tag:blogger.com,1999:blog-87318133574586499912024-03-12T19:03:38.595-03:00The Fascia Therapy BlogGavin Broomes B.Sc., FTMA(c)Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.comBlogger131125tag:blogger.com,1999:blog-8731813357458649991.post-34178434443102743272018-08-07T12:43:00.002-03:002018-08-07T12:43:56.613-03:00Standing Frames: The Broader Discussion<div class="separator" style="clear: both; text-align: center;">
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The discussions I typically have surrounding standing frames (or "verticalization" in general) typically begin with a formally simplistic question:<br />
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<i><span style="color: blue;">"Are standing frames good or bad?"</span></i></div>
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As those who know me well would expect, my response would be far from a generic "yes / no". There is ALWAYS a contextual consideration to be made...at the very least. </div>
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WHAT standing frame will be used?</div>
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WHO is the standing frame intended for?</div>
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WHAT angle is the intended frame to be set? </div>
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HOW long do you plan on implementing it?</div>
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WHAT is the frequency per week / month? </div>
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WHAT is the status of the hips / legs? </div>
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..the list goes on. </div>
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In an effort to "open the brackets" and engage in the broader exploration, I think it is best to start with the most intuitive (and the most widely understood) rationale for their use. This rationale (in my experience) has been justified as follows: </div>
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<span style="color: blue;"><i>"Vertical loads are good for the hips."</i></span></div>
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This statement is most certainly accurate in the developmental sense...however, in order for it to be given the blanket statement of being "TRUE", you need to add a modifier that makes it so. Therefore, the "truer" statement would be: </div>
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<span style="color: blue;"><i><b>"Under healthy biomechanical situations, </b>vertical loads are good for the hips." </i></span></div>
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This revised (and comparatively more complete) statement is unequivocally true...however, we all understand that disorders of movement and posture have varied and diverse <u>unhealthy</u> biomechanical manifestations. The discussions always generally come back to the original question..</div>
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<i>"So they are bad then?"</i></div>
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Remember....<i>CONTEXT. </i></div>
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I think the best way to approach the process of a broader understanding is to be a bit better (as professionals) in being <u style="font-style: italic;">explicit and defining our statements with much more precision.</u> In other words, I would suggest that the statement actually be changed: </div>
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<span style="color: blue;"><i>"</i><strike style="font-style: italic;">Vertical </strike><b><i>AXIAL</i> <i>loads are good for the hips."</i></b></span></div>
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Let me unpack what may seem to be a nuance: </div>
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Under <i>healthy </i>biomechanical circumstances, you can be sure that the ground force reaction (the mechanical forces entering from the feet) will travel through the foot and ankle, traverse the knee, and ultimately end up in the hip. It is this repetitive "micro-stimulus" that is derived from crawling / walking that drives the evolution of the acetabulum (socket) and the overall development of the hip. </div>
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However, in a situation such as CP, the presence of multiple layers / levels of joint weakness, muscular imbalance, proprioceptive deficits, bony deformation, etc...<u style="font-style: italic;">makes it formally <b>impossible</b> to be completely sure that these ground force reactions are INDEED reaching the hip and not (perhaps) exiting the ankle or knee...or worse, de-stabilizing the joints more.</u> The only way to ensure that the mechanical loads enter the hip is to (through specific and focused methods) generate a stimulus that you are sure travels <b>along the axis </b>of the bone. </div>
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<i>"So now you're saying they are REALLY bad?" </i></div>
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C-O-N-T-E-X-T</div>
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(Finally) Here is how I would respond to the specific question of standing frames.</div>
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In truth, the question is not about whether standing frames themselves are "good or bad"...they are inanimate objects that cannot generate any benefit or damage until they are "attached" to a biological system. Therefore, the more appropriate question is: </div>
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<span style="color: blue;"><i>"Are they good or bad <u><b>for my child?"</b></u></i></span></div>
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To answer that question in the most comprehensive way, we have to get an even MORE broader perspective on CP rehab strategies in general. To be precise, EVERYTHING you do as a parent / professional / caregiver <u style="font-style: italic;">has to service one or all of the <b>social, cognitive, physical</b> needs of the person.</u> </div>
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1. Does a standing frame service any social need? <b>YES.</b> The mere fact of being vertical...or at "eye level" with family, siblings, peers...presents and ENORMOUS benefit to anyone's social interaction and development</div>
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2. Does a standing frame service any cognitive need? <b>YES. </b> Being in the supported, semi-loaded position may facilitate better overall comfort and, as a result, allow for more mental resources to be freed up for cognitive tasks (school, arts, etc...) </div>
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3. Does a standing frame service any physical need? <b>YES*. </b>I purposely inserted the asterisk * here to highlight / remind us that it is the physical needs that the standing frame is most intuitively identified as being the "valuable" tool...but it requires some additional layers of analysis and thought. </div>
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It can be a reliable physical tool when: </div>
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a) The distortion in the feet / ankle / knees are minimal to moderate</div>
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b) There is no presence of extreme muscular tension</div>
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c) The pelvis is somewhat adequately prepared for some minimal amounts of load bearing</div>
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d) Proper consideration is given to the angle (greater the angle, the greater the mechanical loads)</div>
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e) The time spent in the frame does not exceed their tolerance level nor does it generate any muscular fatigue</div>
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f) Any empty spaces behind / between the knees and behind the hips and lower back can be filled. This potentiates a more neutral stance and thus, less excessive muscular activation / tension.</div>
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Therefore, are they good or bad? They are neither. The important element in the equation is the person to be placed in the standing frame. I would summarize in the following way: </div>
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<span style="color: blue;"><i>"You need not be fearful of standing frames nor should you be too accepting of them. They can be "friend or foe"...therefore, as with anything as infinitely complex as the body, you need to implement a focused analysis on whether it is appropriate for YOU." </i></span></div>
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This is obviously a very "compact" narrative that can be expanded into the specific "axial loading techniques", the physiological response of bone, and the varied and diverse options for standing frame use...but I hope that this initial discussion does indeed "open some brackets" and stimulate some productive analysis and thought! </div>
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Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-42300447160422564672017-08-07T16:12:00.000-03:002017-08-07T16:12:36.480-03:00Broader strategies for rehabilitation in Cerebral Palsy<div class="separator" style="clear: both; text-align: center;">
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Time.<br />
Team.<br />
Plan.<br />
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Despite the seemingly intuitive nature of formulating a rehabilitation strategy, I have found that many people (care-givers and care-seekers alike) get easily distracted or otherwise side-tracked by the "shiny object" nature of our current society. As with almost everything, we look for ways that seem to obliterate space and time...finding ways to "get it now and get it quickly". <br />
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Within the context of CP...and in fact, within the context of biological reality...tissues, systems, and physiological behavior cannot be altered to fit any intended framework. Therefore we are bound to (surprise, surprise) the biophysical limits of our universe. Given this inherent thought process, I have found that one of the most common and pervasive questions presented to me falls within the framework of <i>"what is the best therapy for CP?" </i>Most people, after putting this question to me, come away partially disappointed...mainly because my response is usually prefaced by the comment that the question itself is far too simplistic. My response is (paradoxically) equally simplistic however: <br />
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<b><i>"It's not a question of WHAT is the best therapy, but WHEN is the best therapy." </i></b></div>
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To put it simply, the human organism is constantly in flux and experiences remodeling and "renovation" at all times. More importantly, the child with CP is growing and changing exponentially quicker. Length, mass, fluid flow, pressure gradients...EVERYTHING is changing on a daily basis. Therefore we come across a fundamental question / challenge / dilemma: <i>How can one framework or strategy properly / adequately compensate for these rapid and (sometimes unpredictable) transformations? </i>The answer is that none of them can. However...there ARE enough varied frameworks currently out there that fundamentally serve specific roles <u>at different points</u> in the developmental process. The more primitive focus (IMHO) is to identify the specific priorities at that specific point in the developmental process and only then determine which strategy best serves these priorities. </div>
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Certainly a complex chore...but, this is where the "professional" comes in. Rather than promote any one strategy or idea, beginning to frame the larger "big picture" and building a clearer understanding (over time) of the "path" will help to understand the varied "vehicles" through which the journey will take place. </div>
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Again, CP is multilayered and there are levels of complexity that are formally impossible to fully understand and, by extension, influence. However, there are certain parameters that both follow the normal developmental sequence AND present very viable "blueprints" for building a long term rehabilitation strategy. Although the potential combination and permutations are enormous, they ultimately follow this process: </div>
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1. Structural Transformation / Change</div>
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2. Muscular Strengthening / Priming</div>
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3. Movement Stimulation</div>
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This in not an open-ended sequence, rather one that is cyclical and one that potentiates itself through each new cycle. </div>
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Understanding this cyclical nature of development, it becomes formally "easier" to identify the most efficient and relevant therapy(ies) / strategy(ies) to implement. </div>
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Long term success requires a diversity in approaches as well as the broader understanding to navigate the TRANSITIONS. The blog has been silent this year...but not for any reason other than it has been a year or growth and exploration...so I am hoping to be able to share the fruits here soon! </div>
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Cheers!</div>
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Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-11878405799801809942016-11-22T18:33:00.003-03:002016-11-22T21:38:38.265-03:00Cerebral Palsy and the "Economy of Health"<div class="separator" style="clear: both; text-align: center;">
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The intrinsic (and extrinsic) complexities of Cerebral Palsy (CP) are numerous...to say the least. Although this statement is generally quite intuitive, this reality sometimes / oftentimes gets lost when the actual business of strategic rehabilitative planning comes into play. In other words, looking at all of these diverse complexities (whether biomechanical or systemic) as a group / sum of separate individual challenges will result in a large part of the "big picture" being missed. To put it plainly, <em>complex problems require complex solutions. </em></div>
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This isn't to say that things are TOO complex...nor do I suggest that there is a dark cloud hanging over us all the time. However, coming to grips with the understanding that (from a fundamental perspective) CP is a multi-layered complexity, will ultimately bridge the gap to another fundamental understanding...which is, to my belief, the most important: </div>
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<em>"The human organism is perhaps the most elegant manifestation of organic connectivity known to science." </em></div>
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Going through the actual true physiological meaning of that statement is far too involved for the relatively limited resources of a blog...but being a HUGE fan of analogies, I will simply import the one that I find to resonate the easiest and (more importantly) tends to "stick" in a more internal way. </div>
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<u>The Economy of Health</u></div>
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Indeed, there is a big difference between the economy (as we understand it) and a biological system...however the actual <em>interaction, irritability, volatility, inter/intra-dependence, and connectivity </em>are surprisingly comparable. Further, almost everyone intrinsically understands the general premise of "deficit and surplus"...or "asset and liability"...and most certainly "TAXATION". </div>
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Let us first refer to a healthy organism (thus, healthy economy) as our essential reference point. A healthy organism boasts a critical amount of "natural resources" from which the to draw from. For example, we have a certain amount of energy stored, and (from a neurological standpoint) our brains operate at a high level of efficiency and are able to effectively manage the autonomic requirements as well as serve as the central "hub" for everything we do voluntarily. Further, our biomechanical "infrastructure" is set up so that they adequately meet the demands and rigours of our external environment. </div>
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In CP, the overall "health economy" tends to slip and slide, rise and fall...all depending on the specific underlying robustness of the entire organism. To put it more plainly: </div>
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1. "Natural Resources" are low. Respiration is altered and therefore oxygen / oxygenation is functioning at levels that do not support a growing organism </div>
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2. Systemic and biomechanical "deficits" begin to impinge on the overall amount of health "assets" one is able to contribute to the system. This, in turn, results in a reduction in organic resources available for self-healing and self-regulation. </div>
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3. Irritability (ability to interpret problems and respond to stresses) becomes delayed. Similar to housing crashes and stock market plunges, the body's ability to <em>recognize, diagnose, and adapt </em>to stimulus is critical...and when overall "economic health assets" are low, this becomes more and more difficult. </div>
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4. For every systemic and/or biomechanical process (whether voluntary or involuntary), there is a heavy <strong><em>systemic and biomechanical </em><em><u>"TAX"</u></em></strong> that is added on to that said process. For example, normal levels of activity that would intuitively be acceptable for healthy individuals is ultimately outside of the range of manageability for someone with CP. Although physical activity IS necessary for development and progress, it has to be mitigated by the imposed "systemic / biomechanical tax" that must be paid. More importantly, it needs to be determined (individually) whether the payment of that tax is acceptable...or, and acceptable risk. As an example, weight bearing activities are key to the development of balance and proprioception, but is the joint itself developmentally able (architecturally) to support and sustain full or partial body weight? Therefore, the calculus becomes <em>"how much of a biomechanical tax are we willing to pay by working on balance and proprioception?" </em>The reverse calculus can also be part of the larger equation...<em>"how much proprioception and balance work will be loosing if we focus on architectural integrity?" </em>Although different practical questions, they are both considerations with a larger, complex, and interconnected system. </div>
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In summary, I do not claim that a simple analogy will make the actual job of strategic planning less <em>difficult...</em>however, the understanding of the basic concept of how thriving economies work...from the more global "macro" economics down to the "micro" economics of our own household management, we get a different (but already instantly relatable) perspective on <u>how the bigger picture is laid out...and how it is more than a simple "sum of parts".</u> </div>
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There is an interdependence and connectivity that cannot be dissected...and although the objective of progress and improvement sometimes seems daunting, economies (whether financial or biological) CAN indeed turn around. It is most certainly a <em><u>process of deceleration, control, and gradual "U-turn"</u></em>...but it can be done. </div>
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Last take-away: </div>
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<em>"Save all of your 'systemic and biomechanical pennies'...guard them and deposit them. Every cent counts. It isn't simply a case of <strong>reducing your deficits...</strong>but a focused effort on <strong>growing your assets</strong> as well." </em></div>
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Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-70494953805856379932016-05-26T15:07:00.002-03:002016-05-26T15:32:20.966-03:00Navigating Hip Pain in Cerebral Palsy<div class="separator" style="clear: both; text-align: center;">
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In a continuing series on hip pain in Cerebral Palsy (CP), I wanted to share an interesting (an actually quite common) occurence when addressing the issue of hip pain in children with CP and other neurodevelomental disorders. As most parents know, ANY sign or indications of pain / discomfort that comes from the hip immediately generate a swell of stress, anxiety, and worry about hip subluxation, hip dysplasia, and other common dysfunction of the hips. All of these are common and generally manifest at some point along the line...but it is important to take the time to carefully address / assess the SOURCE of the pain so that it can be resolved as quickly as possible as well as provide better insight on how to proceed in the most efficient manner.<br />
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Most cases of hip dysfunction / pathology are diagnosed / confirmed with an x-ray, but it is important to (first and foremost) understand the role and <i>limitations </i>of an x-ray. In a previous post on <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2012/09/cerebral-palsy-guidebook-hip-subluxation.html" target="_blank">hip subluxation</a>, I explore in detail the specific nuances of understanding the pediatric hip x-ray...which I recommend you read / re-read either before or after this post. In that particular post, I outline a set of practical questions that should be asked <i><u>in conjunction with</u></i> the information acquired via the x-ray that will help in providing some clarityand ultimately help navigate what is generally a worrisome period of time.<br />
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The standard procedure when hip pain is suspected is to take an immediate x-ray. While this is intuitive and indeed necessary, the subsequent analysis oftentimes gets limited to ONLY the hip joint itself...meaning that once the images are taken, almost all of the focus and magnified and intensified in one specific area. The reality (in any healthy or pathological condition) is that pain can be manifest in a wide number of areas...and for a wide number of reasons.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1D4Uj29PThiWPjtScnULH79HvxtO8t2gxkc-k6OD2BIBi_t-2rEyXwhnBZMcM0qCm3zQovTcx9nDLMtRuTAGTKdsRENkheNSzGeckaaYkWKQLI2AHmwps2ZyY9iYDc5dLSlRhefROS6k/s1600/Slide1.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1D4Uj29PThiWPjtScnULH79HvxtO8t2gxkc-k6OD2BIBi_t-2rEyXwhnBZMcM0qCm3zQovTcx9nDLMtRuTAGTKdsRENkheNSzGeckaaYkWKQLI2AHmwps2ZyY9iYDc5dLSlRhefROS6k/s400/Slide1.PNG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Neutral (without internal rotation)</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Internal Rotation</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Lowenstein</td></tr>
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The above images are a few quick "grabs" of some x-rays I reviewed a few weeks ago of a young girl who had recently begun experiencing pain in the hip area...manifesting during transfers and changes in position. NB: Not high quality images, but satisfactory for "pictures of pictures". As "standard operating procedure", the x-rays were taken to examine the condition of the hip joint...and ultimately "confirm or discard" any specific issues with subluxation, dysplasia, or other common challenges.<br />
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Although my strategy going into any and all x-ray assessment is to look at the area in question, it is also (without question and without fail) to carefully examine and explore <u><i><b>all of the articulations and bone mass captured in the image.</b></i></u> That is to say, <i>not focusing on the hip joint itself and (whenever possible) look at the adjacent segment(s) above and below...all the way until you are "off the page". </i><br />
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Before reading on, have a look at all of the images and take mental note of (if anything) strikes you or "jumps out" at you. <br />
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When I first saw these, there was a very immediate and explicit observation that literally leaped off the images...but, as a matter of practice, I followed through with a careful exploration of the bony information on the hip provided by these particular x-rays. Without going into a lengthy and detailed assessment of these images, I will identify two main observations:<br />
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1. The overall status of the hip / hip joint (as captured in these x-rays) looks relatively stable and, within the context of her particular pathology, look very good. The variation between neutral, internal rotation, and Lowenstein is very small and negligible (perhaps even non-existent)...which generally suggests (with a certain level of confidence) that the joint and joint capsule are generally stable. <br />
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2. There are some obvious asymmetries in the <u><i>pelvis.</i></u><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0gV2ajtGVl6rehdGe6Eufr3Pr9voLDM0dbG2iEa0c52kCzUwqec5g9M7Zsj0FTo7GbEhv3xpUAMgnbvl_ZjblyrDUzoMA9MLbBpJjwaGbFulDbpduyNK9VehB42pByHpZKGKkUO80Ha0/s1600/Slide1a.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="420" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0gV2ajtGVl6rehdGe6Eufr3Pr9voLDM0dbG2iEa0c52kCzUwqec5g9M7Zsj0FTo7GbEhv3xpUAMgnbvl_ZjblyrDUzoMA9MLbBpJjwaGbFulDbpduyNK9VehB42pByHpZKGKkUO80Ha0/s640/Slide1a.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Asymmetric Pelvic Foramen</td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRvM4ol74lebKDQ4dhvJXFmv1FVHtRDWYTuNKHH_YLh3JS64dQYUgiBfcQa1IZvBuMamipxpKBBepHbCN0yBxmlYEqe3e2LiF2uVgIKECoKOfqPn5TqwjJ5Aei3rDpGi8ONXRkBIR5YjQ/s1600/33077-hipfemur1.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRvM4ol74lebKDQ4dhvJXFmv1FVHtRDWYTuNKHH_YLh3JS64dQYUgiBfcQa1IZvBuMamipxpKBBepHbCN0yBxmlYEqe3e2LiF2uVgIKECoKOfqPn5TqwjJ5Aei3rDpGi8ONXRkBIR5YjQ/s320/33077-hipfemur1.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Healthy Pelvis</td></tr>
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The pelvic foramen is essentially the "hole" that is formed by the joining of halves of the pelvis (which are connected at the front by the symphysis pubis and connect with the sacrum at the back). A healthy pelvis will manifest a more symmetrical hole. As demonstrated in the image below, the formal "shape" of the foramen is much more "circular or cylindrical".<br />
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This was the first explicit indication of the potential genesis of pain...but the exploration continued.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyNuM2KLFenXMLUtXgihFVIHIvVUZRmbKqH2-bjPuLgCwj2mdQmIXifSXmMHn7VXeWMw6KfGJxeG2jDqzm-iZJm3NSs5g8gD0UroUJoBehmeFPrtLA7o-ZGSuUZlxXLceTzBuyolZaqEM/s1600/Slide2a.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="404" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyNuM2KLFenXMLUtXgihFVIHIvVUZRmbKqH2-bjPuLgCwj2mdQmIXifSXmMHn7VXeWMw6KfGJxeG2jDqzm-iZJm3NSs5g8gD0UroUJoBehmeFPrtLA7o-ZGSuUZlxXLceTzBuyolZaqEM/s640/Slide2a.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Obturator Foramena</td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
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<i>Note the shape and size of both Obturator Foramena (red arrows) </i></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhypQtPW-lLtymnCQqowrl0-z5hVplZJOHQjqoAxciBonAYGsJ5FpUCUn9bn7afoJyFS3iMq7Iz1cxZzzYvQ8lCz0dujSWzh0pcz1JngDgA_baTT2fuPhO-tqEc-AZX8yBi7PX0KuUEB-Y/s1600/Slide3a.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="358" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhypQtPW-lLtymnCQqowrl0-z5hVplZJOHQjqoAxciBonAYGsJ5FpUCUn9bn7afoJyFS3iMq7Iz1cxZzzYvQ8lCz0dujSWzh0pcz1JngDgA_baTT2fuPhO-tqEc-AZX8yBi7PX0KuUEB-Y/s640/Slide3a.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Obturator Foramena (with abduction)</td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
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Of particular note and importance, when the legs are abducted, the overall shape (and therefore, position) of the obturator foramena (as well as the pelvic foramen, by the way) <b><u><i>change considerably.</i></u></b> In other words, there is considerable disruption in structural integrity. This visual information was then integrated into the previous set of symptoms and information gathered earlier. To summarize: </div>
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<i>a) Significant pain that seems to come from the <u>left hip</u></i> <i>(the "D" indicates the Right side).</i></div>
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<i>b) Pain is manifest almost exclusively during movement and transfers. More specifically with hip flexion.</i></div>
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<i>c) Favored position (pain-free position) is neutral with no flexion or extension of the hip.</i></div>
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<i>d) Underlying condition of high muscular tone (globally manifested).</i></div>
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Items C and D are of particular relevance when we consider the plethora of muscles and muscular attachments that enter / exit the hip...especially at the deepest levels. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvqitgMa9dfKYUbRlT9GZZ3o3LdnCUI7q6C7psnTl52BvS-VZ4WPkOmpmIfcJEQ302HaT9T9eV7u7mR_JZIuRBzhJRXUYZ7hlzCw-4afDNSrUDXkFAKMNcSvk9OWHn3madVN849LT0r5o/s1600/Posterior_Hip_Muscles.PNG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="433" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvqitgMa9dfKYUbRlT9GZZ3o3LdnCUI7q6C7psnTl52BvS-VZ4WPkOmpmIfcJEQ302HaT9T9eV7u7mR_JZIuRBzhJRXUYZ7hlzCw-4afDNSrUDXkFAKMNcSvk9OWHn3madVN849LT0r5o/s640/Posterior_Hip_Muscles.PNG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Deep Muscles of the Hip and Pelvis</td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
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The above illustration is an example some of the deep and intermediate muscles of the hip (left image is posterior, right image is anterior). When we import the specific findings in the x-ray, the obvious conclusion is that the pelvis itself is manifesting a <i><u>posterior tilt of the left side</u></i>. Although there are many potential "reasons" for this, the fundamental realities of CP are always at the nucleus: </div>
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1. ALL joints / articulations within the context of CP are <u><i><b>weak</b></i></u>...and therefore <i>subject to excessive movement and displacement</i></div>
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2. There is ALWAYS a certain level of muscular imbalance and disproportional levels of tension and weakness. </div>
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RESULT: Proportionally high levels of muscular tension and imbalance stress the various articulations and can potentially generate acute or chronic pain / dysfunction. </div>
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In this particular case, it was concluded that the most likely genesis of the pain was this posterior tilt. In essence, the acute bouts of pain during transfers and movement can be attributed to reflexatory muscular spasms of the deep hip / pelvic muscles. If we refer back to the illustration above and simply abserve the number of muscles that originate or attach onto and around the pelvis (obturator foramen, symphysis pubis, etc..) it is not difficult to extrapolate the potential chance(s) for irregular stress and strain on the whole muscular system. </div>
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With respect to the more practical "navigation" and management of pain, the specific objective becomes a tactical one: </div>
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a) Manage levels of pain</div>
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b) Address the status and state of the muscles involved (those that play an immediate role in either reducing the amount of pelvic tilt and those that come under immediate threat of spasm). </div>
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c) Implement a <i>strategic</i> mid-to-longterm plan to address the strength and integrity of the pelivs and pelvic joints (reduce the likelyhood of re-occurence and/or reduce the intensity/frequency/duration of pain). </div>
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In summary, the main message is to (as best possible) engage in habits that encourage and facilitate a broad analysis of not only the area in question but the entire system. In many cases, the formal "outlet" of pain (where it is felt) can have immediate and direct links but also indirect links to adjacent structures and architecture. </div>
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Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-68521645868460477012016-02-25T16:24:00.002-03:002016-02-25T20:15:41.242-03:00The Importance of Recovery in Cerebral Palsy<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMDhfrY-4GfbaIqAZtRFOi0Au2tjinP6PaCUYLBzyBWI3oBpDZhcHXdiTHgPZ10eSZoJ4_Ti_zm66je0lkQzcsX-Xx9XKikqZhtzUfOKm3e3uFF7qG9pP2T0pgDbNkPaysWF8wRrhFmWk/s1600/kids+yoga+2+jan2012.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMDhfrY-4GfbaIqAZtRFOi0Au2tjinP6PaCUYLBzyBWI3oBpDZhcHXdiTHgPZ10eSZoJ4_Ti_zm66je0lkQzcsX-Xx9XKikqZhtzUfOKm3e3uFF7qG9pP2T0pgDbNkPaysWF8wRrhFmWk/s400/kids+yoga+2+jan2012.png" width="400" /></a></div>
In the race to achieve developmental milestones, promote dynamic movement, and improve overall function, I have found that the "larger picture" is sometimes clouded if not lost completely. By this I mean that the human organism operates (oscillates) within what I like to call a specific <span style="color: blue;"><em>Biophysical Continuum. </em><span style="color: black;">In other words, we are not simply "ON" all the time...in fact, we exist within specific "states" of activation. By <em>activation</em>, I refer to <u>what is the predominant systemic / biomechanical system operating at any given time.</u> </span></span><br />
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This perspective is an attempt to provide some clarity on the human organism (person) as a whole...or as a "Supersystem" that is something more than just the sum of separate individual systems. Rather, it is an exponentially complex and inter/intradependent piece of evolution and engineering. In effect, it is likely beyond our current capabilities to truly comprehend...which is why the Biophysical Continuum is a valuable tool in navigating the journey through neurodevelopmental challenges. <br />
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<u>Biophysical Continuum </u><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggcUTaCz2_PXiQO5tQGYW2FLClpYOm9kyollxRDoPaid3TsOpUSbgozO43lbvHjPmDdkvDqoY6kHSk3bq3aPK_W560hb3Dvn2ZJj7HoH2U6ZKDsg_R5BKfFgijiXzIGWwkXps63SX7R4w/s1600/Slide4.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggcUTaCz2_PXiQO5tQGYW2FLClpYOm9kyollxRDoPaid3TsOpUSbgozO43lbvHjPmDdkvDqoY6kHSk3bq3aPK_W560hb3Dvn2ZJj7HoH2U6ZKDsg_R5BKfFgijiXzIGWwkXps63SX7R4w/s640/Slide4.PNG" width="640" /></a></div>
As shown in the graphic above, we can effectively separate a full day into 3 formal "states": <br />
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1. Activation<br />
2. Relaxation<br />
3. Recovery<br />
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Being a continuum, there is no explicit "point" at which one state becomes another...rather that we "slide" seamlessly from one state to another, and at many times during the day, we exists in a state that can be a hybrid "blend" of either <em>activation / relaxation </em>and <em>relaxation / recovery. </em><br />
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<strong><em>Activation</em></strong> can be formally identified as "exercise and movement". To be precise, it is manifest by <u>HIGH levels of muscular, neurological, and mental resources.</u> There is a higher rate of catabolic activity which contributes to increased levels of metabolic build-up (lactic acid, etc...) which is toxic to the body and needs to be flushed, and there is a greater stress on biomechanical architecture and neurological resources (concentration). <strong><em>Relaxation</em></strong> can be misleading, however within the context of this post, I refer to it as those mental and physical activities that take place during the course of the day. In other words, the "routine" that takes place when we are not either sleeping or exercising. In this phase, the mental / neurological / physical requirements are well within tolerable limits...mainly because they are likely to be habits that have become somewhat "automatic" and are essentially done within any real conscious effort or concern. More importantly, systemic function is essentially at a "net zero" level...meaning that there is a sufficient amount of "input" to satisfy the required "output". <strong><em>Recovery</em></strong> is most accurately defined as "sleep" (and in many cases, meditation as well). It is during this phase that our systemic "oscillation" (respiration, digestion, lymphatic system, microcirculation) plays a primary role while the neuromuscular "engine" reverts to a primitive and formal "off" state. This is THE state at which our evolutionary development and "operation" are hard at work. We slip from any voluntary / conscious influence and are essentially operating on the autonomic / involuntary / primitive level. <br />
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This is where we formally enter into our most valuable <em><u>self-healing, self-regulating, and recovery phase.</u></em><br />
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If we assign a generic amount of time during a 24-hour day, we are presented with a breakdown that approaches something like the graphic above. If we assume an average amount of sleep that centers around 8 hours (a lot for some and too little for others, but you get my meaning), an average of 30-60 minutes of what could be considered as "exercise / movement" based activity, and the remaining 15 hours manifested as "daily activity"...we are left with a "colour-code" that looks like that. In essence, this is an example of an environment that is <em><span style="color: blue;">sustainable. </span></em><br />
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<span style="color: black;"><br /></span>If we consider the realities in CP (and all neurodevelopmental disorders, in fact) we get a vastly different picture. Disorders of movement and posture require extremely high levels of muscular activation (even to accomplish those tasks that we generally consider "easy") as well as high levels or mental resources. To be precise, <em>many if not most of what we normally classify within the context of "daily activity", falls into the category of "athletic exercise" in the individual with CP. </em><br />
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The ultimate outcome is an environment that stresses ALL systemic and biomechanical resources...the result of which are those common challenges we see with alarming and consistent regularity: <br />
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-underweight<br />
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All of this taking place under the influence of (in most cases) irregular and/or insufficient sleep patterns.<br />
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The "bottom line" is that the mechanical and systemic equivalent in a healthy individual is something akin to exercising 14 hours a day, sleeping about 4 hours a night, and leaving approximately 6 hours to accomplish everything else we would attribute to daily function (eat, shower, leisure, study, work). When placed within THIS context, the stress on the CP body becomes more clear...it is an enormous challenge to a growing organism <br />
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<em><span style="color: blue;"><span style="color: black;">The body does not have adequate time to engage in the process of self-healing and self-regulation...meaning that recovery is insufficient and incomplete.</span> </span></em></div>
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<span style="color: black;">In summary, my primary message is intended to reflect the following: </span></div>
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<em><span style="color: blue;">ANY strategy that contributes to relaxation and enhanced sleep potential is a valuable and VITAL component to all rehabilitation plans. Although all of the efforts to improve movement, balance, coordination, fine motor skill, etc...are critically important, they also ADD to the biomechanical, systemic, and neurological daily requirement. Therefore, a careful and focused effort to potentiate the "rest and recovery" of an individual with CP will result in a Biophysical Continuum that is more <u>harmonious and consistent with a sustainable supersystem. </u></span></em></div>
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In essence, the "investment into recovery" pays HUGE dividends within the realm of movement and dynamic function. A system that is rested, fresh, and fluid will perform significantly better...which ultimately results in a better rate of progress. More importantly, it "raises the ceiling" of potential and greatly enhances the prognosis and opportunity for a best-case scenario. </div>
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Cheers!</div>
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-32298847035730945292016-02-12T14:51:00.001-03:002016-02-12T14:51:43.648-03:00Early Detection and Intervention: Strategies for Immediate Action<div class="separator" style="border-image: none; clear: both; text-align: center;">
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One of the most frustrating realities within the context of Cerebral Palsy (CP) is that "diagnosis", as such, is generally made around the age of 2 years old. In other words, although it may be known that there is SOME level of neurological damage (or at the very least the POSSIBILITY of neurological damage), the "call to action" with respect to a definitive rehabilitation plan is generally deferred until after an official diagnosis is confirmed. To be clear, this is not to say that nothing is being done nor does it mean that best interests are not taken into account...what it does mean, however, is that specific strategies and action plans become significantly <em>more defined and clear</em> once the diagnosis has been made. The logical question people are likely to have after reading that last statement is: <em>what's so strange about that? </em>The answer comes back in the form of another practical question: </div>
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<em><span style="color: blue;">Why must we wait until things are so "black" before we act?</span></em></div>
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<span style="color: black;">In other words, there are many things that can be done within the "grey areas" that do not necessarily require a "diagnosis" in order to confirm viability. Further, the first 12-24 months of life present <strong>enormous</strong> opportunities to implement profound change due to the high level of neuroplasticity and biomechanical compliance. The need for a diagnosis goes well beyond the practical debate and extends into issues of liability and systemic function of the medical system...to be precise, <em>almost the entire rehabilitation plan is<u> pre-set</u> based on the diagnosis. </em>Although I agree with the necessity for standardization over customization (especially when we are speaking about providing a service to a larger mass of people), it does not mean that there is no room for individual strategies to be formulated that will result in a plethora of tangible (and intangible) positive outcomes. </span></div>
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The next level of questioning is likely to be quite intuitive: </div>
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<em><span style="color: blue;">If we don't have a diagnosis, how will we know where to start?</span></em></div>
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From a broader and more global perspective, we simply need to understand the fundamental reality that, regardless of whether there is a specific pathology involved or not, <em>every human being requires healthy and robust systemic function (vital functions) in order to sustain life. </em>More specifically: </div>
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-Respiratory Mechanics</div>
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-Microcirculation (blood and interstitial / intercellular fluid)</div>
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Regardless of the diagnosis (or even the <em>presence </em>of a pathology), these are considerations that can be addresses and potentiated in a more immediate fashion. This lends to the "organic" perspective as a precursor to the "mechanistic" perspective. In other words: </div>
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<em><span style="color: blue;">The diagnosis establishes the mechanistic strategy ("what is not working and how do we fix it") while early intervention establishes the organic strategy ("what is working and how can it work better"). </span></em></div>
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<span style="color: black;">It should be said that <u>both</u> of these perspective play a role in an effective and efficient rehabilitation strategy...however, the insertion of an organic perspective is what (in my opinion) is generally lacking and even overlooked completely. </span></div>
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<u><strong>Early Detection:</strong></u></div>
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One of my most proud accomplishments with respect to Fascia Therapy is the fact that it addresses these specific "voids" within the strategic options that parents / families / care-givers have. Beyond being a viable "standalone" platform, adjunct / complement, and tactical management strategy, it has a well defined protocol for early detection and intervention. </div>
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Over the last 3 years, I have been fortunate enough to work with Dr. Veronica Delgado who is a well known physiatrist and doctor in Chile. She has essentially formulated an "Early Detection Protocol" that uses a simple scoring system to identify potential markers for neurological impairment. In addition (and in conjunction with), I have formulated a specific evaluation protocol that identifies postural and structural markers as well. </div>
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Using both the neurological and structural metrics, we are better able to identify levels risk and therefore set a proper early intervention strategy. </div>
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<strong><u>Early Intervention: </u></strong></div>
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As stated earlier, as well in a few of my earlier posts on the importance of <em>respiratory mechanics</em> in neurodevelopmental disorders <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2014/09/respiration-and-neurodevelopmental.html" target="_blank">Part 1</a> and <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2014/12/respiration-and-neurodevelopmental.html" target="_blank">Part 2</a> , addressing and potentiating improved respiratory function extends not only into the systemic understanding, but has PROFOUND implications on the development of the pelvis and shoulder girdle...thereby having direct influence on health and function of the hips, legs, and arms. This perspective is something that is worth a read / re-read. </div>
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The Fascia Therapy concept addresses this consideration with what is called the Respiratory Protocol which has proven to be a valuable complement to early intervention strategies as well as part of a larger management strategy for all ages with neurological challenges. </div>
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Along with the respiratory protocol, there are a group of specialized techniques that potentiate and enhance microcirculation, more specifically <u>interstitial fluid.</u> To put it briefly, interstitial fluid is essentially the medium by which waste product is transported from the bloodstream to the lymphatic system...therefore having a profound impact on systemic health and homeostasis. On addition, immune system function depends greatly on robust interstitial fluid flow. In CP, microcirculation is greatly diminished and effectively manifests in poor tissue quality (colour, texture) as well as overall systemic deficits (chronic illness, stiffness, injury). Being able to properly identify priority "targets" using these techniques greatly enhances systemic homeostasis and ultimately produces a stronger and more resistant organism. </div>
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In summary, this post is intended to underscore the reality that, although "black and white" situations do indeed exist, the "grey areas" are exponentially larger...and they should be looked at as opportunities to implement profound, permanent, and lasting improvement. </div>
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Cheers!</div>
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Gavin </div>
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Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-87990956150550315952016-01-09T16:24:00.003-03:002016-01-09T16:24:53.083-03:00Functional Range Conditioning for Cerebral Palsy: Introduction<div style="border-image: none; clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;">
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Taking all of this into account, I will begin the process of sharing a strategy I have called Functional Range Conditioning for CP. It is a relatively comprehensive set of skills from the objective observers perspective that is based in an equally "heavy" physiological foundation...but at the same time, it is something that lends well to the "end-user". This means that it has been specifically formulated to resonate well with any parent / care-giver and therefore serve as a valuable tool that can be used directly in the home. </div>
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The term "Functional Range Conditioning" is something I have essentially borrowed from an already established methodology used in athletes that efficiently and effectively frames an essential (and fundamental) reality: </div>
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<em><span style="color: blue;">In order for functional performance to improve (and thus reach maximum potential), we must first ensure that <strong>joints actually <u>behave</u> as joints.</strong> If the singular articulations are dysfunctional, then the movement potential of the entire body is limited. </span></em></div>
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Therefore, the strategy --- when addressing the issue of restricted / reduced ranges of motion --- is to <strong>first</strong> identify the dynamic <u>behaviour</u> of the joints before engaging in any active (or aggressive) stretching protocols. </div>
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<u>Mitigating the challenges and risks of stretching</u></div>
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Challenges and risks??! These specific things are identified in detail in the earlier stretching post, but once you have absorbed these risks and challenges, the next practical question becomes: </div>
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<em>"How do I (we) navigate and reduce them? </em></div>
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One of the MANY architectural challenges in CP is the inherent "mismatch" between the excessive strength (tightness) of the muscle fiber and the relative weakness of the connective tissue "anchors" (tendon, tendon attachment to the bone). In other words, when we import a standard stretching protocol to CP, it is impossible to confidently be sure that the stretch itself is actually stretching muscle or in fact stressing / straining the tendon and/or the attachments to the bone. </div>
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Therefore, <u>before</u> any angular (dynamic) movement is done, we should first provide some essential "nutrition" to the joint itself. This is the first step in Functional Range Conditioning: </div>
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<strong>1. Joint Health and Nutrition</strong></div>
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In order to achieve true productive range of motion, the joints MUST be healthy (or as healthy as possible) and formally behave (perform) as they are designed. The reality in CP is that the majority of the synovial joints manifest moderate to profound stiffness. In other words, the joint capsule (the connective tissue that covers the entire joint like a sac) manifests a certain <u>fibrosis.</u> This means that rather than being a pliable and adjustable membrane, it is tight, fibrous, and relatively unforgiving. </div>
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"Sponge Analogy" </div>
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I have used the Sponge Analogy on many occasions and I can honestly say that it is one of my most favorite ways of explaining joint behaviour in a way that is almost instantaneously understandable. </div>
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Joint require a certain level of fluid...not only within the joint itself, but within the layers of tissue and even down to the cellular level. This fluid essentially "bathes" the joint...providing not only lubrication and movement freedom, but also NUTRIENTS. When a joint is fibrotic, it can formally be related to a <em>dry sponge. </em></div>
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The image above essentially demonstrates the 3 states that joints can manifest. They should not be considered as 3 separate states, however...this should be looked at as a <strong>continuum.</strong> Meaning that there is a gradual change in state when we move from one extreme to the other. </div>
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<em>Dry Sponge</em></div>
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The dry sponge represents the fibrotic joint. It is rigid, in some cases distorted, and very much devoid of nutrients. </div>
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<em>Moist Sponge</em></div>
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This is meant to represent the "ideal homeostatic state" of a joint. There is sufficient amounts of interstitial fluid to maintain its integrity as well as provide it with the required amount of nourishment. </div>
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<em>Wet Sponge</em></div>
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The wet sponge represents the joint that has experienced some form of trauma...whether it be an acute injury or the result of long-term chronic stress. Think of this as <em><u>swelling or edema. </u></em></div>
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If we consider this analogy, then imposing angular dynamic movement (stretching) around this joint can potentially (if not likely) run the risk of unseen (and potentially de-stabilizing) injury or insult. As a matter of strategic wisdom, when we are dealing with the challenges of CP and stiff / fibrotic joints...</div>
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<em><span style="color: blue;">The first "order of business" is to implement those techniques and interventions that are the most efficient at moving and mobilizing Interstitial Fluid <strong><u>towards</u> the joint itself.</strong></span></em></div>
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These techniques and interventions are part of the specific skillset and toolset used within the Fascia Therapy framework and are easily delivered during our training sessions. </div>
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<strong>2. Functional Range Development</strong></div>
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This step is implemented after (or in some cases, concurrently) the joint health and integrity step. This step has 2 fundamental aspects: a) use specialized manual techniques to relax stiff and tight muscle...and b) impose progressive multi-joint movement patterns (using varied tools such as pilates balls and stability balls) to engage and activate the <u>entire neuromuscular chain</u> just as it would be engaged and activated in a real-life environment. </div>
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These movement patterns are quite varied and are essentially dependant on the individuals intrinsic movement competence and abilities...however, they are implemented based on the process of natural human motor development and formally help to potentiate movement through the developmental process in a more efficient and timely manner. </div>
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In summary, this is only an initial overview of the framework of Functional Range Conditioning. As with any approach, it should not be considered as a magic bullet...nor does it's existence and/or implementation negate or diminish the outcomes of other strategies. It is meant to serve as a viable and realistic adjunct to all long term rehabilitative strategies...more specifically, a safe and effective way to develop, activate, and nourish better movement coordination and performance. </div>
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More to come!</div>
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Cheers,</div>
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Gavin </div>
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Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com2tag:blogger.com,1999:blog-8731813357458649991.post-17949915637160167192015-11-29T11:40:00.001-03:002015-11-29T11:40:13.024-03:00Rigidity and Spasticity: What's the Difference? <div class="separator" style="clear: both; text-align: center;">
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This is a question that, strangely enough, does not get asked very much...at least to me. The reason I would categorize this fact as "strange" is that, within the context of neurodevelopmental disorders, they manifest quite differently...and with respect to their effect / affect ratios, they both present vastly different challenges. In my estimation, the reason for this is partially the fault of the general population of medical professionals...an unintentional error, of course. It speaks to an underlying dysfunction which I have called a "Diagnostic Disability"...which in plain terms means that the medical / health profession at large are not using the same "technical language". Although the alphabet is the same, words are used within vastly difference contexts and, over time, essentially become merged and "blurred". The terms "rigidity" and "spasticity" are victims of this phenomenon and therefore have essentially become synonymous with each other. As part of the process of navigating complex physical / physiological challenges (for both families AND professionals), it is important to (at the very least) take time to provide a well-defined "glossary of terms" so that those you work with have a clear understanding of what is being said. <br />
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The medical physiology of rigidity and spasticity are relatively complex and therefore getting into these complexities would not be a productive exercise simply because the objective of this post (and the next post to follow) is to provide a global understanding that is easily integrated and which can be built upon. As always, information is best absorbed in "digestible" chunks. <br />
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Within the realm of Cerebral Palsy (CP) and other disorders of movement and posture, it is important to remember (and understand) that muscular dysfunction cannot be classified into specific and explicit "categories"....that is to say, nothing in the real world is a manifestation of one pure issue. Everyone is essentially a tangled mix of tension, stiffness, weakness, rigidity, spasticity, etc...even more so, they all overlap with each other in many ways. To be specific, the observable MANIFESTATIONS of any and all of these issues often appears the same. With this in mind, the pressing challenge becomes <u>how to identify the most prominent biomechanical muscular limitation</u> ...with the end objective being to efficiently formulate effective treatment goals as well as implement the appropriate management strategy at home (sleeping, resting, feeding, etc...). Being able to <u>identify</u> is always the first step...once that has been done, the process of "what to do about it" becomes more clear and therefore results in better treatment outcomes. <br />
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<u><b>1. Spasticity is velocity dependant whereas rigidity is not</b></u><br />
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The response to passive movement is an effective way to identify spasticity versus rigidity. A spastic muscle will generally appear relaxed when at rest, but when moved passively (extended) it will increase in tone and then return to a generally relaxed state when the movement is stopped. The rigid muscle will express high tone at rest and throughout the entire movement.<br />
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<u><b>2. Spasticity, in general, involves single muscle groups whereas rigidity is global</b></u><br />
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Although not considered to be a "black and white" reality, spasticity is oftentimes found to be present in the "anti-gravity" muscles such as the hamstrings, hip flexors, biceps, etc... Rigidity, although can certainly be found in the anit-gravity muscles, is more commonly a global manifestation.<br />
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<u><b>3. From a clinical perspective, long standing spasticity leads to contractures more than long standing rigidity.</b></u><br />
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This statement is a very generalized clinical statement which simply defines some of the treatment parameters. Contractures are always an ever-present reality regardless of specific diagnosis or classification, however a long-standing situation of rigidity tends to result in less (or less severe) complications with contractures. <br />
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The follow-up to this post will discuss some of the theory and strategies that parents / care-givers can implement immediately. The issue of rigidity versus spasticity becomes more multi-layered when we realize that both of these (somewhat different and exclusive) manifestations is generally addressed in the same way: STRETCHING. I would recommend a read / re-read of my previous post on <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2012/05/stretching-and-cerebral-palsy-what-you.html" target="_blank">stretching and CP</a> to absorb / re-absorb the underlying challenges and considerations of implementing stretching protocols. Stay tuned for the second part of this post:<br />
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"ALTERNATIVES TO TRADITIONAL STRETCHING: HOW AND WHY"<br />
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Cheers! <br />
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com1tag:blogger.com,1999:blog-8731813357458649991.post-65518926872020178642015-08-16T19:22:00.001-03:002015-08-16T19:30:42.849-03:00AFO's and Cerebral Palsy: Do or Don't? <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-JS8kH82n082-72P0yDbQTe9l8Z6BNtzz-lrdQq5NHfiHY7tl9t6tFTD65O-WVHayJgFc7qNyevSeNeMGBvTlzGy0jEuhR3sXS530W0r-ogpGRTuA45bPY29kg0D1GQnXpyCZm0cKZjA/s1600/ankle-foot-orthosis-afo-orthopedic-immobilization-pediatric-71168-164071.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-JS8kH82n082-72P0yDbQTe9l8Z6BNtzz-lrdQq5NHfiHY7tl9t6tFTD65O-WVHayJgFc7qNyevSeNeMGBvTlzGy0jEuhR3sXS530W0r-ogpGRTuA45bPY29kg0D1GQnXpyCZm0cKZjA/s400/ankle-foot-orthosis-afo-orthopedic-immobilization-pediatric-71168-164071.jpg" width="293" /></a></div>
Although it remains one of the main issues / topics discussed during almost every family meeting or training session, I haven't quite given AFO's (all orthotics in general) the attention it deserves. The general perception on this issue is, for the most part, driven by untuition. In other words, the feet are distorted so let's do something to straighten (or fix) them. Despite this intuition, the same question arises with alarming regularity:<br />
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<i>"Should we use them or not?" </i><br />
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I have never been a big fan of blanket responses...meaning that there is very little I can answer with a short "Yes" or "No". With respect to AFO's, the reality of <u>what you should do</u> will reveal itself once you walk yourself through a series of steps and practical questions. This is to say that, the question of "should we or shouldn't we" is far to simplistic...this needs to be examined with a more comprehensive process and the "answer" is distinct for every family. <br />
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Every family will need to flash this question through their own "prism" and ultimately decide what is best for them and their shared value system...which is why I find it is much more efficient to avoid blanket responses and set a specific framework of understanding and examination so that every family will ultimately arrive at the most productive response. The first practical question to ask yourself is:<br />
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<i>What is (are) your specific intention(s) of using AFO's? </i><br />
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AFO's (and orthotics) have been a rehabilitation option for hundreds of years. The main difference / evolution has been that the materials used are lighter, customizable, and more efficient to manufacture...however the general mechanical premise is the same. I mention this for a specific reason:<br />
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<i>If the intention / objective of using AFO's is to reverse or "fix" a biomechanical distortion, this would be an over-simplification of a vastly more complex situation. </i><br />
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Meaning that, historically there has been no significant evidence or research that points to the premise that AFO's <u><i>reverse</i></u> biomechanical distortion. We then come to the next level of questioning and formulation:<br />
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If they do not reverse or fix anything, what use do they serve?<br />
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Again, the issue isn't whether they are good or bad, but how they are used and to what end. AFO's are excellent adjuncts / complements to larger rehabilitation strategies for children who are either ambulatory or who demonstrate some level of weight-bearing (partial) directly on their feet. Therefore...<br />
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<b><i>AFO's are extremely valuable when the main objective is additional <u>support and safety</u> within a larger rehabilitation strategy for walking improvement / development. </i></b><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi205Pn6YeHij5ytvToQma2YRPF2PJGr8nXuKs1FcfYbArfQ0svxvsW8ZSchqih21ofngm53i4uXLFlSX0J6VtAViyR01Ytq2XMGaSt2a1at9uzrv-EAUBcbaA-odD3g61QnDwzMbcU1Yc/s1600/HEKOActionImage.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi205Pn6YeHij5ytvToQma2YRPF2PJGr8nXuKs1FcfYbArfQ0svxvsW8ZSchqih21ofngm53i4uXLFlSX0J6VtAViyR01Ytq2XMGaSt2a1at9uzrv-EAUBcbaA-odD3g61QnDwzMbcU1Yc/s320/HEKOActionImage.png" width="217" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Foot Orthotic with Knee Orthotic</td></tr>
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In other words, they can provide a significant window of opportunity to amplify and/or expediate the development process by imposing a small amount of support to otherwise weak articulations so that the ENTIRE biomechanical organism (the whole body) can engage and interact as a whole...as it is meant to do. <br />
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In some cases, this formulation can be overwhelming...and whereas more information is usually helpful, sometimes it can confuse as opposed to clarify. Therefore, I can break down the process into something that is likely to be more user-friendly and easier to process.<br />
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<b><u>Helpful "Do / Don't" Checklist</u></b><br />
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1. The use of the AFO associated with pain or discomfort. DON'T<br />
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2. The use of AFO's results in more enagement and interaction with the environment. DO<br />
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3. Is your child relatively functional and have some general weight-bearing ability already in place?<br />
Yes --- DO<br />
No --- DON'T<br />
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4. My goal is to reverse deformities in the foot. --- DON'T<br />
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5. The use of AFO's are part of a larger strategy. --- DO<br />
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In reality, this "checklist" is quite generic...but it serves to amplify the central premise that AFO's are neutral to the question of good or bad...right or wrong. It is the specific intention that sets the framework for their efficient use. It is easy to get caught up in the <b><i>laws of contradiction</i></b>...which is to say that, if their use is GOOD then their non-use is BAD. The law of contradiction is a reality that simply states if one thing is 100% good all the time, then the opposite to that action is bad 100% of the time...which is far from the reality. <br />
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Again, this formulation is something that MUST be put through each family prism. Therefore, it is perfectly acceptable that my very perspective is dismissed and discarded...but the issue is not convincing or "conviction" as such, rather to ensure that decisions are made VIA some form of analysis and exploration as opposed to the more simplistic (and perhaps convenient) mechanisms. <br />
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<i> </i>Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-82446427599790414072015-08-05T14:51:00.002-03:002015-08-05T14:51:22.982-03:00Activating the hands in Cerebral Palsy<div class="separator" style="clear: both; text-align: center;">
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This post is a follow up to the previous post on <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2015/07/sensory-body-mapping-brain-exercises.html" target="_blank">sensory brain exercises for CP</a>. Although these sensory exercises are useful, they are somewhat limited when you are presented with a hand that is consistently (and/or rigidly) closed or fisted. In addition, the closed fist is almost always accompanied and characterized by some distortion and asymmetry...both of which may make simple sensory exercises difficult and frustrating. With this in mind, I wanted to shed some additional light on the issue of hands and (hopefully) provide some options and avenues for those parents and families that want to actively potentiate some improvement in the hands and, perhaps more importantly, provide some clarity on some realities about the developmental process...which always proves to be helpful and immediately useful. <br />
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<u><b>"Don't put that in your mouth"</b></u><br />
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Words that every parent has said (or yelled) at one time or another, correct? Although it is an intuitive understanding that babies / children will put things in their mouth, it is oftentimes difficult for parents (and people in general) to truly understand and formulate the reason <u><i>why</i></u> this is done...and universally across the board. ALL humans do / did this! <br />
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This type of behaviour is simply the manifestation of the natural developmental process of exploration and discovery. In the first few months, a baby's visual field is still quite immature therefore in order to genuinely get "a sense" of themselves and their surroundings, they need to expose things to those senses that have reached a higher order. In other words, they formally "feel" things with their mouths. This includes hands, feet, and pretty much any object that is within reach. <br />
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As a natural and healthy part of the developmental process, children will go through this phase during the first few months (and first year) and then when their visual competence and acuity begins to develop more, they will begin to actually grasp and hold things within their field of view. Although they are still likely to put things into their mouths for "enhanced feedback", they will consistently stare at and track objects that enter their field of view. <br />
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<u><b>Missing Links and Activation in CP</b></u><br />
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When we put this into the context of CP (and neurodevelopmental disorders), the reality in many cases is that the opportunity to enter this exploration phase of "hands / feet / objects in the mouth" has never been experienced...whether due to direct neurological impairment, significant physical limitations, or both <u><i>the hands (and even the feet) have never been fundamentally "woken up" or activated.</i></u> <br />
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<u>Point of interest:</u> A new born baby will consistently manifest a closed fist (with the thumbs outside), but as he/she develops and begins the fundamental process of self-exploration, the hands and fingers are exposed to high levels of sensory input...essentially activating them, while at the same time the brain itself is formally "registering" the hands / feet and creating a working body map of them as well. In CP, more specifically in those GMFCS Level 4 and 5 classifications, the hands seem to maintain some level of "closure" and (as the hands and fingers get longer and wider) distortion. This is not to say that distortion and/or asymmetry in the hands is 100% due to this missing phase...however, the fact that fundamental activation VIA these mechanisms was limited or even absent is most certainly a part of the reason...and therefore, by definition, part of the <i>solution. </i><br />
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<u><b>"Little things...BIG difference"</b></u><br />
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With respect to tangible and practical "things to do", this would vary greatly on an individual level...however there are certainly some standardized and "generic" ideas that are usually quite helpful and, paradoxically, nothing new. Alot of what is done within the scope of Occupational Therapy fits quite well within this narrative, however as parents it is always strategically wise to potentiate and activate your own level of understanding, knowledge, and skill...for the simple reason that whatever is done in the home and by YOU is done with the most care, attention, and concentration possible. <br />
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It is not likely a realistic idea to attempt to literally put a hand into the mouth, but it is relevant to know and understand that <u><i>the head and face are areas of high sensory competence</i></u>...meaning that hands that are passively touching, brushing along, and/or placed onto the head and face (especially near the mouth) generate a very powerful sensory "activation". Beyond some of the <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2015/07/sensory-body-mapping-brain-exercises.html" target="_blank">sensory brain exercises</a> mentioned in my earlier post, massaging and rubbing the hands with creams, essential oils (Lavender), or balms will also impose useful and productive stimulus. <br />
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If your child has relativilty good visual acuity, you can combine these with some active (relatively unstructured) play with tools / toys of varied textures (feathers, balls, etc...) that can be brought into their field of vision and (with help) encourage interaction. <br />
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<u><b>"Awareness before Activation"</b></u><br />
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One of the fundamental messages proposed in the previous post is the simple understanding that a "mechano-sensory awareness" must be developed in order for any productive activation can begin. Extrapolating this idea, FUNCTION (which is the overall objective) is formally the manifestation of organized and coordinated activation...therefore starting at the root and addressing the fundamentals of <i>awareness</i> will provide significant help in achieving that objective. <br />
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Cheers!<br />
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com3tag:blogger.com,1999:blog-8731813357458649991.post-29568545016685114072015-07-27T13:41:00.000-03:002016-02-01T18:49:08.572-03:00Brain Exercises for Cerebral Palsy: Sensory Body Mapping<div class="separator" style="clear: both; text-align: center;">
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One of the biggest (if not THE biggest) mysteries of mankind if the human brain. It has been said that we only truly understand about 2% of how the brain works...which begs the question as to what (if anything) can we really do about improving or "re-training" it. Despite the odds being stacked against us, we certainly have windows of opportunity to confidently work within the parameters of this 2%.<br />
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Most of my work within the Fascia Therapy context revolves around the biomechanical and systemic manifestations of injury and / or neurodevelopmental disorder, but this does not imply that there aren't any simple and user-friendly things that can be done to extract the maximum best-case scenario by tapping into a resource that has an infinite amount of influence and potential.<br />
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<u><b>"It's all in your head."</b></u><br />
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A common expression, however from a formal perspective it is paradoxically quite accurate. Things such as pain perception have long been studied and identified as something that can actually be controlled via some form of training. More relevant to the context of this blog, I will use the example of a more familiar phenomenon called <i>Phantom Limb </i>to set the groundwork towards understanding the mechanism of Sensory Body Mapping.<br />
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Phantom Limb is a phenomenon characterized by a person with a recently amputated limb continuing to perceive their lost limb as still being attached. In other words, they still continue to "receive" sensory input to the brain which often times is characterized by severe pain. There have been many (largely inconclusive) theories on how this happens...but the prevailing opinion is that the severed nerve ending in the stump are irritated and therefore increase afferent (sensory) signals to the brain. The reason as to "why" it would be interpreted by the brain as an entire limb (which is no longer there) is the real mystery...however, there have been some interesting studies in the last 5-8 years regarding the brains way of "mapping" the body which can be (at the very least) extrapolated into a working theory or model.<br />
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The brain essentially keeps and registers a "blueprint" of the entire body so that when any kind of sensory stimulus enters into the system (hot / cold, texture, sound, etc...) the brain can identify <i><b>where it is coming from or where this stimulus is being applied. </b></i>For example, if you place both hands behind your back (so that you don't see them) and touch both index fingers together, your brain will immediately register some pressure being applied to the fingertips. This is a generic demonstration of afferent (sensory information TOWARDS the brain) pathways being opened and used. In healthy individuals, the "map" of the body (in this case, map of the entire hand) is well developed...therefore we are able to receive sensory information, process it, and engage in fine motor skills via efferent (motor instructions LEAVING the brain) pathways. In general, coordinated movement is a formal "loop"...starting with sensory information going to the brain and resulting in programmed movement being generated by motor instructions going to the body. <br />
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<u><b>The "Shrunken" Map</b></u><br />
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This relates quite heavily to the phenomenon of Phantom Limb...which is essentially a representation of the brain's "body map" <i>remaining in place</i> while the limb is no longer there. My theory with respect to neurodevelopmental disorders can be considered as the "reverse" situation...a situation whereby <u><i><b>the body map was never fully developed due to limited or lack of use.</b></i></u> What does this mean in practical terms? According to these recents studies, when a limb (hand / foot / etc...) is contracted and goes unused over time, the representation of that particular limb <b><i>is reduced considerably in the brain. </i></b>In other words, a hand that is consistently closed with no use of the fingers will formally be registered in the brain as a "club or stump". When this "shrunken body map" scenario takes hold, a significant (if not all) amount of motor function will be manifested with the "neurological intent" of using a club...not a hand. In practical terms, movement will be characterized by more gross motor patterns (swinging, swatting) and very little (if any) fine motor skill. <br />
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This is a dilemma for most because the subjective impression is that they either <i>do not know how to use their hands or do not WANT to use their hands...</i>but in alot of cases, it is simply a question of the <u>brain not having a proper body map established.</u> To compound this scenario, persistent and chronic non-use of the limb results in sensory (afferent) pathways going unopened and unused for years...essentially becoming dormant. Beyond the progressive deterioration that can be accompanied with growth and development, this reducing sensory challenge only serves to aggravate the situation. <br />
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<u><b>"Re-drawing the map"</b></u><br />
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Sensory Body Mapping is therefore the formal adjunct "technique" that is designed with the following objectives:<br />
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1. Re-awaken dormant sensory (afferent) pathways<br />
2."Re-draw" the body map that was previously reduced or non-existent via sensory pathways<br />
3. Potentiate gradual improvement in motor skill (particularly fine motor skill)<br />
4. Facilitate an environment that potentiates further coordination and function<br />
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Simple Steps:<br />
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This pattern is generally repeated for a few minutes at a time which can then be followed by some active / unstructured play using toys or various textured objects. This tpye of activity is more functional and will serve to potentiate the stimulus now travelling through the re-opened sensory pathways.<br />
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If the hands are in a closed position, this can also be done on the dorsum (back) of the hand in a similar fashion. The back of the hand contains less soft tissue, therefore the stokes may be done by using a softer implement such as a small paintbrush. Additionally, this form of "mappping" can be done in different areas of the body...all of which require a specific framework (or grid).<br />
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The strategy is to use this type of mechanism as a complement to the larger rehabilitation plan in an effort to extract the best possible result. Coordinated and productive movement / function is the net result of a reciprocal relationship between sensory and motor function...therefore potentiating and improving sensory integrity is an essential component to developing (or re-establishing) better motor control and function.<br />
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More specifics on how it looks to come on the FT YouTube page.<br />
Try it out!<br />
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Cheers,<br />
G. <br />
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com1tag:blogger.com,1999:blog-8731813357458649991.post-51152564522117850642015-06-08T12:44:00.002-03:002015-06-08T12:44:42.672-03:00The Nourish Initiative<div class="separator" style="clear: both; text-align: center;">
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-19916527537122861912015-06-07T12:40:00.002-03:002015-06-07T18:01:13.457-03:00Hip Subluxation and Cerebral Palsy: Understanding the "WHY"<div class="separator" style="clear: both; text-align: center;">
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This post is meant to serve as a follow-up to an earlier post from 2012 that outlines some of the fundamental flaws in the "diagnosis" of <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2012/09/cerebral-palsy-guidebook-hip-subluxation.html" target="_blank">hip subluxation</a>, therefore I highly recommend that you refer to this earlier post either before or right after reading this one. They are both extensions of a much larger discussion on the challenges of hip pathology in general.<br />
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The post from 2012 essentially detailed some of the fundamental criteria for efficiently (and accurately) putting the issue of hip subluxation into perspective. To be specific, the fundamental failure to implement a more comprehenisve assessment of the hip before making any decisions on intervention that are more invasive than what is actually required.<br />
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In continuing this narrative, beyond providing some insight into accurate analysis and assessment, it is equally important to provide some clarity as to "why" the issue of hip subluxation / dysplasia / dislocation is so pervasive in Cerebral Palsy (CP) and other disorders of movement and posture. To be clear, every child is unique and every person manifests unique challenges and symptoms...however, there are some developmental links that can be traced back to fundamental "roots" of these challenges. Although understanding does not provide a formal "solution" to these challenges, <i>understanding WHY they develop is fundamental to providing parents and family with some sense of clarity, direction, and understanding. </i>These are all elements that sometimes get lost in the search for the best solution.<br />
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In a post from December of last year called <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2014/12/respiration-and-neurodevelopmental.html" target="_blank">Respiration and Neurodevelopmental Disorders: Part 2</a>, I outlined the fundamental (and critical) link between respiration and the development / growth of the pelvis. In brief, the immediate engagement of the respiratory mechanism (immediately after birth) is the <u><i>most important catalyst for the continuing development of the shoulder girdle and pelvic girdle.</i></u> In other words, if this mechanism is altered or deficient (which it is in the case of CP, pre-mature births, and other developmental disorders) they cascade effect is that the HEALTHY development of the pelvis is altered as well. Why is this relevant? We should all understand (and integrate) the reality that the <i>legs (and their performance and function</i>) <i>are completely dependant on a <b>well-developed and fully developed pelvis.</b></i> Therefore, ANY deficit in the pelvis (volume, integrity, etc...) will reflect in the legs.<br />
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So...what is happening in the pelvis (specifically) that has this effect of creating consistent environments that allow for subluxation?<br />
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To be precise, the respiratory dysfunction essentially triggers a delay in the volumetric development of the thorax (chest) and pelvis...in other words, <u><i><b>developmental growth is much slower than chronological growth (age).</b></i></u> Additionally, while volumetric development is significantly delayed, <u><i>longitudinal growth tends to remain in place.</i></u> To put it more specifically, the legs grow in <b><u>length</u></b> at a rate that is more proportional to the childs age. The result:<br />
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<i><span style="color: blue;">As the child gets older, the pelvis remains relatively small while the legs continue to grow and develop (in density and muscular mass) at a rate that is more aligned with chronoligical age...which formally gets characterized by an attempt to<b> "fit legs into a pelvis that is architecturally too small to accomodate them."</b></span></i></div>
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If you examine any x-ray of a child with CP (or even a simple photo, for that matter), you will notice that the pelvis and upper thorax almost always appear much smaller in proportion to the rest of the body. In addition, they will appear significantly smaller when compared to a healthy child of the same age. Therefore if you were take a child of 4 years old, the "developmental age" of their pelvis would be more approximate of a child of 2 years old...this architectural "mismatch" essentially results in the body<u><i> trying to insert 4 year old legs into a 2 year old pelvis. </i></u></div>
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<i><span style="color: blue;"><b> </b></span></i></div>
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<span style="color: blue;"><span style="color: black;">From a biomechanical perspective, this is just <b>not possible.</b> The result is profound joint instability, severe muscular imbalances (weakness, tightness), mechanical stresses on the ligaments and tendons, and...possibly / eventually...situations of hip pathology (subluxation / dysplasia / dislocation). </span></span></div>
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The next set of practical questions a parent or professional may have would likely be derived from "where does all of this information take us....what can we do about it?" Of course, there are a number of interventions that are generally intuitive and show some definite benefit...but in the realization that <i>respiration plays a fundamental role in the health and development of the pelvis, it makes strategic sense to include / integrate any and all strategies that address an improvement in respiratory mechanics. </i>This is precisely why the most fundamental element of the Fascia Therapy concept is the Respiratory Protocol. By efficiently addressing respiratory mechanics and "redistributing" the healthy hydraulic stimulus of respiration, we are essentially <u><i><b>"restarting" and re-initiating the proper respiratory stimulus that was missing from the beginning.</b></i></u> When combined with additional carefully selected interventions, the challenges of hip subluxation can more often than not be reduced and, in some cases, reversed. This is a strategy that can help to avoid those options that are significantly more invasive and generally painful. </div>
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In summary, the issue of hip subluxation remains one of the most prevalent concerns and preoccupations in most families. Although it is sometimes the subject of "hot debate", this debate is almost exclusively rooted in how to "fix" it. This is (of course) intuitive and important...however, in order to ensure that the chosen method of "fixing" is, in fact, the best one for your child, you should (at the very least) have a solid grasp on what is going on from a developmental / architectural standpoint as well as an understanding as to why these issues "pop up" in almost all cases and almost always within a specific age range. </div>
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Hopefully this provides some insight into understanding some of the "why's". </div>
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Cheers!</div>
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Gavin </div>
Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com4tag:blogger.com,1999:blog-8731813357458649991.post-80632271815823855452015-05-16T14:37:00.003-03:002015-05-17T20:25:20.206-03:00Developmental Exercises for Improved Arm Function: The Fascia Therapy Techniques<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9Dcim3aXsB2J9W39D5k4uEHO3EauRVqn4W4UYV2rAtA_55oB4zuY7yfnCAvDk6uP1tIZo8NE5Tb0NPWpX6OTndA8PHdz0YyMhtk6VtLnV0RUTzNK5aGy9MEhcd6EyyIcfBE8xZroPhTg/s1600/iS_000016258267_boy_hanging_in_tree.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9Dcim3aXsB2J9W39D5k4uEHO3EauRVqn4W4UYV2rAtA_55oB4zuY7yfnCAvDk6uP1tIZo8NE5Tb0NPWpX6OTndA8PHdz0YyMhtk6VtLnV0RUTzNK5aGy9MEhcd6EyyIcfBE8xZroPhTg/s320/iS_000016258267_boy_hanging_in_tree.jpg" width="320" /></a></div>
One of the most overlooked and under-appreciated aspects of any rehabilitation strategy is paradoxically the most important: <b><i>the human developmental process. </i></b><br />
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Although people generally have some intuitive understanding about development and developmental stages, it often gets clouded and blurred when we are dealing with complex conditions characteristic of many neurodevelopmental disorders. This is understandable...if a parent is presented with some level of distortion in their childs arms, extreme muscular tension, reduced fine motor skills, or even complete lack of gross motor skill, this will be the object of much attention, focus, and intervention.<br />
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As it should be.<br />
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However, beyond these valuable interventions, it is important to remember that alot of these manifestations are in reality <i>symptomatic. </i>In other words, they <u>reflect</u> the underlying condition of developmental delay. Therefore, an added strategy of "re-starting" and potentiating the developmental process is a direct way of addressing the <u>root</u> as well as the symptoms. This may sound relatively straightforward, but the next logical question is: <i>what is the specific developmental process and HOW do we actively re-start it?</i><br />
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To put this into complete context, we would need a much more comprehensive exchange than is permitted within the context of a "blog" format...however, I will deliver the fundamental tenets of the Fascia Therapy philosophy which is that <u><i><b>the key to efficient and effective rehabilitation of neurodevelopmental disorders is to follow and adhere to the fundamental laws of human development.</b></i></u> In essence, the human organism (and, in fact, all biological organisms) go through a specific process of developmental evolution...the result of which is a fully formed, fully functional person. When there is an alteration / injury / event that influences the developmental process (regardless of whether they occur in utero or after birth) there will always be a delay or cessation of said process. Therefore, children with neurodevelopmental disorders (Cerebral Palsy, Miller-Diekers, West Syndrome, etc...) are often never exposed to the <i>environmental triggers</i> that facilitate and potentiate healthy development.<br />
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To put this into a more specific context (and to keep within the mandate of this particular post), a significant part of the reason there are so many complex (and progressive) challenges with the arms and arm function is that the shoulder girdle itself (the space where the arm sits and is made up of the collar bone and the shoulder blade) <u><i>was never properly and sufficiently exposed to the two main mechanical catalysts for development: <b>Traction and Compression.</b></i></u><br />
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<b><u>Traction and Compression</u></b><br />
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<b>Traction</b> is the term used to express a tensional (pulling) stress that attempts to <i>separate</i> one element from the other.<br />
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As illustrated in the adjacent image, a tractional stimulus is something we have seen and experienced ourselves throughout our lifetime...and most likely never paid any attention to (the formal term is called 'brachiation'). WHY do children like to hang from things? This is a multi-layered answer that generally extends into the exploration of motor and sensory limits...but there is a very IMPORTANT stimulus being imposed on the shoulder joint. <br />
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Children with neurodevelopmental disorders have either very limited or NO exposure to this type of stimulus. Tractional (tensional) integrity is essential, not only for gross motor and fine motor skill, but for those "lifestyle-essential" skills that involve pulling (either objects or oneself).<br />
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<b>Compression </b>is a term that can be considered the polar opposite of traction...meaning that there is some external stress (force) that attempts to bring two elements much closer to each other.<br />
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Although both tractional AND compressional stimulus are essential, the compressional stimulii is the most fundamental...in other words, <i><u>it is the one that comes FIRST in the developmental process.</u></i> The act of crawling / creeping generates vital micro-stimulus directly into the shoulder joint which ultimately potentiates and develops shoulder integrity and strength...which then get re-activated during the tractional phase a little later on.<br />
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Once again, neurodevelopmental disorders limit (and in more severe cases, eliminate) the exposure of the shoulder joint to this critical form of stimulus.<br />
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To capsulate all of this information into a more practical narrative, beyond the more common and familiar interventions designed to improve arm function, there are specific techniques that have the specific goal of <u><i>mimicking the fundamental tractional and compressional stimulii in a safe and passive way with the explicit objective of re-initializing the developmental process.</i></u> Of course, these techniques require some basic level instruction, but they are fundamentally user-friendly and can be taught to both professionals as well as parents...but beyond the knowledge of knowing WHAT can be done and HOW you do it, it is fundamentally critical to understand <b><i>WHY it is done.</i></b> <br />
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More technical rants to come!<br />
Cheers...<br />
G. Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-21891825564101189362015-04-24T22:01:00.002-03:002015-04-24T22:01:38.324-03:00Cannabis and Neurological Disorders<div class="separator" style="clear: both; text-align: center;">
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Likely one of the most debated and examined topic of the last couple of years. When I started this blog in 2011, Cannabis wasn't even part of the rehabilitative lexicon...let alone something that should recieve any attention or study. However, it has become extremely relevant...and paradoxically controversial. <br />
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I won't assume that I am an expert at discussing the pharmaceutical aspects of medicinal use of cannabis...this is well beyond my current scope of practice. However, being immersed in the the world of neurological disorders and "on the ground" for the last 9 years, I have experience and seismic shift in perception...not only within the landscape in general but within my own perception as well. The instinctive "hesitation" from the world in general is understandible...but this initial reaction is something we should understand as being shaped by social perception not by fact. The reality is that medical uses have been in place for quite some time. Depending on the literature and sources, it can be traced back to 50 A.D. in China. Regardless, there is likely only one way to truly understand the relevance of cannabis oil:<br />
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Go to the front lines...talk to the people, talk to the parents...see how it's made, see how it's administered...see the results.<br />
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You will surely be amazed.<br />
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There are so many "tracks" to take regarding this discussion...so I have decided to make this first entry rather short. I fully expect to expand on this topic and be able to dig into some of the more specific topics revolving around this "hot button" topic. But in order to look at the details with the proper perspective, you need to have a good "view" of the larger picture..<i>.</i><br />
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<i><b>"What would YOU do?" </b></i><br />
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Your child experiences 5-10 seizures per day...does not eat, cannot sleep...there is more fear than joy, more pain than comfort, and more sadness than hope. Yet here you have the possibility of moving all of those metric with something that has demonstrated countless precedent...is completely natural...and can be prepared, not by a pharmaceutical company but, by YOU. Would you not try <i>anything</i>?<br />
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From a professional perspective, having seen the process from cultivation, preparation, extraction, and delivery...I can confidently and responsibly say that without question it is a careful, complex, and comprehensive process that likely surpasses anything being currently rolled out by any pharmaceutical company...and more importantly, the results are nothing short of incredible.<br />
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From a personal perspective, I can only defer to my parental instincts and ask myself the very question posed a few paragraphs prior: <i>"what would I do?" </i><br />
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Case closed. <br />
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It isn't a political, legal, or even moral debate...<i>the stuff just plain WORKS. </i><br />
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Much respect and reverence for those people and families on the front line (you know who you are). You represent the purest definition of "soldier" there is. <br />
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-89868023856127954612014-12-18T15:40:00.000-03:002014-12-18T15:40:18.761-03:00Respiration and Neurodevelopmental Disorders: Part 2<div class="separator" style="clear: both; text-align: center;">
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This second installment comes after a solid 3 months after the first one...intentional simply because there is always a certain amount of time needed to take in, "chew", and digest information when it involves important and otherwise complex topics. <br />
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Although each part will essentially stand on it's own, I recommend that everyone read / re-read part 1 so that the information within this brief post will have more impact and relevance. <br />
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In the previous installment, I went into some small detail with respect to certain key mechanical realities regarding respiration. This particular dialogue will simply attempt to highlight some additional elements that provide some added insight into the importance of the respiratory mechanism...not only within the relatively specific topic of neurodevelopmental disorders (NDD's) but within the entire human experience context as well. With this objective in mind, I will identify 2 fundamental realities that should amplify the relevance respiration has on BOTH systemic and mechanical development. <br />
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<b><i>1. Respiration / Breathing is the earliest critical biomechanical action that takes place following birth.</i></b> <br />
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In order to understand this statement more clearly, we need to ask a fundamental question: <i>"what does every human organism do as soon as they are born?" </i>That's not too difficult to answer...drink, eat, breathe, and evacuate. Nothing more. The systemic necessities are relatively simple and straightforward...these are things that are essential for survival. The MECHANICAL relevance of respiration is not so obvious, but it is none-the-less equally important. <br />
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The above video extract is simply a demonstration of the fundamental phenomenon of "hydraulic brassage" or hydraulic pumping. In short, the breathing action generates what can be considered as a "hydraulic massage and pumping" that is <u>directed upwards towards the upper chest and downwards into the pelvis and into the pelvic floor.</u> Why is this important? <br />
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<span style="color: blue;">It is the direct action of this hydraulic brassage that drives the further development and architecture of the pelvis (pelvic girdle) and the upper chest (shoulder girdle). </span></div>
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<span style="color: blue;"><span style="color: black;">Basic observation will demonstrate that every child is born with a comparatively small pelvis and upper thorax (chest)</span> </span>in relation to the rest of the body...and this essential respiratory action of breathing within a gravitational field (under the weight of their own body) that is THE key catalyst for pelvic and shoulder development. If we extrapolate this reality further, we come to the nex tlevel of practical question: Why is the development of the pelvic and shoulder girdle so fundamental and relevant? </div>
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<span style="color: blue;">The pelvis (and the health thereof) determines and regulates EVERYTHING biomechanically relevant to the legs. Likewise, the shoulder girdle (and the health thereof) is critically relevant to the function and performance of the arms. </span></div>
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<span style="color: blue;"><span style="color: black;">This sheds some valuable light into the otherwsie complex world of NDD's. In other words, one of the most dominant characteristics of any neurodevelopmental disorder is the presence of a comparatively small pelvis and upper chest. Therefore, it is not unusual that they also manifest common challenges with gross and motor performance of the arms and legs. This identifies the developmental importance of addressing respiration as a fundamental objective within any and all treatment strategies. </span></span></div>
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<span style="color: blue;"><span style="color: black;"><b><i>2. Respiration is one of the most powerful catalysts / stimulus for biomechanical symmetry</i></b></span></span></div>
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<span style="color: blue;"><span style="color: black;">Given that it is the most primitive and earliest mechanical stimulus, as well as the fact that it is present during the most "plastic" stages of life, respiration is one of the main drivers in the establishment of symmetry and homogenous development. Many of the structural distortions (particularly in the chest / thorax) have their roots in a deficient / inefficient respiratory mechanism during early stages of life. </span></span></div>
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<span style="color: blue;"><span style="color: black;">In summary, the main message is as follows: EVERY neurodevelopmental disorder, whether mild or severe, will manifest some deficit in respiratory mechanics. Therefore a careful and comprehensive assessment of breathing patterns and underlying challenges will always ultimately generate a high "rate of return" with respect to progress and long-term rehabilitation strategy. </span></span></div>
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<span style="color: blue;"><span style="color: black;">More to come...</span></span></div>
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<span style="color: blue;"><span style="color: black;">Cheers! </span></span></div>
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<span style="color: blue;"><span style="color: black;"><b><i> </i></b> </span> </span></div>
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com2tag:blogger.com,1999:blog-8731813357458649991.post-82587967248261195312014-09-18T20:56:00.000-03:002014-09-18T20:56:00.317-03:00Respiration and Neurodevelopmental Disorders: Part 1<br />
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This is a topic that is quite "heavy" and therefore needs to be broken into more disgestible parts. The first part will focus on the fundamental theory behind <i>why the respiratory mechanism is the most important stimulus / catalyst for the efficient development of a child with a neurodevelopmentsal disorder. </i>This is essentially an expanded exploration of <a href="http://thescienceofphysicalrehabilitation.blogspot.com.ar/2013/09/the-fascia-therapy-theorem-growth-and.html" target="_blank">The Fascia Therapy Theorem</a> I wrote about last year. I will also provide the fundamental information about respiration in healthy newborns so that a working understanding of <i>"how it is supposed to work"</i> can be established in an effort to make the link into the more complex nature of neurodevelopmental disorders. My intention is to keep this as "user-friendly" as possible...as I am know to occasionally engage in more technical vocabulary...so that this important understanding can be absorbed and assimilated by a larger number of people. Most important of which is the immediate family unit. <br />
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<u>Mechanics of respiration:</u><br />
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Most people overlook respiration (breathing) because it is something that occurs in the background and outside of any conscious effort or consideration. The paradox is that breathing is a very complex mechanical marvel. It isn't merely a case of the lungs "inflating and deflating"...the lungs are elastic organs that are <u><i>continuous with the entire thorax (chest wall).</i></u> Therefore, the act of inflation / deflation involves more than the lungs...it involves an active contribution of the chest wall itself as well as the diaphragm. In other words, the ability for the lungs to draw in air (oxygen) is dependant on the integrity of the chest wall and the performance of the diaphgram. <br />
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In the newborn child, the relationship between the lungs and the chest wall is an exponentially more intimate one. To explain this with more clarity, we need to introduce a very important term: <br />
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<i>COMPLIANCE.</i><br />
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Compliance is defined as <i>the opposite of stiffness. </i>In the context of respiration, the lungs AND the chest wall (ribs, sternum) are <u>very compliant.</u> What does this mean in practical terms? <br />
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<i>When the newborn infant breathes, the lungs and the chest wall experience elastic deformation</i></div>
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In other words, the chest wall is essentially "soft" and is easily influenced by the mechanics of breathing. This characteristic of compliance becomes more relevant as the infant grows. To be precise, <i>at approximately 18-24 months of age, the chest wall <b>stiffens considerably.</b></i> In essense, the chest wall loses compliance at a rapid rate as the child enters into this range of 18-24 months. This is perhaps the <u>most significant and important process</u> in a childs development. The gradual stiffening of the chest wall (which actually begins BEFORE 18 months and accelerates after) results in the increased development of what is called a <u><i><b>"hydraulic pumping"</b></i></u> stimulus that is directed up into the upper thorax and down into the pelvis and pelvic floor. To be precise, <b><u>the reduced compliance of the chest wall causes the majority of the mechanical movement to be re-directed upwards and downwards.</u></b></div>
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Once again, what does this mean in practical terms? It means that the stffening of the chest wall is the primary catalyst for the development of the pelvis and the shoulder girdle. In other words, <i>it is this precise hydraulic "pumping"</i> <i>of the pelvic floor and upper thorax that DRIVES the growth</i> <i>of the pelvis (crucial for the later development of the legs) and the shoulder girdle (crucial for the later development of function of the arms). </i></div>
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<u>Altered mechanics in newborns / children with neurodevelopmental disorders:</u></div>
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The important reality to take away from part 1 of this discussion is the following: </div>
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<span style="color: blue;"><i>All children / newborns with a neurodevelopmental disorder manifest altered respiratory mechanics and therefore are not fully exposed to this critical "hydraulic pumping" action. </i></span></div>
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<span style="color: blue;"><span style="color: black;">Why is this? </span></span></div>
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<span style="color: blue;"><span style="color: black;">One of the most prevalent characteristics of neurodevelopmental disorders is <i>profound connective tissue weakness.</i> In more laymans terms, everything from the tendons, ligaments, bones, organs, etc...are formally weak and remain weak throughout growth and maturation. In the context of respiration, this is represented explicitly in <b>the chest wall...</b></span></span></div>
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<span style="color: blue;"><span style="color: black;"><i>The chest wall REMAINS compliant (elastic) long after 18-24 months...therefore the fundamentally critical hydraulic pump <u>never reaches the pelvis and upper thorax.</u></i> This is manifested almost unanimously in all affected children by the common characteristic of a <b>small pelvis and small upper thorax. </b>This ultimately reflects in the considerable delay (or arrest) or functional development of the arms and legs. Furthermore, it plays a significant role in the altered respiratory mechanics which lead to a multitude of systemic challenges due to altered oxygen saturation. </span></span></div>
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In summary, the vicious cycle of deterioration takes place as such: </div>
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1. Significant Prolonged Chest Wall Compliance (Thoracic Weakness)</div>
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2. Irregular Respiratory Mechanics and Altered Synchronicity (Active or Laboured Breathing)</div>
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3. Abnormal circulating Oxygen levels, Hypocapnia, Reduced cerebral blood flow, smooth muscle constriction in the intestines (constipation), Magnesium and Calcium imbalances in muscles (muscular tension)</div>
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**** The consequences of #3 can be a catalyst for further impaired neurological development ***</div>
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4. Repetitive deformation and subsequent distortion of the chest wall (sometimes manifested as a caved-in sternum or asymmetry)</div>
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5. Permanent structural distortion and chronic systemic distress</div>
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All of the above should represent some familiar challenge(s) in children with neurodevelopmental disorders. Regardless of the specific diagnosis, these challenges are universal because of the immediate impact on respiration. Paradoxically, this understanding actually <b>improves </b>our ability to positively affect the trajectory of improvement and essentially reduce the negative effects of this altered mechanism. The upcoming posts will further explain this process as well as (perhaps more importantly) introduce strategies to essentially "re-start" the respiratory "hydraulic pump" with some very safe and simple practical exercises. </div>
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Stay tuned!</div>
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<i> </i><br />
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Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-29898401825110984732014-06-02T18:08:00.001-03:002014-06-02T18:08:31.601-03:00Think Small: How the little things make the biggest difference<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDt1IHQbQOSw1u-tIEPSORP5zvv7okUhN7z1R4hXc87nZZTXddvOlE_9vG8vIqtGUx8-w8lxIZ7ov9T-H3l_yRnHuXajlZSDEVwdzowPXshbvpAMutNxmrJJNEpgm_87mJu46ruPeNxdQ/s1600/20080729-073236-10.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDt1IHQbQOSw1u-tIEPSORP5zvv7okUhN7z1R4hXc87nZZTXddvOlE_9vG8vIqtGUx8-w8lxIZ7ov9T-H3l_yRnHuXajlZSDEVwdzowPXshbvpAMutNxmrJJNEpgm_87mJu46ruPeNxdQ/s1600/20080729-073236-10.jpg" height="286" width="400" /></a></div>
Definitely counter-intuitive...especially when you view it from the rehabilitation perspective. The instinctive thing is to think BIG...<i>what will be the singular plan towards my rehabilitative goals.</i><br />
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I recently saw an interesting report on television that studied the decline in some pre-school kids in China. The researchers were examining scholastic teaching habits, pre-school formats and scheduling, even down to the books themselves. One day, one of the researchers noticed that none of the children they were using as their test group were wearing glasses. <i>Was it because children in China has inherently better eyesight? </i>What they found was that almost 45% of the kids actually NEEDED glasses but could not afford them. So they embarked on a different trajectory and split their study group into two parts: one group were given glasses (those who needed them) and the other group remained as previous. The results were surprising...the group that were given glasses experienced a significant increase in test scores and overall performance. Indeed, this is an example of how tackling the small things can yield exponential results.<br />
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This can fundamentally be extrapolated into the rehabilitation domain. The search for the "wonder drug" will always continue...and the discovery of a "super-technique" will always be in the works...but the small things are the most immediate and accessible resources at our disposal (both as practitioners and patients). In fact, most empirical evidence demonstrates that the addition of the "small things" potentiates the effectiveness of any and all other strategies...essentially making them the most important catalyst for improvement, especially when the subject is a child. <br />
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The "small things" are numerous...so it would be next to impossible to list them, but they are fundamentally based in the idea that the senses and emotions carry an important weight in the rehabilitation equation. <br />
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-Aromas and scents<br />
-soft music<br />
-massage<br />
-mindful nutrition<br />
-purposeful activities that generate feelings of accomplishment<br />
-exposure to sunlight, sea, and the earth<br />
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Each situation is a unique environment and therefore each "small things list" will reflect a different flavour...but the idea has been proven to yield excellent benefits. <br />
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<span style="color: blue;"><i>The small things are equivalent to the stitching in any fabric. Even though the quilt is a marvelously beautiful and functional product, it's effectiveness lies in the intricacy and collective contribution of each individual stitch and thread. </i></span></div>
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<span style="color: blue;"><span style="color: black;">There is a best-selling book called "Don't Sweat the Small Stuff"...an eloquent self-help read that is both entertaining and useful. But within the more complex world of rehabilitation...you don't need to "sweat" the small things, but most certainly be purposeful and mindful. </span><i> </i></span></div>
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<span style="color: blue;"><i> </i></span><br />
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-23874459380248799532014-05-15T19:36:00.001-03:002014-05-15T19:36:25.711-03:00Nutrición y Fascia Therapy<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwujaLNCj8lZWhXNSXsf26jj4RWcpxiEJD63VKS6lTMXG5hB2Q4QGxf79kpZemLo-ylnHtVBv2THbd0Qv2YIDwt1xkES6SfO_CMXlAvmJvd53alSlTQco-i5p_Fbjc2XYbnrj4iY4Xp70/s1600/5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwujaLNCj8lZWhXNSXsf26jj4RWcpxiEJD63VKS6lTMXG5hB2Q4QGxf79kpZemLo-ylnHtVBv2THbd0Qv2YIDwt1xkES6SfO_CMXlAvmJvd53alSlTQco-i5p_Fbjc2XYbnrj4iY4Xp70/s1600/5.jpg" height="272" width="640" /></a></div>
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<![endif]--><span style="font-family: Verdana,sans-serif;"><b><i><span lang="ES-CL" style="font-size: 11pt; line-height: 107%;">Pamela
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<![endif]--><i><span lang="ES-CL" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 107%; mso-ansi-language: ES-CL; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Nutricionista
y Dietista</span></i></span><br />
<span lang="ES-CL" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 107%; mso-ansi-language: ES-CL; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><i><span lang="ES-CL" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 107%; mso-ansi-language: ES-CL; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Fascia Therapy </span></i></span><br />
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</span></i><span lang="ES-CL" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 107%; mso-ansi-language: ES-CL; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span></span><br />
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<span lang="ES-CL">La buena alimentación es fundamental para
tener una nutrición adecuada y permitir el óptimo funcionamiento y desarrollo
del cuerpo.</span><span lang="ES-CL"> Cada persona, ya antes de nacer, tiene
impreso un programa genético que, ajeno a nuestra voluntad, se va desarrollando
a lo largo de toda su vida. El correcto desarrollo y potencialidad de este
programa genético depende, entre otros factores, de una buena nutrición.</span>
</div>
<span lang="ES-CL" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 107%; mso-ansi-language: ES-CL; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span lang="ES-CL" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 107%; mso-ansi-language: ES-CL; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><div class="MsoNormal">
<span lang="ES-CL">Cada etapa de la vida tiene distintas necesidades
nutricionales. Desde el embarazo la buena nutrición es fundamental para
potenciar el desarrollo del feto en formación; en esta etapa todo lo que come,
bebe o siente la madre influirá en el niño/a. Fundamental es el consumo de
alimentos nutritivos como verduras, frutas, semillas, legumbres, cereales; entre
otros y limitar el consumo de alimentos altamente azucarados, con exceso de
sodio, colorante, químicos, colesterol o<span style="mso-spacerun: yes;">
</span>grasas saturadas y/o trans, que pueden afectar el desarrollo fetal y/o la
salud de la madre .Desde el útero materno el niño/a ya percibe el sabor de
todos los alimentos que consume su madre a través del liquido amniótico, por lo
que es fundamental que la mujer embarazada consuma variedad de alimentos sanos
y una dieta balanceada.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="ES-CL">En los primeros 6 meses de vida el bebe
solo necesita de la Lactancia materna para estar bien nutrido, ya que esta
aporta todos los nutrientes, vitaminas, agua y minerales que necesita para
crecer adecuadamente .Existen ciertos casos en que la Lactancia materna no
puede ser posible y se recurre a formulas lácteas especiales para tratar de
cubrir los requerimientos nutricionales del niño/a.</span></div>
<div class="MsoNormal">
<span lang="ES-CL">Luego se comienza con la introducción de
otros alimentos; como cereales, verduras, frutas y cárneos, con el fin de
cubrir todas las necesidades nutricionales .A medida que el niño va creciendo
la alimentación debe ir variando en <span style="mso-spacerun: yes;"> </span>consistencias,
horarios y frecuencias de consumo, pero siempre se debe mantener una
alimentación variada, saludable y nutritiva.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="ES-CL">Los niños/as con necesidades especiales
necesitan mantener un estado nutricional normal, ya que al igual que en los
otros niños, la desnutrición y sobrepeso, dificultan la rehabilitación,
aumentan complicaciones metabólicas e incluso puede agravar la enfermedad base.
En estos casos cada niño puede necesitar una alimentación en particular, con
inclusión y/o exclusión de ciertos alimentos con el fin de mejorar su estado
nutricional.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="ES-CL">Una adecuada nutrición tiene múltiples
beneficios ;optimiza el crecimiento, colabora en una mejor evolución de la enfermedad,
disminuye infecciones, ayuda a disminuir irritabilidad y espasticidad, aumenta
estado de alerta, mejora disposición a participar en terapias, puede contribuir
a mejorar su desarrollo psicomotor.</span></div>
<div class="MsoNormal">
<br /></div>
</span><i><span lang="ES-CL" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 107%; mso-ansi-language: ES-CL; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
</span></i> </span>Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-30832753396607433232014-05-14T17:25:00.001-03:002014-05-14T17:25:03.860-03:00Fascia Therapy in Argentina<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEXXBujdeo28MWSxTx3vGrNpibDKC_ONFlYq8KFTSe1okmvWwjXUltPS9pB1_LRynh0xulye_c1_SWxN4DBBkLK4XhaSUi6SfzZ_VsoxSwgZ3uWoOIVOf2-reqSYGvYmUDFXs05pl8rJg/s1600/bsas_FT2.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEXXBujdeo28MWSxTx3vGrNpibDKC_ONFlYq8KFTSe1okmvWwjXUltPS9pB1_LRynh0xulye_c1_SWxN4DBBkLK4XhaSUi6SfzZ_VsoxSwgZ3uWoOIVOf2-reqSYGvYmUDFXs05pl8rJg/s1600/bsas_FT2.png" height="640" width="480" /></a></div>
Some small promotion happening here: The Fascia Therapy concept will be presenting in Buenos Aires, Argentina at the end of June. <br />
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Many have asked me <i>"what is it...why is it different?"...</i><br />
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The presentation will hopefully shed some light on that in great detail, but to summarize it's less of a "therapy" per se and more of a <i>philosophy. </i>This philosophy is based on the idea that, beyond the conventional "disease fighting" strategies, there is a significant opportunity to affect health and well-being by placing some focus on the physiological systems that contribute to efficient systemic function...in essence, potentiating an <i>organic</i> (from within) response that will facilitate self-healing and auto-regulation. <br />
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Hopefully we will see Fascia Therapy in your neck of the woods sometime soon! <br />
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Cheers! <br />
<i> </i><br />
<i> </i>Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-36895689843605639382014-04-22T20:31:00.001-03:002014-04-22T21:52:37.620-03:00Walking and Cerebral Palsy: What evolution tells us...<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgypZo-sByjOdF2oIqBDnigcbuUz2qNLGZOZaIshxV07vx0xJ78RxZpvVXCmsm_hE9_tYB1elua4wcPnXmYIw3BqNviEJ7q9DZezUqLdRnkcmm3_E8H2opsyNEZ2j-u1O3bNbiiewgJIsw/s1600/crouch_gait_470.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgypZo-sByjOdF2oIqBDnigcbuUz2qNLGZOZaIshxV07vx0xJ78RxZpvVXCmsm_hE9_tYB1elua4wcPnXmYIw3BqNviEJ7q9DZezUqLdRnkcmm3_E8H2opsyNEZ2j-u1O3bNbiiewgJIsw/s1600/crouch_gait_470.jpg" height="183" width="320" /></a></div>
This is certainly a topic of great discussion, debate, and concern...so it shouldn't be a surprise that I would eventually get down to writing something more specific about it. I would have done so sooner, but the reality is that it is such a complex subject...with multiple layers and considerations...that it was difficult to even decide on a worthy <b>starting point</b> in which to begin this dialogue. However, I recently came across an interesting image that essentially served to crystallize some aspects to the point where I was comfortable to start my attempt at presenting my specific theory with respect to Cerebral Palsy (CP) and the ever-elusive goal of walking.<br />
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Again, given that this is such a complex biomechanical function, I can only present it in a somewhat "generic" fashion...that is, to present a broader perspective from which we can all then begin to plug in the holes and begin the process of further formulation and evaluation. In my opinion, anything worthy of presentation should manifest some <u>fact, extrapolation of fact, or theory</u> that can be relatively easy to explain. Let's see if it pans out!<br />
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<u><b>Developmental Evolution</b></u><br />
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A potentially strange title that can lead to some confusion...but my intent is to simply point of that <i>development and evolution</i> are essential frameworks that hold fundamentals truths and realities that often go overlooked. <b> </b><br />
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Evolution itself is a construct that effectively states that we as humans evolved from the oceans, then to land, and essentially began our journey as <u><b>quadrupedal</b></u> beings...meaning we walked on all fours. In fact, the interesting part is that we still maintain some aspects of this "early evolution" today...as babies and toddlers, we move on all fours. This leads to the first fundamental reality:<br />
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<div style="text-align: center;">
<span style="color: blue;"><i>Bipedal locomotion must first pass through the process of quadrupedal development.</i></span></div>
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<u><b>The Pelvis</b></u></div>
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When we understand the process of quadruped-to-biped with respect to human locomotion, it makes sense to identify the specific <i>characteristics </i>that define (or differentiate) the quadruped versus the biped. Although there are likely to be many, my theory revolves around 2 main considerations: <i>the pelvis and the spine.</i></div>
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We therefore come to a fundamental question: <i>What is the difference between a quadruped pelvis and a biped pelvis?</i> The answer to this raises quite a few interesting points: </div>
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<u>1. The quadrupedal pelvis is proportionally alot smaller than a bipedal pelvis</u></div>
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This means that, in relation to the rest of the body, the pelvis occupies a smaller percentage of the entire body mass and frame.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpgG5nMMwdr2kS8jaRTikZH5T6UmJkCycUvyofQGqzZaO9Xu0zRvjoo0LGd-Fn0NrEjWqfEv5AgfScbOApnwg1OwaHMH_fRCO0mTNSHvSVRnMYcfNaTYN_wR9zLOPsY53LUwBXFuGaXwg/s1600/canine-skeleton.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpgG5nMMwdr2kS8jaRTikZH5T6UmJkCycUvyofQGqzZaO9Xu0zRvjoo0LGd-Fn0NrEjWqfEv5AgfScbOApnwg1OwaHMH_fRCO0mTNSHvSVRnMYcfNaTYN_wR9zLOPsY53LUwBXFuGaXwg/s1600/canine-skeleton.jpeg" height="232" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Canine Skeleton</td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizmbEOWS1XZCZ5xu9071TEv0xWbNFF8rmBCZxepFpPVxfbB2g7-66opUm63CL1mlMk9Nynfr_1Pc1Gh1BDoaO5cgaEg0J2n_xpaNda0Vc2HUDIgLpkLQufwHMkUw7igDpk8b7uMaOO1hc/s1600/TigerSkelLyd1.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizmbEOWS1XZCZ5xu9071TEv0xWbNFF8rmBCZxepFpPVxfbB2g7-66opUm63CL1mlMk9Nynfr_1Pc1Gh1BDoaO5cgaEg0J2n_xpaNda0Vc2HUDIgLpkLQufwHMkUw7igDpk8b7uMaOO1hc/s1600/TigerSkelLyd1.png" height="185" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Feline Skeleton</td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
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If we take 2 examples of our most popular domesticated animals (dogs and cats) we are immediately struck with the fact that, although they are amazingly agile creatures, their pelvis is realtively small in comparison to the rest of their body. In fact, it is almost comparable to the shoulder blade. This shouldn't be too much of a shocker...afterall, their weight is designed to be transmitted through 4 limbs, so the shoulder blade and pelvis would naturally be of comparable size. However, when we put it into the context of HUMAN development, this begs the question: <i>Is it that the shoulder blade is that much bigger in proportion, or is it that the pelvis is that much smaller? </i>I think the answer is clearly skewed towards a small pelvis.<br />
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We can even extrapolate this theory even further to include our most genetically similar cousin, the primate. The interesting thing about the primate (beyond the fact that it shares almost 90% of our genetic makeup) is that it is paradoxically considered as BOTH quadruped and biped.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitOXVmqTBCXLiERFIfg7fxjWeDLsQT5hwFzUjYBY0NPMZ-M7UC36Qsxc9S2EdhkueW0-32ZC2E0ik0Qwfl26tNedGGC8nr9BjK4y2tFZJYD-drw2Ghe-bPBypA1yPWcpx3N3d1TWojRV0/s1600/gorillaskeleton.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitOXVmqTBCXLiERFIfg7fxjWeDLsQT5hwFzUjYBY0NPMZ-M7UC36Qsxc9S2EdhkueW0-32ZC2E0ik0Qwfl26tNedGGC8nr9BjK4y2tFZJYD-drw2Ghe-bPBypA1yPWcpx3N3d1TWojRV0/s1600/gorillaskeleton.jpg" height="320" width="273" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gorilla Skeleton</td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
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We can therefore safely assume that the primate is a reflection of the <u><i><b>transition from quadruped to biped.</b></i></u> This is quite a luxury to be be able to examine this animal within this context. When we have a look at the above image, we can identify that there is indeed a <u>larger</u> pelvis (in comparison to the rest of the body), but it remains somewhat smaller in comparison to our own representation within the human frame. This is a strong indication that the transfer process from 4 limbs to 2, requires significantly more structural consideration with respect to the pelvis...in other words, its formal "architecture" needs to change.<br />
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To supplement all of the above images, the pelvis is also quite <b>narrow</b>...which completes a more 3-dimensional understanding of how the pelvis plays a role in the understanding of our evolution.<br />
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<b><u>The Spine</u></b><br />
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Using all of the images previously posted above, the spine becomes the second area of focus. What is it?<br />
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<u>2. The quadruped spine manifests a <i>single-curve</i></u>.<br />
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If we look at the overall "layout" of the spine, it definitely represents what would be considered a primary curve within the human context...meaning that the lumbar and cervical spine do not manifest the secondary convex curve. Perhaps more interesting is the observation of the larger pelvis in conjunction with the disappearance (reduction) of the length of the tail. The tail is essentially an extension of the spine, therefore there is an inverse relationship...smaller tail, larger pelvis. This can be attributed to the changes in center of gravity and equilibrium.<br />
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...So what in the world does all of this mean?<br />
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Let's have a look at how we humans play into this theory. Take a look at the picture below...given the explicit observations mentioned in the previous sections, what do you notice?<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtpdy-zpa2_tWCslN4VseiG4tMEwg2wk19UDq4DXcj4MREnJfFyRJ2FpkU4UbodvA-BXyNwKKEgiixIn3W3xpJ7ZYDnLJ81ix6ubi4ldRn0u8rmVxMkK4l3ygRiyPOmVVq8m0LoEgNwcs/s1600/baby+skeleton.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtpdy-zpa2_tWCslN4VseiG4tMEwg2wk19UDq4DXcj4MREnJfFyRJ2FpkU4UbodvA-BXyNwKKEgiixIn3W3xpJ7ZYDnLJ81ix6ubi4ldRn0u8rmVxMkK4l3ygRiyPOmVVq8m0LoEgNwcs/s1600/baby+skeleton.jpg" height="256" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Human Baby Skeleton</td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
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For the sake of formality, I will detail my specific observations:<br />
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<span style="color: blue;"><i>In the earliest developmental stages, the human organism manifests a singular curve of the spine and a pelvis that is proportionally smaller to the rest of the body. </i></span></div>
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<span style="color: blue;"><span style="color: black;">Therefore, as developmental evolution dictates, <u><i><b>the human organism is formally prepared for quadruped locomotion BEFORE entering into bipedal locomotion.</b></i></u> As the baby develops into a toddler, the pelvis will transform into a more substancial load-bearing structure (and therefore grow volumetrically and circumferentially) and the spine will begin its journey towards the characteristic secondary curves. All of this will converge at the 10-14 month period when the toddler eventually begins to walk. </span></span></div>
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<u><span style="color: blue;"><span style="color: black;"><b>Links to Cerebral Palsy</b> </span><i> </i></span></u></div>
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The fundamental objective of this post is to tie this theory into some practical understanding of how CP is manifest and to hopefully provide some clarity on an otherwise overwhelming confusion. The realities of CP play directly into this theory in some very straightforward ways: </div>
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<i><span style="color: blue;">Cerebral Palsy falls under the umbrella of "developmental delay", therefore the early developmental phases (quapruped phase) persist well beyond the first year of life and can still be manifest into puberty. We therefore are confronted with a confusing reality: chronological age is not congruous with developmental age. This "mismatch" potentiates a possible deviation from developmental priorities and some potential misinterpretation of "progress". </span></i></div>
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<i><span style="color: blue;">The expectation, if the individual is older than 2 years, is that they should be walking and therefore a large proportion of strategic planning (and expectation) is skewed towards verticalization, casting, and cosmetic "straightness". However, <b><u>if the developmental manifestation remains that of a quadruped, then bipedal locomotion is not only unrealistic, but also counterproductive.</u></b></span></i><span style="color: blue;"> <i>In other words, if the pelvis in relation to the rest of the body remains small and the spine persists in a singular curve (or even straight), then developmental evolution dictates that ANY load-bearing strategy should be oriented towards <u>quaprupedal equilibrium / stability / locomotion.</u></i></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVhBMlzZdMkxqL-oZvDaGjJrKqxnxYsqA3vI0YB9sbpeYq9mIAOxyEv3QwV8qWeXN51fo-PyckziKv99W8L5cMatzNQgOTVyaDx9lI3N8ETkP8TcaHwqnFuxDrELk8J3vwpV1YEL3gvOQ/s1600/iStock_000002051529Large.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVhBMlzZdMkxqL-oZvDaGjJrKqxnxYsqA3vI0YB9sbpeYq9mIAOxyEv3QwV8qWeXN51fo-PyckziKv99W8L5cMatzNQgOTVyaDx9lI3N8ETkP8TcaHwqnFuxDrELk8J3vwpV1YEL3gvOQ/s1600/iStock_000002051529Large.jpg" height="264" width="320" /></a></div>
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<span style="color: blue;"><span style="color: black;">The truth about walking and CP is that it formally <u>has nothing to do with the legs</u>...which is paradoxical! </span></span></div>
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<span style="color: blue;"><span style="color: black;">The pelvis is the essential architectural weight-bearing structure that needs to be in place if any realistic expectations are to be considered. Further, it has been long studied and determined (largey by the works of Gracovetsky) that <i><u>movement is derived from the spinal "engine"</u></i>... meaning that the spine is functionally the genesis for all motion and that the legs simply "magnify or amplify" that motion. </span></span></div>
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<span style="color: blue;"><span style="color: black;"><u><b>Links to Practical Rehabilitation Strategy</b></u></span></span></div>
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<span style="color: blue;"><span style="color: black;">There are countless "ideal" strategies populating the landscape, however if you apply<i> </i>these fundamentals of evolution, you will be left with some tangible frameworks to derive an appropriate and effective strategy: </span></span></div>
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<span style="color: blue;"><span style="color: black;">1. Promote systemic development and function</span></span></div>
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<span style="color: blue;"><span style="color: black;">Any mechanical performance depends on effective absorption and utilization of all systemic assets (nutrition, oxygen, blood, etc...) </span></span><i><span style="color: blue;"></span></i>therefore promotion of the respiratory, digestive, immune, and circulatory systems will contribute exponentially. </div>
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2. Implement strategies that help to potentiate pelvic health and integrity</div>
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3. Reduce / avoid any unnecessary load-bearing or verticalization </div>
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The notion that simple vertical positioning will resolve the issue is formally simplistic when placed against the evolutionary litmus test. </div>
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4. Always refer to developmental milestones as a blueprint for priorities.</div>
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Development in the human organism always follows the same sequence...meaning that development from basic postural performance to more complex movements has a very explicit order. This order is not revolutionary, nor is it some unknown "secret"...it is the gradual progression from simple horizontal exposure to gravity straight through to a completely vertical position. This sequence can readily be found and searched as "developmental milestones". </div>
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As always, these rants tends to evolve into "mini-novels", but the hope and expectation is to shed some light and to tie in some well understood realities...not to attempt to generate full understanding, but more importantly to provide some basic idea of "direction". </div>
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Cheers! </div>
<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-85514728570604541792014-04-09T17:34:00.002-03:002014-04-13T12:31:29.516-03:00Fundamentals of the Fascia Therapy concept<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjydYqik_OCkucA0VjHcZqbRBvByrA0kUUnfvPXVnrJjV6cV2jzJr8WnzFmxo4o5pDuixnjl68SVnzfgcS7_0VY03okgnOhQ7GzprzC4W1j0znVIkDzOF7I5xG3BhnbPRvWISTJCqzXzgE/s1600/puzzleflowersbloom01.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjydYqik_OCkucA0VjHcZqbRBvByrA0kUUnfvPXVnrJjV6cV2jzJr8WnzFmxo4o5pDuixnjl68SVnzfgcS7_0VY03okgnOhQ7GzprzC4W1j0znVIkDzOF7I5xG3BhnbPRvWISTJCqzXzgE/s1600/puzzleflowersbloom01.png" height="292" width="320" /></a></div>
This post serves to further enhance the broader outline of <a href="http://www.thescienceofphysicalrehabilitation.blogspot.com.ar/2013/08/the-fascia-therapy-theorem.html" target="_blank">The Fascia Therapy Theorem</a> by expanding the fundamentals of the critical initial stages of treatment and rehabilitation. Although the concept itself is relatively comprehensive, the overwhelming reality is that even though specific treatment strategies will ultimately differ form person to person...but each of them must follow certain laws of human development at the inception.<br />
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The essential fundamentals of the FT concept follows these laws and therefore reflect efficient treatment responses as well more reliable treatment strategies.<br />
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1. Systemic Homeostasis:<br />
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This is the fundamental starting point for all of the FT treatment strategies. It is characterized by specific and focused efforts to stabilize and potentiate the essential physiological oscillators of the body (respiration, digestion, circulation, lymphatic drainage). Every efficient and successful biomechanical strategy must first secure a working systemic homeostasis in order to meet the requirements of more advanced movement. This means that systemic function must be sufficiently <i>adaptive, irritable (responds to stimulus), and interconnected (inter-system communication). </i><br />
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2. Structural Integrity:<br />
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This stage generally appears soon after (or at the same time) and the development of systemic homeostasis. It is characterized by purposeful development of basic postural skills and the potentiation of efficient closed-chain activities. This involves many stages, but always begins with the development of passive hydraulic strength of the trunk (passive postural competence). <br />
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3. Psychomotor Development:<br />
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This phase typically manifests once a critical mass of systemic and structural integrity have been achieved. Further, it is the <i><u>fundamental link to the development of productive movement skills.</u></i> The development of healthy structure is also a key component, however structural integrity is merely a cosmetic benefit unless there is a specific strategy in place to <u>activate and potentiate</u> movement abilities. <br />
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<i> </i> <br />
The above chart effectively outlines the basic framework that is followed. It begins with essential exposure to sensory input and the use of guided techniques that impose gradual stimulii in an effort to stimulate intrinsic response and development. For example, basic motor development essentially starts in a supine position (facing up) and progresses via small oscillations (rolls) from side to side. This type of movement is a precursor to the eventual objective of independant rolling.<br />
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Although the process follows multiple steps and is quite complex, the overall framework serves as a helpful guide to effective and efficient practice and implementation. From perception based interventions, to transfers, to the process of trial and error and so on...psychomotor development is an essential component to the transition to productive function.<br />
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4. Active Potentiation and Integration: <br />
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This stage can involve interventions that are outside of the rehabilitatiove domain. It is the strategic integration of all of the fundamental parameters to healthy life and living (Social, Cognitive, Physical).<br />
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The physical (structural and systemic) and psychomotor strategies generally remain in place, although sometimes reduced to a more "maintenance oriented" role, while the integration of <u>Cognitive and Affective </u>development strategies take a more prominent role. These are generally manifested well within the occupational therapist role, teachers, home care, and even parents themselves. In essence, the physical development and competence give rise to more potential success within the cognitive and affective metrics.<br />
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It is important to note that during this entire process, it is VITAL that a comprehensive nutritional regimen be formulated. People generally associate nutritional regimens with "aggresive, military, unrealistic" formulas...but this is simply a misguided perception manifested by our fitness crazed society. Nutritional regimens are characterized by comprensive evaluation of nutritional and dietary requirements for each individual case...tailored to contribute to the specific objectives of the rehabilitation strategy. The development process requires energy...it requires fuel in order to potentiate growth and also to resist failure or illness. In addition, it isn't simply WHAT is being consumed but also HOW it is being absorbed. Dysfunctional digestive function affects nutrient absorption and therefore disrupts proper metabolism...respiratory irregularities contribute to higher cardiac activity and therefore can negatively impact thermoregulation. Nutrition plays and essential role in facilitating smooth and peaceful transition throughout the entire process.<br />
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There is considerably more "guts" to the concept itself...but I am hopeful that this (along with the philosophical explanation of the Fascia Therapy Theorem --- link at the beginning of the post) will give some helpful answers to the question of <i>"what is Fascia Therapy?" </i><br />
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Cheers! <i> </i><br />
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-9359917478554470862014-03-24T13:25:00.003-03:002014-03-24T13:25:40.218-03:00New name, new location, same good stuff...<div class="separator" style="clear: both; text-align: center;">
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Just a little update and (relatively small) newsflash. <br />
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I have changed the name of this blog so that it becomes more organic to the webpage launch of my concept called Fascia Therapy. The FT concept has been evolving over the last year and is now ready to move into its own "virtual home" on the internet...therefore I will be providing a direct link to the blog from the website itself. <br />
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I would consider this an "evolution" as opposed to a change, per se. The random rants, occassional tangents, and (hopefully) informative material still comes from the same brain and will ultimately appear and manifest the same tone and overall perspective. If anything else, this evolution will facilitate more perspectives and even more potential contribution from a more diverse group of professionals...which will ultimately result in an even broader diversification of knowledge. <br />
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Cheers!<br />
-GB-Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-49431063190655736682014-03-20T12:35:00.001-03:002014-03-20T16:34:32.745-03:00Professional Profiles: Kenny Spracklin B.Sc., CAT(C), CSCS<div class="separator" style="clear: both; text-align: center;">
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I suppose it is only fitting to have good friend and fellow health / rehab enthusiast Kenny Spracklin as the subject the blogs first expert professional profile. The mandate of these profiles is not only to present like-minded perspectives and approaches, but also to enhance the scope of knowledge and understanding by putting forth diverse experiences and opinions from a variety of professionals from varied fields of practice.<br />
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Not only are Kenny's experiences amazing and insightful, they are without question informative and valuable. "Professionalism" is an intuitive concept, but in reality it is a very complex process that fundamentally never stops evolving. Hold on to your hats...here comes my Q&A with expert therapist and trainer, Kenny Spracklin. <br />
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<b><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Tell
us a bit about yourself, your professional career and how you came to where you
are now.</b></div>
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<i>I come
from a very active and competitive sport background. I have been playing and
involved with sport since I was a toddler following my dad around the arenas. I
studied at Concordia University in the AT program and had great instructors
that inspired me to challenge the profession and myself to help define what
therapy and training really are. I was encouraged early on in my studies to
look outside the box from time to time and question everything. I have never
looked back since. I remain friends with some of these instructors that have
influenced me and allowed me this freedom to learn and push the envelope to
this day. Today, I am happy to say that I am among some of the top in the field
at what I do and have recently helped Team Canada win some Olympic medals in
different disciplines at the Games in Sochi, Russia. It’s very rewarding to see
an athlete you’ve been helping for years achieve what they have set out for as
a life-long goal. </i></div>
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<i>I have quite a few
influences in my life. I’ve always been pretty internally motivated, so I
haven’t really needed anyone for this matter, but I have been inspired by many
people. These inspirations range from my dad being a single parent who raised
myself and my younger brother at such a young age himself, to teachers that
I’ve had, to actual athletes I’ve worked with and their relatives. (For
example; a good friend of mine and athlete I feel privileged to help has inspired
me through his story countless times…I still get goose-bumps when I watch him
and his brother together)</i></div>
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<i>My grandmother was
probably the most influential person in my life though. She was a key part to
my road to success so far in life. She would tell me this on a regular basis
“Don’t put off ‘til tomorrow what you can do today”…this has stuck with me my
entire life and I can still visualize her saying it to me when I stray away
from my tasks. She believed that we were all here to help as many people as we
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"> <b> </b></span></span></span><b>3. How
do you put these experiences / motivations / inspirations into practice at
work?</b></div>
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<b> </b><i>Putting
one’s self in a position where you can literally take on any opportunity that
comes your way is a skill that I’ve developed over the years and continue to
work on. Nothing beats hard work and determination!!! Putting yourself in the
right place at the right time, is not as easy as it sounds. You need to be
willing to work harder than everyone else is willing to work. I pride myself in
having an extremely devoted work ethic. I was lucky to have been brought up
without much and we struggled with our means growing up; but I am truly
appreciative everyday for having gone through this because it allowed me to
know just how much I can endure to get what I want in life. The true secret to
life…Hard Work!!!</i></div>
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unique?<span style="mso-spacerun: yes;"> </span></b></div>
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<i>I am very
fortunate to interact with people from all over the world form very different backgrounds, and although there are vast differences among them culturally… there’s
one thing I have noticed as recurring content…curiosity! For example, when I
went to Nepal and India, the first questions that I would get were about where
I was from and asking how cold Canada was and if I lived in an igloo, lol. We
are all so curious about what happens in other cultures, lifestyles, etc…that
regardless of where we live and what we do, we always wonder what it is like to
“be” someone else in another place…even if it’s just for a moment. I love
interacting with people from anywhere; I was blessed, or cursed depending on
how you look at it, with the gift of gab that stems from my grandfather, haha.
I can go up to any random person and start having full conversations and begin a
friendship just like that. I am a very curious person myself and I want to
experience as much as possible. I love sharing stories with people who’ve lived
the unique experiences! I feel this is a very similar commonality throughout
the world. </i></div>
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<b><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;"> 5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span>In
the field of physical rehabilitation, the issue of professional ethics is quite
well understood but paradoxically overlooked in a lot of cases.<span style="mso-spacerun: yes;"> </span>What is your personal / professional
perspective on ethics and the workplace?</b></div>
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<i>This
is a tough question to answer in a sense that with the social media access
these days, privacy is somewhat limited as well. Things get blown out of
context, words get skewed, and people’s lives can get invaded which affects
their careers. Ethics in the workplace should be a very tight held
confidentiality spectrum…yet we see it from time to time where a player’s MRI
report comes out or concussion report…etc. All these things have the media on a
field day which could very well affect the athlete or patient and his/her
well-being. </i></div>
<i>
</i><br />
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<i>
</i><br />
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<i>There
are also clinics that I have worked in or visited that the ethics practiced by it’s
members or clients has been very professional without any boundary overlooked.
Unfortunately, this is not always the case. I personally shy away from the
negative surroundings, simply because the nothing good can ultimately come from
it. </i></div>
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recent trip to Sochi for the winter Olympics gave you a unique look into one of
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</span>What was the biggest surprise and what was the biggest disappointment
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<i>The Sochi Olympic
games was an amazing career and personal highlight for me! Being an athlete
turned therapist/performance specialist, I had to holster my excitement until
my athletes were done competing, hahaha. The atmosphere at the games were
unreal. The biggest (not necessarily surprise) highlight was watching the
athletes I work with cross the finish line as winners and then accepting their
medals!!! Pure uncontrolled joy in these moments!!! All the sacrifice over the
years spent in the gym, on the treatment table, in the planes, on the courses,
hotels rooms, awful food….all worth it!!! Getting to hug an athlete you’ve been
working with for years at the bottom of the course when they’ve won a medal…the
feeling was out of this world!!!</i></div>
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<i>I didn’t really have
any disappointments to be honest. Russia did an extremely great job at hosting
the event in my opinion. The hospitality was great and accommodations were all
fine. The weather conditions were subject to many arguments, but were not in anyone’s
control. </i></div>
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<i>Top three….eeeesh!!!
</i></div>
<i>
</i><br />
<div class="MsoListParagraphCxSpMiddle">
<i>I live life to the
fullest and try to experience everything, so I have hundreds of challenges and
adventures that I have done that all mean something different to me. This is an
extremely tough question to rank my top three, but here it goes, haha. </i></div>
<i>
</i><br />
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<br /></div>
<i>
</i><br />
<div class="MsoListParagraphCxSpMiddle">
<i>3. Australian
adventure.<span style="mso-spacerun: yes;"> </span></i></div>
<i>
</i><br />
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<i>- My trip to Oz was
amazing. I am a certified skydiver and deep water wreck diver, so I traveled
along the eastern coast line to explore everything from sunken ship wrecks to
the marine life along the Great Barrier Reef. When I wasn’t jumping out of
planes or scuba diving, I was waiting for the perfect wave on my surf board. I
went out there to work for a few weeks with some athletes and simply extended
my stay a couple months. Many other mini adventures like learning to sail a
catamaran in the Whitsundays and shark diving without a cage were some of my
other amazing challenges I did out there that taught me more about my internal
patience. </i></div>
<i>
</i><br />
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<br /></div>
<i>
</i><br />
<div class="MsoListParagraphCxSpMiddle">
<i>2. Climbing Mt.
Everest</i></div>
<i>
</i><br />
<div class="MsoListParagraphCxSpLast">
<i>- Besides the major
culture adjustment, the challenges I faced on Everest are way too complicated
to explain in just a few sentences. The expedition will always be significant
to me in many ways. The journey will be something that I remember and cherish
forever…even the “near death” close calls.</i><br />
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<i>1. Being
A Traveling Professional<span style="mso-spacerun: yes;"> </span></i><br />
<i><span style="mso-spacerun: yes;"> </span>- As a professional that travels with athletes all over the world, I get
to see things form different perspectives. I feel blessed to be able to do what
I love to do at the highest level and see the world at the same time. There are
lots of challenges when it comes to traveling with athletes and
treating/training on the road, but being able to expose myself to countless new
environments and methods of adapting to my surroundings<span style="mso-spacerun: yes;"> </span>makes me a much better professional. I am
never really in a comfort zone and because if this I always have to stay on
edge and at the top of my game to help all my athletes perform at their very
best. I have literally tapped two ski bags together to use as weights when I
didn’t have a gym to bring the athletes to…there are no rules, only concepts. </i><br />
<i>
</i><br />
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<i>Notable
mentions: </i></div>
<i>
</i><br />
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<i>- Cycling
Across Canada was my first big trip and set the bench mark for all my other
adventures and guidelines to where I know how much to push myself.</i></div>
<i>
</i><br />
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<i>- Surf
trips in different locations around the world. <span style="mso-spacerun: yes;"> </span></i></div>
<i>
</i><br />
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<i>-
Olympics in Sochi/Watching my professional athletes play live.</i></div>
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experiences.<span style="mso-spacerun: yes;"> </span></b></div>
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</div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<i>If
you’re doing this for the money…pick another career, hahaha. </i></div>
<i>
</i><br />
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<i>If you
think that you can simply take some courses and finish your degree and get
right into working with the pros…think again, lol… If you aren’t ready for the
real grind of getting your “hands dirty” and years of sleepless nights without
money coming in and low budget facilities and/or equipment to work with…it may
not be for you. However, if you are willing to put in all the work and are
truly genuine about what you are doing…there really is no limit to where you
can go. Enjoy the ride! </i></div>
<i>
</i><br />
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<br /></div>
<i>
</i><br />
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<br /></div>
<i>
</i><br />
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<i>Kenny
Spracklin BSc, CATC, CSCS</i></div>
<i>
</i><br />
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<i>Head
of Athlete Development</i></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt;">
<br /></div>
<br />
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<![endif]--><span style="color: red;"><span style="color: black;">As promised, a very insightful gathering of experience and information. Be sure to connect with Kenny and keep up with ever evolving exploits and to plug into his vast hardrive of knowledge! </span></span></div>
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<span style="color: red;"><span style="color: black;">Cheers! </span></span>
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<br />Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0tag:blogger.com,1999:blog-8731813357458649991.post-74998275594087441862014-02-28T19:53:00.000-03:002014-02-28T19:53:04.878-03:00The Structure of Scientific Revolutions<div class="separator" style="clear: both; text-align: center;">
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The following are snipets from one of the most influencial and insightful books I have ever read. The book itself is quite comprehensive...and therefore contains many more sage and intelligent points than those I will mention here. The passages I will include here are from the first half of the book that essentially outline the nature of natural science and the "response to crisis"...but it is the first half that had the greatest impact on my personal and professional perspective on how to formulate strategy and how to go about the craft of searching for new frameworks and new solutions. Again, <u><i>the following are passages from The Structure of Scientific Revolutions by Thomas Kuhn and therefore all credit goes to the author. </i></u><br />
<br />
<br />
<b>The Route to Normal Science</b><br />
<br />
"To be accepted as a paradigm, a theory must seem better than its competitors, but it need not, and in fact never does, explain all the facts with which it can be confronted. (Normal science) suggests which experiments would be worth performing and which...would not."<br />
<br />
"Truth emerges more readily from error than from confusion."<br />
<br />
"The new paradigm implies a new and more rigid definition of the field. Those unwilling or unable to accomodate their work to it must proceed in isolation or attach themselves to some other group."<br />
<br />
"In science, a paradigm is rarely an object for replication. Instead, ...it is an object for further articulation and specification under new or more stringent conditions. ...Paradigms gain their status because they are more successful than their competitors in solving a few problems that the group of practitioners has come to recognize as being acute."<br />
<br />
<b>Normal Science as Puzzle-solving</b><br />
<br />
"Perhaps the most striking feature of the normal research problems we have just encountered is <u>how little they aim to produce major novelties, conceptual or phenomenal." <b> </b></u><br />
<br />
<b>The Response to Crisis</b><br />
<br />
"Often a new paradigm emerges, at least in embryo, before a crisis has developed or been explicitely recognized."<br />
<b> </b><br />
"Crisis often proliferates new discoveries."<br />
<br />
'The proliferation of competing articulations, the willingness to try anything, the expression of explicit discontent, the recourse to philosophy and to debate over fundamentals, all these are symptoms of a transition from normal to extraordinary research."<br />
<br />
<b>The Nature and Necessity of Scientific Revolutions</b><br />
<br />
"Normal research, which is <i>cumulative, </i>owes its success to the ability of scientists regularly to select problems that can be solved with conceptual and instrumental techniques close to those already in existence."<br />
<b> </b><br />
<b> </b><br />
To summarize, this book focuses on a deeper core concept of science...and even calls into question the very manner in which science is exacted. Further, it places a microscope over the intrinsic motivators and "drivers" of the scientist...<i>is it real research if we already know t</i>he <i>result? Is it real science if the parameters from which the study begins are entrenched within a specific paradigm? </i>All of these are very good questions...and Kuhn manages to propel the concept of the necessity for revolutions of all types.<br />
<br />
Very, VERY highly recommended read. Gavin Broomes B.Sc. FTMA (c)http://www.blogger.com/profile/12269088947106245117noreply@blogger.com0