Another reason therapists don't know

[BB]

Thanks, Patrick. Good stuff.

If a PT argues that the "help" is really just a catalyst for self correction, the assumption is that in time, the patient would reach resolution in the absence of said catalyst. If one argued that the "help" assists resolution, the assumption is that the patient would not reach resolution if left to their own devices.

I'd only add this:

If one argued that the "help" assists resolution, the assumption is that the patient would not reach resolution AS QUICKLY if left to their own devices.

The possible exception is chronic widespread pain, which very well may not be able to reach resolution at all without help. These situations are dripping so much with confounding contextual and coping factors that sorting it all out would likely be impossible. In keeping with the chemical reaction terminology (catalyst increases the rate of reaction), their reaction may be taking place in a contaminated solvent.

Thanks for the discussion all.

[Barrett Dorko]

I really like the "as quickly" addition by Cory. There's always the possibility that the WRONG information has been given the patient by someone they really trust. That doesn't make this person bad, just willfully ignorant.

They abound.

[John W]

I would also add that the patient might not reach resolution as efficiently or cost-effectively.

Our current modern health care systems have virtually no sense of the relative value of interventions to treat pain.

I agree with Bob. This is a social problem- or more accurately- a sociopolitical problem. Our modern health care systems have indisputably failed to provide consistent value for patients. Why are we surprised that they are bankrupting our countries?

[marcel]

May I add, the outcomes of the whiplash motor control study recently brought up by D.Butler showed a relative inexpensive intervention is equally effective compared to a 20 hour intervention. There are more examples like that study. Wonder if these signals are noticed sociopolitically.

[Barrett Dorko]

Wouldn't treating our patients more effectively be bad news for the companies that hire PTs and collect the money for their services?

[Evanthis Raftopoulos]

Hi John, if you have been able to sort out those concepts clearly in your mind and how they are linked to the pain experience, and if you have been able to communicate that effectively to the patients and in way that positively influences perception and cognition, then great. I don't think that explaining some of those concepts (excitomotor, sensorimotor, ideomotor) is necessary, but if you feel that it makes a difference then I understand your efforts of defending their usefulness. I think that language is very important, but like with our general approach to patient care, what I think is optimal language (which is also patient dependent) may slightly differ from what you or anybody else here thinks is optimal. I'm confident that most of us here in SS have more similarities than differences in our day to day interactions with patients. Moreover, I 'm confident that all of the PT's who participate here educate their patients in what they think is going on with them (to the best of their knowledge), the role of movement/exercise in their recovery, and the importance of self management.

About volitional, non volitional, and ideomotion. My understanding is that SC the method is partially founded on these ambiguous concepts. Do you practice SC with your patients?

[Barrett Dorko]

Evan,

You seem not to know, despite being told repeatedly by the guy who uses the term all the time and has taught it for many years, that Simple Contact is NOT just a method employed (in my case, gentle touch to enhance awareness), but an understanding of neuroscience, anatomy, neurophysiology, cultural influence and the use of active motion.

Asking John if he "uses" all of that is, well, troublesome.

You're not able to figure this out?

[Evanthis Raftopoulos]

I have no doubt that John values and understands “neuroscience, anatomy, neurophysiology, cultural influence and the use of active motion”. I asked him if he is using SC, meaning the manual/ritual part of it, i.e. what you demonstrate here http://www.youtube.com/watch?v=ccPqSOY3uOs

[John W]

I don't think that explaining some of those concepts (excitomotor, sensorimotor, ideomotor) is necessary, but if you feel that it makes a difference then I understand your efforts of defending their usefulness.

Evan,
My understanding of using a science-based approach to care is that it's most likely to result in the most effective outcome and advance the field of knowledge so that our interventions can improve. This is what I understand a professional provider of care is obligated to do. Also in doing so, I have to be comfortable with a certain level of uncertainty, which includes not knowing exactly how the patient will respond to the information that I provide. I routinely get quizzical looks, and have to backtrack or rephrase my point to get it across. Sometimes, patients don't quite get it, so I move on. Often, they do get it, and their improved understanding fosters a better treatment interaction.

I don't categorize movements for patients in this way because I "feel" that it makes a difference. I think your choice of words, although perhaps not intentional, is condescending. This implies that I haven't given this much thought, and that the ultimate decision to use this approach is driven by emotion. I think you should avoid guessing what motivates me to communicate with my patients in the way that I choose to do. You've already said that you disagree, and I think you should leave it at that.

I've never taken Barrett's course, so I'm not sure if I formally practice SC with my patients. I do, however, when I sense that they are moving in what appears to be an unplanned way, ask them about the characteristics of correction, and encourage them to move in ways that bring this about.

I'm confident that most of us here in SS have more similarities than differences in our day to day interactions with patients. Moreover, I 'm confident that all of the PT's who participate here educate their patients in what they think is going on with them (to the best of their knowledge), the role of movement/exercise in their recovery, and the importance of self management.

Does this mean you're not going to share with us how you communicate what you do with your patients? I wonder where your confidence comes from that you have more similarities than differences in your treatment interaction with others here at SS?

[Evanthis Raftopoulos]

This implies that I haven't given this much thought, and that the ultimate decision to use this approach is driven by emotion.

Not in my mind, it implies that you feel confident in what you do because of your current understanding.

I've never taken Barrett's course, so I'm not sure if I formally practice SC with my patients. I do, however, when I sense that they are moving in what appears to be an unplanned way, ask them about the characteristics of correction, and encourage them to move in ways that bring this about.

I also encourage movement that does not follow a predictable to the observer pattern (through exploration or self modification of given exercise) , but I don’t consider this as SC.

I wonder where your confidence comes from that you have more similarities than differences in your treatment interaction with others here at SS?

My confidence comes from my participation here.

[Barrett Dorko]

John,

I guess that means "No, I'm not going to describe what I do, demonstrate it or defend it."

Of course, I could be wrong, and Evan is certainly under no such obligation.

wicked has asked the price of my course, but that's always up to the sponsor.

[John W]

I also encourage movement that does not follow a predictable to the observer pattern (through exploration or self modification of given exercise) , but I don’t consider this as SC.

Sounds like we're in agreement here. I don't know that I'd call it SC either. I'm planning on attending Barrett's course in October at Rod Henderson's clinic. Maybe after that I will call it SC. I don't think it really matters much, though.

My confidence comes from my participation here.

That last question wasn't directed at you. I'll take you at your word that you're confident you practice like others here. I was wondering out loud how you explain your rationale for treating pain with your patients. Since you've never provided so much as an anecdotal report, all we have to go on is dozens if not hundreds of comments where you theorize. Nothing wrong with that. I'm just wondering where this rubber meets the road for you.

I'm a hands-on learner.

[John W]

I'm struck by the irony of wicked's question. If more PTs took Barrett's course and applied what they learned in the clinic, the companies that charge for PT services would see a drastic reduction in their income.

Other than that, I'm not sure why he/she even asked the question.

[Barrett Dorko]

Yes John, I wondered as well.

Increasing the amount of time any therapist spends treating a patient is $ in the bank.

However, I make the case that knowing more means you have to do less. The billing needed?

I remain confused.

[Chunk]

I make the case that knowing more means you have to do less..

:clap2::clap2: