Another reason therapists don't know

[advantage1]

Barrett,

I think that one reason for the resistance to the term ideomotion is due to our professions love of biomechanics. Those in the orthopedic world love biomechanics and the idea that they can have an effect on a patients. There's still a strong belief that manual therapy effects a persons biomechanics directly. This is easily grasped by many and is a long held belief. Understanding ideomotion requires that you first understand that we have a limited role effecting a patients biomechanics directly. Many can't let go of this idea. Secondly, it requires an understanding of the neuromatix and many of the concepts written by yourself, Melzack, Wall, Ramachandran to name a few. Some just don't care enough to do this reading. For me it took a long time to accept this idea of ideomotion. It was when I read Wall describe withdrawl, protection and resolution that the light bulb went off in my head. This site also helped me to understnad the concept of defense vs. defect which also ties incely into the idea of ideomotion. In order for me to reach this understanding I had to drop many of my long held beliefs about pain and biomechanics. I also had to become an autodidact and read in my spare time. Unfortunately, many that treat patients state they're too busy to read.

[Jo Bowyer]

Don't you run the risk of your own ideomotor response unconsciously guiding the movement?

As someone who has never attended an SC course but has worked with ideomotion since the '70s to the extent that it feels as natural as breathing, I am aware that my ideomotion interacts with that of the patient to the extent that something emerges from the two of us, not dissimilar to that which happens with jamming musicians and dancers or actors engaged in improvisation.



Musical Mystery: Researchers Examine Science Behind Performer Movements

http://neurosciencenews.com/musician-movements-6891/

Update 14/06/2017

[Barrett Dorko]

Josh,

Thanks for asking. I've been asked this about a thousand times before.

No, you needn't touch others. Again, in case you haven't read this before, ideomotion is inherent to life. Not pain and not the presence of another. Perhaps I need to say that differently because that doesn't seem to be getting across.

Then again, it often helps a bit more to speak to a friend than if a friend isn't present. This doesn't mean your friend tells you what to say. Anyone who thinks that I'm moving others soon finds out I'm not. If I were, I think I would have figured that out a while ago. Guiding them in what I suppose is a corrective way is called manual coercion or passive movement or manipulation. How the hell would I know which way that was?

I don't do that.

[Barrett Dorko]

Josh,

You wondered quite reasonably why a therapist was even needed.

Don't you work near another who is giving out all kinds of bad advice? Is their excuse for knowing nothing about neuroscience because they don't get HBO? Aren't they nice but willfully ignorant? Isn't it your job to counteract that in some way? Wouldn't whomever you work for completely HATE the idea of self-correction?

Testing the presence of SC, which is really just permission to move naturally, and its sham would be rather difficult.

Handcuffs come to mind though.

[Josh]

If you don't move or coerce them in any way, and it doesn't matter if you are there, does it matter where you touch them. If it doesn't, I'd have a tough paying for this as an insurance company paying for PT.

If we can't test or falsify you method as a treatment for pain against a sham, how are we supposed to adopt the method?

I haven't been around long enough to believe my bosses would like me to prolong recovery and correction because it would be bad for business, if that's what you're implying.

[Barrett Dorko]

Josh says:

I haven't been around long enough to believe my bosses would like me to prolong recovery and correction because it would be bad for business, if that's what you're implying.

Worked in any SNFs as a traveler yet?

I'm not implying this, I'm saying it.

[nari]

I have to admit I am lost with the confusion over SC/ideomotion. It seems so simple and effective everyone could employ it as part of their program - although, if working in the USA I do not know how it could be "counted" as a treatment.

There seems to be resistance because:

The therapist doesn't have to do anything?

In that case why is the patient there if the therapist doesn't "do" anything?

(Touch is NOT required for elicitation of ideomotion, but it can be useful at times).

It is not biomechanical, therefore is not appropriate?

The patient might fall over during movements?

The whole concept is not in the texts?

Therapist may feel uncomfortable trying to explain why the pain has gone/eased?

Nari

[Barrett Dorko]

I hear you Nari.

Stepping away from biomechanics is problematic. My guess is that it would be best to simply make something up. Isn't this what therapists do anyway?

Why do people always worry about the patients falling over? I think that this is an unreasonable concern.

Throw in some Feldenkrais and/or Cory's work and you've got your HEP. Write something "functional" into your plan of care.

I think the problem is that the ankle weights will grow a bit dusty - and that's a problem.

I must ask Josh: The COTA (your boss) has the responsibility of making sure you're 90% productive and they want you to see some Medicare B who has no hope of being rehabilitated. Maybe there's more than one of them.

What are you going to do?

[Barrett Dorko]

I forgot to mention that 75% of your patients are now on "ultra high" Medicare designation.

If I'm exaggerating, please, somebody point this out.

[Josh]

Nope, never worked as a traveler. I do work with patients in a rehab hospital and we set goals every year to shorten LOS and get patients home safely.

I wouldn't chose to work in a setting as you describe, because it would drive me crazy. It sounds as if you don't enjoy it either.

Please don't assume I can't step away from biomechanics enough to understand SC/ideomotion. I don't think this method is as defensible and bullet proof as a physical therapy intervention as others. It also doesn't mean I haven't read enough neuroscience material. It means that we may have to agree to disagree on the importance of sc/ideomotion in PT.

[gollygosh]

Biomechanics has its place. It just isn't as big a place as our profession has given it. Motion is much more important. If I can get out of the way and get the patient to move ala ideomotion, or ala feldenkreis with awareness--as opposed to worshipping, goniometric movement in standard test positions--then I am being therapeutic.

[Barrett Dorko]

Josh says:

I don't think this method is as defensible and bullet proof as a physical therapy intervention as others. It also doesn't mean I haven't read enough neuroscience material. It means that we may have to agree to disagree on the importance of sc/ideomotion in PT.

I don't want that. I want to discuss.

I'm still waiting for anyone doing what has been done in PT for many years to state a defensible premise.

Working in a rehab facility, it makes sense you're encouraged to get people better and home.

Guess what?

[Johnny_Nada]

nari,
I'm addressing your comments from an insurance provider perspective.

if working in the USA I do not know how it could be "counted" as a treatment.

The difficulty is how to justify it as skilled?

The therapist doesn't have to do anything?

..case in point…

Therapist may feel uncomfortable trying to explain why the pain has gone/eased?

I am still waiting for some decent literature to support this occurs with SC/ideomotion more than other 'treatments.' I hear this from all people: manual therapist, continuous mobilizers, MDTers, dry needlers, massage therapists, crania-myofascia-strainer-skin scrapers etc.

[Barrett Dorko]

Is it assumed that the therapists doesn't do any explaining, teaching, context creating, encouraging, lifting (if necessary), guarding, documenting, studying, knowing, speaking, coordinating and several other things I can't think of right now?

I know it's hard (maybe uncomfortable) to try to explain to other therapists how it is that corrective movement can help, especially when weeks of strengthening is preferred.

[Keith]

Correct me if I am off base here, but it seems that Simple Contact is often understood as interchangeable with the term 'ideomotion', which is not at all the point.

Simple Contact is a method/approach whereby the locus of control is handed over to the patient in an effort to allow them to explore their own body schema. The time spent with 'hands-on' is educational - some people can get out their whiteboards and share their story, SC simply encourages the patient to move in a novel way (ideomotion). Deep breathing exercises can accompany SC to down-regulate the sympathetic nervous system. Encouraging ideomotion is a portion of a treatment session, not necessarily a session in-and-of itself. That ideomotion/educational portion is followed up by strengthening if/as appropriate and exercises/activities to be completed independently outside of the formal P.T. setting (ideomotion, Feldenkrais, etc). That, in my estimation, is Simple Contact - not ideomotion alone.

Where's the problem?

Respectfully,
Keith