Friday, December 27, 2013

Beware of Dogmas

dogma
 
ˈdɒgmə/
noun
noun: dogma; plural noun: dogmas
1.

a principle or set of principles laid down by an authority as incontrovertibly true.


 


The definition alone should tell the entire story.  Dogmas can be found in any and all walks of life...from philosophy to religion...physics to faith.  The real trouble starts when dogmas populate the rehabilitative landscape and begin to infiltrate what would normally be rationale thinking.  


 


Almost everything within the physical world falls under the banner of fact, extrapolation of fact, or theory.  However, when it comes to the human organism (with all of its systemic and mechanical complexities) very little can truly be considered a fact or incontrovertibly true with respect to the issue of rehabilitation.  Therefore we are left with (at best) extrapolation of fact or theory...which should always be treated with explicit focus and thought.  


 


There is, in fact, no true "best treatment"...nor is there a "best therapy".  What is represented is a system of "best fit"...or standardization...that best serves the masses and (more often than not) serves the "authority" that espouses said principles.  The human organism is a complex and comprehensive orchestra of chemical, hormonal, neurological, mechanical, and histological activity...it is logistically impossible to expect (let alone claim) one perspective or strategy to service all of these considerations. 


 


"...incontrovertibly true...laid down by an authority..." 


 


Search the history books and they will be riddled with things not so incontrovertible that we spoken by those not so much an authority.  Treat everything as extrapolation of fact or theory...truth is relative. 

Thursday, December 26, 2013

The year the lights came on...

As the traditional year-end reflections begin, it is quite understandable that we are struck with some sobering moments and surprising moments of clarity.  Although I typically refrain from the cliche of "new year / new beginnings", it has become more and more clear that the chronological changing of the calendar year has some psychological benefit.  Although time itself is a mere construct (the future doesn't really exist...it is always "now"...and the past is simply a reflection of multiple "nows"), the notion of being able to reflect on past experiences, integrate them into your current mindset, and project them into a certain "future" can be a considerable benefit to how you perform and how you behave.  This behaviour, as a consequence, can potentially yield some more favorable results and therefore enhance your experience throughout the rest of the coming year.

...but I've never been one to believe that new years "resolutions" are anything more than temporary.  Although many may be sincere, they are not serious...it is merely a "flirtation" with seriousness.

With this being said, I will condense my dialogue towards what is obviously an end of the year rant...but rather than focus on the standard "what will the new year bring"  I will share a few thoughts on "what the past year brought".  The credit for this paradoxical new years reflection goes to my friend Jordan who eloquently put his past year into great perspective...and as most effective strategies go, I will copy...combine...and transform that idea into something my own.

From a personal and professional perspective, this past year has been nothing short of transformational.  From a personal standpoint, it has unveiled (with explicit clarity) my strengths and my weaknesses.  This can be be temporarily confusing due to the paradoxical feelings of pleasant surprise at discovering true strengths and at the same time confronting some personal failings.  The end result is quite liberating in the sense that I am now essentially more consciously aware and can therefore play to my strengths as well as accept and "re-direct" my weaknesses.  Without this clarity, you essentially ride a comfortable wave of "unconscious incompetence" and glide along completely unaware of how ineffective, unproductive, and unprofessional you are...although it could be blissful to live in that bubble, it will always inevitably burst at some point down the line.

From a professional standpoint, this past year has been representative of "the good, the bad, and the ugly".  The details would be far too comprehensive to deliver within this format...and likely quite boring to everyone except myself.  However the beginning of the year started with a very stark and explicit lesson in how competent and professional attitude translates into responsible professional practice.  This caused me to examine, analyze, and question the standards of practice being implemented within my work environment at that time.  It is not to surprising that calling into question the business practices of a top-down, bureaucratic, and mechanistic organization would irk those in control of your professional career...and even more UNsurprising is the fact that this resulted in my very prompt and surgical dismissal.  "Services no longer required".

There is however (to re-invent a popular quote) a "silver cloud to this dark lining".  This was a clear message to the idea that the previous standards of practice were not only ineffective, but unproductive.  Therefore, I came to the sobering (and actually quite common sensical, if you think about it) realization that the best form of conduct in this field is to always proceed with a very clear and explicit philosophies and self-definition.  Additionally, regardless of the specific circumstances we should be bound to always proceed with:

Accountability
Transparency
Authenticity

It may sound intuitive and instinctive...but it is often overlooked.  In retrospect, although it was always implied, it was (in my opinion) nothing more than window dressing.  Putting this idea back into the actual organizational and intrinsic operation of Fascia Therapy (the "child" that is the result of the events of 2013...webpage coming very soon!) has resulted in progress that has not only surpassed the previous years combined but has yielded potential significant contribution to the evolution of the standards of practice.  Transparency breeds inclusion...inclusion expands the scope of professional resources...and the whole is greater than the sums of its parts.  

In summary, my future reflections will likely be referenced as "pre and post-2013"...and even though this rant comes at the traditional time of "new beginnings", the actual new beginnings came at the beginning of 2013 when the lights came on and provided a brand new perspective on a great many things.  To implement a true "scientific perspective" on the new year:   

The future is not set because it is only a construct...it serves only to reference the "now".  Therefore, it is silly to plan for the future at the exclusion of living now...not only because it doesnt exist but because, if it did indeed exist, it is only useful to those who can manage to live in the "now". 

Therefore the "new year" is always now...and now is always a new year, so everyday is a good day to re-assess, re-examine, and re-integrate.  Move forward with a clear sense of definition and proceed with transparency.  These are lesson learned from the past year...which will surely be put into practice "now".  

Cheers and Happy New Year! ;)







Thursday, November 28, 2013

(UN)Professional Ethics: Authors' Op-Ed

My previous Op-Ed post proved to be surprisingly refreshing and therefore I will jump into another "tirade" while I am still experiencing the current urge to rant. 

This particular piece is closely related to the previous one...although it hits a more fundamental point of interest:  Ethics.  More specifically, professional ethics.  Although typically defined as a set of moral principles, morality is paradoxically subjective...therefore definition of ethical behaviour is also subjective and open for infinite debate and discussion.  However, when you extrapolate this discussion into the world of health care / health services, the concept begins to condense and become much more explicit.  In my personal opinion, the fundamental issue is not necessarily what you do...rather how you do it.  In other words, even if you are engaging in what could be considered improper professional ethical behaviour, if you are explicit about your objectives and means, people will inevitably make their own decisions...therefore the definition of ethics travels through the concept of transparency.  Regardless of intrinsic good intention or honorable objectives, if an individual or organization engages in the practice of misinformation and subterfuge...the inevitable impression (and ultimate conclusion) is that they operate with an agenda that is not aligned with those they claim to serve.  It would be somewhat naive to assume that my position is the "moral high ground"...or that I exist on a different level...however, in recent months I have been exposed to the extremes of this mindset.  On one hand, I have witnessed this practice of subterfuge first hand...and on the other, I have experienced the benefits of implementing focused efforts in transparency....both of which clearly "bracket" this fundamental idea.

self-definition, transparency, authenticity and accountability

These are the hallmarks of ethical practice...if these fundamentals are not met, the individual or organization is subject to understandable scrutiny.  This general framework must be integrated into a functioning system that includes rules of conduct, values, moral principles, and ethical practice.  These need to be "built-in" metrics that are subject to internal and external assessment...and should also evolve with the changing dynamic of health care seekers and health care providers.  

I am certain that everyone who reads this will extract their own personal experiences from it...those who know me well may (or may not) be able to speculate where this is coming from...however, regardless of who is speaking or who is being spoken OF, the notion of better professional practice benefits all...and the practice of subterfuge is effectively apoptosis (self-suicide) and only serves to demonstrate a clear and definite need to re-define and re-examine.   

Good ideas don't need to be "sold", intentions should be explicit and transparent, and subterfuge is a poor weapon...especially when it is a weapon of choice.  

 

Monday, November 11, 2013

Sustainability

The paradoxes within the medical construct are numerous.  The merging of health "services" with private corporative interests results in a landscape that is almost impossible to navigate...further, it becomes so polluted that the "environment" of confusion and chaos tends to result in simple apathy.  "It is the way it is...so we just need to comply."   This confusion isn't by design, per se...rather a symptom of the realities and challenges of providing care to the masses.  However, although the "macro"system is essentially to large and integrated to adapt, the "micro" system is what matters...and, paradoxically, likely to yield the most beneficial impact to the individual care-seeker.  This "micro" system involves the interactions between the care-seeker and individual care provider...it is at this basic level that the most fruitful decisions are made.

With this being said, the overall strategy of "how to navigate" is still quite ambiguous and elusive.  However there is one simple term that can be imported into this discussion and should present some insight into direction, course, and focus:  SUSTAINABILITY.  The human organism is a self-sustaining system that is engineered to self-heal and self-regulate.  As with all things biological, it is subject to entropy...but it's elegance is mirrored by the infinite complexity and ability to "take care of itself" and adapt.  What does this mean?  This "organic" reality is paradoxically opposite to the strategic formulation of the "macro" system:  The idea that there is a "pill for everything" and that all biomechanical challenges can be "fixed" with simple inorganic concepts is purely mechanistic!  How is it possible to understand and accept that the human organism is infinitely complex, organic, and self-sustaning and similarly attempt to import mechanistic concepts in an attempt to "fix what is broken".

It seems that, if we consider the body similar to the ecology, we only need to provide the necessary stimulus that will help to promote sustainability and self-regulation.  Within the ecological context, this is equivalent to planting more trees, reducing pollution, reducing impingement onto natural resources, etc...  In the biological context, it means "help the body to help itself".  It isn't necessary to solve all of the mysteries of the human body...they are not ours to manipulate.  The only flaw is self-awareness...which lends to ideas of the ability to manage a complex system with simplistic strategies.  Focused strategies on respiratory development, hydration, lymphatic drainage, and reduction of general muscualr tension will facilitate exponential increases in the ability to manage and auto-regulate...essentially "fertilizing" the body so that it can more effectively receive and absorb positive stimulus.

As once quoted by DaVinci:  "simplicity is the ultimate sophistication"...supporting sustainability is well within the grasp of the individual care-seeker and care-provider and therefore should be a resource that is well examined and integrated into every rehabilitative strategy.

Cheers!


Thursday, November 7, 2013

Interoception: Balancing Inside and Out

One of the most insightful terms I have come across in a long time is the term: Interoception.  Although quite intuitive, I had never heard of it expressed with an actual term.

Interoception is formally the same concept as the more familiar term "proprioception"...however it is fundamentally exclusive.  Proprioception is sensitivity and sensory information received from the external environment such as temperature, gradients, pressure, velocity, etc.  Interoception is defined as: sensitivity to stimuli originating inside of the body.  

To expand on this a little more, the interoceptive process is autonomic, involuntary, and exists on what is essentially a "primitive" level.  It has been associated with visceral sensory neuroscience...which effectively theorizes that there is a high level of afferent (towards the brain, sensory) activity that is being generated from the internal organs and visceral organizational network that ultimately affect our mood, sense of well-being, and emotions.  This is an obviously fascinating topic for me simply due to the fact that this term lends to the fundamental understanding of systemic homeostasis...and perhaps more importantly, provides insight into potential "management strategies" to expand, enhance, and broaden rehabilitative strategies.  Further, this presents a viable bridge (or at least realistic extrapolation) to the idea that visceral manipulation (in its varied forms --- Osteopathy, Fascia Therapy, etc...) can essentially generate improvement in those elusive "intangible" and qualitative metrics (happiness, sense of self, relaxation). 

Like most innovative ideas, this perspective and form of thought came from Russia and Eastern Europe starting with Pavlov...however, it seems that even with our supposed "advanced technological capabilities" we cannot even seem to rationalize that which can't be measured quantitatively.  Interoception involves slightly smaller nerve bundles that access higher and deeper functioning within the brain and therefore is "lumped" within the context of the autonomic nervous system. 

The theoretical and conceptual formulation may yet take time to fully resolve and crystalize...however from a practical perspective, this further confirms what many practitioners have objectively observed for quite awhile...there is a definite link between visceral manipulation and global enhancement of health and well-being.  Further, that the myth that the brain and nervous system are somehow elevated to a "higher plane" is debunked...and the realization that they are fundamentally material comes into perspective.  Material is subject to mechanical influence and therefore the logical extrapolation of fact is that what we do has a direct impact on "who we are".   Although we are far from fully understanding what can perhaps be considered as "metaphysical" process...it should none-the-less be given adequate consideration and study so that treatment outcomes are more effective and manifest their maximum potential. 


Sunday, October 27, 2013

The Top 3 Fundamentals in Neurodevelopmental Disorders

Another small rant designed to (hopefully) stimulate some thought and perspective.  The title is admitedly somewhat "brazen"...since it is objectively impossible to classify fundamentals...but it's goal is simply to catch the eye and direct it towards a more important discussion.

The mechanical, physiological, and systemic implications of neurodevelopmental disorders (NDD) are far to complex to discuss in any realistic time frame or space, however there are some conceptual frameworks that should ultimately serve to direct and "mediate" any given formulation with respect to long-term strategic planning.  I have classifed them into a "Top 3" list to keep an otherwise overwhelming topic relatively light and easily "digestible".

1. Be humble...it's not something we can "control"

The most common error with respect to management and strategy is to naively assume that NDD's can be selectively controlled and managed.  This is a reflection of a relatively simplistic "mechanistic" perspective that essentially extrapolates simple singular solutions to complex systemic and mechanical challenges.  This does not mean that we are completely helpless...rather it means that our ultimate effect is minimal if we attempt to "fix" things by addressing them as a group of exclusive problems.  It is, in my view, far more efficient to support the biological systems that serve to facilitate and potentiate self-healing and self-regulation (respiration, digestion, lymphatic drainage, immune function).  In essence, the small increments of support to self-regulation ultimate yield exponential benefit due to the body's ability to convert microstimulus significantly more efficiently and therefore increase it's ability to intrinsically heal itself.  This is a more "organic" approach and, in conjunction with some carefully selected mechanistic interventions, effectively activates the infinite potential within the human organism itself to contribute to development and enhancement.

2. Mix it up

One of the most overlooked realities within the biological perspective is paradoxically a well understood fundamental concept:  the body responds to imposed stimulus and demands.  Despite this intuitive statement, it somehow loses it's way as soon as the issue of NDD's enters the discussion.  One of the most insightful and informative fundamentals reaches back to the topic of evolution...we are essentially designed to survive.  Therefore the human organism thrives and adapts to stimulus in order to accomplish this survival mechanism.  Furthermore, and perhaps more importantly, it responds to randomness, variability, and volatility.  The necessity for improvement and "strengthening" is a function of the imposed stimulus...therefore the long term strategy should reflect a certain randomness (implementation in irregular cycles), variability (changes in frequency, duration, etc), and volatility (variations in intensity expressed within the parameters of the overall strategy).  These are obviously meant to be implemented in small degrees and expressed in MICRO-changes...

3. Systemic focus is a "win-win" situation

Whenever in doubt, or in the most difficult of situations "when all else fails", it is important to remember that the development, nourishment, and activation of systemic function ALWAYS yields positive results.  In reality, the eventual "success" of any intervention relies on the intrinsic ability if the human organism to recieve, absorb, and assimilate any given stimulus...therefore the systemic competence essentially serves as the modifier for overall efficiency.  If systemic competence and homeostasis is poor, then the ability to absorb and assimilate is low...resulting in significant reduction in "investment of stimulus".  However, a robust systemic performance serves to potentiate and expediate the process of healing and development...which is achieved via more efficient oxygen exchange, improved lymphatic performance, increased nutrient absorption, and metabolic competence...to name a few.

In summary, a compartmentalized and mechanistic perspective is exponentially more effective when the organic evaluation and strategy has been considered and put into place.

Cheers!

Friday, October 25, 2013

The Spine and the X-Ray: What you should know.


This post is credited completely to the work of Serge Gracovetsky, a well-known researcher in spinal function.  Although his findings and research have been public for more than 3 decades, it is only recently that his hypotheses from way back in the 80's are proving to have been quite insightful and, arguably, ahead of its time.  Further, it is always encouraging to find some parallels and "symbiosis" between ones own philosophy and that of a renowned and true expert in the field.

The title of this post is relatively self explanatory: There is an intrinsic "disability" that exists within the diagnostic framework that is systemic and often leads to confusion and, in some cases, mis-interpretation of information.  

This "disability" takes many forms...no standardized diagnostic "language", established uniform standards of measurements, and obvious rampant objective differences.  Gracovetsky points this out rather explicitely in alot of his work...although he doesn't refer to "diagnostic disability", he often demonstrates the simplicity of past and current assessment protocol.  This isn't, in my view, and effort to discredit...rather to highlight that a more focused effort is required along with more broader perspectives of evaluation and assessment.  I will refer to work he formulated regarding the spinal "engine".

QUESTION:  What is the function of the spine? 

This SHOULD be an explicit and straightforward question...however, you would find that even among the "experts" you would have some objective differences and responses.  You would encounter some within the "spine is a supportive structure" camp...and you would also find some heavily entrenched within the "spine is a functional unit that generates movement"...and as expected, some would attempt to skirt this line.

REALIZATION:  If we cannot agree on the function, how can we decide on how to treat or do surgery? 

This is quite thought-provoking in my view.  How can a standardized protocol of practice and intervention be implemented when the function of a given biological unit cannot be unanimously understood and percieved?  We therefore come to the most popular diagnostic tool that has been the standard since it
 was discovered in 1895...the X-Ray.

Wilhelm Rontgen took this radiograph of his wife's left hand on December 22, 1895, shortly after his discovery of X-rays.
 Since that time, it has obviously undergone some significant technological refinement and has evolved into a very useful tool in the evaluative process.  Although its merits and advantages are obvious and beneficial, it has been elevated to a status that isn't truly warranted and, in my view, is potentially misleading. 


It is used very frequently as a diagnostic tool...which is something I have written about in the past...and this strategy is fundamentally flawed.  The most significant failure of this strategy is that it is a 2-dimensional representation of a 3-dimensional system...therefore a great deal of information is missing.  The explicit example of how much information is left out is one that almost everyone can relate to:  What is the difference between looking at a picture of a mountain top and actually being there live? The difference is exponentially different and distinct!  Further, it is fundamentally almost impossible to gauge function and movement potential from a still image...therefore as Gracovetsky postulates:


Function cannot be deduced by radiology


One of the most impacting realizations I have experienced came from one of his presentations on "The Spinal Engine".  He posted an image of  a spine and asked a straightforward question:  Can this person lift 10 lbs? 


The answers were understandibly varied...some refering to some degenerative symptoms that were observable, some refered to issues of alignment, etc.   Here is the "punch-line": 

This is an x-ray of a cadaver

Gracovetsky:  If radiology cannot determine if a patient is even alive...why is it used in disability assessment??  Quite insightful...

He goes on to stipulate that one of the most common errors made within the evaluative paradigm (and which is one that I have shared and expressed for quite some time) is the assumed link between anatomy and function.  In other words, the anatomical and topographical representation is a reflection of functional competence...and this is a simplistic and formally inefficient strategy.  Therefore the "Gracovetsky effect" results in a paradoxically simple rule: 


Function must be measured independantly as part of a comprehensive investigation of injury or dysfunction

I'm hoping that this insight results in similar broadening of perspective...even if only slightly.  

Cheers!

Tuesday, September 10, 2013

The Fascia Therapy Theorem: Growth and Development

As mentioned in a previous post, I would be sharing bits and pieces of the upcoming publication of the Fascia Therapy concept and its application with the realm of neurodevelopmental disorders (NDD).  Although NDD is a vastly complex definition with a diverse spectrum of manifestations, the Fascia Therapy Theorem attempts to implant the rehabilitative strategy within a systematic framework that will ultimately support and facilitate effective understanding, implementation, and (eventually) outcomes.

Therefore, I have decided to "dissect" the fundamental developmental theory, that can therefore be imported into a variety of different pathological or non-pathological circumstances, to share here in this post.  It serves to provide a foundation for further strategic formulation and planning, as well as to convert an otherwise complex systemic and mechanical challenge into a more manageable task. It essentially outlines the theory of the fundamental interdependance of compressional and tensional forces within the growth and development context.  Moreover, it demonstrates the sequential "evolution" from primitive compressional stresses, to secondary tensional involvement, and finally to integrate into the biological organism that manifest biotensegral properties.




The main objective of this "sneek-peek" is to determine the more fundamental and prominent stages of development within the first year of life.  The first 12 months of life are critical to the future potential of the human organism, therefore an enhanced perspective on the evolution from compressional forces to the addition of tensional stresses to form a conglomerate biotensegral organism will ultimately help to design effective strategy.

More to come!

Sunday, September 1, 2013

Function Defined

Function is a term that is intrinsically well understood and has implications beyond the biomechanical spectrum.  It is this precise "comfort level" with this term which perpetuates occasional oversight and oversimplification of its true definition.

The general "definition" of function can be summarized as an outcome that is derived from one or more interdependant sources. For example, force (F) is a function of mass (m) and acceleration (a).  In the biomechanical sense, "function" is essentially the same...however this concept is often lost. 

Therefore, a focused "re-learning" of the component parts of function will ultimately provide an expanded perspective into how this understanding can translate into more efficient and productive treatment strategies.  This can be done via a very simple formula:

Function = Force Activation Source + Force Transferring Source + Force Limiting Agent

The Force Activation Source refers specifically to the muscles themselves.  Although forces are also generated from  interactions with the ground, exposure to environmental stimulii, and autonomic activity, the musculoskeletal system is the primary catalyst with respect to function in the "locomotive" sense. 

Force Transferring Source is likely the most underappreciated component of this equation.  The common error is to consider the source of force only...however how the generated force is transmitted and transfered effectively determines the overall outcome.  There are 3 primary considerations within the transferring context: 

1) Tendons  2) Myofascia / Periosteum  3) Adjacent Tissues

During muscle activation, tensional force is subsequently translated into the tendon which is intimately related to the periosteum at the insertion point (in fact, tendon and periosteum are continuous with each other and are actually a singular tissue which has been characterized as 2 different tissues out of convenience).  This myotendinal / periosteal action is governed by the myofascial "architecture" that provides a paradoxical connection and "disconnection" of the working / non-working muscles...which essentially perpetuates metabolically efficient operation.  The considerations of adjacent tissues is a relevant consideration because they are directly involved in either the loss or gain in energy.  Adjacent tissues that manifest some dysfunction (fibrosis, edema, etc) can reduce the overall transmission of force...and perhaps more relevant, contribute to chronic conditions due to inefficient muscle activation and force transmission.

Limiting Agents are the vast array of ligaments and joint capsules that surround and contribute to biomechanical operation.  These specialized connective tissues are designed to absorb forces and therefore stabilize and protect excessive impacts and ranges of motions. 

In summary, the Function Equation should be well integrated and implemented when any functional assessment and evaluation is in effect.

FeQ = F(a) + F(t) + L

In more practical terms, the careful evaluation of muscular performance, fascial health, tendonal integrity, adjacent structures, and joint integrity of at least 4-5 adjacent joints should be fundamental minimal "starting point" for any sage rehabilitative strategy.

Cheers!


Wednesday, August 7, 2013

The Fascia Therapy Theorem





























This post serves more as a "heads-up" as opposed to anything otherwise informative.  To date, I have managed to accumulate a solid 21 years of professional experience in the field of health sciences...ranging from high performance fitness training, teaching human anatomy in University science labs, and more recently to the rehabilitative challenges of neurodevelopmental disorders.  Although the years may span a decent period of time, it is actually the diverse population of people and experiences that are perhaps the most valuable.  I have been fortunate enough to work with some of the most physically impressive specimens as well as some of the most fragile individuals imagineable...and everything in between. 

It is with this plethora of exposure, combined with many interactions with intelligent collegues, and some all-important healthy criticism, that has lead to the Fascia Therapy concept I am currently launching in Chile and abroad.  This new and refreshing endeavour has lead to the opportunity to present this experience and philosophy in writing in the form of a formal publication...hopefully to be released sometime in the very near future.  This conglomerate of experiences, theories, formulations, and philosophies has come together to form what I have termed: The Fascia Therapy Theorem for Neurodevelopmental Disorders.  

Although the official text has yet to be completed...and is still very much in "draft" form, I wanted to share the current introduction here for those interested to read.  I am somewhat unfamiliar with publication "protocol", however I am hoping to be able to share more "bits and pieces" as time goes along.  It is only a very small portion if the entire text, but it should present a decent image and "texture" for the entire body of work.

Cheers!




New Frameworks and Solutions in Rehabilitation for Neurodevelopmental Disorders
Gavin Broomes  B.Sc.




 Introduction:

                The objective of this chapter is to present a global perspective on what can be considered a very elusive and daunting topic.  Neurodevelopmental disorders are very diverse and present equally diverse manifestations and challenges.  However, despite this reality, there are some very tangible similarities that essentially allow the medical professional / practitioner to impose a significant amount of productive and positive benefit which will ultimately result in more manageable situations, more efficient treatment strategies, and significantly better treatment outcomes. 

In the 20+ years of formal education, clinical, and hands-on experience leading up to this current philosophy, I have been fortunate enough to have been exposed to a very wide spectrum of human performance…from the most highly trained athlete to the most fragile child with neurodevelopmental disorder.  It is my firm belief and conviction that this exposure has provided some valuable insight and perspective into the exponentially complex human organism.  In essence, a very explicit demonstration of not what separates these two polarities (which is relatively obvious and certainly intuitive)…rather what is the common thread between them.  This is a seemingly paradoxical suggestion…how can two polarities (extremes) share anything in common?  The answer to this is that both are not exclusive entities, but are simply very different manifestations of the singular human condition. To be more precise, they both share the same embryological material and subsequently contain the same “architectural building blocks”…which effectively serve as the key to elicit the most powerful systemic and mechanical change.   

This fundamental understanding was the genesis for the development of the new frameworks and solutions presented in this chapter.  It was important for me to formulate this relatively complex philosophy to reflect a certain “neutrality” with respect to any specific belief, conviction, or position a professional may have.  Any such bias would inevitably result in the breaking of the “law of contradiction” which specifies that any allegiance towards a specific “technique” or approach would essentially imply that any other course of action or belief would be “wrong”…therefore a philosophy that is based in fundamental neutrality can be applied across the entire spectrum of personal and professional ideals and convictions. 






1.       Organic Versus Mechanistic Perspectives:

The Organic vs. Mechanistic comparison is typically associated with the analysis of business models and issues surrounding hierarchical structures of large corporations, however when this general philosophy is imported into the biological analysis it demonstrates equal ability to elicit enhanced clarity and perspective on an otherwise complex task.

Mechanistic Organization
This type of organization is characterized by hierarchical and “bureaucratic” focus.  Within the biological context, this is the overall equivalent to the overwhelming focus and attention solely on the neurological considerations…or in essence, a “top-down” mentality where the central nervous system (brain) is locus of control for everything.  This analysis is in-line with the precise definition of a mechanistic organization:  highly centralized authority, formalized “procedures and practice”, specialized functions. 

The mechanistic perspective in the neurodevelopmental context is almost a necessity due to the fact that it is easier and simpler to manage.  Additionally, it provides significant quantitative metrics through which practitioners can measure progress, deterioration, and even assign diagnoses.  Although relatively easier to manage, it is very sensitive to rapid change.  The essential “chain of command” is quite strong and therefore requires that all decision-making come directly from the top.  In that sense, the brain is considered as the overriding system that ultimately controls, moderates, and directly influences all physiological functions…from the systemic to the mechanical.  Further, this organizational structure is characterized by “communication” and information flowing solely from the upper levels…even more so, any communication that goes to (or comes from) the bottom is vertical, meaning that there is very little lateral communication within the lower levels.


Organic Organization
In contrast the mechanistic organization, organic organization is characterized by what is defined as “flatness”, which essentially means that communication and interaction is primarily horizontal.  Ironically, there is also a certain low level of specialization which indicates that elements (tissues, in the biological context) adopt many different roles depending on the specific environment and stimulus.  An example of this would be the paradoxical role of connective tissue as both “connecting” and “disconnecting” contributors…in addition to its role in force transmission, injury repair, and systemic homeostasis.  Additionally, there is a characteristic “decentralization” in the decision-making process…meaning that some actions / reactions are directly and indirectly managed by the lower levels (or the more primitive levels, in the biological context). 

The organic organization reflects a contrasting “bottom-up” performance and therefore is extremely adaptable and flexible to sudden, large, or rapid change.  The sharing of roles and responsibilities makes it “less fragile” and more robust. 


 Organic Organization and links to rehabilitation

This analogy is less of a dichotomy and more of a continuum.  To be precise, the human organism is exponentially more complex than a business model therefore it cannot be explained with a relatively simplistic analysis as this.  The “organic versus mechanistic” model ultimately serves as a philosophical framework that essentially encompasses a larger fundamental understanding which then results in a certain clarity of thought. 

The complexities of the human organism are far too numerous to describe…and given that we have yet to uncover ALL of the wonders of the human body, the absolute complexity remains a mystery.  It is this fundamental reality that underlines the necessity for an expanded perspective when it comes to the added complexities of neurodevelopmental disorder. 

Assuming a hierarchical / mechanistic approach alone lends to the unrealistic assumption that we have ultimate control over the human organism and the associated systemic and mechanical manifestations.  The infinite number of micro and macro processes that take place every second of every day are incalculable…and occur without conscious or voluntary input…and in some cases completely outside of the neurological context, relying solely on mechanical inputs to facilitate gene expression and tissue differentiation.   In essence, the majority of human processes exist on this “primitive and autonomic” plane.  The so-called “voluntary or mechanistic” manifestations are effectively REFLECTIONS of a functioning organic system of auto-regulation, self-organization, and self-healing. Therefore, any and all interventions that develop, support, and nourish the primitive systemic oscillations (respiration, circulation, digestion, lymph) ultimately provide the most beneficial and “metabolic cost-effective” strategy for improvement of overall health and homeostasis.




Monday, July 15, 2013

Rehabilitative Strategies in Cerebral Palsy: Understanding Hierarchy



The title is quite a mouthful...but it is a very precise description of an otherwise overlooked reality.  Hierarchical structures not only provide a sense of structure and organization (where things exist in relation to others) but they give a rather profound demonstration of perspective...or to be more precise, a sense of direction and flow.

As the colourful image explicitly demonstrates, each component has its own individual identity and purpose...however, it exists within a larger framework.  Although each has its own intrinsic operation and purpose, it essentially serves the larger whole.  This is likely intuitive to most, however this intuition seems to be put aside as soon as a therapeutic or rehabilitative context is in play.

Although exponentially more complex, the developmental process can be thought of as a very sophisticated and comprehensive hierarchy.


The most basic and fundamental elements of any human organism (for the simple sake of survivial) are the vital functions.  Without coherent establishment of the systems that sustain life, any other consideration(s) are irrelevant.  Further, proper functioning (or interaction) of the human organism within the environment REQUIRES that these vital functions be well-established in order to generate productive results.

The primary dilemma with this fundamental perspective is that these critical components are somewhat difficult to measure in the quantitative sense...in essense, they are QUALITATIVELY measured.  The conflict between what "can" and "can't" be measured is quite prolific in the rehabilitative context...meaning that thise elements that have no quantitative measure are very often dismissed or disregarded.  However, the reality still exists:  without the development, maintenance, and nourishment of systemic homeostasis there is no life...even if the operating level / coherence is poor, there is still an overwhelming need to develop these fundamental elements to their best potential. 


Mobility and closed-chain can easily be confused and inter-changed within the neurodevelopmental disorder (NDD) context.  In more practical terms, it referes to the selective independant mobility (freedom) that exists within each of the diverse segments of the body.  This includes ALL of the traditional "joint-like" articulations as well as the equally important fascia larticulations within the body.  Therefore, the term "mobility" is used, not to define movement as such, rather to describe some level of intrinsic elasticity and adjustment to positional changes.  If we extend this description further, we arrive at the term "closed-chain"...which can understandibly refer to a vast number of specific movements and dynamic activity.  But, once again, when we consider the NDD context, a closed chain activity refers primarily to postural characterisitics such as independant sitting, balance, and counterbalance.  These considerations MUST be addressed and developed before any consideration or focused strategy regarding more dynamic (open-chain) function. 



It isn't until we reach the "peak" of this schematic that we entertain the notion of what would be considered "traditional movement-based strategy".  If we consider this generic illustration, it clearly suggests that any and all movement-based strategy must be "earned" via the establishment of coherence between the elements that preceed it.

In summary, the general "landscape" of the rehabilitation strategy should reflect the natural process of development and growth.  This is indeed an obvious over-simplification of the reality...however working frameworks only require a solid philosophical basis from which to operate.  Effectively, a simple framework can be a valuable tools when assigning treatment strategy and protocols...and most certainly yields some enhanced clarity and perspective.

Cheers!