Saturday, December 21, 2013

The Orthopedic Card

I'm about sick of what I'm starting to call "movement elitism." The idea is that, unless you move perfectly, you shouldn't move. Because… you'll ingrain "pathological movement patterns." I've railed against this before. And here it goes again...

Curious Person (CP)
Clinical Movement Elitist (CME)

CP: Why should a stroke survivor not move when they're alone? 
CME: Because they move wrong.
CP: What will moving wrong do?
CME: Make it so they'll never move right.
CP: So what should the survivor do to practice movement?
CME: Wait until there's a clinician around to tell them how to move.
CP: Won't the survivor run out of money eventually?
CME: It’s worth every penny because bad movement is bad. It will make moving right harder.
CP: Don't we all learn to move by correcting mistakes?
CME: Yes but survivors need guidance.
CP: Couldn't they sit in front of a mirror and model the movement of the "good" side?
CME: Yes, but they'd fail in the execution.
CP: So they need to be perfect right out the box?
CME: Yup.
CP: What if they can't move right?
CME: I move them.
CP: Doesn't that defeat the purpose any "productive struggle"?
CME: Survivors shouldn't struggle too much.
CP: Why should they not struggle?
CME: They'll move even worse.
CP: Survivors need lots and lots of repetitions to recover moment, right?
CME: Yup.
CP: And that has to do with forging new pathways in the brain?
CME: Yup. It takes thousands of repetitions to get the brain to regain control over muscles.
CP: How long do you typically see a patient?
CME: About an hour a day.
CP: How many repetitions do you have survivors do in a typical session?
CME: A many as we can.
CP: Did you know that the number of repetitions done in a typical stroke rehab session has been counted?
CME: I did not. Know.
CP: The average number of repetitions in a typical session for the arm is 18 and for the leg its 38
CME: It will take a while.
CP: How do you reckon the survivor will get to the thousands of repetitions they need?
The movement elitist may seem cornered, but they have an ace…
CME: Even if they could practice on their own, and even if that practice is beneficial, the bad movement will cause orthopedic problems like bad joint movement and pain. It may be good for their brain but it’s gonna be bad for their body.
CP: Couldn’t the improved movement and the better brain control lead to less ortho problems?


Mike said...

I'm tired of many 'specialists' who believe they know a lot just because they got a therapy diploma but short on common sense and hardly read the latest research publications.It explains why the USA and the rest of the world as well is full of disabled neurological disorder patients.As a stroke then hemidystonia patient myself who do my own research and rehab( because of the absence of specialist who understand that both hemiparesis and hemidystonia can be reversed) , I continue to improve only by doing movements I lost by the thousands. Had I stayed longer at the rehab center, I should have ended up disabled until now and taking those seizure meds that were recently shown to affect neuroplastic activity of the brain.

oc1dean said...

And if you are lucky enough to get therapy everyday it will only take 152 years to get to 1 million repetitions for the arm and 72 years for the leg. I think I'll be dead long before that.

Amy said...

Well Dean if I'm careful, I might have another 72 years left in me. Nothing traumatic better happen to me. Ummmm......
Screw my arm, I sure as hell don't have 152 years.
Mike - you can meditate that anger away.

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