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SKIN IS THE OUTSIDE OF THE BRAIN

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  • Barrett wrote an essay about a treatment encounter. Barrett reports being sort of afraid of this guy, who seemed to expect a more er, coercive approach than SC.

    Bas' comment:
    There IS the possibility that one person's light touch triggers a defensive response; I have experienced that myself, and heard from patients that they too have had this experience.

    (I cringe when I remember that person's - uninvited - shoulder "rub" while sitting at a computer)
    This can be seen as an illustration how important the touch on skin is type our brain: a small variant in something I generally liked, and I literally pulled away immediately.

    Touch is meaningless without context.
    , reminded me of it.


    I can't find the essay, maybe Barrett will.

    Touch isn't necessary but it can help in most cases. I would hope my PT would be the kind who has reflected upon the matter.

    This, I think, should factor into the clinical reasoning of every therapist who makes the decision to apply touch in order to treat pain.

    I once said something like: you have to think of the past, present and future of the human's NM everytime you touch them.

    That's why I would rather not see therapists perform certain moves that evoke the snapping of one's neck or arranging the individual's limbs and handling them in ways that might evoke being in a situation of confinement or aggression.

    Reading a lot about the neuroscience of metaphors and sign language has helped shape my reasoning as well.

    I handle and massage necks every day. Very, very gently. That that, even if it is done ever so gently, can get my client's brain to start feeling threatened, is not lost on me.

    I'm always very interested when those eyelids start fluttering.

    If anything is derivative, it's manual therapy. It's a derivative of primate grooming. They do it gently, yet firmly, in the wild. From what I can tell, at least. Sometimes they apply lots body weight. They move and position the limbs. They are after parasites, after all.

    And they are all about getting their blood fix.
    Last edited by caro; 02-08-2015, 08:29 PM.
    Carol Lynn Chevrier LMT
    " The truth is, people may see things differently. But they don't really want to. '' Don Draper.

    Comment


    • Caro,

      I don't know what essay you're speaking of, but I will say that anything invisible to me makes me wary. I know that many things are optical illusions though. Vision's a complex thing.

      Seeing something and acting upon it is also complex.

      That's why we ask questions, question ourselves and present arguments. That's why Soma Simple exists.
      Barrett L. Dorko

      Comment


      • It's in Shallow Dive. The guy blames his weight issues on something in the culture. You say: I think he's right.

        I'll find it eventually.
        Carol Lynn Chevrier LMT
        " The truth is, people may see things differently. But they don't really want to. '' Don Draper.

        Comment


        • Here it is.

          By Barrett L. Dorko. from his book, Shallow dive p. 179. (1996)
          Man to man.
          Mike is short and rotund. Formerly a federal marshal and sheriff's deputy, he now has his own business making ammunition and explosives. His remarks about the government, politics, and hunting (he calls it ''killing something'') make it clear that we don't share much in the way of personal philosophy and I keep my mouth shut. This seems not to discourage his commenting on a variety of topics of his own choosing.
          When I can sneak in some questions and examine him, it's clear that his recurrent spinal pain includes no pathology and should respond quickly to a little manual care and exercise. I'm not concerned about helping him with his pain but I worry about getting through a few sessions without provoking him somehow.
          I've spent a lot of time meeting with other men the past few years. I read all the contemporary literature about the recent movement of men together to reduce our isolation from one and other. Along with three other men I lead retreats that focus on the common problems and opportunities that being a man in modern times offers us. It's hard work. It's often painful. It's the best thing I do.
          I've learned that the first thing the majority of men feel when in relation to other men is fear. If fear is considered an instinct rather than an emotion it will be accompanied physiologically by sympathetic dominance and psychologically by a range of emotions, all of them negative.
          Mike seems suspicious of my tendency to handle his limbs gently. He tells me of his numerous visits to the chiropractor and he's certainly used to and expectant of forceful manipulation although it never relieved his pain.
          Mike's body is easy to change with treatment. He moves instinctively in a corrective fashion the moment I touch him, and does not object to my explanations or suggestions about how things might change. I have the feeling that I am getting more cooperation and change out of this man than most people do. (You should hear him speak of his fellow drivers on the way here.)
          Mike was an adviser to the Vietnamese in 1963 (''some advice'' he says) has been shot twice, and still carries a load of buckshot in his lumbar region. After a few altercations with prisoners, he left the sheriff's department in a hurry and seems to have a ''survivalist'' mentality that colors most of his statements about others and the future.
          Mike likes me. I think he sees me as one of the few non threatening men he's ever met. I haven't mentioned his obesity and although he has yet to do any of the exercises I suggest, I accept the excuse that there is too much work to do. He says it's because of the Brady Bill and I believe him.
          Our paths have been different to say the least. I've never been shot at or physically attacked. The closest I ever came to the military service was the high school marching band.
          Still, my manner has allowed both Mike and I to see how we're the same. I told him we both make money when others become fearful and he agreed. He told me that he loves Wagnerian opera and has a copy of the entire ''Ring Cycle.'' We both think ''Jeremiah Johnson'' was a great movie.
          A few years ago we would have clashed and I'm sure I would have felt that it was because Mike was a jerk and nothing else. Taking the time to be with other men and facing the fear it produces has shown me the common ground my gender struggles to find each day. It certainly makes it easier to help a man like Mike.
          Carol Lynn Chevrier LMT
          " The truth is, people may see things differently. But they don't really want to. '' Don Draper.

          Comment


          • Mason,
            Why wouldn't interoceptive information contribute to a sense of body ownership- of the sense of self? I don't recall anyone here suggesting that tactile sensory information is essential for the sense of body ownership. I think the argument all along has been that a body in a state of threat will will attend to exteroception to the extent that the input is perceived to either increase or decrease that threat. Any nociceptive input perceived to come from the environment would obviously tend to increase the sense of external threat, whereas external non-nociceptive input that reduces the threat associated with movement could potentially reduce it. The question is what kind of external sensory-discriminative input to provide the patient while minimizing the threat to agency/self-efficacy.

            Since low levels of agency/self-efficacy have been strongly associated with delayed recovery from MSK injury, then it follows that we should intervene in a way that draws the patient's attention towards their own ability to reduce isometric activity (associated with persistent threat) and increase isotonic activity (which should positively impact the abnormal neurodynamics). This should be done while avoiding nociceptive input. I think the former can be achieved by permitting the expression of ideomotor movement and also through various forms forms of movement exploration and attempts to change the patient's opinion of offending movements (edgework, novel movements, ATM).
            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


            • Neuro-immune-endocrine functions of the skin: an overview

              Wonders of skin (from this open access paper:Neuro-immune-endocrine functions of the skin: an overview. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938165/)

              Number 5 is the one that pertains to manual therapy I think..
              1. "a complex organ involved in multiple neuro-immuno-endocrine functions"
              2. "neuro-immuno-endocrine functions are tightly networked to central regulatory systems" (not surprising in that) "its embryologic ectodermal-derived sibling is the brain"
              3. "Equivalent of hypothalamo–pituitary–adrenal axis in the skin": (can) "regulate local stress responses": "corticotropin releasing factor/hormone (CRF), proopiomelanocortin (POMC)-derived β-endorphin (β-END), adrenocorticotropin (ACTH) and α-melanocyte-stimulating hormone (α-MSH), the corresponding CRF-receptor 1 (CRF1) melanocortin and opiate receptors."
              4. "the key enzymes of corticosteroid synthesis that results in the cutaneous production of corticosterone and cortisol are expressed in the skin"
              5. "skin can activate systemic HPA either by neural signaling via afferent nerve fibers to the brain OR by skin-derived factors that may activate pituitary gland or adrenal cortex"
              6. "cutaneous equivalent of the central HPA axis is nonrandom and models the same hierarchical, organizational and cell type-specific regulatory loops structure."
              7. "Cutaneous opioid system" - two different precursor proteins: "POMC is the precursor for ACTH and endorphins, mainly β-END" and "proenkephalin, transformed into multiple enkephalins, predominantly Leu-enkephalin and Metenkephalin"
              8. "At least two cannabinoids receptors, CB1 and CB2, have been discovered in the skin" - "play an important role in the abundant neuroendocrine activities of the skin" - "profound anti-inflammatory, antipruritic, antitumorigenic and antinociceptive effects"
              9. "Cutaneous cholinergic system" - regulates keratinocytes
              10. Serotonin: "hydroxylation of L-tryptophan via tryptophan hydroxylase occurs in the skin"
              11. Melatonin: "Unlike the pineal gland that is separated from the external environment and produces melatonin based on circadian rhythm, skin can produce this hormone as needed in response to its environment." (skin melatonin)"acts as a powerful free radical scavenging molecule," "functions to modify hair growth cycling and works to maintain mitochondrial function that is necessary for cell homeostasis"
              12. Hypothalamic- pituitary -thyroid axis: "skin can also communicate with itself and systemically via both the thyroid-releasing hormone and thyroid-stimulating hormone (TSH) receptors" in its "melanocytes, keratinocytes, fibroblasts and hair follicles" "T4 stimulates the proliferation of hair follicle keratinocytes and T3 inhibits their apoptosis"
              13. "Cutaneous secosteroidogenic system" - good old Vitamin D, plus "mammalian skin is an extra-adrenal site of mineralo/glucocorticoid synthesis, which is regulated by endogenous and environmental factors" and "skin is also an important site for estrogen and androgen production, activation and metabolism"
              The skin complexity would be surprising if we did not remember that its embryologic ectodermal-derived sibling is the brain.
              Diane
              www.dermoneuromodulation.com
              SensibleSolutionsPhysiotherapy
              HumanAntiGravitySuit blog
              Neurotonics PT Teamblog
              Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
              Canadian Physiotherapy Association Pain Science Division Facebook page
              @PainPhysiosCan
              WCPT PhysiotherapyPainNetwork on Facebook
              @WCPTPTPN
              Neuroscience and Pain Science for Manual PTs Facebook page

              @dfjpt
              SomaSimple on Facebook
              @somasimple

              "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

              “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

              “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

              "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

              "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

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              • Lateral skin stretch and proprioception

                Lateral skin stretch and proprioception.
                Diane
                www.dermoneuromodulation.com
                SensibleSolutionsPhysiotherapy
                HumanAntiGravitySuit blog
                Neurotonics PT Teamblog
                Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                Canadian Physiotherapy Association Pain Science Division Facebook page
                @PainPhysiosCan
                WCPT PhysiotherapyPainNetwork on Facebook
                @WCPTPTPN
                Neuroscience and Pain Science for Manual PTs Facebook page

                @dfjpt
                SomaSimple on Facebook
                @somasimple

                "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                Comment


                • Tactile looming

                  http://www.cell.com/current-biology/...822(16)30134-8

                  The Change in Fingertip Contact Area as a Novel Proprioceptive Cue

                  Abstract

                  The Change in Fingertip Contact Area as a Novel Proprioceptive Cue

                  Highlights
                  •Pushing a finger against a soft surface provokes an increase of the contact area
                  •This increase in contact area potentially provides a cue to finger displacement
                  •We ran psychophysical experiments to test this hypothesis
                  •Results revealed a novel proprioceptive cue, i.e., the change in contact area

                  Summary
                  Humans, many animals, and certain robotic hands have deformable fingertip pads [ 1, 2 ]. Deformable pads have the advantage of conforming to the objects that are being touched, ensuring a stable grasp for a large range of forces and shapes. Pad deformations change with finger displacements during touch. Pushing a finger against an external surface typically provokes an increase of the gross contact area [ 3 ], potentially providing a relative motion cue, a situation comparable to looming in vision [ 4 ]. The rate of increase of the area of contact also depends on the compliance of the object [ 5 ]. Because objects normally do not suddenly change compliance, participants may interpret an artificially induced variation in compliance, which coincides with a change in the gross contact area, as a change in finger displacement, and consequently they may misestimate their finger’s position relative to the touched object. To test this, we asked participants to compare the perceived displacements of their finger while contacting an object varying pseudo-randomly in compliance from trial to trial. Results indicate a bias in the perception of finger displacement induced by the change in compliance, hence in contact area, indicating that participants interpreted the altered cutaneous input as a cue to proprioception. This situation highlights the capacity of the brain to take advantage of knowledge of the mechanical properties of the body and of the external environment.

                  Discussion
                  Many mammals, birds, and other species have soft pads on the volar side of their extremities. The soft pads rapidly conform to external surfaces ensuring secure grips and stable interactions with objects [1]. Soft fingers have been also used in robotic hands to increase grasp stability [2, 21]. Besides having advantages for grasping, the patterns of pad deformation (such as the change in contact area and the deformation due to slip and roll motion) also provide rich information to the tactile system [12]. The evolution of skin strain patterns during tactile slip provides relative motion information similar to optic flow in vision [22]. Observers can reproduce displacement paths by integrating tactile slip motion over time [23] and experience the shape of curved objects from a rolling interaction of finger pads with an object [24]. The evolution of the gross contact area provides information about the softness of touched objects [5, 15, 17, 18, 19], a finding which is confirmed by our third experiment.

                  Although the role of pad deformation in cutaneous touch is well established, its contribution to proprioception is less clear. In the present study, we demonstrated that a change in the contact area provides a cue to finger displacement relative to an object. According to classical studies in physiology, muscle spindles, Golgi tendon organs, and receptors in the joints provide crucial information on the static position and movement of our limbs [25]. Information from cutaneous mechanoreceptors also contributes to our sense of position [26, 27, 28]. Stretching the skin around the proximal interphalangeal joint, i.e., around the second knuckle, induced a vivid sensation of movement in anesthetized fingers [29]. Furthermore, during the movement of the elbow joint, skin stretch in a direction in line with muscle stretch applied simultaneously with external vibrations increased the perceived movement sensation [30]. The literature has largely overlooked the role of finger pad deformation due to object interaction as a cue to relative motion. In the current study, changes in the gross contact area produced during the indentation of an elastic surface induced a sensation of relative finger motion. Recently, it was found that, when pushing with a finger against a stiff, stationary object, microscopic fluctuations in the counter-surface could elicit a sensation of finger displacement [27]. These results provide converging evidence that an important source of proprioceptive information comes from skin deformation during interaction with external objects.

                  In the experiments presented here, the change in gross contact area provided a motion cue that could be compared to looming in vision. This effect, termed “tactile looming,” supports the hypothesis that similar motion detection processes are implemented in vision and touch [31]. In the two sensory systems, a 2D sensory sheet (i.e., the retina or the skin) provides important information about the relative motion of our own body with respect to external objects. Moreover, previous studies showed an analog of visual looming in audition [32, 33], which might suggest a canonical computation of looming stimuli across different senses.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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