Walking and Cerebral Palsy: What evolution tells us...

This is certainly a topic of great discussion, debate, and concern...so it shouldn't be a surprise that I would eventually get down to writing something more specific about it. I would have done so sooner, but the reality is that it is such a complex subject...with multiple layers and considerations...that it was difficult to even decide on a worthy starting point in which to begin this dialogue.  However, I recently came across an interesting image that essentially served to crystallize some aspects to the point where I was comfortable to start my attempt at presenting my specific theory with respect to Cerebral Palsy (CP) and the ever-elusive goal of walking.

Again, given that this is such a complex biomechanical function, I can only present it in a somewhat "generic" fashion...that is, to present a broader perspective from which we can all then begin to plug in the holes and begin the process of further formulation and evaluation.  In my opinion, anything worthy of presentation should manifest some fact, extrapolation of fact, or theory that can be relatively easy to explain.  Let's see if it pans out!


Developmental Evolution

A potentially strange title that can lead to some confusion...but my intent is to simply point of that development and evolution are essential frameworks that hold fundamentals truths and realities that often go overlooked.  

Evolution itself is a construct that effectively states that we as humans evolved from the oceans, then to land, and essentially began our journey as quadrupedal beings...meaning we walked on all fours.  In fact, the interesting part is that we still maintain some aspects of this "early evolution" today...as babies and toddlers, we move on all fours.  This leads to the first fundamental reality:

Bipedal locomotion must first pass through the process of quadrupedal development.

The Pelvis

When we understand the process of quadruped-to-biped with respect to human locomotion, it makes sense to identify the specific characteristics that define (or differentiate) the quadruped versus the biped.  Although there are likely to be many, my theory revolves around 2 main considerations:  the pelvis and the spine.

We therefore come to a fundamental question: What is the difference between a quadruped pelvis and a biped pelvis?  The answer to this raises quite a few interesting points: 

1. The quadrupedal pelvis is proportionally alot smaller than a bipedal pelvis

This means that, in relation to the rest of the body, the pelvis occupies a smaller percentage of the entire body mass and frame.

Canine Skeleton

Feline Skeleton

If we take 2 examples of our most popular domesticated animals (dogs and cats) we are immediately struck with the fact that, although they are amazingly agile creatures, their pelvis is realtively small in comparison to the rest of their body.  In fact, it is almost comparable to the shoulder blade.  This shouldn't be too much of a shocker...afterall, their weight is designed to be transmitted through 4 limbs, so the shoulder blade and pelvis would naturally be of comparable size.  However, when we put it into the context of HUMAN development, this begs the question: Is it that the shoulder blade is that much bigger in proportion, or is it that the pelvis is that much smaller?   I think the answer is clearly skewed towards a small pelvis.

We can even extrapolate this theory even further to include our most genetically similar cousin, the primate.  The interesting thing about the primate (beyond the fact that it shares almost 90% of our genetic makeup) is that it is paradoxically considered as BOTH quadruped and biped.

Gorilla Skeleton

We can therefore safely assume that the primate is a reflection of the transition from quadruped to biped.  This is quite a luxury to be be able to examine this animal within this context.  When we have a look at the above image, we can identify that there is indeed a larger pelvis (in comparison to the rest of the body), but it remains somewhat smaller in comparison to our own representation within the human frame.  This is a strong indication that the transfer process from 4 limbs to 2, requires significantly more structural consideration with respect to the pelvis...in other words, its formal "architecture" needs to change.

To supplement all of the above images, the pelvis is also quite narrow...which completes a more 3-dimensional understanding of how the pelvis plays a role in the understanding of our evolution.


The Spine

Using all of the images previously posted above, the spine becomes the second area of focus.  What is it?

2. The quadruped spine manifests a single-curve.

If we look at the overall "layout" of the spine, it definitely represents what would be considered a primary curve within the human context...meaning that the lumbar and cervical spine do not manifest the secondary convex curve.  Perhaps more interesting is the observation of the larger pelvis in conjunction with the disappearance (reduction) of the length of the tail.  The tail is essentially an extension of the spine, therefore there is an inverse relationship...smaller tail, larger pelvis.  This can be attributed to the changes in center of gravity and equilibrium.


...So what in the world does all of this mean?

Let's have a look at how we humans play into this theory.  Take a look at the picture below...given the explicit observations mentioned in the previous sections, what do you notice?

Human Baby Skeleton

For the sake of formality, I will detail my specific observations:

In the earliest developmental stages, the human organism manifests a singular curve of the spine and a pelvis that is proportionally smaller to the rest of the body. 

Therefore, as developmental evolution dictates, the human organism is formally prepared for quadruped locomotion BEFORE entering into bipedal locomotion.   As the baby develops into a toddler, the pelvis will transform into a more substancial load-bearing structure (and therefore grow volumetrically and circumferentially) and the spine will begin its journey towards the characteristic secondary curves.  All of this will converge at the 10-14 month period when the toddler eventually begins to walk.  

Links to Cerebral Palsy 

The fundamental objective of this post is to tie this theory into some practical understanding of how CP is manifest and to hopefully provide some clarity on an otherwise overwhelming confusion.  The realities of CP play directly into this theory in some very straightforward ways: 

Cerebral Palsy falls under the umbrella of "developmental delay", therefore the early developmental phases (quapruped phase) persist well beyond the first year of life and can still be manifest into puberty.  We therefore are confronted with a confusing reality: chronological age is not congruous with developmental age.  This "mismatch" potentiates a possible deviation from developmental priorities and some potential misinterpretation of "progress".  

The expectation, if the individual is older than 2 years, is that they should be walking and therefore a large proportion of strategic planning (and expectation) is skewed towards verticalization, casting, and cosmetic "straightness".  However, if the developmental manifestation remains that of a quadruped, then bipedal locomotion is not only unrealistic, but also counterproductive.  In other words, if the pelvis in relation to the rest of the body remains small and the spine persists in a singular curve (or even straight), then developmental evolution dictates that ANY load-bearing strategy should be oriented towards quaprupedal equilibrium / stability / locomotion.

The truth about walking and CP is that it formally has nothing to do with the legs...which is paradoxical! 

The pelvis is the essential architectural weight-bearing structure that needs to be in place if any realistic expectations are to be considered.  Further, it has been long studied and determined (largey by the works of Gracovetsky) that movement is derived from the spinal "engine"... meaning that the spine is functionally the genesis for all motion and that the legs simply "magnify or amplify" that motion.  

Links to Practical Rehabilitation Strategy

There are countless "ideal" strategies populating the landscape, however if you apply these fundamentals of evolution, you will be left with some tangible frameworks to derive an appropriate and effective strategy: 

1. Promote systemic development and function

Any mechanical performance depends on effective absorption and utilization of all systemic assets (nutrition, oxygen, blood, etc...) therefore promotion of the respiratory, digestive, immune, and circulatory systems will contribute exponentially. 

2. Implement strategies that help to potentiate pelvic health and integrity

3. Reduce / avoid any unnecessary load-bearing or verticalization 

The notion that simple vertical positioning will resolve the issue is formally simplistic when placed against the evolutionary litmus test. 

4. Always refer to developmental milestones as a blueprint for priorities.

Development in the human organism always follows the same sequence...meaning that development from basic postural performance to more complex movements has a very explicit order.  This order is not revolutionary, nor is it some unknown "secret"...it is the gradual progression from simple horizontal exposure to gravity straight through to a completely vertical position.  This sequence can readily be found and searched as "developmental milestones".  

As always, these rants tends to evolve into "mini-novels", but the hope and expectation is to shed some light and to tie in some well understood realities...not to attempt to generate full understanding, but more importantly to provide some basic idea of "direction".  

Cheers!

Fundamentals of the Fascia Therapy concept

This post serves to further enhance the broader outline of The Fascia Therapy Theorem by expanding the fundamentals of the critical initial stages of treatment and rehabilitation.  Although the concept itself is relatively comprehensive, the overwhelming reality is that even though specific treatment strategies will ultimately differ form person to person...but each of them must follow certain laws of human development at the inception.

The essential fundamentals of the FT concept follows these laws and therefore reflect efficient treatment responses as well more reliable treatment strategies.


1. Systemic Homeostasis:

This is the fundamental starting point for all of the FT treatment strategies.  It is characterized by specific and focused efforts to stabilize and potentiate the essential physiological oscillators of the body (respiration, digestion, circulation, lymphatic drainage).  Every efficient and successful biomechanical strategy must first secure a working systemic homeostasis in order to meet the requirements of more advanced movement.  This means that systemic function must be sufficiently adaptive, irritable (responds to stimulus), and interconnected (inter-system communication). 

2. Structural Integrity:

This stage generally appears soon after (or at the same time) and the development of systemic homeostasis.  It is characterized by purposeful development of basic postural skills and the potentiation of efficient closed-chain activities.  This involves many stages, but always begins with the development of passive hydraulic strength of the trunk (passive postural competence).

3. Psychomotor Development:

This phase typically manifests once a critical mass of systemic and structural integrity have been achieved.  Further, it is the fundamental link to the development of productive movement skills.  The development of healthy structure is also a key component, however structural integrity is merely a cosmetic benefit unless there is a specific strategy in place to activate and potentiate movement abilities.

 
The above chart effectively outlines the basic framework that is followed.  It begins with essential exposure to sensory input and the use of guided techniques that impose gradual stimulii in an effort to stimulate intrinsic response and development.  For example, basic motor  development essentially starts in a supine position (facing up) and progresses via small oscillations (rolls) from side to side.  This type of movement is a precursor to the eventual objective of independant rolling.

Although the process follows multiple steps and is quite complex, the overall framework serves as a helpful guide to effective and efficient practice and implementation.  From perception based interventions, to transfers, to the process of trial and error and so on...psychomotor development is an essential component to the transition to productive function.


4. Active Potentiation and Integration:

This stage can involve interventions that are outside of the rehabilitatiove domain.  It is the strategic integration of all of the fundamental parameters to healthy life and living (Social, Cognitive, Physical).

The physical (structural and systemic) and psychomotor strategies generally remain in place, although sometimes reduced to a more "maintenance oriented" role, while the integration of Cognitive and Affective development strategies take a more prominent role.  These are generally manifested well within the occupational therapist role, teachers, home care, and even parents themselves.  In essence, the physical development and competence give rise to more potential success within the cognitive and affective metrics.


It is important to note that during this entire process, it is VITAL that a comprehensive nutritional regimen be formulated.  People generally associate nutritional regimens with "aggresive, military, unrealistic" formulas...but this is simply a misguided perception manifested by our fitness crazed society.  Nutritional regimens are characterized by comprensive evaluation of nutritional and dietary requirements for each individual case...tailored to contribute to the specific objectives of the rehabilitation strategy.  The development process requires energy...it requires fuel in order to potentiate growth and also to resist failure or illness.  In addition, it isn't simply WHAT is being consumed but also HOW it is being absorbed.  Dysfunctional digestive function affects nutrient absorption and therefore disrupts proper metabolism...respiratory irregularities contribute to higher cardiac activity and therefore can negatively impact thermoregulation.  Nutrition plays and essential role in facilitating smooth and peaceful transition throughout the entire process.

There is considerably more "guts" to the concept itself...but I am hopeful that this (along with the philosophical explanation of the Fascia Therapy Theorem --- link at the beginning of the post) will give some helpful answers to the question of "what is Fascia Therapy?" 

Cheers! 

New name, new location, same good stuff...

Just a little update and (relatively small) newsflash. 

I have changed the name of this blog so that it becomes more organic to the webpage launch of my concept called Fascia Therapy.  The FT concept has been evolving over the last year and is now ready to move into its own "virtual home" on the internet...therefore I will be providing a direct link to the blog from the website itself. 

I would consider this an "evolution" as opposed to a change, per se.  The random rants, occassional tangents, and (hopefully) informative material still comes from the same brain and will ultimately appear and manifest the same tone and overall perspective.  If anything else, this evolution will facilitate more perspectives and even more potential contribution from a more diverse group of professionals...which will ultimately result in an even broader diversification of knowledge. 

Cheers!
-GB-

Professional Profiles: Kenny Spracklin B.Sc., CAT(C), CSCS

I suppose it is only fitting to have good friend and fellow health / rehab enthusiast Kenny Spracklin as the subject the blogs first expert professional profile.  The mandate of these profiles is not only to present like-minded perspectives and approaches, but also to enhance the scope of knowledge and understanding by putting forth diverse experiences and opinions from a variety of professionals from varied fields of practice.


Not only are Kenny's experiences amazing and insightful, they are without question informative and valuable.  "Professionalism" is an intuitive concept, but in reality it is a very complex process that fundamentally never stops evolving.  Hold on to your hats...here comes my Q&A with expert therapist and trainer, Kenny Spracklin.

1.       Tell us a bit about yourself, your professional career and how you came to where you are now.

I come from a very active and competitive sport background. I have been playing and involved with sport since I was a toddler following my dad around the arenas. I studied at Concordia University in the AT program and had great instructors that inspired me to challenge the profession and myself to help define what therapy and training really are. I was encouraged early on in my studies to look outside the box from time to time and question everything. I have never looked back since. I remain friends with some of these instructors that have influenced me and allowed me this freedom to learn and push the envelope to this day. Today, I am happy to say that I am among some of the top in the field at what I do and have recently helped Team Canada win some Olympic medals in different disciplines at the Games in Sochi, Russia. It’s very rewarding to see an athlete you’ve been helping for years achieve what they have set out for as a life-long goal. 

2.       What (or who) have been your greatest motivators / inspiration (if any) with respect to your career path?

I have quite a few influences in my life. I’ve always been pretty internally motivated, so I haven’t really needed anyone for this matter, but I have been inspired by many people. These inspirations range from my dad being a single parent who raised myself and my younger brother at such a young age himself, to teachers that I’ve had, to actual athletes I’ve worked with and their relatives. (For example; a good friend of mine and athlete I feel privileged to help has inspired me through his story countless times…I still get goose-bumps when I watch him and his brother together)

My grandmother was probably the most influential person in my life though. She was a key part to my road to success so far in life. She would tell me this on a regular basis “Don’t put off ‘til tomorrow what you can do today”…this has stuck with me my entire life and I can still visualize her saying it to me when I stray away from my tasks. She believed that we were all here to help as many people as we could…and that’s essentially what I’m trying to do with my life.  

       3.  How do you put these experiences / motivations / inspirations into practice at work?

 Putting one’s self in a position where you can literally take on any opportunity that comes your way is a skill that I’ve developed over the years and continue to work on. Nothing beats hard work and determination!!! Putting yourself in the right place at the right time, is not as easy as it sounds. You need to be willing to work harder than everyone else is willing to work. I pride myself in having an extremely devoted work ethic. I was lucky to have been brought up without much and we struggled with our means growing up; but I am truly appreciative everyday for having gone through this because it allowed me to know just how much I can endure to get what I want in life. The true secret to life…Hard Work!!!

   4.       You interact with quite a lot of people from different walks of life, sports, disciplines…what are the commonalities between them and what makes them each unique?  

I am very fortunate to interact with people from all over the world form very different backgrounds, and although there are vast differences among them culturally… there’s one thing I have noticed as recurring content…curiosity! For example, when I went to Nepal and India, the first questions that I would get were about where I was from and asking how cold Canada was and if I lived in an igloo, lol. We are all so curious about what happens in other cultures, lifestyles, etc…that regardless of where we live and what we do, we always wonder what it is like to “be” someone else in another place…even if it’s just for a moment. I love interacting with people from anywhere; I was blessed, or cursed depending on how you look at it, with the gift of gab that stems from my grandfather, haha. I can go up to any random person and start having full conversations and begin a friendship just like that. I am a very curious person myself and I want to experience as much as possible. I love sharing stories with people who’ve lived the unique experiences! I feel this is a very similar commonality throughout the world. 

      

     5.       In the field of physical rehabilitation, the issue of professional ethics is quite well understood but paradoxically overlooked in a lot of cases.  What is your personal / professional perspective on ethics and the workplace?

This is a tough question to answer in a sense that with the social media access these days, privacy is somewhat limited as well. Things get blown out of context, words get skewed, and people’s lives can get invaded which affects their careers. Ethics in the workplace should be a very tight held confidentiality spectrum…yet we see it from time to time where a player’s MRI report comes out or concussion report…etc. All these things have the media on a field day which could very well affect the athlete or patient and his/her well-being.

There are also clinics that I have worked in or visited that the ethics practiced by it’s members or clients has been very professional without any boundary overlooked. Unfortunately, this is not always the case. I personally shy away from the negative surroundings, simply because the nothing good can ultimately come from it. 

 

      6.       Your recent trip to Sochi for the winter Olympics gave you a unique look into one of the most intense sporting events on the globe.  What was the biggest surprise and what was the biggest disappointment (if any). 

The Sochi Olympic games was an amazing career and personal highlight for me! Being an athlete turned therapist/performance specialist, I had to holster my excitement until my athletes were done competing, hahaha. The atmosphere at the games were unreal. The biggest (not necessarily surprise) highlight was watching the athletes I work with cross the finish line as winners and then accepting their medals!!! Pure uncontrolled joy in these moments!!! All the sacrifice over the years spent in the gym, on the treatment table, in the planes, on the courses, hotels rooms, awful food….all worth it!!! Getting to hug an athlete you’ve been working with for years at the bottom of the course when they’ve won a medal…the feeling was out of this world!!!

I didn’t really have any disappointments to be honest. Russia did an extremely great job at hosting the event in my opinion. The hospitality was great and accommodations were all fine. The weather conditions were subject to many arguments, but were not in anyone’s control. 

7.       Some of your accomplishments are quite impressive.  Cycling across Canada, climbing Mount Everest, going to the Winter Olympics to name a few.  How would you rank the top 3 experiences in your life and what was the most challenging about each of them?

Top three….eeeesh!!!

I live life to the fullest and try to experience everything, so I have hundreds of challenges and adventures that I have done that all mean something different to me. This is an extremely tough question to rank my top three, but here it goes, haha.

3. Australian adventure. 

- My trip to Oz was amazing. I am a certified skydiver and deep water wreck diver, so I traveled along the eastern coast line to explore everything from sunken ship wrecks to the marine life along the Great Barrier Reef. When I wasn’t jumping out of planes or scuba diving, I was waiting for the perfect wave on my surf board. I went out there to work for a few weeks with some athletes and simply extended my stay a couple months. Many other mini adventures like learning to sail a catamaran in the Whitsundays and shark diving without a cage were some of my other amazing challenges I did out there that taught me more about my internal patience.

2. Climbing Mt. Everest

- Besides the major culture adjustment, the challenges I faced on Everest are way too complicated to explain in just a few sentences. The expedition will always be significant to me in many ways. The journey will be something that I remember and cherish forever…even the “near death” close calls.

1. Being A Traveling Professional                                                                                           
 - As a professional that travels with athletes all over the world, I get to see things form different perspectives. I feel blessed to be able to do what I love to do at the highest level and see the world at the same time. There are lots of challenges when it comes to traveling with athletes and treating/training on the road, but being able to expose myself to countless new environments and methods of adapting to my surroundings  makes me a much better professional. I am never really in a comfort zone and because if this I always have to stay on edge and at the top of my game to help all my athletes perform at their very best. I have literally tapped two ski bags together to use as weights when I didn’t have a gym to bring the athletes to…there are no rules, only concepts.

Notable mentions:

- Cycling Across Canada was my first big trip and set the bench mark for all my other adventures and guidelines to where I know how much to push myself.

- Surf trips in different locations around the world.  

- Olympics in Sochi/Watching my professional athletes play live.

 

8.       As an active professional working at the highest levels of physical competence, what would you say to those who are seeking similar career / life experiences.  

If you’re doing this for the money…pick another career, hahaha.

If you think that you can simply take some courses and finish your degree and get right into working with the pros…think again, lol… If you aren’t ready for the real grind of getting your “hands dirty” and years of sleepless nights without money coming in and low budget facilities and/or equipment to work with…it may not be for you. However, if you are willing to put in all the work and are truly genuine about what you are doing…there really is no limit to where you can go. Enjoy the ride!

Kenny Spracklin BSc, CATC, CSCS

Head of Athlete Development

Facebook: https://www.facebook.com/kennyspracklinpro

Instagram: @kennyspracklin

Twitter: @kennyspracklin

http://kennyspracklin.com/

As promised, a very insightful gathering of experience and information. Be sure to connect with Kenny and keep up with ever evolving exploits and to plug into his vast hardrive of knowledge! 

Cheers!