On ABR and beyond...

Cerebral Palsy – Giving a Boot To Neurological Dogmas. Part 1

In many countries New Year is the time when people throw away everything old and useless that accumulated in a house with the idea of having a fresh start and letting the new things in.

I admire the tradition and decided to follow suite – the first post of 2011 is about flushing  down the drain the outdated neurological dogmas that paralyze and lead astray professionals and parents of kids with Cerebral Palsy alike.  

Disclaimer – big and bold: everything you are going to read is my own extremely biased opinion that is most unlikely to be supported by qualified medical professionals.

I’d actually go even further and say this – to leave no doubts about my extreme biasness:

In my opinion, “brain-based” approach to Cerebral Palsy that treats ‘brain injury’, i.e. damage to a part of the brain,  and ‘Cerebral Palsy’ – disorder of posture and movement/failure in reaching biomechanical developmental milestones -- as the interchangeable synonyms – is the most important obstacle that stifles the progress of physical rehabilitation and freezes current abysmal status quo.

In other words, a neurological paradigm is: a blindfold over your eyes; sticky glue, quicksand and rocky terrain underneath your feet; iron gloves over your hands; plugs in your years and shackles around your feet  – all of these in a single nasty package… So you are welcome to figure your chances of success if you are  ever lured by

In Part 2, I am going to go over 16 most obvious reasons why neurology leads you astray and why the guidance by neurologists who define the discourse of today’s interpretation and approach to Cerebral Palsy is the worst and most unproductive thing that is responsible for astonishing lack of progress in Cerebral Palsy therapies over the last 100 years.

I’ve been thinking about these flaws for years and collected quite a pile – but in order to spare you from a nearly endless list – I gave myself a time line: I put the kitchen timer on 10 minutes and proceeded to write down as many stubs exposing the  fundamental flaws of neurology and brain-centered paradigm for Cerebral Palsy as possible.

By the moment  the timer went “Bzzz” – I was on reason # 16.

Well, If I were to give myself ½ hour – I’d  probably come up with a list that would have been three times as long– but I think even a basic version will do to begin with.

However, before proceeding to Part 2 – the actual list – I wanted to immerse you in the context of the case – I hope that’ll give you an improved perspective.

I do not know whether it’s my nerdy self but I find this picture incredibly funny and strangely appealing.

This is the cover of Harper’s Magazine and it has been on my office’s kitchen table since October but every time I walk past it – I can’t help smiling… The white-haired man with the badge: “Hello my name is Sigmund”, who is being kicked out from a gathering as an unwelcome trespasser by a muscle-bound security,   is obviously Dr. Sigmund Freud.

BioTensegrity meeting in Rome

My sincere apologies for neglecting the blog for so long…

Once there is an interruption – it’s difficult to get back on track. When writing the new posts is more or less consistent – say, weekly, – I develop a certain routine and flow. But after several weeks of interruption it seems that returning back to writing has to happen with a “bang” –by producing some major post that goes above the routine. At the same time delivering something major require preparation, which leads to postponement – and so it goes…

Fortunately, finally there is a major reason – so I am relieved to be back to the blogging and hopefully I’ll manage to stay on course (surely having comments and questions – greatly enhances the experience and puts the pressure on me to keep writing :-).

I spent the last 5 days in Rome participating in the invitation-only event called 2^nd annual Bio-Tensegrity Group Meeting, which is a mastermind group with participants of diverse backgrounds – researchers; biomechanics scholars; bodywork practitioners – who contribute to the ongoing development of Bio-Tensegrity paradigm and study  various avenues  applying it in practice.

Major Breakthrough for ABR!

I’ve been in quite jubilant mode for the last few days – we’ve got our first really major article published in a “Journal of Bodywork and Movement Therapies” (JBMT) – “The presence of physiological stress-shielding in the degenerative cycle of musculoskeletal disorders”.

This is THE place to be published for anyone who addresses complex musculoskeletal challenges; and JBMT has the reputation of being at the cutting edge of new developments in hands-on therapies, strategies and concepts.   To a great extent “Journal of Bodywork and Movement Therapies” is also a main tribune for a rapidly growing Fascia community that transcends borders between bodyworkers, biomechanical researchers, medical and fitness specialist etc.

So, congratulations to Mark Driscoll – the most serious:-) and intellectually disciplined person in  the entire ABR Team–  he did the most of the heavy lifting for seeing this work through and I hope that our collaborative effort will result in a lot more of worthy publications in the future. Congratulations to all the members of ABR Teams worldwide with this inaugural step to a developing ABR recognition – after all ABR Trainers are the people closest to you, they are the ones who actually hand you, the parents,  the tools of overcoming the ‘vicious’ degenerative cycle  caused by physiological stress shielding that our article describes so convincingly and eloquently ( well, I couldn’t help some blatant self-promotion :-)

And of course, I am very happy to share  this major breakthrough with entire ABR community and with all the families who  honored us with trust and commitment even at the times when we had a lot less of ‘official’ credibility to back ABR up.

You see, there are ‘articles’ and ‘Articles’ – I’d dare to say that this one belongs to the latter category.

First, because “The presence of physiological stress-shielding in the degenerative cycle of musculoskeletal disorders” is a large (6 pages) conceptual article.

Having conceptual article published by a leading academic journal is quite a ‘big deal’ because usually the articles that are easiest to publish are the ones that address a very particular smaller subject or document a study result. The more statistics and measurements are in – the less friction there is in a publishing process.

Mathematician’s Lament – On Math and Elegance of Reason

This is a 25-page essay about math written by a mathematician turned high-school math teacher and I wish that everyone have read it before getting to high school – it would have made a ton of difference.

http://www.maa.org/devlin/LockhartsLament.pdf

At first glance this is an off-topic in respect to ABR and that’s why I kept it on my desktop for a few weeks without really being sure whether I should bug you with it – you have hard time for finding spare minutes to read practical tangible stuff – whilst this one appears to be somewhat remote.

However, I decided to go ahead with it for one main reason – it’s about elegance, it’s about seeing art and fun, it’s about understanding that math is a toolkit of your thinking, a huge booster to your inner game…

Unfortunately, what most of you think about math is the exact opposite – numbers, dreaded formulas and regimented routines.

I lost count of times when someone tells me as a compliment: “Sure you are good with numbers since you studied math ”… That drives me crazy – I am not an number-cruncher for goodness sake! Sure I am literate – but numbers have nothing to do with math! Try complimenting a writer on knowing alphabet and drawing letters really neatly..

Anyway, I have a hidden hope that after reading this essay -- your ‘inner game’ in respect to ABR will change a little bit and you’ll be more likely to look at your everyday ABR work not as a regimented dread of repeated automatic movements but as an active quest in looking for the best response through every single application.

If that ever happens there are two winners: you – since a daily dread will turn into an exciting quest; and your child – since your efficiency will skyrocket…

Well, and I guess there is a third winner: me –being happy in helping you to elevate your game…

P.S. I know you are very busy and a 25 page reading is very likely to be postponed indefinitely…

If that’s the case – please do me a favor and read pages 1-5 to begin with -- but do it today.

If you have more time – read pages 18-22. Then if you have a bit more time – pages 8-11.

P.P.S. And this post is an excellent opportunity to draw one’s attention to one of the most influential books that I have ever read: “Mathematics and the Physical World” by Morris Kline. If you have older kids who are in high school or about to go to college – this book will change the way one looks at higher math once and forever. I admit that I read it just after I graduated – I wished so badly I had it a few years back – that would have made my studies times more efficient.

Master your own fascia use.

Let’s start the ‘Lessons from Fascia Research’ with an important tip that refers to all of us – providers of ABR exercises.

Have you ever complained of the pains in the shoulders, neck or back – linking them to your ABR exercises?

If the answer is ‘Yes’ – the following information about the fascia properties is going to be of value and help you to manage your positioning more efficiently.

The issue of the ‘pains’ has been a sting in my heart for ages… This really bugged me because, on the one hand, I feel bad for being somewhat at the origin of this discomfort yet, on the other hand, it is especially disturbing since there is no legitimate intrinsic reasons for that.

Let me explain.

Most often musculoskeletal pains relate to some form of repetitive strain injury, where the micro-tearing causes inflammation that heals incompletely or with the fibrotic deterioration of tissue, that in turn puts the remaining healthy fibers into even greater exposure and so the vicious circle perpetuates towards accumulation of critical loss of healthy tissue and thus the problem becomes chronic.   

However, when teaching the ABR technique – especially the 3Q – we emphasize several main points:

·                Maximum relaxation, i.e. ‘switching off’ all of the unnecessary muscle groups in your hands, arms and shoulder girdle.

·                Comfortable positioning – balanced position of the body with minimal challenge to the lower back etc. We emphasize the necessity of support for any suspended element of your body – be it the shoulder or the arm or the upper body.

Getting serious... GMFCS -- the acronym all of you should know and understand

GMFCS curves – the fundamental benchmark: No more ‘wiggle room’ and ‘muddy waters’ for the prognosis of ‘hawkish’ interventions.

Words of caution/ discretion advised:

LONG POST WITH A COUPLE OF EXTRA LINKS TO MORE READING…

I couldn’t manage to make this post light-hearted. If you feel that harsh exposure to reality is going to make you feel uncomfortable – probably you should skip this post.

If we are any serious in approaching the Cerebral  Palsy 'peacenick' vs. ’hawk’ dilemma, the first thing we should be talking is how to evaluate and compare the performances and outcomes – otherwise we’d end up with a divide that is just purely ideological.

As the very first step we need the benchmark… Without the benchmark to compare to – any meaningful evaluation is difficult – the winner will always be defined by the loudest mouth and the strongest authority backing.

For many generations of families affected by Cerebral Palsy that was the unfortunate reality. The entire Cerebral Palsy field was defined in super-blurred categories of ‘mild’, ‘moderate’, ‘severe’ – where it was impossible to pin down any true efficiency.

These muddy waters created a very peculiar situation that most of you are familiar with.

On the one hand, the literature and conference proceedings always had the same gloomy prefaces and intros: ‘the problems are still unsolved and poorly understood’; ‘general prognosis remains grim’ etc. – describing very pessimistic overall picture.

On the other hand, if you were to meet any particular, local medical specialist – you were most likely to experience a lot of pressure for ‘hawkish’ methods: each and every of them would beat oneself on the chest with examples of incredible progress children achieve following his interventions and at the same time drawing some really horrific pictures of the future for those ‘infidels’ who dared to doubt the ‘hawkish’ path.

Globally it was acknowledged that there was not much known and much to be done for children with Cerebral Palsy, motor function outcomes are unpredictable and not necessarily being better than the natural evolution without any forceful intervention; however, locally you were most likely to meet an ‘alpha-hawk’ – a ‘star’, a doubtless guru preaching the absolute necessity of ‘hawkish’ interventions who’d be looking for adoration and consider himself a real difference-maker…