatement of something she had published in JOSPT in July of 2002:
“What is the evidence that postural impairments contribute to pain problems and need to be included in therapists’ examinations? The simple answer to that question is that there is very little research to support a relationship between musculoskeletal pain and “posture”. Many respected texts and articles by physicians, physical therapists, and physical educators have cited the importance of good postural alignment to health, but clinical studies have not supported these beliefs. Though I am fully aware of the lack of evidence, I cannot imagine treating any patient without assessing posture or, more precisely, alignment.”
As a moderator I have a responsibility to delete posts that are personally insulting, inaccurate and irrelevant. Disagreement does not come into play. I wait until all three elements are present before doing so. Thousands of posts have passed the test and only five have not; all by the same person or their surrogate. You do the math.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,10,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 17:40<noscript>July 17, 2005 10:40 AM</noscript>:
I don't have to do the math... you don't have a public list of who has been deleted, why the post was deleted and who did the deleting. Without that, it is just your word against my word.
How did all that crap between Jason and Wags get to stay up? Hmm... probably because the disagreement didn't involve you.
Anything I post that questions your theory or your beliefs tends to be "personally insulting." I don't believe that what I tend to post is generally "inaccurate" or "irrelevant." Of course, that is my perspective. I also don't go out of my way to insult you. We all choose how we respond to external comments; we choose how we want to feel about them. You are the one choosing to feel personally insulted. You delete in the heat of your emotions... deleting in the heat of your emotions means that I've struck a chord. There are only two letters that differentiate delete from debate, an "le" and a "ba." No decent, thought-provoking conversations can occur when choosing the "le" choice. And, you don't even give those reading a chance to put me in my place... so, again, it is just your words against my words in what happened in the past. You don't like me and you never will... I could care less, but you do need to work on your objectivity. And if you do supposedly like "fierce conversations," then you should step up to the plate and provide answers....
And... taking a comment from Sahrmann in 2002 is like considered old news (if it was published in 2002 that means she probably said it sometime in 2001)... she has published stuff and has had poster presentations in 2004 and 2005. That means she's doing something about that fact of lack of evidence....
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,11,28,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 18:28<noscript>July 17, 2005 11:28 AM</noscript>:
She's trying, but hasn't yet succeeded.
I don't moderate the ortho threads.
Thank you so much for your personal assessment of my emotional state.
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,17,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 00:36<noscript>July 17, 2005 05:36 PM</noscript>:
I think the above sort of demonstrates the two camps. The neuromodulator group and the others. It does seem to be partly a matter of whether you agree with Barrett or not in the Bullypulpit.
While I have been impressed and appreciative of Barretts answering of my questions and comments, I do notice that in the Bullypulpit there is a lot of talk about not being accepted, being shunned, others being insulting etc but that there also seems to be a lot of insulting, shunning and not accepting and feeling it is morally justified.
Should there be a discussion about personalities and individuals actions on this list? I don't know, that seems to be part of what "Fierce conversations" would suggest.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,18,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 01:55<noscript>July 17, 2005 06:55 PM</noscript>:
You know, Barrett, the case studies that Sahrmann has out are a start. One has to start somewhere. Succeed or not succeed, she's at least being responsible and publishing her theory and results. If she finds out that she is wrong when someone steps up and does some large trial... that isn't failure - she added a lot to our profession. It seems as though you want her to fail. Oh, because if she fails that gives more credibility to your unproven theory... Kind of like that lobster affect Sarah referred to. That's sad... someone taking the risk and some in the same profession definitely not being supportive and having an open mind to the findings.
Randy, the above isn't an example of two camps... the above is an example of me being very, very frustrated with a man in control. And, since no one here had the opportunity to read what I posted, you have no idea if what I posted was insulting or not. We're all adults, others here read what I write... so, I guess technically, all of you can make your own judgments as to why something I posted would be deleted.
I could care less if Barrett and I never see eye to eye. It does bother me that posts are deleted, and you know, without any notice to me for the rationale.... and no option for me to either apologize if I learn that my intent was not what was perceived by the receiver. Go over in Fierce Conversations... I asked very specific questions. For anyone using any particular technque or theory of treatment on a regular basis - the questions are pretty basic, simple questions. I also would rationalize that before anyone jumped on the bandwagon of a theory that it might be nice to know what patients respond, how the patients respond and in what timeframe to expect change. We've all basically agreed that if something someone is doing "works" and is as good as another technique that has been read in literature, then why change the professionals preferred choice of intervention. The same philosophy of, if it ain't broke, don't fix it. But.. I don't receive any answers. So, it does give pause to think... hmmm, why? Why no response? Especially if you see the thread was initiated by Barrett AND Barrett supposedly does appreciate fierce conversations compared to tea party conversations.... I felt it was the perfect opportunity to learn. I truly can't argue much of anything without some basic information. And, honestly... I refuse to pay money to go to some course that introduces some theory if there isn't any type of substantial evidence that the theory works. Sorry.. just saying "it works" doesn't do it for me. I have been told that I have high expectations, and I do... I know chronic pain is the most difficult to treat, but there is no reason for me to just jump ship and halt my current preferred practice patterns at the snap of my finger just because those types of patients are the most difficult and it is difficult to get results and that maybe it is because I have no clue what I am doing... Evidence would sway me if the evidence was better than my outcomes. Simple...
In regard to the two camps... well, the Barrett believers and the Barrett non-believers. I'm more partial to the non-believers group, but as I continue to state it is because no answers have been offered and Barrett has made no change over the years to do a case study or anything in a peer-reviewed journal. I'm not like the sheep in a field. I'm not someone who will just blindly trust someone based on years of experience and traveling the continent doing continuing education.
Personalities? Well.. I shouldn't be in this field. I could be a lawyer, business owner (oh, wait, I am now), engineer, mechanic... but definitely nothing in the health care world. Extroverted, Judging, Thinking, and Intuitive. From a course I went to... I'm perceived a "shark." If I have some goal... either you help or get out of my way. LOL And I believe THAT is where my frustration comes in... I've had a goal to understand Barrett's theory along with his outcomes and it ain't happening yet. I get to a point where I think, "screw it." And you know, I'm at that point again. Moseley writes some nice stuff, it makes sense AND wow, it is in peer-reviewed literature. AND, when you see someone in the neurodynamic camp teaming up with someone in the lumbar stabilization camp (Hodges), hmmm, that makes me think that the lumbar stablization group doesn't quite believe that exercise is the only factor leading to better outcomes. I'll keep my eyes on Moseley and his articles - at least they answer questions and are thought provoking (if only in my head without any external conversations).
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,19,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 02:03<noscript>July 17, 2005 07:03 PM</noscript>:
Randy,
I agree, but I also think that there may be others ways of defining the camps, if they do truly exist.....the Cartesians and non-Cartesians, the skeptics and the believers, the orthopedic and neurological. I haven't quite put my finger on it yet, but something just doesn't sit right with me while reading these discussions lately. I certainly hope people don't feel like they are being "bullied" if they post here, and I also hope people feel they can honestly express their opinions without personal attack. Fierce conversations aren't about everybody agreeing or even agreeing to disagree...it's about putting in all out there and "tackling the issues" not taking the high road. To quote Susan Scott, "the 'fierce' version of confrontation is not firing at someone from across the room, but rather standing side by side, looking at the issue together. All confrontation is a search for truth. Who owns the truth? Each of us owns a piece of it, and nobody owns all of it. Let's keep in mind that confrontation is a conversation. As with all fierce conversations, the four purposes of a confrontation are to: interrogate reality, provoke learning, tackle tough challenges, and enrich relationships." I think the discussions of late haven't addressed the last three purposes, and this is what is leaving the bad taste in my mouth.
Sarah
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,19,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 02:10<noscript>July 17, 2005 07:10 PM</noscript>:
HeHe.. Sarah, that's the other thing about my personality... I don't care about enriching relationships. If they happen, they happen, but I'm not going to be all touchy, feely to make any "relationship" happen with anyone. The first three points, definitely.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,21,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 04:18<noscript>July 17, 2005 09:18 PM</noscript>:
Randy
I like your last sentence.
I think it is important to keep a perspective on what someone is REALLY saying; reading between the lines can be informative.
Personality intrudes everywhere into all conversations; it is what makes us human with all our strengths and weaknesses revealed, despite efforts to conceal or suppress. It doesn't mean we take things personally; we just accept that Joe Blow has thoughts different from Jane Smith.
And, if we all agreed with each other on a topic then there is no point in posting that topic anymore. Agreeing to boost someone's ego can be dishonest; agreeing to validate one's uncertain opinions on a topic is another thing.
Re camps- I don't think there are just two, there are several. but the boundaries are becoming more and more blurry. We are talking processes, rather than selected bits of anatomy as individual units.
One of the difficulties with the 'neurodynamic approach' is that it is quite abstract in the sense it can't be 'seen' and can be difficult to measure. As PTs this can seem nebulous, and not sitting well with more black and white issues, such as orthopaedics. It is easier to track back and forth with ortho stuff, though I am not saying ortho is easy.
I don't always agree with what is posted in RE, but that doesn't worry me at all. I am quite happy to debate, but on RE this sometimes gets out of hand, and other posters withdraw. One cannot have a debate with reluctant participants, for whatever reason they are reluctant. That's why there are lurkers...and if they prefer that way of learning, well and good. Evidence-based learning has done quite a bit to deter participants in a forum; and this is unfortunate.
Particularly when the researchers change their mind as to what is EBP from one year to the next.
I would agree that a deleted post requires an explanation from the deleter. This is a courtesy, I think. However, if one doesn't like the heat.....
Nari
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,0,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 07:48<noscript>July 18, 2005 12:48 AM</noscript>:
Nari, nice post, good reflection of all points of view, even handed. I nominate you to be referee/ facilitator of fierce forum conversations with your even handed tone and perspective.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,5,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 12:20<noscript>July 18, 2005 05:20 AM</noscript>:
Nari,
I explained why the posts were deleted. What would be the point in repeating what someone had just said if the presence of those words had already been deemed inappropriate?
As I said, just one person does this sort of posting to the degree that makes moderation necessary-and disagreement with me has nothing to do with it despite her claims to the contrary.
There are a hundred or so posts on this BB from her disagreeing, questioning and criticizing me and they have not been deleted. Does that indicate anything to you about my decision? As far as taking the heat, well, I'm surprised that you would imagine I'm unwilling to do that.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,6,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 13:05<noscript>July 18, 2005 06:05 AM</noscript>:
Barrett,
My last sentence was intended as a general remark; it was not directed at anyone specifically at all. Perhaps I placed it in the wrong context; and rereading it, I most likely did. I don't fire volleys at any one person, only at systems and sometimes the blanket physical/physio therapy profession as a whole. I think this fact has been consistent in previous posts of mine.
In fact I am surprised that some posts over the last few years have survived the chop; but my judgement of what passes muster is only mine.
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,6,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 13:08<noscript>July 18, 2005 06:08 AM</noscript>:
Again, how do we know that something has been deleted, Barrett? If I hadn't posted anything on it, no one would have even known you deleted something. Hmmm... again, I can only go by what you say.
It is really sad that you are painting a picture that I posted something so very inappropriate. My husband's post was full of poker theory... he was supporting my claim that you play like a fish. But he pointed out the flaws in your belief in how to play poker. And.. according to him, I should apologize to you for calling you a "fish." He agreed with me, but told me that since I don't play poker, then I don't have the right to call anyone a "fish." He said that was the biggest insult a poker player could receive... but you left that post out in the public.. hmmm. I will apologize for that, I had no idea it was that big of an insult. That wasn't what was insulting to you though, because you left that post public.
And, no, Barrett, you can't take the heat. Deleting posts that are more tame than you are indicating is an action that is either controling, cowardly, or laziness because I'm not worth the time or effort for a response. I didn't save those posts, so I don't remember the exact specifics of them, but that doesn't matter. If you could take the heat, you could go point by point through sentences in which you disagreed.
I'm so glad to know I need to be "moderated." If I were a "brown noser" or a "yes, sir" type of person, I bet you that my posts would just shine and never be deleted. Those kinds of posts definitely aren't thought-provoking... and they definitely don't lead to any debate or questioning.
Nari and Diane, I do fully appreciate your posts and they do make me think. Barrett is more my target for strong questioning because he's the one traveling the continent doing continuing education. It disappointments me that he has all those course listings yet can't answer simple questions that I believe are both important and required if you've got someone paying you money. That's the difference - he's making a profit off of his theory without any evidence. In my opinion, that is just as bad as myofascial release and craniosacral. It falls under "preying" on the "victims" who have difficulty treating patients in chronic pain. That is just plain wrong in my mind...
And... I do tend to direct my posts to the person intended - reduces confusion...
<hr> Posted by Eric Matheson (Member # 2368) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,7,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 14:38<noscript>July 18, 2005 07:38 AM</noscript>:
SJ, Do you actually read and give any thought to the posts Barrett has made over the years? In my experience every question I have ever had has an answer somewhere, and I had alot of questions to begin with. What exactly are your questions anyways? Its hard to pick them out amongst all the rage that's emanating from you at the moment.
As for comparing what Barrett is doing to myofascial release and craniosacral, your way off base with that one. It would seem you just don't have the capacity to grasp what modern pain neuroscience is telling you. In spite of your opinions on the matter, there is something 'to get' here, it just takes a little hard work, an interogation of reality. You can't be spoon fed answers forever. When you find the answers on your own I'm sure you'll find the journey to have been more enjoyable.
Eric
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,9,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 16:53<noscript>July 18, 2005 09:53 AM</noscript>:
With all due respect SJ, you really are making a lot of statements, out of what is clear to me to be ignorance, about what Simple Contact is, and what it is not. Allow for me to enlighten you:
To understand Simple Contact and how it is NOT in any way a sibling, nor cousin of Upledger or Barnes, one must first have a firm understanding of the Nagi Disability model. For those of you who are active APTA member, you can find it in the first chapter of the GUIDE to Physical Therapy Practice. In essence:
Pathology ß> Impairment ß> Functional Limitation ß> Disability
PT traditionally tried to treat impairment to impact function (1970's), then we evolved to eye function with hope of impacting disability (1990's). Despite this development of thought, Rothstien and Echternach's recognized the limitations of application of this model when used by the clinician in a left to right manner. In reality, it’s not that simple. Pathology, Impairment, Functional Limitations, and Disabilities all combine to define the patient condition. Pathology doesn’t always lead to impairment, nor impairment to functional limitation, nor functional limitation to disability. However, they argued, every disability has an underlying functional limitation, which has an underlying impairment. Their Hypothesis Oriented Algorithum (an evaluative model suggesting the clinician examine disability first and set goals at that level before objectively assessing the patient) was well articulated, and the case for well described by Sue Campbell in her McMillian Lecture several years ago. It was considered rather progressive with respect to evaluation. That was “way back” in 1999. The philosophy of Simple Contact suggests a similar paradigm shift from treating up the chain to treating down the chain. Specifically, Simple Contact first demands of the clinician that they consider the inadequacies of this treatment approach (Mr. Dorko alludes to this with respect to manipulating the spinal impairment and having patients realize no improvement in functional limitation nor disability). It suggests something of a change from the traditional approach to care (e.g. treat the pain in assumption of getting an improvement in ability to sit or stand, in an assumption of restoring the patient to full home and occupational functioning . . . to a model of treating at the disability level so as to remove cultural barriers to movement within a safe and protected environment, so as to impact the functional limitation of inability to sit or stand secondary to pain, so as to remove the impairment of pain. It is, in the final analysis, a treatment application of Rothstien and Echternach's Hypothesis Oriented Algorithum. Simple Contact is, in many ways, application of a treatment method directly born from the Hypothesis Oriented Algorithum.
To talk about Simple Contact in these terms, clearly and unambiguously separates the concept from Barnes and Upledger, while at the same time placing it and it’s users in the same camp as people like Rothstien, Echternach, and Guccione. In other words, Simple Contact is as much a disability model as it is a therapeutic approach. Those who stand in opposition to it generally either don’t fully understand the disability model, or think in err that Simple Contact is a therapeutic technique exerting effect at the impairment level, as opposed to a therapeutic concept that exerts effect at the disability level.
From there it’s important for the clinician to recognize pain as being the result of either chemical bioagents or mechanical deformation. A review of neurologist Alfred Breig’s work is warranted here --- with the punctuating point being that movement alleviates the pain of mechanical deformation, but that culture and society restrict the patient’s expression of movements (ideomotor) that would alleviate pain. That, by definition, is a disability. The fact that this disability leads to functional limitations of inability to sit or stand for long enough periods to be task successful shouldn’t be a hard sell --- and what’s the impairment that results? Well, pain of course. Simple Contact is difficult to describe in text because it does not involve the application of a technique designed to alter impairment. Instead, it changes the environment so as remove disability, thereby removing functional limitation, thereby removing impairment.
To punctuate this point, consider how most PT’s treat with respect to the Nagi model: Manual therapists, for example, would assume that by manipulating they can decrease pain and improve range of motion. They may in fact be able to do this --- but it misses the point if this wasn’t the impairment causing the functional limitation causing the disability. What if, as you suggest (and I can get you more references), the lack of concordance between radiographic findings and symptomlogy means that another structure (perhaps “kinking” in the associated neurodynamic system) is the impairment truly limiting the patient’s function and abilities?
Enter Simple Contact. The idea being that the true disability is the patient living within a culture that disallows the pain-relieving ideomotor movements that may alleviate “kinking” in the associated neurodynamic system. Simple Contact treatment, therefore, exists not at the impairment level, but at the disability level by removing the cultural/sociological barriers created by our “sit-still and sit-up-straight” culture. All Simple contact does, is provide the patient a safe environment to move without sociologically imposed norms of what constitutes acceptable forms of movement. As applied to the Nagi model of Disability, Simple Contact makes the following assumption:
Specifically, this involves touching the patient in high-neuro-dense areas so as to facilitate the patient through movement patterns that they are just aching to be allowed to execute --- but that would be socially unacceptable for them to do without “permission,” and even more strange for them to do in public. Simple Contact affords the patient the permission/inviation to do so. Without disablity, functional limitation is alleviated. Without functional limitation, impairments are alleviated extremely efficiently and quite dramaticly.
In the end, I think it’s an important point to note the Simple Contact is not a treatment at all. It is, in the final analysis, a comprehensive treatment approach.
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,10,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 17:02<noscript>July 18, 2005 10:02 AM</noscript>:
"That's the difference - he's making a profit off of his theory without any evidence. In my opinion, that is just as bad as myofascial release and craniosacral. It falls under "preying" on the "victims" who have difficulty treating patients in chronic pain."
SJ,
I know you've never been a big fan of Barrett's, and that's your perogative, but let's back up a little, and don't throw out the baby with the bath water.
First of all, just because Barrett has not produced the outcome findings you are looking for, doesn't mean that his theories don't have evidence. Barrett's treatment is based largely on studies done by Patrick Wall, whom you just can't refute with any inkling of objectivity.
Second of all, you're choosing to categorize people who attend his courses as victims who aren't able to treat chronic pain. I for one have been to his course twice, nobody twisted my arm, I think we all have patients whom could be classified as difficult, but overall I have been succesful with chronic pain patients. I hardly think that I have been victimized, or led astray into blindly following some type of guru, which is exactly what you are implying when you compare those of us who have attended one of his workshops to a CST/MFR seminar. I like to think that I am not that stupid.
Scott
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,10,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 17:33<noscript>July 18, 2005 10:33 AM</noscript>:
Wow Andrew, your post certainly seems to put a bit of traction under the tires.
[IMG]smile.gif[/IMG] ,
<hr> Posted by BGruber (Member # 4186) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,11,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 18:52<noscript>July 18, 2005 11:52 AM</noscript>:
To SJ - I am one of those innocent victims, preyed upon by Barret as you describe. I took his class a week before I was scheduled for lumbar injections to help abate the pain in my back which had me seeing stars for nearly a year. But I took Barrett's class for the continuing ed credits, not for actual pain relief which I had already begun to believe was only a dream. Drugs and weeks of physical therapy had failed miserably.
How dare Barrett actually suggest that he might be able to help me. How dare he use me as one of the class subjects. How dare he offer me in one session more relief than I could even remember feeling in my back. How dare he equip me with all of the strategies and skills I needed to continue the process on my own - and continue to answer my questions and support me as best as he could through subsequent emails.
I never went for the injections. I took the class last August and began on a new path of movement and posturing and trust that my body would fix itself if I listened to what it needed me to do instead of superimposing 25 years of education and practice on it. I embarked on a steady road to repair that stunned my physiatrist - though apparently not enough to take me up on my offer to coordinate some research, AT NO COST, to see if we couldn't help some of her other injection or surgery bound candidates.
SJ, I understand your desire for evidence. And my personal story is not science. I can tell you only that it is all the evidence I needed.
And evidence should always be scrutinized as carefully as non-evidence, as there is much research that is so pitifully conducted and slanted. But one of my favorite quotes is this:
“Absence of evidence should never be confused with evidence of absence” (Dr. Nicholas Hall.)And in the absence of evidence, one might ask exactly what there is to lose in trying this non-invasive, non-traumatic, non-harmful-in-any-way technique? I've watched patients go through a 2nd and 3rd laminectomy even though the "evidence" says the success of these surgeries plummet with each successive attempt. I've seen patients ingest a host of sanctioned and non-sanctioned meds, herbs, enzymes, and supplements, even when the "evidence" clearly states these items can be harmful - or lethal. Why wouldn't anyone want to try manually managing pain first? If it doesn't work, what is lost? The cost of a few therapy sessions? Certainly no more (and often far less) than any other form of treatment we might try. And let us not forget that, after all, they are ALL just tries. We know that not every treatment works for everyone - shouldn't we keep all of our options open?
You're mad at Barrett for making money on the course? Have you not been to any of the classes I've been to where instructors spend only a fraction of their time teaching and the rest of the time trying to sell you their wares? Barrett spends 6 of 6 hours teaching, and offers you all of his wares for free - including a website with volumes of information and even an opportunity for an unhappy customer to kick him in the face.
No, I'm not a family member, not a life-long friend. And I'm not one of the sheep you believe he herds - I don't even agree with everything Barrett has to say. I'm just one of those folks he "victimized" during his nationwide search. He got my $169, by golly.
I'm a victim alright - pain free for almost a year now. Fully returned to all of my activites. Grateful every morning I step out of bed without having to calculate each motion. Humbled that I can be hugged without having to brace myself first.
Barret, you scoundrel, I want a refund!
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,11,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 18:59<noscript>July 18, 2005 11:59 AM</noscript>:
Dr Ball,
That was the best explanation I have seen so far. Explanation to that level has not been done by the other proponents, and I do appreciate your ability to provide it for those of us who just dont get it.....yet.
If you get a chance, could you elaborate on the following section, perhaps with a pseudo-transcript of what might go on when an imaginary patient walks through the door? (discovering the lack of expressed motions, the touching to elicit these movements, etc). When you use the term "strange" to discuss the surpressed movements, I get an image of someone hopping on one foot, rubbing one's tummy while patting one's head. Im pretty sure thats not what is going on.
Steve Hill PT
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,12,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 19:03<noscript>July 18, 2005 12:03 PM</noscript>:
Eric, I don't have an ounce of rage. The questions are over at "fierce conversation."
Eric, I have given a lot of thought to what Barrett has written. I'm really not questioning his theory - it is somewhat plausible. In my opinion there are some gaps in his theory that don't seem to add up. I don't think "ideomotor activity" has anything to do with it... I also don't believe that society doesn't allow a person's choice of movement patterns. What I believe is that if results occur, then something happened centrally such that new or improved neuroplasticity occurs disallowing for the old pain pathways to continue to persist. I guess that is a pretty simplistic summation on my part, but I do like simplicity. You can drop the "spoonfed" comment - completely uncalled for and definitely inappropriate.
I honestly have no clue as to what exactly the manual technique is or how to do it or what to do.... I've given up on attempting to understand that aspect. Drew, I believe you are potentially wrong in what you wrote to some degree, because a technique is supposedly performed. Just the name "simple contact" indicates some type of manual technique.
Drew, I didn't mean to say that Barrett's technique is like myofascial release or craniosacral treatment approaches. My intent was the comparison of two techniques that are out there that are not supported in peer-reviewed literature. I can go to those continuing education courses and learn those techniques, if I choose. Barrett is basically at that same kind of level when comparing because his theory isn't in peer-reviewed litearture either, nor are any outcomes or case studies. Along those lines of thinking, I believe I am correct. I don't appreciate being tagged as "ignorant." I'm not "ignorant." I did specifically ask about changes in both pain and disability level... maybe you should review the "fierce conversation" so you can better understand my thought processes.
Scott, I didn't actually intend to categorize anyone as a "victim." I just don't know how else to communicate the frustration that Barrett's marketing strategies seem to be just that. Questions I ask aren't answered... and there seems to be an air or an undertone that his approach is a better alternative compared to other approaches. If it is expected that I should just believe what I read without questioning, then someone has some erroneous expectations. If I believe and accept without questioning, then yes, I am easy prey.
In the end and overall, I guess me trying to get answers from Barrett really doesn't matter, does it? I am a self-learner and I'll figure things out just like I always do. (Others at this site have been very kind, patient and helpful to my learning.) I will continue to grow and learn in regard to understanding chronic pain independently and with the help of others here. It just irritates me that someone can go off teaching a theory, but refuses to do any combined clinical/research work to substantiate the theory - no case study, no outcomes and no answers to my questions that should have at least some kind of ball park response.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,12,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 19:15<noscript>July 18, 2005 12:15 PM</noscript>:
BGruber,
I'm glad you had results. I'm also glad that you didn't need surgery. Surgery can be overrated at times.
It is also nice to know that Barrett will answer questions and provide support.
Why is it that everyone thinks I'm mad at Barrett? I don't really know him. I keep using the word "frustrated." Mad does not equal frustration. In this day in age, it is irresponsible to be providing continuing education courses without providing outcome information... just a simple belief and a simple request... and it is very logical. If every therapist demanded it, I believe as a profession would be better. But, since I'm the only one demanding it, then I'm an outlier.
Why don't you also head over and check out "fierce conversations." I'm not asking the world in wanting to have an idea on outcomes. A responsible practitioner practicing a particular method should be able to provide a response...
But, I am happy that you had results. My beef isn't that patients aren't getting results, nor is my beef that his approach doesn't work... that has never been my beef.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,12,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 19:53<noscript>July 18, 2005 12:53 PM</noscript>:
SJ,
You're beginning to sound a bit like Dr. Childs. I respect the guy, but you're both missing the point to some degree. An improvement in impairment isn't the same thing as an improvement in function or an improvement in abilities. Furthermore, I'd ask why some in the profession seem to be so fixated on impairment for the sake of impairment alone. The Rowland-Morris and Oswestry are, when used in this manner, are reflexions of a thought process born from the idea that improvement in impairment alone begets function and resultant ability . . . this is an assumption that is by no means perfect. In addition, I doubt that Dr. Child's would disagree with the notion that lack of evidence is the same thing as lack of effect --- a concept that seems to escape some of the posters to this thread.
The point is simply that SIMPLE CONTACT (and I agree that Barrett could stand to choose a better name) is a conceptual concept, a treatment approach, it is not, as you continue to suggest in error --- and intervention per se.
The problem is that when patients are facilitated to move comfortably, it looks very, very, similar to a myofascial unwinding. It is this aspect that makes many people (including myself and Barrett) uncomfortable with it. Outcome studies would not be difficult to conduct, and I'm planning a few --- but ya'll must be patient, I just used it on my first patient this morning.
Drew
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,13,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 20:21<noscript>July 18, 2005 01:21 PM</noscript>:
It can’t be easy, often having to write, “I didn’t mean to say…” or “I didn’t actually intend…” or ‘I don’t really know anything (about the thing I’m criticizing) but…”
If I take issue with being called a predator I suppose it would be pointed out that the actual word was never used-only that I was described as someone who “preys” upon “victims.” Gee, how did I ever get to “predator” from that?
Several of the questions in “fierce conversations” require answers with a bunch of numbers I don’t and probably never will have and several others deal with issues of time and pathology irrelevant to the issue of care as I provide it, so I let them go. Perhaps I should have explained this so as not to be called “cowardly” or “lazy.” But perhaps these weren’t the words that were meant to be said. Add “irresponsible” and “profiteer” to that list. In truth, a part of me figured that if I never answered these questions certain people would stay away from my course. It is a bad part of me and I need to work on that, but that’s a personal issue.
I will owe Andrew big time for some time to come for putting my work within a context even the APTA Guide can live with. My mind works-but it doesn’t work that way. I’m glad his does.
<hr> Posted by Sebastian Asselbergs (Member # 174) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,14,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 21:00<noscript>July 18, 2005 02:00 PM</noscript>:
Drew, very well said!
Sjbird, - you are clear and open. I know where you are coming from having been in exactly the same boat a few years ago. I really think that the post by drew is very fundamental to Barrett's approach/concept. I still have to attend a course by Barrett - after all these years of first bashing heads and then grudgingly starting to see his concepts (mostly by trying some stuff in my practice....). Absolutely not saying you are in the wrong here - just that I have been in exactly the same boat.
And Barrett, check to see if that post by Drew has copyright: if not, cut and paste it on your website.
I respect sjbird and Barrett equally for their fierce sense of self and unabashed opinions.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,15,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 22:14<noscript>July 18, 2005 03:14 PM</noscript>:
Barrett, you never understand what I'm trying to say and most folks that understand you never understand me. My words get twisted and are taken too personally... which then means I have to back peddle and figure out another way to say the same thing to get into thick skulls.
Drew, where did I ever say that improvement in impairment equals improvement in function? I never said that... I never alluded to that. So, you are interpreting something inaccurately. Lack of evidence does not equal lack of effect... I completely agree with that statement. That concept doesn't escape me one bit. The problem is that we have so many different options from which to choose and no one seems to be desiring to provide "effect." The same crew of researchers are carrying the workload. If no one else does it, where will we be in 10-20 years - may need to forget that 2020 vision? Will we be considered any better than chiropractors, massage therapists or herbal specialist folks? Just something to think about...
Semantics Drew... we all get so darn hung up on semantics... I could care less if what Barrett proposes is an approach, a theory or an intervention... It is what it is and when I ask specific questions and don't get a response, well, for anyone using a particular approach, that person has an idea of what generally occurs, in what time frame, with what patient population. There is no outcome data and there is no case study - so how about if someone explain to me who I should gear this approach for? Paint me a picture of what that patient looks like (that was the reason for my questions) AND give me some expectations of when results are seen, how long they last (gee, if I'm not getting results in the expected time frame, I should probably move on to some other approach)? Am I the only one that thinks this way? No one else tries to have an idea of when to do what and with who and has an idea of when to expect some kind of response and the degree of that response? And, I am not John Childs... and I'm not "missing the point." Since you are one with an MBA, you should definitely understand the desire to know utilization rates and changes in function. I believe we are going to be pushed to know that kind of crap. So.. am I really "missing the point" or do I understand it quite well, but the "point" is too difficult to just put out there for all to see? It seems to me that no one seems to understand my point to contemplate it.
Barrett, I'd like you to to take a deep breath. Forget the feelings you have toward me and how it always becomes a personal issue whenever I'm interested in something. Just follow along and not do any deep thinking. I'm not going to say that I'm not interested in your theory/approach/intervention (whatever word...), I've been interested all along. I've learned a lot from reading the various posts that consider the neurological system. I give you guys full credit. But why do you find it so wrong of me to ask for a definition of the patient population? Why is it wrong for me to ask the average results? Why is it wrong for me to try to evaluate my practices with what you are doing to see if maybe I need to change something I'm doing because I am inadequate? Without some hint of a response to those questions, I have no idea if my outcomes are within the same range, better or worse. I'm a bit more practical - I won't fly to some course on a whim just out of curiosity and to drink a few beers. I need to have a solid rationale as to why I want to go to a course and what I want to gain from it and how my practice patterns and my outcomes will change. Isn't that the bottom line? To be the best you can be and continue to improve? You need to let your "personal" issues, whatever they may be be put aside - I do believe that the questions that I asked were very good ones. You don't want people like me in your course - someone who has researched it to a degree and is coming because that someone believes that what you have is of value to them versus out of curiosity? In my opinion, if your responses for a specific described patient population indicate a higher level of function, less pain in a shorter amount of time without re-entry into the medical field - you're sitting on a gold mine. Until those questions are answered though, no one is going to know... or they have to learn on their own how their outcomes change. Well.. sorry, I'm not going to pay for a theory without knowing the outcomes because I need to know that your outcomes are more superior than mine...
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,15,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 22:35<noscript>July 18, 2005 03:35 PM</noscript>:
I truly don't get this: I get called all these names and I'm the one who needs to calm down? You'll know I'm not calm when I start name calling. In six years on this BB I have never done that. Conveniently ignoring my comments about being referred to as cowardly and lazy does not mean this hasn't happened again-today. Oh yea, let's not forget "thick skulls," which at least gives me some company.
I have said for years that Simple Contact is a way of addressing an abnormal neurodynamic, and that this is a condition described over and over in several texts, the latest of which is Shacklock's. It has also been discussed in detail in past threads. "If I only had the Noive" comes to mind, but there are many others.
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,15,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 22:40<noscript>July 18, 2005 03:40 PM</noscript>:
"You don't want people like me in your course - someone who has researched it to a degree and is coming because that someone believes that what you have is of value to them versus out of curiosity?"
SJ,
I don't know how much I am like you, but that statement is exactly why I attended Barrett's course in the 1st place.
And you should try to talk to Drew in person, I had to get out my thesauras every other sentence. ( The guide to PT practice for the others).
Scott [IMG]smile.gif[/IMG]
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,16,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 23:18<noscript>July 18, 2005 04:18 PM</noscript>:
Andrew, you have certainly sparked my interest. You seem to have a very firm grasp on Simple Contact theory. I find some parts simply bizarre.
Examples of socially acceptable movements/postures would include bending forward knees locked rounded back to pick up a pencil/or engine block, sitting in class butt at the front on the seat and leaning back, shoveling dirt feet planted lifting and twisting back to dump dirt into wheelbarrow, etc. So wouldn’t socially unacceptable movements include the posture/bodymechanics PTs are already teaching?
Diane gave me a clear example of how she provides treatment to a patient. I wonder if someone can give an example of a Simple Contact treatment. Also BGruber could you give an example of your new movement patterns and how it differed from the old patterns?
My mouth is open, bring on the spoon
.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,17,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 00:36<noscript>July 18, 2005 05:36 PM</noscript>:
This would be a good time for Barrett to jump in with a description between socially discouraged movement, and socially discouraged expression of ideomotor movements. I had a hard time with the term "ideomotor" as it seemed to me that what was being described was encouragement of feed-forward isometric preparations for subsequent movement encouraged to full expression. That's a little different that Phoebe running --- but closer to in the ballpark than I've seen to date of someone with no exposure to Simple Contact to date.
That's your cue Barrett . . .
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,17,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 00:57<noscript>July 18, 2005 05:57 PM</noscript>:
Drew
I agree that your excerpt is great reading. I think it may encapsulate the camps that SJ referred to; looking at a process vs looking at what is tangible and visible. Arguably that is simplistic - but with no prior first hand knowledge of Simple Contact, I am not sure of the ground I'm on.
Which is why I (and another Aussie)are going to Vancouver in September to "do" Barrett's course. There is too much implication in its intent (from what I have gathered) to ignore. Anything based on neurodynamics cannot afford to be ignored by PTs; and there is enough evidence around to support that, and has been supporting, for a decade or so.
(Mind you, I am also keen to have a look at Canada's West Coast as well!)
Nari
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,18,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 01:32<noscript>July 18, 2005 06:32 PM</noscript>:
Wow! I think Drew just blew my mind with that summation. I was already confused with 'Simple Contact' and may be even more so now. Maybe I'm still a tadpole...who knows, but I still find the approach confusing. I guess I'm in the same boat as SJ...wanting to know what patient population it works best for, what outcomes to expect, time frames, etc. Maybe some of those questions would be answered for me if I took the course.
What is an example of a 'socially unacceptable' movement or movement pattern? Why do they need 'permission'? I realize these may be elementary questions to someone like Barrett or Drew, but it may help me to understand a little bit of what's going on during 'Simple Contact'.
Thanks! [IMG]smile.gif[/IMG]
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,18,34,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 01:34<noscript>July 18, 2005 06:34 PM</noscript>:
I think Barrett should get someone like Drew to paint a picture and give an easily understandable (ok, maybe not drew") description of what he does and why he does it. I have so many posts about people trying to understand it, even people who have attended the course saying" I'm not sure what it is I'm supposed to do".
Concepts are sometimes harder to explain than techniques but when so many people just aren't getting it, then something is obviously missing. I've been on here about a year and now have, I think, a fair idea, of what is done and why. I would just describe it but I think Barrett would have to approve it, it's his theory.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,18,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 01:42<noscript>July 18, 2005 06:42 PM</noscript>:
People initially "need permission" to move ideomotorically because the culture is arrayed against it. Therapists collude with that.
I’m sure Andrew will recall seeing the young woman I worked with at the end of class; several years of persistent discomfort, pain altered with movement, sympathetic dominant, no relevant pathology, internal rotation of the hip on the same side as the pain-all indications of an abnormal dynamic.
I placed my hands about her shoulders, deforming the skin just enough to elicit depolarization. She began to turn left and right, her feet fixed on the floor, various movements of the torso followed including combinations of sidebending, flexion and extension, both arms began to participate with movement from all the joints. If that sounds like it would look strange, well, I suppose it does, but many years ago I figured out that if these motions were effortless, warming, led to relaxation and were surprising to the patient that they should be considered corrective in nature, specifically of the abnormal neurodynamic that serves as the essential diagnosis.
There’s no wild dancing about, nothing that looks goofily planned, no emotive response, trance-like state or fearful reaction-nothing but movement-often slow but not always, often powerful but not always, often large but not always. Changes in pain are common but not always. The shift toward warmth heralding an increase in parasympathetic tone is its major attribute.
If this isn’t simply a complete manifestation of ideomotor activity (long unrequited beforehand) then what is it?
<hr> Posted by Eric Matheson (Member # 2368) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,19,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 02:16<noscript>July 18, 2005 07:16 PM</noscript>:
It sure makes detailed measurements of scapular position seems like a big waste of time.
Eric
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,19,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 02:36<noscript>July 18, 2005 07:36 PM</noscript>:
Drew, loved the explanation of how Simple Contact fits into the Nagi Model. I had never thought of it quite that way. When did you take Barrett's course?
SJ, you might want to start trying to be a little more concerned with relationships considering that is the way people interact with each other as human beings. How can you not care about relating to another person?? You can't just blaze through life saying whatever is on your mind, without considering the consequences of your actions. As Susan Scott says, the conversation is the relationship, and "relationships succeed or fail, gradually, then suddenly, one conversation at a time." Our thoughts become words, words become actions, and actions define our character. It is not something to be taken lightly.
I see your point of wanting to have outcomes, but as Barrett stated, most of your questions aren't framed in a way that applies to his deep model or approach. It's like trying to predict how many raindrops will fall on a leaf during a storm. There are too many variables. Each person is so unique and brings such unique experiences to the table that one cannot begin to categorize, classify, or prognosticate about outcomes. How would those outcomes even be measured, and could they be generalized to any degree? Good luck on coming up with research studies, Drew. I have a feeling if anyone can do it, you can.
Sarah
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,19,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 02:37<noscript>July 18, 2005 07:37 PM</noscript>:
Eric
It sure does.
And the same MIGHT be said of a heck of a lot of other studies that examine the minutiae without acknowledging the big picture.
Barrett
Thank you for that example. It makes you sound rather like an enzyme...there, that's a name you may not have been called yet. [IMG]wink.gif[/IMG]
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:05<noscript>July 18, 2005 08:05 PM</noscript>:
I think it's hard to take the Simple Contact workshop without a foundation in Disablity models. In addition, it was helpful to me to have a foundation in functional pre-tests and post-tests (such as those provided by Institute of Phyical Arts BET and Functional Orthopedics courses). Finally, upon using Simple Contact for the first time in my clinic this morning, it was helpful to have a foundation in neural tension positions so as to recgonize them when the patient sought "flirting" with them during ideomotor movement.
Simple Contact is a great course, but I think it would difficult to take as a stand-alone without either this discussion, or a foundation in some of the aforementioned concepts.
In answer to your question Sarah. I've known Barrett for several years now from APTA conferences, but I only took his course this past weekend. A study on simple contact would be . . . well, simple. Match a few subjects and compare improvements in range of motion for patients treated with simple contact versus those treated via some other medium. Cervical range of motion, glenohumoral range of motion, or resting LE external rotation (a measure of sympathetic/parasympathetic tone) could be used as outcome measures. The issue is that until recently, there was not much interest in Simple Contact among PhD's because it sounded too much like Barnes and Upledger. That's starting to change. It certainly got the attention of this skeptic --- so maybe I'll do a few case reports to start, once I finish my DPT in a few weeks.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:15<noscript>July 18, 2005 08:15 PM</noscript>:
Sarah, you know, a bulletin board never captures the full person. Just remember that. As a whole, relationships are never as important to me as compared to goals. Hence my ENTJ. That is my prefenence... If I decide that someone is worth it to me, then the relationship I have is always very strong. I'm pretty successful overall, so I don't plan on changing my personality to fit what others seem to think would be better.
Sarah, my questions are definitely not even close to being framed to his model... you read them. And, yes, believe it or not, patients can be grossly classified or categorized. If you think about it... there is an "average" representation in what we treat and there is generally a large standard deviation of that "average." The standard deviation captures the variation, but there is an average. If Drew is going to be doing any outcome studies, I definitely recommend somehow classifying patients and I honestly say that The Guide is helpful only to a very, very small degree. The outcomes can be measured with valid and reliable outcome tools - those tools are out there. I would also recommend that the outcome studies that Drew may be pursuing would need more than one therapist using the approach and collecting data because as a single therapist, I would highly doubt that he'll snag enough data on his lonesome to tell him anything meaningful, especially if he has a mixed case patient load as in most outpatient orthopaedic settings. Or, I can say that it will take more than a couple of years...
Barrett, I believe that has been your best post that describes what you do. I'll ask some more pointed questions to get a picture in my head.
1) approximate age of the person?
2) where was pain located and the person's description of the pain?
3)what do you mean by "pain altered by movement"? How was the pain altered and by what movement?
4) How did you determine sympathetic dominant? What did you use to assess sympathetic versus parasympathetic dominance?
5) IR of hip ipsilateral... in what position? sitting, standing, walking, supine?
6) What amount of pressure is enough to elicit depolarization? And, how do you know depolarization occurs?
7) What position was she in when you used some manual pressure?
8) What are you saying to her as you apply this pressure? What is she saying?
9) And.. how do you educate the person before you put their hands on them? What kind of conversation occurs before you begin?
I'm beginning to get a visual... so who ever asked that question, thanks.
hmm, Drew.. I just read your post... I believe you do need to remember that physical impairment does not always lead to loss of function. I'd advise a stronger study that incorporates standardized outcome measures... just tracking impairment is going to gain you what? Just something to think about...
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:23<noscript>July 18, 2005 08:23 PM</noscript>:
I've not much to add. Drew, I enjoyed your idea and it would fit in just as well with the changing language of disablement (my APTA plug for the day).
Ideomotor activity, to my understanding, doesn't necessarily look different at all. It could look like driving a car. It could look like scratching your head. It is the underpinning of all volitional behavior.
From Herman Spitz's Nonconscious Movements: From mysical message to facilitated communication (p. 123)
Simple Contact, as I understand it, appreciates this fact. The approach attempts to ease the bottleneck. The greater the amount of information that needs to get through the bottleneck, the longer the the time spent in PT. Controlling for that in studies would certainly be a challenge. Drew...luck.
jon
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:33<noscript>July 18, 2005 08:33 PM</noscript>:
I think the first step would be a self-controlled single subject design. An A-B-A-B study, for example, where a subject was assessed, treated with treatment A, reassessed, treated with treatment B, reassessed, and then the process repeated.
I agree with SJ's points about also classifying patients and also defining functional limitation and disablity. This gets very cumbersome in a large study, which is why a single subject (that's different than a case study folks), or pilot study would be a good first step.
Drew
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,21,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 04:16<noscript>July 18, 2005 09:16 PM</noscript>:
Barrett, Thank you for your specific example. If it was ideomotor movement, what was the thought or idea that precipitated the movement?
“A child on his first day of schooling will breath and swallow (exicitomotor) and the teacher says nothing, he startles in his seat if the door slams (sensorimotor) and no one complains. But if he shifts in his seat in order to grow more comfortable, if he expresses fear or anticipation or anxiety that is deemed inappropriate, there is a very good chance that all of this movement will be discouraged.”
I think this adds another piece to the puzzle.
Barrett I think you would pull your hair out if you worked in the military environment with the mandatory stiff posture and formations.
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,21,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 04:36<noscript>July 18, 2005 09:36 PM</noscript>:
Zack, I will add that goes for being a trained dancer as well.....nope, sorry can't picture it! [IMG]smile.gif[/IMG]
Drew, what would ROM have to do with anything? Isn't Barrett the one always telling us that ROM, strength, posture, etc are not related to pain? For outcomes, I would think you would want to test pain with a visual analog scale or do some functional test like Oswestry. But even so, that would be missing the mark somehow.
SJ, very true that personalities don't come across well online. For instance, I am actually rather soft spoken and quiet.....no, really. [IMG]smile.gif[/IMG] And the most common Meyers-Briggs personality I get when I take those tests is INFJ (which is what Ghandi and Eleanor Roosevelt were too, supposedly). If that doesn't paint an odd picture......
Sarah
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,22,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 05:14<noscript>July 18, 2005 10:14 PM</noscript>:
Zack,
Thanks for the example! Which one of Barrett's essays did that come from? I guess I need to get it together and READ more. [IMG]smile.gif[/IMG]
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,22,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 05:55<noscript>July 18, 2005 10:55 PM</noscript>:
Chris, It’s in his Without Volition essay, here is an interesting link using Barrett’s essay as a citation. Ideomotor
I am still far away from grasping the concepts for treatment of pain using neurodynamics and Simple Touch, but I think I am beginning to get closer.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,1,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 08:59<noscript>July 19, 2005 01:59 AM</noscript>:
Zack
People are made to sit still and behave in a fairly docile manner in all sorts of situations.
School is one example, especially with young kids; the Army is likely to be another; some social situation where everyone sits or stands like stuffed ducks until the alcohol kicks in; in the movies where forty people sit, again like stuffed ducks because moving is culturally a crime in a cinema; and lots of others.
What happens if we sit too long? Pain - eventually. What happens if we sit upright for too long? Whew, a relief to slump.
People with persistent pain are in chains - they really do need permission to move. I have had many experiences with patients with stiff and painful backs or knees or something or the other...and they find out they actually can move much more naturally, once they are aware they can.
Neurodynamics is one technique, there are others that are orthopaedically based; and they can work, while still fitting in with the traditional requirements (if needed) of ROM and strength and that stuff. Simple Contact may circumvent the need for complex and much debated interventions, and I am interested to find out that it can.
What about qualitative study? That may hit the mark better.
Nari
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,2,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 09:33<noscript>July 19, 2005 02:33 AM</noscript>:
This is one area that I disagree with Barrett on, at least partly. There is culturally induced movement inhibition, I believe, but why does it only cause some people to have pain? Why don't people move naturally when alone, they fart, scratch their butts and pick their noses when they are alone,(Ok, I do, I'm guessing they do too)why don't they move naturally?
I think it is a matter of kinesthetic awareness? somatosensory awareness? being in touch with your body? Cultural inhibition may be one of the reasons for it but not the only one. Obviously since treatment is a social situation as well as a physical one, this is one inhibition that has to be dealt with. (I read an interesting article on Bullying. It made reference to the fact that fighting was not mainly a matter of physicality but of sociality. Fighting as a social act. This was something that I intuitively knew.)
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,2,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 09:57<noscript>July 19, 2005 02:57 AM</noscript>:
Randy
People do move naturally when they are alone; or so I think. Cultural inhibitions are strong, and those who defy them are branded as antisocial.
Not everybody descends into a pain state if constrained; just as not everyone develops persistent pain after a sprain or fracture. I don't really know why; but the researchers seem to be into it in a big way.
Fighting and pecking order are social in nature; any society develops skills in both. They become exaggerated in extreme societies, of which the world has seen plenty. Maybe fighting has some virtues somewhere, because society seems to have progressed along those lines since whenever.
Nari
<hr> Posted by gary s (Member # 1098) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,7,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 14:46<noscript>July 19, 2005 07:46 AM</noscript>:
Bird,
Question 3 "pain altered with movement".
I refer you to one of the greatest minds of our time--Henny Youngman.
The patient says "Doctor, it hurts when I do this." "Then don't do that!"
Gary
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,13,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 20:01<noscript>July 19, 2005 01:01 PM</noscript>:
I thought I had a neurodynamic problem once, but it was all in my head. Good thing it was concrete. (vs abstract, otherwise it would have clashed with my brain).
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,15,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 22:20<noscript>July 19, 2005 03:20 PM</noscript>:
Having just picked up Michael Shacklock's Clinical Neurodynamics and being one of those therapists in the "Other Camp" (EBP driven), I am learning a great deal from this thread. I understand clearly the psychosocial considerations and how they impact treatment/interactions (Ans am huge on the educational aspect of things) but never understood what the heck Barrett and others were doing with these patients. Like SJ and Chris I would like further examples to further understand how you are working clinically. It would seem that many who use the techniques like the metaphorical approach but more concrete examples would help some of us folks.
More specifically, are there any challenges to carry over effect and dependancy when treatment requires a therapist to place their hands on a certain part of the patients body to allow "normal Neurodynamic"?
I'm all ears.....
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,15,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 22:31<noscript>July 19, 2005 03:31 PM</noscript>:
Steve,
Ideomotor activity is inherent to life and is not dependent upon the the presence of the therapist's hands (or the presence of the therapist for that matter) to be expressed. It does help to touch another to make them aware of their own motion and their learned tendency to inhibit it, but this is only the beginning of the lesson. The sooner the patient learns that this is their motion the better. I use another's heartbeat as an example. With our hands we can make them aware of it, but we don't significantly alter its expression with our presence. That's up to the person who owns the heart.
See "Do Nothing" and "Body Counseling" on my site for more about how this method is initiated and progressed.
Thanks for asking.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,17,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 00:37<noscript>July 19, 2005 05:37 PM</noscript>:
Gary
Couldn't resist replying to your post; telling/asking someone not to do something because it hurts can set off a whole chain of fear-avoidance issues that can be a precursor to persistent pain states....it does depend on the issue, but as a general rule, not good advice!
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,19,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 02:14<noscript>July 19, 2005 07:14 PM</noscript>:
LOL Nari Actually, it does depend on what it is that hurts. Sometimes people can be so stupid and say "It hurts when I do *blank*" and *blank* is just some stupid motion that who knows why he/she does it. Of course, it's all in the manner in which you tell the patient... a little humor and a chuckle do seem to work. The patient gets the point pretty easily that he/she is being kind of stupid...
Gary... actually, the comment about "altered pain with movement" was too general for me... altered (hmm, worse or better?) and movement (a specific movement, any movement, movement of what and where)?
For me to really understand a lot of what is written here, sometimes I need just a little bit more information and detail to understand the big picture. Until I get the details, I can't say in my head... "Oh, okay." But again, not everyone views my questions as being necessary or pertinent. They definitely are to me though.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,19,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 02:58<noscript>July 19, 2005 07:58 PM</noscript>:
I've been using Simple Contact for 2 days now, and I've seen some pretty amazing improvements in range of motion in that time from the patients of mine that were hitting a brick wall with treatment. I'll give two examples:
One patient with cervical disk problem and radicular symptoms that I treated with primarily manual therapy including suboccipital release, manual traction, and Maitland/Sultan dial-a-neck techniques improved cervical range of motion th the left from 20 degrees to 60 degrees in 6 visits. She is 2/10 pain at best, except when she tries to clean house, which spikes her pain up to 6/10. She arrived in 5/10 pain today, with a massive knot in her left upper trap. I started with her in sitting. I did a quick review of what I was about to do, and why I was about to do it, then had her sit in a chair. I placed my hands on her ears, very softly, and she began to sidebend her head from side to side with VERY low amplitude. That went on for about 5 minutes and she began to increase amplitude, move into counterclockwise rotation, and then move toward a head nodding. At this point I had her stand. She continued the head nodding and began to incorporate something of a longus coli neck retraction into her movement. While keeping my hand on one of her ears, I placed my hand softly on her left elbow (the one with radicular symptoms). Her left arm flung up into about 85 degrees abduction. Almost violently. From there she began to turn her head to the right and back to center, to the right and back to center, while at the same time extending her elbow extending her arm past the frontal plane while in 60 degrees or so horizonal abduction, and with wrist extension. In essence, she went right into the brachial plexus stretch that, until now, she had resisted secondary to pain. After a few minutes of that, she sighed, and her head turned left as her arm shot up to brush her right cheek.
This is friggin weird. I thought to myself.
I then sat the patient down again and did a few of the functional movement pattern/IPA tests with her. I was startled to find her forward head reduced to nearly normal. I was VERY surprised to find her cervical rotation to the left 85 degrees pain-free. An that knot I didn't even touch . . . gone.
During the same treatment time, one of the other skeptics in the clinic, a former Maitland fellow who is 1/2 way to her certified functional manual therapy certification, was also using simple contact with her patient. A patient with a chronic thoracic pain that she'd been treating for about 6 weeks now with limited success. She got similar results to the ones I got . . . full restoration of normal and functional movement, and a complete elimitation of pain.
I'm not saying that Simple Contact is a panacea, and it's not worked for every patient --- but even in the ones it's not worked for as a treatment, it has provided VALUABLE information as an evaluative modality with respect to how willing the patient is to move, what movement patterns they seek, etc.
As a result, the most experienced skeptics in my clinic are now going 'round going "Friggin Simple Contact." The fact that it's getting better impairment level results, AND restoring patient to function in ways that the tools in our 20 years of combined experience between the two of us does not --- is REALLY bruising to our respective professional egos.
My concern about simple contact is that despite the outcomes, am I really following the patient, or am I leading the patient much like facilitated communication? Some would say it doesn't matter, that the interaction yields real and objective improvement --- but that's frankly not enough for me.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,20,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 03:16<noscript>July 19, 2005 08:16 PM</noscript>:
Drew... how about if you kind of communicate what it was you told her you were going to do, why you were going to do it and any other communications that occurred? And, why did you put your hands on her ears?
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:03<noscript>July 19, 2005 09:03 PM</noscript>:
Hi Drew,
Can this patient produce this motion in your absence? If so I think you can rule out facilitated communication.
jon
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:15<noscript>July 19, 2005 09:15 PM</noscript>:
Andrew,
As Jon says, this isn't your movement if the patient can proceed on their own-something I know you can teach them. Anyway, if the results are as you describe (old news to me), how did you suddenly get so smart?
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:21<noscript>July 19, 2005 09:21 PM</noscript>:
SJ,
Review the posting where I talked about treating at the disablity level, sociologic barriers to movement, etc. That's what I talked to her about. She was clearly afraid to move, I explained to her that part of that might be, in addition to protecting herself from the assumption of pain upon movement, that society frowns upon "fidgeting" but that we were going to create a safe, comfortable, and judgement-free space for her to just move. Just play with movement and let her body do what it wants to do. Skin deformation enhances sensory activity, which in turn helps ideomotor movement "bubble-up" to full-expression. Remember that we are constantly in flux between positive and negative action potentials. It's only when positive outweigh negative that we cross action potential into action threshold. Touching a person in a neruo-dense area (usually over boney prominence or cartilaginous protrusions) help ideomotor action potentials to increase to cross threshold and produce movement. I'd say that's in theory, but there are actually some good NCV studies that support this, I just don't have them off the top of my head, but I think they were done at Virginia Commonwealth back in the '70s.
Jon,
Most, but not all patients, CAN produce this motion in absense of a PT. That's the level you want to get most patients. Barrett demonstrates this point rather dramatically in his workshops.
Drew
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:31<noscript>July 19, 2005 09:31 PM</noscript>:
Barrett,
I think that a therapist has to be in a certain place, have gone through a lot of manual ideas before ending up in the "been there, done that" kind of place. For me, I couldn't ever have been able to deal with simple contact had it not been for an understanding of the GUIDE, the Nagi model of disablity, NDT training, and the mind-blowingly skilled and passionate manual therapists I'm surrounded by at Lake Norman Regional Medical Center just North of Charlotte, NC (We're looking for PRN therapists, by the way --- so if anyone wants to work with us in a rather challenging and fast-paced environment, let my Director Kevin Kucko, PT, know that you've been following my posts at RehabEdge and would be interested in working with us --- 704-660-4470). Your experiences Barrett, (and some may not know this) are unique. You taught mainpulation with Stan Parris and Ola Grimsby. You met Berta Bobath back when she was still teaching NDT.
It takes a while to come to a place where simple contact can be understood and accepted at a level that can be evaluated as more than the esoteric Barnes/Upledger nonsense that it often looks like.
I find it hard, for example, to wax research concepts with colleagues. I don't want to talk down to them, so I often simply assume that they know at least most of what I'm talking about --- and that if they don't, they'll ask a question. I know that often over-estimate where people are in that regard, and take my experiences for granted. I suggest that your arrival at simple contact is much the same. I urge you not to take your past experiences for granted. Others on the board may not have had them, and as such, it's harder for them to arrive at a place open for skeptical evaluation of simple contact concepts.
Hopefully, this discussion will start to change that --- but be careful what you wish for my friend!
Drew
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,23,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 06:32<noscript>July 19, 2005 11:32 PM</noscript>:
Drew, thanks for the clinical descriptions. I'm glad you took Barrett's course. Very interesting, helped to have something more concrete, i.e., an experiential description. Looking forward to your experience, Nari.
However, Drew, I do think that a specific knowledge or experience base in preparation isn't necessary, notice I said specific, everyone. Plenty of movements occurr without acceptable (to everyone) explanations, but they cannot be denied if experienced (Barrett suggested dousing is ideomotor, he did not state it is bogus, although that may be his opinion. I think he is right about the ideomotor part, I just don't know how the douser's body knows when to cause the motion). I suspect experiencing something is the key to acceptance, regardless of the theoretical rationale.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,4,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 11:39<noscript>July 20, 2005 04:39 AM</noscript>:
What about seances - they are supposed to be ideomotor in nature....but I've never been to one.
Can someone explain what facilitated communication really means??
Thanks
Nari
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:00<noscript>July 20, 2005 05:00 AM</noscript>:
Drew,
Why do believe that a therapist must have "been there, done that" to understand and appreciate Simple Contact? I have always thought that the comprehensive and meticulous logic supporting it was enough even for students to be swayed.
I came across Barrett's work two years ago in the middle of my undergraduate degree - and therefore I haven't "been anywhere" yet. I tell you, I have had a very hard time getting through my postgraduate studies to pass the board exams because it is now so hard for me to swallow much of the manual therapy 'traditions' necessary for this. But then, maybe that's because I hadn't been indocrinated yet.
Luke
PS: I have learned a lot from your posts here, thankyou. Where can I read about the Nagi model?
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:18<noscript>July 20, 2005 05:18 AM</noscript>:
I don't think that a person has to have "been there, done that" so much as be able to apply simple contact within a much larger scope of the patient condition. My difficulty with simple contact is that because its application is so easy, and its philosophical underpinnings so different, the same kinds of people attracted to Barnes and Upledger end up attracted to simple contact.
Sure, there are some that have a wide scope of experiences, but there are others who simply can't cut it in an evidence-based outcome environment. Some who simply have difficulty with understanding the pathoanatomical concepts of Maitland or Mulligan, difficulty with the manual therapy application of Paris or Grismby --- and end up gravitating toward that which, in application, appears to require little thought because no one else in the clinic is doing it.
At its worst, that's what simple contact COULD be. It takes a certain level of experience with patients doing traditional care, using traditional concepts before being able to explain simple contact in descrete non-esoteric terms. Case in point is what happened to this thread after I took Barrett's course and re-defined/re-articulated exactly what it was that he was really doing. Furthermore, it's difficult to assess and articulate why patients are or are not moving in certain ways ideomotorically without a firm grasp of other neurotension and functional movement pattern concepts.
Finally, you can read about the Nagi model by simply gooleing "Nagi AND Disability" or spending a few bucks for the American Physical Therapy Association's GUIDE to Physical Therapist Practice. I'm sure at least one of your professors has a copy --- I'm sure that Chris Maher does.
Drew
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:32<noscript>July 20, 2005 05:32 AM</noscript>:
Drew,
I agree that a certain amount of background knowledge is neccessary to understand it. As Barrett advises, I have never thought to separate the technique out from the whole picture, but I understand your point about such an exclusion being tempting to some.
I am in Australia and studying osteopathic medicine so I doubt my professors have the GUIDE. I'll try google. Thanks.
Luke
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:55<noscript>July 20, 2005 05:55 AM</noscript>:
Yogi,
The dowser moves the dowser's rod-they just don't know they're doing it. Neither does the person running the Ouija board or the person holding the pendulum or the poker player revealing a tell. This is all ideomotor movement but poorly understood which is why it's called "the mischief maker."
In case you didn't know, dowsing doesn't actually work and many studies have proven this. It's a matter of luck, and you're going to be a lot luckier in New England than Arizona, which would explain why you find almost no dowsers in the southwest. If you think it "works" via electromagnetic forces or something like that you should consider reading a little Newton before suggesting that.
Drew,
Remember the "Easy and Simple" lecture I did? It covers what you're saying about what we should know.
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,9,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 16:38<noscript>July 20, 2005 09:38 AM</noscript>:
Nari,
Im about to reconstruct my treatment rooms with eggshell floors if this is the case.
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,15,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 22:48<noscript>July 20, 2005 03:48 PM</noscript>:
Drew, Barrett or any others who wish to reply,
So I'm thinking about this culturally limited response to pain and the explanations surrounding it when my two year old son starts limping with his foot essentially inverted as he steps - he had a splinter in his medial foot earlier in the day. How does his response, since he doesn't really have a whole lot of culturally reinforced behaviour (Although it might be argued that his socialization is significant at two, he had just taken a whiz on the front lawn with 10 people watching so he couldn't be that culturally bound)? It would just seem a good way to avoid something painful and my guess is that later today when I get home he will walk just fine.
If this simple contact technique is giving some proprioceptive feedback that allows a heightened neural system to down regulate, is it more effective with a chronic pain patient who has had gaurded movements reinforced both culturally (Ie. the housewife who has 10 kids and has gone from doing everything to being waited on hand and foot by the kids) and internally (Ie. increases paravertebral tone to avoid movements that might hurt and then the spasm that occurs with anticipation of pain perpetuates the condition)?
Sorry for all the questions but I'm trying to understand exactly what you guys are discussing here.
Steve
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,16,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 23:59<noscript>July 20, 2005 04:59 PM</noscript>:
Shill
If we talk about tendon repair and fractures, then healing has to be allowed to occur in one way or the other. I am referring to the acute back, neck, the tweaked knee and the sprained ankle. Sure, a bit of a rest can be helpful; and if there are raging neurological signs, essential. But the key is not too long. A day at the most; and there is evidence that we may delay the recovery by unwittingly installing a fear of movement. McKenzie's EIL, though it does work for some, can promote this fear of normal movement.
Pain education will allay fears, when folks understand that their disc is not going to wander around and cause rabid destruction if they take a walk; and particularly if they understand the pain is not 'coming from the disc'.
I did say "in general" - but what I said still relates to the sprained ankle, etc. and not the full 3rd degree tear. The farmer who injures his back in the middle of the harvesting is not going to rest and watch others - he will keep going, and mostly, do better than those who want treatment from us to 'fix them up', and perhaps be concerned that if they turn or bend, they will become much worse.
Again, we are dealing with personalities here - not damaged tissue so much - and we need to read where the patient's priorities lie. Their own resources should translate into their own movements, not ours....and we should initiate that process as much as possible [IMG]smile.gif[/IMG]
OK, bring on the flack...
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,17,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 00:10<noscript>July 20, 2005 05:10 PM</noscript>:
Steve,
I would have thought that to be the case, but over the past 3 days that I've been using it now, I've had 2 people out of about 20 flare-up --- and flare-up bad. One had fibromyalgia, the other seems to have an undiagnosed cervical disk problem. The one with fibro continued to complain today, the disk said that her arm ached, but that she felt "free" today and appreciated the increased range of motion --- she just felt beat up.
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,19,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 02:01<noscript>July 20, 2005 07:01 PM</noscript>:
Steve
Perhaps your boy had better things to think about or do when he had a sore foot - in other words, it was a drama at the time, but soon forgotten.
As adults we know more about nasty things that can happen, and that awareness keeps us from just ignoring a pain alike a splinter. He moved naturally at the time, and then returned to his usual self. Adults also do this, but there is that proportion who just can't adapt to a change in sensation/circumstances..etc. It seems we need a key to unlock something.
Flare-ups are inevitable...I reckon..for some people. I have found it is due to people overdoing their home programs (neuro) because they were so excited at the initial pain relief they went overboard, despite education; and also those who just don't or can't respond as anticipated.
This maybe is par for the course, that certain percentage of people who do not respond for reasons we can only speculate about?
Nari
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,20,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 03:35<noscript>July 20, 2005 08:35 PM</noscript>:
OK Barrett, maybe dousing AND facilitated communication doesn't work ( the Southwest argument was a telling blow.)
Not sure if this is pertinent to the discussion, but Steve reminded me with his kid. I am recently struck by how strong the will and desire for mobility is, by a 4-yr old with mitochondial disease, a muscular dystrophy. Despite no head or trunk control, she does a dancer split to aid her rolling which she does constantly, the parents say, and attempts to position and prop herself against furniture, to sit with support. I am reminded of the 3-yr old burned child who was exaggerating his dependency, because it was novel and fun to be waited on, esp. since Mom fed into it. I told his Dad, Don't worry, he's three, he'll get tired of limiting his playing and running, for Mom's attention. And he did, pretty quickly.
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:01<noscript>July 21, 2005 07:01 AM</noscript>:
Drew, those are pretty good outcomes.
Diane
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:36<noscript>July 21, 2005 07:36 AM</noscript>:
Yogi,
There's really no "maybe" about it, as numerous studies have shown.
You're right, a child's desire to move will overwhelm them, and this can be turned into a kind of therapy within the context of their diagnosis, of course.
Is the fidgeting we do a creative act? That is to say, does it arise from the unconscious after that internal conversation that begins, "What do I want to do?" I believe so. And like any creative act it can be remarkably therapeutic on several levels. As PTs our primary concern would be this motion's tendency to reduce the mechanical deformation responsible for the patient's pain. Maybe we should come up with a way of allowing it to grow. So it "looks funny." So what? Maybe it hurts a bit and briefly. So what? Aren't we getting motion out of sensitized tissue?
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,50,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:50<noscript>July 21, 2005 07:50 AM</noscript>:
And is motion not lotion?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:58<noscript>July 21, 2005 07:58 AM</noscript>:
Diane,
I can't disagree, but it's also correction.
That is, if it's instinctive and a representation of Wall's "resolution" phase of motor response to painful signals. The barrier between protection and resolution is a culture that insists on choreography by some "expert" in normal functioning, and that, ideally, would be us. The problem is that the therapy community doesn't know that ideomotor movement exists. This makes them a little less "expert" than would be ideal.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,12,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 19:48<noscript>July 21, 2005 12:48 PM</noscript>:
The bottom line for me is this --- placebo or not, it's getting patients moving and weight shifting in ways that they had not over the course of a month in therapy. Better balance, better segmential motion --- you name it.
It's really starting to irritate me, as I'm going through a crisis of faith as to why the heck I ever went to PT in the first place --- and I'm getting hives just thinking about how I'm sounding more and more like a chiropractor every day --- talking about the body's "innate intelligence" to heal itself.
Somebody HELP!
Drew
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,12,54,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 19:54<noscript>July 21, 2005 12:54 PM</noscript>:
Drew, you have a sense of humor. There's another crisis for you. Oh no.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,13,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 20:01<noscript>July 21, 2005 01:01 PM</noscript>:
Drew,
Maybe it will help to say we are "self-corrective" and leave the concept of "healing" out of it. The word "heal" has been abused by too many charlatans to make it useful any longer.
Aren't you glad you came to my course? As Gary Shapiro has said many times (I'm paraphrasing), "Barrett transformed the way I understand and treat many of my patients. He also ruined my career. Thanks a lot Barrett!"
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,13,47,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 20:47<noscript>July 21, 2005 01:47 PM</noscript>:
Yeah --- but it gives me (or more to the point, us) food for case study, and eventual single-subject research. Do you have a copy of Irene McEwen's book? I think it's a good starting place for how we're going to have to write this stuff up.
Finally, and I KNOW it's going to take some prodding --- but would you consider doing a few manipulations now and again --- if only to compare it's effects in a case-controlled environment to simple contact? Let me finish my DPT (end of August), but I'm in if you're in. If not, I'm sure you still have a few contacts in that Paris/Grimsby circle that would be happy to partner with us for an honest comparison in the interests of the advancement of the profession . . . In fact, John Childs is coming to NC in a few weeks, maybe I can chat with him about the idea. If not he, I think there's at least one other member/fellow of the AAOMPT's in the area.
"Friggin Simple Contact!"
Drew
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,13,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 20:58<noscript>July 21, 2005 01:58 PM</noscript>:
If there are awards given for creating cognitive dissonance, I vote for Barrett. Previously I never even considered what a talent that is.
jon
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,14,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 21:57<noscript>July 21, 2005 02:57 PM</noscript>:
From learning and teaching.com:
Cognitive dissonance is a psychological phenomenon which refers to the discomfort felt at a discrepancy between what you already know or believe, and new information or interpretation. It therefore occurs when there is a need to accommodate new ideas, and it may be necessary for it to develop so that we become "open" to them. Neighbour (1992) makes the generation of appropriate dissonance into a major feature of tutorial (and other) teaching: he shows how to drive this kind of intellectual wedge between learners' current beliefs and "reality".
Beyond this benign if uncomfortable aspect, however, dissonance can go "over the top", leading to two interesting side-effects for learning:
First, if someone is called upon to learn something which contradicts what they already think they know — particularly if they are committed to that prior knowledge — they are likely to resist the new learning. Even Carl Rogers recognised this. Accommodation is more difficult than Assimilation, in Piaget's terms.
Second, and—counter-intuitively, perhaps—if learning something has been difficult, uncomfortable, or even humiliating enough, people are less likely to concede that the content of what has been learned is useless, pointless or valueless. To do so would be to admit that one has been "had", or "conned".
Drew
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:02<noscript>July 21, 2005 03:02 PM</noscript>:
Jon and Drew,
So, does all this fancy talk jive with my nickname, "Barrett, The Great Destroyer"?
I hope so, because "Barrett, The introducer of cognitive dissonance" somehow just doesn't sound nearly as cool.
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:12<noscript>July 21, 2005 03:12 PM</noscript>:
Actually, I had a different name in mind but I figured if I wanted you to answer any questions I may have that I'd better not (all laugh).
jon
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:37<noscript>July 21, 2005 03:37 PM</noscript>:
I believe "Barrett, the Thick Skull" has been proposed. But I do like "The Destroyer" better. Sounds very mythical.
In the way of helping others understand what would drive someone to attend Barrett's course, let me give a concrete example. This from a decidedly EBP and biomechanically based therapist such as me. Not to mention some of the verbal battles I have had with Barrett in the past. (anyone remember the Thoughtfulness Dies thread?)
I had a patient in the other day who is about 3 mos s/p cervical fusion. She is far out of her brace and was doing very well on my regimen of active motion, Tx manip/mob, gentle cervical mobs, and Deep Neck flexor exercises. She came in having a "bad day", with descriptions of cervical pain and spasm on one side of her neck. In fact, as she tried to hold her head still and speak to me about it, the pain was clearly getting worse. I told her to relax and let her neck move if she wanted to. I then laid her down supine and began to attempt the cervical mobilizations I have seen work in the clinic and have seen considerable research support for. The first few seemed to help, but then she began to worsen again. There was so much muscular splinting going on. I had some thoughts:
1. her body is seeking movement to relieve her pain
2. she is trying to remain still and thwarting that natural response
3. I have friggin' NO IDEA about how much, in what direction, or whether at all I should move her neck myself or tell her how to move it.
4. No amount of biomechanics knowledge or certifications could ever help me with number 3 above
5. There was no success with the treatments I had attempted that day that were backed by what is commonly called in our profession "evidence" - outcome studies of good or reasonable quality.
It was that day that I resolved to attend Barrett's course (sorry I missed you in Fairfax, VA). Though I couldn't attend the course, I truly have an idea (after reading his essays, researching some neuroscience, and being willing to step outside my previous training/ indoctrination) about what it is he is offering.
He seems to be offering a way for me to create a safe place for that patient to move, a way to explain the kind of movement she needs without telling her what to do, and a way to help elicit that movement, which must come from her.
Now, THAT'S what I want to learn.
J
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:53<noscript>July 21, 2005 03:53 PM</noscript>:
Jason,
You are at the door-just turn the knob and it will open by itself. Let this patient move while seated with nothing more than the contact of your hands somewhere on her skin, ask her if the characteristics of correction are emerging (softening, warmng, surprising and effortless movement) and when this happens because you did nothing more than give her permission to trust herself as you have learned to do-then you don't have to attend my course.
Our patients aren't helped by our "skills" nearly so much as they are by the depth of our understanding. Of course, our understanding must be supported by a thorough knowledge of the materials we are seeking to change.
You might want to write that down somewhere.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,16,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 23:20<noscript>July 21, 2005 04:20 PM</noscript>:
Jason,
I'd agree with Barrett. I would suggest, however, before trying it on a paying patient, try it out on someone with less fear of movement --- it will give you a better idea what to expect.
With a patient like the one you describe. I (after explaining the value of movement and the subconcious fear to do so after a cervical fusion) turn down the lights, put my hands on their ears and simply say, "Your body won't let you do anything that's going to hurt you. My hands simply give you something of a physical sense of "permission" to experiment with movement, to learn for yourself what is safe. I can't teach you that. No one can, but I can create a safe environment for you to try, and if you don't yet trust your body, that's okay, that's why my hands are here --- I'm not going to let you hurt yourself. So okay Mrs. Jones, take a deep breath, close your eyes, and slowly show us how your head wants to move."
Within three seconds or so, the patient begins to move. With these fear-dominant patients, it's usually side to side, small amplitude, then a little nodding, and then about 10 minutes of neck retrations and rotations. After a few minutes, about 5 to 10 more, it's almost like there's a blast of heat coming off the patient. It's not anything metaphysical . . . it's the patient switching from a sympathetic mode to a parasympathetic mode . . . and releasing blood to the extremities from the core (remember fight or flight?). That's when, for me at least, amplitude of movement begins to increase. It's about 60 seconds after "heat blast," and you can almost set your watch to it. Careful off the patient's speed though, cause you don't want momentumm to carry them into a place they didn't intend to go. Then move to the arms.
After about 30 minutes of this, the muscle guarding isn't decreased. It's **** near gone. After that, I'll continue with your traditional Maitland/Sultan techniques. I'm starting to think of Simple Contact as a good pre-manual therapy experience for the patient, what gets me is that so often, the patient's ROM is fully restored, muscle knots released, and intervertebral hypomobility restored --- so there ends of being little need for the manual therapy.
The problem is, I LIKE doing manual therapy.
Drew
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,16,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 23:38<noscript>July 21, 2005 04:38 PM</noscript>:
In teaching this for patient's to do on their own, I have found that a way for them to do it more instinctively, and not trying to pattern movements, is tell them to hum or sing in their head, also works when I am present and assisting them. Of course nothing by AC/DC or Metallica, to large of an amplitude going on. [IMG]smile.gif[/IMG]
Scott
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,17,34,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 00:34<noscript>July 21, 2005 05:34 PM</noscript>:
Drew
I think quite a few PTs have gone or are going through what you mentioned in an earlier post - a sort of identity crisis. Manual therapy can be fun, but it doesn't need to be thrown out; it still serves as a facilitator of rapport and a means of contact.
Barrett is quite right - patients are helped less by our tangible skills and more by our level of understanding of the persons before us. If we hadn't done PT, that level of understanding would not be there. Maybe it would be if we had done chiro - maybe not.
Jason, your story about the woman with her sore neck is a classic. Particularly Point #3...that awesome moment when the brain is racing around hoping to land on appropriate neuron links, and preferably the patient's rather than one's own.
The Bullypit is very alive at present; more action potentials than you can shake a stick at.
What caused this metamorphosis??? [IMG]tongue.gif[/IMG]
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,18,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 01:01<noscript>July 21, 2005 06:01 PM</noscript>:
I have enjoyed the review of this post, one thing I found of interest:
Sarah you state, "each person is so unique and brings such unique experiences to the table that one cannot begin to categorize, classify or prognosticate about the outcome"
This brougt to mind a qoute attributed to JE Upledger in a letter to the editor, PTJournal volume 76, #2 Feb 1996. He wrote in to defend the lack of data to support the existence of craniosacral motion:
"I believe that before you can investigate something as subtle as energy, you have to understand and experience it. It also strikes me that once you have experienced this energy, your motivation to prove its existence is diluted. Your experience provides your confirmation"
I am hoping that you Barret, and the others here who have experienced this Simple Contact do not allow that experience to dilute your motivation to confirm it.
Thanks!
Rick
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:10<noscript>July 21, 2005 07:10 PM</noscript>:
I'm patiently waiting for Nanaimo. I will have no unlearning to do, or very little..
Meanwhile, I do have one tiny conceptual niggle going on.
Here it is:
1. The extremities and skin become full of blood with sympathetic activation, not parasympathetic.
2. Parasympathetic is rest/digest. Blood is in the core, gut is busy processing, all is sleepy and skin is cool.
3. Fight/flight etc, is sympathetic; peristalisis slows while blood shunts to the limbs to get away from the tiger or pummel it.
4. Mick Thacker, in Topical Issues in Pain, has spoken of this. He says that rather than the sympathetics being tuned too high in chronic pain, they are tuned too low. In other words, chronic pain goes with parasympathetic dominance, not sympathetic dominance. At the very least there is imbalance, but not to sympathetic dominance.
5. This is consistant with not enough circulation getting to the peripheral nerves, or by the same token, not enough drainage away. Sluggish pipes. Metabolic waste building up and bothering chemoreceptors. Formation of abnormal impulse generating sites. Sympathetics increase blood flow and drainage by widening vessels to feed/drain/flush nerves/muscles.
6. This also fits Peter Levine's work, (Waking the Tiger) where he set up a scenario where an imaginary tiger was set to jump on a woman who was stuck in a state of shock (parasympathetic dominant, possums that go to sleep/limp when threatened) to activate her sympathetic NS to save her. A battle brings up sympathetics, successfully winning it restores balance to the nervous system. Even if it's all in the head.
7. This is also consistant with touch in general, which stimulates the fastest largest sensors in the skin; the nervous system wants to know rapidly what is happening out at the skin. Touch stimulates sympathetics more than parasympathetics, at least at the start.
8. Therefore, surely with a heat rush, it's a (desireable) increase in sympathetics, not parasympathetics.
It's an issue I'd like to see discussed and if I'm wrong, point out how please.
Diane
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:18<noscript>July 21, 2005 07:18 PM</noscript>:
Nari, I'd like to credit my ranting with re-energizing the Bullypit, but I think the real facilitator was Drew, whom I am extremely envious of simply because he went to Barrett's course only 3 days ago, yet has an amazing understanding of Simple Contact and has been able to practice it in abundance. I need to create a safe environment for myself first, before I can really start to use it, as I am already dodging bullets every day for being too weird and not playing nice at the "tea parties". (Had my performance review today so I am feeling sulky).
Rick, I think my comment just stems from my innate fear of trying to standardize care. That concept always scared me, because it takes out the creativity factor: the thing that makes PT an "art". To say that patient "x" with condition "y" will respond to treatments "a" "b" and "c" because they meet criteria "z", sounds too much like following a recipe (read protocol) and not treating the whole person. Does anyone see what I'm getting at? Maybe someone else can verbalize what I am thinking better than I can at the moment (still sulking).
Jason, glad to see you've joined in and that you want to take Barrett's course, but from what I've just read, you really don't "need" to because you have already gotten it. You just need to practice. Not to try to take money out of your pocket, Barrett! [IMG]smile.gif[/IMG]
Sarah
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:21<noscript>July 21, 2005 07:21 PM</noscript>:
Diane,
Very good point. I was actually confused by this myself when I took Barrett's course.
Sulky Sarah
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:25<noscript>July 21, 2005 07:25 PM</noscript>:
Diane,
I think (and I could be wrong) that you've got it backwards. As I read your thoughts, there is a contradition there, so as I see it, you're neither completely right nor completely wrong. I don't think I made it any easier the way I wrote my last post, which may have added to the confusion.
Allow me to clarify ---
What happens in sympathetic mode is that the blood is drawn up into the head and truck. It's a nifty little mechanism that both increases blood to the brain, and helps to minimize blood loss and bruising in the extermities as we strike and are struck. People in a sympathetic mode are ready to "fight or flight," and for whatever reason, simple contact helps to relax them in a way that a PT saying, "Relax, RELAX, RELAXXX!!!" just doesn't seem to do . . .
In parasympathetic tone, we DO rest and digest, blood IS increased to the gut, but is also otherwise more evenly distributed. Capillary dilation occurs at the skin, we are no longer concerned with loss of blood upon fight or flight.
When patients are parasympathetic dominant, they tend to be "chill" and low-toned. Excessive amounts of which can also result in pain born from hypotonia and poor muscle control. I had a patient with pes planus/chonromalasia/PFPS like this just the other day.
When a patient shifts state from sympathetic to parasympathetic, therefore, there is an increase in extremity blood flow as blood is no longer shunted. Furthermore, the blood in the head and trunk is allowed greater capillary dilation to flow to the skin surface. This shift, accounts for the "heat blast."
Finally Sarah, I hate to say it, but being an evidence-based PhD working in the clinic has it's perks in that every now and again, I can "explore" a bit, and as long as I make it clear what I'm doing and that I plan to collect data --- no one really questions it.
We'll see what happens in a week, a month, or a year.
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:52<noscript>July 21, 2005 07:52 PM</noscript>:
Sarah
I think the re-energising started before Drew did the SC course (not to take any credit off him, mind you). Although lots of PTs follow recipes and protocols, I have the feeling it's because they HAVE to, not want to; and I always resisted protocols as far as I could get away with it. I could never work out, even 11 years ago, why it was assumed that all patients are the same; all that changes is the pathology. Nobody minded, some may have thought I was weird, but I am used to that; generally we are a liberally minded lot in Oz and terribly nice to each other at the tea parties.
I don't think I will have much unlearning to do in Nanaimo either; as long as nobody (and I know Barrett will not) tramples over the world of neurodynamics, then I'm happy. Back in 1990 when I heard David Butler trampling all over ultrasound "therapy", I rejoiced. Yeehah!
Nari
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,22,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 05:48<noscript>July 21, 2005 10:48 PM</noscript>:
Thanks Drew,
I've started a new thread on this, Sympathetically Maintained Pain: Myth or Reality? based on the Mick Thacker and Louis Gifford chapter by the same name. Stay tuned, anyone interested in learning more about this, from these two. I plan to learn a whole lot by reproducing their chapter here.
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,0,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 07:07<noscript>July 22, 2005 12:07 AM</noscript>:
Hello all,
I think this revitilization you speak of is because Drew and others have started to explain what simple contact is and I think maybe I'm starting to get an idea too. Interestingly the disillusion Drew speaks of is something I have experienced over the last two years. Interestingly, this disillusion has come way of reading evidence based research and I think this still ties in with what Drew and Barrett explain.
So here is how I see simple contact (And feel free to comment, I am hoping for feedback upon which to change my model):
The disillusionment comes from the poor theoretical basis upon which manual therapy systems are based, not there actual effect. Ie. biomechanical, postural etc. The manipulation/mobilization/muscle balance treatments likely all have a similar neuromodulation effect that is likely usefull for individuals who have no psychosocial component to their pain - this effect is likely neuromodulation and as long as there is no other issues (Ie. Psychosocial) the system is reset and the body is able to recover when the system is "Normalized" (Loosely used phrase). Unfortunately, the vast majority of our patients have a psychosocial component to their pain/dysfunction (Literature suggests as many as 50% of patient visits to MDs office have a psychosocial component to their problem and this number is likely higher when they reach a physio clinic. Other research also suggests that the biggest predictors of non recovery are not physically based but rather psychosocial). We in turn attempt to put these patients in to our biological model which serves to reinforce their behaviour and disability with strict movement patterns (Ie. exercise based on a Sharmann model), advice on rest and unconscious body language. This is often perpetuated when the treatment is ineffective and the patients concern is now there is something significantly wrong with them. The treatment is ineffective because the master controller (CNS) unconsciously continues to wind up the system with gaurding behaviours that perpetuate pain and display to others their injury (Ie. limping).
Where simple contact comes in is it first of all allows the patient to calm the central nervous system in its distressed state by recognizing the hieghtened condition it is in (Ie. Therapist empathy) and acknowledges that it is "normal" (Again loosely used) for a significant number of individuals in pain to get to this state of self-perpetuated pain. It also realizes that the reinforcers for this state of pain can be from a multitude of causers ie. depression, fear, anxiety, societal reinforcement etc. These are the patients that cause us the most distress as therapists because they dont fit into our models of treatment and we end up questioning their integrity as oppossed to our treatment methods.
From here, the therapist continues to support the patient through manual contact which allows the patient freedom to move. The manual contact also provide increased proprioceptive feedback for the patient to help actualize (Along with the education the patient is provided ala Drews post)how their system is in a hieghtened state and the CNS can begin to down regulate tone in the system. From here "Normal" patterns of movement begin to emerge and patterns of protective behaviour that have emerged can be rewired back to "Normal"
Sorry if this post isnt as elequent as other and the vernacular might not be exact but I did this on a quick stream of consciousness manner. How am I doing here? Is this the concept you are getting at? What am I missing?
Looking forward to responses....
Steve
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,6,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 13:01<noscript>July 22, 2005 06:01 AM</noscript>:
Steve,
I appreciate your effort. What I see missing is the word "ideomotor" anywhere. This movement is essential for recovery and should be regularly and fully expressed by all of us. As I have said many times, I don't seek calming or relaxation-these qualities are simply a consequence of authentic expression, and that's what I want.
Drew's descriptions of his patient's movements are not especially uncommon but I often see patients who can't be seen to move at all yet report distinct relief and display all kinds of objective improvement. Since there is no sensation without movement of some sort I'm guessing this movement is purely internal; commonly palpable with just a bit of practice, visible in an unusual way (see "A Sense of Things" on my site) and certainly felt by the patient in a variety of ways.
Drew hasn't described this and though I find his interpretations of what his patient's movement reveals about their system interesting I don't make all of these presumptions any longer having been proven wrong too many times. I suppose this situation is a consequence of Drew having witnessed the movement for four days and my having done so for twenty-five years. "The Persistence of Memory" thread further discusses the dreamy quality of this movement.
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,11,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 18:33<noscript>July 22, 2005 11:33 AM</noscript>:
Steve, thank you for your post, what I have had some trouble with in reading this thread is the perception that us Manual folks are just grabbing joints and shaking them around without any concept as to the effects on the nervous system. In fact, throughout my manual therapy education it was stressed that the hands on contact, the inhibitory nature of a gentle joint ossilation and the fact the we keep a pt. close to us, allow them to feel safe and comforted may be just as important as gaining plasticity in the tissue, if not more so.
Skin contact allowing your receptors to interact with the patients was also stressed. I guess what I am saying here is that I don't think the division between the "two camps" is necessarily as big as some would like it to be.
An example: Just today, new post ACL patient, staples still in. She had developed the fear of allowing her knee to move, every time she relaxed her quad, the staples would pull, she became fearful and contracted her quad again, splinting against this motion. A little skin contact by me on the distal quad, some education and calming talk, some gentle patellar mobs and WALLA! her quad relaxed and she realized that it wouldn't hurt to move. We all do this every day in our clinics.
Very interesting concepts and I appreciate the dialouge.
Rick
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,12,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 19:05<noscript>July 22, 2005 12:05 PM</noscript>:
Rick,
I agree entirely. Training can accomplish a lot, but care is what helps the most with fear and pain.
A Danish therapist recently completed a study of the neurophysiologic effects of joint mobilization and linked the abstract to the NOIGroup.com discussion list. I've invited him to send it our way but he's yet to do this. Find it there in the thread titled "Proprioception and Pain."
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,14,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 21:08<noscript>July 22, 2005 02:08 PM</noscript>:
Barret,
Thanks for the feedback, Im starting to get your theoretical model but obviously have a ways to go before attaining full understanding.
Rick,
I reviewed my post and it kind of sounds like the manual therapy education has no neuromodulation component - it does, just that it is underestimated in my opinion.
Steve
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,14,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 21:19<noscript>July 22, 2005 02:19 PM</noscript>:
Steve and Rick, I think it also depends on which school of manual therapy one has been trained in. Some take the neurological aspects into consideration more than others, but you definitely have a good point, Rick. That's why I truly believe our greatest tool is our hands (ok, and our brains too)
Sarah
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,17,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 00:06<noscript>July 22, 2005 05:06 PM</noscript>:
Steve
Manual therapy has a neuromodulation component, as does sitting with a patient talking to them, not necessarily about pain ed. Everything we do has this component.
A useful tip to think about (or I have found it so)is the fact although we think we are assessing someone's CNS or SNS or 5th metacarpal, we are also constantly being assessed by the patient's CNS etc as well. Any hands-on or verbal dialogue is being assessed.
When you think about it, that is more thought provoking than being assessed by a supervisor, as a student. (Though I have forgotten what that is really like!)
Rick, we certainly do that sort of action which you described with your patient; but we tend to refer to it as 'relaxing' the patient. It's more dynamic than that....neurodynamic.
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,9,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 16:12<noscript>July 23, 2005 09:12 AM</noscript>:
Diane, what is nanaimo? Anyone?
Thanks,
Rick
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,9,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 16:32<noscript>July 23, 2005 09:32 AM</noscript>:
It's a city on Vancouver Island in British Columbia, Canada where Barrett is going to be presenting a two-day workshop on Simple Contact (his normal course is one day). Some folks from the forums are going to be there (Diane, Nari, Luke) I believe Eric Matheson is the coordinator if you want to email him for more info.
Sarah
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,15,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 22:53<noscript>July 23, 2005 03:53 PM</noscript>:
Rick, I read your above post again. It occurred to me that i failed to mention the biggest difference between manual therapy and Simple Contact. Manual therapists approach a patient with the intent to "do" something to the patient's body....whether you are trying to "gain more plasticity" or oscillate or whatever, you are the actor imposing your will on the patient. Simple Contact approaches the patient's body as an observer, and does not try to impose on them any of the therapists own will. The therapist is simply there to make the patient more aware of his/her own processes through afferent signals from stretch-activated ion channels in the skin. Therefore, the patient is not a passive participant, but an active one.
It is, as Drew points out so eloquently, a paradigm shift from trying to treat the impairment to treating the disability, or a shift from treating the dysfunctional tissue to treating the whole person within the cultural and social context. Correct me if I'm off here guys.
A couple of questions for Drew: now that you have been using Simple Contact for a week, are you going to change the way you evaluate patients? And how are you documenting and billing for these sessions?? I have been struggling with that myself in tring to incorporate Simple Contact into my practice.
Sarah
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,16,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 23:26<noscript>July 23, 2005 04:26 PM</noscript>:
I'm a strong proponent of standardized evaluation as described in the APTA's GUIDE TO PHYSICAL THERAPIST PRACTICE. As such, I do not find that simple contact does, nor should it, change our evaluation beyond a new "test and measure" that we may choose to use (or not to use) in the examination of a patient with a neuromuscular or musculoskeletal impairment (e.g. practice pattern).
Lately, my notes have had a bit more about sympathetic/parasympathetic dominance in the assessment portions of the SOAP note, and I'll talk about what kinds of movement patterns the patient may seem to seek (e.g. most of my patients last week were big on seeking median nerve stretch positions). Beyond that, I try to stay away from documentation in "simple contact" terms. For me, that would violate the very spirit of the disablity-level approach to patients that, in my opinion, is the biggest value of simple contact in the first place. I'll talk about how long the patient was able to sit, how long they were able to stand, dissociation of head movements from the trunk, and improvements in range of motion and pain. I'm always sure to document functional improvements that the patient reports (e.g. new ablity to stand and move long enough to load/unload the dishwasher without pain).
In following the patient, sometimes the patient seeks to play with balance, other times it's posture, other times it's a longus coli nod over, and over, and over again. In "simple" terms, the patient "tells" me what to bill.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,17,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 00:39<noscript>July 23, 2005 05:39 PM</noscript>:
And, it doesn't appear that is it your "skill" that is being used, but instead the patient does it. LOL Nothing like charging them for doing it all. LOL
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,17,49,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 00:49<noscript>July 23, 2005 05:49 PM</noscript>:
SJ
Have a think about a patient paying for the skills of the therapist - that storehouse of knowledge that must be there for a process like Simple Contact to be enabled, or active neurodynamics or useful dialogue.
Drew
Great post.
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,17,49,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 00:49<noscript>July 23, 2005 05:49 PM</noscript>:
SJ,
That's what bugs me. I didn't need to go to PT school to DO simple contact, just to EXPLAIN simple contact. It makes me rabid that I'm getting far better outcomes (at the impairment, function, and disablity levels) all of the sudden. How do I justify charing the patient? Simple. The patient isn't paying for me to fix them, they are paying for access to the information that I have in my head. The information that, once provided, will help them with their impairments, functional limitation, and disabilities.
I appreciate your "joke" of, "Nothing like charging them [the patient] for doing it all," (at least it had better be bad joke in poor taste) and I trust that's not a subtle attack on my ethics as, in the final analysis, it's outcomes that are most important.
And in case you were wondering. Unless it's in person . . . no, I can't take a joke [IMG]smile.gif[/IMG]
.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,18,27,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 01:27<noscript>July 23, 2005 06:27 PM</noscript>:
It was a joke... (with an honest twist to it) Me? Poor taste? Never... I guess everyone's perceptions are different though.
I'd like to see a classification system of sorts as a way to identify responders. Everyone pretty much tells me that I'm missing everything Barrett has written. Well... put it in black and white - specifically what patients respond? Actually, there probably isn't an answer because data hasn't been collected from a large slew of chronic pain patients to identify their characteristics, but for those of you using the approach, you've got to have some rationale behind using the approach. I certainly hope "chronic pain" isn't the all in one variable.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,19,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 02:58<noscript>July 23, 2005 07:58 PM</noscript>:
It's the same rationale as doing any other treatment SJ. Lack of ROM, poor balance, poor intervertebral motion, poor standing tolerance, poor sitting tolerance, etc. Barrett and I may disagree on this point, but I don't think that pain should be treated for the sake of pain alone. Pain should be treated in a functional context, or send the patient to a chronic pain technician like a massage therapist or chiropractor.
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,23,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 06:37<noscript>July 23, 2005 11:37 PM</noscript>:
Drew,
So do you bill for two units of manual therapy? And in your notes, under O: Simple Contact?
What do you mean you stay away from documentation in simple contact terms?
Sarah
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,9,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 16:20<noscript>July 24, 2005 09:20 AM</noscript>:
Sarah,
Sometimes I'll bill for manual therapy, other times it's neuromuscular re-ed, sometimes it's a therapeutic activity. I generally don't do simple contact for more than 15 minutes or so, so no, it's usually only one unit, and then another unit of something else. Documentation shouldn't really change all that much. I don't mean to be coy, but I'm having difficulty understanding what other clinician's documentation difficulties are. Maybe it's simply a function of my having done pediatrics for so long and having gotten used to using some play technique designed to promote one of several goals --- and then writing about which of the goals the child chose to work on during the play session. In many ways, documentation of simple contact is much the same.
My objective may read something like this:
"With simple contact applied to the head, shoulders and UEs, patient tolerated 15 minutes of standing with 10 minutes of self-induced weight shifts in the frontal plane, and an additional 5 minutes of trunk rotation to the right."
I'd bill that as neuromuscular re-education, and (being that the patient was previously able to stand for a 5 minute max) await word next visit about standing tolerance for functional activities --- which would go in my subjective for the following visit.
SJ,
I see your point about a "classification system" but that would derail the disability focus of simple contact --- and allow for people to make the mistake of seeing SC as just another impairment-level treatment. Furthermore, your comments suggest a certain (yet common) misundertanding about what (according the the APTA) physical therapy is, and what physical therapy is not. You're not alone, mind you, and I am constantly shocked and amazed at the numbers of PHYSICAL THERAPISTS who don't really know what physical theapy is, versus what it is not.
According to our unified diagnostic and treatment document, the GUIDE, "chronic pain" in and of itself, is NOT something that physical therapists treat. There is NOT an impairment-level diagnostic pattern in the GUIDE called "chronic pain" and treating chronic pain, in absence of such a diagnosis is, in my opinion, not physical therapy in the first place. It is, technically out of our scope of practice and at best, massage therapy or chiropractic.
The impairment level diagnosis that we'd use would be found in the GUIDE to PT practice (and we should be limiting our use of other classification systems such as McKenzie, Maitland, etc --- unless ALSO diagnosed at the impairment level). I could see myself using simple contact, in conjuction with other techniques, for the following impairment level diagnostic practice-patterns:
4B Impaired Posture
4C Impaired Muscle Performance
4F Impaired Joint Mobility, Motor Function, and Reflex Integrity associated with Spinal Disorders
4H Impaired Joint Mobility, Motor Function, Muscle Performance and ROM, associated with Joint Arthroplasty
4I Impaired Joint Mobility, Moro Function, Muscle Performance and ROM, associated with bony or soft tissue surgery
5A Primary Prevetion/Risk Reduction for Loss of Balance and Falling
5C Impaired Motor Fucntion and Sensory Interity Associted with Nonprogressive Disorders of the CNS --- Congenital Origin or Acquired in Infancy/Childhood
5D Impaired Motor Fucntion and Sensory Interity Associted with Nonprogressive Disorders of the CNS --- Congenital Origin or Acquired in Adulthood
5E Impaired Miotor Function and Sensory7 Integrity Associated with Progressive Disorders of the CNS
5F Impaired Peripheral Nerve Integrity and Mucle Performance Associated with Peripheral Nerve Injury.
5G Impaired Motor Function and Sensory Integrity Associated with Acute or Chronic Polyneuropathies
5H Impaired Motor Function, Peripheral Nerve Integirty, and Sensory Integriy Associated with nonprogressive disorders of the spinal cord.
6B Impaired Aerobic Capaciy/Endurance Associated with Deconditioning.
That's 13 different impairment-level diagnostic practice patterns to choose from (none of which being the abstract and esoteric "chronic pain"), that simple contact may be appropriate for, and each with a multitutde of pathology-level ICD-9 codes feeding into each.
That's the answer.
What we don't know, and what would be a great study for a doctoral student (DPT, DSc, or PhD), would be to examine simple contact's impact upon the patient in each of these practice patterns.
For me, "chronic pain" isn't the "all in one variable." As it's not a physical therapy diagnosis, it's not a variable at all --- although some of the patients placed within any of the above physical therapy diagnostic patterns may also have chronic pain.
Drew
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,11,9,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 18:09<noscript>July 24, 2005 11:09 AM</noscript>:
Drew,
Where have you been all my life?
I'm no psychic, but I have the feeling your answer will not satisfy everybody. Not simple enough prehaps.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,11,44,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 18:44<noscript>July 24, 2005 11:44 AM</noscript>:
Drew, how about a step back and a reduction in belitting techniques, okay? I don't appreciate you using me in any example especially since you don't know me nor do you know what I am thinking.
A classification system does not derail any disability focus. Since one of the first steps we do as a clinician is classify, classifying a patient intuitively increases the potential for greater outcomes. Everything we do is based on how we initially classified the patient.
The Guide does a poor job in assisting in evaluating outcomes and it isn't good enough in defining patients - but at least a variety of categories have been identified and those categories can begin to have subcategories which may be more helpful to create a more common language between professionals. In my opinion, it is a good start, but there are a lot of weaknesses overall.
Frankly, I don't care what the APTA thinks physical therapy is... physical therapy is the provision of services by a physical therapist or a physical therapist assistant that has a focus on getting the person back to life at the highest functional level possible in the shortest amount of time combined with a focus on empowering and educating the patient creating greater independence in his/her physical being. There are all sorts of views and all sorts of techniques out there to get the person back to life.
So, back to the classification deal I keep asking about.
Realistically, in a non-direct access state, a patient comes in to physical therapy with a little piece of paper with commonly... "shoulder pain" or "back pain" or "leg pain." So, generally speaking, we get some piece of paper from a physician that has very general words on it that doesn't tell us a darn thing. Then, the next step we do is what? There are all sorts of options out there, but I prefer a review of systems and then some general subjective information about the person, previous level of function, who the person has seen, what diagnostic tests have been done and the results, medications, previous surgeries and previous medical conditions... and then a bit about the current complaint. I toss in a couple of standardized outcome measures for giggles and kicks. Why do I do all that? Well, it's all a part of the "examination" aspect of what we're supposed to do. Also... all that crap goes in my brain to get churned to come up with some kind of classification of what the heck may be going on and how it needs to be tackled. In the end, I have to come up with some sort of diagnosis... I have to clump a bunch of information together that seems relevant to me and that information is synthesized to a degree for me to prognose and then come up with appropriate interventions.
It's all in the Guide.... ALL of our initial decisions are based right from the get go by how we classify the patient. You know, the "looks like a duck, walks like a duck, sounds like a duck" MUST be a duck philosophy. I have no problem with that - I practice that way, it is very logical and makes complete sense to me.
So... as I continue to ask and now maybe it can be more fully understood since I referenced the Guide.... How are you classifying the patients that you treat that you use Simple Contact to get results? Maybe you don't? Maybe you just do the Simple Contact and viola... the person improves or doesn't improve? But, I would hope and assume there is a rationale for the use and something was identified that indicated that Simple Contact may be of benefit. And, hey, realistically, to reduce the interpretation that I'm focusing on Simple Contact, I am... but any activity or choice of theory or practice can be placed in the same location as Simple Contact.
Research can be done in regard to this approach... At the moment, there is no "reference standard" to know that someone needs "permission" to move. Is there a difference in how "normals" respond to Simple Contact compared to those that are being treated? How do you identify those folks that will respond? What types of findings tend to indicate that there is greater probability for a response to the approach?
And Drew... we do treat chronic pain. For the majority of the patients that walk in the door, the chief complaint is pain... whether it is acute, subacute or chronic in nature. We grab our handy, dandy ICD-9 book and identify something for billing purposes, but if we didn't have third party payers involved would we do that step or would we just deal with the complaint? The only reason the Guide came about was to help third party payers understand what we do AND put a ton of options under the sun in every category to help with reimbursement issues. That Guide was published for politics - not necessarily to help us do what we do. If it were of high clinical relevance, everyone would want and would use The Guide.... as a whole we don't use it.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,15,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 22:07<noscript>July 24, 2005 03:07 PM</noscript>:
SJ,
Let me remind you that it was YOU, and not me who began with an implication of poor ethics. Joke or not, it was inappropriate and I've let it slide on more than one occasion. If you can’t take the response, I suggest that you don’t cast stones in the first place. Otherwise, you reap what you sew. Most posters have been here for a while and will recognize that I patiently absorbed quite a bit of inappropriateness from you before politely responding that your statements are often inappropriate.
If you can't take being belittled, stop putting others in a position to have no choice but to respond in retaliatory slam-dunk fashion.
Beyond that, my statements were straight from the GUIDE to physical therapist practice. Like it or not, it IS the official document that defines what is, and what is not, within the scope of physical therapist practice. It is a living document for defining patients at the impairment level, and not intended to be written in stone. No one disagrees that clinicians need to be involved in the process so as to make the GUIDE more and more applicable to the clinic each time that it is revised. In all of the state and national meetings that I’ve attended over the years on that very subject, I don’t recall ever seeing you at one. I agree with some of your points, but you’re beginning to sound more and more like someone who doesn’t like their elected official (e.g. the answer to your questions), but upon questioning admits to never having voted in the first place (e.g. participated in the process). You say that it does, “a poor job in assisting in evaluating outcomes and it isn't good enough in defining patients.” I disagree with the use of the word “poor” here, but you’re certainly entitled to your opinion --- even if it does stand in sharp contrast to most academics, clinician/adjunct faculty, entry-level DPT’s, tDPT’s, and DScPT’s.
You say, “frankly, I don't care what the APTA thinks physical therapy is,” and go on to state your personal opinion about what physical therapy should be. Right or wrong, the opinion of a single therapist proclaiming a non-standardized personal opinion on the subject is even more irrelevant than you consider the efforts of the APTA.
So, back to the classification deal you keep asking about . . .
I believe that I’ve answered your question, and more than that, put it into a context of standardized diagnostics and classification in keeping with the APTA’s vision 2020. If you are either unfamiliar with, or in disagreement with, this process --- there isn’t much beyond what I’ve stated that’s going to change your opinion because your beef isn’t with me, my opinions, nor of simple contact --- but rather with physical therapists as clinical doctors, the APTA’s vision 2020, and a whole host of other topics that, while related, are not the subject of this thread.
I am curious to know what kind of “diagnosis” you’re coming up with if you’re not using the guide. Although most PT’s THINK they would have no trouble diagnosing, for example, a herniated disk versus spinal stenosis, or a medial meniscal injury versus an ACL tear --- I’ve been taken aback with how few PT’s understand the sensitivity and specificity of the clinical tests they are using. Furthermore, diagnosis at the pathology level IS NOT currently considered within the scope of physical therapist practice in most states. Most of us do it to one extent or another, but that doesn’t make it altogether legal, and as such, I’m not going to dignify such a conversation with suggestions on how to diagnose/classify at the pathology level when that’s not an activity that we’re supposed to be doing in the first place.
I think what you’re asking, however, is within the aforementioned practice patterns, how do I determine which patients I’m going to use simple contact on, and which ones I’m not. The same could be asked of just about any technique or clinical test. Age, gender, beliefs, personality type, apprehension to movement, balance difficulties, loss of range of motion, all go into these decisions. Simple contact is no different. I use the same set of criteria to assess the value of the application of simple contact as I do for myofasical release, manipulation, or a Maitland technique. I feel a lower action threshold for simple contact than most other techniques for balance, range of motion, or balance because it’s so gentile and generally more patients can tolerate simple contact than the other manual techniques. Furthermore, the outcomes I get in terms of range of motion, balance, pain relief, standing tolerance, etc. tend to be far better using simple contact than just about any other approach. As such my action threshold is less for simple contact than it would be for manipulation, mobilization, soft tissue release, NDT, or even indirect Maitland joint mobilization techniques.
You do raise some additional good points with respect to what needs to be researched with respect to simple contact. First thing is first, however, we need a slew of case studies to demonstrate outcomes effectiveness --- the second step is to look at the case studies for common themes. This will help to design studies to examine some of your higher-level questions, but we're not even at that stage yet.
Finally, you misquote my discourse on chronic pain. I did not disagree that we don't treat chronic pain. What I said was that I disagree that we do or should treat chronic pain in isolation. If that is what a PT is doing, in my opinion, they are not engaged in the practice of physical therapy --- at least not as CURRENTLY defined. The practice of physical therapy is more professional, more broad, more advanced than the simplistic and myopic vision of the 1980's PT treating pain and pain only. I contend that we treat patients who have movement pathology, SOME OF WHOM HAPPEN TO BE IN CHRONIC PAIN. Not the other way around. This is the position of the APTA. You have the right to disagree, but you’re not in disagreement with me, nor with the APTA, but rather the current standards of your profession. In other words, I didn't call you or anyone else who practices this way inappropriate --- dated perhaps --- but not inappropriate.
”For the majority of the patients that walk in the door, the chief complaint is pain... whether it is acute, subacute or chronic in nature. We grab our handy, dandy ICD-9 book and identify something for billing purposes, but if we didn't have third party payers involved would we do that step or would we just deal with the complaint?”
I’d hope that you don’t really mean this. Pain is the beginning of the discussion, but the movement pathology is the focus. If not, the care administered IS NOT physical therapy --- or at least not skilled intervention. It would be technical care that could be administered by any massage therapist, athletic trainer, chiropractor, or PT aide. If we’re as a group of PT’s not really focusing upon movement pathology, it’s no wonder why so many massage therapists, chiropractors, and athletic trainers THINK that physical therapy is a modality and not a profession. I say to ANYONE working this way --- stop being a physical therapy technician and start acting like a professional, because it’s you (the generic "you," not you personally) that is the problem --- not the massage therapists, chiropractors, or athletic trainers who use as their standard the weakest link within physical therapy.
“That Guide was published for politics - not necessarily to help us do what we do. If it were of high clinical relevance, everyone would want and would use The Guide.... as a whole we don't use it.”
You’re entitled to your opinion, and perhaps the GUIDE isn’t well used where you are, but it’s catching on in the area where I work, and the new-grad DPT’s and tDPT’s are using it, if for no other reason than (for example) to define to the MD’s, and other PT’s who may see their patient with diabetic peripheral neuropathy, the prioritization of impairments (balance, endurance, posture, loss of sensation) to be worked on in helping the patient achieve the most optimal of ambulatory skills.
You asked for a classification system. The GUIDE offers that. If you don’t like the answer, your problem is with the GUIDE and the APTA's push for standardized evaluation and classification, not with simple contact.
Drew
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,16,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 23:31<noscript>July 24, 2005 04:31 PM</noscript>:
The language in the Guide hasn't been updated since 2001. Perhaps it is time, especially since the APTA is taking the position of adopting a more international language of disablement. Maybe something like this:
5D Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the CNS
could become
5D Participation restriction with associated impaired Motor Function and Sensory Integrity contributed to by Nonprogressive Disorders of the CNS
Ok, maybe Barrett should write it. Oh boy, now that would be a document.
What would others have it read?
jon
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,17,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 00:19<noscript>July 24, 2005 05:19 PM</noscript>:
Drew, I was joking, I did the LOL AND I admitted to joking. Ethics weren't even a part of those two sentences... Geesh... So, because I joke, you decide that it is reasonable and fair to face your slam dunk retaliation? Is that what this is about? Wow... sorry I'm taking some things seriously and trying to have a discussion, while you are busy trying to figure out a way to slam me. Hope you enjoy yourself...
Ummm, since you don't know what I look like, how would you know my presence? LOL Just a friendly jab at you combined with a bit of a joke because I do have a point. I have been to sessions that deal with the Guide. Beats me if you were in any of them, I wasn't looking for you. It does do a poor job in assisting in evaluating outcomes - I have an abstract submitted regarding that issue and a paper that is close to ready for submission. So... I believe that I do warrant the capability to have an opinion on the topic. You can disagree with me if you wish, but until you try evaluating outcomes and try to piece the Guide into it, technically I would be the one with a better opinion because I have done that. I have questioned other clinicians (involved in research) about the guide and the weaknesses with it and they seem to agree with my opinion.
Anyways.. my statements were from the guide also. I didn't mention all the 5 elements of patient/client management... but simply they are examination, evaluation, diagnosis, prognosis and intervention although I do believe there are 6 and firmly believe outcomes should be the 6th. So, where was I in error when mentioning diagnosis? Specifically from the guide "Diagnosis - Both the process and the end result of evaluating examination data, which the physical therapist organizes into defined clusters, syndromes, or categories to help determine the prognosis (including the plan of care) and the most appropriate intervention strategies." I never said at what level I diagnose, but I do have to have some sort of idea what I think I'm treating and why and then figure out what approach to use. The guide does not have a classification system in place that assists with the clinical decision making process.
Well, if it takes the guide to help with establishing goals and making sure a thorough examination process occurred, then I guess that's the new grad and the tDPTS's choice. I believe I learned that kind of stuff without the guide years ago. I have personally used the guide clinically to categorize patients into a practice pattern and to identify if during an episode of care my number of visits and duration of time is outside of the acceptable range - but that's all I've used it for. AND.. those numbers are a joke if we as a profession were to need to meet the utilization rates in the guide.
No, Drew, you didn't answer my question regarding classification or how you determine what patients will respond. All you did was spew out the preferred practice patterns in the guide. Every patient should fit into one of them, I agree... but when you examine and evaluate the patient, I would hope that you would have a more specific type of classification from which to work. The guide is a very general, basic categorization, in my opinion. And you are very correct, my question can be asked of any technique... it falls under the idea of rationalizing. You haven't provided me a rationale for the patients that you choose to perform Simple Contact with. You examine and then in your final evaluation, what specifics drive your decision-making process to use Simple Contact?
ICD-9 codes do not capture any movement pathology... so, basically we are tagging a code to the patient. A code that we cross our fingers and hope is payable... but a code that generally doesn't relate to what or why we provide the intervention that we do. The code is not related to impairment nor function, but pathology. Thank you for qualifying a general "you" versus a "me." If there weren't third party payers involved, I wouldn't open that stupid book. There has to be a better way...
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,17,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 00:26<noscript>July 24, 2005 05:26 PM</noscript>:
Drew
I'm at a bit of a loss deciphering the complexities of the Guide as I have never used anything like it before; as yet we do not use classifications (in a free system). So I may be out of hand here, but your statement re chronic pain surprises me, a little.
If a patient comes in complaining of pain, (and the vast majority do) and they have had the pain for, say, eight months, I treat that pain. That is our goal. Pain is not looked at as always the the result of an impairment, unless that fact is blatantly obvious on assessment. The process does not necessarily mean we focus on 'fixing' the impairment; we focus on optimising function and lifestyle. This may include attention to the impairment, or not; but whatever we do, we are aiming to improve the person's functional wellbeing.
That, to my way of thinking, is definitely physical therapy as I understand the loose definition here. I don't see SC or physical activity as coming in under 'attention to an impairment' anymore than I see taking a good psychosocial history does; they are essential in the assessment and management of the big picture.
I am probably confused by the USA system, which is different, but I am interested in the US approach, so feel free to 'sort me out', either yourself or SJ or anyone else.
Nari
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,18,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 01:07<noscript>July 24, 2005 06:07 PM</noscript>:
Nari,
I think it's a mistake to think of "pain" as a thing of some sort. It's not even a sensation but rather a perception. As best stated by physiologist Allen I. Bausbaum; "Pain is not just a stimulus that is transmitted over specific pathways, but rather a complex perception, the nature of which depends not only on the intensity of the stimulus but on the situation in which it is experienced..."
I am often able to point out to my patients, as I'm sure you do, that what they're feeling is a consequence of behavior that they can often (not always) become aware of and alter.
You're right, without a complaint of pain most people wouldn't seek our help but though I know it is #1 in their head I have to get them to see how it is connected to something else; something that we can both see. Ultimately that's the thing we'll treat together-and the pain will take care of itself.
I'm hoping you'll agree.
How the guide fits in here for those of us in the states-well, I'll leave that up to Drew.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,18,44,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 01:44<noscript>July 24, 2005 06:44 PM</noscript>:
Barrett
I do agree; I like to think of pain as an experience as well as a perception. It is a matter of shifting the understanding of its origin from a physical 'cause' (as patients see it). But if someone comes in with a painful back, the pain, according to many, is a 'thing'. It 'takes over' patients and for many the experience actually becomes 'them', and they talk to it, as though it was an 'evil spirit'.
Maybe we are not so very far removed from the ages where people recovered quickly once they were exorcised or blessed or whatever. We still are working with a powerful concept.
It is all a matter of perception and what we think we see.
Nari
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,19,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 02:45<noscript>July 24, 2005 07:45 PM</noscript>:
Barrett:
I must admit you have gotten me interested in this concept and I have even purchased "Clinical Neurodynamics". As I started to read over vacation (just returned from Alaska), I found it odd that even Shacklock refers to pain as often coming from a mechanical probelm in another area as it is percieved to be coming from. Although pain may only be a "perception", isn't our role also to address the mechanical problem as well ?
Ex: "Acute LBP resulting in a subsequent stiff neck."
This is only one example from many in "Clinical Neurodynamics" of which I have presented others (I think it was in the LBP treatment approach thread).
I think this is why I find this so hard to comprehend.
JBeneciuk
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,20,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 03:10<noscript>July 24, 2005 08:10 PM</noscript>:
I am less likely to address the central issues than most, and find in Butler's recent work especially an emphasis here that I don't feel is necessary.
I think the primary problem is, in fact, in the periphery and movement there will inevitably have widespread effects mechanically through the nervous tissue. There are also reflexive considerations during such a change that we can neither predict or control.
I have said for years that "neural tension" is a problematic term because (as Shacklock says) "the corallary for tension to therapists is "stretch," which they do." For a number of reasons, this is a bad idea. I prefer movements that lengthen without stretching. This seems to be what ideomotion accomplishes.
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,20,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 03:45<noscript>July 24, 2005 08:45 PM</noscript>:
When you refer to "reflexive considerations", are you referring to the mechanical interface surrounding the neural structure or within the neural structure itself?
My reason for asking this is because my understanding is that the mechanical interface surrounding the neural strucutre is where the mechanical problem would (could) be initiated...and in turn cause the compression or excessive tension on the neural structure. Is this logical?
I agree that "neural tension" is a problematic term and appreciate the rationale that Shacklock gave supporting this notion.
Thanks
JBeneciuk
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,20,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 03:57<noscript>July 24, 2005 08:57 PM</noscript>:
I'm talking about the connections between the nerves themselves.
I think the interface is where trouble can be found, but, to my knowledge, this is not especially well understood. Sunderland wrote of "the irritative nerve lesion" that was a consequence of a loss of undulations within the nerve, not any loss of continuity or adherence to the interface. And no, I don't know how people get like this. It just seems evident that they do.
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,21,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 04:38<noscript>July 24, 2005 09:38 PM</noscript>:
But Barrett, can't you agree that an injury can trigger a process where significant interface changes occur (ex: muscular guarding to protect against movements that would otherwise place excessive stess on neuro strucures) and in this case addressing the muscular guarding prior to the nerve would be a rational approach?
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,21,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 04:46<noscript>July 24, 2005 09:46 PM</noscript>:
When I refer to addressing the muscle guarding first, I do not mean deep soft-tissue massage, instead a superficial approach to allow the muscle to "let-go", this can be done by simple positioning...regarless, aren't we addressing the muscle (read mechanical-interface) first?
Jbeneciuk
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,5,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 12:52<noscript>July 25, 2005 05:52 AM</noscript>:
Jbeneciuk,
As luck would have it, no less an authority than David Butler just said this over on NOI.com:
"Early in my career, I thought (if neural) that it was mainly due physically unhealthy dura and nerves - sticky scars, adhesions etc.
Now, at a guess, in my view, maybe 10-15% of patients have true physically unhealthy nervous systems. The remainder of the "neural tension" or "neurodynamic" findings are due to the nervous system attempting to cope with a variety of threats. Just at you can construct a pain or autonomic or endocrine response to help you cope, so too can the nervous system alter its properties to make you more sensitive if the "self" deems that it is beneficial to you. The nervous system has a varity of "tools" to do this such as ion channel changes and filum terminale tightening.
In such cases, the therapeutic target should be the threat(s), not the stuck piece of nervous system."
(Barrett) I appreciate what David says here. My tendency clinically is to approach the problem by carefully interpreting the muscular activity present, reasoning that is the best way for me to sense what the brain is trying to do in response to the painful stimulus. This is where Wall’s “resolution” phase of instinctive response becomes important and, I think, should be understood as ideomotor activity designed to correct things, not just protect. By getting the patient to amplify that isotonically as opposed to trying to get rid of the “spasm” as many therapists do, I have seen the sort of changes Drew reports for many years.
As the movement emerges, physiologic and sensory changes that can be explained by saying the nervous tissue is becoming less taut and more adequately supported nutritionally are seen and reported. Perhaps we’ll never know what happened exactly, but this deep model of function and dysfunction is the best I’ve seen-and it sure beats what I call “hanging out at the joint” as many manual specialists tend to do.
Thanks for the questions.
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,12,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 19:57<noscript>July 25, 2005 12:57 PM</noscript>:
Barrett,
Butler's quote would make one think that the 85-90% of pts. without "truly unhealthy nervous systems" would benefit from psychological counseling, rather than PT/pain injections/meds/chiro/massage/etc., to relieve their pain.
What is it about ideomotion that removes the "threat" that the pts. nervous system is defending against?
I have some vague ideas dancing around my noggin, but nothing worth putting in print.
mike t
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,13,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 20:06<noscript>July 25, 2005 01:06 PM</noscript>:
It's a good question.
Wouldn't movement into a position of less mechanical stress relieve the feeling as well as the reality of perceived threat? "The Suppression of Flight" on my site addresses this issue specifically, suggesting that movements aren't only mechanically effective but ritually effective as well.
David, it seems to me, has grown to have more faith in counseling to do this job than I, but I think it's because he can't get his mind around ideomotion as an adjunct to coercion and education. I've never been able to convince him otherwise.
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,16,30,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 23:30<noscript>July 25, 2005 04:30 PM</noscript>:
Barrett,
Like many people, I think David would like to see the studies first. I asked his thoughts on your ideas at a course this year and he said 'You know, I think there is something in Barrett's ideomotor work, I wish he would do something about getting it into the literature though" (or close to)
Luke
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,16,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 23:58<noscript>July 25, 2005 04:58 PM</noscript>:
I think part of the problem here re muscle spasm is our traditional teaching that if you see something not quite right in an area which symptoms are occuring (roughly), treat it. We treat visible things, and muscle spasm is one of them, and also seeing that one quad is 1.5 cm larger than the other; (not kidding!!)or lack of movement around a joint or set of joints.
We were not trained to think WHY there was spasm, and how it exists, because nobody knew for sure.
It is only when one sees how a SLR on one side reproduces pain in the presenting contralateral shoulder or neck, or a painful lumbar spine leads to a stiff neck and then 'swops' around, attention to neurodynamics does start to make sense.
I wonder why we would want to 'give away' our patients to counsellors, telling them to come back when they feel better...because there may be nothing for us to do then. maybe that is a good thing....but is it?
Surely we should look at basic psychosocial assessments, where a lot of their emotional problems come out anyway and rapport is established. Clearly, with obvious depressive states, we refer. But most of these patients with pain here and there should be able to be managed by us.
In the future, I think it would be useful to be referred to as: physiolopsycholosophists. [IMG]wink.gif[/IMG]
OK, so I'm dreaming.
Nari
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,18,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 01:10<noscript>July 25, 2005 06:10 PM</noscript>:
Nari,
There's a paragraph about this muscular "spasm" in "Asking Why: Evolutionary Reasoning and Manual Care" on my site:
"Asking why any movement dysfunction is present may often lead us to conclude that manual coercion is unreasonable. To put it simply, when the therapist pushes upon the patient in an effort to reduce instinctive muscular response or to correct bony alignment the adaptive response is being inappropriately extinguished. Remember that the concept of defense in evolutionary reasoning isn’t the simple guarding normally assumed to account for persistent muscular contraction; this activity is more accurately considered the beginning of a corrective maneuver. It has been my experience that, when amplified, muscular activity concurrent with restricted movement or supposed aberrations of ideal posture will lead quite rapidly to a reduction in the sympathetic increase known to complicate and perpetuate painful conditions. This is the basic idea behind the use of Simple Contact, the method of handling I teach and employ. Clinically the patient will report a warming sensation while a palpable reduction in muscular resting tone will become evident. Ideally, manual care reverses the effects of the defect (sustained sympathetic tone) while simultaneously enhancing the body’s naturally occurring defense (ideomotor activity). At the present time, manual care rarely accomplishes either of these tasks."
This reinterpretation of muscular activity changes everything. At least, I think it does.
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,18,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 01:45<noscript>July 25, 2005 06:45 PM</noscript>:
Drew, a question for you
You have mentioned balance several times in the last few pages, specifically the improvements in balance that you have witnessed in your clients since initiating simple contact treatments 3-4 days ago. How, specifically, did you manage to measure those balance improvements? Are you truly seeing change or is your obvious enthusiasm for this new (to you) approach clouding your view. Perhaps your patients are picking up on this enthusiasm and that in itself is responsible for this percieved improvement in balance. Honestly, and this is not a knock at all, I am a bit surprised by how much you seem to have bought into these results after admittedly just working with this treatment concept over the last few days, with a limited number of subjects, no controls and some obvious, maybe very waranted enthusiasm.
Rick
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,19,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 02:25<noscript>July 25, 2005 07:25 PM</noscript>:
Rick,
Excellent question. In several patients who complained of balance as either their prime complaint or a secondary complaint, I conducted a Timed-Up-and Go (TUG), as well as a BERG balance test. Although I have not retested any of the patients on the BERG yet, several patients improved their scores from about 16 seconds to about 13 seconds. According to Shumway-Cook, this crosses the 14 second threshold from fall risk with 87% sensitivity to confidence of no-fall with 87% specificity.
It usually takes me about 2 weeks to get this kind of change in a patient --- with simple contact it was only a single visit. It wasn't anything fancy, mind you, just actively allowing the fear-dominated patient to safely play with trunk mobility and balance.
Honestly, I too am more than a little surprised (and frankly annoyed) by how well the approach works for SOME patients. It is not a panacea, but I do find that it makes manual therapy MUCH easier to do. Just today my skeptial colleague said that she had a patient who generally does a lot of guarding, allow for her to sink so deep into the abdomen after simple contact, that the patient felt spinal mobilization from an anterior approach.
Do not misunderstand me. I would not call me so much enthusiastic so much as impressed that the approach isn't complete hogwash. All it really is, is safe facilitation of active movement. As a former peds therapist who trained with Lois Bly, the idea of safe facilitation of active movement a la simple contact isn't that much of a leap from traditional neurodevelopmental therapy.
There clearly is something very valuable to SC, and it should, in my opinion, be further investigated before putting it into the same category as myofasical unwinding, craniosacral therapy, and strain-counterstrain and dismissed out of hand.
Drew
<hr> Posted by pablo w (Member # 2185) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,22,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 05:26<noscript>July 25, 2005 10:26 PM</noscript>:
I don't really get the impression that anyone is dismissing Simple Contact out of hand. It's just that as yet there are no published outcomes in peer reviewed publications about the effectiveness of the approach. I understand the background and the theory (I think) and the reasons why it should work and probably how it would work. I don't have the resources to attend one of Barrett's courses (too far away), so I may never find out exactly how Barrett does what he does.
Questions such as "what type of patient is most likely to respond to a Simple Contact approach?" are quite important, though. Will they respond to Simple Contact with better outcomes that they would to other approaches? I understand Barrett is not a researcher, neither am I but we can still ask these questions.
If Simple Contact is safe facilitation of active movement, then I am probably using a Simple Contact approach without meaning to. Oops. I could certainly hone those skills, so I hope Barrett makes it to Australia (Sydney or canberra ideally, Barrett) as I do think there is a lot of value in what Barrett teaches.
I also doubt that anyone is suggesting we become counsellors. With some patients that wouldn't go astray, though. I believe physiotherapists have the advantage when it comes to understanding the body and motor behaviour, and a capacity to take in new concepts. We are also not trained to keep our hands off patients (as psychologists, at least in Australia, are). We have a strong background in anatomy and physiology, as well as in neuroscience. I think it makes us very versatile as clinicians. There is also dogma, but that can be challenged with evidence.
Even if Simple Contact is a different paradigm, do we need to abandon what works from a more "traditional" paradigm? I think not, but that I would need to know when to switch paradigms, and look for consilience between different approaches whaich work (I figure if they work, they must be working because of some common elements). So under what circumstances do we need to make the shift to "simple Contact thinking"? It's probably been covered before, I'm a slow learner.
Pablo
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,22,47,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 05:47<noscript>July 25, 2005 10:47 PM</noscript>:
Didn't ANYONE like my new name for a PT?? [IMG]wink.gif[/IMG]
The fact that Drew had such good results with patients shortly after doing the SC course could suggest:
1) we all get good results after attending an inspiring course (for several weeks after attending David's SNS course everybody got better with neurodynamics) and/or
2) there is a huge and valuable placebo factor in someone's hands and/or
3) there are positive factors within SC's effects that no-one can 'see', measure or evaluate.
Maybe all three.
Barrett:
Have you noticed that certain types of people consistently respond much better or more quickly to SC than others do? This certainly happens with more traditional therapy.
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,5,4,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 12:04<noscript>July 26, 2005 05:04 AM</noscript>:
Nari,
That's just the thing, "Simple contact" isn't non-traditional at all. It is active movement, it is weight shifting, it is passive range of motion. There is NOT a paucity of evidence for these things --- just a paucity of it being called simple contact.
Lack of evidence is not the same thing as lack of effect, and we must be sure to use ALL relevant search terms in a PICO Medline search. Using "simple contact" alone is much to limiting.
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,5,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 12:18<noscript>July 26, 2005 05:18 AM</noscript>:
Drew
Don't get too excited...I don't think I was criticising anything or anyone for lack of evidence. I agree that lack of evidence is not the same thing as lack of effect; in fact I am not sure what you were meaning by your remarks.
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:00<noscript>July 26, 2005 06:00 AM</noscript>:
Drew, it can't be passive range of motion if you aren't doing anything...
Hey, I'll let everyone know that I tried the "simple contact" thing. I prefaced the session with the same kind of stuff Drew mentioned he said. I didn't do it on a patient (lack of outcomes or anything in peer-reviewed literature). I used the approach on my office manager. I gently placed my hands, well, the positions changed depending on what she wanted... but anyways, I got a big nothing. 30 minutes of standing or sitting with keeping my trap shut and hmmm, no response, no anything. Oh, she did move somewhat... she said her pain was reduced (she's been in pain for years but you'd never really know it by looking at her). I learned more about her psychosocial issues. So, no, I'm not "excited" about the theory or the apporach. What am I missing? What did I do wrong? I didn't do anything... I didn't see any outward change...
LOL Drew.. using "simple contact" AND pain gets 3 hits... none of which pertain. Barret, D [au] gets nothing. So.. what do you suggest should be used in a search in medline that WILL demonstrate some evidence?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:02<noscript>July 26, 2005 06:02 AM</noscript>:
Nari,
I say repeatedly as I teach that ideomotor activity is primarily designed to reduce the mechanical deformation concurrent with an abnormal neurodynamic, so the essential diagnosis I seek to find and alter is covered.
However, I also stress that you simply cannot know who will become effectively and fully aware of that activity and use it on their own. Time and again I've been wrong in my assumptions regarding another's tendency to trust their own movement and understand what it is I'm trying to teach them one way or another. When I think back on what I originally thought the "ideal" patient would look like, things like gender, age, educational background and ethnicity I realize that all I was doing was revealing my own prejudices. Simple Contact has taught me over and over to get rid of that and just meet the patient where they happen to be. Of course, most of that I can't see and will never know.
When students ask (and they do) "Would you do this with an old man, construction worker, Alzheimer's patient, someone with Parkinson's etc.", I point out that their understanding of the relevant essential diagnosis is incomplete and their prejudice regarding others is showing. "Touch them as I suggest," I say, "and let me know what happens to their complaint of pain. I presume they are capable of hurting for the same reasons anyone else does, and if an abnormal neurodynamic is part of that, well, now you have a way of approaching that problem."
I hope that answers your question.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,13,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:13<noscript>July 26, 2005 06:13 AM</noscript>:
Thanks Barrett, you have answered it, and with an answer I expected. I was looking for a sort of a confirmation of ideas brewing in the brain.
More later
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:37<noscript>July 26, 2005 06:37 AM</noscript>:
Barret,
Thank you for your posts, my own prejudices had me picturing a female, 35-60 years old, 30-40# overweight, depressed, possilble hx of psychological or physical abuse in their past, possibly divorced or at least unhappy, low self esteem as the ideal type candidate for Simple Contact. Maybe because this describes the type of patient that I know I am going to have trouble getting many results with using my manual skills. This is the type that I try the MFR, Feldenkrais, strain/counterstrain, dare I say compasioned listening and so on with and admittedly having trouble getting the carry over/ lasting results with. Your last post reminds me that I can't let my own prejudices cloud my perceptions of all of my patients.
Drew, thanks for your reply, you answered my concerns, now keep us up to date on how things progress, I am particularly interested in long term carry-over vs. dependence on repeated treatments ie MFR.
Barret, how do your concepts compare to those that the Feldenkrais people teach?
Thanks,
Rick
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:48<noscript>July 26, 2005 06:48 AM</noscript>:
Rick,
I spent four days in a class conducted by Feldenkrais himself in 1980-he passed away in '84-and was transformed.
I watched him work hands-on and did everything he suggested for long hours in a conference room in the Poconos and never again thought of the connective tissue first when observing restricted motion. The exercises I teach in class are essentially from his Awareness Through Movement, and I give him all the credit.
Interestingly, he completed only one training in the states and three students from that class have been students of mine at various times. Independently they each expressed sadness at what they feel his work has become as the various teachers and marketers have taken over. They see what is being taught now as often far different than his original work and I would agree. Each said to me, "You're doing what Moshe did."
When things are going badly, and they do at times, I remember this.
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,8,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 15:58<noscript>July 26, 2005 08:58 AM</noscript>:
Thanks Barret, I have only seen it (Feldenkrais) practiced once, in a large classroom, but it did seem to resemble what Drew has discussed in this thread.
Rick
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,12,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 19:25<noscript>July 26, 2005 12:25 PM</noscript>:
I have yet to figure out where everyone finds the time to write all these posts. When I finally find a spare minute to post, I have to spend 15 minutes catching up. Whew!
I feel like I have grasp of the theory and ideas behind SC, although I could have not stated it nearly as well as Drew has. My problem with its implementation has been in the area of touch and enviornment. I can't seem to stop my hands from wanting to DO something and the clinic I work in is much to loud and busy. If anyone has any thoughts, ideas or, well, metaphors for the former, I would be happy to hear them. The latter is a matter of making a decision. You can leave that one to me.
mike t
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,16,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 23:03<noscript>July 26, 2005 04:03 PM</noscript>:
Barrett, at the very least you know there is a lot of interest in SC based on the amount of questions in this thread.
I have a hard time believing that the patient is performing ideomotor movements during the treatment sessions. You give them 'permission' to move and they move voluntarily, unless they are under hynotism which is a true ideomotor action. Does anyone think the patient is really performing involuntary and unconscious motor behavior during SC? If so how do you know?
Does it matter?
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,19,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 27-07-2005 02:39<noscript>July 26, 2005 07:39 PM</noscript>:
Hi Zack,
Great questions. I'll give my personal opinions. If you haven't already, see this link, originally posted in the thread "Janet Jackson Effect".
The finding of Libet would suggest that our movement is initiated nonconsciously. This is, I think, different than involuntary (but I might be wrong about that). Stick with me here for a minute because you asked a lot in a remarkably short post.
My thoughts are that ideomotion occurs when there is no antagonistic representation of the action to be performed. I don't think that the only condition that this can happen in is one of hypnosis. Consider the following quote from and essay titled,
The responsible brain
Does it matter?
What do you think?
jon
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,20,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 27-07-2005 03:03<noscript>July 26, 2005 08:03 PM</noscript>:
Regarding hypnosis: Consider the following from skepdic.com
jon
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,27,17,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 28-07-2005 00:22<noscript>July 27, 2005 05:22 PM</noscript>:
jon
As usual, great links.
I was thinking, in your second last post, about constraint and freedom (permission to move) and its role in, say, an aerobics or bellydancing class; the participants are taught how to move to begin with, but end up in what looks like spontaneously-styled movements within a framework.
How do you think this fits in with the theme of permission to move and constraint?
Nari
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,31,20,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 03:23<noscript>July 31, 2005 08:23 PM</noscript>:
Not having attended Barrett's class yet, I have felt a little anxious about trying Simple Contact even though I know all the necessary instruction is either here or on Barrett's website. Anyway, I got finally got over that this morning.
Wow. I have never seen a lower back turn bright red and break into a sweat like that before. I was expecting a slight increase in warmth, nowhere near what happened though. I took my hand away from the patient's sacrum after only 90 seconds, saying "good", and he continued happily for several minutes. He felt softening, and he wasn't the only one who was surprised.
Wow.
Luke
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,0,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 07:18<noscript>August 01, 2005 12:18 AM</noscript>:
Luke, you're off and almost running by the sound of it. Would be interested in any follow-up you have when you see him next.
Did you converse with him while maintaining the contact?
Nari
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,15,4,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 22:04<noscript>August 01, 2005 03:04 PM</noscript>:
Jon,
This is the point where I really want to ask "How the heck did you do that?!?", but I know that it is a pointless question. I am going to guess that your answer would sound something like "I touched him and he moved".
I would like to trade hands with someone who has had success with SC and see what happens. Frustration, frustration, frustration.
mike t
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,16,51,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 23:51<noscript>August 01, 2005 04:51 PM</noscript>:
Mike,
I am assuming you meant to write Luke, instead of Jon.
Honestly, I don't think it had much to do with my hands. I asked him to allow himself to move in any way that emerged, and then I waited.
Luke
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,17,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 00:36<noscript>August 01, 2005 05:36 PM</noscript>:
And Luke, you were probably not frustrated, and instead were just interested, and that "idea" probably "motored" right on out of your own hands and his nervous system was able to sample that, kinesthetically, along with your own words, auditorally... humans being human, he just went ahead and did his best to comply, and his brain worked out a way to do it. Contact. Simple.
Mike, maybe your frustration sends mixed signals.
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:14<noscript>August 02, 2005 10:14 AM</noscript>:
Mike, you're not the only one.
I just sit there with my hands on them and nothing seems to happen.
They even move in all sorts of interesting ways, but no "characteristics of correction" ever emerge, and I remain a bit puzzled.
But I guess that's what the course is for. [IMG]smile.gif[/IMG]
J
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,29,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:29<noscript>August 02, 2005 10:29 AM</noscript>:
Jason,
You're going to kick yourself when you discover how easy it is to get what so many in the course get though they know a tenth of what you know about all of this. I keep looking for a way of instructing this with greater clarity across this medium. I know that if I actually accomplished this it would cost me students and money. I don't care.
Hang in there. Check for courses near Virginia. Isn't Tennessee somewhere near you? Vermont?
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,34,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:34<noscript>August 02, 2005 10:34 AM</noscript>:
Tennesee is SOMEWHERE near me, but a bit too far.
I live in Northern Virginia, actually about 20 minutes from where your Fairfax seminar was held.
I am starting my DPT on 29AUG and the money is a bit tight, so I am hoping to save enough for the course when it comes this way, but probably won't have enough to travel.
Thanks, though.
I hear patience is a big part of eliciting ideomotor movement. Maybe I just need to have more of that, both with my patients and with attending the course.
[IMG]smile.gif[/IMG]
J
<hr> Posted by vt2c1ms (Member # 4967) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:38<noscript>August 02, 2005 10:38 AM</noscript>:
Jason,
Glad to see you are pursuing the DPT. What is your reasoning for it home vegetus, that is, if you don't mind sharing.
Mark
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:42<noscript>August 02, 2005 10:42 AM</noscript>:
I have the time and some money right now, it's a good move I need to make for the long term, and with no kids yet and a reasonably stable job, it's the best option for me right now.
Thanks for your interest.
Now if only I could elicit that darn ideomotor movement, that would be something. I'd trade a DPT course for that, I think.
J
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:45<noscript>August 02, 2005 10:45 AM</noscript>:
I think I just need to take some time with some of my chronic pain patients and give this a shot. I guess my confusion lies somewhere between where do I place my hands and/or what response am I hoping to elicit. I have a better understanding of the latter simply from reading everyone's posts and Barrett's essays. I agree with Jason in regards to patience. Even though I have yet to attempt 'Simple Contact', I would imagine that patience is indeed a virtue.
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:02<noscript>August 02, 2005 12:02 PM</noscript>:
All,
You are all going to laugh at me, and actually I am laughing at me as I type this, but I tried something I think might resemble the hand placement, the "allow yourself to move however you feel you want to" ideas associated with simple contact, with a patient with a history of chronic pain, whom I am seeing for a total hip rehab program. I just rested my hand on her trochanter, on the affected side, over the incision, supported the affected limb at the knee, and she started whipping that leg all over the place. I had to control her from going too far into flexion, where she might dislocate, as well as restraining the adduction a bit, for the same reason. I was almost laughing myself while her leg was flailing around. This near laughter had more to do with the fact that I had no idea what I was doing than anything else. She said it felt great, and I asked her why she moved the way she did, and she said "because thats what I felt like I needed to do". Incidently, she was moving it, not me, as she frequently broke contact with my supporting hand.
By the way, Im a skeptical, show me the studies type of PT. I have no idea how I, of all people, got this movement to be elicited. Trust?
She loved it. I just hope it lasts.
Steve
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:02<noscript>August 02, 2005 12:02 PM</noscript>:
Jason,
You're and Chris are right about the patience thing. I teach specifically that you need three seconds. I know in today's world of therapy that's a long time. I'm not kidding. Maybe one of my recent students reading this will jump in and explain. Nah, probably not.
No kids yet and money's already tight? Boy, wait till the kids show up. One of my favorite questions:
How much money does it take to raise a child?
Answer: How much have you got?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:05<noscript>August 02, 2005 12:05 PM</noscript>:
Shill,
Any measurable changes in range subsequently? Did she warm up?
I'll be looking for your check in the mail.
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:08<noscript>August 02, 2005 12:08 PM</noscript>:
How long does it take to raise a child.
As long as you live.
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:12<noscript>August 02, 2005 12:12 PM</noscript>:
I'm havin' enough trouble with two kitty cats, I use them as a metaphor for ideomotor action with patients all the time.
Perhaps I am misspending my 3 seconds...
[IMG]smile.gif[/IMG]
J
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:02<noscript>August 02, 2005 07:02 PM</noscript>:
Diane,
Since you mention it, my frustration probably does show a bit. Masking my emotions has never been a strong point. Couldn't win at poker if I tried. There is also this lack of confidence that I can elicit ideomotor movement. I know that sounds dumb considering all that I have read here and learned at Barrett's course, but that is my personality.
mike t
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:02<noscript>August 02, 2005 07:02 PM</noscript>:
Steve,
You had me cracking up with your last post as I visualized your scenario! Now, I'm envious and I want to try it as well. So let me get this straight...you placed one hand on her trochanter and the other supporting her involved leg. What position was she in? What did you do with your hands...leave them there? You then proceeded to ask her to move as she desires and WHAM...she flailed about?
Thanks!
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:20<noscript>August 02, 2005 07:20 PM</noscript>:
My Dad said to me late last year in an ironic tone, "Mate, you know I've only just recently worked out what being a father is all about. It's all about writting cheques."
Barrett,
How often do you see the area turn red and burning hot? Was this incidence particularly strong?
Luke
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,29,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:29<noscript>August 02, 2005 07:29 PM</noscript>:
Luke,
This sign is not common. Typically I just get the the sensation of warmth, reported by the patient. It might get red but I wouldn't know it. I don't remove clothing in order to treat people.
It might also be noted that I give no verbal cues regarding movement. Simple Contact is "manual permission and acceptance," so nothing needs to be actually said.
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,20,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 03:06<noscript>August 02, 2005 08:06 PM</noscript>:
Barrett,
No skin temp changes, as her pants were on, but she stated a feeling of warmth and general goodness. As far as measurable changes go, she abducted a lot further than she was willing to go earlier. She doesnt have any true passive restrictions, just active ones. I have been non-judgemental of her pain from the start, and this has helped tremendously. Her gait was bizarre at first, more substitution patterns than I had ever seen, and now it looks like normal (whatever that means) gait. So I can document the reduction in sideflexion during gait, improved stride length, less trendelenburg, and I document the motions she went through as AROM exercises, counting roughly the number of reps of each movement she goes through.
I appreciate your growing acceptance of those of us who take a while to get it. You'll find us bullheaded ones to be the some of the most enjoyable people you could meet.
Chris,
She was sidelying, on the unaffected (although, all sides are affected), the non-surgical side. My hands simply supported the leg at the knee, although again, repeatedly, she broke contact with that hand. I just placed them there, and asked her to do whatever she felt like doing. That was it. I might add that I had a patient today with whom I tried the same thing, and nothing occurred. But I imagine both are typical.
Steve
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,20,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 03:10<noscript>August 02, 2005 08:10 PM</noscript>:
Barrett,
Do you ever have patients who stand there thinking 'What is he doing?" Does verbal cueing help in this situation?
Luke
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,20,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 03:48<noscript>August 02, 2005 08:48 PM</noscript>:
No one ever asks me this. I talk them through the concept and, at this point, I always get something.
If your contact is what I'm suggesting the movement may only be felt and not seen, not all that different than feeling a pulse-minus the rhythm and regularity. Ideomotor expression is present at all times and when we get out of the patient's way, position them properly (give them a few options) and wait patiently it always shows up. The warmth Shill reported is a very common occurance.
Mike T's failure to see this despite having taken the course surprises me if he is in fact sticking with it. I recall his speaking to me of the lack of support he anticipated from his boss. This is no small thing and I hope he can somehow get past that. As far as what his "hands should do," well, they are to just deform the skin and nothing more. What's so hard about that? If your friend needs you to listen, how hard is it to sit down and shut up?
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,21,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 04:06<noscript>August 02, 2005 09:06 PM</noscript>:
About actual heat, seems rare. The first time it happened to me was about 10 years ago, while doing muscle energy with a guy's T spine. Suddenly this tight, sore, sort of swollen spot he'd had right of about T4 for many years, gave us both a heat blast, then disappeared. It's happened in milder form just a couple times since with a few other people.
The sweating seems more common. The pulsey twitchy feel is pretty much present and normal with treatment on everyone, in fact if I don't feel it I move on to somewhere else on the body. And I haven't had Barrett's class yet.
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,4,12,17,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 04-08-2005 19:17<noscript>August 04, 2005 12:17 PM</noscript>:
Barrett,
Sticking with it has been difficult. Our clinic is fast paced. When I attempted to use SC and my results were negligible, I had to move on to other treatments. Have I given it a fair shot? Probably not. This is partially my fault, partially the situation I am in.
I have a new pt. tonight with a diagnosis of LBP. My plan is to use SC as my first treatment and go from there.
mike t
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,4,12,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 04-08-2005 19:22<noscript>August 04, 2005 12:22 PM</noscript>:
Mike,
I appreciate your honesty-good luck with your boss. As Carlos Castenada says: "The heart of a warrior is tempered by dealing with impossible people in positions of power."
In the end, for mechanical deformation we're all looking for the best movement-sometimes that motion appears a little more slowly than we'd prefer.
<hr> Posted by dragonfire (Member # 4369) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,5,20,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 03:39<noscript>August 05, 2005 08:39 PM</noscript>:
Barrett,
With me just lightly touching their bodies, I've found some success in getting patients pain level down by instructing them to move in any direction that's ok with them, meaning painless. Is that still considered ideomotor or is that conscious effort? Do you suggest verbal instruction or just slightly touching them to initiate movement?
I usually just get a report of softening and relaxing response, although today, a parkinsons patient also dx with fibromyalgia told me she felt like she was on fire with pain before tx but after simple contact, felt like doused fire instead.
What I've noticed though is that when patients come back, their pain is just as painful as before. Also, I don't always get a successful outcome- meaning nothing happens when I touch the patients and I go back to thinking, what am I doing? [IMG]confused.gif[/IMG]
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,5,20,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 03:58<noscript>August 05, 2005 08:58 PM</noscript>:
Dragonfire,
Am I mistaken or didn't you take my course? Before I answer I'd like to know.
<hr> Posted by dragonfire (Member # 4369) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,6,0,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 07:31<noscript>August 06, 2005 12:31 AM</noscript>:
You are not mistaken. I have attended your course. And I have been applying SC at work which brought me to the question. I only read portions of this thread so if I am asking you to repeat something that has already been said, pardon me.
I understand that ideomotor movement is instinctive, allows expression, and refers to those corrective motions that make us comfortable or experience less pain. I also understand that increased awareness on the part of the patient enhances correction thru gentle touch and verbal instruction from the therapist.
My question is on the verbal instruction. I am unsure if giving an instruction to move in a painfree way results in volition as opposed to instinctive movement. I have had success in reducing pain with me telling patients that they can move where its ok and I say this when nothing happens with tactile stimulation. But I wonder, when you give the above instruction to a person, doesn't this result in a conscious course of action? On the other hand, I also think of the instruction as a way of creating a safe environment, telling the patient that he/she can move where its ok, facilitating corrective motion. I have also thought that maybe, it would be better to just use my hands to do the talking. In other words, to just shut up.
I have been reading your course workbook, relating it with actual experiences with patients, been reading your essays, and attempting to fill in the gaps to make my SC knowledge a cohesive whole. For years, I have no knowledge of ideomotor motion. Now I do. And to top that, I have questions. I consider that double progress.
<hr> Posted by PTPete (Member # 3243) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,6,12,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 19:31<noscript>August 06, 2005 12:31 PM</noscript>:
In my understanding, SC requires no verbal instruction to the patient. Pain-free motion is not neccessarily a requirement either. If I recall Barrett's thoughts on this correctly, resolution may in fact be uncomfortable. Barrett please correct me if I'm off base here. Personally, I simply tell the patient to follow their instinct and move in any manner they wish. I've had no flare-ups, some mild symptom reduction, but no miracle cures either. I'll keep trying, using fewer leeches has actually been quite rewarding...thanks Barrett.
Pete
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,6,12,54,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 19:54<noscript>August 06, 2005 12:54 PM</noscript>:
Dragon,
Pete’s right, the characteristics of correction do not include movement toward comfort and therefore this should not be encouraged verbally or otherwise. In fact, I never tell people what to do, I just follow them around. I move around, three seconds at a time if that is what’s needed, as you may recall.
Stick with it, do less, say nothing that might indicate that you’re the choreographer and you’ll probably progress. Think of this, I’ve been promoting this site for over a year and a couple thousand therapists have very positively responded in class to the idea of such a place. Still, I can count on one hand the number of students who have shown enough curiosity to contribute here as you have. Your interest is rare, and your desire to work in a new way with these patients is something I don’t often see.
<hr> Posted by dragonfire (Member # 4369) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,8,6,4,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-08-2005 13:04<noscript>August 08, 2005 06:04 AM</noscript>:
Pete & Barrett,
Thank you much for the feedback and clarification. I think instructing patients to follow their instinct is indeed better or just simply not say anything at all.
And Barrett, that last post was a compliment, thanks but really, more thanks to you!
DF
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,10,22,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 05:01<noscript>August 10, 2005 10:01 PM</noscript>:
I attended a "Simple Contact" course in Florida this year for the 1st time. I was very impressed by the concepts, but not so much by the presentation. I shared this opinion on the evaluation given to us at the end of the day. It was a while ago so I don't remember exactly what I wrote. Of course this is based on my own "perception," so I mean no disrespect with my reasoning.
I think there was too much time criticizing other modalities, rather than embracing the whole point of "Simple Contact" for any kind of therapy. This is definitely the 1st time I've ever heard a speaker actually give specific names of whom he was bashing(which is how it seemed) or doesn't agree with.......in a negative way. Also, there was one instance where Barrett asked the question: "Does anyone hear use myofascial release in there practice?"
There was a therapist that who had some training from Barnes himself. Well this was asked after Barrett gave his reasoning on how ineffective it was. The therapist was brave enough to raise her hand still when the question was asked, and there was absolutely no embracing for this therapist's thought process or defense for what she practices. It was almost like if she took a breath for a split second b/c sentences, that was Barrett's cue to jump right in defend himself. Now it must be very hard as a presenter/speaker to know your audience completely, but I'm sure there are common rules on respecting your students.
Now I"m a youngster in the health field so I have more to learn than anyone. But, it is in my experience that whenever attending a conference or listening to someone share their knowledge...(which is greatly appreciated)....it is usually a sign of insecurity or uncertainty if one needs to bash others. This is only a fraction of what I got out of this workshop, besides some good treatment approaches, but I'll list a few more things that I saw happen.
.
1) there were at least 5 times(that I can remember) where Barrett asked a question and no one knew the answer. Personally I've never seen someone get so frustrated with "students"(b/c that's what we are) in a learning environment.....and actually show this through his tone, body language, and most importanty....his words. There was 1 question he asked on a hand pathology that no one seemed to know, and he really ripped everyone a new a-hole. Something was said along the lines "How do a bunch of pt's not know what a ......is." This happened pretty early in the seminar, so I tried to dismiss that in my own misinterpertation of what he meant.
2) he used 2 people as demos and I was really impressed by the results in movement, but not in his ability to uplift there spirit through positive feedback and encouragement. Now the demos may have had a different response b/c of physical changes, therefore effecting their emotional state, but there was definitely no sense of connection(from what I saw) b/n Barrett and the demos. I don't even think there was every any eye contact b/n them. That was a vauge description, but I think everyone gets the point.
These were a few things that jumped out at me and I could list a lot more, but the the whole point that I'm trying to make here is how easily one's perception on how the 411 was presented can dictate the efficacy of a concept. I've used the "Simple Contact" technique after the seminar and had good and minor results. I'm no expert on Human function, but Barrett definitely has something going with "Simple Contact."
Building on success, using positivety and encouragement, trusting the innate wisdom of the body to heal itself and not my own personal tool box of modalitites I would say have to be a part of any modality. Without them, like Gary Gray would say, there's a huge "gaposis."
I'm definitely not an english scholar.....OBVIOUSLY or great therapist, that's probably why it's takened me so long to participate in this thread. The participants in this topic are way above my head in knowledge and no way would I challenge the efficacy of their treatment approach.
To conclude my thoughts, there were a lot of great things that I learned and am I excited to share with clients. I'm not a big believer in jump on the "this seminar sucks" wagon, but I think the principles and concepts could have been presented in a better fashion with respect of all the participants. The principles and concepts are important in any seminar, but if you seperate that out from being positive and encouraging to your attendees, I'm afraid this great thought process of "Simple Contact" won't reach the level it should. Maybe it was the time of day, or the crappy weather, possibly the tasteless food that they served in the hotel restaurant, but I came to learn...and that I did. A far greater lesson than any scientific research study can find.
Will I ever attend another Barrett Dorko seminar? maybe......not
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,5,50,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 12:50<noscript>August 11, 2005 05:50 AM</noscript>:
Barrett has repeatedly commented that those who have participated in his course don't come to the edge... David, maybe you have provided insight from your perceptions in Florida as to why.
Learning from a person that is confident, positive and at ease with oneself combined with being ever so humble creates a much better learning environment. I have been really amazed at some sessions I have taken that have what I would consider headliner therapists who are leaders in our profession. Overall, they make me jealous with their style - they've proved that they know what they know and I've always been impressed with the respect they direct toward those in the session and the openness they tend to have along with serious contemplation of the questions that are asked.
When one teaches, it is a package deal. Students don't just focus on the material being presented and it is difficult to ignore aspects of a teacher that grate on nerves.
I'm sure the Canadian session will be much different.... I actually would love to see a video tape because I wonder how Barrett will respond to questions and the experiences of others who have a parallel philosophy of care. I see the dynamics changing... quite a few of those participating aren't schmucks and are always processing new information and integrating it into their experiences and knowledge base. Should be interesting....
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,8,11,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 15:11<noscript>August 11, 2005 08:11 AM</noscript>:
David,
I'l be the first to agree with you, Barrett is not one that coddles, but:
For many things Barrett may be, insecure or uncertain is not one of them. I have been too two of Barrett's course, my perception of what you state as bashing is different.
I think all of us as PT's are ill prepared when we come out of school to deal with "pain" itself, I can speak only for myself, but I got minimal exposure to pain concepts. So when we try to learn new concepts after graduation by going to cont ed classes, we are at a disadvantage if the concepts we are presented with are foreign to us, and usually they are. Pointing out that a philosophy behind a certain modality is bogus, is not bashing, it's research. Sometimes the truth is not nice,and is hard to handle
Scott
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,9,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 16:07<noscript>August 11, 2005 09:07 AM</noscript>:
OaksPT,
I appreciate your thoughts on your experiences. In now way am I judging his character. I wasn't the only 1 at the seminar to say that....ob break. Being the young kid there, I kept my mouth shut most of the, but couldn't help hear the same reactions from quite a few of the attendees.
We all know seminars like this can be the driving force for the health professional wanted to continue in the field. But, there was way too much negativity. Maybe I'm spoiled after quite a few Gary Gray seminars b/c he not only provides "great" information(in my opinion at least), but shows great respect to whatever level you come in as any kind of therapist, doctor, trainer, etc. Whether Gary used someone as a demo, asked a question (and the most ridiculous answer came out of someone), or answered questions, he totally uplifted and built on that person's successes. I encourage anyone who has a attended Barrett's seminars to attend a Gary Gray seminar to see what I mean. I only use this example for those who have experienced both. By the way this in not a plug for his seminars b/c there are many great therapist out there teaching.
thanks
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,9,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 16:35<noscript>August 11, 2005 09:35 AM</noscript>:
David,
First of all I want to say I appreciate that you came here to say what you said. It is one of those "fierce conversations" in my opinion.
Second, I've had my own run-ins with Barrett (on line, when I picked up on and reacted to "negativity" as I perceived it) and to his credit he never decided to shut me out of his learning loop based on anything interpersonal.
Third, I expect to actually learn new things at his workshop. I don't know how I'll respond to his teaching style, that remains to be seen. Like you, I respond effortlessly to engaging, soothing, and respectful teachers; my brain sort of disarms, falls open and the stuff pours in. David Butler comes to mind..
However, I can't put aside the fact that a growth curve has occurred for me in the last 3 or more years, tracking Barrett's writing and book references among others. I think at least part of the growth was caused by the in-TRA-personal discomfort Barrett's ideas instigated. There are precious few PTs who involve themselves in learning about physical contact and what goes on physically within that interface. Because hands-on is my preferred area of investigation/ pain treatment, I decided to accept Barrett in that journey, warts and all, quite a long time ago.
One thing I'm pretty sure of, Barrett's teaching style will not include any emotional manipulation. In no way do I expect to find him creeping into my mind through some unlocked back window, appealing to unconscious memeplexes. In other words, I'm pretty sure I'll be able to trust him as a teacher, and that his material will be reality based, that he teaches from that level and not from his own belief system. As for any potential negativity, forewarned is forearmed, and I choose to let that go by as best I can, simply not allow myself to be affected/infected.
Regards,
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,12,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 19:25<noscript>August 11, 2005 12:25 PM</noscript>:
Hi David,
I'm not sure what you were driving at in your second point about the demos. Could you elaborate on that?
Thanks,
jon
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,17,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 00:32<noscript>August 11, 2005 05:32 PM</noscript>:
I am not sure what is meant by 'coddling'; surely adults who enrol in a course to learn (which is why we do it in the first place) do not need 'coddling'....?
Comparisons are odious, but I have been to two Butler courses and he does not coddle at all. All that comes out is enthusiasm and clarity of thought processes. I was a demo for several techniques, and eye contact was minimal - his eyes were for the rest of the group. I thought that was entirely appropriate. He made a facetious remark about 'these people from the ACT' (Australian Capital Territory, which includes Canberra) which I thought was very funny.
Like Diane, I will wait and see how the course pans out in September. I endorse Scott's remarks.
Nari
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,18,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 01:40<noscript>August 11, 2005 06:40 PM</noscript>:
I don't think I'm mistaken or that I'm breaking any HIPPA rules as I believe this has been mentioned in a distant thread but I believe Barrett has some degree of Asperger's syndrome. If so, perhaps he can fax his course notes to Gary Gray (whom I've not met) or David Butler (also worth going to see) for a more entertaining presentation of his original work. Do you suppose they would be interested in presenting it?
jon
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,21,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 04:05<noscript>August 11, 2005 09:05 PM</noscript>:
It is very tough to express one's opinions without sounding narrow-minded. Unfortunately, my writing skills don't reflect my ability to express verbally. I felt it was necessary to express my experience b/c I think teachers(in which all of you are) have a much greater impact on a student's reflection of their abilities.
SJBird55,
I don't know how much insight one person can provide, but from what I experienced and read everyday on these threads....it's starting to add up.
OaksPT,
I don't ever expect a teacher to coddle his/her students. But, I do expect teachers to show respect to their students.
Diane,
I appreciate your response. I came to that workshop ready to learn. I had no pre-conceived notions of Barrett b/c I never read any of his work. I heard great things about his information. So in no way did I except what was going to happen that day. I'm told I have a pretty positive attitude. Like I said before, I kept my mouth shut the whole time and just observed. I prefer to concentrate on the positive side, that's why I was so hesitent on participating in this thread.
My final thoughts on this whole matter is this: There are "great" dissemenators of information and than there are "great" teachers.
I'll stick with the "great" teachers.
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,21,50,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 04:50<noscript>August 11, 2005 09:50 PM</noscript>:
Great post David. Being young, brave enough for critical feedback, willing to use your real name and knowing what you want sure are positive signs of successful future. Pick your teachers well and good luck.
jon
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,6,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 13:25<noscript>August 12, 2005 06:25 AM</noscript>:
David, I'm not doubting that what you experienced and what you read here isn't adding up. I full heartedly agree with your assumptions. I wouldn't choose to attend his course for the simple matter that I don't agree nor do I put up with his type of attitude. I'd just make the class miserable because even though I'm a "student" that doesn't mean that I have to sit there and tolerate crap and his type of attitude - it isn't appropriate. I wouldn't be able to block out and ignore the crap and be able to settle and learn. So, kudos to all of you that can ignore and focus... as with pain there are thresholds and I have a low threshold for what I am able to easily tolerate.
Jon, and that may be the case, but it doesn't excuse Barrett for his type of communication. No wonder he doesn't understand half of what I write - and now I'm seeing that no, it isn't all my fault the number of miscommunications that occur, in particular between him and me. (Others in public have stated they've had communication issues with him also. Mine just continues and continues like the energizer bunny.)
And, for that matter, the forum is a really irritating way to communicate - here we are publicly talking about a third party. That just seems wrong to me... so, Barrett, I may have been talking to Jon and to David about you, but in my opinion, you need to realize and accept that when it comes to communication and social issues that you do have a disadvantage. I'm going to state that I don't appreciate that the miscommunication is always blamed on me and "what I meant." At least I try to clarify when there is confusion and I try to address that confusion by rewording versus deleting posts or ignoring posts.
David... technically, you aren't a physical therapist, are you?
I'm going to be changing the topic somewhat... how do I politely word (without offending David).. but what the heck was a nonPT or non PTA doing at a course a PT was instructing? Does the ability for anyone to attend a course indicate that what we do isn't "special" to just our field? And then we sit back and wonder why we can't protect the terms "physical therapy" as well as we would like... we are our worst enemy sometimes.
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,6,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 13:53<noscript>August 12, 2005 06:53 AM</noscript>:
Well, that's a different thread, SJ.
[IMG]smile.gif[/IMG]
As long as David doesn't call what he does "Physical Therapy" then I have no issue. I have learned quite a bit from people who didn't have the magic letters "P" and "T" in their credentials somewhere.
David's a smart guy and he knows he's not a Physical Therapist, just as I know I'm not a strength and conditioning coach. But some overlap is good.
I don't think we can say in one breath that Barrett's work isn't widely accepted and then say it's unfortunate to share it with those that aren't PTs. I don't think jealously trying to guard treatments for ourselves (which I don't think you're suggesting, but others have) is an intellectually defensible position. Isn't this part of our profession's issue with chiros?
Just thinking on a Friday...
J
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,9,56,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 16:56<noscript>August 12, 2005 09:56 AM</noscript>:
SJBIRD,
No I'm not a P.T and I don't attempt to act as one. I do "attempt" to take up as much knowledge from any source that I feel is pertinent to my cause........to help people. As a Personal Trainer and LMT I refuse to limit myself to the educational resources out there. I mean this in no offense, but Barrett's seminar was nothing above other things that I've learned.
I think health professions as "whole" should be able to "appreciate" all forms of healing and determine by their scope of practice what can be used. If you look at my credentials, you may see FES. Now that's there b/c it stands for Functional Enhancement Specialist......that's what we all are.....not tool experts. I wish there was a uniform title out there so we wouldn't limit ourselves on we can learn and not. I PROMISE I won't take this information from Barrett and teach all my fellow trainers. But I DO PROMISE I will continue on my journey of being a better trainer, massage therapist, motivator, listener.....to every one of my client.
You're whole tune seemed to change once you realized I wasn't a PT.
Jon,
There's no need hide my identity if I believe in something. Thanks.
Jason,
I appreciate your comments. Maybe I'll go back to school and get my PT's license and I can have those magic letters after by name [IMG]smile.gif[/IMG] I consider it quite often....on a serious note.
Overall, I'm done with this thread and I'll go back to my little world of learning and appreciating all you experts. One day when I've reached a level of knowledge I will have the opportunity to be a "great" teacher and not just kid full of information.
In closing, hopefully one day I'll come across Barrett again in a different venue and my impression will change for the better. I don't believe someone has bad intentions when doing anything. But the means don't always justify the end.
thanks
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,18,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 01:05<noscript>August 12, 2005 06:05 PM</noscript>:
I'm sorry David is departing the thread.
Most courses (intranational ones anyway) seem to be not restricted to PTs only. David Butler's courses are certainly open to chiros, doctors, etc. I don't see that this is a problem; knowledge is for sharing. We can choose to use it or not; if it enhances clinical practice, so be it. PTs are not sacrosanct, and neither do we 'own' knowledge. If someone (a non-PT) attends a course and distorts this knowledge so that it ceases to be based on science, that is a problem, but it can't preclude that person from trying to learn in the first place.
We all enjoy someone who is skilled and presents well before a group, to fit our perceptions of what a good teacher is. But that doesn't always happen; and even with a 'bad' teacher, knowledge will filter through (if we permit it) the cloud of personal impressions.
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,7,30,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 14:30<noscript>August 13, 2005 07:30 AM</noscript>:
David, I was just contemplating the issue of continuing education courses. I really didn't have a tone - (hence prefacing it by "not offending David").
I don't know, I go through times of contemplation (and I'm in one now): Who is a health professional and who is not and who determines that? What defines a health professional? And then, what is physical therapy? If others can be doing some of the services we as physical therapists provide, then how is it only physical therapy when a physical therapist does it?
Actually, Jas, I'm not being jealous. I was just thinking that if what physical therapists teach is open to anyone who wants to sit in on the course and learn and the person learns indications, contraindications, prognosis, outcomes and the approach/technique... well, if what was learned is a service that is provided by physical therapists and now the other person who is a non PT learns it and does it ... then, technically, both the non PT and the PT are able to do the same service, so... how is it that it can only be tagged "physical therapy" when an actual physical therapist does it?
Nari, it wasn't just a lecture on pain that Barrett was providing knowledge - he also got into demos and approaches and some clinical hands-on material. I don't really have a problem with sharing knowledge, I'm just contemplating the clinical aspects.
As I said, just contemplating...
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,9,56,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 16:56<noscript>August 13, 2005 09:56 AM</noscript>:
Barrett is a generous, kind, thoughtful, and insightful person. I have known him for years as a teacher, mentor, and friend, your experience with him isn't what I've experienced.
He does, however, present a much wider breadth of information than most other presenters. As such, his philosophy is to present philosophy and theory . . . and discuss it, rather than present specific treatment techniques (e.g. what to do). That tends to frustrate people. Undoubtably. Furthermore, he has be burned by many, many, people over the years simply for challenging them to refine their theories. The response, more often than not, has been to attack Barrett personally --- sometimes he responds in kind. Generally, he responds in ways that are not mean, just frustrating. It's hard for a clinician to hear that they're not reading enough, not collecting enough information, not THINKING enough.
Teaching someome to fish is a different process than giving someone a fish. Of course if the fish given happens to be unedible . . . what have you got?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,10,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 17:46<noscript>August 13, 2005 10:46 AM</noscript>:
Nari,
If I were you reading what I’d read the past few days I’d also be concerned about what I might see in me while seated in the class in Nanaimo. If I didn’t know myself, well, I’d be quite concerned too. But I’ve spent thirty years standing before groups of my peers, speaking of the latest advances in our knowledge and understanding of humans in pain, of clinical life, clinical reasoning and the enormous responsibility the therapeutic professions have inherited. By that I mean the burden of treating those the medical people cannot help chemically or via surgical means. As you know, there are many out there like that. If we have succeeded at reducing the numbers of those who suffer from chronic pain it isn’t obvious to me. Any number of statistical indicators make it clear that this is epidemic and growing. I commonly speak to therapists in pain who long ago abandoned their own methods of management. They are often stoic but desperate, quiet but seething within. In any class I teach I’d say they comprise about a quarter of the students, probably more.
It’s a volatile mix, and six times each month I step into the middle of it and do what I can to navigate the attitudes, knowledge, misconceptions, memeplexes and unconscious projections of those who sit before me. I learned long ago that, from me, constant positive reinforcement (what many in therapy with delicate sensibilities seem to want) was neither possible nor always helpful. There are teachers like that and some are my friends. I used to teach along side one who was hugged by everyone leaving the room. I didn’t get any of this, and I’d wonder. But after a while I came to realize that this man didn’t really have much more than the gift any chameleon has, and who he was, what he thought, how he related to others was little more that an airy, light, meaningless and empty thing. It couldn’t be weighed, its effect was negligible, and, most importantly, it couldn’t be trusted at all. He was whatever suited the needs of those around him. I saw that he paid for his popularity dearly and in ways I would avoid at all costs.
Being me has its price. Not being me costs even more. I accept that, and, knowing what I can about you through this medium, I’d be willing to bet you’ll see yourself in what I do while negotiating the minefield every class represents. Perhaps, like many, you’ll be impressed by my patience. I’ve been told this many times. Of course, these people just don’t contribute their thoughts here. Drat.
Thirty years and people still come. It must mean something.
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,16,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 23:00<noscript>August 13, 2005 04:00 PM</noscript>:
SJ,
My bringing up Asperger's was not an attempt to excuse behavior but rather to try to help explain why someone may perceive another as being disrespectful. That is, I know Barrett is not but as you noted that misperception is not isolated.
"Patient" is an excellent descriptor. You should have seen how well he suffered through my miserable presentation of myself during a lunch the day my wife and I had met with him. In retrospect, his patience was amazing. It is due to that sort of thing that I may seem to be on the ingratiating side but my posts are honest.
As far as having other practitioners attend, I suppose every CE provider has to grapple with who their audience will be. Since the only manual skill needed for Simple Contact is touching someone it would be hard to preclude those who do this for a living regardless of title. Why such a thing might work is what the rest of the course is about and clearly many benefit from education regarding this.
Besides, how bad can a person be who performs the 'squeaky head gag'. Hilarious.
jon
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,21,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 04:25<noscript>August 13, 2005 09:25 PM</noscript>:
Drew, well, an Indian once told me that Gar (fish) isn't inedible if you pressure cook it, it softens the bones.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,22,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 05:02<noscript>August 13, 2005 10:02 PM</noscript>:
Barrett
What have you been reading over the last few days?
I agree that a teacher who bends according to whatever wind he thinks is blowing off the class is dodgy with respect to the honesty of his presenting material.
What does intrigue me is the number of PTs in the classes whom you say are in a chronic pain state.
Why is this so? Is it an indicator of burn-out?
Nari
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,14,6,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 13:18<noscript>August 14, 2005 06:18 AM</noscript>:
Nari,
I don't think therapists are in pain because they're therapists or because they have any significant psychological component to their pain. Not at all. They hurt for the same reason my patients do-they are mechanically deformed beyond their tolerance (in the nervous tissue) and they have not yet moved in a fashion that resolves the problem. I demonstrate this constantly.
Why do they remain like this, commonly for years prior to attending the course? Perhaps there's a clue in the fact that virtually none of them have any knowledge of the subjects we discuss here in the Bullypit. In Nashville, Louisville and Lexington this past week I had a total of 114 students. Not a single one was aware of discussion groups on the Internet. I'm not making this up.
Burn-out doesn't describe this.
I am currently reading "Rebuilt-How Becoming Part Computer Made Me More Human" by Michael Chorost and "Radical Evolution-The Promise and Peril of Enhancing Our Minds, Our Bodies-And What it Means to be Human" by Joel Garreau. I'm also rereading portions of "A Man in Full" by Tom Wolf.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,14,6,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 13:58<noscript>August 14, 2005 06:58 AM</noscript>:
Nari,
It just occurred to me that you weren't asking for a list of books on my desk. I was referring to the massage therapist's decription of my behavior while teaching. It doesn't resemble anything I do, have done or will do.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,14,17,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-08-2005 00:31<noscript>August 14, 2005 05:31 PM</noscript>:
Barrett, either way, it was interesting to read both your reading list and your opinion on the MT's comments. Like jon, do you ever get to sleep or eat??
I know formal burnout indicators do not include the mechanical deformation you describe, but as these indicators were developed by psychs,would they recognise any factor related to neural function, anyway? (not denigrating psychs.. I think they are great)
All I can say re your second post is an old cliche: most things in life occur as a result of expectations and our perceptions of satisfied or unfulfilled expectations. Expectations are useful and necessary..it's how we interpret the outcomes that counts. We seem to enjoy shooting messengers sometimes; not that we would necessarily do better, but someone who stands in front of a group is automatically expected to perform better than any one else in the group, or they wouldn't be there in the first place. This always clouds accurate perceptions of what is good and what is 'not'.
Nari
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,24,20,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 03:59<noscript>August 24, 2005 08:59 PM</noscript>:
Interesting discussion about teaching styles. I have attended both Barrett's course and Gary Gray's course and, as much as I love Gary Gray's personality and attitude, I thought he was an ineffective speaker in terms of getting his ideas across to the audience. Thank goodness Dave Tiberio was there to translate all the Gray-isms and bring some solid research to the lectures. Overall, I would describe it as fun and inspirational, but I didn't really come away with a lot for my brain to chew on.
Barrett, on the other hand, was not as "perky" and optimistic but his presentation was much more informative, in-depth and thought-provoking. He challenged us and gave us a new foundation and understanding for treating our patients.
Both speakers truly believed in what they were teaching, having spent most of their professional lives developing theories and honing the material. Both presented with sincerity and integrity and I respect them both as teachers.
I think Nari has a good point about expectations. Our perceptions are definitely clouded by our expectations, and maybe David knew a little bit more about what Gary Gray was going to say and was therefore more open to perceive it.
I also think SJ has a point about the fact that David is not a PT, only because he has not been indoctrinated by the PT culture and doesn't have the same understanding of rehabilitation and injury/pain as a PT. Given this, he may not have perceived Barrett's comments as a wake up call, but more as an unprovoked attack (not knowing the full history of our profession and the day-to-day workings of a PT clinic). Having said that, I strongly feel that he should continue to learn, take courses, and contribute here to give us his perspective. So, I hope you will come back David.
On a lighter note, what have I been doing lately?? Well, I have had some mechanical deformation beyond my threshold (too much sitting at the computer) and have been giving my body a break. Doing quite a bit of reading, purely for entertainment....aka J.K. Rowling. Had to read the whole Harry Potter series again after the 6th book came out. [IMG]smile.gif[/IMG]
Sarah
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,24,21,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 04:52<noscript>August 24, 2005 09:52 PM</noscript>:
Hi Sarah,
Welcome back.
What can Harry Potter tell us about pain/suffering? I'm being serious. I have not read the book so this isn't a riddle or a test, I'm just curious and making an assumption that there is something to be found in 6 volumes.
jon
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,24,23,29,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 06:29<noscript>August 24, 2005 11:29 PM</noscript>:
Hang on to your wand. He's always dropping it, or losing it or getting it taken away. Since apparently you can't do magic without it, then I'd have that thing glued to me, or least tied on. I guess you can wonder about the need for a tool to practice what seems inherent.
The main thing though, is that despite what he's been through and likely will have to go through, he's not a victim, and doesn't let himself become one.
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,25,0,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 07:08<noscript>August 25, 2005 12:08 AM</noscript>:
If I remember the book correctly, he gets a headache whenever his arch enemy is nearby, right in that zigzag scar on his head where he was nearly killed by the same guy when he was a baby. It's a warning, like pain is supposed to be.
His other big pain is being an orphan (parents killed by the same guy during the scarring episode), an emotional pain that will never heal, one he will have to learn to live with and will make him a better wizard probably.
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,25,12,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 19:59<noscript>August 25, 2005 12:59 PM</noscript>:
Who'da thunk a discussion of the lack of correlation between pain and scapular positioning would end up discussing "Harry Potter" a hundred or so posts later? Always interesting.
Harry always seems to be on a ride which he can't fully control. He is desperately trying to figure out who he is and what is going on. Many people are trying to help, even the wisest of the wise (The Ministry of Magic, Dumbledore), but they often end up making things worse through stubborn refusal to see the truth or a genuine desire to help. It certainly seems that he needs some sort of "consumatory act" to regain control.
mike t
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,25,15,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 22:40<noscript>August 25, 2005 03:40 PM</noscript>:
Amazing where threads will go...
I admit total ignorance of the subject - have never read one word of Potter...
heretical!
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,26,6,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-08-2005 13:07<noscript>August 26, 2005 06:07 AM</noscript>:
My 2 cents,
I have only seen Barret speak once, at an Ola Grimsby forum a few years back. He had a group of manual physical therapist stand up and sing his version of "If I only had a brain", I thought it was great. His lecture provided a lot of insight to a group who, as a group probably didn't have any idea what to expect from him (were mostly thick headed joint guys, don't you know). At the time I gave Ola a lot of credit for bringing him in and reminding us not to loose focus on the patient while in the midst of trying to find something stuck that we could loosen. I can't speak for anyone else in attendance but I did not find him insensitive or arogant at all. His teaching style was all right by me.
Rick
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,26,13,11,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-08-2005 20:11<noscript>August 26, 2005 01:11 PM</noscript>:
I really didn't expect to hijack the thread again! But now I'm going to go with it...
I think many people can identify with the Harry Potter stories, as they contain the classic archtypes such as the reluctant hero, the egotistical villain (always going off on some big diatribe before attempting to kill the hero), and the loyal sidekick. I personally identify more with Hermione being brainy and bookish (with curly hair). As for pain and suffering, I think the theme is that what doesn't kill us makes us stronger and that deeper understanding is gained through trials. Good always triumphs over evil. Cliche I know, but it works for me.
Sarah
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,1,21,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 04:40<noscript>September 01, 2005 09:40 PM</noscript>:
Yikes, I killed the thread......in any case, can someone please look at my scapula? I think it is too far away from my spine. [IMG]wink.gif[/IMG]
Sarah
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,1,22,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 05:35<noscript>September 01, 2005 10:35 PM</noscript>:
Sarah
I don't think you killed it; it simply ran its course and 220+ responses would indicate that, perhaps!
I know why your scapula is off beam - it's wandering about. After all they talk about wandering placentae..so why not the scapula? [IMG]wink.gif[/IMG]
Nari
<hr> Posted by gary s (Member # 1098) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,1,22,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 05:45<noscript>September 01, 2005 10:45 PM</noscript>:
Nari,
I think it's wandering uterus.
Gary
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,2,0,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 07:19<noscript>September 02, 2005 12:19 AM</noscript>:
Gary
True, there is a wandering uterus, but there is also a wandering placenta..so I learned during 10 years of perinatal work. Still could be an urban/midwife myth! Maybe a pseudowandering placenta...
Nari
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,2,6,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 13:19<noscript>September 02, 2005 06:19 AM</noscript>:
My brain wanders all the time.
jon
<hr> Posted by Sebastian Asselbergs (Member # 174) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,6,6,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-09-2005 13:31<noscript>September 06, 2005 06:31 AM</noscript>:
my scapula wonders where my brain wandered...
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,7,16,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-09-2005 23:48<noscript>September 07, 2005 04:48 PM</noscript>:
Sebastian, don't worry, as long as the reptilian brain is around you can live on reflexes. Isn't it great that a pithed cat can walk on a treadmill. And this thread is about what?
Sarah, I kill alot of threads too, don't feel lonesome.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,7,18,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-09-2005 01:55<noscript>September 07, 2005 06:55 PM</noscript>:
Who was the b----r who pithed the cat??? (I am a cat lover).
Sarah, this has been one of the most inspiring threads yet - and it is still going, though with a severe case of wandering. Much better, though, than standing still with brainrot.
Eric -start another thread like this one! [IMG]tongue.gif[/IMG]
Nari
From Arch Phys Med Rehabil. 2005 Jul;86(7):1349-55
quote: <hr> Abstract Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests. Objective To examine the interobserver reliability, internal consistency, and clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain. Design Prospective repeated-measures design. Setting Private practices for physical therapy and hospital outpatient physical therapy divisions. Participants Twenty-nine patients with shoulder pain who were diagnosed by a physician as having a shoulder disorder. Interventions Not applicable. Main Outcome Measures Study participants filled in a visual analog scale for pain and the Shoulder Disability Questionnaire. Next, 2 assessors performed the following tests: measurement of the distance between the posterior border of the acromion and the table, measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and the lateral scapular slide test. Results The interobserver reliability coefficients were greater than .88 (intraclass correlation coefficients) for the measurement of the distance between the posterior border of the acromion and the table, were greater than .50 for the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and were greater than .70 for the lateral scapular slide test. The Cronbach alpha coefficient for internal consistency for all tests was .88. No associations between the outcome of the tests and self-reported pain severity or disability were found. Conclusions These data provide evidence favoring the interobserver reliability of 2 of 3 tests for the assessment of scapular positioning in patients with shoulder pain. The clinical importance of the tests' outcomes, however, is questionable. <hr>
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,13,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-07-2005 20:23<noscript>July 15, 2005 01:23 PM</noscript>:
Two days and no reply from Barrett? He must be busy.
mike t
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,16,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-07-2005 23:36<noscript>July 15, 2005 04:36 PM</noscript>:
Mike,
I figured anybody who can read and reason can see that the deeply imbeded memeplex first planted by Kendall over fifty years ago had again been challenged powerfully on the Seringetti of the collective mind of the therapy community. As it goes, however, this animal/meme of Kendall's remains remarkably resilient and we shouldn't forget that it's being nurtured regularly by thousands of academics who still hold it up and ask their students to admire it. It remains King of the Jungle in the Darwinian sense offered us by Edelman in his original work on neuronal patterning.
Despite this wonderful reference in opposition, I don't think this thing will die in my lifetime-not without support from the schools. I don't think that's going to happen.
If Sahrmann were to see this study would she say, "Ah well, I'm going to examine posture and relate it to pain anyway. Some day I'll be proven right about this."
Is that what you're looking for?
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,16,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-07-2005 23:52<noscript>July 15, 2005 04:52 PM</noscript>:
Eric
A very odd study. Who would really WANT to know about interobserver reliability on scapular positioning? And when we discover it's OK...so what? Someone must have been feeling bored and decided to do a study or two....
Nari
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,19,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 02:25<noscript>July 15, 2005 07:25 PM</noscript>:
Nari, they were either bored or they were forced to do it (PT students). But either way, proving the null hypothesis is just as valuable to research as proving the hypothesis. Not that this study really proves anything, it is just one link in the chain....
Don't you think we need a little debate here? Are the lines so clearly drawn in this forum that no one bothers to challenge anyone else because we've "been there, done that?" (except Wags and Jason of course, but I don't even know what that was about). I'm sure the majority of people reading this forum treat people with shoulder pain by strengthening the scapular stabilizers and rotator cuff, stretching the pecs and lats, and mobilizing the capsule. I know I do. Should we really throw all this out the window? Mobilizing, strengthening and stretching is what physical therapists do....it's in our schools because it is what physical therapy is....look at the APTA Guide to Physical Therapy Practice. It's what we get paid for, why should we be ashamed of it? There is certainly a place for traditional physical therapy for musculoseletal injuries.
Geesh, I get the impression that this forum has become a dysfunctional marriage where neither side is really talking to the other anymore, just giving them the silent treatment. Whatever happened to interrogating reality??
Ok, I'm done ranting.
Sarah (aka Anakin)
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,20,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 03:26<noscript>July 15, 2005 08:26 PM</noscript>:
Sarah
I loved your rant. Should be more of it.
Sure we can continue with scapular stabilising and RC work plus capsular stretches (whatever they are supposed to do); if we get good results, that's fine. If we don't - what next? Do we simply say that physical therapy doesn't work for some shoulder pain? Probably it doesn't, but we should offer more than protocol exercises if progress is poor. Neurodynamically-based movements may just do that, though no guarantee - as with everything.
I also think the situation in the USA is quite different; there seem to be certain expectations (correct me if I'm wrong)that a PT will perform certain routines given a rough diagnosis from the doctor. We don't operate that way; we assess and treat according to what we find. The medical diagnosis here is so often inaccurate and based on imaging findings; the doctors generally accept we will sort it out and manage, and they are only too glad to hand over.
Sometimes a GP might say -"but the US showed SS tendonitis" or "..a 2x3 tear in the SS" - and we explain that it was not relevant to restoring function and resolving pain. OK, I should say "I" and not "we"..as we approach things differently from one PT to another.
Who is who in the opposite sides that you mention in this forum? I thought it was a matter of differing opinions/beliefs/clinical practice, which is a positive way of looking at PT in general.
I did notice that there was a deafening silence after Pablo posted the info on CRPS; I can't explain the lack of interest, unless CRPS is not a familiar condition in PT practices...?
Sarah, launch into Fierce Conversations forum...I think you have a lot to offer.
Nari
<hr> Posted by Eric Matheson (Member # 2368) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,15,22,24,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 05:24<noscript>July 15, 2005 10:24 PM</noscript>:
Nari, an odd study indeed, in part. Have to admit I haven't read any more than the abstract yet. Hope to get to it this weekend. I have a pdf version I'm happy to forward on if anyone's interested.
Eric
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,16,9,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-07-2005 16:16<noscript>July 16, 2005 09:16 AM</noscript>:
Sarah,
I think using the word "ashamed" is inappropriate. It implies that those who differ with you are saying you should be so, and that certainly isn't true of me. As far as I know, the difference between shame and guilt is this: guilt means you feel you've done something wrong-shame means you think there's something wrong with you. People who practice in certain ways might be guilty of poor reasoning, but I doubt there's something fundamentally wrong with them as people.
PTs can practice any way they want, but if they only do it because "that's what PTs do" I have to wonder how this is justified given new knowledge. Can you think of another profession that would say this? Do engineers still use slide rules? Do doctors still bleed people?
If what you do "works" you are obligated to explain that and defend your method-nothing less. This forum has been over that issue many times, and when people aren't interested in doing that with anything more than platitudes I can certainly grow quiet. Don't mistake that for acceptance. I'm shaking my head as I read their words.
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,16,20,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 03:19<noscript>July 16, 2005 08:19 PM</noscript>:
Nari,
I was re-reading some of my PT school textbooks such as Hertling & Kessler, and they state that joint mobilizations don't actually stretch the capsule, but instead provide some kind of neuromodulation that isn't yet well understood. That book also had a whole chapter on pain with an introduction by Melzack (as I stated in another thread). So, I think it is possible to read between the lines and figure out that there is more going on with what we traditionally do, than just simple strengthening and stretching (a topic that has been beaten to death here lately).
My point in the previous post was based on a concern that people reading the forum lately would not feel welcome to contribute if they did not completely fit into one or the other camps which seem to be forming. I am welcoming a healthy exachange of ideas and friendly debate.
Barrett, yes "ashamed" was probably not the correct word. Maybe I should have said, are we too "intimidated" to speak up for what we do?
Unfortunately, Nari, there is nothing going on over in the Fierce Conversations thread, or I would be there in a flash. I'm afraid I killed it with my lobster story....or maybe it's just too obscure to understand. I know SJ has been waiting for a response from Barrett. And though I know some of the answers to her questions from being at his course, I was hoping he would dignify her with a response. (hint, hint).
Sarah
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,1,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 08:46<noscript>July 17, 2005 01:46 AM</noscript>:
Sarah,
I've definitely noticed the two camps, and have asked pretty much the same thing. Why? It's like Democrats and Republicans, they all want the same thing, just take a different approach on how to get there. Where there should be 90% agreement and 10% difference the opposite happens because people generally seemed entrenched in their own perspective. I've only seen a few who actually regularly contribute equally to both. Jason is one of the few who seems to have accepted new ideas and perspectives.
We've discussed this before of course, my theory is much of it has to do with personality/learning styles. Notice the conceptual and metaphorical style of the posts in the Bullypulpit as compared to the others.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,1,47,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 08:47<noscript>July 17, 2005 01:47 AM</noscript>:
Sarah
I can understand how a capsular stretch can result in neuromodulation; it surprises me that someone would need to do a posterior capsular stretch when, given normal circumstances, that part of the capsule would be posturally stretched most of the time anyway..
I don't think the lobster metaphor killed the thread...probably my terminally boiling frog might have!!
Nari
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,6,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 13:42<noscript>July 17, 2005 06:42 AM</noscript>:
I think that different points of view are what have significantly increased my learning experience here on rehabedge. It sure would be dull if everyone's post after the leading post or the first responding post said, "I agree". That said, I'd like to inquire, because inquiring minds want to know, what are the two "camps" that Sarah and Randy are seeing?
jon
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,8,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 15:16<noscript>July 17, 2005 08:16 AM</noscript>:
Shh.. did I just slip into the Bullypit? I won't let the door hit me in the behind as I leave... LOL
There will never be a discussion or a debate until questions are answered. I refuse to go any further on that joke of a "firece converation" thread. What's the point?
I can kick and scream and throw a tantrum, but no one will hear it. LOL I don't know if there are 2 camps... but there is definitely imbalance. When my husband and I get 2 posts deleted... that right there speaks volumes. The person in control would rather choose to delete versus debate. Remember when there was a bit of talk about cults... uh, huh... I view that kind of action as cultish. Only allowing thoughts that are in agreement with the "leader" so to speak creates a situation of total control. Why waste my time to question and disagree with some things when the post will be deleted? When the person in control begins to either have fear or take things too personally, then those that don't have control definitely won't be heard.
In my opinion it is flat out ridiculous and irresponsible to believe that only one approach will be the best approach for patients. I believe it is best practice to know what approach to use for which patient and at what time in their episode of care, combined with what the patient wants and has available as resources. There is no "one way" and to believe that each theory is right in all situations is wrong. Look at all the research coming out on the importance of classifying patients... you get better results using the appropropriate approaches on the appropriate patient. That is kind of common sense...
In regard to the slam against Sahrmann... well, in her defense, at least her theory is beginning to be published in peer-reviewed literature. She believes in her approach enough to do the extra work to have papers submitted and accepted and published. I don't know, but actions speak more than words to me. There are a lot of words in some people's beliefs, but no "actions" to support those words. Is it because of fear that the belief is wrong? Is it because of fear that the results aren't as great as believed? Is it because those that speak the theory do not believe that anything else is needed to support the theory?
And, hey, I'm not saying that all the neurodynamic stuff is wrong... I just don't believe that it needs to be utilized on every single patient and that the time and presentation of when that approach should be used needs to be defined along with the expectation of results after the technique is used.
And.. I'm out.. I did copy this so that if it is deleted... I will repost it. It pisses me off whenever my posts get deleted. That type of control of what people get to read is unfair... ah, but I'm anonymous and questioning the one in power... bad Bird, bad Bird... And, I guess I have learned that the world isn't fair, so I should quit complaining...
And, in regard to the actual article... scapular positioning... Bournephysio would definitely have an excellent critique of the study. He's done 3 dimensional measurements with high tech equipment... Eric, if you wanted any feedback on that study, you could repost the abstract in the ortho section and you might snag Bournephysio's attention - I don't believe he generally posts in this section... after a while that door slamming your hinney gets a little old...
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,9,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 16:52<noscript>July 17, 2005 09:52 AM</noscript>:
The comment about Sahrmann’s attitude is not a “slam,” it is in fact a simple restatement of something she had published in JOSPT in July of 2002:
“What is the evidence that postural impairments contribute to pain problems and need to be included in therapists’ examinations? The simple answer to that question is that there is very little research to support a relationship between musculoskeletal pain and “posture”. Many respected texts and articles by physicians, physical therapists, and physical educators have cited the importance of good postural alignment to health, but clinical studies have not supported these beliefs. Though I am fully aware of the lack of evidence, I cannot imagine treating any patient without assessing posture or, more precisely, alignment.”
As a moderator I have a responsibility to delete posts that are personally insulting, inaccurate and irrelevant. Disagreement does not come into play. I wait until all three elements are present before doing so. Thousands of posts have passed the test and only five have not; all by the same person or their surrogate. You do the math.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,10,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 17:40<noscript>July 17, 2005 10:40 AM</noscript>:
I don't have to do the math... you don't have a public list of who has been deleted, why the post was deleted and who did the deleting. Without that, it is just your word against my word.
How did all that crap between Jason and Wags get to stay up? Hmm... probably because the disagreement didn't involve you.
Anything I post that questions your theory or your beliefs tends to be "personally insulting." I don't believe that what I tend to post is generally "inaccurate" or "irrelevant." Of course, that is my perspective. I also don't go out of my way to insult you. We all choose how we respond to external comments; we choose how we want to feel about them. You are the one choosing to feel personally insulted. You delete in the heat of your emotions... deleting in the heat of your emotions means that I've struck a chord. There are only two letters that differentiate delete from debate, an "le" and a "ba." No decent, thought-provoking conversations can occur when choosing the "le" choice. And, you don't even give those reading a chance to put me in my place... so, again, it is just your words against my words in what happened in the past. You don't like me and you never will... I could care less, but you do need to work on your objectivity. And if you do supposedly like "fierce conversations," then you should step up to the plate and provide answers....
And... taking a comment from Sahrmann in 2002 is like considered old news (if it was published in 2002 that means she probably said it sometime in 2001)... she has published stuff and has had poster presentations in 2004 and 2005. That means she's doing something about that fact of lack of evidence....
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,11,28,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 17-07-2005 18:28<noscript>July 17, 2005 11:28 AM</noscript>:
She's trying, but hasn't yet succeeded.
I don't moderate the ortho threads.
Thank you so much for your personal assessment of my emotional state.
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,17,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 00:36<noscript>July 17, 2005 05:36 PM</noscript>:
I think the above sort of demonstrates the two camps. The neuromodulator group and the others. It does seem to be partly a matter of whether you agree with Barrett or not in the Bullypulpit.
While I have been impressed and appreciative of Barretts answering of my questions and comments, I do notice that in the Bullypulpit there is a lot of talk about not being accepted, being shunned, others being insulting etc but that there also seems to be a lot of insulting, shunning and not accepting and feeling it is morally justified.
Should there be a discussion about personalities and individuals actions on this list? I don't know, that seems to be part of what "Fierce conversations" would suggest.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,18,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 01:55<noscript>July 17, 2005 06:55 PM</noscript>:
You know, Barrett, the case studies that Sahrmann has out are a start. One has to start somewhere. Succeed or not succeed, she's at least being responsible and publishing her theory and results. If she finds out that she is wrong when someone steps up and does some large trial... that isn't failure - she added a lot to our profession. It seems as though you want her to fail. Oh, because if she fails that gives more credibility to your unproven theory... Kind of like that lobster affect Sarah referred to. That's sad... someone taking the risk and some in the same profession definitely not being supportive and having an open mind to the findings.
Randy, the above isn't an example of two camps... the above is an example of me being very, very frustrated with a man in control. And, since no one here had the opportunity to read what I posted, you have no idea if what I posted was insulting or not. We're all adults, others here read what I write... so, I guess technically, all of you can make your own judgments as to why something I posted would be deleted.
I could care less if Barrett and I never see eye to eye. It does bother me that posts are deleted, and you know, without any notice to me for the rationale.... and no option for me to either apologize if I learn that my intent was not what was perceived by the receiver. Go over in Fierce Conversations... I asked very specific questions. For anyone using any particular technque or theory of treatment on a regular basis - the questions are pretty basic, simple questions. I also would rationalize that before anyone jumped on the bandwagon of a theory that it might be nice to know what patients respond, how the patients respond and in what timeframe to expect change. We've all basically agreed that if something someone is doing "works" and is as good as another technique that has been read in literature, then why change the professionals preferred choice of intervention. The same philosophy of, if it ain't broke, don't fix it. But.. I don't receive any answers. So, it does give pause to think... hmmm, why? Why no response? Especially if you see the thread was initiated by Barrett AND Barrett supposedly does appreciate fierce conversations compared to tea party conversations.... I felt it was the perfect opportunity to learn. I truly can't argue much of anything without some basic information. And, honestly... I refuse to pay money to go to some course that introduces some theory if there isn't any type of substantial evidence that the theory works. Sorry.. just saying "it works" doesn't do it for me. I have been told that I have high expectations, and I do... I know chronic pain is the most difficult to treat, but there is no reason for me to just jump ship and halt my current preferred practice patterns at the snap of my finger just because those types of patients are the most difficult and it is difficult to get results and that maybe it is because I have no clue what I am doing... Evidence would sway me if the evidence was better than my outcomes. Simple...
In regard to the two camps... well, the Barrett believers and the Barrett non-believers. I'm more partial to the non-believers group, but as I continue to state it is because no answers have been offered and Barrett has made no change over the years to do a case study or anything in a peer-reviewed journal. I'm not like the sheep in a field. I'm not someone who will just blindly trust someone based on years of experience and traveling the continent doing continuing education.
Personalities? Well.. I shouldn't be in this field. I could be a lawyer, business owner (oh, wait, I am now), engineer, mechanic... but definitely nothing in the health care world. Extroverted, Judging, Thinking, and Intuitive. From a course I went to... I'm perceived a "shark." If I have some goal... either you help or get out of my way. LOL And I believe THAT is where my frustration comes in... I've had a goal to understand Barrett's theory along with his outcomes and it ain't happening yet. I get to a point where I think, "screw it." And you know, I'm at that point again. Moseley writes some nice stuff, it makes sense AND wow, it is in peer-reviewed literature. AND, when you see someone in the neurodynamic camp teaming up with someone in the lumbar stabilization camp (Hodges), hmmm, that makes me think that the lumbar stablization group doesn't quite believe that exercise is the only factor leading to better outcomes. I'll keep my eyes on Moseley and his articles - at least they answer questions and are thought provoking (if only in my head without any external conversations).
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,19,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 02:03<noscript>July 17, 2005 07:03 PM</noscript>:
Randy,
I agree, but I also think that there may be others ways of defining the camps, if they do truly exist.....the Cartesians and non-Cartesians, the skeptics and the believers, the orthopedic and neurological. I haven't quite put my finger on it yet, but something just doesn't sit right with me while reading these discussions lately. I certainly hope people don't feel like they are being "bullied" if they post here, and I also hope people feel they can honestly express their opinions without personal attack. Fierce conversations aren't about everybody agreeing or even agreeing to disagree...it's about putting in all out there and "tackling the issues" not taking the high road. To quote Susan Scott, "the 'fierce' version of confrontation is not firing at someone from across the room, but rather standing side by side, looking at the issue together. All confrontation is a search for truth. Who owns the truth? Each of us owns a piece of it, and nobody owns all of it. Let's keep in mind that confrontation is a conversation. As with all fierce conversations, the four purposes of a confrontation are to: interrogate reality, provoke learning, tackle tough challenges, and enrich relationships." I think the discussions of late haven't addressed the last three purposes, and this is what is leaving the bad taste in my mouth.
Sarah
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,19,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 02:10<noscript>July 17, 2005 07:10 PM</noscript>:
HeHe.. Sarah, that's the other thing about my personality... I don't care about enriching relationships. If they happen, they happen, but I'm not going to be all touchy, feely to make any "relationship" happen with anyone. The first three points, definitely.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,17,21,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 04:18<noscript>July 17, 2005 09:18 PM</noscript>:
Randy
I like your last sentence.
I think it is important to keep a perspective on what someone is REALLY saying; reading between the lines can be informative.
Personality intrudes everywhere into all conversations; it is what makes us human with all our strengths and weaknesses revealed, despite efforts to conceal or suppress. It doesn't mean we take things personally; we just accept that Joe Blow has thoughts different from Jane Smith.
And, if we all agreed with each other on a topic then there is no point in posting that topic anymore. Agreeing to boost someone's ego can be dishonest; agreeing to validate one's uncertain opinions on a topic is another thing.
Re camps- I don't think there are just two, there are several. but the boundaries are becoming more and more blurry. We are talking processes, rather than selected bits of anatomy as individual units.
One of the difficulties with the 'neurodynamic approach' is that it is quite abstract in the sense it can't be 'seen' and can be difficult to measure. As PTs this can seem nebulous, and not sitting well with more black and white issues, such as orthopaedics. It is easier to track back and forth with ortho stuff, though I am not saying ortho is easy.
I don't always agree with what is posted in RE, but that doesn't worry me at all. I am quite happy to debate, but on RE this sometimes gets out of hand, and other posters withdraw. One cannot have a debate with reluctant participants, for whatever reason they are reluctant. That's why there are lurkers...and if they prefer that way of learning, well and good. Evidence-based learning has done quite a bit to deter participants in a forum; and this is unfortunate.
Particularly when the researchers change their mind as to what is EBP from one year to the next.
I would agree that a deleted post requires an explanation from the deleter. This is a courtesy, I think. However, if one doesn't like the heat.....
Nari
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,0,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 07:48<noscript>July 18, 2005 12:48 AM</noscript>:
Nari, nice post, good reflection of all points of view, even handed. I nominate you to be referee/ facilitator of fierce forum conversations with your even handed tone and perspective.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,5,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 12:20<noscript>July 18, 2005 05:20 AM</noscript>:
Nari,
I explained why the posts were deleted. What would be the point in repeating what someone had just said if the presence of those words had already been deemed inappropriate?
As I said, just one person does this sort of posting to the degree that makes moderation necessary-and disagreement with me has nothing to do with it despite her claims to the contrary.
There are a hundred or so posts on this BB from her disagreeing, questioning and criticizing me and they have not been deleted. Does that indicate anything to you about my decision? As far as taking the heat, well, I'm surprised that you would imagine I'm unwilling to do that.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,6,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 13:05<noscript>July 18, 2005 06:05 AM</noscript>:
Barrett,
My last sentence was intended as a general remark; it was not directed at anyone specifically at all. Perhaps I placed it in the wrong context; and rereading it, I most likely did. I don't fire volleys at any one person, only at systems and sometimes the blanket physical/physio therapy profession as a whole. I think this fact has been consistent in previous posts of mine.
In fact I am surprised that some posts over the last few years have survived the chop; but my judgement of what passes muster is only mine.
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,6,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 13:08<noscript>July 18, 2005 06:08 AM</noscript>:
Again, how do we know that something has been deleted, Barrett? If I hadn't posted anything on it, no one would have even known you deleted something. Hmmm... again, I can only go by what you say.
It is really sad that you are painting a picture that I posted something so very inappropriate. My husband's post was full of poker theory... he was supporting my claim that you play like a fish. But he pointed out the flaws in your belief in how to play poker. And.. according to him, I should apologize to you for calling you a "fish." He agreed with me, but told me that since I don't play poker, then I don't have the right to call anyone a "fish." He said that was the biggest insult a poker player could receive... but you left that post out in the public.. hmmm. I will apologize for that, I had no idea it was that big of an insult. That wasn't what was insulting to you though, because you left that post public.
And, no, Barrett, you can't take the heat. Deleting posts that are more tame than you are indicating is an action that is either controling, cowardly, or laziness because I'm not worth the time or effort for a response. I didn't save those posts, so I don't remember the exact specifics of them, but that doesn't matter. If you could take the heat, you could go point by point through sentences in which you disagreed.
I'm so glad to know I need to be "moderated." If I were a "brown noser" or a "yes, sir" type of person, I bet you that my posts would just shine and never be deleted. Those kinds of posts definitely aren't thought-provoking... and they definitely don't lead to any debate or questioning.
Nari and Diane, I do fully appreciate your posts and they do make me think. Barrett is more my target for strong questioning because he's the one traveling the continent doing continuing education. It disappointments me that he has all those course listings yet can't answer simple questions that I believe are both important and required if you've got someone paying you money. That's the difference - he's making a profit off of his theory without any evidence. In my opinion, that is just as bad as myofascial release and craniosacral. It falls under "preying" on the "victims" who have difficulty treating patients in chronic pain. That is just plain wrong in my mind...
And... I do tend to direct my posts to the person intended - reduces confusion...
<hr> Posted by Eric Matheson (Member # 2368) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,7,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 14:38<noscript>July 18, 2005 07:38 AM</noscript>:
SJ, Do you actually read and give any thought to the posts Barrett has made over the years? In my experience every question I have ever had has an answer somewhere, and I had alot of questions to begin with. What exactly are your questions anyways? Its hard to pick them out amongst all the rage that's emanating from you at the moment.
As for comparing what Barrett is doing to myofascial release and craniosacral, your way off base with that one. It would seem you just don't have the capacity to grasp what modern pain neuroscience is telling you. In spite of your opinions on the matter, there is something 'to get' here, it just takes a little hard work, an interogation of reality. You can't be spoon fed answers forever. When you find the answers on your own I'm sure you'll find the journey to have been more enjoyable.
Eric
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,9,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 16:53<noscript>July 18, 2005 09:53 AM</noscript>:
With all due respect SJ, you really are making a lot of statements, out of what is clear to me to be ignorance, about what Simple Contact is, and what it is not. Allow for me to enlighten you:
To understand Simple Contact and how it is NOT in any way a sibling, nor cousin of Upledger or Barnes, one must first have a firm understanding of the Nagi Disability model. For those of you who are active APTA member, you can find it in the first chapter of the GUIDE to Physical Therapy Practice. In essence:
Pathology ß> Impairment ß> Functional Limitation ß> Disability
PT traditionally tried to treat impairment to impact function (1970's), then we evolved to eye function with hope of impacting disability (1990's). Despite this development of thought, Rothstien and Echternach's recognized the limitations of application of this model when used by the clinician in a left to right manner. In reality, it’s not that simple. Pathology, Impairment, Functional Limitations, and Disabilities all combine to define the patient condition. Pathology doesn’t always lead to impairment, nor impairment to functional limitation, nor functional limitation to disability. However, they argued, every disability has an underlying functional limitation, which has an underlying impairment. Their Hypothesis Oriented Algorithum (an evaluative model suggesting the clinician examine disability first and set goals at that level before objectively assessing the patient) was well articulated, and the case for well described by Sue Campbell in her McMillian Lecture several years ago. It was considered rather progressive with respect to evaluation. That was “way back” in 1999. The philosophy of Simple Contact suggests a similar paradigm shift from treating up the chain to treating down the chain. Specifically, Simple Contact first demands of the clinician that they consider the inadequacies of this treatment approach (Mr. Dorko alludes to this with respect to manipulating the spinal impairment and having patients realize no improvement in functional limitation nor disability). It suggests something of a change from the traditional approach to care (e.g. treat the pain in assumption of getting an improvement in ability to sit or stand, in an assumption of restoring the patient to full home and occupational functioning . . . to a model of treating at the disability level so as to remove cultural barriers to movement within a safe and protected environment, so as to impact the functional limitation of inability to sit or stand secondary to pain, so as to remove the impairment of pain. It is, in the final analysis, a treatment application of Rothstien and Echternach's Hypothesis Oriented Algorithum. Simple Contact is, in many ways, application of a treatment method directly born from the Hypothesis Oriented Algorithum.
To talk about Simple Contact in these terms, clearly and unambiguously separates the concept from Barnes and Upledger, while at the same time placing it and it’s users in the same camp as people like Rothstien, Echternach, and Guccione. In other words, Simple Contact is as much a disability model as it is a therapeutic approach. Those who stand in opposition to it generally either don’t fully understand the disability model, or think in err that Simple Contact is a therapeutic technique exerting effect at the impairment level, as opposed to a therapeutic concept that exerts effect at the disability level.
From there it’s important for the clinician to recognize pain as being the result of either chemical bioagents or mechanical deformation. A review of neurologist Alfred Breig’s work is warranted here --- with the punctuating point being that movement alleviates the pain of mechanical deformation, but that culture and society restrict the patient’s expression of movements (ideomotor) that would alleviate pain. That, by definition, is a disability. The fact that this disability leads to functional limitations of inability to sit or stand for long enough periods to be task successful shouldn’t be a hard sell --- and what’s the impairment that results? Well, pain of course. Simple Contact is difficult to describe in text because it does not involve the application of a technique designed to alter impairment. Instead, it changes the environment so as remove disability, thereby removing functional limitation, thereby removing impairment.
To punctuate this point, consider how most PT’s treat with respect to the Nagi model: Manual therapists, for example, would assume that by manipulating they can decrease pain and improve range of motion. They may in fact be able to do this --- but it misses the point if this wasn’t the impairment causing the functional limitation causing the disability. What if, as you suggest (and I can get you more references), the lack of concordance between radiographic findings and symptomlogy means that another structure (perhaps “kinking” in the associated neurodynamic system) is the impairment truly limiting the patient’s function and abilities?
Enter Simple Contact. The idea being that the true disability is the patient living within a culture that disallows the pain-relieving ideomotor movements that may alleviate “kinking” in the associated neurodynamic system. Simple Contact treatment, therefore, exists not at the impairment level, but at the disability level by removing the cultural/sociological barriers created by our “sit-still and sit-up-straight” culture. All Simple contact does, is provide the patient a safe environment to move without sociologically imposed norms of what constitutes acceptable forms of movement. As applied to the Nagi model of Disability, Simple Contact makes the following assumption:
Specifically, this involves touching the patient in high-neuro-dense areas so as to facilitate the patient through movement patterns that they are just aching to be allowed to execute --- but that would be socially unacceptable for them to do without “permission,” and even more strange for them to do in public. Simple Contact affords the patient the permission/inviation to do so. Without disablity, functional limitation is alleviated. Without functional limitation, impairments are alleviated extremely efficiently and quite dramaticly.
In the end, I think it’s an important point to note the Simple Contact is not a treatment at all. It is, in the final analysis, a comprehensive treatment approach.
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,10,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 17:02<noscript>July 18, 2005 10:02 AM</noscript>:
"That's the difference - he's making a profit off of his theory without any evidence. In my opinion, that is just as bad as myofascial release and craniosacral. It falls under "preying" on the "victims" who have difficulty treating patients in chronic pain."
SJ,
I know you've never been a big fan of Barrett's, and that's your perogative, but let's back up a little, and don't throw out the baby with the bath water.
First of all, just because Barrett has not produced the outcome findings you are looking for, doesn't mean that his theories don't have evidence. Barrett's treatment is based largely on studies done by Patrick Wall, whom you just can't refute with any inkling of objectivity.
Second of all, you're choosing to categorize people who attend his courses as victims who aren't able to treat chronic pain. I for one have been to his course twice, nobody twisted my arm, I think we all have patients whom could be classified as difficult, but overall I have been succesful with chronic pain patients. I hardly think that I have been victimized, or led astray into blindly following some type of guru, which is exactly what you are implying when you compare those of us who have attended one of his workshops to a CST/MFR seminar. I like to think that I am not that stupid.
Scott
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,10,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 17:33<noscript>July 18, 2005 10:33 AM</noscript>:
Wow Andrew, your post certainly seems to put a bit of traction under the tires.
[IMG]smile.gif[/IMG] ,
<hr> Posted by BGruber (Member # 4186) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,11,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 18:52<noscript>July 18, 2005 11:52 AM</noscript>:
To SJ - I am one of those innocent victims, preyed upon by Barret as you describe. I took his class a week before I was scheduled for lumbar injections to help abate the pain in my back which had me seeing stars for nearly a year. But I took Barrett's class for the continuing ed credits, not for actual pain relief which I had already begun to believe was only a dream. Drugs and weeks of physical therapy had failed miserably.
How dare Barrett actually suggest that he might be able to help me. How dare he use me as one of the class subjects. How dare he offer me in one session more relief than I could even remember feeling in my back. How dare he equip me with all of the strategies and skills I needed to continue the process on my own - and continue to answer my questions and support me as best as he could through subsequent emails.
I never went for the injections. I took the class last August and began on a new path of movement and posturing and trust that my body would fix itself if I listened to what it needed me to do instead of superimposing 25 years of education and practice on it. I embarked on a steady road to repair that stunned my physiatrist - though apparently not enough to take me up on my offer to coordinate some research, AT NO COST, to see if we couldn't help some of her other injection or surgery bound candidates.
SJ, I understand your desire for evidence. And my personal story is not science. I can tell you only that it is all the evidence I needed.
And evidence should always be scrutinized as carefully as non-evidence, as there is much research that is so pitifully conducted and slanted. But one of my favorite quotes is this:
“Absence of evidence should never be confused with evidence of absence” (Dr. Nicholas Hall.)And in the absence of evidence, one might ask exactly what there is to lose in trying this non-invasive, non-traumatic, non-harmful-in-any-way technique? I've watched patients go through a 2nd and 3rd laminectomy even though the "evidence" says the success of these surgeries plummet with each successive attempt. I've seen patients ingest a host of sanctioned and non-sanctioned meds, herbs, enzymes, and supplements, even when the "evidence" clearly states these items can be harmful - or lethal. Why wouldn't anyone want to try manually managing pain first? If it doesn't work, what is lost? The cost of a few therapy sessions? Certainly no more (and often far less) than any other form of treatment we might try. And let us not forget that, after all, they are ALL just tries. We know that not every treatment works for everyone - shouldn't we keep all of our options open?
You're mad at Barrett for making money on the course? Have you not been to any of the classes I've been to where instructors spend only a fraction of their time teaching and the rest of the time trying to sell you their wares? Barrett spends 6 of 6 hours teaching, and offers you all of his wares for free - including a website with volumes of information and even an opportunity for an unhappy customer to kick him in the face.
No, I'm not a family member, not a life-long friend. And I'm not one of the sheep you believe he herds - I don't even agree with everything Barrett has to say. I'm just one of those folks he "victimized" during his nationwide search. He got my $169, by golly.
I'm a victim alright - pain free for almost a year now. Fully returned to all of my activites. Grateful every morning I step out of bed without having to calculate each motion. Humbled that I can be hugged without having to brace myself first.
Barret, you scoundrel, I want a refund!
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,11,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 18:59<noscript>July 18, 2005 11:59 AM</noscript>:
Dr Ball,
That was the best explanation I have seen so far. Explanation to that level has not been done by the other proponents, and I do appreciate your ability to provide it for those of us who just dont get it.....yet.
If you get a chance, could you elaborate on the following section, perhaps with a pseudo-transcript of what might go on when an imaginary patient walks through the door? (discovering the lack of expressed motions, the touching to elicit these movements, etc). When you use the term "strange" to discuss the surpressed movements, I get an image of someone hopping on one foot, rubbing one's tummy while patting one's head. Im pretty sure thats not what is going on.
quote: <hr> All Simple contact does, is provide the patient a safe environment to move without sociologically imposed norms of what constitutes acceptable forms of movement. As applied to the Nagi model of Disability, Simple Contact makes the following assumption:
Specifically, this involves touching the patient in high-neuro-dense areas so as to facilitate the patient through movement patterns that they are just aching to be allowed to execute --- but that would be socially unacceptable for them to do without “permission,” and even more strange for them to do in public. Simple Contact affords the patient the permission/inviation to do so. Without disablity, functional limitation is alleviated. Without functional limitation, impairments are alleviated extremely efficiently and quite dramaticly.
In the end, I think it’s an important point to note the Simple Contact is not a treatment at all. It is, in the final analysis, a comprehensive treatment approach.
<hr>
Thanks,Specifically, this involves touching the patient in high-neuro-dense areas so as to facilitate the patient through movement patterns that they are just aching to be allowed to execute --- but that would be socially unacceptable for them to do without “permission,” and even more strange for them to do in public. Simple Contact affords the patient the permission/inviation to do so. Without disablity, functional limitation is alleviated. Without functional limitation, impairments are alleviated extremely efficiently and quite dramaticly.
In the end, I think it’s an important point to note the Simple Contact is not a treatment at all. It is, in the final analysis, a comprehensive treatment approach.
<hr>
Steve Hill PT
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,12,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 19:03<noscript>July 18, 2005 12:03 PM</noscript>:
Eric, I don't have an ounce of rage. The questions are over at "fierce conversation."
Eric, I have given a lot of thought to what Barrett has written. I'm really not questioning his theory - it is somewhat plausible. In my opinion there are some gaps in his theory that don't seem to add up. I don't think "ideomotor activity" has anything to do with it... I also don't believe that society doesn't allow a person's choice of movement patterns. What I believe is that if results occur, then something happened centrally such that new or improved neuroplasticity occurs disallowing for the old pain pathways to continue to persist. I guess that is a pretty simplistic summation on my part, but I do like simplicity. You can drop the "spoonfed" comment - completely uncalled for and definitely inappropriate.
I honestly have no clue as to what exactly the manual technique is or how to do it or what to do.... I've given up on attempting to understand that aspect. Drew, I believe you are potentially wrong in what you wrote to some degree, because a technique is supposedly performed. Just the name "simple contact" indicates some type of manual technique.
Drew, I didn't mean to say that Barrett's technique is like myofascial release or craniosacral treatment approaches. My intent was the comparison of two techniques that are out there that are not supported in peer-reviewed literature. I can go to those continuing education courses and learn those techniques, if I choose. Barrett is basically at that same kind of level when comparing because his theory isn't in peer-reviewed litearture either, nor are any outcomes or case studies. Along those lines of thinking, I believe I am correct. I don't appreciate being tagged as "ignorant." I'm not "ignorant." I did specifically ask about changes in both pain and disability level... maybe you should review the "fierce conversation" so you can better understand my thought processes.
Scott, I didn't actually intend to categorize anyone as a "victim." I just don't know how else to communicate the frustration that Barrett's marketing strategies seem to be just that. Questions I ask aren't answered... and there seems to be an air or an undertone that his approach is a better alternative compared to other approaches. If it is expected that I should just believe what I read without questioning, then someone has some erroneous expectations. If I believe and accept without questioning, then yes, I am easy prey.
In the end and overall, I guess me trying to get answers from Barrett really doesn't matter, does it? I am a self-learner and I'll figure things out just like I always do. (Others at this site have been very kind, patient and helpful to my learning.) I will continue to grow and learn in regard to understanding chronic pain independently and with the help of others here. It just irritates me that someone can go off teaching a theory, but refuses to do any combined clinical/research work to substantiate the theory - no case study, no outcomes and no answers to my questions that should have at least some kind of ball park response.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,12,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 19:15<noscript>July 18, 2005 12:15 PM</noscript>:
BGruber,
I'm glad you had results. I'm also glad that you didn't need surgery. Surgery can be overrated at times.
It is also nice to know that Barrett will answer questions and provide support.
Why is it that everyone thinks I'm mad at Barrett? I don't really know him. I keep using the word "frustrated." Mad does not equal frustration. In this day in age, it is irresponsible to be providing continuing education courses without providing outcome information... just a simple belief and a simple request... and it is very logical. If every therapist demanded it, I believe as a profession would be better. But, since I'm the only one demanding it, then I'm an outlier.
Why don't you also head over and check out "fierce conversations." I'm not asking the world in wanting to have an idea on outcomes. A responsible practitioner practicing a particular method should be able to provide a response...
But, I am happy that you had results. My beef isn't that patients aren't getting results, nor is my beef that his approach doesn't work... that has never been my beef.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,12,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 19:53<noscript>July 18, 2005 12:53 PM</noscript>:
SJ,
You're beginning to sound a bit like Dr. Childs. I respect the guy, but you're both missing the point to some degree. An improvement in impairment isn't the same thing as an improvement in function or an improvement in abilities. Furthermore, I'd ask why some in the profession seem to be so fixated on impairment for the sake of impairment alone. The Rowland-Morris and Oswestry are, when used in this manner, are reflexions of a thought process born from the idea that improvement in impairment alone begets function and resultant ability . . . this is an assumption that is by no means perfect. In addition, I doubt that Dr. Child's would disagree with the notion that lack of evidence is the same thing as lack of effect --- a concept that seems to escape some of the posters to this thread.
The point is simply that SIMPLE CONTACT (and I agree that Barrett could stand to choose a better name) is a conceptual concept, a treatment approach, it is not, as you continue to suggest in error --- and intervention per se.
The problem is that when patients are facilitated to move comfortably, it looks very, very, similar to a myofascial unwinding. It is this aspect that makes many people (including myself and Barrett) uncomfortable with it. Outcome studies would not be difficult to conduct, and I'm planning a few --- but ya'll must be patient, I just used it on my first patient this morning.
Drew
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,13,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 20:21<noscript>July 18, 2005 01:21 PM</noscript>:
It can’t be easy, often having to write, “I didn’t mean to say…” or “I didn’t actually intend…” or ‘I don’t really know anything (about the thing I’m criticizing) but…”
If I take issue with being called a predator I suppose it would be pointed out that the actual word was never used-only that I was described as someone who “preys” upon “victims.” Gee, how did I ever get to “predator” from that?
Several of the questions in “fierce conversations” require answers with a bunch of numbers I don’t and probably never will have and several others deal with issues of time and pathology irrelevant to the issue of care as I provide it, so I let them go. Perhaps I should have explained this so as not to be called “cowardly” or “lazy.” But perhaps these weren’t the words that were meant to be said. Add “irresponsible” and “profiteer” to that list. In truth, a part of me figured that if I never answered these questions certain people would stay away from my course. It is a bad part of me and I need to work on that, but that’s a personal issue.
I will owe Andrew big time for some time to come for putting my work within a context even the APTA Guide can live with. My mind works-but it doesn’t work that way. I’m glad his does.
<hr> Posted by Sebastian Asselbergs (Member # 174) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,14,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 21:00<noscript>July 18, 2005 02:00 PM</noscript>:
Drew, very well said!
Sjbird, - you are clear and open. I know where you are coming from having been in exactly the same boat a few years ago. I really think that the post by drew is very fundamental to Barrett's approach/concept. I still have to attend a course by Barrett - after all these years of first bashing heads and then grudgingly starting to see his concepts (mostly by trying some stuff in my practice....). Absolutely not saying you are in the wrong here - just that I have been in exactly the same boat.
And Barrett, check to see if that post by Drew has copyright: if not, cut and paste it on your website.
I respect sjbird and Barrett equally for their fierce sense of self and unabashed opinions.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,15,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 22:14<noscript>July 18, 2005 03:14 PM</noscript>:
Barrett, you never understand what I'm trying to say and most folks that understand you never understand me. My words get twisted and are taken too personally... which then means I have to back peddle and figure out another way to say the same thing to get into thick skulls.
Drew, where did I ever say that improvement in impairment equals improvement in function? I never said that... I never alluded to that. So, you are interpreting something inaccurately. Lack of evidence does not equal lack of effect... I completely agree with that statement. That concept doesn't escape me one bit. The problem is that we have so many different options from which to choose and no one seems to be desiring to provide "effect." The same crew of researchers are carrying the workload. If no one else does it, where will we be in 10-20 years - may need to forget that 2020 vision? Will we be considered any better than chiropractors, massage therapists or herbal specialist folks? Just something to think about...
Semantics Drew... we all get so darn hung up on semantics... I could care less if what Barrett proposes is an approach, a theory or an intervention... It is what it is and when I ask specific questions and don't get a response, well, for anyone using a particular approach, that person has an idea of what generally occurs, in what time frame, with what patient population. There is no outcome data and there is no case study - so how about if someone explain to me who I should gear this approach for? Paint me a picture of what that patient looks like (that was the reason for my questions) AND give me some expectations of when results are seen, how long they last (gee, if I'm not getting results in the expected time frame, I should probably move on to some other approach)? Am I the only one that thinks this way? No one else tries to have an idea of when to do what and with who and has an idea of when to expect some kind of response and the degree of that response? And, I am not John Childs... and I'm not "missing the point." Since you are one with an MBA, you should definitely understand the desire to know utilization rates and changes in function. I believe we are going to be pushed to know that kind of crap. So.. am I really "missing the point" or do I understand it quite well, but the "point" is too difficult to just put out there for all to see? It seems to me that no one seems to understand my point to contemplate it.
Barrett, I'd like you to to take a deep breath. Forget the feelings you have toward me and how it always becomes a personal issue whenever I'm interested in something. Just follow along and not do any deep thinking. I'm not going to say that I'm not interested in your theory/approach/intervention (whatever word...), I've been interested all along. I've learned a lot from reading the various posts that consider the neurological system. I give you guys full credit. But why do you find it so wrong of me to ask for a definition of the patient population? Why is it wrong for me to ask the average results? Why is it wrong for me to try to evaluate my practices with what you are doing to see if maybe I need to change something I'm doing because I am inadequate? Without some hint of a response to those questions, I have no idea if my outcomes are within the same range, better or worse. I'm a bit more practical - I won't fly to some course on a whim just out of curiosity and to drink a few beers. I need to have a solid rationale as to why I want to go to a course and what I want to gain from it and how my practice patterns and my outcomes will change. Isn't that the bottom line? To be the best you can be and continue to improve? You need to let your "personal" issues, whatever they may be be put aside - I do believe that the questions that I asked were very good ones. You don't want people like me in your course - someone who has researched it to a degree and is coming because that someone believes that what you have is of value to them versus out of curiosity? In my opinion, if your responses for a specific described patient population indicate a higher level of function, less pain in a shorter amount of time without re-entry into the medical field - you're sitting on a gold mine. Until those questions are answered though, no one is going to know... or they have to learn on their own how their outcomes change. Well.. sorry, I'm not going to pay for a theory without knowing the outcomes because I need to know that your outcomes are more superior than mine...
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,15,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 22:35<noscript>July 18, 2005 03:35 PM</noscript>:
I truly don't get this: I get called all these names and I'm the one who needs to calm down? You'll know I'm not calm when I start name calling. In six years on this BB I have never done that. Conveniently ignoring my comments about being referred to as cowardly and lazy does not mean this hasn't happened again-today. Oh yea, let's not forget "thick skulls," which at least gives me some company.
I have said for years that Simple Contact is a way of addressing an abnormal neurodynamic, and that this is a condition described over and over in several texts, the latest of which is Shacklock's. It has also been discussed in detail in past threads. "If I only had the Noive" comes to mind, but there are many others.
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,15,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 22:40<noscript>July 18, 2005 03:40 PM</noscript>:
"You don't want people like me in your course - someone who has researched it to a degree and is coming because that someone believes that what you have is of value to them versus out of curiosity?"
SJ,
I don't know how much I am like you, but that statement is exactly why I attended Barrett's course in the 1st place.
And you should try to talk to Drew in person, I had to get out my thesauras every other sentence. ( The guide to PT practice for the others).
Scott [IMG]smile.gif[/IMG]
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,16,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 18-07-2005 23:18<noscript>July 18, 2005 04:18 PM</noscript>:
Andrew, you have certainly sparked my interest. You seem to have a very firm grasp on Simple Contact theory. I find some parts simply bizarre.
quote: <hr> this involves touching the patient in high-neuro-dense areas so as to facilitate the patient through movement patterns that they are just aching to be allowed to execute --- but that would be socially unacceptable for them to do without “permission,” and even more strange for them to do in public.
<hr>
I’m picturing some very strange movements. Has anyone ever seen the Friends episode when Phebe preferred to run while waving her arms above her head because it felt good, even if it was socially unacceptable? <hr>
Examples of socially acceptable movements/postures would include bending forward knees locked rounded back to pick up a pencil/or engine block, sitting in class butt at the front on the seat and leaning back, shoveling dirt feet planted lifting and twisting back to dump dirt into wheelbarrow, etc. So wouldn’t socially unacceptable movements include the posture/bodymechanics PTs are already teaching?
Diane gave me a clear example of how she provides treatment to a patient. I wonder if someone can give an example of a Simple Contact treatment. Also BGruber could you give an example of your new movement patterns and how it differed from the old patterns?
My mouth is open, bring on the spoon
. <hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,17,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 00:36<noscript>July 18, 2005 05:36 PM</noscript>:
This would be a good time for Barrett to jump in with a description between socially discouraged movement, and socially discouraged expression of ideomotor movements. I had a hard time with the term "ideomotor" as it seemed to me that what was being described was encouragement of feed-forward isometric preparations for subsequent movement encouraged to full expression. That's a little different that Phoebe running --- but closer to in the ballpark than I've seen to date of someone with no exposure to Simple Contact to date.
That's your cue Barrett . . .
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,17,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 00:57<noscript>July 18, 2005 05:57 PM</noscript>:
Drew
I agree that your excerpt is great reading. I think it may encapsulate the camps that SJ referred to; looking at a process vs looking at what is tangible and visible. Arguably that is simplistic - but with no prior first hand knowledge of Simple Contact, I am not sure of the ground I'm on.
Which is why I (and another Aussie)are going to Vancouver in September to "do" Barrett's course. There is too much implication in its intent (from what I have gathered) to ignore. Anything based on neurodynamics cannot afford to be ignored by PTs; and there is enough evidence around to support that, and has been supporting, for a decade or so.
(Mind you, I am also keen to have a look at Canada's West Coast as well!)
Nari
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,18,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 01:32<noscript>July 18, 2005 06:32 PM</noscript>:
Wow! I think Drew just blew my mind with that summation. I was already confused with 'Simple Contact' and may be even more so now. Maybe I'm still a tadpole...who knows, but I still find the approach confusing. I guess I'm in the same boat as SJ...wanting to know what patient population it works best for, what outcomes to expect, time frames, etc. Maybe some of those questions would be answered for me if I took the course.
What is an example of a 'socially unacceptable' movement or movement pattern? Why do they need 'permission'? I realize these may be elementary questions to someone like Barrett or Drew, but it may help me to understand a little bit of what's going on during 'Simple Contact'.
Thanks! [IMG]smile.gif[/IMG]
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,18,34,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 01:34<noscript>July 18, 2005 06:34 PM</noscript>:
I think Barrett should get someone like Drew to paint a picture and give an easily understandable (ok, maybe not drew") description of what he does and why he does it. I have so many posts about people trying to understand it, even people who have attended the course saying" I'm not sure what it is I'm supposed to do".
Concepts are sometimes harder to explain than techniques but when so many people just aren't getting it, then something is obviously missing. I've been on here about a year and now have, I think, a fair idea, of what is done and why. I would just describe it but I think Barrett would have to approve it, it's his theory.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,18,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 01:42<noscript>July 18, 2005 06:42 PM</noscript>:
People initially "need permission" to move ideomotorically because the culture is arrayed against it. Therapists collude with that.
I’m sure Andrew will recall seeing the young woman I worked with at the end of class; several years of persistent discomfort, pain altered with movement, sympathetic dominant, no relevant pathology, internal rotation of the hip on the same side as the pain-all indications of an abnormal dynamic.
I placed my hands about her shoulders, deforming the skin just enough to elicit depolarization. She began to turn left and right, her feet fixed on the floor, various movements of the torso followed including combinations of sidebending, flexion and extension, both arms began to participate with movement from all the joints. If that sounds like it would look strange, well, I suppose it does, but many years ago I figured out that if these motions were effortless, warming, led to relaxation and were surprising to the patient that they should be considered corrective in nature, specifically of the abnormal neurodynamic that serves as the essential diagnosis.
There’s no wild dancing about, nothing that looks goofily planned, no emotive response, trance-like state or fearful reaction-nothing but movement-often slow but not always, often powerful but not always, often large but not always. Changes in pain are common but not always. The shift toward warmth heralding an increase in parasympathetic tone is its major attribute.
If this isn’t simply a complete manifestation of ideomotor activity (long unrequited beforehand) then what is it?
<hr> Posted by Eric Matheson (Member # 2368) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,19,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 02:16<noscript>July 18, 2005 07:16 PM</noscript>:
It sure makes detailed measurements of scapular position seems like a big waste of time.
Eric
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,19,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 02:36<noscript>July 18, 2005 07:36 PM</noscript>:
Drew, loved the explanation of how Simple Contact fits into the Nagi Model. I had never thought of it quite that way. When did you take Barrett's course?
SJ, you might want to start trying to be a little more concerned with relationships considering that is the way people interact with each other as human beings. How can you not care about relating to another person?? You can't just blaze through life saying whatever is on your mind, without considering the consequences of your actions. As Susan Scott says, the conversation is the relationship, and "relationships succeed or fail, gradually, then suddenly, one conversation at a time." Our thoughts become words, words become actions, and actions define our character. It is not something to be taken lightly.
I see your point of wanting to have outcomes, but as Barrett stated, most of your questions aren't framed in a way that applies to his deep model or approach. It's like trying to predict how many raindrops will fall on a leaf during a storm. There are too many variables. Each person is so unique and brings such unique experiences to the table that one cannot begin to categorize, classify, or prognosticate about outcomes. How would those outcomes even be measured, and could they be generalized to any degree? Good luck on coming up with research studies, Drew. I have a feeling if anyone can do it, you can.
Sarah
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,19,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 02:37<noscript>July 18, 2005 07:37 PM</noscript>:
Eric
It sure does.
And the same MIGHT be said of a heck of a lot of other studies that examine the minutiae without acknowledging the big picture.
Barrett
Thank you for that example. It makes you sound rather like an enzyme...there, that's a name you may not have been called yet. [IMG]wink.gif[/IMG]
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:05<noscript>July 18, 2005 08:05 PM</noscript>:
I think it's hard to take the Simple Contact workshop without a foundation in Disablity models. In addition, it was helpful to me to have a foundation in functional pre-tests and post-tests (such as those provided by Institute of Phyical Arts BET and Functional Orthopedics courses). Finally, upon using Simple Contact for the first time in my clinic this morning, it was helpful to have a foundation in neural tension positions so as to recgonize them when the patient sought "flirting" with them during ideomotor movement.
Simple Contact is a great course, but I think it would difficult to take as a stand-alone without either this discussion, or a foundation in some of the aforementioned concepts.
In answer to your question Sarah. I've known Barrett for several years now from APTA conferences, but I only took his course this past weekend. A study on simple contact would be . . . well, simple. Match a few subjects and compare improvements in range of motion for patients treated with simple contact versus those treated via some other medium. Cervical range of motion, glenohumoral range of motion, or resting LE external rotation (a measure of sympathetic/parasympathetic tone) could be used as outcome measures. The issue is that until recently, there was not much interest in Simple Contact among PhD's because it sounded too much like Barnes and Upledger. That's starting to change. It certainly got the attention of this skeptic --- so maybe I'll do a few case reports to start, once I finish my DPT in a few weeks.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:15<noscript>July 18, 2005 08:15 PM</noscript>:
Sarah, you know, a bulletin board never captures the full person. Just remember that. As a whole, relationships are never as important to me as compared to goals. Hence my ENTJ. That is my prefenence... If I decide that someone is worth it to me, then the relationship I have is always very strong. I'm pretty successful overall, so I don't plan on changing my personality to fit what others seem to think would be better.
Sarah, my questions are definitely not even close to being framed to his model... you read them. And, yes, believe it or not, patients can be grossly classified or categorized. If you think about it... there is an "average" representation in what we treat and there is generally a large standard deviation of that "average." The standard deviation captures the variation, but there is an average. If Drew is going to be doing any outcome studies, I definitely recommend somehow classifying patients and I honestly say that The Guide is helpful only to a very, very small degree. The outcomes can be measured with valid and reliable outcome tools - those tools are out there. I would also recommend that the outcome studies that Drew may be pursuing would need more than one therapist using the approach and collecting data because as a single therapist, I would highly doubt that he'll snag enough data on his lonesome to tell him anything meaningful, especially if he has a mixed case patient load as in most outpatient orthopaedic settings. Or, I can say that it will take more than a couple of years...
Barrett, I believe that has been your best post that describes what you do. I'll ask some more pointed questions to get a picture in my head.
1) approximate age of the person?
2) where was pain located and the person's description of the pain?
3)what do you mean by "pain altered by movement"? How was the pain altered and by what movement?
4) How did you determine sympathetic dominant? What did you use to assess sympathetic versus parasympathetic dominance?
5) IR of hip ipsilateral... in what position? sitting, standing, walking, supine?
6) What amount of pressure is enough to elicit depolarization? And, how do you know depolarization occurs?
7) What position was she in when you used some manual pressure?
8) What are you saying to her as you apply this pressure? What is she saying?
9) And.. how do you educate the person before you put their hands on them? What kind of conversation occurs before you begin?
I'm beginning to get a visual... so who ever asked that question, thanks.
hmm, Drew.. I just read your post... I believe you do need to remember that physical impairment does not always lead to loss of function. I'd advise a stronger study that incorporates standardized outcome measures... just tracking impairment is going to gain you what? Just something to think about...
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:23<noscript>July 18, 2005 08:23 PM</noscript>:
I've not much to add. Drew, I enjoyed your idea and it would fit in just as well with the changing language of disablement (my APTA plug for the day).
Ideomotor activity, to my understanding, doesn't necessarily look different at all. It could look like driving a car. It could look like scratching your head. It is the underpinning of all volitional behavior.
From Herman Spitz's Nonconscious Movements: From mysical message to facilitated communication (p. 123)
quote: <hr> The central fact upon which all else hinges is that we can process only a limited amount of information, be it outside stimuli or interior thoughts, in a given period of time (Miller, 1956)...Not only are conscious mental operations limited, but attention is also limited. These are major bottlenecks. One way in which these bottlenecks are eased is the spontaneous assignment of well-learned activites to another system, one that does not use precious space in consiousness. Another is to supplant learning by gathering information outside of conscious attention. For Arthur Reber (1992) this is a fundamental process in evolution because an organism that can extract information without attending to it and that can "use that information to guide its actions is going to have a decided advantage over organisms with similar overall design but lacking such facility" <hr>
Personal opinion:Simple Contact, as I understand it, appreciates this fact. The approach attempts to ease the bottleneck. The greater the amount of information that needs to get through the bottleneck, the longer the the time spent in PT. Controlling for that in studies would certainly be a challenge. Drew...luck.
jon
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,20,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 03:33<noscript>July 18, 2005 08:33 PM</noscript>:
I think the first step would be a self-controlled single subject design. An A-B-A-B study, for example, where a subject was assessed, treated with treatment A, reassessed, treated with treatment B, reassessed, and then the process repeated.
I agree with SJ's points about also classifying patients and also defining functional limitation and disablity. This gets very cumbersome in a large study, which is why a single subject (that's different than a case study folks), or pilot study would be a good first step.
Drew
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,21,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 04:16<noscript>July 18, 2005 09:16 PM</noscript>:
Barrett, Thank you for your specific example. If it was ideomotor movement, what was the thought or idea that precipitated the movement?
quote: <hr> People initially "need permission" to move ideomotorically because the culture is arrayed against it.
<hr>
That is what Andrew said, you didn’t answer Chris’ question. I’ll quote one of your essays to provide the answer. I really liked this example of suppressing ideomotor movement.<hr>
“A child on his first day of schooling will breath and swallow (exicitomotor) and the teacher says nothing, he startles in his seat if the door slams (sensorimotor) and no one complains. But if he shifts in his seat in order to grow more comfortable, if he expresses fear or anticipation or anxiety that is deemed inappropriate, there is a very good chance that all of this movement will be discouraged.”
I think this adds another piece to the puzzle.
Barrett I think you would pull your hair out if you worked in the military environment with the mandatory stiff posture and formations.
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,21,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 04:36<noscript>July 18, 2005 09:36 PM</noscript>:
Zack, I will add that goes for being a trained dancer as well.....nope, sorry can't picture it! [IMG]smile.gif[/IMG]
Drew, what would ROM have to do with anything? Isn't Barrett the one always telling us that ROM, strength, posture, etc are not related to pain? For outcomes, I would think you would want to test pain with a visual analog scale or do some functional test like Oswestry. But even so, that would be missing the mark somehow.
SJ, very true that personalities don't come across well online. For instance, I am actually rather soft spoken and quiet.....no, really. [IMG]smile.gif[/IMG] And the most common Meyers-Briggs personality I get when I take those tests is INFJ (which is what Ghandi and Eleanor Roosevelt were too, supposedly). If that doesn't paint an odd picture......
Sarah
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,22,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 05:14<noscript>July 18, 2005 10:14 PM</noscript>:
Zack,
Thanks for the example! Which one of Barrett's essays did that come from? I guess I need to get it together and READ more. [IMG]smile.gif[/IMG]
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,18,22,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 05:55<noscript>July 18, 2005 10:55 PM</noscript>:
Chris, It’s in his Without Volition essay, here is an interesting link using Barrett’s essay as a citation. Ideomotor
I am still far away from grasping the concepts for treatment of pain using neurodynamics and Simple Touch, but I think I am beginning to get closer.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,1,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 08:59<noscript>July 19, 2005 01:59 AM</noscript>:
Zack
People are made to sit still and behave in a fairly docile manner in all sorts of situations.
School is one example, especially with young kids; the Army is likely to be another; some social situation where everyone sits or stands like stuffed ducks until the alcohol kicks in; in the movies where forty people sit, again like stuffed ducks because moving is culturally a crime in a cinema; and lots of others.
What happens if we sit too long? Pain - eventually. What happens if we sit upright for too long? Whew, a relief to slump.
People with persistent pain are in chains - they really do need permission to move. I have had many experiences with patients with stiff and painful backs or knees or something or the other...and they find out they actually can move much more naturally, once they are aware they can.
Neurodynamics is one technique, there are others that are orthopaedically based; and they can work, while still fitting in with the traditional requirements (if needed) of ROM and strength and that stuff. Simple Contact may circumvent the need for complex and much debated interventions, and I am interested to find out that it can.
What about qualitative study? That may hit the mark better.
Nari
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,2,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 09:33<noscript>July 19, 2005 02:33 AM</noscript>:
This is one area that I disagree with Barrett on, at least partly. There is culturally induced movement inhibition, I believe, but why does it only cause some people to have pain? Why don't people move naturally when alone, they fart, scratch their butts and pick their noses when they are alone,(Ok, I do, I'm guessing they do too)why don't they move naturally?
I think it is a matter of kinesthetic awareness? somatosensory awareness? being in touch with your body? Cultural inhibition may be one of the reasons for it but not the only one. Obviously since treatment is a social situation as well as a physical one, this is one inhibition that has to be dealt with. (I read an interesting article on Bullying. It made reference to the fact that fighting was not mainly a matter of physicality but of sociality. Fighting as a social act. This was something that I intuitively knew.)
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,2,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 09:57<noscript>July 19, 2005 02:57 AM</noscript>:
Randy
People do move naturally when they are alone; or so I think. Cultural inhibitions are strong, and those who defy them are branded as antisocial.
Not everybody descends into a pain state if constrained; just as not everyone develops persistent pain after a sprain or fracture. I don't really know why; but the researchers seem to be into it in a big way.
Fighting and pecking order are social in nature; any society develops skills in both. They become exaggerated in extreme societies, of which the world has seen plenty. Maybe fighting has some virtues somewhere, because society seems to have progressed along those lines since whenever.
Nari
<hr> Posted by gary s (Member # 1098) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,7,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 14:46<noscript>July 19, 2005 07:46 AM</noscript>:
Bird,
Question 3 "pain altered with movement".
I refer you to one of the greatest minds of our time--Henny Youngman.
The patient says "Doctor, it hurts when I do this." "Then don't do that!"
Gary
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,13,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 20:01<noscript>July 19, 2005 01:01 PM</noscript>:
I thought I had a neurodynamic problem once, but it was all in my head. Good thing it was concrete. (vs abstract, otherwise it would have clashed with my brain).
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,15,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 22:20<noscript>July 19, 2005 03:20 PM</noscript>:
Having just picked up Michael Shacklock's Clinical Neurodynamics and being one of those therapists in the "Other Camp" (EBP driven), I am learning a great deal from this thread. I understand clearly the psychosocial considerations and how they impact treatment/interactions (Ans am huge on the educational aspect of things) but never understood what the heck Barrett and others were doing with these patients. Like SJ and Chris I would like further examples to further understand how you are working clinically. It would seem that many who use the techniques like the metaphorical approach but more concrete examples would help some of us folks.
More specifically, are there any challenges to carry over effect and dependancy when treatment requires a therapist to place their hands on a certain part of the patients body to allow "normal Neurodynamic"?
I'm all ears.....
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,15,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 19-07-2005 22:31<noscript>July 19, 2005 03:31 PM</noscript>:
Steve,
Ideomotor activity is inherent to life and is not dependent upon the the presence of the therapist's hands (or the presence of the therapist for that matter) to be expressed. It does help to touch another to make them aware of their own motion and their learned tendency to inhibit it, but this is only the beginning of the lesson. The sooner the patient learns that this is their motion the better. I use another's heartbeat as an example. With our hands we can make them aware of it, but we don't significantly alter its expression with our presence. That's up to the person who owns the heart.
See "Do Nothing" and "Body Counseling" on my site for more about how this method is initiated and progressed.
Thanks for asking.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,17,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 00:37<noscript>July 19, 2005 05:37 PM</noscript>:
Gary
Couldn't resist replying to your post; telling/asking someone not to do something because it hurts can set off a whole chain of fear-avoidance issues that can be a precursor to persistent pain states....it does depend on the issue, but as a general rule, not good advice!
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,19,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 02:14<noscript>July 19, 2005 07:14 PM</noscript>:
LOL Nari Actually, it does depend on what it is that hurts. Sometimes people can be so stupid and say "It hurts when I do *blank*" and *blank* is just some stupid motion that who knows why he/she does it. Of course, it's all in the manner in which you tell the patient... a little humor and a chuckle do seem to work. The patient gets the point pretty easily that he/she is being kind of stupid...
Gary... actually, the comment about "altered pain with movement" was too general for me... altered (hmm, worse or better?) and movement (a specific movement, any movement, movement of what and where)?
For me to really understand a lot of what is written here, sometimes I need just a little bit more information and detail to understand the big picture. Until I get the details, I can't say in my head... "Oh, okay." But again, not everyone views my questions as being necessary or pertinent. They definitely are to me though.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,19,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 02:58<noscript>July 19, 2005 07:58 PM</noscript>:
I've been using Simple Contact for 2 days now, and I've seen some pretty amazing improvements in range of motion in that time from the patients of mine that were hitting a brick wall with treatment. I'll give two examples:
One patient with cervical disk problem and radicular symptoms that I treated with primarily manual therapy including suboccipital release, manual traction, and Maitland/Sultan dial-a-neck techniques improved cervical range of motion th the left from 20 degrees to 60 degrees in 6 visits. She is 2/10 pain at best, except when she tries to clean house, which spikes her pain up to 6/10. She arrived in 5/10 pain today, with a massive knot in her left upper trap. I started with her in sitting. I did a quick review of what I was about to do, and why I was about to do it, then had her sit in a chair. I placed my hands on her ears, very softly, and she began to sidebend her head from side to side with VERY low amplitude. That went on for about 5 minutes and she began to increase amplitude, move into counterclockwise rotation, and then move toward a head nodding. At this point I had her stand. She continued the head nodding and began to incorporate something of a longus coli neck retraction into her movement. While keeping my hand on one of her ears, I placed my hand softly on her left elbow (the one with radicular symptoms). Her left arm flung up into about 85 degrees abduction. Almost violently. From there she began to turn her head to the right and back to center, to the right and back to center, while at the same time extending her elbow extending her arm past the frontal plane while in 60 degrees or so horizonal abduction, and with wrist extension. In essence, she went right into the brachial plexus stretch that, until now, she had resisted secondary to pain. After a few minutes of that, she sighed, and her head turned left as her arm shot up to brush her right cheek.
This is friggin weird. I thought to myself.
I then sat the patient down again and did a few of the functional movement pattern/IPA tests with her. I was startled to find her forward head reduced to nearly normal. I was VERY surprised to find her cervical rotation to the left 85 degrees pain-free. An that knot I didn't even touch . . . gone.
During the same treatment time, one of the other skeptics in the clinic, a former Maitland fellow who is 1/2 way to her certified functional manual therapy certification, was also using simple contact with her patient. A patient with a chronic thoracic pain that she'd been treating for about 6 weeks now with limited success. She got similar results to the ones I got . . . full restoration of normal and functional movement, and a complete elimitation of pain.
I'm not saying that Simple Contact is a panacea, and it's not worked for every patient --- but even in the ones it's not worked for as a treatment, it has provided VALUABLE information as an evaluative modality with respect to how willing the patient is to move, what movement patterns they seek, etc.
As a result, the most experienced skeptics in my clinic are now going 'round going "Friggin Simple Contact." The fact that it's getting better impairment level results, AND restoring patient to function in ways that the tools in our 20 years of combined experience between the two of us does not --- is REALLY bruising to our respective professional egos.
My concern about simple contact is that despite the outcomes, am I really following the patient, or am I leading the patient much like facilitated communication? Some would say it doesn't matter, that the interaction yields real and objective improvement --- but that's frankly not enough for me.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,20,16,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 03:16<noscript>July 19, 2005 08:16 PM</noscript>:
Drew... how about if you kind of communicate what it was you told her you were going to do, why you were going to do it and any other communications that occurred? And, why did you put your hands on her ears?
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:03<noscript>July 19, 2005 09:03 PM</noscript>:
Hi Drew,
Can this patient produce this motion in your absence? If so I think you can rule out facilitated communication.
jon
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:15<noscript>July 19, 2005 09:15 PM</noscript>:
Andrew,
As Jon says, this isn't your movement if the patient can proceed on their own-something I know you can teach them. Anyway, if the results are as you describe (old news to me), how did you suddenly get so smart?
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:21<noscript>July 19, 2005 09:21 PM</noscript>:
SJ,
Review the posting where I talked about treating at the disablity level, sociologic barriers to movement, etc. That's what I talked to her about. She was clearly afraid to move, I explained to her that part of that might be, in addition to protecting herself from the assumption of pain upon movement, that society frowns upon "fidgeting" but that we were going to create a safe, comfortable, and judgement-free space for her to just move. Just play with movement and let her body do what it wants to do. Skin deformation enhances sensory activity, which in turn helps ideomotor movement "bubble-up" to full-expression. Remember that we are constantly in flux between positive and negative action potentials. It's only when positive outweigh negative that we cross action potential into action threshold. Touching a person in a neruo-dense area (usually over boney prominence or cartilaginous protrusions) help ideomotor action potentials to increase to cross threshold and produce movement. I'd say that's in theory, but there are actually some good NCV studies that support this, I just don't have them off the top of my head, but I think they were done at Virginia Commonwealth back in the '70s.
Jon,
Most, but not all patients, CAN produce this motion in absense of a PT. That's the level you want to get most patients. Barrett demonstrates this point rather dramatically in his workshops.
Drew
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,21,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 04:31<noscript>July 19, 2005 09:31 PM</noscript>:
Barrett,
I think that a therapist has to be in a certain place, have gone through a lot of manual ideas before ending up in the "been there, done that" kind of place. For me, I couldn't ever have been able to deal with simple contact had it not been for an understanding of the GUIDE, the Nagi model of disablity, NDT training, and the mind-blowingly skilled and passionate manual therapists I'm surrounded by at Lake Norman Regional Medical Center just North of Charlotte, NC (We're looking for PRN therapists, by the way --- so if anyone wants to work with us in a rather challenging and fast-paced environment, let my Director Kevin Kucko, PT, know that you've been following my posts at RehabEdge and would be interested in working with us --- 704-660-4470). Your experiences Barrett, (and some may not know this) are unique. You taught mainpulation with Stan Parris and Ola Grimsby. You met Berta Bobath back when she was still teaching NDT.
It takes a while to come to a place where simple contact can be understood and accepted at a level that can be evaluated as more than the esoteric Barnes/Upledger nonsense that it often looks like.
I find it hard, for example, to wax research concepts with colleagues. I don't want to talk down to them, so I often simply assume that they know at least most of what I'm talking about --- and that if they don't, they'll ask a question. I know that often over-estimate where people are in that regard, and take my experiences for granted. I suggest that your arrival at simple contact is much the same. I urge you not to take your past experiences for granted. Others on the board may not have had them, and as such, it's harder for them to arrive at a place open for skeptical evaluation of simple contact concepts.
Hopefully, this discussion will start to change that --- but be careful what you wish for my friend!
Drew
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,19,23,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 06:32<noscript>July 19, 2005 11:32 PM</noscript>:
Drew, thanks for the clinical descriptions. I'm glad you took Barrett's course. Very interesting, helped to have something more concrete, i.e., an experiential description. Looking forward to your experience, Nari.
However, Drew, I do think that a specific knowledge or experience base in preparation isn't necessary, notice I said specific, everyone. Plenty of movements occurr without acceptable (to everyone) explanations, but they cannot be denied if experienced (Barrett suggested dousing is ideomotor, he did not state it is bogus, although that may be his opinion. I think he is right about the ideomotor part, I just don't know how the douser's body knows when to cause the motion). I suspect experiencing something is the key to acceptance, regardless of the theoretical rationale.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,4,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 11:39<noscript>July 20, 2005 04:39 AM</noscript>:
What about seances - they are supposed to be ideomotor in nature....but I've never been to one.
Can someone explain what facilitated communication really means??
Thanks
Nari
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:00<noscript>July 20, 2005 05:00 AM</noscript>:
Drew,
Why do believe that a therapist must have "been there, done that" to understand and appreciate Simple Contact? I have always thought that the comprehensive and meticulous logic supporting it was enough even for students to be swayed.
I came across Barrett's work two years ago in the middle of my undergraduate degree - and therefore I haven't "been anywhere" yet. I tell you, I have had a very hard time getting through my postgraduate studies to pass the board exams because it is now so hard for me to swallow much of the manual therapy 'traditions' necessary for this. But then, maybe that's because I hadn't been indocrinated yet.
Luke
PS: I have learned a lot from your posts here, thankyou. Where can I read about the Nagi model?
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:18<noscript>July 20, 2005 05:18 AM</noscript>:
I don't think that a person has to have "been there, done that" so much as be able to apply simple contact within a much larger scope of the patient condition. My difficulty with simple contact is that because its application is so easy, and its philosophical underpinnings so different, the same kinds of people attracted to Barnes and Upledger end up attracted to simple contact.
Sure, there are some that have a wide scope of experiences, but there are others who simply can't cut it in an evidence-based outcome environment. Some who simply have difficulty with understanding the pathoanatomical concepts of Maitland or Mulligan, difficulty with the manual therapy application of Paris or Grismby --- and end up gravitating toward that which, in application, appears to require little thought because no one else in the clinic is doing it.
At its worst, that's what simple contact COULD be. It takes a certain level of experience with patients doing traditional care, using traditional concepts before being able to explain simple contact in descrete non-esoteric terms. Case in point is what happened to this thread after I took Barrett's course and re-defined/re-articulated exactly what it was that he was really doing. Furthermore, it's difficult to assess and articulate why patients are or are not moving in certain ways ideomotorically without a firm grasp of other neurotension and functional movement pattern concepts.
Finally, you can read about the Nagi model by simply gooleing "Nagi AND Disability" or spending a few bucks for the American Physical Therapy Association's GUIDE to Physical Therapist Practice. I'm sure at least one of your professors has a copy --- I'm sure that Chris Maher does.
Drew
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:32<noscript>July 20, 2005 05:32 AM</noscript>:
Drew,
I agree that a certain amount of background knowledge is neccessary to understand it. As Barrett advises, I have never thought to separate the technique out from the whole picture, but I understand your point about such an exclusion being tempting to some.
I am in Australia and studying osteopathic medicine so I doubt my professors have the GUIDE. I'll try google. Thanks.
Luke
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,5,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 12:55<noscript>July 20, 2005 05:55 AM</noscript>:
Yogi,
The dowser moves the dowser's rod-they just don't know they're doing it. Neither does the person running the Ouija board or the person holding the pendulum or the poker player revealing a tell. This is all ideomotor movement but poorly understood which is why it's called "the mischief maker."
In case you didn't know, dowsing doesn't actually work and many studies have proven this. It's a matter of luck, and you're going to be a lot luckier in New England than Arizona, which would explain why you find almost no dowsers in the southwest. If you think it "works" via electromagnetic forces or something like that you should consider reading a little Newton before suggesting that.
Drew,
Remember the "Easy and Simple" lecture I did? It covers what you're saying about what we should know.
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,9,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 16:38<noscript>July 20, 2005 09:38 AM</noscript>:
Nari,
quote: <hr> telling/asking someone not to do something because it hurts can set off a whole chain of fear-avoidance issues that can be a precursor to persistent pain states....it does depend on the issue, but as a general rule, not good advice! <hr>
I imagine you are applying this to the chronic situtation, but even so....What about the basic, general rehab principle of injured tissue protection? Can you just tell people to move however they wish, and still allow this to occur? What if you simply avoid it for an amount of time sufficient to allow healing to occur, and tell your patient this? Seems logical, no? Do you feel patients will still develop these fears with this advice? Im about to reconstruct my treatment rooms with eggshell floors if this is the case.
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,15,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 22:48<noscript>July 20, 2005 03:48 PM</noscript>:
Drew, Barrett or any others who wish to reply,
So I'm thinking about this culturally limited response to pain and the explanations surrounding it when my two year old son starts limping with his foot essentially inverted as he steps - he had a splinter in his medial foot earlier in the day. How does his response, since he doesn't really have a whole lot of culturally reinforced behaviour (Although it might be argued that his socialization is significant at two, he had just taken a whiz on the front lawn with 10 people watching so he couldn't be that culturally bound)? It would just seem a good way to avoid something painful and my guess is that later today when I get home he will walk just fine.
If this simple contact technique is giving some proprioceptive feedback that allows a heightened neural system to down regulate, is it more effective with a chronic pain patient who has had gaurded movements reinforced both culturally (Ie. the housewife who has 10 kids and has gone from doing everything to being waited on hand and foot by the kids) and internally (Ie. increases paravertebral tone to avoid movements that might hurt and then the spasm that occurs with anticipation of pain perpetuates the condition)?
Sorry for all the questions but I'm trying to understand exactly what you guys are discussing here.
Steve
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,16,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 20-07-2005 23:59<noscript>July 20, 2005 04:59 PM</noscript>:
Shill
If we talk about tendon repair and fractures, then healing has to be allowed to occur in one way or the other. I am referring to the acute back, neck, the tweaked knee and the sprained ankle. Sure, a bit of a rest can be helpful; and if there are raging neurological signs, essential. But the key is not too long. A day at the most; and there is evidence that we may delay the recovery by unwittingly installing a fear of movement. McKenzie's EIL, though it does work for some, can promote this fear of normal movement.
Pain education will allay fears, when folks understand that their disc is not going to wander around and cause rabid destruction if they take a walk; and particularly if they understand the pain is not 'coming from the disc'.
I did say "in general" - but what I said still relates to the sprained ankle, etc. and not the full 3rd degree tear. The farmer who injures his back in the middle of the harvesting is not going to rest and watch others - he will keep going, and mostly, do better than those who want treatment from us to 'fix them up', and perhaps be concerned that if they turn or bend, they will become much worse.
Again, we are dealing with personalities here - not damaged tissue so much - and we need to read where the patient's priorities lie. Their own resources should translate into their own movements, not ours....and we should initiate that process as much as possible [IMG]smile.gif[/IMG]
OK, bring on the flack...
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,17,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 00:10<noscript>July 20, 2005 05:10 PM</noscript>:
Steve,
I would have thought that to be the case, but over the past 3 days that I've been using it now, I've had 2 people out of about 20 flare-up --- and flare-up bad. One had fibromyalgia, the other seems to have an undiagnosed cervical disk problem. The one with fibro continued to complain today, the disk said that her arm ached, but that she felt "free" today and appreciated the increased range of motion --- she just felt beat up.
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,19,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 02:01<noscript>July 20, 2005 07:01 PM</noscript>:
Steve
Perhaps your boy had better things to think about or do when he had a sore foot - in other words, it was a drama at the time, but soon forgotten.
As adults we know more about nasty things that can happen, and that awareness keeps us from just ignoring a pain alike a splinter. He moved naturally at the time, and then returned to his usual self. Adults also do this, but there is that proportion who just can't adapt to a change in sensation/circumstances..etc. It seems we need a key to unlock something.
Flare-ups are inevitable...I reckon..for some people. I have found it is due to people overdoing their home programs (neuro) because they were so excited at the initial pain relief they went overboard, despite education; and also those who just don't or can't respond as anticipated.
This maybe is par for the course, that certain percentage of people who do not respond for reasons we can only speculate about?
Nari
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,20,20,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 03:35<noscript>July 20, 2005 08:35 PM</noscript>:
OK Barrett, maybe dousing AND facilitated communication doesn't work ( the Southwest argument was a telling blow.)
Not sure if this is pertinent to the discussion, but Steve reminded me with his kid. I am recently struck by how strong the will and desire for mobility is, by a 4-yr old with mitochondial disease, a muscular dystrophy. Despite no head or trunk control, she does a dancer split to aid her rolling which she does constantly, the parents say, and attempts to position and prop herself against furniture, to sit with support. I am reminded of the 3-yr old burned child who was exaggerating his dependency, because it was novel and fun to be waited on, esp. since Mom fed into it. I told his Dad, Don't worry, he's three, he'll get tired of limiting his playing and running, for Mom's attention. And he did, pretty quickly.
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:01<noscript>July 21, 2005 07:01 AM</noscript>:
Drew, those are pretty good outcomes.
Diane
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:36<noscript>July 21, 2005 07:36 AM</noscript>:
Yogi,
There's really no "maybe" about it, as numerous studies have shown.
You're right, a child's desire to move will overwhelm them, and this can be turned into a kind of therapy within the context of their diagnosis, of course.
Is the fidgeting we do a creative act? That is to say, does it arise from the unconscious after that internal conversation that begins, "What do I want to do?" I believe so. And like any creative act it can be remarkably therapeutic on several levels. As PTs our primary concern would be this motion's tendency to reduce the mechanical deformation responsible for the patient's pain. Maybe we should come up with a way of allowing it to grow. So it "looks funny." So what? Maybe it hurts a bit and briefly. So what? Aren't we getting motion out of sensitized tissue?
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,50,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:50<noscript>July 21, 2005 07:50 AM</noscript>:
And is motion not lotion?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,7,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 14:58<noscript>July 21, 2005 07:58 AM</noscript>:
Diane,
I can't disagree, but it's also correction.
That is, if it's instinctive and a representation of Wall's "resolution" phase of motor response to painful signals. The barrier between protection and resolution is a culture that insists on choreography by some "expert" in normal functioning, and that, ideally, would be us. The problem is that the therapy community doesn't know that ideomotor movement exists. This makes them a little less "expert" than would be ideal.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,12,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 19:48<noscript>July 21, 2005 12:48 PM</noscript>:
The bottom line for me is this --- placebo or not, it's getting patients moving and weight shifting in ways that they had not over the course of a month in therapy. Better balance, better segmential motion --- you name it.
It's really starting to irritate me, as I'm going through a crisis of faith as to why the heck I ever went to PT in the first place --- and I'm getting hives just thinking about how I'm sounding more and more like a chiropractor every day --- talking about the body's "innate intelligence" to heal itself.
Somebody HELP!
Drew
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,12,54,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 19:54<noscript>July 21, 2005 12:54 PM</noscript>:
Drew, you have a sense of humor. There's another crisis for you. Oh no.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,13,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 20:01<noscript>July 21, 2005 01:01 PM</noscript>:
Drew,
Maybe it will help to say we are "self-corrective" and leave the concept of "healing" out of it. The word "heal" has been abused by too many charlatans to make it useful any longer.
Aren't you glad you came to my course? As Gary Shapiro has said many times (I'm paraphrasing), "Barrett transformed the way I understand and treat many of my patients. He also ruined my career. Thanks a lot Barrett!"
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,13,47,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 20:47<noscript>July 21, 2005 01:47 PM</noscript>:
Yeah --- but it gives me (or more to the point, us) food for case study, and eventual single-subject research. Do you have a copy of Irene McEwen's book? I think it's a good starting place for how we're going to have to write this stuff up.
Finally, and I KNOW it's going to take some prodding --- but would you consider doing a few manipulations now and again --- if only to compare it's effects in a case-controlled environment to simple contact? Let me finish my DPT (end of August), but I'm in if you're in. If not, I'm sure you still have a few contacts in that Paris/Grimsby circle that would be happy to partner with us for an honest comparison in the interests of the advancement of the profession . . . In fact, John Childs is coming to NC in a few weeks, maybe I can chat with him about the idea. If not he, I think there's at least one other member/fellow of the AAOMPT's in the area.
"Friggin Simple Contact!"
Drew
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,13,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 20:58<noscript>July 21, 2005 01:58 PM</noscript>:
If there are awards given for creating cognitive dissonance, I vote for Barrett. Previously I never even considered what a talent that is.
jon
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,14,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 21:57<noscript>July 21, 2005 02:57 PM</noscript>:
From learning and teaching.com:
Cognitive dissonance is a psychological phenomenon which refers to the discomfort felt at a discrepancy between what you already know or believe, and new information or interpretation. It therefore occurs when there is a need to accommodate new ideas, and it may be necessary for it to develop so that we become "open" to them. Neighbour (1992) makes the generation of appropriate dissonance into a major feature of tutorial (and other) teaching: he shows how to drive this kind of intellectual wedge between learners' current beliefs and "reality".
Beyond this benign if uncomfortable aspect, however, dissonance can go "over the top", leading to two interesting side-effects for learning:
First, if someone is called upon to learn something which contradicts what they already think they know — particularly if they are committed to that prior knowledge — they are likely to resist the new learning. Even Carl Rogers recognised this. Accommodation is more difficult than Assimilation, in Piaget's terms.
Second, and—counter-intuitively, perhaps—if learning something has been difficult, uncomfortable, or even humiliating enough, people are less likely to concede that the content of what has been learned is useless, pointless or valueless. To do so would be to admit that one has been "had", or "conned".
Drew
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:02<noscript>July 21, 2005 03:02 PM</noscript>:
Jon and Drew,
So, does all this fancy talk jive with my nickname, "Barrett, The Great Destroyer"?
I hope so, because "Barrett, The introducer of cognitive dissonance" somehow just doesn't sound nearly as cool.
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:12<noscript>July 21, 2005 03:12 PM</noscript>:
Actually, I had a different name in mind but I figured if I wanted you to answer any questions I may have that I'd better not (all laugh).
jon
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:37<noscript>July 21, 2005 03:37 PM</noscript>:
I believe "Barrett, the Thick Skull" has been proposed. But I do like "The Destroyer" better. Sounds very mythical.
In the way of helping others understand what would drive someone to attend Barrett's course, let me give a concrete example. This from a decidedly EBP and biomechanically based therapist such as me. Not to mention some of the verbal battles I have had with Barrett in the past. (anyone remember the Thoughtfulness Dies thread?)
I had a patient in the other day who is about 3 mos s/p cervical fusion. She is far out of her brace and was doing very well on my regimen of active motion, Tx manip/mob, gentle cervical mobs, and Deep Neck flexor exercises. She came in having a "bad day", with descriptions of cervical pain and spasm on one side of her neck. In fact, as she tried to hold her head still and speak to me about it, the pain was clearly getting worse. I told her to relax and let her neck move if she wanted to. I then laid her down supine and began to attempt the cervical mobilizations I have seen work in the clinic and have seen considerable research support for. The first few seemed to help, but then she began to worsen again. There was so much muscular splinting going on. I had some thoughts:
1. her body is seeking movement to relieve her pain
2. she is trying to remain still and thwarting that natural response
3. I have friggin' NO IDEA about how much, in what direction, or whether at all I should move her neck myself or tell her how to move it.
4. No amount of biomechanics knowledge or certifications could ever help me with number 3 above
5. There was no success with the treatments I had attempted that day that were backed by what is commonly called in our profession "evidence" - outcome studies of good or reasonable quality.
It was that day that I resolved to attend Barrett's course (sorry I missed you in Fairfax, VA). Though I couldn't attend the course, I truly have an idea (after reading his essays, researching some neuroscience, and being willing to step outside my previous training/ indoctrination) about what it is he is offering.
He seems to be offering a way for me to create a safe place for that patient to move, a way to explain the kind of movement she needs without telling her what to do, and a way to help elicit that movement, which must come from her.
Now, THAT'S what I want to learn.
J
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,15,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 22:53<noscript>July 21, 2005 03:53 PM</noscript>:
Jason,
You are at the door-just turn the knob and it will open by itself. Let this patient move while seated with nothing more than the contact of your hands somewhere on her skin, ask her if the characteristics of correction are emerging (softening, warmng, surprising and effortless movement) and when this happens because you did nothing more than give her permission to trust herself as you have learned to do-then you don't have to attend my course.
Our patients aren't helped by our "skills" nearly so much as they are by the depth of our understanding. Of course, our understanding must be supported by a thorough knowledge of the materials we are seeking to change.
You might want to write that down somewhere.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,16,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 23:20<noscript>July 21, 2005 04:20 PM</noscript>:
Jason,
I'd agree with Barrett. I would suggest, however, before trying it on a paying patient, try it out on someone with less fear of movement --- it will give you a better idea what to expect.
With a patient like the one you describe. I (after explaining the value of movement and the subconcious fear to do so after a cervical fusion) turn down the lights, put my hands on their ears and simply say, "Your body won't let you do anything that's going to hurt you. My hands simply give you something of a physical sense of "permission" to experiment with movement, to learn for yourself what is safe. I can't teach you that. No one can, but I can create a safe environment for you to try, and if you don't yet trust your body, that's okay, that's why my hands are here --- I'm not going to let you hurt yourself. So okay Mrs. Jones, take a deep breath, close your eyes, and slowly show us how your head wants to move."
Within three seconds or so, the patient begins to move. With these fear-dominant patients, it's usually side to side, small amplitude, then a little nodding, and then about 10 minutes of neck retrations and rotations. After a few minutes, about 5 to 10 more, it's almost like there's a blast of heat coming off the patient. It's not anything metaphysical . . . it's the patient switching from a sympathetic mode to a parasympathetic mode . . . and releasing blood to the extremities from the core (remember fight or flight?). That's when, for me at least, amplitude of movement begins to increase. It's about 60 seconds after "heat blast," and you can almost set your watch to it. Careful off the patient's speed though, cause you don't want momentumm to carry them into a place they didn't intend to go. Then move to the arms.
After about 30 minutes of this, the muscle guarding isn't decreased. It's **** near gone. After that, I'll continue with your traditional Maitland/Sultan techniques. I'm starting to think of Simple Contact as a good pre-manual therapy experience for the patient, what gets me is that so often, the patient's ROM is fully restored, muscle knots released, and intervertebral hypomobility restored --- so there ends of being little need for the manual therapy.
The problem is, I LIKE doing manual therapy.
Drew
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,16,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-07-2005 23:38<noscript>July 21, 2005 04:38 PM</noscript>:
In teaching this for patient's to do on their own, I have found that a way for them to do it more instinctively, and not trying to pattern movements, is tell them to hum or sing in their head, also works when I am present and assisting them. Of course nothing by AC/DC or Metallica, to large of an amplitude going on. [IMG]smile.gif[/IMG]
Scott
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,17,34,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 00:34<noscript>July 21, 2005 05:34 PM</noscript>:
Drew
I think quite a few PTs have gone or are going through what you mentioned in an earlier post - a sort of identity crisis. Manual therapy can be fun, but it doesn't need to be thrown out; it still serves as a facilitator of rapport and a means of contact.
Barrett is quite right - patients are helped less by our tangible skills and more by our level of understanding of the persons before us. If we hadn't done PT, that level of understanding would not be there. Maybe it would be if we had done chiro - maybe not.
Jason, your story about the woman with her sore neck is a classic. Particularly Point #3...that awesome moment when the brain is racing around hoping to land on appropriate neuron links, and preferably the patient's rather than one's own.
The Bullypit is very alive at present; more action potentials than you can shake a stick at.
What caused this metamorphosis??? [IMG]tongue.gif[/IMG]
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,18,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 01:01<noscript>July 21, 2005 06:01 PM</noscript>:
I have enjoyed the review of this post, one thing I found of interest:
Sarah you state, "each person is so unique and brings such unique experiences to the table that one cannot begin to categorize, classify or prognosticate about the outcome"
This brougt to mind a qoute attributed to JE Upledger in a letter to the editor, PTJournal volume 76, #2 Feb 1996. He wrote in to defend the lack of data to support the existence of craniosacral motion:
"I believe that before you can investigate something as subtle as energy, you have to understand and experience it. It also strikes me that once you have experienced this energy, your motivation to prove its existence is diluted. Your experience provides your confirmation"
I am hoping that you Barret, and the others here who have experienced this Simple Contact do not allow that experience to dilute your motivation to confirm it.
Thanks!
Rick
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:10<noscript>July 21, 2005 07:10 PM</noscript>:
I'm patiently waiting for Nanaimo. I will have no unlearning to do, or very little..
Meanwhile, I do have one tiny conceptual niggle going on.
Here it is:
quote: <hr> it's almost like there's a blast of heat coming off the patient. It's not anything metaphysical . . . it's the patient switching from a sympathetic mode to a parasympathetic mode . . . and releasing blood to the extremities from the core (remember fight or flight?) <hr>
Here are my thoughts:1. The extremities and skin become full of blood with sympathetic activation, not parasympathetic.
2. Parasympathetic is rest/digest. Blood is in the core, gut is busy processing, all is sleepy and skin is cool.
3. Fight/flight etc, is sympathetic; peristalisis slows while blood shunts to the limbs to get away from the tiger or pummel it.
4. Mick Thacker, in Topical Issues in Pain, has spoken of this. He says that rather than the sympathetics being tuned too high in chronic pain, they are tuned too low. In other words, chronic pain goes with parasympathetic dominance, not sympathetic dominance. At the very least there is imbalance, but not to sympathetic dominance.
5. This is consistant with not enough circulation getting to the peripheral nerves, or by the same token, not enough drainage away. Sluggish pipes. Metabolic waste building up and bothering chemoreceptors. Formation of abnormal impulse generating sites. Sympathetics increase blood flow and drainage by widening vessels to feed/drain/flush nerves/muscles.
6. This also fits Peter Levine's work, (Waking the Tiger) where he set up a scenario where an imaginary tiger was set to jump on a woman who was stuck in a state of shock (parasympathetic dominant, possums that go to sleep/limp when threatened) to activate her sympathetic NS to save her. A battle brings up sympathetics, successfully winning it restores balance to the nervous system. Even if it's all in the head.
7. This is also consistant with touch in general, which stimulates the fastest largest sensors in the skin; the nervous system wants to know rapidly what is happening out at the skin. Touch stimulates sympathetics more than parasympathetics, at least at the start.
8. Therefore, surely with a heat rush, it's a (desireable) increase in sympathetics, not parasympathetics.
It's an issue I'd like to see discussed and if I'm wrong, point out how please.
Diane
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:18<noscript>July 21, 2005 07:18 PM</noscript>:
Nari, I'd like to credit my ranting with re-energizing the Bullypit, but I think the real facilitator was Drew, whom I am extremely envious of simply because he went to Barrett's course only 3 days ago, yet has an amazing understanding of Simple Contact and has been able to practice it in abundance. I need to create a safe environment for myself first, before I can really start to use it, as I am already dodging bullets every day for being too weird and not playing nice at the "tea parties". (Had my performance review today so I am feeling sulky).
Rick, I think my comment just stems from my innate fear of trying to standardize care. That concept always scared me, because it takes out the creativity factor: the thing that makes PT an "art". To say that patient "x" with condition "y" will respond to treatments "a" "b" and "c" because they meet criteria "z", sounds too much like following a recipe (read protocol) and not treating the whole person. Does anyone see what I'm getting at? Maybe someone else can verbalize what I am thinking better than I can at the moment (still sulking).
Jason, glad to see you've joined in and that you want to take Barrett's course, but from what I've just read, you really don't "need" to because you have already gotten it. You just need to practice. Not to try to take money out of your pocket, Barrett! [IMG]smile.gif[/IMG]
Sarah
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:21<noscript>July 21, 2005 07:21 PM</noscript>:
Diane,
Very good point. I was actually confused by this myself when I took Barrett's course.
Sulky Sarah
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:25<noscript>July 21, 2005 07:25 PM</noscript>:
Diane,
I think (and I could be wrong) that you've got it backwards. As I read your thoughts, there is a contradition there, so as I see it, you're neither completely right nor completely wrong. I don't think I made it any easier the way I wrote my last post, which may have added to the confusion.
Allow me to clarify ---
What happens in sympathetic mode is that the blood is drawn up into the head and truck. It's a nifty little mechanism that both increases blood to the brain, and helps to minimize blood loss and bruising in the extermities as we strike and are struck. People in a sympathetic mode are ready to "fight or flight," and for whatever reason, simple contact helps to relax them in a way that a PT saying, "Relax, RELAX, RELAXXX!!!" just doesn't seem to do . . .
In parasympathetic tone, we DO rest and digest, blood IS increased to the gut, but is also otherwise more evenly distributed. Capillary dilation occurs at the skin, we are no longer concerned with loss of blood upon fight or flight.
When patients are parasympathetic dominant, they tend to be "chill" and low-toned. Excessive amounts of which can also result in pain born from hypotonia and poor muscle control. I had a patient with pes planus/chonromalasia/PFPS like this just the other day.
When a patient shifts state from sympathetic to parasympathetic, therefore, there is an increase in extremity blood flow as blood is no longer shunted. Furthermore, the blood in the head and trunk is allowed greater capillary dilation to flow to the skin surface. This shift, accounts for the "heat blast."
Finally Sarah, I hate to say it, but being an evidence-based PhD working in the clinic has it's perks in that every now and again, I can "explore" a bit, and as long as I make it clear what I'm doing and that I plan to collect data --- no one really questions it.
We'll see what happens in a week, a month, or a year.
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,19,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 02:52<noscript>July 21, 2005 07:52 PM</noscript>:
Sarah
I think the re-energising started before Drew did the SC course (not to take any credit off him, mind you). Although lots of PTs follow recipes and protocols, I have the feeling it's because they HAVE to, not want to; and I always resisted protocols as far as I could get away with it. I could never work out, even 11 years ago, why it was assumed that all patients are the same; all that changes is the pathology. Nobody minded, some may have thought I was weird, but I am used to that; generally we are a liberally minded lot in Oz and terribly nice to each other at the tea parties.
I don't think I will have much unlearning to do in Nanaimo either; as long as nobody (and I know Barrett will not) tramples over the world of neurodynamics, then I'm happy. Back in 1990 when I heard David Butler trampling all over ultrasound "therapy", I rejoiced. Yeehah!
Nari
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,21,22,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 05:48<noscript>July 21, 2005 10:48 PM</noscript>:
Thanks Drew,
I've started a new thread on this, Sympathetically Maintained Pain: Myth or Reality? based on the Mick Thacker and Louis Gifford chapter by the same name. Stay tuned, anyone interested in learning more about this, from these two. I plan to learn a whole lot by reproducing their chapter here.
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,0,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 07:07<noscript>July 22, 2005 12:07 AM</noscript>:
Hello all,
I think this revitilization you speak of is because Drew and others have started to explain what simple contact is and I think maybe I'm starting to get an idea too. Interestingly the disillusion Drew speaks of is something I have experienced over the last two years. Interestingly, this disillusion has come way of reading evidence based research and I think this still ties in with what Drew and Barrett explain.
So here is how I see simple contact (And feel free to comment, I am hoping for feedback upon which to change my model):
The disillusionment comes from the poor theoretical basis upon which manual therapy systems are based, not there actual effect. Ie. biomechanical, postural etc. The manipulation/mobilization/muscle balance treatments likely all have a similar neuromodulation effect that is likely usefull for individuals who have no psychosocial component to their pain - this effect is likely neuromodulation and as long as there is no other issues (Ie. Psychosocial) the system is reset and the body is able to recover when the system is "Normalized" (Loosely used phrase). Unfortunately, the vast majority of our patients have a psychosocial component to their pain/dysfunction (Literature suggests as many as 50% of patient visits to MDs office have a psychosocial component to their problem and this number is likely higher when they reach a physio clinic. Other research also suggests that the biggest predictors of non recovery are not physically based but rather psychosocial). We in turn attempt to put these patients in to our biological model which serves to reinforce their behaviour and disability with strict movement patterns (Ie. exercise based on a Sharmann model), advice on rest and unconscious body language. This is often perpetuated when the treatment is ineffective and the patients concern is now there is something significantly wrong with them. The treatment is ineffective because the master controller (CNS) unconsciously continues to wind up the system with gaurding behaviours that perpetuate pain and display to others their injury (Ie. limping).
Where simple contact comes in is it first of all allows the patient to calm the central nervous system in its distressed state by recognizing the hieghtened condition it is in (Ie. Therapist empathy) and acknowledges that it is "normal" (Again loosely used) for a significant number of individuals in pain to get to this state of self-perpetuated pain. It also realizes that the reinforcers for this state of pain can be from a multitude of causers ie. depression, fear, anxiety, societal reinforcement etc. These are the patients that cause us the most distress as therapists because they dont fit into our models of treatment and we end up questioning their integrity as oppossed to our treatment methods.
From here, the therapist continues to support the patient through manual contact which allows the patient freedom to move. The manual contact also provide increased proprioceptive feedback for the patient to help actualize (Along with the education the patient is provided ala Drews post)how their system is in a hieghtened state and the CNS can begin to down regulate tone in the system. From here "Normal" patterns of movement begin to emerge and patterns of protective behaviour that have emerged can be rewired back to "Normal"
Sorry if this post isnt as elequent as other and the vernacular might not be exact but I did this on a quick stream of consciousness manner. How am I doing here? Is this the concept you are getting at? What am I missing?
Looking forward to responses....
Steve
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,6,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 13:01<noscript>July 22, 2005 06:01 AM</noscript>:
Steve,
I appreciate your effort. What I see missing is the word "ideomotor" anywhere. This movement is essential for recovery and should be regularly and fully expressed by all of us. As I have said many times, I don't seek calming or relaxation-these qualities are simply a consequence of authentic expression, and that's what I want.
Drew's descriptions of his patient's movements are not especially uncommon but I often see patients who can't be seen to move at all yet report distinct relief and display all kinds of objective improvement. Since there is no sensation without movement of some sort I'm guessing this movement is purely internal; commonly palpable with just a bit of practice, visible in an unusual way (see "A Sense of Things" on my site) and certainly felt by the patient in a variety of ways.
Drew hasn't described this and though I find his interpretations of what his patient's movement reveals about their system interesting I don't make all of these presumptions any longer having been proven wrong too many times. I suppose this situation is a consequence of Drew having witnessed the movement for four days and my having done so for twenty-five years. "The Persistence of Memory" thread further discusses the dreamy quality of this movement.
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,11,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 18:33<noscript>July 22, 2005 11:33 AM</noscript>:
Steve, thank you for your post, what I have had some trouble with in reading this thread is the perception that us Manual folks are just grabbing joints and shaking them around without any concept as to the effects on the nervous system. In fact, throughout my manual therapy education it was stressed that the hands on contact, the inhibitory nature of a gentle joint ossilation and the fact the we keep a pt. close to us, allow them to feel safe and comforted may be just as important as gaining plasticity in the tissue, if not more so.
Skin contact allowing your receptors to interact with the patients was also stressed. I guess what I am saying here is that I don't think the division between the "two camps" is necessarily as big as some would like it to be.
An example: Just today, new post ACL patient, staples still in. She had developed the fear of allowing her knee to move, every time she relaxed her quad, the staples would pull, she became fearful and contracted her quad again, splinting against this motion. A little skin contact by me on the distal quad, some education and calming talk, some gentle patellar mobs and WALLA! her quad relaxed and she realized that it wouldn't hurt to move. We all do this every day in our clinics.
Very interesting concepts and I appreciate the dialouge.
Rick
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,12,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 19:05<noscript>July 22, 2005 12:05 PM</noscript>:
Rick,
I agree entirely. Training can accomplish a lot, but care is what helps the most with fear and pain.
A Danish therapist recently completed a study of the neurophysiologic effects of joint mobilization and linked the abstract to the NOIGroup.com discussion list. I've invited him to send it our way but he's yet to do this. Find it there in the thread titled "Proprioception and Pain."
<hr> Posted by steve (Member # 2476) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,14,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 21:08<noscript>July 22, 2005 02:08 PM</noscript>:
Barret,
Thanks for the feedback, Im starting to get your theoretical model but obviously have a ways to go before attaining full understanding.
Rick,
I reviewed my post and it kind of sounds like the manual therapy education has no neuromodulation component - it does, just that it is underestimated in my opinion.
Steve
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,14,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-07-2005 21:19<noscript>July 22, 2005 02:19 PM</noscript>:
Steve and Rick, I think it also depends on which school of manual therapy one has been trained in. Some take the neurological aspects into consideration more than others, but you definitely have a good point, Rick. That's why I truly believe our greatest tool is our hands (ok, and our brains too)
Sarah
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,22,17,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 00:06<noscript>July 22, 2005 05:06 PM</noscript>:
Steve
Manual therapy has a neuromodulation component, as does sitting with a patient talking to them, not necessarily about pain ed. Everything we do has this component.
A useful tip to think about (or I have found it so)is the fact although we think we are assessing someone's CNS or SNS or 5th metacarpal, we are also constantly being assessed by the patient's CNS etc as well. Any hands-on or verbal dialogue is being assessed.
When you think about it, that is more thought provoking than being assessed by a supervisor, as a student. (Though I have forgotten what that is really like!)
Rick, we certainly do that sort of action which you described with your patient; but we tend to refer to it as 'relaxing' the patient. It's more dynamic than that....neurodynamic.
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,9,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 16:12<noscript>July 23, 2005 09:12 AM</noscript>:
Diane, what is nanaimo? Anyone?
Thanks,
Rick
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,9,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 16:32<noscript>July 23, 2005 09:32 AM</noscript>:
It's a city on Vancouver Island in British Columbia, Canada where Barrett is going to be presenting a two-day workshop on Simple Contact (his normal course is one day). Some folks from the forums are going to be there (Diane, Nari, Luke) I believe Eric Matheson is the coordinator if you want to email him for more info.
Sarah
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,15,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 22:53<noscript>July 23, 2005 03:53 PM</noscript>:
Rick, I read your above post again. It occurred to me that i failed to mention the biggest difference between manual therapy and Simple Contact. Manual therapists approach a patient with the intent to "do" something to the patient's body....whether you are trying to "gain more plasticity" or oscillate or whatever, you are the actor imposing your will on the patient. Simple Contact approaches the patient's body as an observer, and does not try to impose on them any of the therapists own will. The therapist is simply there to make the patient more aware of his/her own processes through afferent signals from stretch-activated ion channels in the skin. Therefore, the patient is not a passive participant, but an active one.
It is, as Drew points out so eloquently, a paradigm shift from trying to treat the impairment to treating the disability, or a shift from treating the dysfunctional tissue to treating the whole person within the cultural and social context. Correct me if I'm off here guys.
A couple of questions for Drew: now that you have been using Simple Contact for a week, are you going to change the way you evaluate patients? And how are you documenting and billing for these sessions?? I have been struggling with that myself in tring to incorporate Simple Contact into my practice.
Sarah
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,16,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-07-2005 23:26<noscript>July 23, 2005 04:26 PM</noscript>:
I'm a strong proponent of standardized evaluation as described in the APTA's GUIDE TO PHYSICAL THERAPIST PRACTICE. As such, I do not find that simple contact does, nor should it, change our evaluation beyond a new "test and measure" that we may choose to use (or not to use) in the examination of a patient with a neuromuscular or musculoskeletal impairment (e.g. practice pattern).
Lately, my notes have had a bit more about sympathetic/parasympathetic dominance in the assessment portions of the SOAP note, and I'll talk about what kinds of movement patterns the patient may seem to seek (e.g. most of my patients last week were big on seeking median nerve stretch positions). Beyond that, I try to stay away from documentation in "simple contact" terms. For me, that would violate the very spirit of the disablity-level approach to patients that, in my opinion, is the biggest value of simple contact in the first place. I'll talk about how long the patient was able to sit, how long they were able to stand, dissociation of head movements from the trunk, and improvements in range of motion and pain. I'm always sure to document functional improvements that the patient reports (e.g. new ablity to stand and move long enough to load/unload the dishwasher without pain).
In following the patient, sometimes the patient seeks to play with balance, other times it's posture, other times it's a longus coli nod over, and over, and over again. In "simple" terms, the patient "tells" me what to bill.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,17,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 00:39<noscript>July 23, 2005 05:39 PM</noscript>:
And, it doesn't appear that is it your "skill" that is being used, but instead the patient does it. LOL Nothing like charging them for doing it all. LOL
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,17,49,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 00:49<noscript>July 23, 2005 05:49 PM</noscript>:
SJ
Have a think about a patient paying for the skills of the therapist - that storehouse of knowledge that must be there for a process like Simple Contact to be enabled, or active neurodynamics or useful dialogue.
Drew
Great post.
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,17,49,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 00:49<noscript>July 23, 2005 05:49 PM</noscript>:
SJ,
That's what bugs me. I didn't need to go to PT school to DO simple contact, just to EXPLAIN simple contact. It makes me rabid that I'm getting far better outcomes (at the impairment, function, and disablity levels) all of the sudden. How do I justify charing the patient? Simple. The patient isn't paying for me to fix them, they are paying for access to the information that I have in my head. The information that, once provided, will help them with their impairments, functional limitation, and disabilities.
I appreciate your "joke" of, "Nothing like charging them [the patient] for doing it all," (at least it had better be bad joke in poor taste) and I trust that's not a subtle attack on my ethics as, in the final analysis, it's outcomes that are most important.
And in case you were wondering. Unless it's in person . . . no, I can't take a joke [IMG]smile.gif[/IMG]
.
Drew
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,18,27,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 01:27<noscript>July 23, 2005 06:27 PM</noscript>:
It was a joke... (with an honest twist to it) Me? Poor taste? Never... I guess everyone's perceptions are different though.
I'd like to see a classification system of sorts as a way to identify responders. Everyone pretty much tells me that I'm missing everything Barrett has written. Well... put it in black and white - specifically what patients respond? Actually, there probably isn't an answer because data hasn't been collected from a large slew of chronic pain patients to identify their characteristics, but for those of you using the approach, you've got to have some rationale behind using the approach. I certainly hope "chronic pain" isn't the all in one variable.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,19,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 02:58<noscript>July 23, 2005 07:58 PM</noscript>:
It's the same rationale as doing any other treatment SJ. Lack of ROM, poor balance, poor intervertebral motion, poor standing tolerance, poor sitting tolerance, etc. Barrett and I may disagree on this point, but I don't think that pain should be treated for the sake of pain alone. Pain should be treated in a functional context, or send the patient to a chronic pain technician like a massage therapist or chiropractor.
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,23,23,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 06:37<noscript>July 23, 2005 11:37 PM</noscript>:
Drew,
So do you bill for two units of manual therapy? And in your notes, under O: Simple Contact?
What do you mean you stay away from documentation in simple contact terms?
Sarah
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,9,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 16:20<noscript>July 24, 2005 09:20 AM</noscript>:
Sarah,
Sometimes I'll bill for manual therapy, other times it's neuromuscular re-ed, sometimes it's a therapeutic activity. I generally don't do simple contact for more than 15 minutes or so, so no, it's usually only one unit, and then another unit of something else. Documentation shouldn't really change all that much. I don't mean to be coy, but I'm having difficulty understanding what other clinician's documentation difficulties are. Maybe it's simply a function of my having done pediatrics for so long and having gotten used to using some play technique designed to promote one of several goals --- and then writing about which of the goals the child chose to work on during the play session. In many ways, documentation of simple contact is much the same.
My objective may read something like this:
"With simple contact applied to the head, shoulders and UEs, patient tolerated 15 minutes of standing with 10 minutes of self-induced weight shifts in the frontal plane, and an additional 5 minutes of trunk rotation to the right."
I'd bill that as neuromuscular re-education, and (being that the patient was previously able to stand for a 5 minute max) await word next visit about standing tolerance for functional activities --- which would go in my subjective for the following visit.
SJ,
I see your point about a "classification system" but that would derail the disability focus of simple contact --- and allow for people to make the mistake of seeing SC as just another impairment-level treatment. Furthermore, your comments suggest a certain (yet common) misundertanding about what (according the the APTA) physical therapy is, and what physical therapy is not. You're not alone, mind you, and I am constantly shocked and amazed at the numbers of PHYSICAL THERAPISTS who don't really know what physical theapy is, versus what it is not.
According to our unified diagnostic and treatment document, the GUIDE, "chronic pain" in and of itself, is NOT something that physical therapists treat. There is NOT an impairment-level diagnostic pattern in the GUIDE called "chronic pain" and treating chronic pain, in absence of such a diagnosis is, in my opinion, not physical therapy in the first place. It is, technically out of our scope of practice and at best, massage therapy or chiropractic.
The impairment level diagnosis that we'd use would be found in the GUIDE to PT practice (and we should be limiting our use of other classification systems such as McKenzie, Maitland, etc --- unless ALSO diagnosed at the impairment level). I could see myself using simple contact, in conjuction with other techniques, for the following impairment level diagnostic practice-patterns:
4B Impaired Posture
4C Impaired Muscle Performance
4F Impaired Joint Mobility, Motor Function, and Reflex Integrity associated with Spinal Disorders
4H Impaired Joint Mobility, Motor Function, Muscle Performance and ROM, associated with Joint Arthroplasty
4I Impaired Joint Mobility, Moro Function, Muscle Performance and ROM, associated with bony or soft tissue surgery
5A Primary Prevetion/Risk Reduction for Loss of Balance and Falling
5C Impaired Motor Fucntion and Sensory Interity Associted with Nonprogressive Disorders of the CNS --- Congenital Origin or Acquired in Infancy/Childhood
5D Impaired Motor Fucntion and Sensory Interity Associted with Nonprogressive Disorders of the CNS --- Congenital Origin or Acquired in Adulthood
5E Impaired Miotor Function and Sensory7 Integrity Associated with Progressive Disorders of the CNS
5F Impaired Peripheral Nerve Integrity and Mucle Performance Associated with Peripheral Nerve Injury.
5G Impaired Motor Function and Sensory Integrity Associated with Acute or Chronic Polyneuropathies
5H Impaired Motor Function, Peripheral Nerve Integirty, and Sensory Integriy Associated with nonprogressive disorders of the spinal cord.
6B Impaired Aerobic Capaciy/Endurance Associated with Deconditioning.
That's 13 different impairment-level diagnostic practice patterns to choose from (none of which being the abstract and esoteric "chronic pain"), that simple contact may be appropriate for, and each with a multitutde of pathology-level ICD-9 codes feeding into each.
That's the answer.
What we don't know, and what would be a great study for a doctoral student (DPT, DSc, or PhD), would be to examine simple contact's impact upon the patient in each of these practice patterns.
For me, "chronic pain" isn't the "all in one variable." As it's not a physical therapy diagnosis, it's not a variable at all --- although some of the patients placed within any of the above physical therapy diagnostic patterns may also have chronic pain.
Drew
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,11,9,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 18:09<noscript>July 24, 2005 11:09 AM</noscript>:
Drew,
Where have you been all my life?
I'm no psychic, but I have the feeling your answer will not satisfy everybody. Not simple enough prehaps.
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,11,44,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 18:44<noscript>July 24, 2005 11:44 AM</noscript>:
Drew, how about a step back and a reduction in belitting techniques, okay? I don't appreciate you using me in any example especially since you don't know me nor do you know what I am thinking.
A classification system does not derail any disability focus. Since one of the first steps we do as a clinician is classify, classifying a patient intuitively increases the potential for greater outcomes. Everything we do is based on how we initially classified the patient.
The Guide does a poor job in assisting in evaluating outcomes and it isn't good enough in defining patients - but at least a variety of categories have been identified and those categories can begin to have subcategories which may be more helpful to create a more common language between professionals. In my opinion, it is a good start, but there are a lot of weaknesses overall.
Frankly, I don't care what the APTA thinks physical therapy is... physical therapy is the provision of services by a physical therapist or a physical therapist assistant that has a focus on getting the person back to life at the highest functional level possible in the shortest amount of time combined with a focus on empowering and educating the patient creating greater independence in his/her physical being. There are all sorts of views and all sorts of techniques out there to get the person back to life.
So, back to the classification deal I keep asking about.
Realistically, in a non-direct access state, a patient comes in to physical therapy with a little piece of paper with commonly... "shoulder pain" or "back pain" or "leg pain." So, generally speaking, we get some piece of paper from a physician that has very general words on it that doesn't tell us a darn thing. Then, the next step we do is what? There are all sorts of options out there, but I prefer a review of systems and then some general subjective information about the person, previous level of function, who the person has seen, what diagnostic tests have been done and the results, medications, previous surgeries and previous medical conditions... and then a bit about the current complaint. I toss in a couple of standardized outcome measures for giggles and kicks. Why do I do all that? Well, it's all a part of the "examination" aspect of what we're supposed to do. Also... all that crap goes in my brain to get churned to come up with some kind of classification of what the heck may be going on and how it needs to be tackled. In the end, I have to come up with some sort of diagnosis... I have to clump a bunch of information together that seems relevant to me and that information is synthesized to a degree for me to prognose and then come up with appropriate interventions.
It's all in the Guide.... ALL of our initial decisions are based right from the get go by how we classify the patient. You know, the "looks like a duck, walks like a duck, sounds like a duck" MUST be a duck philosophy. I have no problem with that - I practice that way, it is very logical and makes complete sense to me.
So... as I continue to ask and now maybe it can be more fully understood since I referenced the Guide.... How are you classifying the patients that you treat that you use Simple Contact to get results? Maybe you don't? Maybe you just do the Simple Contact and viola... the person improves or doesn't improve? But, I would hope and assume there is a rationale for the use and something was identified that indicated that Simple Contact may be of benefit. And, hey, realistically, to reduce the interpretation that I'm focusing on Simple Contact, I am... but any activity or choice of theory or practice can be placed in the same location as Simple Contact.
Research can be done in regard to this approach... At the moment, there is no "reference standard" to know that someone needs "permission" to move. Is there a difference in how "normals" respond to Simple Contact compared to those that are being treated? How do you identify those folks that will respond? What types of findings tend to indicate that there is greater probability for a response to the approach?
And Drew... we do treat chronic pain. For the majority of the patients that walk in the door, the chief complaint is pain... whether it is acute, subacute or chronic in nature. We grab our handy, dandy ICD-9 book and identify something for billing purposes, but if we didn't have third party payers involved would we do that step or would we just deal with the complaint? The only reason the Guide came about was to help third party payers understand what we do AND put a ton of options under the sun in every category to help with reimbursement issues. That Guide was published for politics - not necessarily to help us do what we do. If it were of high clinical relevance, everyone would want and would use The Guide.... as a whole we don't use it.
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,15,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 22:07<noscript>July 24, 2005 03:07 PM</noscript>:
SJ,
Let me remind you that it was YOU, and not me who began with an implication of poor ethics. Joke or not, it was inappropriate and I've let it slide on more than one occasion. If you can’t take the response, I suggest that you don’t cast stones in the first place. Otherwise, you reap what you sew. Most posters have been here for a while and will recognize that I patiently absorbed quite a bit of inappropriateness from you before politely responding that your statements are often inappropriate.
If you can't take being belittled, stop putting others in a position to have no choice but to respond in retaliatory slam-dunk fashion.
Beyond that, my statements were straight from the GUIDE to physical therapist practice. Like it or not, it IS the official document that defines what is, and what is not, within the scope of physical therapist practice. It is a living document for defining patients at the impairment level, and not intended to be written in stone. No one disagrees that clinicians need to be involved in the process so as to make the GUIDE more and more applicable to the clinic each time that it is revised. In all of the state and national meetings that I’ve attended over the years on that very subject, I don’t recall ever seeing you at one. I agree with some of your points, but you’re beginning to sound more and more like someone who doesn’t like their elected official (e.g. the answer to your questions), but upon questioning admits to never having voted in the first place (e.g. participated in the process). You say that it does, “a poor job in assisting in evaluating outcomes and it isn't good enough in defining patients.” I disagree with the use of the word “poor” here, but you’re certainly entitled to your opinion --- even if it does stand in sharp contrast to most academics, clinician/adjunct faculty, entry-level DPT’s, tDPT’s, and DScPT’s.
You say, “frankly, I don't care what the APTA thinks physical therapy is,” and go on to state your personal opinion about what physical therapy should be. Right or wrong, the opinion of a single therapist proclaiming a non-standardized personal opinion on the subject is even more irrelevant than you consider the efforts of the APTA.
So, back to the classification deal you keep asking about . . .
I believe that I’ve answered your question, and more than that, put it into a context of standardized diagnostics and classification in keeping with the APTA’s vision 2020. If you are either unfamiliar with, or in disagreement with, this process --- there isn’t much beyond what I’ve stated that’s going to change your opinion because your beef isn’t with me, my opinions, nor of simple contact --- but rather with physical therapists as clinical doctors, the APTA’s vision 2020, and a whole host of other topics that, while related, are not the subject of this thread.
I am curious to know what kind of “diagnosis” you’re coming up with if you’re not using the guide. Although most PT’s THINK they would have no trouble diagnosing, for example, a herniated disk versus spinal stenosis, or a medial meniscal injury versus an ACL tear --- I’ve been taken aback with how few PT’s understand the sensitivity and specificity of the clinical tests they are using. Furthermore, diagnosis at the pathology level IS NOT currently considered within the scope of physical therapist practice in most states. Most of us do it to one extent or another, but that doesn’t make it altogether legal, and as such, I’m not going to dignify such a conversation with suggestions on how to diagnose/classify at the pathology level when that’s not an activity that we’re supposed to be doing in the first place.
I think what you’re asking, however, is within the aforementioned practice patterns, how do I determine which patients I’m going to use simple contact on, and which ones I’m not. The same could be asked of just about any technique or clinical test. Age, gender, beliefs, personality type, apprehension to movement, balance difficulties, loss of range of motion, all go into these decisions. Simple contact is no different. I use the same set of criteria to assess the value of the application of simple contact as I do for myofasical release, manipulation, or a Maitland technique. I feel a lower action threshold for simple contact than most other techniques for balance, range of motion, or balance because it’s so gentile and generally more patients can tolerate simple contact than the other manual techniques. Furthermore, the outcomes I get in terms of range of motion, balance, pain relief, standing tolerance, etc. tend to be far better using simple contact than just about any other approach. As such my action threshold is less for simple contact than it would be for manipulation, mobilization, soft tissue release, NDT, or even indirect Maitland joint mobilization techniques.
You do raise some additional good points with respect to what needs to be researched with respect to simple contact. First thing is first, however, we need a slew of case studies to demonstrate outcomes effectiveness --- the second step is to look at the case studies for common themes. This will help to design studies to examine some of your higher-level questions, but we're not even at that stage yet.
Finally, you misquote my discourse on chronic pain. I did not disagree that we don't treat chronic pain. What I said was that I disagree that we do or should treat chronic pain in isolation. If that is what a PT is doing, in my opinion, they are not engaged in the practice of physical therapy --- at least not as CURRENTLY defined. The practice of physical therapy is more professional, more broad, more advanced than the simplistic and myopic vision of the 1980's PT treating pain and pain only. I contend that we treat patients who have movement pathology, SOME OF WHOM HAPPEN TO BE IN CHRONIC PAIN. Not the other way around. This is the position of the APTA. You have the right to disagree, but you’re not in disagreement with me, nor with the APTA, but rather the current standards of your profession. In other words, I didn't call you or anyone else who practices this way inappropriate --- dated perhaps --- but not inappropriate.
”For the majority of the patients that walk in the door, the chief complaint is pain... whether it is acute, subacute or chronic in nature. We grab our handy, dandy ICD-9 book and identify something for billing purposes, but if we didn't have third party payers involved would we do that step or would we just deal with the complaint?”
I’d hope that you don’t really mean this. Pain is the beginning of the discussion, but the movement pathology is the focus. If not, the care administered IS NOT physical therapy --- or at least not skilled intervention. It would be technical care that could be administered by any massage therapist, athletic trainer, chiropractor, or PT aide. If we’re as a group of PT’s not really focusing upon movement pathology, it’s no wonder why so many massage therapists, chiropractors, and athletic trainers THINK that physical therapy is a modality and not a profession. I say to ANYONE working this way --- stop being a physical therapy technician and start acting like a professional, because it’s you (the generic "you," not you personally) that is the problem --- not the massage therapists, chiropractors, or athletic trainers who use as their standard the weakest link within physical therapy.
“That Guide was published for politics - not necessarily to help us do what we do. If it were of high clinical relevance, everyone would want and would use The Guide.... as a whole we don't use it.”
You’re entitled to your opinion, and perhaps the GUIDE isn’t well used where you are, but it’s catching on in the area where I work, and the new-grad DPT’s and tDPT’s are using it, if for no other reason than (for example) to define to the MD’s, and other PT’s who may see their patient with diabetic peripheral neuropathy, the prioritization of impairments (balance, endurance, posture, loss of sensation) to be worked on in helping the patient achieve the most optimal of ambulatory skills.
You asked for a classification system. The GUIDE offers that. If you don’t like the answer, your problem is with the GUIDE and the APTA's push for standardized evaluation and classification, not with simple contact.
Drew
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,16,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-07-2005 23:31<noscript>July 24, 2005 04:31 PM</noscript>:
The language in the Guide hasn't been updated since 2001. Perhaps it is time, especially since the APTA is taking the position of adopting a more international language of disablement. Maybe something like this:
5D Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the CNS
could become
5D Participation restriction with associated impaired Motor Function and Sensory Integrity contributed to by Nonprogressive Disorders of the CNS
Ok, maybe Barrett should write it. Oh boy, now that would be a document.
What would others have it read?
jon
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,17,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 00:19<noscript>July 24, 2005 05:19 PM</noscript>:
Drew, I was joking, I did the LOL AND I admitted to joking. Ethics weren't even a part of those two sentences... Geesh... So, because I joke, you decide that it is reasonable and fair to face your slam dunk retaliation? Is that what this is about? Wow... sorry I'm taking some things seriously and trying to have a discussion, while you are busy trying to figure out a way to slam me. Hope you enjoy yourself...
Ummm, since you don't know what I look like, how would you know my presence? LOL Just a friendly jab at you combined with a bit of a joke because I do have a point. I have been to sessions that deal with the Guide. Beats me if you were in any of them, I wasn't looking for you. It does do a poor job in assisting in evaluating outcomes - I have an abstract submitted regarding that issue and a paper that is close to ready for submission. So... I believe that I do warrant the capability to have an opinion on the topic. You can disagree with me if you wish, but until you try evaluating outcomes and try to piece the Guide into it, technically I would be the one with a better opinion because I have done that. I have questioned other clinicians (involved in research) about the guide and the weaknesses with it and they seem to agree with my opinion.
Anyways.. my statements were from the guide also. I didn't mention all the 5 elements of patient/client management... but simply they are examination, evaluation, diagnosis, prognosis and intervention although I do believe there are 6 and firmly believe outcomes should be the 6th. So, where was I in error when mentioning diagnosis? Specifically from the guide "Diagnosis - Both the process and the end result of evaluating examination data, which the physical therapist organizes into defined clusters, syndromes, or categories to help determine the prognosis (including the plan of care) and the most appropriate intervention strategies." I never said at what level I diagnose, but I do have to have some sort of idea what I think I'm treating and why and then figure out what approach to use. The guide does not have a classification system in place that assists with the clinical decision making process.
Well, if it takes the guide to help with establishing goals and making sure a thorough examination process occurred, then I guess that's the new grad and the tDPTS's choice. I believe I learned that kind of stuff without the guide years ago. I have personally used the guide clinically to categorize patients into a practice pattern and to identify if during an episode of care my number of visits and duration of time is outside of the acceptable range - but that's all I've used it for. AND.. those numbers are a joke if we as a profession were to need to meet the utilization rates in the guide.
No, Drew, you didn't answer my question regarding classification or how you determine what patients will respond. All you did was spew out the preferred practice patterns in the guide. Every patient should fit into one of them, I agree... but when you examine and evaluate the patient, I would hope that you would have a more specific type of classification from which to work. The guide is a very general, basic categorization, in my opinion. And you are very correct, my question can be asked of any technique... it falls under the idea of rationalizing. You haven't provided me a rationale for the patients that you choose to perform Simple Contact with. You examine and then in your final evaluation, what specifics drive your decision-making process to use Simple Contact?
ICD-9 codes do not capture any movement pathology... so, basically we are tagging a code to the patient. A code that we cross our fingers and hope is payable... but a code that generally doesn't relate to what or why we provide the intervention that we do. The code is not related to impairment nor function, but pathology. Thank you for qualifying a general "you" versus a "me." If there weren't third party payers involved, I wouldn't open that stupid book. There has to be a better way...
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,17,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 00:26<noscript>July 24, 2005 05:26 PM</noscript>:
Drew
I'm at a bit of a loss deciphering the complexities of the Guide as I have never used anything like it before; as yet we do not use classifications (in a free system). So I may be out of hand here, but your statement re chronic pain surprises me, a little.
If a patient comes in complaining of pain, (and the vast majority do) and they have had the pain for, say, eight months, I treat that pain. That is our goal. Pain is not looked at as always the the result of an impairment, unless that fact is blatantly obvious on assessment. The process does not necessarily mean we focus on 'fixing' the impairment; we focus on optimising function and lifestyle. This may include attention to the impairment, or not; but whatever we do, we are aiming to improve the person's functional wellbeing.
That, to my way of thinking, is definitely physical therapy as I understand the loose definition here. I don't see SC or physical activity as coming in under 'attention to an impairment' anymore than I see taking a good psychosocial history does; they are essential in the assessment and management of the big picture.
I am probably confused by the USA system, which is different, but I am interested in the US approach, so feel free to 'sort me out', either yourself or SJ or anyone else.
Nari
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,18,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 01:07<noscript>July 24, 2005 06:07 PM</noscript>:
Nari,
I think it's a mistake to think of "pain" as a thing of some sort. It's not even a sensation but rather a perception. As best stated by physiologist Allen I. Bausbaum; "Pain is not just a stimulus that is transmitted over specific pathways, but rather a complex perception, the nature of which depends not only on the intensity of the stimulus but on the situation in which it is experienced..."
I am often able to point out to my patients, as I'm sure you do, that what they're feeling is a consequence of behavior that they can often (not always) become aware of and alter.
You're right, without a complaint of pain most people wouldn't seek our help but though I know it is #1 in their head I have to get them to see how it is connected to something else; something that we can both see. Ultimately that's the thing we'll treat together-and the pain will take care of itself.
I'm hoping you'll agree.
How the guide fits in here for those of us in the states-well, I'll leave that up to Drew.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,18,44,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 01:44<noscript>July 24, 2005 06:44 PM</noscript>:
Barrett
I do agree; I like to think of pain as an experience as well as a perception. It is a matter of shifting the understanding of its origin from a physical 'cause' (as patients see it). But if someone comes in with a painful back, the pain, according to many, is a 'thing'. It 'takes over' patients and for many the experience actually becomes 'them', and they talk to it, as though it was an 'evil spirit'.
Maybe we are not so very far removed from the ages where people recovered quickly once they were exorcised or blessed or whatever. We still are working with a powerful concept.
It is all a matter of perception and what we think we see.
Nari
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,19,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 02:45<noscript>July 24, 2005 07:45 PM</noscript>:
Barrett:
I must admit you have gotten me interested in this concept and I have even purchased "Clinical Neurodynamics". As I started to read over vacation (just returned from Alaska), I found it odd that even Shacklock refers to pain as often coming from a mechanical probelm in another area as it is percieved to be coming from. Although pain may only be a "perception", isn't our role also to address the mechanical problem as well ?
Ex: "Acute LBP resulting in a subsequent stiff neck."
This is only one example from many in "Clinical Neurodynamics" of which I have presented others (I think it was in the LBP treatment approach thread).
I think this is why I find this so hard to comprehend.
JBeneciuk
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,20,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 03:10<noscript>July 24, 2005 08:10 PM</noscript>:
I am less likely to address the central issues than most, and find in Butler's recent work especially an emphasis here that I don't feel is necessary.
I think the primary problem is, in fact, in the periphery and movement there will inevitably have widespread effects mechanically through the nervous tissue. There are also reflexive considerations during such a change that we can neither predict or control.
I have said for years that "neural tension" is a problematic term because (as Shacklock says) "the corallary for tension to therapists is "stretch," which they do." For a number of reasons, this is a bad idea. I prefer movements that lengthen without stretching. This seems to be what ideomotion accomplishes.
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,20,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 03:45<noscript>July 24, 2005 08:45 PM</noscript>:
When you refer to "reflexive considerations", are you referring to the mechanical interface surrounding the neural structure or within the neural structure itself?
My reason for asking this is because my understanding is that the mechanical interface surrounding the neural strucutre is where the mechanical problem would (could) be initiated...and in turn cause the compression or excessive tension on the neural structure. Is this logical?
I agree that "neural tension" is a problematic term and appreciate the rationale that Shacklock gave supporting this notion.
Thanks
JBeneciuk
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,20,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 03:57<noscript>July 24, 2005 08:57 PM</noscript>:
I'm talking about the connections between the nerves themselves.
I think the interface is where trouble can be found, but, to my knowledge, this is not especially well understood. Sunderland wrote of "the irritative nerve lesion" that was a consequence of a loss of undulations within the nerve, not any loss of continuity or adherence to the interface. And no, I don't know how people get like this. It just seems evident that they do.
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,21,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 04:38<noscript>July 24, 2005 09:38 PM</noscript>:
But Barrett, can't you agree that an injury can trigger a process where significant interface changes occur (ex: muscular guarding to protect against movements that would otherwise place excessive stess on neuro strucures) and in this case addressing the muscular guarding prior to the nerve would be a rational approach?
<hr> Posted by jbeneciuk (Member # 4087) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,24,21,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 04:46<noscript>July 24, 2005 09:46 PM</noscript>:
When I refer to addressing the muscle guarding first, I do not mean deep soft-tissue massage, instead a superficial approach to allow the muscle to "let-go", this can be done by simple positioning...regarless, aren't we addressing the muscle (read mechanical-interface) first?
Jbeneciuk
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,5,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 12:52<noscript>July 25, 2005 05:52 AM</noscript>:
Jbeneciuk,
As luck would have it, no less an authority than David Butler just said this over on NOI.com:
"Early in my career, I thought (if neural) that it was mainly due physically unhealthy dura and nerves - sticky scars, adhesions etc.
Now, at a guess, in my view, maybe 10-15% of patients have true physically unhealthy nervous systems. The remainder of the "neural tension" or "neurodynamic" findings are due to the nervous system attempting to cope with a variety of threats. Just at you can construct a pain or autonomic or endocrine response to help you cope, so too can the nervous system alter its properties to make you more sensitive if the "self" deems that it is beneficial to you. The nervous system has a varity of "tools" to do this such as ion channel changes and filum terminale tightening.
In such cases, the therapeutic target should be the threat(s), not the stuck piece of nervous system."
(Barrett) I appreciate what David says here. My tendency clinically is to approach the problem by carefully interpreting the muscular activity present, reasoning that is the best way for me to sense what the brain is trying to do in response to the painful stimulus. This is where Wall’s “resolution” phase of instinctive response becomes important and, I think, should be understood as ideomotor activity designed to correct things, not just protect. By getting the patient to amplify that isotonically as opposed to trying to get rid of the “spasm” as many therapists do, I have seen the sort of changes Drew reports for many years.
As the movement emerges, physiologic and sensory changes that can be explained by saying the nervous tissue is becoming less taut and more adequately supported nutritionally are seen and reported. Perhaps we’ll never know what happened exactly, but this deep model of function and dysfunction is the best I’ve seen-and it sure beats what I call “hanging out at the joint” as many manual specialists tend to do.
Thanks for the questions.
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,12,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 19:57<noscript>July 25, 2005 12:57 PM</noscript>:
Barrett,
Butler's quote would make one think that the 85-90% of pts. without "truly unhealthy nervous systems" would benefit from psychological counseling, rather than PT/pain injections/meds/chiro/massage/etc., to relieve their pain.
What is it about ideomotion that removes the "threat" that the pts. nervous system is defending against?
I have some vague ideas dancing around my noggin, but nothing worth putting in print.
mike t
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,13,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 20:06<noscript>July 25, 2005 01:06 PM</noscript>:
It's a good question.
Wouldn't movement into a position of less mechanical stress relieve the feeling as well as the reality of perceived threat? "The Suppression of Flight" on my site addresses this issue specifically, suggesting that movements aren't only mechanically effective but ritually effective as well.
David, it seems to me, has grown to have more faith in counseling to do this job than I, but I think it's because he can't get his mind around ideomotion as an adjunct to coercion and education. I've never been able to convince him otherwise.
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,16,30,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 23:30<noscript>July 25, 2005 04:30 PM</noscript>:
Barrett,
Like many people, I think David would like to see the studies first. I asked his thoughts on your ideas at a course this year and he said 'You know, I think there is something in Barrett's ideomotor work, I wish he would do something about getting it into the literature though" (or close to)
Luke
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,16,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-07-2005 23:58<noscript>July 25, 2005 04:58 PM</noscript>:
I think part of the problem here re muscle spasm is our traditional teaching that if you see something not quite right in an area which symptoms are occuring (roughly), treat it. We treat visible things, and muscle spasm is one of them, and also seeing that one quad is 1.5 cm larger than the other; (not kidding!!)or lack of movement around a joint or set of joints.
We were not trained to think WHY there was spasm, and how it exists, because nobody knew for sure.
It is only when one sees how a SLR on one side reproduces pain in the presenting contralateral shoulder or neck, or a painful lumbar spine leads to a stiff neck and then 'swops' around, attention to neurodynamics does start to make sense.
I wonder why we would want to 'give away' our patients to counsellors, telling them to come back when they feel better...because there may be nothing for us to do then. maybe that is a good thing....but is it?
Surely we should look at basic psychosocial assessments, where a lot of their emotional problems come out anyway and rapport is established. Clearly, with obvious depressive states, we refer. But most of these patients with pain here and there should be able to be managed by us.
In the future, I think it would be useful to be referred to as: physiolopsycholosophists. [IMG]wink.gif[/IMG]
OK, so I'm dreaming.
Nari
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,18,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 01:10<noscript>July 25, 2005 06:10 PM</noscript>:
Nari,
There's a paragraph about this muscular "spasm" in "Asking Why: Evolutionary Reasoning and Manual Care" on my site:
"Asking why any movement dysfunction is present may often lead us to conclude that manual coercion is unreasonable. To put it simply, when the therapist pushes upon the patient in an effort to reduce instinctive muscular response or to correct bony alignment the adaptive response is being inappropriately extinguished. Remember that the concept of defense in evolutionary reasoning isn’t the simple guarding normally assumed to account for persistent muscular contraction; this activity is more accurately considered the beginning of a corrective maneuver. It has been my experience that, when amplified, muscular activity concurrent with restricted movement or supposed aberrations of ideal posture will lead quite rapidly to a reduction in the sympathetic increase known to complicate and perpetuate painful conditions. This is the basic idea behind the use of Simple Contact, the method of handling I teach and employ. Clinically the patient will report a warming sensation while a palpable reduction in muscular resting tone will become evident. Ideally, manual care reverses the effects of the defect (sustained sympathetic tone) while simultaneously enhancing the body’s naturally occurring defense (ideomotor activity). At the present time, manual care rarely accomplishes either of these tasks."
This reinterpretation of muscular activity changes everything. At least, I think it does.
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,18,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 01:45<noscript>July 25, 2005 06:45 PM</noscript>:
Drew, a question for you
You have mentioned balance several times in the last few pages, specifically the improvements in balance that you have witnessed in your clients since initiating simple contact treatments 3-4 days ago. How, specifically, did you manage to measure those balance improvements? Are you truly seeing change or is your obvious enthusiasm for this new (to you) approach clouding your view. Perhaps your patients are picking up on this enthusiasm and that in itself is responsible for this percieved improvement in balance. Honestly, and this is not a knock at all, I am a bit surprised by how much you seem to have bought into these results after admittedly just working with this treatment concept over the last few days, with a limited number of subjects, no controls and some obvious, maybe very waranted enthusiasm.
Rick
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,19,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 02:25<noscript>July 25, 2005 07:25 PM</noscript>:
Rick,
Excellent question. In several patients who complained of balance as either their prime complaint or a secondary complaint, I conducted a Timed-Up-and Go (TUG), as well as a BERG balance test. Although I have not retested any of the patients on the BERG yet, several patients improved their scores from about 16 seconds to about 13 seconds. According to Shumway-Cook, this crosses the 14 second threshold from fall risk with 87% sensitivity to confidence of no-fall with 87% specificity.
It usually takes me about 2 weeks to get this kind of change in a patient --- with simple contact it was only a single visit. It wasn't anything fancy, mind you, just actively allowing the fear-dominated patient to safely play with trunk mobility and balance.
Honestly, I too am more than a little surprised (and frankly annoyed) by how well the approach works for SOME patients. It is not a panacea, but I do find that it makes manual therapy MUCH easier to do. Just today my skeptial colleague said that she had a patient who generally does a lot of guarding, allow for her to sink so deep into the abdomen after simple contact, that the patient felt spinal mobilization from an anterior approach.
Do not misunderstand me. I would not call me so much enthusiastic so much as impressed that the approach isn't complete hogwash. All it really is, is safe facilitation of active movement. As a former peds therapist who trained with Lois Bly, the idea of safe facilitation of active movement a la simple contact isn't that much of a leap from traditional neurodevelopmental therapy.
There clearly is something very valuable to SC, and it should, in my opinion, be further investigated before putting it into the same category as myofasical unwinding, craniosacral therapy, and strain-counterstrain and dismissed out of hand.
Drew
<hr> Posted by pablo w (Member # 2185) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,22,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 05:26<noscript>July 25, 2005 10:26 PM</noscript>:
I don't really get the impression that anyone is dismissing Simple Contact out of hand. It's just that as yet there are no published outcomes in peer reviewed publications about the effectiveness of the approach. I understand the background and the theory (I think) and the reasons why it should work and probably how it would work. I don't have the resources to attend one of Barrett's courses (too far away), so I may never find out exactly how Barrett does what he does.
Questions such as "what type of patient is most likely to respond to a Simple Contact approach?" are quite important, though. Will they respond to Simple Contact with better outcomes that they would to other approaches? I understand Barrett is not a researcher, neither am I but we can still ask these questions.
If Simple Contact is safe facilitation of active movement, then I am probably using a Simple Contact approach without meaning to. Oops. I could certainly hone those skills, so I hope Barrett makes it to Australia (Sydney or canberra ideally, Barrett) as I do think there is a lot of value in what Barrett teaches.
I also doubt that anyone is suggesting we become counsellors. With some patients that wouldn't go astray, though. I believe physiotherapists have the advantage when it comes to understanding the body and motor behaviour, and a capacity to take in new concepts. We are also not trained to keep our hands off patients (as psychologists, at least in Australia, are). We have a strong background in anatomy and physiology, as well as in neuroscience. I think it makes us very versatile as clinicians. There is also dogma, but that can be challenged with evidence.
Even if Simple Contact is a different paradigm, do we need to abandon what works from a more "traditional" paradigm? I think not, but that I would need to know when to switch paradigms, and look for consilience between different approaches whaich work (I figure if they work, they must be working because of some common elements). So under what circumstances do we need to make the shift to "simple Contact thinking"? It's probably been covered before, I'm a slow learner.
Pablo
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,25,22,47,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 05:47<noscript>July 25, 2005 10:47 PM</noscript>:
Didn't ANYONE like my new name for a PT?? [IMG]wink.gif[/IMG]
The fact that Drew had such good results with patients shortly after doing the SC course could suggest:
1) we all get good results after attending an inspiring course (for several weeks after attending David's SNS course everybody got better with neurodynamics) and/or
2) there is a huge and valuable placebo factor in someone's hands and/or
3) there are positive factors within SC's effects that no-one can 'see', measure or evaluate.
Maybe all three.
Barrett:
Have you noticed that certain types of people consistently respond much better or more quickly to SC than others do? This certainly happens with more traditional therapy.
Nari
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,5,4,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 12:04<noscript>July 26, 2005 05:04 AM</noscript>:
Nari,
That's just the thing, "Simple contact" isn't non-traditional at all. It is active movement, it is weight shifting, it is passive range of motion. There is NOT a paucity of evidence for these things --- just a paucity of it being called simple contact.
Lack of evidence is not the same thing as lack of effect, and we must be sure to use ALL relevant search terms in a PICO Medline search. Using "simple contact" alone is much to limiting.
Drew
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,5,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 12:18<noscript>July 26, 2005 05:18 AM</noscript>:
Drew
Don't get too excited...I don't think I was criticising anything or anyone for lack of evidence. I agree that lack of evidence is not the same thing as lack of effect; in fact I am not sure what you were meaning by your remarks.
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:00<noscript>July 26, 2005 06:00 AM</noscript>:
Drew, it can't be passive range of motion if you aren't doing anything...
Hey, I'll let everyone know that I tried the "simple contact" thing. I prefaced the session with the same kind of stuff Drew mentioned he said. I didn't do it on a patient (lack of outcomes or anything in peer-reviewed literature). I used the approach on my office manager. I gently placed my hands, well, the positions changed depending on what she wanted... but anyways, I got a big nothing. 30 minutes of standing or sitting with keeping my trap shut and hmmm, no response, no anything. Oh, she did move somewhat... she said her pain was reduced (she's been in pain for years but you'd never really know it by looking at her). I learned more about her psychosocial issues. So, no, I'm not "excited" about the theory or the apporach. What am I missing? What did I do wrong? I didn't do anything... I didn't see any outward change...
LOL Drew.. using "simple contact" AND pain gets 3 hits... none of which pertain. Barret, D [au] gets nothing. So.. what do you suggest should be used in a search in medline that WILL demonstrate some evidence?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:02<noscript>July 26, 2005 06:02 AM</noscript>:
Nari,
I say repeatedly as I teach that ideomotor activity is primarily designed to reduce the mechanical deformation concurrent with an abnormal neurodynamic, so the essential diagnosis I seek to find and alter is covered.
However, I also stress that you simply cannot know who will become effectively and fully aware of that activity and use it on their own. Time and again I've been wrong in my assumptions regarding another's tendency to trust their own movement and understand what it is I'm trying to teach them one way or another. When I think back on what I originally thought the "ideal" patient would look like, things like gender, age, educational background and ethnicity I realize that all I was doing was revealing my own prejudices. Simple Contact has taught me over and over to get rid of that and just meet the patient where they happen to be. Of course, most of that I can't see and will never know.
When students ask (and they do) "Would you do this with an old man, construction worker, Alzheimer's patient, someone with Parkinson's etc.", I point out that their understanding of the relevant essential diagnosis is incomplete and their prejudice regarding others is showing. "Touch them as I suggest," I say, "and let me know what happens to their complaint of pain. I presume they are capable of hurting for the same reasons anyone else does, and if an abnormal neurodynamic is part of that, well, now you have a way of approaching that problem."
I hope that answers your question.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,13,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:13<noscript>July 26, 2005 06:13 AM</noscript>:
Thanks Barrett, you have answered it, and with an answer I expected. I was looking for a sort of a confirmation of ideas brewing in the brain.
More later
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,37,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:37<noscript>July 26, 2005 06:37 AM</noscript>:
Barret,
Thank you for your posts, my own prejudices had me picturing a female, 35-60 years old, 30-40# overweight, depressed, possilble hx of psychological or physical abuse in their past, possibly divorced or at least unhappy, low self esteem as the ideal type candidate for Simple Contact. Maybe because this describes the type of patient that I know I am going to have trouble getting many results with using my manual skills. This is the type that I try the MFR, Feldenkrais, strain/counterstrain, dare I say compasioned listening and so on with and admittedly having trouble getting the carry over/ lasting results with. Your last post reminds me that I can't let my own prejudices cloud my perceptions of all of my patients.
Drew, thanks for your reply, you answered my concerns, now keep us up to date on how things progress, I am particularly interested in long term carry-over vs. dependence on repeated treatments ie MFR.
Barret, how do your concepts compare to those that the Feldenkrais people teach?
Thanks,
Rick
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,6,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 13:48<noscript>July 26, 2005 06:48 AM</noscript>:
Rick,
I spent four days in a class conducted by Feldenkrais himself in 1980-he passed away in '84-and was transformed.
I watched him work hands-on and did everything he suggested for long hours in a conference room in the Poconos and never again thought of the connective tissue first when observing restricted motion. The exercises I teach in class are essentially from his Awareness Through Movement, and I give him all the credit.
Interestingly, he completed only one training in the states and three students from that class have been students of mine at various times. Independently they each expressed sadness at what they feel his work has become as the various teachers and marketers have taken over. They see what is being taught now as often far different than his original work and I would agree. Each said to me, "You're doing what Moshe did."
When things are going badly, and they do at times, I remember this.
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,8,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 15:58<noscript>July 26, 2005 08:58 AM</noscript>:
Thanks Barret, I have only seen it (Feldenkrais) practiced once, in a large classroom, but it did seem to resemble what Drew has discussed in this thread.
Rick
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,12,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 19:25<noscript>July 26, 2005 12:25 PM</noscript>:
I have yet to figure out where everyone finds the time to write all these posts. When I finally find a spare minute to post, I have to spend 15 minutes catching up. Whew!
I feel like I have grasp of the theory and ideas behind SC, although I could have not stated it nearly as well as Drew has. My problem with its implementation has been in the area of touch and enviornment. I can't seem to stop my hands from wanting to DO something and the clinic I work in is much to loud and busy. If anyone has any thoughts, ideas or, well, metaphors for the former, I would be happy to hear them. The latter is a matter of making a decision. You can leave that one to me.
mike t
<hr> Posted by Zack (Member # 4688) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,16,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-07-2005 23:03<noscript>July 26, 2005 04:03 PM</noscript>:
Barrett, at the very least you know there is a lot of interest in SC based on the amount of questions in this thread.
I have a hard time believing that the patient is performing ideomotor movements during the treatment sessions. You give them 'permission' to move and they move voluntarily, unless they are under hynotism which is a true ideomotor action. Does anyone think the patient is really performing involuntary and unconscious motor behavior during SC? If so how do you know?
Does it matter?
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,19,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 27-07-2005 02:39<noscript>July 26, 2005 07:39 PM</noscript>:
Hi Zack,
Great questions. I'll give my personal opinions. If you haven't already, see this link, originally posted in the thread "Janet Jackson Effect".
The finding of Libet would suggest that our movement is initiated nonconsciously. This is, I think, different than involuntary (but I might be wrong about that). Stick with me here for a minute because you asked a lot in a remarkably short post.
My thoughts are that ideomotion occurs when there is no antagonistic representation of the action to be performed. I don't think that the only condition that this can happen in is one of hypnosis. Consider the following quote from and essay titled,
The responsible brain
quote: <hr> In 1954, A. J. Ayer put forth the theory of “soft determinism.” He argued, as had many philosophers such as David Hume, that even if determinism exists, a person can still act freely. Ayer posits that free actions result from desires, intentions, and decisions without external compulsion or constraint. He makes the distinction between free action and constrained action (not between uncaused and caused action). Free actions are those that originate in oneself, by one’s own will (unless one is suffering from a disorder) whereas constrained actions are those caused by external sources (for example, by someone or something forcing you physically or mentally to perform an action under hypnosis, or by disorders like kleptomania). When someone performs a free action A, he or she could have done B. When someone is constrained to do A, he or she could only have done A. Ayer thus argues that actions are free as long as they are not constrained. Free actions depend not on the existence of a cause, but rather the source of the cause. Though Ayer did not explicitly discuss the brain’s role, one could put it in terms of the brain: the brain is determined, but the person is free (pp. 98-99, The Ethical Brain). <hr>
My belief is that Simple Contact embraces free action, not constrained action.Does it matter?
What do you think?
jon
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,26,20,3,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 27-07-2005 03:03<noscript>July 26, 2005 08:03 PM</noscript>:
Regarding hypnosis: Consider the following from skepdic.com
quote: <hr> This has nothing to do with putting the subject into a trance and exercising control over the subconscious mind. Hypnosis is a learned behavior, according to Spanos, issuing out of a socio-cognitive context. We can accomplish the same things in a variety of ways: going to college or reading a book, taking training courses or teaching oneself a new skill, listening to pep talks or giving ourselves a pep talk, enrolling in motivation courses or simply making a willful determination to accomplish specific goals. In short, what is called hypnosis is an act of social conformity rather than a unique state of consciousness. <hr>
If this is accurate, then I guess we all do hypnosis regularly, Simple Contact or not. jon
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,27,17,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 28-07-2005 00:22<noscript>July 27, 2005 05:22 PM</noscript>:
jon
As usual, great links.
I was thinking, in your second last post, about constraint and freedom (permission to move) and its role in, say, an aerobics or bellydancing class; the participants are taught how to move to begin with, but end up in what looks like spontaneously-styled movements within a framework.
How do you think this fits in with the theme of permission to move and constraint?
Nari
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,6,31,20,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 03:23<noscript>July 31, 2005 08:23 PM</noscript>:
Not having attended Barrett's class yet, I have felt a little anxious about trying Simple Contact even though I know all the necessary instruction is either here or on Barrett's website. Anyway, I got finally got over that this morning.
Wow. I have never seen a lower back turn bright red and break into a sweat like that before. I was expecting a slight increase in warmth, nowhere near what happened though. I took my hand away from the patient's sacrum after only 90 seconds, saying "good", and he continued happily for several minutes. He felt softening, and he wasn't the only one who was surprised.
Wow.
Luke
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,0,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 07:18<noscript>August 01, 2005 12:18 AM</noscript>:
Luke, you're off and almost running by the sound of it. Would be interested in any follow-up you have when you see him next.
Did you converse with him while maintaining the contact?
Nari
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,15,4,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 22:04<noscript>August 01, 2005 03:04 PM</noscript>:
Jon,
This is the point where I really want to ask "How the heck did you do that?!?", but I know that it is a pointless question. I am going to guess that your answer would sound something like "I touched him and he moved".
I would like to trade hands with someone who has had success with SC and see what happens. Frustration, frustration, frustration.
mike t
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,16,51,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 01-08-2005 23:51<noscript>August 01, 2005 04:51 PM</noscript>:
Mike,
I am assuming you meant to write Luke, instead of Jon.
Honestly, I don't think it had much to do with my hands. I asked him to allow himself to move in any way that emerged, and then I waited.
Luke
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,1,17,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 00:36<noscript>August 01, 2005 05:36 PM</noscript>:
And Luke, you were probably not frustrated, and instead were just interested, and that "idea" probably "motored" right on out of your own hands and his nervous system was able to sample that, kinesthetically, along with your own words, auditorally... humans being human, he just went ahead and did his best to comply, and his brain worked out a way to do it. Contact. Simple.
Mike, maybe your frustration sends mixed signals.
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:14<noscript>August 02, 2005 10:14 AM</noscript>:
Mike, you're not the only one.
I just sit there with my hands on them and nothing seems to happen.
They even move in all sorts of interesting ways, but no "characteristics of correction" ever emerge, and I remain a bit puzzled.
But I guess that's what the course is for. [IMG]smile.gif[/IMG]
J
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,29,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:29<noscript>August 02, 2005 10:29 AM</noscript>:
Jason,
You're going to kick yourself when you discover how easy it is to get what so many in the course get though they know a tenth of what you know about all of this. I keep looking for a way of instructing this with greater clarity across this medium. I know that if I actually accomplished this it would cost me students and money. I don't care.
Hang in there. Check for courses near Virginia. Isn't Tennessee somewhere near you? Vermont?
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,34,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:34<noscript>August 02, 2005 10:34 AM</noscript>:
Tennesee is SOMEWHERE near me, but a bit too far.
I live in Northern Virginia, actually about 20 minutes from where your Fairfax seminar was held.
I am starting my DPT on 29AUG and the money is a bit tight, so I am hoping to save enough for the course when it comes this way, but probably won't have enough to travel.
Thanks, though.
I hear patience is a big part of eliciting ideomotor movement. Maybe I just need to have more of that, both with my patients and with attending the course.
[IMG]smile.gif[/IMG]
J
<hr> Posted by vt2c1ms (Member # 4967) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:38<noscript>August 02, 2005 10:38 AM</noscript>:
Jason,
Glad to see you are pursuing the DPT. What is your reasoning for it home vegetus, that is, if you don't mind sharing.
Mark
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:42<noscript>August 02, 2005 10:42 AM</noscript>:
I have the time and some money right now, it's a good move I need to make for the long term, and with no kids yet and a reasonably stable job, it's the best option for me right now.
Thanks for your interest.
Now if only I could elicit that darn ideomotor movement, that would be something. I'd trade a DPT course for that, I think.
J
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,10,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 17:45<noscript>August 02, 2005 10:45 AM</noscript>:
I think I just need to take some time with some of my chronic pain patients and give this a shot. I guess my confusion lies somewhere between where do I place my hands and/or what response am I hoping to elicit. I have a better understanding of the latter simply from reading everyone's posts and Barrett's essays. I agree with Jason in regards to patience. Even though I have yet to attempt 'Simple Contact', I would imagine that patience is indeed a virtue.
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:02<noscript>August 02, 2005 12:02 PM</noscript>:
All,
You are all going to laugh at me, and actually I am laughing at me as I type this, but I tried something I think might resemble the hand placement, the "allow yourself to move however you feel you want to" ideas associated with simple contact, with a patient with a history of chronic pain, whom I am seeing for a total hip rehab program. I just rested my hand on her trochanter, on the affected side, over the incision, supported the affected limb at the knee, and she started whipping that leg all over the place. I had to control her from going too far into flexion, where she might dislocate, as well as restraining the adduction a bit, for the same reason. I was almost laughing myself while her leg was flailing around. This near laughter had more to do with the fact that I had no idea what I was doing than anything else. She said it felt great, and I asked her why she moved the way she did, and she said "because thats what I felt like I needed to do". Incidently, she was moving it, not me, as she frequently broke contact with my supporting hand.
By the way, Im a skeptical, show me the studies type of PT. I have no idea how I, of all people, got this movement to be elicited. Trust?
She loved it. I just hope it lasts.
Steve
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:02<noscript>August 02, 2005 12:02 PM</noscript>:
Jason,
You're and Chris are right about the patience thing. I teach specifically that you need three seconds. I know in today's world of therapy that's a long time. I'm not kidding. Maybe one of my recent students reading this will jump in and explain. Nah, probably not.
No kids yet and money's already tight? Boy, wait till the kids show up. One of my favorite questions:
How much money does it take to raise a child?
Answer: How much have you got?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:05<noscript>August 02, 2005 12:05 PM</noscript>:
Shill,
Any measurable changes in range subsequently? Did she warm up?
I'll be looking for your check in the mail.
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:08<noscript>August 02, 2005 12:08 PM</noscript>:
How long does it take to raise a child.
As long as you live.
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,12,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-08-2005 19:12<noscript>August 02, 2005 12:12 PM</noscript>:
I'm havin' enough trouble with two kitty cats, I use them as a metaphor for ideomotor action with patients all the time.
Perhaps I am misspending my 3 seconds...
[IMG]smile.gif[/IMG]
J
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:02<noscript>August 02, 2005 07:02 PM</noscript>:
Diane,
Since you mention it, my frustration probably does show a bit. Masking my emotions has never been a strong point. Couldn't win at poker if I tried. There is also this lack of confidence that I can elicit ideomotor movement. I know that sounds dumb considering all that I have read here and learned at Barrett's course, but that is my personality.
mike t
<hr> Posted by Chris Adams (Member # 3013) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:02<noscript>August 02, 2005 07:02 PM</noscript>:
Steve,
You had me cracking up with your last post as I visualized your scenario! Now, I'm envious and I want to try it as well. So let me get this straight...you placed one hand on her trochanter and the other supporting her involved leg. What position was she in? What did you do with your hands...leave them there? You then proceeded to ask her to move as she desires and WHAM...she flailed about?
Thanks!
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:20<noscript>August 02, 2005 07:20 PM</noscript>:
My Dad said to me late last year in an ironic tone, "Mate, you know I've only just recently worked out what being a father is all about. It's all about writting cheques."
Barrett,
How often do you see the area turn red and burning hot? Was this incidence particularly strong?
Luke
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,19,29,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 02:29<noscript>August 02, 2005 07:29 PM</noscript>:
Luke,
This sign is not common. Typically I just get the the sensation of warmth, reported by the patient. It might get red but I wouldn't know it. I don't remove clothing in order to treat people.
It might also be noted that I give no verbal cues regarding movement. Simple Contact is "manual permission and acceptance," so nothing needs to be actually said.
<hr> Posted by Shill (Member # 2325) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,20,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 03:06<noscript>August 02, 2005 08:06 PM</noscript>:
Barrett,
No skin temp changes, as her pants were on, but she stated a feeling of warmth and general goodness. As far as measurable changes go, she abducted a lot further than she was willing to go earlier. She doesnt have any true passive restrictions, just active ones. I have been non-judgemental of her pain from the start, and this has helped tremendously. Her gait was bizarre at first, more substitution patterns than I had ever seen, and now it looks like normal (whatever that means) gait. So I can document the reduction in sideflexion during gait, improved stride length, less trendelenburg, and I document the motions she went through as AROM exercises, counting roughly the number of reps of each movement she goes through.
I appreciate your growing acceptance of those of us who take a while to get it. You'll find us bullheaded ones to be the some of the most enjoyable people you could meet.
Chris,
She was sidelying, on the unaffected (although, all sides are affected), the non-surgical side. My hands simply supported the leg at the knee, although again, repeatedly, she broke contact with that hand. I just placed them there, and asked her to do whatever she felt like doing. That was it. I might add that I had a patient today with whom I tried the same thing, and nothing occurred. But I imagine both are typical.
Steve
<hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,20,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 03:10<noscript>August 02, 2005 08:10 PM</noscript>:
Barrett,
Do you ever have patients who stand there thinking 'What is he doing?" Does verbal cueing help in this situation?
Luke
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,20,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 03:48<noscript>August 02, 2005 08:48 PM</noscript>:
No one ever asks me this. I talk them through the concept and, at this point, I always get something.
If your contact is what I'm suggesting the movement may only be felt and not seen, not all that different than feeling a pulse-minus the rhythm and regularity. Ideomotor expression is present at all times and when we get out of the patient's way, position them properly (give them a few options) and wait patiently it always shows up. The warmth Shill reported is a very common occurance.
Mike T's failure to see this despite having taken the course surprises me if he is in fact sticking with it. I recall his speaking to me of the lack of support he anticipated from his boss. This is no small thing and I hope he can somehow get past that. As far as what his "hands should do," well, they are to just deform the skin and nothing more. What's so hard about that? If your friend needs you to listen, how hard is it to sit down and shut up?
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,2,21,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 03-08-2005 04:06<noscript>August 02, 2005 09:06 PM</noscript>:
About actual heat, seems rare. The first time it happened to me was about 10 years ago, while doing muscle energy with a guy's T spine. Suddenly this tight, sore, sort of swollen spot he'd had right of about T4 for many years, gave us both a heat blast, then disappeared. It's happened in milder form just a couple times since with a few other people.
The sweating seems more common. The pulsey twitchy feel is pretty much present and normal with treatment on everyone, in fact if I don't feel it I move on to somewhere else on the body. And I haven't had Barrett's class yet.
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,4,12,17,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 04-08-2005 19:17<noscript>August 04, 2005 12:17 PM</noscript>:
Barrett,
Sticking with it has been difficult. Our clinic is fast paced. When I attempted to use SC and my results were negligible, I had to move on to other treatments. Have I given it a fair shot? Probably not. This is partially my fault, partially the situation I am in.
I have a new pt. tonight with a diagnosis of LBP. My plan is to use SC as my first treatment and go from there.
mike t
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,4,12,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 04-08-2005 19:22<noscript>August 04, 2005 12:22 PM</noscript>:
Mike,
I appreciate your honesty-good luck with your boss. As Carlos Castenada says: "The heart of a warrior is tempered by dealing with impossible people in positions of power."
In the end, for mechanical deformation we're all looking for the best movement-sometimes that motion appears a little more slowly than we'd prefer.
<hr> Posted by dragonfire (Member # 4369) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,5,20,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 03:39<noscript>August 05, 2005 08:39 PM</noscript>:
Barrett,
With me just lightly touching their bodies, I've found some success in getting patients pain level down by instructing them to move in any direction that's ok with them, meaning painless. Is that still considered ideomotor or is that conscious effort? Do you suggest verbal instruction or just slightly touching them to initiate movement?
I usually just get a report of softening and relaxing response, although today, a parkinsons patient also dx with fibromyalgia told me she felt like she was on fire with pain before tx but after simple contact, felt like doused fire instead.
What I've noticed though is that when patients come back, their pain is just as painful as before. Also, I don't always get a successful outcome- meaning nothing happens when I touch the patients and I go back to thinking, what am I doing? [IMG]confused.gif[/IMG]
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,5,20,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 03:58<noscript>August 05, 2005 08:58 PM</noscript>:
Dragonfire,
Am I mistaken or didn't you take my course? Before I answer I'd like to know.
<hr> Posted by dragonfire (Member # 4369) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,6,0,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 07:31<noscript>August 06, 2005 12:31 AM</noscript>:
You are not mistaken. I have attended your course. And I have been applying SC at work which brought me to the question. I only read portions of this thread so if I am asking you to repeat something that has already been said, pardon me.
I understand that ideomotor movement is instinctive, allows expression, and refers to those corrective motions that make us comfortable or experience less pain. I also understand that increased awareness on the part of the patient enhances correction thru gentle touch and verbal instruction from the therapist.
My question is on the verbal instruction. I am unsure if giving an instruction to move in a painfree way results in volition as opposed to instinctive movement. I have had success in reducing pain with me telling patients that they can move where its ok and I say this when nothing happens with tactile stimulation. But I wonder, when you give the above instruction to a person, doesn't this result in a conscious course of action? On the other hand, I also think of the instruction as a way of creating a safe environment, telling the patient that he/she can move where its ok, facilitating corrective motion. I have also thought that maybe, it would be better to just use my hands to do the talking. In other words, to just shut up.
I have been reading your course workbook, relating it with actual experiences with patients, been reading your essays, and attempting to fill in the gaps to make my SC knowledge a cohesive whole. For years, I have no knowledge of ideomotor motion. Now I do. And to top that, I have questions. I consider that double progress.
<hr> Posted by PTPete (Member # 3243) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,6,12,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 19:31<noscript>August 06, 2005 12:31 PM</noscript>:
In my understanding, SC requires no verbal instruction to the patient. Pain-free motion is not neccessarily a requirement either. If I recall Barrett's thoughts on this correctly, resolution may in fact be uncomfortable. Barrett please correct me if I'm off base here. Personally, I simply tell the patient to follow their instinct and move in any manner they wish. I've had no flare-ups, some mild symptom reduction, but no miracle cures either. I'll keep trying, using fewer leeches has actually been quite rewarding...thanks Barrett.
Pete
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,6,12,54,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-08-2005 19:54<noscript>August 06, 2005 12:54 PM</noscript>:
Dragon,
Pete’s right, the characteristics of correction do not include movement toward comfort and therefore this should not be encouraged verbally or otherwise. In fact, I never tell people what to do, I just follow them around. I move around, three seconds at a time if that is what’s needed, as you may recall.
Stick with it, do less, say nothing that might indicate that you’re the choreographer and you’ll probably progress. Think of this, I’ve been promoting this site for over a year and a couple thousand therapists have very positively responded in class to the idea of such a place. Still, I can count on one hand the number of students who have shown enough curiosity to contribute here as you have. Your interest is rare, and your desire to work in a new way with these patients is something I don’t often see.
<hr> Posted by dragonfire (Member # 4369) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,8,6,4,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-08-2005 13:04<noscript>August 08, 2005 06:04 AM</noscript>:
Pete & Barrett,
Thank you much for the feedback and clarification. I think instructing patients to follow their instinct is indeed better or just simply not say anything at all.
And Barrett, that last post was a compliment, thanks but really, more thanks to you!
DF
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,10,22,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 05:01<noscript>August 10, 2005 10:01 PM</noscript>:
I attended a "Simple Contact" course in Florida this year for the 1st time. I was very impressed by the concepts, but not so much by the presentation. I shared this opinion on the evaluation given to us at the end of the day. It was a while ago so I don't remember exactly what I wrote. Of course this is based on my own "perception," so I mean no disrespect with my reasoning.
I think there was too much time criticizing other modalities, rather than embracing the whole point of "Simple Contact" for any kind of therapy. This is definitely the 1st time I've ever heard a speaker actually give specific names of whom he was bashing(which is how it seemed) or doesn't agree with.......in a negative way. Also, there was one instance where Barrett asked the question: "Does anyone hear use myofascial release in there practice?"
There was a therapist that who had some training from Barnes himself. Well this was asked after Barrett gave his reasoning on how ineffective it was. The therapist was brave enough to raise her hand still when the question was asked, and there was absolutely no embracing for this therapist's thought process or defense for what she practices. It was almost like if she took a breath for a split second b/c sentences, that was Barrett's cue to jump right in defend himself. Now it must be very hard as a presenter/speaker to know your audience completely, but I'm sure there are common rules on respecting your students.
Now I"m a youngster in the health field so I have more to learn than anyone. But, it is in my experience that whenever attending a conference or listening to someone share their knowledge...(which is greatly appreciated)....it is usually a sign of insecurity or uncertainty if one needs to bash others. This is only a fraction of what I got out of this workshop, besides some good treatment approaches, but I'll list a few more things that I saw happen.
.
1) there were at least 5 times(that I can remember) where Barrett asked a question and no one knew the answer. Personally I've never seen someone get so frustrated with "students"(b/c that's what we are) in a learning environment.....and actually show this through his tone, body language, and most importanty....his words. There was 1 question he asked on a hand pathology that no one seemed to know, and he really ripped everyone a new a-hole. Something was said along the lines "How do a bunch of pt's not know what a ......is." This happened pretty early in the seminar, so I tried to dismiss that in my own misinterpertation of what he meant.
2) he used 2 people as demos and I was really impressed by the results in movement, but not in his ability to uplift there spirit through positive feedback and encouragement. Now the demos may have had a different response b/c of physical changes, therefore effecting their emotional state, but there was definitely no sense of connection(from what I saw) b/n Barrett and the demos. I don't even think there was every any eye contact b/n them. That was a vauge description, but I think everyone gets the point.
These were a few things that jumped out at me and I could list a lot more, but the the whole point that I'm trying to make here is how easily one's perception on how the 411 was presented can dictate the efficacy of a concept. I've used the "Simple Contact" technique after the seminar and had good and minor results. I'm no expert on Human function, but Barrett definitely has something going with "Simple Contact."
Building on success, using positivety and encouragement, trusting the innate wisdom of the body to heal itself and not my own personal tool box of modalitites I would say have to be a part of any modality. Without them, like Gary Gray would say, there's a huge "gaposis."
I'm definitely not an english scholar.....OBVIOUSLY or great therapist, that's probably why it's takened me so long to participate in this thread. The participants in this topic are way above my head in knowledge and no way would I challenge the efficacy of their treatment approach.
To conclude my thoughts, there were a lot of great things that I learned and am I excited to share with clients. I'm not a big believer in jump on the "this seminar sucks" wagon, but I think the principles and concepts could have been presented in a better fashion with respect of all the participants. The principles and concepts are important in any seminar, but if you seperate that out from being positive and encouraging to your attendees, I'm afraid this great thought process of "Simple Contact" won't reach the level it should. Maybe it was the time of day, or the crappy weather, possibly the tasteless food that they served in the hotel restaurant, but I came to learn...and that I did. A far greater lesson than any scientific research study can find.
Will I ever attend another Barrett Dorko seminar? maybe......not
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,5,50,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 12:50<noscript>August 11, 2005 05:50 AM</noscript>:
Barrett has repeatedly commented that those who have participated in his course don't come to the edge... David, maybe you have provided insight from your perceptions in Florida as to why.
Learning from a person that is confident, positive and at ease with oneself combined with being ever so humble creates a much better learning environment. I have been really amazed at some sessions I have taken that have what I would consider headliner therapists who are leaders in our profession. Overall, they make me jealous with their style - they've proved that they know what they know and I've always been impressed with the respect they direct toward those in the session and the openness they tend to have along with serious contemplation of the questions that are asked.
When one teaches, it is a package deal. Students don't just focus on the material being presented and it is difficult to ignore aspects of a teacher that grate on nerves.
I'm sure the Canadian session will be much different.... I actually would love to see a video tape because I wonder how Barrett will respond to questions and the experiences of others who have a parallel philosophy of care. I see the dynamics changing... quite a few of those participating aren't schmucks and are always processing new information and integrating it into their experiences and knowledge base. Should be interesting....
<hr> Posted by OaksPT (Member # 2776) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,8,11,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 15:11<noscript>August 11, 2005 08:11 AM</noscript>:
David,
I'l be the first to agree with you, Barrett is not one that coddles, but:
For many things Barrett may be, insecure or uncertain is not one of them. I have been too two of Barrett's course, my perception of what you state as bashing is different.
I think all of us as PT's are ill prepared when we come out of school to deal with "pain" itself, I can speak only for myself, but I got minimal exposure to pain concepts. So when we try to learn new concepts after graduation by going to cont ed classes, we are at a disadvantage if the concepts we are presented with are foreign to us, and usually they are. Pointing out that a philosophy behind a certain modality is bogus, is not bashing, it's research. Sometimes the truth is not nice,and is hard to handle
Scott
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,9,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 16:07<noscript>August 11, 2005 09:07 AM</noscript>:
OaksPT,
I appreciate your thoughts on your experiences. In now way am I judging his character. I wasn't the only 1 at the seminar to say that....ob break. Being the young kid there, I kept my mouth shut most of the, but couldn't help hear the same reactions from quite a few of the attendees.
We all know seminars like this can be the driving force for the health professional wanted to continue in the field. But, there was way too much negativity. Maybe I'm spoiled after quite a few Gary Gray seminars b/c he not only provides "great" information(in my opinion at least), but shows great respect to whatever level you come in as any kind of therapist, doctor, trainer, etc. Whether Gary used someone as a demo, asked a question (and the most ridiculous answer came out of someone), or answered questions, he totally uplifted and built on that person's successes. I encourage anyone who has a attended Barrett's seminars to attend a Gary Gray seminar to see what I mean. I only use this example for those who have experienced both. By the way this in not a plug for his seminars b/c there are many great therapist out there teaching.
thanks
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,9,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 16:35<noscript>August 11, 2005 09:35 AM</noscript>:
David,
First of all I want to say I appreciate that you came here to say what you said. It is one of those "fierce conversations" in my opinion.
Second, I've had my own run-ins with Barrett (on line, when I picked up on and reacted to "negativity" as I perceived it) and to his credit he never decided to shut me out of his learning loop based on anything interpersonal.
Third, I expect to actually learn new things at his workshop. I don't know how I'll respond to his teaching style, that remains to be seen. Like you, I respond effortlessly to engaging, soothing, and respectful teachers; my brain sort of disarms, falls open and the stuff pours in. David Butler comes to mind..
However, I can't put aside the fact that a growth curve has occurred for me in the last 3 or more years, tracking Barrett's writing and book references among others. I think at least part of the growth was caused by the in-TRA-personal discomfort Barrett's ideas instigated. There are precious few PTs who involve themselves in learning about physical contact and what goes on physically within that interface. Because hands-on is my preferred area of investigation/ pain treatment, I decided to accept Barrett in that journey, warts and all, quite a long time ago.
One thing I'm pretty sure of, Barrett's teaching style will not include any emotional manipulation. In no way do I expect to find him creeping into my mind through some unlocked back window, appealing to unconscious memeplexes. In other words, I'm pretty sure I'll be able to trust him as a teacher, and that his material will be reality based, that he teaches from that level and not from his own belief system. As for any potential negativity, forewarned is forearmed, and I choose to let that go by as best I can, simply not allow myself to be affected/infected.
Regards,
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,12,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-08-2005 19:25<noscript>August 11, 2005 12:25 PM</noscript>:
Hi David,
I'm not sure what you were driving at in your second point about the demos. Could you elaborate on that?
Thanks,
jon
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,17,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 00:32<noscript>August 11, 2005 05:32 PM</noscript>:
I am not sure what is meant by 'coddling'; surely adults who enrol in a course to learn (which is why we do it in the first place) do not need 'coddling'....?
Comparisons are odious, but I have been to two Butler courses and he does not coddle at all. All that comes out is enthusiasm and clarity of thought processes. I was a demo for several techniques, and eye contact was minimal - his eyes were for the rest of the group. I thought that was entirely appropriate. He made a facetious remark about 'these people from the ACT' (Australian Capital Territory, which includes Canberra) which I thought was very funny.
Like Diane, I will wait and see how the course pans out in September. I endorse Scott's remarks.
Nari
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,18,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 01:40<noscript>August 11, 2005 06:40 PM</noscript>:
I don't think I'm mistaken or that I'm breaking any HIPPA rules as I believe this has been mentioned in a distant thread but I believe Barrett has some degree of Asperger's syndrome. If so, perhaps he can fax his course notes to Gary Gray (whom I've not met) or David Butler (also worth going to see) for a more entertaining presentation of his original work. Do you suppose they would be interested in presenting it?
jon
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,21,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 04:05<noscript>August 11, 2005 09:05 PM</noscript>:
It is very tough to express one's opinions without sounding narrow-minded. Unfortunately, my writing skills don't reflect my ability to express verbally. I felt it was necessary to express my experience b/c I think teachers(in which all of you are) have a much greater impact on a student's reflection of their abilities.
SJBird55,
I don't know how much insight one person can provide, but from what I experienced and read everyday on these threads....it's starting to add up.
OaksPT,
I don't ever expect a teacher to coddle his/her students. But, I do expect teachers to show respect to their students.
Diane,
I appreciate your response. I came to that workshop ready to learn. I had no pre-conceived notions of Barrett b/c I never read any of his work. I heard great things about his information. So in no way did I except what was going to happen that day. I'm told I have a pretty positive attitude. Like I said before, I kept my mouth shut the whole time and just observed. I prefer to concentrate on the positive side, that's why I was so hesitent on participating in this thread.
My final thoughts on this whole matter is this: There are "great" dissemenators of information and than there are "great" teachers.
I'll stick with the "great" teachers.
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,11,21,50,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 04:50<noscript>August 11, 2005 09:50 PM</noscript>:
Great post David. Being young, brave enough for critical feedback, willing to use your real name and knowing what you want sure are positive signs of successful future. Pick your teachers well and good luck.
jon
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,6,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 13:25<noscript>August 12, 2005 06:25 AM</noscript>:
David, I'm not doubting that what you experienced and what you read here isn't adding up. I full heartedly agree with your assumptions. I wouldn't choose to attend his course for the simple matter that I don't agree nor do I put up with his type of attitude. I'd just make the class miserable because even though I'm a "student" that doesn't mean that I have to sit there and tolerate crap and his type of attitude - it isn't appropriate. I wouldn't be able to block out and ignore the crap and be able to settle and learn. So, kudos to all of you that can ignore and focus... as with pain there are thresholds and I have a low threshold for what I am able to easily tolerate.
Jon, and that may be the case, but it doesn't excuse Barrett for his type of communication. No wonder he doesn't understand half of what I write - and now I'm seeing that no, it isn't all my fault the number of miscommunications that occur, in particular between him and me. (Others in public have stated they've had communication issues with him also. Mine just continues and continues like the energizer bunny.)
And, for that matter, the forum is a really irritating way to communicate - here we are publicly talking about a third party. That just seems wrong to me... so, Barrett, I may have been talking to Jon and to David about you, but in my opinion, you need to realize and accept that when it comes to communication and social issues that you do have a disadvantage. I'm going to state that I don't appreciate that the miscommunication is always blamed on me and "what I meant." At least I try to clarify when there is confusion and I try to address that confusion by rewording versus deleting posts or ignoring posts.
David... technically, you aren't a physical therapist, are you?
I'm going to be changing the topic somewhat... how do I politely word (without offending David).. but what the heck was a nonPT or non PTA doing at a course a PT was instructing? Does the ability for anyone to attend a course indicate that what we do isn't "special" to just our field? And then we sit back and wonder why we can't protect the terms "physical therapy" as well as we would like... we are our worst enemy sometimes.
<hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,6,53,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 13:53<noscript>August 12, 2005 06:53 AM</noscript>:
Well, that's a different thread, SJ.
[IMG]smile.gif[/IMG]
As long as David doesn't call what he does "Physical Therapy" then I have no issue. I have learned quite a bit from people who didn't have the magic letters "P" and "T" in their credentials somewhere.
David's a smart guy and he knows he's not a Physical Therapist, just as I know I'm not a strength and conditioning coach. But some overlap is good.
I don't think we can say in one breath that Barrett's work isn't widely accepted and then say it's unfortunate to share it with those that aren't PTs. I don't think jealously trying to guard treatments for ourselves (which I don't think you're suggesting, but others have) is an intellectually defensible position. Isn't this part of our profession's issue with chiros?
Just thinking on a Friday...
J
<hr> Posted by AllAboutMovement (Member # 4853) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,9,56,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-08-2005 16:56<noscript>August 12, 2005 09:56 AM</noscript>:
SJBIRD,
No I'm not a P.T and I don't attempt to act as one. I do "attempt" to take up as much knowledge from any source that I feel is pertinent to my cause........to help people. As a Personal Trainer and LMT I refuse to limit myself to the educational resources out there. I mean this in no offense, but Barrett's seminar was nothing above other things that I've learned.
I think health professions as "whole" should be able to "appreciate" all forms of healing and determine by their scope of practice what can be used. If you look at my credentials, you may see FES. Now that's there b/c it stands for Functional Enhancement Specialist......that's what we all are.....not tool experts. I wish there was a uniform title out there so we wouldn't limit ourselves on we can learn and not. I PROMISE I won't take this information from Barrett and teach all my fellow trainers. But I DO PROMISE I will continue on my journey of being a better trainer, massage therapist, motivator, listener.....to every one of my client.
You're whole tune seemed to change once you realized I wasn't a PT.
Jon,
There's no need hide my identity if I believe in something. Thanks.
Jason,
I appreciate your comments. Maybe I'll go back to school and get my PT's license and I can have those magic letters after by name [IMG]smile.gif[/IMG] I consider it quite often....on a serious note.
Overall, I'm done with this thread and I'll go back to my little world of learning and appreciating all you experts. One day when I've reached a level of knowledge I will have the opportunity to be a "great" teacher and not just kid full of information.
In closing, hopefully one day I'll come across Barrett again in a different venue and my impression will change for the better. I don't believe someone has bad intentions when doing anything. But the means don't always justify the end.
thanks
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,12,18,5,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 01:05<noscript>August 12, 2005 06:05 PM</noscript>:
I'm sorry David is departing the thread.
Most courses (intranational ones anyway) seem to be not restricted to PTs only. David Butler's courses are certainly open to chiros, doctors, etc. I don't see that this is a problem; knowledge is for sharing. We can choose to use it or not; if it enhances clinical practice, so be it. PTs are not sacrosanct, and neither do we 'own' knowledge. If someone (a non-PT) attends a course and distorts this knowledge so that it ceases to be based on science, that is a problem, but it can't preclude that person from trying to learn in the first place.
We all enjoy someone who is skilled and presents well before a group, to fit our perceptions of what a good teacher is. But that doesn't always happen; and even with a 'bad' teacher, knowledge will filter through (if we permit it) the cloud of personal impressions.
Nari
<hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,7,30,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 14:30<noscript>August 13, 2005 07:30 AM</noscript>:
David, I was just contemplating the issue of continuing education courses. I really didn't have a tone - (hence prefacing it by "not offending David").
I don't know, I go through times of contemplation (and I'm in one now): Who is a health professional and who is not and who determines that? What defines a health professional? And then, what is physical therapy? If others can be doing some of the services we as physical therapists provide, then how is it only physical therapy when a physical therapist does it?
Actually, Jas, I'm not being jealous. I was just thinking that if what physical therapists teach is open to anyone who wants to sit in on the course and learn and the person learns indications, contraindications, prognosis, outcomes and the approach/technique... well, if what was learned is a service that is provided by physical therapists and now the other person who is a non PT learns it and does it ... then, technically, both the non PT and the PT are able to do the same service, so... how is it that it can only be tagged "physical therapy" when an actual physical therapist does it?
Nari, it wasn't just a lecture on pain that Barrett was providing knowledge - he also got into demos and approaches and some clinical hands-on material. I don't really have a problem with sharing knowledge, I'm just contemplating the clinical aspects.
As I said, just contemplating...
<hr> Posted by Andrew M. Ball PT PhD (Member # 1988) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,9,56,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 16:56<noscript>August 13, 2005 09:56 AM</noscript>:
Barrett is a generous, kind, thoughtful, and insightful person. I have known him for years as a teacher, mentor, and friend, your experience with him isn't what I've experienced.
He does, however, present a much wider breadth of information than most other presenters. As such, his philosophy is to present philosophy and theory . . . and discuss it, rather than present specific treatment techniques (e.g. what to do). That tends to frustrate people. Undoubtably. Furthermore, he has be burned by many, many, people over the years simply for challenging them to refine their theories. The response, more often than not, has been to attack Barrett personally --- sometimes he responds in kind. Generally, he responds in ways that are not mean, just frustrating. It's hard for a clinician to hear that they're not reading enough, not collecting enough information, not THINKING enough.
Teaching someome to fish is a different process than giving someone a fish. Of course if the fish given happens to be unedible . . . what have you got?
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,10,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 17:46<noscript>August 13, 2005 10:46 AM</noscript>:
Nari,
If I were you reading what I’d read the past few days I’d also be concerned about what I might see in me while seated in the class in Nanaimo. If I didn’t know myself, well, I’d be quite concerned too. But I’ve spent thirty years standing before groups of my peers, speaking of the latest advances in our knowledge and understanding of humans in pain, of clinical life, clinical reasoning and the enormous responsibility the therapeutic professions have inherited. By that I mean the burden of treating those the medical people cannot help chemically or via surgical means. As you know, there are many out there like that. If we have succeeded at reducing the numbers of those who suffer from chronic pain it isn’t obvious to me. Any number of statistical indicators make it clear that this is epidemic and growing. I commonly speak to therapists in pain who long ago abandoned their own methods of management. They are often stoic but desperate, quiet but seething within. In any class I teach I’d say they comprise about a quarter of the students, probably more.
It’s a volatile mix, and six times each month I step into the middle of it and do what I can to navigate the attitudes, knowledge, misconceptions, memeplexes and unconscious projections of those who sit before me. I learned long ago that, from me, constant positive reinforcement (what many in therapy with delicate sensibilities seem to want) was neither possible nor always helpful. There are teachers like that and some are my friends. I used to teach along side one who was hugged by everyone leaving the room. I didn’t get any of this, and I’d wonder. But after a while I came to realize that this man didn’t really have much more than the gift any chameleon has, and who he was, what he thought, how he related to others was little more that an airy, light, meaningless and empty thing. It couldn’t be weighed, its effect was negligible, and, most importantly, it couldn’t be trusted at all. He was whatever suited the needs of those around him. I saw that he paid for his popularity dearly and in ways I would avoid at all costs.
Being me has its price. Not being me costs even more. I accept that, and, knowing what I can about you through this medium, I’d be willing to bet you’ll see yourself in what I do while negotiating the minefield every class represents. Perhaps, like many, you’ll be impressed by my patience. I’ve been told this many times. Of course, these people just don’t contribute their thoughts here. Drat.
Thirty years and people still come. It must mean something.
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,16,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-08-2005 23:00<noscript>August 13, 2005 04:00 PM</noscript>:
SJ,
My bringing up Asperger's was not an attempt to excuse behavior but rather to try to help explain why someone may perceive another as being disrespectful. That is, I know Barrett is not but as you noted that misperception is not isolated.
"Patient" is an excellent descriptor. You should have seen how well he suffered through my miserable presentation of myself during a lunch the day my wife and I had met with him. In retrospect, his patience was amazing. It is due to that sort of thing that I may seem to be on the ingratiating side but my posts are honest.
As far as having other practitioners attend, I suppose every CE provider has to grapple with who their audience will be. Since the only manual skill needed for Simple Contact is touching someone it would be hard to preclude those who do this for a living regardless of title. Why such a thing might work is what the rest of the course is about and clearly many benefit from education regarding this.
Besides, how bad can a person be who performs the 'squeaky head gag'. Hilarious.
jon
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,21,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 04:25<noscript>August 13, 2005 09:25 PM</noscript>:
Drew, well, an Indian once told me that Gar (fish) isn't inedible if you pressure cook it, it softens the bones.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,13,22,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 05:02<noscript>August 13, 2005 10:02 PM</noscript>:
Barrett
What have you been reading over the last few days?
I agree that a teacher who bends according to whatever wind he thinks is blowing off the class is dodgy with respect to the honesty of his presenting material.
What does intrigue me is the number of PTs in the classes whom you say are in a chronic pain state.
Why is this so? Is it an indicator of burn-out?
Nari
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,14,6,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 13:18<noscript>August 14, 2005 06:18 AM</noscript>:
Nari,
I don't think therapists are in pain because they're therapists or because they have any significant psychological component to their pain. Not at all. They hurt for the same reason my patients do-they are mechanically deformed beyond their tolerance (in the nervous tissue) and they have not yet moved in a fashion that resolves the problem. I demonstrate this constantly.
Why do they remain like this, commonly for years prior to attending the course? Perhaps there's a clue in the fact that virtually none of them have any knowledge of the subjects we discuss here in the Bullypit. In Nashville, Louisville and Lexington this past week I had a total of 114 students. Not a single one was aware of discussion groups on the Internet. I'm not making this up.
Burn-out doesn't describe this.
I am currently reading "Rebuilt-How Becoming Part Computer Made Me More Human" by Michael Chorost and "Radical Evolution-The Promise and Peril of Enhancing Our Minds, Our Bodies-And What it Means to be Human" by Joel Garreau. I'm also rereading portions of "A Man in Full" by Tom Wolf.
<hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,14,6,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 14-08-2005 13:58<noscript>August 14, 2005 06:58 AM</noscript>:
Nari,
It just occurred to me that you weren't asking for a list of books on my desk. I was referring to the massage therapist's decription of my behavior while teaching. It doesn't resemble anything I do, have done or will do.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,14,17,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-08-2005 00:31<noscript>August 14, 2005 05:31 PM</noscript>:
Barrett, either way, it was interesting to read both your reading list and your opinion on the MT's comments. Like jon, do you ever get to sleep or eat??
I know formal burnout indicators do not include the mechanical deformation you describe, but as these indicators were developed by psychs,would they recognise any factor related to neural function, anyway? (not denigrating psychs.. I think they are great)
All I can say re your second post is an old cliche: most things in life occur as a result of expectations and our perceptions of satisfied or unfulfilled expectations. Expectations are useful and necessary..it's how we interpret the outcomes that counts. We seem to enjoy shooting messengers sometimes; not that we would necessarily do better, but someone who stands in front of a group is automatically expected to perform better than any one else in the group, or they wouldn't be there in the first place. This always clouds accurate perceptions of what is good and what is 'not'.
Nari
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,24,20,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 03:59<noscript>August 24, 2005 08:59 PM</noscript>:
Interesting discussion about teaching styles. I have attended both Barrett's course and Gary Gray's course and, as much as I love Gary Gray's personality and attitude, I thought he was an ineffective speaker in terms of getting his ideas across to the audience. Thank goodness Dave Tiberio was there to translate all the Gray-isms and bring some solid research to the lectures. Overall, I would describe it as fun and inspirational, but I didn't really come away with a lot for my brain to chew on.
Barrett, on the other hand, was not as "perky" and optimistic but his presentation was much more informative, in-depth and thought-provoking. He challenged us and gave us a new foundation and understanding for treating our patients.
Both speakers truly believed in what they were teaching, having spent most of their professional lives developing theories and honing the material. Both presented with sincerity and integrity and I respect them both as teachers.
I think Nari has a good point about expectations. Our perceptions are definitely clouded by our expectations, and maybe David knew a little bit more about what Gary Gray was going to say and was therefore more open to perceive it.
I also think SJ has a point about the fact that David is not a PT, only because he has not been indoctrinated by the PT culture and doesn't have the same understanding of rehabilitation and injury/pain as a PT. Given this, he may not have perceived Barrett's comments as a wake up call, but more as an unprovoked attack (not knowing the full history of our profession and the day-to-day workings of a PT clinic). Having said that, I strongly feel that he should continue to learn, take courses, and contribute here to give us his perspective. So, I hope you will come back David.
On a lighter note, what have I been doing lately?? Well, I have had some mechanical deformation beyond my threshold (too much sitting at the computer) and have been giving my body a break. Doing quite a bit of reading, purely for entertainment....aka J.K. Rowling. Had to read the whole Harry Potter series again after the 6th book came out. [IMG]smile.gif[/IMG]
Sarah
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,24,21,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 04:52<noscript>August 24, 2005 09:52 PM</noscript>:
Hi Sarah,
Welcome back.
What can Harry Potter tell us about pain/suffering? I'm being serious. I have not read the book so this isn't a riddle or a test, I'm just curious and making an assumption that there is something to be found in 6 volumes.
jon
<hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,24,23,29,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 06:29<noscript>August 24, 2005 11:29 PM</noscript>:
Hang on to your wand. He's always dropping it, or losing it or getting it taken away. Since apparently you can't do magic without it, then I'd have that thing glued to me, or least tied on. I guess you can wonder about the need for a tool to practice what seems inherent.
The main thing though, is that despite what he's been through and likely will have to go through, he's not a victim, and doesn't let himself become one.
<hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,25,0,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 07:08<noscript>August 25, 2005 12:08 AM</noscript>:
If I remember the book correctly, he gets a headache whenever his arch enemy is nearby, right in that zigzag scar on his head where he was nearly killed by the same guy when he was a baby. It's a warning, like pain is supposed to be.
His other big pain is being an orphan (parents killed by the same guy during the scarring episode), an emotional pain that will never heal, one he will have to learn to live with and will make him a better wizard probably.
<hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,25,12,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 19:59<noscript>August 25, 2005 12:59 PM</noscript>:
Who'da thunk a discussion of the lack of correlation between pain and scapular positioning would end up discussing "Harry Potter" a hundred or so posts later? Always interesting.
Harry always seems to be on a ride which he can't fully control. He is desperately trying to figure out who he is and what is going on. Many people are trying to help, even the wisest of the wise (The Ministry of Magic, Dumbledore), but they often end up making things worse through stubborn refusal to see the truth or a genuine desire to help. It certainly seems that he needs some sort of "consumatory act" to regain control.
mike t
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,25,15,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-08-2005 22:40<noscript>August 25, 2005 03:40 PM</noscript>:
Amazing where threads will go...
I admit total ignorance of the subject - have never read one word of Potter...
heretical!
Nari
<hr> Posted by Rick (Member # 4173) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,26,6,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-08-2005 13:07<noscript>August 26, 2005 06:07 AM</noscript>:
My 2 cents,
I have only seen Barret speak once, at an Ola Grimsby forum a few years back. He had a group of manual physical therapist stand up and sing his version of "If I only had a brain", I thought it was great. His lecture provided a lot of insight to a group who, as a group probably didn't have any idea what to expect from him (were mostly thick headed joint guys, don't you know). At the time I gave Ola a lot of credit for bringing him in and reminding us not to loose focus on the patient while in the midst of trying to find something stuck that we could loosen. I can't speak for anyone else in attendance but I did not find him insensitive or arogant at all. His teaching style was all right by me.
Rick
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,7,26,13,11,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-08-2005 20:11<noscript>August 26, 2005 01:11 PM</noscript>:
I really didn't expect to hijack the thread again! But now I'm going to go with it...
I think many people can identify with the Harry Potter stories, as they contain the classic archtypes such as the reluctant hero, the egotistical villain (always going off on some big diatribe before attempting to kill the hero), and the loyal sidekick. I personally identify more with Hermione being brainy and bookish (with curly hair). As for pain and suffering, I think the theme is that what doesn't kill us makes us stronger and that deeper understanding is gained through trials. Good always triumphs over evil. Cliche I know, but it works for me.
Sarah
<hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,1,21,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 04:40<noscript>September 01, 2005 09:40 PM</noscript>:
Yikes, I killed the thread......in any case, can someone please look at my scapula? I think it is too far away from my spine. [IMG]wink.gif[/IMG]
Sarah
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,1,22,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 05:35<noscript>September 01, 2005 10:35 PM</noscript>:
Sarah
I don't think you killed it; it simply ran its course and 220+ responses would indicate that, perhaps!
I know why your scapula is off beam - it's wandering about. After all they talk about wandering placentae..so why not the scapula? [IMG]wink.gif[/IMG]
Nari
<hr> Posted by gary s (Member # 1098) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,1,22,45,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 05:45<noscript>September 01, 2005 10:45 PM</noscript>:
Nari,
I think it's wandering uterus.
Gary
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,2,0,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 07:19<noscript>September 02, 2005 12:19 AM</noscript>:
Gary
True, there is a wandering uterus, but there is also a wandering placenta..so I learned during 10 years of perinatal work. Still could be an urban/midwife myth! Maybe a pseudowandering placenta...
Nari
<hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,2,6,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 02-09-2005 13:19<noscript>September 02, 2005 06:19 AM</noscript>:
My brain wanders all the time.
jon
<hr> Posted by Sebastian Asselbergs (Member # 174) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,6,6,31,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-09-2005 13:31<noscript>September 06, 2005 06:31 AM</noscript>:
my scapula wonders where my brain wandered...
<hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,7,16,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-09-2005 23:48<noscript>September 07, 2005 04:48 PM</noscript>:
Sebastian, don't worry, as long as the reptilian brain is around you can live on reflexes. Isn't it great that a pithed cat can walk on a treadmill. And this thread is about what?
Sarah, I kill alot of threads too, don't feel lonesome.
<hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,8,7,18,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-09-2005 01:55<noscript>September 07, 2005 06:55 PM</noscript>:
Who was the b----r who pithed the cat??? (I am a cat lover).
Sarah, this has been one of the most inspiring threads yet - and it is still going, though with a severe case of wandering. Much better, though, than standing still with brainrot.
Eric -start another thread like this one! [IMG]tongue.gif[/IMG]
Nari