Monday, March 25, 2013

Anti-Fragile: Broadening Perspectives in Health and Rehabilitation

I have recently been turned onto the "cross-pollenation" of philosophies and perspectives from adiverse range of sources.  The recent exposure to the sociological concept of Salutogenesis is the likely culprit of this cross-pollenation. 

The most recent discovery on this journey is the concept derived by Nassem Nicolas Taleb called Antifragility. His recent book is accurately titled: Antifragile: Things that Gain from Disorder.  In the introduction to his book, he described it as follows:

"Some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, and stressors and love adventure, risk, and uncertainty. Yet, in spite of the ubiquity of the phenomenon, there is no word for the exact opposite of fragile. Let us call it antifragile. Antifragility is beyond resilience or robustness. The resilient resists shocks and stays the same; the antifragile gets better."

He makes reference and uses examples in both the business AND bilogical world and, although I have yet to read his book, the concept already opens new perspectives with respect to achieving optimal health as well as setting working frameworks for rehabilitive strategy.  

The definition of antifragile is based upon our intrinsic understanding of fragility...things that are fragile are highly susceptible to damage or failure when stressors are applied.  By definition, ANTI-fragility is the opposite.  In his formulations, Taleb makes reference to the term "robustness" as a common representation of the opposite of fragility...however, this term does not go far enough.  Robustness simple means that it "resists" damage and remains the same.  The concept of antifragility is more complex and suggests that systems are stressed and not only resist damage or failure, but actually develop and improve from such chaos. In essense, the system becomes more sensitive to volativity and adapts accordingly.  In addition, it is characterized by an inverse relationship between vulnerability and readiness...high vulnerability is a reflection of poor readiness and effective readiness reduces vulnerability. 

In the business model, fragility is manifest more often in the "top-down" management style where strategies are formulated and implemented from the top and driven downwards through the chain.  This results in a fragile system that manifests poor readiness and therefore is exposed to high levels of vulnerability.  The business model that manifests high information access from the bottom-up yield much higher adaptability ratings, react more positively to volatility and uncertainty, and demonstrate a higher level of variability.  In essense, they are able to react and respond to stressors that would typically collapse a fragile system. 

In the biological framework, this concept have some significant level of applicability as well.  Although there may be diverse representations of the "top-down" approach (high neurological focus), there is essentially a clearer antifragile perspective that can be identified. 

In effect, those systems that are resposible for irritability / adaptability, sensory feedback, autonomic response, and systemic "oscillation" (cardiac rhythm, respiration, digestion) are those elements that transform fragile systems into antifragile ones.  What does this mean for the health-seeker / therapist / rehabilitation plan?  Hearty focus and attention to the development and maintenance of these systems. 

In practical terms, the contribution to the movement of interstitial fluid (through manual massage techniques) would be the paramount platform in which to achieve this.  This results in the movement of stagnant fluid, removal of metabolic waste, and delivery of nutrient rich fluid.  The product would be increases in lymphatic motility, reduction in tissue "toxicity", and therefore an improvement in systemic homeostatic management and improved immune function (improved irritability / adaptability).  Further, attention to the nourishement and strengthening of the connective tissue / fascia will serve to improve sensory competence, equalize and recalibrate muscular imbalances, as well as promote healthy force transmission and distribution thorughout the body.  This is more of a architectural consideration, but relates to the adaptability to daily interaction with the environment that are potentially volatile.  Finally, interventions that address the development of respiratory and digestive mechanics.  These last two considerations are of particular importance due to their direct links to the more primitive functions related to sustaining life itself. 

In summary, it isn't a simple case of building systems that are invulnerable to damage...rather a careful and purposeful strategy to develop the systems that contribute the most to an anti-fragile environment.

More to come as I jump into more specifics identified in his book! 

Saturday, March 23, 2013

Therapeutic Hands

The human hand is quite honestly the most under-appreciated and under-valued tool in the therapists toolbox.  The last 5 decades of traditional "therpay" have been dominated by electronic modalities such as Muscle Stim, Ultrasound, T.E.N.S., etc...which have by default relegated the use of the hands to some sort of "B-League" status.  In essense, the general procedure is to assess with the hands and then confirm with some diagnistic "tool".  The most efficient approach is not only different from this, it is completely the opposite.

Every person has within them a highly efficient sensory tool known as the hand.  Without exception, every one of us has flipped through a magazine, novel, or textbook...and on occasion, this flipping results in turning 2 pages over instead of one.  This is IMMEDIATELY registered in your brain and you go back on page and resume your reading.  How thick is 1 sheet of paper? If you actually Google this precise question, you will get 0.0038 inches.  This is extremely understatement if ever I heard one.  Therefore this means that everyone has a built-in sesnory capacity to sense variations of around 0.0038 inches.  When you couple this with accurate, real-time 3-dimension perspective...a hands-on live assessment and evaluation goes a long way!  There is no modality or electronic device capable of such accuracy...nor is there on expected in the near future.  So....the "true" confirmation should be done with the hands, and the various diagnostic tools should service this confirmation.

This information should help to solidify the reality that massage therapy is by far the most reliable intervention that exists today.  From the mechanical perspective, it faciliates the movement of interstitial fluid which is responsible for the transportation of nutrients thorughout the bosy as well as removal of metabolic waste.  In addition, it is a fundamental element in tissue maintenance.  If we expand further into the long term mechanical perspective, consistent mechanical stimulation of the tissue (and movement of fluid) potentiate the development and maintenance of strength.  It has also been shown that the physical contact that occurs in a typical massage therpay session results in productive changes in body voltage and therefore reduces effective energy costs.  The body undergoes the process of entropy, therefore the conservation of energy is vital sustaining health. 

From the physical realm to the more "intangible" domain of relaxation, massage therapy incorporate various sounds, scents, and textures that contribute to the qualitative benefits.  Relaxation is a qualitative other words, it cannot be measured quantitatively.  "How relaxed are you" is not answered with a number of set of units...more relaxed, or less relaxed is the likely option of responses.  The state of relaxation is medically defined as "refreshment of the body or mind" therefore it is an active contributor to the natural recovery process of the body.  In essense, focused strategies that service our built-in capacity to heal facilitate the range and reach of all other therapeutic interventions. 

As DaVinci once quoted: "simplicity is the ultimate sophistication"...and this most definitely applies within the therapeutic world.  The use of the healing hand is essentially one of the most powerful catalysts in the restoration of better health.  It does not plug into the wall nor does it have fancy flashing lights, but it is the most reliable and efficient "modality" every therapist use it! 


Monday, March 18, 2013

Develop, Nourish, and Activate

Recent activities have kept me close to the computer, but far from any decent amount of time to dedicate to regular posting.  However, the busy days and weeks have undoubtedly produced additional growth and perspective...some of which is incremental in nature and some which is more transformational.

I have just returned from a very enlightening couple of weeks in Hawaii where I had the honour and privelege of, not only exploring one of the most beautiful spots on the globe, but interacting with a large group of families and professionals who are truly ahead of the curve with respect to transforming the current ¨disease management¨ system of care into what is more accurately defined as HEALTHcare.  This level of clarity and commitment was both surprising and refreshing...and signals a definite growing trend towards frameworks that are more patient-oriented and family centered.

With this in mind, I thought it would be informative to briefly outline the general framework from which the ¨Thrive and Flourish¨ theme is derived and how it fits into the overall landscape of healthcare.

Broadening Perspectives and Shifting Paradigms:
As is often mentioned in my posts, a consistent effort to gain proper perspective is always the most productive pursuit...therefore when it comes to healthcare in general, it is important to remember one key fundamental:  building and nourishing the health assests that already exist contribute and facilitate any and ALL specific interventions that are implemented.  To be precise, building upon existing repsiratory performance, digestive function, lymphatic drainage, fluid flow, and peripheral blood flow will yield much more ¨return on your investment¨.  Using this economic analogy, it becomes very easy to see where this philosophy is grounded...and how vast the implications are.

If we consider the human organism as a multi-faceted and deeply complex ¨health economy¨, there is ultimately two main approaches that should be considered:  deficit reduction and/or asset building.  

Deficit Reduction:
A focused strategy on deficit reduction revolves around the concept of ¨what is broken and how can we fix it¨.  This approach is obviously intuitive and it is also quite correct.  In the global health economy, deficits (or withdrawls) contribute to a reduction in overall operational performance.  This approach is the most widely implemented and widely-considered...and one of the main reasons is that it fits within a system that is primarily affirmed by quantitative measurement.  For example, specific diagnoses are quantitatively distributed, pharmaceutical dosage, angular range of motion to establish ¨good¨from ¨bad¨, etc...

Investment into Health Assets: 
Although this is commonly considered in the true economic sense, within the mindset of healthcare it is essentially left out of the equation.  Health assets are effectively defined as the systems that are essential for the maintenance of human life...without which, nothing would be of any value at all.  To compare it with the deficit reduction model, this approach would manifest as the ¨what is working and how can we make it work better¨ perspective.  The difficulty behind this is that it is very difficult to measure! How do we establish better respiratory performance, more efficient digestive performance, increased lymphatic competence?  These salutogenetic targets are what are effectivey qualitatively measured!  There is no real need to establish a numeric value to them...rather to be able to identify that there is improvement.

Another familiar economic term is that of taxation.  Within this analogy, it is important to understand that any type of intervention (whether physical, chemical, hormonal, etc...) has a certain systemic / biomechanical tax associated with it.  To use the simplest example, if surgery is deemed as the most reliable intervention for a particular case, then the associated ¨tax¨ needs to enter in the equation...what are the risks involved in the surgery, how long is the rehabilitation time, what are the potential side-effects, etc..

Therefore within this mindset, we come to a fundamental question:  what is the strategy to the development of a growing and thriving health economy?  This is again an example of the counter-intuitive perspective of qualitative assessment:

-No matter how low or how little ¨assets¨ exist, it can always be developed and nourished.

The essential understanding should be that there are a number of factors that support health and a number of forces that are counter to health.  Illness, disability, stress, fatigue, fear, frustration...all of these are just examples of elements that contribute to overall muscualr tension, impaired tissue regenration, interupted fluid flow, etc....while improved fluid flow, achievement, relaxation, etc are all examples of forces that create a fertile environment for the development and nourishment of health assets.   What is the single characteristic that defines all of the salutogenetic factors?  They are all QUALITATIVELY MEASURED.

This overall framework partly explains why massage therapy is indicated for almost every pathology, condition, injury, or directly targets the salutogenetic factors and therefore facilitates incremental ¨deposits of heath assets¨ in to the global health economy.  

In summary, as the economy of our time shows, solutions and perspectives as to how to improve it are vast, diverse, and sometimes conflicting.  However, they all share a common thread in that the solution lies somewhere within a combination of strategic deficit reduction and asset building.  This type of rationale thought surprisingly gets lost when imported into the healthcare industry.  The very word ¨industry¨ suggests a self-perpetuating cycle of product to service specific diseases.  The very humble and simply sophisticated suggestion of this post is to open the doors and broaden the perspective on the health economy to include those strategies that provide direct deposits into even the smallest account.  As history has already shown over decades and centuries, consistent and incremental building of assets (no matter how small) help to service the long-term and sustainable economic health.