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  • So, I think it's reasonable to conclude that any adaptive change in motor output is due to an alteration in the pain neurotag.
    Well that flies in the face of the "bottom up" hypoxic peripheral nerve story. Ie altered motor output relieves mechanical deformation on neural tissue, thus reducing what might be a primary driver of threat processing for a given presentation of pain.

    I don't think we have any way to know whether altered motor output precedes or proceeds from changes to the pain neurotag

    Comment


    • But, I think Diane has also persuasively argued that providing the neuromatrix with an input that "reminds" it of movement via skin stretch is also important.
      If it is reasonable to do this via skin receptors, it is also reasonable to do the same via other receptors that "remind" the brain of movement.

      Comment


      • I find that listening to a patient's verbiage is unreliable.
        To back up Barrett's point.

        Evidence is reviewed which suggests that there may be little or no direct intro- spective access to higher order cognitive processes. Subjects are sometimes (a) unaware of the existence of a stimulus that importantly influenced a response, (b) unaware of the existence of the response, and (c) unaware that the stimulus has affected the response. It is proposed that when people attempt to report on their cognitive processes, that is, on the processes mediating the effects of a stimulus on a response, they do not do so on the basis of any true introspection. Instead, their reports are based on a priori, implicit causal theories, or judg- ments about the extent to which a particular stimulus is a plausible cause of a given response. This suggests that though people may not be able to observe directly their cognitive processes, they will sometimes be able to report accu- rately about them. Accurate reports will occur when influential stimuli are salient and are plausible causes of the responses they produce, and will not occur when stimuli are not salient or are not plausible causes.
        "Why
        From:
        Nisbett, R., & Wilson, T. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review, (3). Retrieved from http://psycnet.apa.org/journals/rev/84/3/231/
        --------------------------------------------------------------
        Body is imbued with mind, and mind is embodied.

        Comment


        • If you do a search on the site you should find threads (possibly quite old threads) explaining ideomotion. In short, you are giving yourself permission for non-volitional movement to occur. No oxymoron.
          Hi Nari, if you need to give yourself permission as you imply, which requires some mental effort, then the movement is volitional to some extend. It seems that by non volitional movement you mean movement that occurs at the subconcious level? Like typing or driving? If yes, then how do you differentiate ‘ideomotion’ from any other movement that we are not focally aware? This goes back to why call this ideomotion and not just movement?

          I totally disagree with your definition of ideomotion here. Where do you get the "small movement we are not aware of" idea?
          Hi Gilbert,

          http://www.skepdic.com/ideomotor.html

          "The term "ideomotor action" was coined by William B. Carpenter in 1852 in his explanation for the movements of rods and pendulums by dowsers, and some table turning or lifting by spirit mediums (the ones that weren't accomplished by cheating). Carpenter argued that muscular movement can be initiated by the mind independently of volition or emotions. We may not be aware of it, but suggestions can be made to the mind by others or by observations. Those suggestions can influence the mind and affect motor behavior.

          ...Furthermore, these tests demonstrate that "honest, intelligent people can unconsciously engage in muscular activity that is consistent with their expectations" (Hyman 1999). They also show suggestions that guide behavior can be given by subtle cues (Hyman 1977)."

          I still fail to see how the above has anything to do with therapy and pain resolution.I still fail to see how one can elicit true ideomotion (as defined above) by giving permission to self or others. I still fail to see the role of 'hands on' in all this. Thank you all for your patience but as Einstein said, “If you can't explain something simply, you don't understand it well enough". I could be wrong, but it seems to me that either this is happening here or what we are talking about is something different than ideomotion.
          -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
          The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

          Comment


          • RE: How to elicit ideomotion in yourself, I can only say what works for me. I need to be alone, relaxed (standing is fine) and then 'give permission' to just wait for movement to start. A light manual contact of my hand over a bony prominence as Barrett has suggested does help. Waiting patiently and 'doing nothing' volitionally are the hard part.

            What it feels like to me: If you've ever done the trick of standing in a doorway and pushing out isometrically with shoulder abuction for a minute, and then moving out of the doorway so your arms rise up by themselves, you know the feeling. There's a reason Barrett includes "effortless" and "surprise" as two of the characteristics. I laughed out loud the first time, as I think others have.
            Thank you for sharing Gilbert, but the example with the doorway contradicts what you say here "Waiting patiently and 'doing nothing' volitionally are the hard part. "
            -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
            The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

            Comment


            • Just try it instead of talking about it...
              only trying to help...

              Comment


              • ....if you need to give yourself permission as you imply, which requires some mental effort, then the movement is volitional to some extend
                Wrong on both counts, Evan.
                Gilbert is, I think, giving a good example of doing nothing plus an exercise to demonstrate what non-volitional movement is, which also arises out of 'doing nothing'.

                I would say that it is possible for some people not to be able to elicit or recognise non-volitional movement or even the characteristics of correction. It may be dependent on many factors, most of which are indeterminate. That is all I can think of to explain the discrepancies.

                Nari

                Comment


                • I posted this awhile back on "passive movement."

                  I do not feel it makes much sense to distinguish between passive movement and active movement. The construct as it is defined and presented in PT school is wholly inadequate. There may be a difference between when a patient "uses" a therapist to move (provide the kinetic energy required for movement) ones arm and when that movement is self propelled. However the degree to which one's nervous system participates more or less in the process of movement seems wholly independent of that fact. (See the posted link for more extrapolated ideas).

                  Further, in this thread on ideomotion I advocated that motion can not be simply parceled into ideomotor motion vs some other type of motion. That is what is implied when people say that the corrective movement was based on ideomotion. I think Barrett may explain simple contact in therapeutic terms as involving ideomotion but this does eliminate the fact that some people's defensive output, hence pain, is based on ideomotion as well. The correction is simply changing the "idea/belief/prediction" that the nervous system is operating under.

                  We should have evolutionary derived cognitive structures that govern which inputs are more salient than others. We are not a blank slate. We do see highly conserved behaviors across the domains of expression of pain and care related behaviors both within humans and non-human primates. It is through these conserved behaviors of expression and care related behaviors that a process of instilling a new belief the being requesting care.

                  What might these inputs look like? I would stratify them as:

                  1. Touch
                  2. non-verbal behaviors
                  3. verbal
                  4. General environmental factors.

                  As you move from 1-4 your go from culturally conserved to culturally specific. Although you could make the argument that you should flip flop 3 and 4 as most modern medical systems adopt relatively similar symbols and contextual cues to accompany them. By far though the degree of change between non-verbal and verbal behaviors is great. As you need a lot more education to understand the verbal than the non-verbal cues one is providing.

                  To return to the ultimate question of passive vs. active, I think one must ask what is the intent that therapist is assisting in the movement in of one's body part? Followed by what does the patient perceive is the intent of the therapist. Either the discrepancy or alignment of these two intents is paramount to understanding if the purpose of the act will reach a therapeutic end.

                  The alignment or discrepancy of intent will be based on how well each expression is matched and reciprocally mirrored.
                  --------------------------------------------------------------
                  Body is imbued with mind, and mind is embodied.

                  Comment


                  • To return to the ultimate question of passive vs. active, I think one must ask what is the intent that therapist is assisting in the movement in of one's body part? Followed by what does the patient perceive is the intent of the therapist.
                    i agree. i have stated several times through this thread "given appropriate education and context setting..."

                    If a PT chooses to use his/her hands to help a person in pain, the intent (in terms of handling) should be to provide novel and non threatening sensory/discrim input... and the education provided to the patient should prime the patient to receive novel and non threatening input.

                    That input could defensibly be delivered as light touch, coercive motion or choreographed/volitional movement. The degree to which a method is defensible, is in my view dependent on the explanatory narrative provided, not the style of handling.

                    Comment


                    • Just try it instead of talking about it...
                      only trying to help...
                      Hi Gilbert, are you talking about the doorway isometrics? If you are right and that is an expression of ideomotion (which I doubt), and if that specific phenomenon is very helpful towards long term pain resolution, then why not just teach the pain patient some isometric exercises vs. SC?

                      Wrong on both counts, Evan.
                      Gilbert is, I think, giving a good example of doing nothing plus an exercise to demonstrate what non-volitional movement is, which also arises out of 'doing nothing'.
                      Hi Nari, in your opinion all non volitional movement = ideomotion? As I asked before, how do you differentiate ‘ideomotion’ from any other movement that we are not focally aware?
                      -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                      The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                      Comment


                      • Eric, thank you for joining the discussion. I'd like to link here what you said in the other thread about ideomotion, perhaps it can help us sort out definitions/meanings

                        " I think I need a more parsimonious definition of ideomotion in order for me to understand the concept. For me ideomotion simply represents how an idea gets expressed as an action--whatever that idea is. This is my parsimonious definition. The idea that we are releasing ideomotion or inhibiting it seems to muddle the waters. The bigger question is what is the "idea" that dictates the expression through ideomotion. "
                        -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                        The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                        Comment


                        • I am at odds with this problem of ideomotion being seen as the result of an idea that dictates expression. I have no idea of the idea and I doubt anyone has; if it is an "idea" then we would have no knowledge of it.

                          All I can suggest is that the doubters try it themselves. Learning more about the hows and whys to enable this expression will probably not assist. Just allow yourself to try eliciting. Others have done this at home and succeeded.

                          Nari

                          Comment


                          • Blaise,

                            I was not referring to you, rather to Evan's statement on the idea and expression of same.
                            Actually, this is becoming more and more complicated, so I will retire this time and suggest again that experimentation really does work on oneself. (Easier the first time than with a patient!)

                            Then again, the second option is to continue with whatever one feels familiar with.

                            Nari

                            Comment


                            • Barrett said:

                              Moving others passively (and I know the concept is problematic) presumes that the therapist knows which way to go and when that doesn't work out especially well either through no lasting response or increased report of pain, the patient's report of what they think is placed in the mix.
                              I could see this being an issue if the therapist is using an explanation that indicates the joint or limb is not moving in a direction and that is the cause of the pain. For example, a RC tendinopathy with pain into abduction. The therapist could make the mistake of stating that the stiff posterior capsule has caused an impingement of the RC. Well we know with evidence that this isn't the case. However, I will still take the patients limb into abduction to the painful level and perform posterior and caudal glides. The difference is that I am not explaining to the patient that this technique will stretch their tight capsule that has led to their pain. My main concern is to provide non-painful afferent input. I do my best to explain why i am using manual therapy so that they understand.

                              I also like passive techniques since it involves taking the arm into the direction that causes their pain and it can then be retested. I think this can be a benefit to the patient when they can get immediate improvemetns in range and realize that they can lift their arm to a higher level. I think that's key to using passive ROM and joint mobilization techniques. I think the reason I still use these techniques is because that was how I was trained. The difference is that I have changed my explanation for there use.

                              I also use Mulligan techniques since it onvloves a manual contact along with active movements. My expereince has been that if the patient gets a reduction in pain with an increase in movment these techniques tend to result in pain-free motion in a shorter time frame.

                              Finally there does seem to be a hierarchy to my approach to manual therapy based on the patients response to me handling them. I will typically start with Mulligan. If the patient can't tolerate these techniques I move to joint mobs near their available range prior to pain. If this isn't tolerated I move to manual techniques with the arm in neutral. These techniques would resemble some DNM techniques.

                              PatrickL said:

                              That input could defensibly be delivered as light touch, coercive motion or choreographed/volitional movement. The degree to which a method is defensible, is in my view dependent on the explanatory narrative provided, not the style of handling.
                              Based on my experience with manual therapy I would agree with this statement.
                              Rob Willcott Physiotherapist

                              Comment


                              • What a great thread.

                                In post #175 Patrick quotes what I say about passive movement "(this) implies that the therapist knows which way to go" and says "No it doesn't."

                                Perhaps I should have said, "The therapist is guessing but seems really confident."

                                Perhaps he and I have different ideas about what passive movement means.
                                Barrett L. Dorko

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