Having taught numerous continuing education courses, I’ve observed many clinicians have difficulty working within the context of a hierarchical thought process when treating patients. In addition to that, many are stuck in a structural, mechanical approach rather than a neurological approach to working with the human body. I designed “Fundamentals of Intervention: An Approach for Treatment” to provide the movement practitioner with the tools necessary to analyze where to begin treating a patient, what a general hierarchy of treatment looks like, and reasonings behind the hierarchical order of treatment. While we are all unique, there are neurological, physiological and psychological commonalities in everyone that can be assessed and worked with. The hierarchical order of treatment in Fundamentals of Intervention: An Approach for Treatment is laid out based on the thought process I use daily in my rehab practice at REAL pt.
The Five Fundamentals of Intervention:
- Treat pain
- Integrate higher level sensory systems: Vestibular, Sensory and Cerebellar
- Improve mobility
- Improve motor control and stability
- Integrate movement
Before delving into the first fundamental of intervention, I want to preface that working at an individual’s threshold is important in creating lasting neuroplastic changes. Treating capacities rather than anatomy allows for a broader, more holistic approach as compared to traditional practice. While it’s important to free a given body part from pain, it’s often even more critical to recognize that the site of injury/pain is not necessary the cause of that injury/pain. Within the paradigm of treating capacities, it doesn’t matter what body part is painful, rather it allows the movement practitioner to assess a patient’s ability to control certain movements, recognizing that often the breakdown at the painful region is due to too much shearing and movement of the bones.
#1 Treat Pain
A primary objective of treatment should focus on reducing pain and increasing awareness about how a specific behavior contributes to pain. This should coincide with patient education about pain being an output and strategies to safely change input. There are many inputs including pressure, temperature, vibration, thought and emotion. Often times, patients aren’t aware of their anxieties or how they potentially contribute to dysfunction and experience of pain. In other words, patients aren’t aware of the characteristics they demonstrate that potentially contribute to pain, let alone know how to change it. Thus, one role of a movement practitioner is to bring forth an awareness of behaviors potentially contributing to pain and what to do about it. Being in a sympathetic state makes it difficult for patients to learn new tasks and create neuroplasticity of the brain. Therefore, an early intervention should focus on creating a state of parasympathetic dominance in patients in order to create lasting behavior change.
The question here is: What are the strategies movement professionals can use to help patients transition from a sympathetic to parasympathetic state in order to create lasting behavior change? Watch my new 2 hour course where I’ll share real-life exercise examples as it pertains to the Integrated to Isolated Spectrum and discuss my other four fundamentals of intervention.
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