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  • #16
    I too am leery of the word "model" - either deep or not.
    I prefer "science-based explanatory framework". But I won't balk at "guiding principles".
    We don't see things as they are, we see things as WE are - Anais Nin

    I suppose it's easier to believe something than it is to understand it.
    Cmdr. Chris Hadfield on rise of poor / pseudo science

    Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

    We don't need a body to feel a body. Ronald Melzack

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    • #17
      Originally posted by keithp View Post
      The posting above reflects why some of my more recent postings on my own blog have focused on how I interact with my patients. I seems that as we move toward EBP and reimbursement squeezes us from all directions, continuing education is being forced to provide the student/enrolled with an efficient list of what to do, but there are few classes (DNM and SC as notable exceptions) that inform therapists HOW to be with their patients. Such approaches are decidedly more humanistic and empathetic in their approach.

      I think my next project (this spring/summer) is to create a repository for stories/yarns to be submitted by patients and therapists alike to try to slowly redirect the conversation from "what was done" to "how care was provided."

      My hope is that stories of interaction, shared among different disciplines, may remind a few folks out there that the best way to "help people" is to remember that they are people.

      Respectfully,
      Keith
      I would love to leave a copy of what you come with Keith to float in my office for my colleagues. I ended up in a feldenkrais training program to realize what you wrote much more succinctly. A guest trainer put it nicely, when going through a FI break out session she reminded all the people handling others to remember it was all about them(the handler), not the person being handled. It goes through my mind almost every day and I am thankful for it. The further I have come in my own exploration the more I appreciate Moshe's statement,"It's not what you do, it's how you do it."

      respectfully,

      chad
      Chad Hardin PT, GCFP

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      • #18
        i agree. to me this points to the extent to which the deep model is just a guess... i still dont think Ive seen anyway clearly articulate what the deep model is that is espoused by SS mods/members. Is there a consensus view? Can it be stated plainly?
        I think it's more than a guess. For instance, we know that the biomedical model does not account for enough variables to effectively treat pain- it lacks both depth and breadth. Scads of empirical evidence now exists showing that biomedicalism has failed miserably in the treatment of pain.

        On the other hand, there are treatment approaches that could be considered biopsychosocial, but they lack depth within one or several domains. For example, MFR is a biologically untenable construct. No one has been able to show that myofascial restrictions have a correlation with the pain experience. Several constructs in manual therapy fail on the biological level, including trigger points, joint restrictions, and muscle imbalances for the simple reason that they confuse defense with defect. Certain brands of MFR err across domains. For instance, the assumption that the benefits of light manual contact are mediated through some connection between emotional states and "restrictions" of myofascial layers fails imputes a degree of power of the practitioner over the patient's psyche that is not only indefensible, but dangerous, in my opinion. The purveyors of this approach will often refer to how "holistic" it is, which is the language they use for "biopsychosocial". However, their approach lacks a deep model- they simply don't have enough facts to support their clinical reasoning process.

        The manual therapy landscape is riddled with poorly articulated and indefensible premises. In other words, they lack a deep model.
        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

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        • #19
          Yes, but John, you haven't stated what your "deep" model is... Biopsychosocial?

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          • #20
            Can you defend what you're describing as reality?

            When that defense contains no wild speculation (no I don't know when things become wild but I know what plausible is) a deeper model will emerge.

            Anyway, deep is just "more than shallow." That's the way we define it in Ohio.
            Last edited by Barrett Dorko; 06-11-2015, 04:23 PM.
            Barrett L. Dorko

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            • #21
              John and Barrett, what is the deep model you espouse?

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              • #22
                Personnaly, I know what my deep model is not. It gets more ambiguous when I try to exactly know what it is. I think it's a lot easier to refute things than it is to prove a thing. The moment you see a black swann, you know they aren't all white. But still don't know for sure no other color exist.

                That is why at the moment I think my main role is to educate what pain is not and what it probably is more likely to be. What I am still really clueless about is what i should really be doing with my hands, or not, per se. Right now I am leaning towards it doesn't really matters, effect sizes will be small regardless, it's a lot more about ritual.

                Overall, reading the above posts of both Keith and Patrick, I have to admit my actual stance is similar to theirs.
                Last edited by Frédéric; 17-02-2015, 11:30 PM.
                Frédéric Wellens, pht
                «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                «
                Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                »
                Friedrich Nietzsche
                www.physioaxis.ca
                chroniquesdedouleur blog

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                • #23
                  Patrick,

                  It's a perfectly good question. I think I'll let John answer it.

                  I know what happens when one isn't present though. Well, I think I do anyhow.

                  John,

                  No need to thank me.
                  Barrett L. Dorko

                  Comment


                  • #24
                    Originally posted by PatrickL View Post
                    John and Barrett, what is the deep model you espouse?
                    Or, if you prefer, does anyone disagree with Patrick's 'Guiding Principles', or is there something that they would add to make it more complete?

                    My guiding principle is that when the primary complaint is pain, the treatment of pain should be primary. The premise for my care must always be science based, in that it is to be born from solid reasoning, established biological/physical laws, and experimental evidence that informs me that pain is an output of brain. I understand that nociception and tissue damage are not irrelevant, but neither are sufficient (i.e there is no pain unless brain says so) or necessary for a pain experience and reductions in pain result from decreased threat to the nervous system. Decreases in threat result from cognitive/evaluative/motivational/affective/exteroceptive/interoceptive inputs that are novel and non threatening. Such inputs can be provided by a PT, and have little to with specific skill aspect of "manips, mobs, releases, massage etc" and more to do with the unique manner in which the client and therapist interact. The therapist who can 'tap in' to a wide range of clients will likely be a more effective PT resulting more from the PT's ability to read people, interact, react, and provide a context than any specific skill set.
                    Respectfully,
                    Keith
                    Blog: Keith's Korner
                    Twitter: @18mmPT

                    Comment


                    • #25
                      I started to answer Patrick's question, and then I got sidetracked because my kids are home on Mardi Gras break. No school all week. Yeah.

                      Anyway, then I read Fred's post when I got back and that pretty much sums up what I was going to say. I know when someone is NOT incorporating a deep model to justify their clinical reasoning process. That takes many forms- usually it falters at the most basic level of biological plausibility, like "myofascial restrictions", "SIJ dysfunctions", "craniosacral rhythms" etc. Other times it's more subtle, like myofascial trigger points, segmental instability and muscle imbalance. These have some degree of biological plausbility, but they fall apart when you start applying rigorous validity tests to them.

                      It seems that what all these flawed, "shallow" models have in common is that they attempt to reify, as Quintner and Cohen refer to it, the pain experience. As Jason Silvernail puts it, the emphasis is on the product rather than the process of one's clinical reasoning. They're all searching for someTHING wrong, and they can't seem to come to grips with the fact that an abnormal/maladaptive neuroDYNAMIC is just that- dynamic!

                      Maybe "shallow" or "deep" isn't the best word to delineate between explanatory models. I think Diane would suggest "less wrong", which I think usually means an proposition has less depth in terms of factual support to back it up.
                      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


                      • #26
                        I can't disagree with most of whats been written, thanks for that.

                        Something I was contemplating:
                        inputs that are novel
                        What does the individual's expectation and previous experience do to this, if anything? Just being nitpicky about "novel" it sort or comes up a lot like "plasticity" Non-threatening seems to be enough for me

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                        • #27
                          Josh,

                          Put Winifred Gallagher into the search function of this site and you'll be given the links to a five part Sunday series I began in '13. It's all about novelty.
                          Barrett L. Dorko

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                          • #28
                            Originally posted by Josh View Post
                            What does the individual's expectation and previous experience do to this, if anything? Just being nitpicky about "novel" it sort or comes up a lot like "plasticity" Non-threatening seems to be enough for me
                            While I understand your viewpoint on the use of the term 'novel' it does not garner the same feelings within me as it may you.

                            I agree that 'novel' activities are intended to be non-threatening, so using the term 'non-threatening' can work on it's own, but I think that the idea of novelty has the potential to borrow from knowledge/understanding pertaining to neurotags and prediction error minimization and can therefore be very useful.

                            Respectfully,
                            Keith
                            Blog: Keith's Korner
                            Twitter: @18mmPT

                            Comment


                            • #29
                              Josh, I understand that "novel input" is about providing a stimuli that the cns will attend to. I agree that input doesn't need to be novel in order for it to be salient. Maybe non threatening and salient fits better?

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                              • #30
                                I'm on the bus to my work at a psychiatric open clinic. So far I haven't even read all your posts in this thread. Still I feel the urge to post like this:
                                All I have to offer is my gratitude

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