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, complex problems require complex solutions.
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:
"The human organism is perhaps the most elegant manifestation of organic connectivity known to science."
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.
The Economy of Health
Indeed, there is a big difference between the economy (as we understand it) and a biological system...however the actual interaction, irritability, volatility, inter/intra-dependence, and connectivity are surprisingly comparable. Further, almost everyone intrinsically understands the general premise of "deficit and surplus"...or "asset and liability"...and most certainly "TAXATION".
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.
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:
1. "Natural Resources" are low. Respiration is altered and therefore oxygen / oxygenation is functioning at levels that do not support a growing organism
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.
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 recognize, diagnose, and adapt to stimulus is critical...and when overall "economic health assets" are low, this becomes more and more difficult.
4. For every systemic and/or biomechanical process (whether voluntary or involuntary), there is a heavy systemic and biomechanical "TAX" 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 "how much of a biomechanical tax are we willing to pay by working on balance and proprioception?" The reverse calculus can also be part of the larger equation..."how much proprioception and balance work will be loosing if we focus on architectural integrity?" Although different practical questions, they are both considerations with a larger, complex, and interconnected system.
In summary, I do not claim that a simple analogy will make the actual job of strategic planning less difficult...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 how the bigger picture is laid out...and how it is more than a simple "sum of parts".
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 process of deceleration, control, and gradual "U-turn"...but it can be done.
Last take-away:
"Save all of your 'systemic and biomechanical pennies'...guard them and deposit them. Every cent counts. It isn't simply a case of reducing your deficits...but a focused effort on growing your assets as well."
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