Monday, August 7, 2017

Broader strategies for rehabilitation in Cerebral Palsy


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".

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 "what is the best therapy for CP?"  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:

"It's not a question of WHAT is the best therapy, but WHEN is the best therapy." 

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:  How can one framework or strategy properly / adequately compensate for these rapid and (sometimes unpredictable) transformations?  The answer is that none of them can.  However...there ARE enough varied frameworks currently out there that fundamentally serve specific roles at different points 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.  

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. 

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: 

1. Structural Transformation / Change
2. Muscular Strengthening / Priming
3. Movement Stimulation

This in not an open-ended sequence, rather one that is cyclical and one that potentiates itself through each new cycle.  

Understanding this cyclical nature of development, it becomes formally "easier" to identify the most efficient and relevant therapy(ies) / strategy(ies) to implement.  

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 I am hoping to be able to share the fruits here soon! 


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