Friday, September 30, 2011

Connective Tissue: Body-Wide Signaling Network?

Once again, i have caught the reading bug and have come across another intelligent article on the growing interest and study of connective tissue and it's implications in the human organism. I have found that the more you ask and the more you dig, you not only find answers but you uncover more questions! This particular article asks a very important and fundamental question: is connective tissue an immense signalling network? It was written 6 years ago and the more current research has shown this to be highly likely (if not true). It also makes another important point: the musculoskeletal system has been studied in relative isolation from the rest of the body...implying that connective tissue has no other function other than something mechanically based.

I am aware that not everyone has the time or energy to plow through scientific is an unlikely source of relaxation for me which most people do not share. Therefore, I have decided to insert the summary into my post because it very accurately captures the essense of the article. For those who are more the link and read on!

SUMMARY: Unspecialized ‘‘loose’’ connective tissue forms an anatomical network throughout the body. This paper
presents the hypothesis that, in addition, connective tissue functions as a body-wide mechanosensitive signaling
network. Three categories of signals are discussed: electrical, cellular and tissue remodeling, each potentially
responsive to mechanical forces over different time scales. It is proposed that these types of signals generate dynamic,
evolving patterns that interact with one another. Such connective tissue signaling would be affected by changes in
movement and posture, and may be altered in pathological conditions (e.g. local decreased mobility due to injury or
pain). Connective tissue thus may function as a previously unrecognized whole body communication system. Since
connective tissue is intimately associated with all other tissues (e.g. lung, intestine), connective tissue signaling may
coherently influence (and be influenced by) the normal or pathological function of a wide variety of organ systems.
Demonstrating the existence of a connective signaling network therefore may profoundly influence our understanding
of health and disease.

c 2006 Elsevier Ltd. All rights reserved.

Connective Tissue: BodyWide Signaling Network

Monday, September 26, 2011

“Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces”

The link below will direct you to a very informative blog post from Leonid Blyum. The issue of splints, orthotics, braces, etc. when addressing the complex rehabilitation of children with Cerebral Palsy comes up with an alarming regularity. In my 6+ years of working directly with these special children and their families, it is undeniably one of the top 2 or 3 topics that always comes up. My main point is not that it SHOULDN'T be a topic of conversation, rather that it has become "standard operating procedure"...and that the use of these devices isn't even examined or questioned. To be more precise, the mere NOTION of asking "is this the best thing for my child and will it do what people are claiming it will do?" is sometimes beyond comprehension for alot of families. The reality is that these approaches have been in "mass circulation" for hundreds of years...the majority of the advancements being in the development of light, softer, and more durable implements...however there is still a fundamental question that remains: "What is the true biomechanical consequence of using these". There is far too much over-simplification when dealing with complex biomechanical disorders..."the foot is twisted in? Let's put on a hard brace to force it back" or "Oh, the hard brace hurts the foot? Ok, let's put a soft brace on". It would be ideal if it were that simple...and if it were, there certainly wouldn't be any need for therapeutic "experts". At any rate, the link to Leonid's post(with accompanying video) will prove to be extremely informative for ANY rehabilitation professional. The thought process and analytical approach extend beyond just cerebral palsy. It is in-depth and most certainly in my "must read" folder!

“Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces”

Braces and orthoses in Cerebral Palsy ABR position Aug 2011 from BlyumABR on Vimeo.

Thursday, September 15, 2011

Redefining the Joint: Part 1

Why in the world would I suggest that the word "joint" be re-defined? It's a simple thing, right? Let's look at the definition as quoted in the Merriam-Webster Dictionary: the point of contact between elements of an animal skeleton with the parts that surround and support it . This definition conjures up the image that likely popped up in your mind...2 bones, some soft tissue around it, and maybe a meniscus in between.

The above image is nothing new to anyone. You have the pivot joint, the ball-and-socket joint, and the infamous hinge joint. This image follows the quoted definition quite nicely. The unfortunate thing is that the mechanics of human movement cannot be compacted into a simple definition and certainly not be explained by simple mathematical models. "Well, what is the right definition then?"...I would be naive to suggest that this definition is "wrong" per se, rather I merely suggest that it is very simplistic. Complex systems, by definition, demand complex explanation and understanding...therefore a more global perspective is required. As per "Gavin's New Trans-anatomical Dictionary", a joint is defined as: Linear and/or angular displacement between separate biological elements . To many of you, this may seem like a fancier way of saying the same thing...however, you couldn't be further from the truth. The reality is that the skeleton (bones) has a "monopoly" on everything joint-related. Why is this so? convention! It's in the dictionary, Gavin. But if you look at my definition, the skeleton is only a PART of it. Linear and/or angular displacement indeed occurs at all of the "typical" spots you would think of (knees, elbows, shoulders, etc)...however, if linear and/or angular displacement is a key element in this definition, you need to consider EVERY area that experiences this displacement as a true joint!!

It is not sufficient to suggest that movement only occurs at the "joints" and the soft tissue is simply a "biological sleeve" that fit over it. It clearly involves sliding of specific fascial layers one on top of the other. For example, the tendons of the wrist actively slide against each other when activated...which, by definition constitutes a joint. As you flex your arms, the fascial layers (from the skin to the triceps) on the back of the arm slide against each other and along the humerus...this constitutes a joint. The fundamental question is: who decides that if there is no bone, there is no joint?". If you consider the scenario where these movements are restrictied or blocked (fascial layers are "glued" together), you would have NO PRODUCTIVE MOVEMENT AT ALL. Therefore, when you consider this fact, the whole idea of "assessing range of motion" becomes something quite daunting...and perhaps even seemingly impossible. We therefore come to a crossroad of sorts. You can either go one way down "Newtonian Anatomical Model Boulevard" and be quite happy and comfortable with the status quo (which is a completely acceptable decision)...or you can go the other way and travel on "Trans-Anatomical Model Road" and walk a path of some unknowns and new discoveries.

I will go into more detail on the transanatomical definition of movement in part 2. For now, i will let you pause at the "crossroad"...digest the concept...and for all of you who choose Transanatomical Road, see you around the corner!

Wednesday, September 14, 2011

The Underlying "Diagnostic Disability".

I recently came to realize that there is an underlying problem within the health care system istelf that leads to more challenges for those seeking our "professional expert guidance". Like most of my "revelations", this came to me by chance through some recommended reading given to me by a collegue (gracias, Daiana!). This very insightful articles effectively describes that one of the main challenges to overcome is our inability to establish a "common language" among rehabilitation professionals. In effect, we are "diagnostically disabled". As explained in the article, the role as diagnostician for the physical therapist is quite challenging and is met with many dilemma's such as lack of consensus among professionals regarding classification, rapid evolution of new knowledge, and the complexity of the diagnostic process. I believe this is at the heart of a fundamental "dysfunctional attitude" among professionals. There is a constant sense of "competition for diagnosis" which inevitably leads to more confusion and frustration for the care-seeker. They are given different and sometimes conflicting information depending on who they refer to. The neurologist will make his / her comments...which may differ from the orthopedic surgeon...then when it comes to the physical therapist, he or she is commited to a plan of action that is contraindicated by the surgeon or even perhaps counter-intuitive to the care-seeker himself!

The article below is an excellent example of how self-examination and consistent search for solutions from within can result in significant positive impact, not only on a personal practice, but on the system as a whole. It also presents some constructive ideas on how to reduce the negative implications of this diagnostic disability on the care-seeker. It was a refreshing read and re-affirmed to me that constructive information can come from anywhere at any keep your eyes peeled and, more importantly, your mind OPEN!.

Disabling Our Diagnostic Dilemmas