On Discovering A Theoretical Goldmine Of Salutogenesis for Cerebral Palsy And Other Updates…
June 13, 2012
Dear friends,
I have been silent in this blog for a while – but clearly not for the lack of productive activities…
First of all – there was a lot of training sessions in May held by the local ABR centers all around the world –from Hong Kong and Australia to Italy, Serbia, Denmark, Belgium, Austria and then, of course, in North and South America… Following our 3 weeks ‘ABR Trainers training’ in Montreal back in April a number of significant technical breakthroughs were introduced through all of the ABR satellite sessions… [For those of you who couldn’t attend in May-June – I really urge you not to delay and make sure you secure yourself a place at the next training session in your area. If you’ve got a job to do – you’ve got to do it in the best possible way, right? ]
Whenever the new things in roll in – I always face a lot of questions from our ABR trainers where we need to iron out all the aspects – strategic allocation of the new TransFascial Viscoelastic (TFVES) applications, the teaching nuances, tactical smarts of maintaining stability and providing optimal area access for the parents… and lots more.
I am really looking forwards with plenty of excitement because the more we see the results of the TransFascial Viscoelastic Applications – the more the “wow!” moments we all experience among the ABR Team – the responses from the dense and resistant areas, which used to take years now show major improvement within months , which is really rewarding and encouraging …
It is also a good opportunity to say thanks for the overwhelming response that my previous post “Prevailing over tragedy -- ABR facilitates amazing recovery” received.
It was a record number of the Facebook likes that I have ever got… Well, of course, the enthusiastic response massages the writers ego :-) – but obviously that’s not the most important aspect.
First of all, it was encouraging to see that most of the professional colleagues and members of fascia community responded with enthusiastic thumbs up – leaving comments like that:
Robert Schleip PhD said...
Hi Leonid and friends.
I just saw this report for the first time. Very very impressive! I agree with you that learning to influence the interstitial fluid flow promises to be a very beneficial contribution to the therapeutic field. After www.fasciacongress.org/2012 I also started to work even slower with my hands in my clinical sessions; thinking about squeezing a sponge-like tissue and allowing it to re-hydrate with fresh liquids afterwards. I hope you continue this line of exploration, as well as the documentation of your results. Very impressive indeed!
Fascianatedly yours
Robert Schleip
But what’s probably even more important is that hopefully the posts like that are going to be of a good morale boost for your own day-in day-out work – clearly showing you that the TransFascial Viscoelastic Applications really delivers the important transformational effects to your children’s bodies.
Another element that I can’t resist to mention – is what is probably can count as my middle name – the appeal for your ‘focus and concentration’…
The recent upgrades to the ABR Techniques // TransFascial Viscoelastic Applications are really powerful, however, that transformational power is unlocked to its full extent only if you really concentrate and pay full and undivided attention to what you are doing.
You don’t need to be superhuman for that – studies clearly show that an average person can easily and reliably distinguish depth variations of 1/5 of a millimeter – which would be 1/100 of an inch (When you can feel that you flipped 2 pages of a magazine or a book instead of one – you are that good!). So it is all very much possible and realistic – but you need to keep your focus…
Imagine you were reading a book flipping 5 or even 10 pages at once – how much good would that do you? – But unfortunately, that’s exactly what often happens to many parents who let their minds drift elsewhere instead of keeping a solid focus on what’s going on under your hand..
But let’s get back on track – I am trying to deliver on my promises of the future post subjects – and whilst I have kind of postponed the completion of the “Reporting about Fascia Congress 3” posts – I am going to stick to the promise given in the previous post where I announced that the healing of the damaged tissues in the knee area was the first step in Luca’s road to recovery after that tragic accident.
Another major transformation that we managed to achieve thanks to some smart ABR strategies/techniques and consistent work of mama Katja – was a spectacular breakthrough in walking abilities that took place within a space of less than 2 weeks.
April 26th Luca was heavily relying on crutches and May 7th he was already walking comfortably with a single hand support and began to walk without the support (or to be precise it was May 5th when the filming took place – I received it on May 7th)
Based on Luca’s walking recovery case – all aspects of it: initial condition and troubles with walking; the designed ABR exercise program; and the transformation achieved – I created the fully fledged series: “The Unconventional Truth About The Walking”.
These series are going to be 5 Videos long (where the Video 4 is actually long enough to be counted as two videos) – and it have already been filmed – so I can pretty much guarantee that these are the posts that are going to appear weekly for the next few weeks.
Well, with all that being said – let me share my recent find that really got me incredibly excited – Discovering a theoretical goldmine!
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The more fundamental they are and the closer to the high-level conceptual axiomatics – the better.
What is even better than a powerful high level theory ? – An under-leveraged and under-utilized high-level theory…
I guess that’s where my approach differs from what most people find valuable, namely the concrete practical tools – the “How To’s” – a new diet, a specific technique, a transforming exercise and so on… The proof is kind of obvious – look at the bestsellers – you are not going to find much of the abstract theories among them but plenty of How To’s” .
Frankly, that bias towards the How To’s” is really hard for me to get… Any specific ‘How To’ is so local and limited comparing to all the possibilities and flowing variety of options that stem from a high-quality deep theory. Unfortunately, that’s exactly what is hard to come by in medical field…
Ok, enough of the pre-ambles.
What I stepped upon – pretty much semi-accidentally – is the concept of salutogenesis.
And it was like a proverbial light bulb –“Wow!” –The Holy Grail that I’ve been looking for nearly 20 years, searching high and low, making my way through all the biomedical terminology heavily contaminated with the narrow meaning of the “war against the pathogens and diseases” – was actually right there, in plain view.
Salutogenesis – is the term coined by the renowned medical sociologist Aaron Antonovsky back in 1979.
It’s a mix of Greek and Latin. Latin: salus = health. Greek: genesis = source.
In combination = Salutogenesis – Sources of health
Although Dr. Antonovsky passed away nearly 20 years ago – the Salutogenesis concept is now very much a staple in the field of public health promotion. It’s talked about by government officials and the healthcare executives alike…
At this point you might be asking some inquisitive questions:
“What’s so great and exciting about salutogenesis if it’s so well-known already and far from being really new?” as well as “Why I have never heard about the Salutogenesis?” and, obviously “What’s in it for me and my child?”…
Well – I am eager to answer those!
“What’s so great about salutogenesis?”
- First and foremost the greatest thing about the Salutogenesis framework is the explicitly clear clarification that pro-health and anti-disease actors and actions are not the same but very different things.
This might sound as an abstract wordplay for you – but please do not fall into this trap.
Think about it like this.
In everyday life – keeping financial losses above bankruptcy is not the same as earning a surplus and profits.
Not conceding a goal into your own net is not the same as scoring the goal into the opponents’ one. Goalkeeper’s job description is very different from a job description of a striker.
Decorating your house and making it really nice is not the same as merely plugging the holes in the otherwise leaking roof.
This list can go on and on and on … It sounds so obvious… I wish it was…
The problem is – that’s exactly the limitation of the traditional medical paradigm and the “disease fighting” system that emerged under it. Somehow – until Dr. Antonovsky came with his definition of Salutogenesis – the entire medical industry worked on the assumption that as long as you haven’t entered a bankruptcy – you should be considered as an affluent prosperous individual.
There are 1000s of methods to track the emergence of the signs of the disease , impairment and disorder but there are no comparably developed methods of evaluating health quality.
Medical expertise can offer 1000s of tools that are going to help you to cut your losses from massive ones to much smaller ones – but the only advice that you’ll get on gaining the positives and “earning health currency” is going to be the vaguest: “Balanced diet and moderate physical exercise are good for you”. That’s it. Beyond that, you are being transferred into the domain of “fitness”, i.e. ‘diluted athletics’ and “wellness”, i.e. ‘pleasure and relaxation’.
The formulation of the Salutogenesis paradigm by Dr. Antonovsky was a major wakeup call for the entire medical system.
You see, the underlying medical paradigm that your doctor is brought upon is “anti-pathogenic”. Doctors fight against the “specific negatives” – which has to be labeled with a diagnosis. The underlying assumption is: “health is the absence of a clear-cut diagnosed problem”. All the tools and reasoning ,and the entire infrastructure of the medical industry serve this premise.
Ironically and confusingly for you – it is also being routinely called a “healthcare sector”… which is a complete misnomer. A word “health” is given a lot of lip service – but nothing practical comes out of it in the reality of a mainstream medicine.
Why? – because if the only tools that you have are “anti-disease” or “anti-disorder” – there is no recognition for specific “pro-health” factors.
Well, that’s exactly the message of salutogenesis – that a distinctly different approach shall be added – employing the ‘salutory’ factors / doing the deliberate ‘salutory’ work – “earning health currency credits… “
That’s an illustration of this new approach to medical paradigm that I pulled out of the literature.
Graph by Univ.-Prof. Dr. Horst Noack, PhD, Medizinische Universität Graz
To get it even clearer – let’s do the simplest color-coding in grayscale.
Death – is the 100% black, Ultimate Health (some unreachable superhero status) – is the 100% white.
At any given moment in time – any person’s health status is a certain shade of gray .
What’s the assumption of the “anti-pathogenic” medical profession? – Eliminate the black, wash it away as much as possible… that’s the definition of a MEDICAL TREATMENT or a THERAPY
Since fighting against the “blackness” is costly and involves doing a lot of damage (think toxic chemicals in the drugs/ think tissue damage through surgery ) – the shade of grey has to be black enough before this SWAT team could be deployed. Otherwise the remedy is more damaging than a problem itself.
What’s the salutory approach? – Add the whiteness.. No matter how dark is the grey or no matter how light is the grey – there is always room to get it better – to inject the salutary whiteness..
I hope you can see the power of this reasoning. Salutory factors are ALWAYS beneficial. There is no heart-breaking dilemma – shall we do it or shall we not? If the fight against “pathogenic enemies” is worth doing the damage to the “peaceful civilians”?
Salutary approach is free from these concerns – no matter if we consider a person with a severe disability or a person whose health is in Olympic grade – there is always room for “adding more health”
So the classic medical anti-pathogenic mandate looks like this:
|
|
“Diagnosed Condition” (disorder or disease)
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A person without a Medical Diagnosis = “Healthy Person” |
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ANTI-DISEASE |
PATHOLOGY EXCESS |
NO PATHOLOGY
|
For the sake of visualization – dark grey is the “disease ” – which ranges from the “slight excess of black” , i.e. early signs, to the “prevalence of black” at the terminal stages.
The medical “guardians” are fighting against the “increasing presence of blackness” via various “treatments/therapies” – they start firing once the enemy gets close enough to the “fortress”.
Contrary to what you might believe – health as such has no specific ‘identity’ in the medical world.
There were numerous attempts made to fix this flaw by World Health Organization but you are welcome to judge how practical is that definition by yourself:
“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” (1948)
“To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective for living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.” (Ottawa Charter; World Health Organization, 1986)
How practical is that? The doctors themselves call it an “ecstatic” definition – with little to none of real practical meaning when it comes to tangible biomedical domain of ‘what needs to be done’.
In practical reality –the almighty Medical DIAGNOSIS defines whether the ‘blackness’ is prevalent enough to be fought against.
The attribution of a person from the domain of being “healthy”, i.e. having no identifiable pathology follows the medical diagnosis.
That’s why the terms “Medical Treatment” and “Therapy” are reserved for the “dark grey” half – with the meaning of “fighting against the excessive wrongs”.
I’ll try to illustrate these points this way. Visuals are not my strongest trait – but I hope you can get the idea well enough.
That’s the reasoning that should clarify for you how, for example, the orthopedic decision-making works.
For instance, the infamous hip subluxation. From a “normal person’s logic” – orthopedic logic is quite strange. Why, say, 25% percent deviation from “straight” has no labels and warrants no strong intervention – just a passive observation or at max having some “preventive attempts” of stretching/ Botox… However, once the measurement is at 33% – then it is labeled as “hip subluxation” and the drastic surgical interventions are pushed on you.
From a “normal” logic – if the “surgical therapy” was really “pro-health” – it doesn’t make sense to wait until the shade of grey becomes so dark – one needs to “fix it” when the deviation is close to zero, not when it has reached the 33%...
But ‘normal’ logic is not applicable to medical reasoning – because it is essentially based on “anti” and the fight against.
The new – world of health care – improved by Salutogenic Paradigm – looks like this:
The big picture is no longer limited to just 2 halves of being “non-pathological” – not black enough to be fought against; and “pathological” – “black enough” to be worthy of a battle.
Now the big picture has 4 quadrants instead of 2 halves.
This transition from 2 halves – along a single coordinate axis, to the 4 quadrants –gives an added dimension to the decision-making.
Salutogenic approach implies that in every grayscale situation – whether the person is in excellent shape or being in serious trouble – there are 2 avenues of making the shade of grey lighter.
Where the anti-pathogenic approach looks for the enemies and attempts to eliminate, “to wash away the blackness” – the salutogenic approach aims at improving the shade of grey by adding the “increments of whiteness”
That’s a really transformational change because when you are adding “the good” – you do not need to worry about the dilemma that anti-pathogenic war machine faces – what if the cure is worse than a disease?
With salutogenic methods – it is never too early and never too late. There is always room for positive ‘pro-health’ contributions.
What does it give us? – Very much the cleanest definition of what ABR is and what is the difference between ABR and medical treatments/therapies.
ABR IS NOT “A THERAPY ”!
Finally I have a clean and “official” way of make things clear.
ABR IS NOT “A THERAPY ”! IT IS A SALUTOGENIC ENHANCEMENT/ IMPROVEMENT METHOD.
For many years I tried explaining that in different versions – calling ABR “strength and conditioning for special needs persons”, “wellness for special needs”, “fitness for special needs” instead of a “treatment for Cerebral Palsy ” or a “Therapy for Cerebral Palsy” but that never really ‘clicked’. Understandably so –all those descriptions never felt right because “conditioning”, “fitness”, “wellness” have some pre-determined meanings that people associate with general ‘healthy’ public/ well children – not with the people affected by developmental and movement impairments.
With ABR being a SALUTOGENIC METHOD – we deliver the SALUTOGENIC ENHANCEMENT to ANY PERSON – whether the one is at the bottom of the Salutary Deficit– like a child with quadriplegic Cerebral Palsy, or being at the level of Salutary Surplus, which in turn ranges from Salutary Comfort – like an ordinary “well” person to the top of Salutary Abundance – like a pro-athlete…
Of course, there are differences between what exact Salutogenic Enhancement priorities are needed for a person affected by Salutary Deficit in comparison to a person who has Salutary Comfort or to a person enjoying Salutary Abundance. However, these differences are secondary – the primary is emphasis on Enhancement, which is about increasing a person’s salutary resources rather than the “fight against” some perceived pathogenic agents.
I’ll try to expand on that graphically:
How ABR works? What is ABR?
ABR DELIVERS THE GRADUAL INCREASE OF SALUTARY RESOURCES FOR PERSONS WHO EXPERIENCE SALUTARY DEFICIT.
In turn gradual increase of one’s salutary resources lead to the gradual reduction of salutary deficit and thus brings a person closer to salutary abundance and high quality functioning. n
That’s the key understanding. ABR approaches your child’s Cerebral Palsy condition as the extreme deficit of salutary resources – especially in quadriplegic cases.
There is nothing we “fight against”… We do not “wage war against the excess pathology”…
Take spasticity for example. We look at it as a reflection of deficit – lack of strength within the underlying fascia and the weakness/ instability of muscular attachments as well as the weakness of joint capsules.
Those are not “pathologies” to be fought against – those are deficits, those are lacking resources that need to build and replenished.
How then ABR Improves the condition of your child with Cerebral Palsy?
For your child with Cerebral Palsy ABR-based increase of salutary resources translates into the reduction of what to medical minds looks like “excess pathology”, i.e. ‘spasticity’, ‘muscular hyper tonus’ etc. –ABR works indirectly making your child’s salutary deficit less and less pronounced…
I hope this brief overview of salutogenic paradigm is helpful and makes things much clearer..
Now the next question – why you have never heard about salutogenesis before? Why don’t your doctor share these exciting news with you? What would happen if you’d bring this new definition of ABR to your local health practitioner and he’ll look it up in a dictionary?
Well, the answer to these questions splits in two.
First, the doctors themselves are trained within the anti- disease/anti-impairment paradigm. Most of the medical practitioners really see no difference between fighting against a particular set of diagnostic conditions they’ve been trained to deal with, and improving one’s health.
Secondly, the unfortunate reality of the present day is the fact that the ideas of salutogenesis have been transformed to practical criteria and methods in the fields of mental health and psychology – but haven’t found any practical implementation in the domain of tangible physical impairments such as Cerebral Palsy or Traumatic Brain Injury.
On the one hand – that’s sad and unfortunate, but on the other hand, – that’s exciting.
That’s what I’d call a superior theory being under-leveraged and under-utilized. That’s what makes a salutogenesis into such a gem and an absolutely exciting find.
Dr. Antonovsky’s salutogenic work came at 2 levels:
- Deep fundamental/ theoretical
- Practical
Like any other researcher he originally started in a particular field of his expertise – medical sociology and psychological evaluations, – and after nearly 30 years of work he was able to transcend the borders of his original field and come up with truly deep and fundamental conceptualization that became the Salutogenic Paradigm.
However, after this ascension from the narrow field of his original expertise into a broader theory – he needed to make a next step – operationalize his salutogenic theory, put it to practice.
Where would a person do such a transition to practice? – Obviously, in the field where his best practical expertise lies in. In Dr. Antonovsky’s case – that’s the field of social aspects of health enhancement and psychology.
So if one looks up the term “Salutogenesis” today – you’ll get under the impression that ‘salutogenesis’ only covers a psychological and mental aspects but has little relationship to anything physical and tangible – and you are not going to find not a single mention about salutogenesis in the context of Cerebral Palsy.
Why? – Because of the infamous division of professional expertise in medicine. The anti-pathogenic paradigm proves itself very resilient at many levels. It’s because of this anti-pathogenic specifics of every disease medicine has specialized into a myriad of sub-domains, but now that compartmentalization itself – insulates those individual sub-domains from the transition to more advanced theoretical base.
Every specialized medical field – especially as insulated as orthopedic profession and neurologists – defends its original rank and file and the “tradition” that is ingrained in its own applications of anti-pathogenic paradigm.
As a result, we observe a paradox – whilst the “virtual” aspects of health – social, mental, psychological – have undergone major transformations in the last 15 years following the influence of salutogenic thinking, in the “tangible” physical and physiological fields – everything remained the same.
How many people actually read thick and convoluted books of theory founders?
Not many.. Those who actually do such reading are usually academics themselves disconnected from the practical field – they do not have the capacity/intention to operationalize and make the theory practical.
This is very alarming, because after some time the new theory that has a potential to revolutionize each and every domain within the biomedical field and to transform “healthcare” into real care for health rather than anti-disease fight – becomes firmly bundled with the narrow set of practical applications that it received.
So if you speak to an orthopedic surgeon today – he’d be firm and confident that salutogenesis doesn’t apply to the field of physical impairments such as Cerebral Palsy – assuring you that indeed salutogenesis is a significant advancement for the ‘virtual’ branches of medicine but not for him.
On the other hand, that’s what makes me really excited
If there is something that I am good at – it’s the ability to operationalize abstract theories into tangible practical tools.
I always found that being straightforward that’s why I value good theories so high. But on the other hand, I am beginning to realize that maybe that’s an exception rather than the rule. After all – apparently there are a lot more of good theories than of equally good practices especially in the biomedical field… Well, for Cerebral Palsy things are obviously worse – there aren’t any good theories, period.
That’s why bringing the salutogenic reasoning to Cerebral Palsy field and to the other fields of special needs developmental enhancement is so important and inspiring!
Well, I hope that I have managed to convey at least some of my enthusiasm and excitement to you , and you’ll happily stop calling ABR being a “therapy” for Cerebral Palsy – and start recognizing it for its true value – being a system of increasing the pro-health salutogenic resources for your kids with Cerebral Palsy, where you the parents deliver the mechanical stimulation to the deep fascial levels as the most effective avenue of replenishing those depleted salutogenic reservoirs that keep you kids from achieving the full developmental potential they deserve..
To this I raise the Cup of Tea ! (I finished 5 while writing this post – hard to say how salutogenic was that :-)
P.S. The posts and videos on “Unconventional Truth About The Walking ” are going to start in a few days. Meanwhile – I am looking forwards for your thoughts and opinions on the Salutogenic help for Cerebral Palsy kids. Are we in tune? Do you have that “gut” feeling of the importance that salutogenic understanding has for fostering and enhancing the developmental achievements for your children? And as always – comments, likes and shares – are really essential for nurturing the writing enthusiasm,– I’d even say, those are really salutogenic for me :-)