Pamphlet 2: the role of therapist

[BB]

I put this together quickly. It is a skeleton only. What do you think?

[Bas Asselbergs]

Cory, I am not sure I would use "Magician" or "Guide" with my population. The whole comparison exercise seems like rather hard cerebral work for the patients, after already having had to absorb quite dramatic new stuff about their pain...I would add "awareness" in the paragraph "These are used to bring relief, awareness, improve quality (etc)".

I think by keeping the pamphlet straight up and simple, it leaves the PT to embellish, illustrate, use analogies or similies - individually tailored to each patient.

"Gentle motion may help nerve oxygenation and may shut off some hypersensitive nerves. This gentle motion can be elicited by the therapist's hands, and/or you can be helped to discover your own instinctive helpful (therapeutic?) motion"

"The therapist will be helped you learn to do this by yourself, so you can influence your recovery even more"


How's that? - Other ideas?

[Javier Gonzalez]

Hi Cory. I´m agree with Bas. I think I would not use "Magician" with my patients.

[nari]

I'm also wary about the word 'magician'; I know what it implies in the context of what Barrett has written, but how would it be construed by other PTs? and patients often talk about a therapist's magic hands; I think they are implying there is no known reason for a therapy to 'work'. Somehow I sense confusion about what we are telling them about the reality of pain physiology and 'magic'.

Examples:
"A therapist can assist you in the process of moving naturally without pain." or
"The most effective therapy often comes from within yourself, and the therapist can help you achieve this."

And I would like to see the word 'awareness' included, along with the assurance that they do not need complex exercises and stretches to try and fit into their day. Quite a few expect and want them, but we can offer an alternative.

Nari

[christophb]

I was thinking along the lines of what a therapist does vs. is.
Educate, Manual care, Movement (any other's/better terms?) Leaving it general enough to accommodate a wider variety of PT but explaining under the headings enough to have the interventions make sense with current pain science and relate to the first pamphlet.

[Diane]

I agree with Nari et al.
How about writing this into your pamphlet on the therapist's role:
[quote]

Our brain can be, for simplicity sake, broken down into 2 animals. One spends its time thinking about and dealing with the present...what is in front of it at the time. The other spends its time thinking about and dealing with what will happen in the future.

The former is reactive. It happens largely without our knowledge of it, but it reacts to the current state of things. The latter is planning. It uses past experience to plan for what to expect in the future and how it should be handled.

The reactive brain acts out in terms of need states. It motivates us to fulfill the needs brought about by the present and its reaction.

The planning brain acts out in terms of goal states. It motivates us to meet the goals it has set for us to meet.

Our reactive brain is built for immediate survival while our planning brain is built to handle long term survival. If we are acting primarily in terms of the reactive brain, we may not meet the needs of the planning brain, and vice versa. In order to meet the need state and the goal state simultaneously they must be made relevant to each other.

Part of your therapist's role is to introduce these two aspects of your system to one another and help them learn to get along better.

[Diane]

I edited out the magician bits, and ended up with this so far. Still lots more space left.

[Bas Asselbergs]

I'd like to see a bit of this:

"Another result from this education and assistance from your therapist: you will feel more empowered. This is a different "state-of-mind"; it has significant effects on the actual function of your brain and glands, which may well result in increased relaxation and painrelief.
With the additional focus on awareness of breathing patterns and danger-free motion, your neurological system will already undergo major changes - a reversal of its present "alarm-state" to a more calm and easy state".

[Diane]

Bas, take the pamphlet, put in what you want, and reattach it. (Need any help attaching it?)

[Bas Asselbergs]

Thanks Diane, here's my first try. (BTW, I have strictly for my own purposes, kept it very straight and rather dry)

[christophb]

I’ve been thinking a bit about Csikszentmihalyi’s concept of flow and how it might work into a section in the therapist's roll pamphlet (although it seems to blend into the patient’s roll as well).

For flow there are 3 things necessary
1. A clear challenge that fully engages attention
2. Skills to meet the challenge
3. Immediate feedback of how you are doing at each step

So for #1: The challenge is pain and if pain education has been successful the patient will see this not as a challenge to fear, but to embrace and move toward resolution vs. withdrawal. Which leads to #2: Skills to meet the challenge. We are born with the skills to instinctively resolve pain, but through social learning or injury and learned protection the skills may be suppressed. The therapist helps catalyze and awaken the awareness of these skills through manual contact or verbal communication. #3 immediate feedback. The therapist helps the patient to monitor the nervous systems response to the treatment intervention. With education and practice the patient becomes aware of the characteristics of successful movement to reduce mechanical deformation and can provide self feedback.

It is ultimately the job of the patient to learn this process independently and learn to let their nervous system manage pain as only it uniquely knows how to do. The therapist merely makes the patient aware of this process.

Any thoughts? Could probably be cleaned up/simplified with bullets.

I can't get into the word documents, so if this has been said I apologize.

Chris

[BB]

I am not sure I would use "Magician" or "Guide" with my population.

Hi Bas,
I'm not sure I would either. I was thinking in terms of how we are perceived based on therapy's reputation...someone to tell me what to do (guide), someone to fix me (magician), or someone to help me figure it out for myself (teacher). I think I get all three of these preconceived notions in the clinic and have to address the mindset of each to proceed.

That said, I agree with you all and like the direction it's going.

[Jon Newman]

I've got a question. It seems that the focus of this pamphlet isn't so general as to be an attempt to describe what physical therapists do but rather the role of PT as it relates to pain. Is that pain in general regardless of other presenting problems?

[christophb]

Good question... I was thinking pain secondary to mechanical deformation. Would it be better to be more general?

[Luke Rickards]

I think it is important to firstly ask ourselves, how does it benefit a patient to understand the role of the therapist?. Describing what I should be doing and its beneficial effects feels more like I'm trying to sell something than educate. I'm not sure patients really want or need to know what my job is. They want and should know what their role in the relationship is, eg self-efficacy, changing beliefs, attending to instinctive responses, all stuff that is probably better placed in a patient education pamphlet.

Just a thought.