Sunday, August 12, 2012

Systemic Homeostasis And Cerebral Palsy

 This is the beginning if what is likely to be a relatively long series of posts...therefore I will make every attempt to keep it as "digestible" as possible.

The stimulus for this particular focus and direction was derived from two sources: 1)  my recent trip to Chile to work with another amazing group of CP children and their (always entertaining) parents and extended family, and 2) a very informative piece of writing I just read (see the One Giant Leap Facebook page for the article on Pain and Stress) that set in motion a train of thought that can only be integrated by writing it down.   Given that this topic is quite comprehensive, it will be more productive to consider this as a general introductory entry into more detailed discussion and explanation.  More importantly, a clear and concise explanation of the overall context will help to solidify the main message of this post.  My thoughts are still relatively "all over the page" at the moment, but my most productive posts historically come from this type of chaotic beginnings.

The following is a very insightful and accurate definition of Homeostasis:  Although the term homeostasis commonly connotes adjustment to achieve balance, McEwen asserts that homeostasis strictly applies to a limited set of systems concerned with maintaining the essentials of the internal milieu. The maintenance of homeostasis is the control of internal processes truly necessary for life such as thermoregulation, blood gases, acid base, fluid levels, metabolite levels, and blood pressure. McEwen’s strict distinction means that homeostasis does not contribute to adaptation; rather, adaptation protects homeostasis.   

This is quite informative when placed within the context of Cerebral Palsy (CP).  Although the statement may seem intuitive, as with many other things in the CP world it gets lost in the myriad of challenges of everyday life (the CP family) and in the dissected, compartmentalized, and (sometimes) overly simplistic "protocols" provided by some health care systems.  The reality is that addressing the needs of the entire organism is logistically impossible to do with any degree of efficiency.  To be precise, the only way a responsible health care delivery system can work (and thrive) is to provide interventions that address the most common denominator...standardization over customization.   This is not a condemnation of the system itself, rather a comment of the necessary reality...it can only be delivered to large numbers of people in this manner.  However, this does not mean that each individual person in "lost"...it simply dictates that each individual CP family unit needs to acquire a fundamental understanding of the conceptual and theoretical realities of CP.  In other words, the more enlightened and informed the CP unit is, the better they are at navigating the multiple theories, philosophies, and interventions and formulating the most effective rehabilitation strategy possible for them.  

 "Failure to sustain homeostasis is fatal. Generic threats to homeostasis include environmental extremes, extreme physical exertion, depletion of essential resources, abnormal feedback processes, aging and disease. Environmental perturbations can threaten homeostatic regulation at any time. The stress response exists to sustain homeostasis." 

When you consider this very accurate statement, the relevance and importance of systemic homeostasis becomes amplified.  The CP individual is continually under excessive physical exertion (excessive muscular activation), experiences abnormal feedback responses (irregular ground force transmission, proprioceptive dysfunction), and in more severe cases is extremely sensitive to temperature change.  Further, this inability to properly adapt to these challenges creates further complication and barriers to improvement.  Therefore the logical rehabilitative strategy should be driven by comprehensive and progressive development / enhancement of systemic homeostasis.  The overwhelming focus and attention in placed squarely on the "biomechanical manifestations" or in some cases on the (relatively unimportant) "cosmetic / aesthetic" presentations.  Although these concerns are indeed a part of the larger picture, they serve no strategic purpose if systemic homeostasis is allowed to deteriorate.  As presented in the article, there are 3 interdependant systems that contribute to the preservation of homeostasis: neural, endocrine, and immune systems.  Further, "the term for the physiological protective, coordinated, adaptive reaction in the service of homeostasis is allostasis. Allostasis insures that the processes sustaining homeostasis stay within normal range".

To summarize this brief introduction,  the overall philosophy emerges quite clearly with respect to the formulation of effective, permanent, and progressive rehabilitation strategies:  The development, enhancement, and protection of systemic homeostasis is the overwhelming priority in the CP individual.  Again, the biomechanical role is significant...most specifically in it's implications in social and cognitive development (see my previous post on the relationship between physical, social, and cognitive development) but it's relevance is dependant on a relatively stable systemic competence.  Further expansion on this subject will explain the various nuances and specifics of homeostasis in the CP individual and then will examine the various strategies to improve and maintain it.  

Cheers!


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