On ABR and beyond...

Hip Subluxation in Quadriplegic Cerebral Palsy_Part 7_How the femur head gets in

This post continues our explorations into the matters of hip subluxation in Cerebral Palsy.

I labeled it as Part 7 – but it might have as well been "The Part 1" since it addresses the issues that puzzle you the most.

"How will the leg bone get in if the "pelvic roof" is flat? " … In more appropriate terms it sounds: "How does the femur head find stability under the flattened acetabulum of the pelvis in cases of severe quadriplegic Cerebral Palsy?" – these are the questions that I receive probably most often.

In this video I give the entire context and reference the development of the pelvis in a healthy child through the transitional phases that it goes through.

The key message is straightforward – "it's not about the roof – it's about the wedging of the pelvic width by the triangle of sacrum". In this video you are going to find really clear illustrations on how it all works.

 

In case there are problems with imbedded video -- please follow the direct link:

Hip Subluxation in Quadriplegic Cerebral Palsy_Part 7_How the femur head gets in

 http://vimeo.com/38842795

As always, I invite you to ask questions , leave comments and click likes to share with your friends. Don't hesitate – speak out! Was it helpful? Have I managed to ease your worries? What image did you have in your "mind's eye" before and has it changed after watching this video?

I am very grateful to a mother of this boy who sent me her elaborate questions and encouraged the making of this video as well as agreeing to share it with the other parents-- probably she's  going to appreciate your feedback as well.

Thanks a lot.

 

9 Valuable Lessons for Cerebral Palsy out of a Single Incident of a Broken Leg

This post might seem as a departure from matters of Cerebral Palsy – but it is definitely – not.

On opposite, I hope that you can see this as the opportunity to understand the fundamentals of rehabilitation domain much better once you have the exposure to the other side of the spectrum – how the surgery and physical therapy handle ‘regular’ fractured bones.

It is really important for you to keep in mind that – all the concepts, diagnostic criteria, best practices and tools of both orthopedic surgery and physical rehabilitation were forged and tested in the field of dealing with fractures, bone and joint displacements, muscle tears etc.

For instance I mentioned a number of times before – that deeply ingrained belief of physical therapy in the benefits of stretching and in the ability of a therapist to restore the proper mobility via stretching – stems from the practices of dealing with muscle contractures that follow the immobilization.

That’s where stretching works the best and every experienced physical therapist has an entire collection of ‘victories’ over contractures behind his or her belt. They witnessed with their own eyes how a severely restricted leg mobility consistently gets improved via stretching until full recovery within weeks.

That’s the experience and the expectation they transfer into the Cerebral Palsy field including quadriplegic Cerebral Palsy. What happens then? – First, they see some 10-15-20% of range increase – they celebrate it and reinforce their believe in being on the right course. Second, when the range increase comes to a halt – they start blaming it on the spasticity and brain injury.

Therefore, when a friend of my son had his lower leg bones fractured in the go-cart accident – I waited for few weeks until he got out of pains and decided to seize this opportunity to illustrate the essential differences between the orthopedic handling, physical therapy, rehabilitation and  recovery of a healthy person after a typical injury to a musculoskeletal system – in contrast to the most important specifics of the challenges experienced by Cerebral Palsy kids especially in quadriplegic condition.

I hope that you are going to find this being a valuable perspective that will improve your understanding of the priorities for your own child and have a clearer focus of where you need to put the most of your efforts.

P.S. As always – please let me know what you think and whether this perspective is helpful. Don’t forget the ‘Like’ button as well.

Cerebral Palsy – reverse or re-arrange?

Writing for this blog always puts me in a real dilemma – on the one hand, there are lots of things I really want to share with you because I believe that you are missing so much of important knowledge about Cerebral Palsy and on rights and wrongs in dealing with it; but on the other hand –I have to switch on the internal censor and ask a simple question: “With what I am eager to share –am I going to help and improve clarity for the families or is it going to add to the information overload?”

In other words – by pouring down all that information on you – am I doing you a service by giving clarity and making your life easier or am I doing you a disservice by adding to overwhelm and exposing you to more concerns and worries?

These internal dilemmas really bugged me  for the things that I have been busy with for the last couple of months. In the preparations to BioTensegrity meeting that took place in Munich few weeks ago – I made a dive into the engineering books on Tensegrity and the original works of Buckminster Fuller (the famous engineer-architect who coined the term “Tensegrity”) and found myself at awe with the depth of his insight… It is really amazing for the person who never really came close to the human body in any tangible sense to have so many remarkable foresights that really  lay a perfect framework for the correct interpretation of the Fascia Man…

The Bio-Tensegrity perspective alone is enough to come up with hours and hours of exciting stuff – of how it all ties in and gives a much deeper understanding of Cerebral Palsy and stages of progress and transformation… but then again? – Do you really have time and sufficient interest for all that? …  

I must admit that this weighing of the pros and contras turned out into the period of the relatively prolonged silence – it’s 2 months since I made the last post in this blog… So after a lot of such internal discussions – I decided to curb my enthusiasm for all things new and to try to focus on the ideas with greatest “de-clogging” value.

So I am going to try to stick to the more earthly matters and self-censor along the lines of what I think matters the most to you and how I can help you in reducing the information overload rather than adding to it...

I can’t promise that the text is going to be simple – but it is definitely going to be de-clogging: if you work your way through this – then you are really going to know what is your starting point in the quest of maximizing your child’s developmental potential.

So here it is –the question that has absolutely the greatest value and that defines the choice of a path: Cerebral Palsy – reverse or re-arrange?  

This question is so essential that it deserves some extra clarification.

“Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces”

“Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces”

Introduction of the tactical information into our communication.

After some intro of a larger scale concepts – such as the key division of all therapies of Cerebral Palsy into the clusters it is time to get more tactical and tackle the smaller issues.

Paradoxically enough, I reckon that these smaller “day-to-day” things are what you are looking for – a lot more eagerly than for a larger scale concepts.

I say paradoxical because obviously everything “day-to-day” tactical – like the subject of today’s post – “Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces” – are entirely defined by what the root concepts  are. So if the concepts – seemingly abstract and removed far from everyday practice – are flawed then the flaw passes down all the way to the tactical everyday decisions, getting worse with every step. And the opposite is true – the new methods can only be considered truly new when they bring different claims at the level of concepts. Otherwise – the new method are just a different remix of the same old song.

The knowledge descent hierarchy is  well-known and goes like this:

• Concepts  (defines the field, the  fundamental criteria for defining directions)– descend into
• Principles (Why thing Work one way or another – introducing the idea of “wrong” and “right”) – descend into
• Processes (how to make it work the “right”) – descend into
• Procedures (exact implementation – what model of a splint to use and how to put it on and how  long to wear).

Fact is – in your experience you are used to the fact that the PTs and OTs always talk to you at the level of ‘Procedures’. Rarely they bother to present a mini explanation dumbed-down from the “Process” level – and when it comes to Principles – their reply is one and only “Brain injury is at fault”.

This is the typical style of interaction of the Pros (Professionals) to the Amateurs – crumbs of information: “Just do as you are told”…

Well, another fact is that most of the local level therapists that you face in your school and treatments encounters where you live–  are the ones that have very vague idea of Principles – they covered a couple of textbooks on those Principles during their  studies – but all that is a long gone history. They are the Process people.

The key feature of the process people is expediting obedience – they are the Sergeants and you are the grunts. Why do you have to do certain things with your kids? – Because he/she, the Sergeant told you so. Why? – Don’t ask – just do what you are told. The Officer (who are supposed to be in touch with the “Principles”) knows and that is enough.

I think that you have noticed that very often when you try to move out of this mold – and start questioning what the therapists – especially the ones who practice in schools – do to your child… they  become really irritated and often quite nasty and vicious.  

Don’t be surprised – medical system is modeled  after the army (in fact the current roles were carved into it during the war times ) – imagine what happens in the army if the ‘grunt’ (rookie soldier of the lowest rank) starts asking questions that go to the Officer level?! Chaos and disorder! – That can’t be tolerated by Sergeants – that’s their job description to handle the grunts and to let the Officers  be free of menial tasks.

You equally shouldn’t be surprised when you find out that a Doctor is often no different  – that’s the Officer who has been so used to copy-paste  quotes from textbooks that he grew into those quotes as dogmas without ever asking deeper “Why” question that belongs to level of Concepts.

Ask any doctor – does he see any flaws with the way the Cobb angle represents scoliosis  and whether the concept of “scoliosis” accurately represents the 3D deformity of the child’s spine? Ask a doctor – does he see any problems with  the way that so-called “hip subluxation” represents the 3D deformity of the pelvis? – He’ll be puzzled and outraged at the same time.

Puzzled – because he never thinks that way – his reasoning ends with the labels “scoliosis” & “hip subluxation” – he never ever questioned the way these labels came to being.

But even more likely he wouldn’t even get to the point of being puzzled – because he is going to be outranged – how could a person with no official qualifications, a grunt – you – dare to question the engraved “Principles”…

What I am trying to do when communicating with you  – is to talk to you at the level of ‘Concepts’ – the really big questions that precede the definition of the “wrong” and “right” by setting the reference system.  

So effectively I am elevating our conversation to the  level of a “General”. Well – often you might feel somewhat lost – because for your entire “service” of being the parent of a child with special needs – you’ve been dealing with Sergeants in a status of a lowly grunt.

Why do I feel that is really important to talk directly to you at the ‘Concepts’ level? – 2 main reasons:

a) I see you as a primary guardian of your child and a primary therapist – so for me you are colleague of an equal statute – a key person. I assume the role of your mentor – but I am definitely not a Sergeant or an Officer.

b) The existent system is logical. It is flawed at the level of the Concepts – if you try to change it at the level of Procedure or Processes or even Principles – things are consistent from one level to another. Wrong principles define the horrid and inefficient Procedures.

But the change has to start all the way from the very origin – the Concepts

But at the same time I understand that often times you might find difficult to see how new Concepts (what I share with you)  relate to the outdated Procedures (realities of your everyday interactions with Sergeants)  and what do you actually need to do in the situations when you are under pressure.

So, I think that the best course of action for me is to do the mix – I will continue share the new Concepts related to Cerebral Palsy with you – but I will also start doing more of the “Response to Outdated Procedure” level explanations.

Probably it is going to take a certain time for me to find the right format – but I am looking forwards for your replies:

a) Am I reading the social dynamics of your everyday situation correctly;

b) How accessible are my Tactical level explanations – what you’d want to get explained – Clearer? Simpler? Broader?

 

Therapies for cerebral palsy- the clusters approach. ABR Workshop at Pac Rim Video Part 1.

Well, dear friends,  the summer is almost over – and it is time to get back to the ABR matters.

I didn’t bug you during the last few weeks with ABR-related food for thought – as parents you deserve some vacation as much as your kids… without me bugging you with large chunks of information to process.

Historically ABR calendar follows the division into the academic/ shool years rather than the calendar ones – so I guess I need to congratulate you with the beginning of the new school year.

More studies are coming your way!... I hope that makes you excited rather than grumpy… :-)

Mind-Blowing Freaking Miracle... Pelvis Transformation in Quadriplegic Cerebral Palsy

Usually I am quite reserved in progress descriptions that kids achieve with ABR – trying to avoid the hype and over-expectations. Typically I am more keen on outlining the specifics of the challenges that lie ahead rather than celebrating the achievements already made. And often enough parents find this style not the most motivating … but that’s the way I see the world:  whatever has been achieved as of today is already part of the past – so, let’s try to focus on the next step forwards…

By telling you this I just want to draw a bit of extra attention to what I am about to share with you today… because this time it is different… and even I cannot contain emotions … because it is indeed – a mind-blowing freaking  unbelievable miracle!

Well, I hope that I have your attention now :-)

… and probably you think that I am going to demonstrate a quadriplegic  child who miraculously went from horizontal incapacitation to running around and jumping on a single leg? – Sorry, not this time…

This type of stuff – “a developmental airlift “, or a “developmental helicopter ride”, that allows to skip phases of development – is cut of heavenly cloth. I am much more earth-bound.

Nonetheless the transformation that I am about to share with you counts on a scale of miracle as long as we stay earth-bound and realistic.

What I am going to demonstrate is an exceptionally rapid structural transformation of a classic distorted and merged quadriplegic pelvis following the “egg” work…

Let’s proceed to the video to have the entire case well illustrated…

I hope that I have managed to get you excited enough to sit through a 35 minute video…

First I wanted to charge straight through to the comparison of before and after – but afterwards decided that it is going to be of greater educational value for you to have it done in 3 parts:

• Normal pelvis structure and X-ray
• Typical pelvis of a child with quadriplegic Cerebral Palsy that ends up under the knife of an orthopedic surgeon with a massive intervention (bone cutting, metal screws insertion etc.)
• The “mind blowing freaking miracle” – amazing transformation of the pelvic structure in a severe spastic quadriplegic child following the “egg” rolling work delivered by the ABR superstar man – Alexander “The Great “from Greece :-)

And all that leads to a not so subtle hint – your child’s future is in YOUR HANDS – but these hands have to be skillful to extract the full potential that ABR work has for your child… – so you need to study and practice and pay attention to detail without rushing to “I got it –can I go home earlier?”

 

P.S. I am going to add a couple of final episodes to the previous video – “Cerebral Palsy and fascia science in a tea cup” – and I hope are going to appreciate the connection that my tea cup simple example of the relationship between a dense film-like membrane and porous underlying gel has with the specifics of skeletal transformations in Cerebral Palsy pelvis…

 

P.P.S. Comments and likes are most appreciated.

 

Fascia and Cerebral Palsy science in a tea cup

This is a mini-post that illustrates that sometimes valuable insights into the fundamentals of what’s happening to fascia and musculoskeletal structures as a result of challenges associated with cerebral palsy could be gained from most mundane everyday experience – from observations of what’s happening in a tea cup –literally…

Anyone who had a training by me knows that: 1) I am a tea fan; 2) that I have a tendency to leave cups with unfinished tea everywhere opting for the new cup of a fresh tea instead..

Well, I’ve been criticized for this untidy habit more time that I can remember – to no avail I must admit… However, sometimes there are some unforeseen bonuses that come out of it…

For the recent weeks I’ve been thinking a lot of how to visualize for parents the effects of fascia layers adhesion in case where the flow of the interstitial fluid is affected and how we can restore their proper division by means of  Thermoplastic elastomers (TPE) as the Force Transfer Medium [well that’s the official title of “egg rolling” :-)]

So couple of days ago I looked at one of my cups with the tea leftovers from a previous day … and found and excellent illustration ..

I hope you are going to find that metaphor/ spatial homology useful and insightful

 

 Thanks …

As usual Facebook likes and comments are most appreciated

Hip Subluxation in Cerebral Palsy-Video 5-Specifics

I guess it is more than a time to proceed from general reviews of hip subluxation in Cerebral palsy videos to the specifics.

 

Video 5 turned out to be quite long -- so I divided it in 2 parts -- but eventually decided to add a summary as well -- that's Part 3.

In these videos I actually go point by point over the original questions, observations and concerns that were voiced in the original 6 min video by Emma's mom.

So even though the videos are quite long I think they are not too difficult to watch since any single topic is covered within a  few minutes max. I hope that in these videos I've managed to illustrate how the concepts introduced in the earlier videos blend together and provide a relatively straightforward framework for analysis of an individual case.

Of course, in an individual case of your child there could be some variations of the angles or of the dominant directions of legs mobility response -- however, the essence always remains the same: One needs to use a transanatomical framework to understand the full scope of transition.

I think that the main practical takeaway from these videos is the idea of evaluating your child's evolution through the chart that takes into account multiple aspects of the evolution in the pelvic region and within lower extremities-- including the percentage measurement of femur head alignment  in respect to the acetabulum but seeing it only as a single entry in a much larger matrix of changes.

I hope this helps.

I feel that these video series on hip subluxation in cerebral palsy give a comprehensive coverage of the subject -- to the point that "there shouldn't be any questions left"...  However, being realistic I am sure there are further questions and I am  looking forwards for receiving them -- because from my perspective of a broad "umbrella" I might be overlooking some of the very specific concerns that you might have.

As the final word for these series I want to express my gratitude to Team Emma for their willingness to go beyond "privacy" and to embrace a collective good for all the parents in a similar situation by making these video series possible. I think that some expression of your appreciation in the comments to this post will be much appreciated by Emma's parents.

P.S. Please do not forget to press Facebook 'Like' button --so more people can benefit from getting a little bit of rational outlook influx towards this emotionally charged issue of hip subluxation.

Cheers...

P.P.S. Do not forget that the best way is to actually to click on the 'ABR on Vimeo' link above -- and then you can actually download this and other videos from Vimeo website. Then you do not need to deal with streaming delays and play interruptions 'that some of you mentioned before

Video 4. Hip Subluxation -Why So Much Attention?--The Truths and the Myths

It's time for the video # 4..

As I mentioned in the overview I tried to cover some of the most wide-spread worries and concerns addressing them with as much of a bird's eye view as possible.

Unfortunately, too often there is so much hysteria being pumped up about the hip subluxation issue by orthopedic profession -- that at some point one might get absolutely swirled by all the pressure and scare-mongering.

I hope the video 4. "Hip Subluxation- Why So Much attention? -- The truths and the myths" is going to help you to get out of being scared mode and panicked cries for help -- and towards being able to approach this complex issue rationally and consciously.

 

I assure you that you have all the necessary intellectual capacity and background to be able to figure out the truths from the myths -- all you need is a bit of help.

I hope these videos will bring you closer to this state of having a clear and rational understanding of what's going on with your child and become confident of your own capacity to deal with challenges should they come your way.

In the previous post I already mentioned that it was difficult to keep this video short -- I couldn't keep myself on the rails all the time and took several tangential educational detours as well.

Hope you do not mind.

So frankly -- I do not know which video is better -- so I put both on. Your feedback is most appreciated and is going to help me to do better videos for you in the future.

Well, that's pretty much it...

P.S. Please do not forget to press Facebook 'Like' button --so more people can benefit from getting a little bit of rational outlook influx towards this emotionally charged issue of hip subluxation.

Cheers...

P.P.S. Do not forget that the best way is to actually to click on the 'ABR on Vimeo' link above -- and then you can actually download this and other videos from Vimeo website. Then you do not need to deal with streaming delays and play interruptions 'that some of you mentioned before

Hip Subluxation in Cerebral Palsy Video Series Overview

What is the best way to defuse fear and confusion that you are constantly being exposed to by medical establishment? – Knowledge.
To be precise – not any knowledge but parent-centered advanced knowledge.
I feel it is important to distinguish parent-centered advanced knowledge from a diluted and dumbed down versions of medical textbooks that you find on ‘official’ websites on Cerebral Palsy.

Hip Subluxation Video Series intend to do exactly that –give you a comprehensive perspective on the subject that is exploited most often by fear-mongers.

I have prepared 8 videos – each of them at least 30 minutes long covering a subject of hip subluxation extensively, digging deep and going broad in order to build it into the entire context of your CP child’s development – especially for quadriplegic kids.

Yes, it’s a lot of information and yes, you need to do your homework encouraging yourself on making an effort to absorb and digest it. However, considering all the emotional and financial costs that fear and confusion around hip subluxation and other ‘scary’ issues related to legs alignment and mobility impose on you – I think this homework is going to be a worthy investment of your time.