Announcement

Collapse
No announcement yet.

Another reason therapists don't know

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • wicked,

    I would suggest that there are a multitude of things within us. Emergence of one changes from moment to moment. Thus - complexity.

    Diane, I'm certain you're right, I used to say elicit, but switched to catalyze long ago.
    Barrett L. Dorko

    Comment


    • I'd argue, in the abscence of anesthesia, that PROM still relies on the patient's instinct, ability to self-correct, ideomotion, unplanned movement, whatever we want to call it, not on luck. I will guess a certain direction will help move towards resolution, but the patient ultimately decides what it will allow and in which direction. So I'd say you could say PROM catalyzes self-correction too. I think that has been one of Patrick's points.

      Comment


      • I think that somewhere it was posited that it was impossible to move another passively, unless they were anesthetized. I would certainly agree with that. Thus, as you say Josh, the patient has a lot to say about resolution. They say it with motion. mainly.

        Since motion (active motion) is often elicited only with another's presence and direction, it always interests me. Many times I've read of people in the waiting room snapping to attention if the therapist walked through, and I've worked beside therapists who think that means they're good at what they do.

        To me, they've only induced fear.

        Isn't the "hand on another" eliciting a "straighter" motion, a higher lift of the arm while dancing (there's a commercial featuring this) disturbing to you? It seems so easy for "proper form" to mutate into that which is pleasing to the therapist's eye that the border toward appearance gets crossed without anyone noticing. The old saw of symmetry is evoked wordlessly and, once again, someone is considered an "expert" because they do more.

        Ken, is this seen in coaching much?
        Barrett L. Dorko

        Comment


        • I think that somewhere it was posited that it was impossible to move another passively, unless they were anesthetized
          Unless the patient was extremely clever with total submission and trust, I suspect this is right. I would imagine this would be difficult to achieve consistently.

          Nari

          Comment


          • But I have pointed out that the locus of control is tied to the narrative, not the manner of touch. I've argued that the risk of increasing nociception is negligible when a defensible narrative is used.
            Patrick,
            Yes, I see that you've pointed this out many times, but I don't see much of an argument. What evidence do you have to support that the manner of touch depends entirely on the narrative used and not the manner of touch? I think this falls into the category of being an extraordinary claim when an assertion is made that one of the most powerful predictors of delayed recovery from musculoskeletal injury is 100% attributable to the verbal interaction with the therapist, while any manual contact with the patient has no bearing on it at all as long as it follows "appropriate education". This assumes that the patient has made a complete shift in their thinking about the injury, it's relationship to their current pain, the biomedical context in which all this has occurred, and any previous experience they've had in that biomedical milieu merely based on a single therapist's diametrically opposed narrative (take a look at Bas's failure story from earlier today). And that's not to mention all the other complex issues that certain individuals might have with touch, including those who've been traumatized by it in various forms by supposed loved ones. (The statistics on physical and sexual abuse of children by family members is sobering, to say the least.) Safe to say, this would be an impressive session of education by any standard. And even Bas, who's been doing it for many years, still admits abject failure with some patients. This happens to me on a regular basis as well.

            Similarly, I don't see how you can assume that the risk of nociception is "negligible" based on a plausible narrative alone. Based on what?

            I think the decision to touch a patient is a profound one. It's fraught with all manner of misinterpretation and expectation on the part of the patient. My opinion is that it's generally taken for granted because it's listed in our licensure laws, and most therapists regularly abuse the privilege because they have no idea why they're doing it and understand even less what happens when they do it. The information that Diane, mostly, has brought here over the last decade on the science of touch and skin I suspect is the tip of an iceberg when it comes to what manual therapists need to know in order to apply manual therapy in a consistently effective manner, not to mention all the harm we've already likely caused by thoughtlessly grabbing hold of patients.

            Until we have a better handle on it (no pun intended), I think it would be wise to err on the side of caution and take a minimalist approach to manual therapy. I don't have nearly as much faith as you do in "appropriate education".
            John Ware, PT
            Fellow of the American Academy of Orthopedic Manual Physical Therapists
            "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
            “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
            be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

            Comment


            • Simple Contact does not "elicit" instinctive behavior, it "catalyzes" it. Another way of putting that is that it offers the patient an opportunity to express something already there.
              In the context of this discussion, catalyzes is just another way of saying that touch in the context of SC elicits or causes the expression of instincts. You are still claiming a causal relationship between what you do and someone’s instinctive behaviors.cause or accelerate (a reaction) by acting as a catalyst.
              cause (an action or process) to begin.


              If a defensible premise does exist for another form of care, reasoning and method, why have the thousands of views to this and other threads not seen one stated. I'm sure the premise is out there, but defending it given what we now know is problematic, to put it kindly.
              In the context of the aporia of pain (as John Quintner puts it), I’m confident that we can come up with a (speculative) premise for any form of care and method. Not only that, but we can also use the premise that you constructed for SC for any other approach. What stops one from claiming that manipulation or needling ‘catalyzes instincts’ ?


              As far as your "accepting instinctive behavior" goes, what might you speculate happens when a trusted acquaintance just sits quietly and you've a story to tell?
              I have nothing to speculate about that. How do you know that the behavior you observe is instinctive and not learned early on?
              -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


              • What stops one from claiming that manipulation or needling ‘catalyzes instincts’?
                There's nothing stopping anyone from making such a claim. Don't hold your breath though waiting for someone to defend it.
                John Ware, PT
                Fellow of the American Academy of Orthopedic Manual Physical Therapists
                "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                Comment


                • And Evan... I have to say that I'm a little disappointed that you wouldn't attempt to speculate on the scenario that Barrett presented. After all this I think he's earned that much.
                  John Ware, PT
                  Fellow of the American Academy of Orthopedic Manual Physical Therapists
                  "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                  “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                  be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                  Comment


                  • Blaise,
                    Barrett has answered dozens of penetrating questions regarding the fundamental premise that the method he's developed is based on. He's been patient and gracious in doing so. It has nothing to do with his being an "authority" on anything. In fact, the only thing that I'm aware that Barrett might be an authority on is juggling and TV shows from the 1960s. After all of this, he asked Evan a straightforward and, I think, very relevant question that goes straight to the heart of what Evan, himself, has been dissecting out over dozens of comments. He in effect just brushed it aside as if some annoying insect had just landed on his shoulder. I think Barrett, since he asked the question, is most deserving of an answer, but so are the rest of us.

                    And also, you seem to be holding me, Barrett, and Diane to a different standard than others. Do you see any foundation, for instance, for Patrick's position, which I just laid out in my last reply to him? Do you think that Patrick's "pointing out" that the narrative is solely sufficient for ensuring that the patient's locus of control remains intact regardless of the type of touch constitutes an argument? Or is it just his opinion? I don't see any references to any research on self-efficacy or the psychology of goals. I don't see any reference in his remarks to the use of an outcome measure showing the effects of his "appropriate education" or even what "appropriate" entails. What does he mean by the risk of nociception being "negligible" with the appropriate narrative?

                    For instance, what if I happened to wear a tie to work that day that reminded the patient of their grandfather, in whom they had tremendous respect and admiration? Would that impact the "appropriateness" of my educational narrative? What if I chose a certain song to play on the stereo when the patient arrived that reminded them of a time when they moved effortlessly? Would that be on the checklist that moves my education from "totally ineffective" to "appropriate"?

                    Patrick is uniquely skilled in highly organized thinking and rhetoric, but I'm not seeing much of an argument here.
                    John Ware, PT
                    Fellow of the American Academy of Orthopedic Manual Physical Therapists
                    "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                    “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                    be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                    Comment


                    • And Evan... I have to say that I'm a little disappointed that you wouldn't attempt to speculate on the scenario that Barrett presented. After all this I think he's earned that much.
                      After all of this, he asked Evan a straightforward and, I think, very relevant question that goes straight to the heart of what Evan, himself, has been dissecting out over dozens of comments. He in effect just brushed it aside as if some annoying insect had just landed on his shoulder.
                      Hi John, I'm not following your point. Perhaps I misinterpreted the question. Is Barrett asking me to make up a story? I have nothing to speculate about “what happens when a trusted acquaintance just sits quietly and you've a story to tell” .
                      -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


                      • The critter brain has a choice to make, based on threat determination: for sure it will check out a new hand (new person touching, novel input, stranger's nervous system). It will have to choose: is this a threat? (whereupon it will try to retreat) or is this a good thing? (and it will try to move closer). I don't see how any of that is not instinctive.
                        Hi Diane, it’s not instinctive if it it has anything to do with memory and learning. Are we pretending that we know how to sort out by observation what is instinct and what is learned behavior?In the context of cognitive biases this seems to be as bad as 'palpatory pareidolia', perhaps worse.

                        Even single-cell organisms do that. They do it through chemo-gradient pursuit or retreat..
                        Yes, and it is reasonable to argue that the higher the intelligence of an organism the less it relies on instincts and the more it relies on memory and learning.
                        -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


                        • What evidence do you have to support that the manner of touch depends entirely on the narrative used and not the manner of touch?
                          John did you mean to write?
                          What evidence do you have to support that the manner of touch locus of control depends entirely on the narrative used and not the manner of touch?

                          I think this falls into the category of being an extraordinary claim when an assertion is made that one of the most powerful predictors of delayed recovery from musculoskeletal injury is 100% attributable to the verbal interaction with the therapist, while any manual contact with the patient has no bearing on it at all as long as it follows "appropriate education".
                          This reads to me like your putting words claims in my mouth. Although I admit that what I've written was open to bring interpreted that way... And that is my fault, sorry.

                          I haven't meant to claim that locus of control is entirely dependent on the PTs verbiage, so I apologize if that's how that post of mine reads. I've argued, or attempted to argue, that I don't think there is necessarily a greater loss of locus of control if one chooses a coercive manner of handling over a non coercive manner. Isn't mfr and cst evidence enough? Perhaps you could re-read post 432, which was a direct response to one of your posts, which to date you haven't directly addressed. I think it best summarizes my position.

                          Similarly, I don't see how you can assume that the risk of nociception is "negligible" based on a plausible narrative alone. Based on what?
                          I argue that if a PT understands enough to provide a defensible narrative/explanation, this will preclude the provision of sensory/discrim input that is aggressive enough to create nociception. Wouldn't a defensible narrative, at minimum, make a point about the importance of providing non threatening inputs? Wouldn't such a narrative preclude the provision of "nociceptive" handling? Why would anyone use a narrative about the provision of non threatening input, and then go ahead and provide threatening input?

                          I think the decision to touch a patient is a profound one. It's fraught with all manner of misinterpretation and expectation on the part of the patient.
                          I agree
                          My opinion is that it's generally taken for granted because it's listed in our licensure laws, and most therapists regularly abuse the privilege because they have no idea why they're doing it and understand even less what happens when they do it.
                          I agree
                          The information that Diane, mostly, has brought here over the last decade on the science of touch and skin I suspect is the tip of an iceberg when it comes to what manual therapists need to know in order to apply manual therapy in a consistently effective manner, not to mention all the harm we've already likely caused by thoughtlessly grabbing hold of patients.
                          By all means suspect until your heart is content. It doesn't have much bearing on my main argument- which is that we can't really make a case for the relative defensibility of coercive vs non coercive touch vs choreographed active movement.

                          I'm certainly not an advocate for thoughtless grabbing of patients. It seems to be a common reaction by yourself, Diane and Barrett to what I write here. If I state that something like "coercive touch is not necessarily less defensible than non coercive touch, it seems to trigger reactive responses based on what I think is an assumption that I'm defending all those thoughtless patient grabbers.

                          Until we have a better handle on it (no pun intended), I think it would be wise to err on the side of caution and take a minimalist approach to manual therapy. I don't have nearly as much faith as you do in "appropriate education".
                          Well, as I said in post 432, I think there is a lower limit to the risks you speak of. So it doesn't make sense to simply state that minimal is better/safer. I'll state again that I don't know where these upper or lower limits lie for a given individual, or a population. I just don't see any reason to think that the upper limit of acceptable risk for loss of locus of control, or for causing nociception is breached when one starts to move a patient passively.

                          I also don't see any reason to think that the role of the skin in manual therapy is ignored at the moment one begins to move a patient passively.

                          I really think that the problem here is that you have convince yourself that light/non coercive touch is the only type of touch that is congruent with breadth and depth of relevant science. There are plenty of coercive handling methods that are incongruous with the relevant science. I don't deny that. I would argue that the basis for such indefensible coercive handling lies in the erroneous understanding of the PT providing the treatment. There are also many non coercive handling methods that are incongruous with the relevant science. All I've done is argue that a non coercive touch is not necessarily indefensible. That's all. You've even agreed with me on this point in this thread already. So I don't know what point you're driving at? That we should take a minimalist approach? What does that even mean? Is your reasoning for applying passive movement more congruous with a minimal approach than someone else's? Does the fact that you find it increasingly difficult to justify the choice to apply passive movement actually justify it? It sounds like you're arguing that passively applied movement is only ok if you really agonize over the decision to apply it.
                          Last edited by PatrickL; 24-05-2014, 02:39 PM.

                          Comment


                          • Apart from the one I’ve repeatedly asked about nociception;
                            http://www.somasimple.com/forums/sho...ns+nociception

                            http://www.somasimple.com/forums/sho...ns+nociception

                            Blaise, I don't know if you've read these two. I didn't fancy re opening the nociception debate in this thread

                            Comment


                            • Evan says in response to a scenario I described earlier regarding our sitting with someone we trust:

                              I have nothing to speculate about that. How do you know that the behavior you observe is instinctive and not learned early on?

                              In this thread there's a reference to Brian Boyd's amazing text specifically titled to act as an extension of Darwin's.

                              Boyd's basic premise is that those humans capable of and willing to tell stories were more likely to survive and pass on their genes. He also states that as any story is extended the narrative becomes “fuzzier” as the details are defended. He does this in over 500 well-documented pages.

                              I've a problem with many stories I hear and wrote about it here. I'd also like the story-teller to get to the point, thus my appreciation of and for the creative act.

                              Evan, if you've no way to speculate about what might happen when someone you trust (a variable thing) sits quietly next to you, I'd suggest you consider Boyd's premise.

                              More from me later.
                              Barrett L. Dorko

                              Comment


                              • Patrick says:

                                I just don't see any reason to think that the upper limit of acceptable risk for loss of locus of control, or for causing nociception is breached when one starts to move a patient passively.

                                I also don't see any reason to think that the role of the skin in manual therapy is ignored at the moment one begins to move a patient passively.
                                In response to your first comment: Where did anyone say that? We've also discussed the problems inherent to "passive" movement of the anaesthetized patient and how what we presume is "passive" actually isn't. Do you think there's "an upper limit of acceptable risk"? Haven't I agreed that deformation of another's skin is a "passive" movement? Are we approaching a "breach" when we begin to direct and choreograph movement more and more? Is there a spectrum of control and direction? Why is ballet far more potentially painful (to say nothing of injurious) than improvisation?

                                The second comment made me smile. Perhaps you can guess why.
                                Barrett L. Dorko

                                Comment

                                Working...
                                X