Therapies for cerebral palsy- the clusters approach. ABR Workshop at Pac Rim Video Part 1.
Cerebral Palsy and Stem Cell “Therapy”. ABR position.

“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?