Friday, December 15, 2006

Brain Architecture

This book (published 2003) is a great refresher for anyone interested in learning more about the nervous system. The author, Larry Swanson, picks up from where a zoologist, G.H. Parker, left off in his book from 1919, The Elementary Nervous System. The first three chapters alone are worth the price of the book, discussing behaviors of creatures without nervous systems, like protozoa and sponges, then the very basic building blocks of the nervous system as they manifest in simple creatures like Cnidaria (jellyfish, hydra).

Stepwise and logically, without missing any small but crucial points, we are taken through the historical milestones of Cajal and others over several centuries of research and conclusions, plus recent findings - and that's all in the first 40 pages. The next 40 pages reviews the basic vertebrate plan, and the rest of the book (a mere 241 pages in all) discusses brain function.

The prose is clear, concise, interesting. Highly recommended as a basic overview/review.

Wednesday, November 22, 2006

Canadian Physiotherapy Pain Sciences Group

A PT friend of mine a long way away wrote to ask if I knew anyone in Victoria doing "soft, gentle" manual therapy. I knew he meant therapy that takes into account the patient, and the patient's pain perceptions, and is not just applied to their tissues as if said tissues were abstracted from the body and not connected to a nervous system, or as if the treatment of the tissues in abstracted isolation would in and of itself lead to a predictable and desireable outcome in terms of pain reduction for the patient.

Unfortunately, there is no category for such therapy. There is a category for "orthopaedic" manual therapy (pushing bones about), one for "acupuncture" (pushing needles into soft tissue, especially the sore spots, with the idea that tissue if aggravated will be stimulated to be less chronic, more acute, and finally "heal"), and various other categories for various definable conditions, age groups, or social classifications of behaviors, such as "sports"...

I settled, with a sigh, on two practitioners out of dozens listed, who had been brave enough to put themselves into a category listed as "complementary." I don't know them, or what sort of "complementary" PT they practice, but I took a chance because sometimes the unknown is less scary than the known. I also am listed as practicing in a "complementary" manner, along with "orthopaedic." To me, an "orthopaedic" listing is necessary, because it lets people know that you've studied the body in detail at least, and have acquired certain skill sets, even if you don't use them much. And "complementary" is my code-word for "willing and able to treat persistent pain problems in people."

It's a compromise.

My attempt to help my friend reminded me of why I was so interested a few years ago in helping set up a pain physiotherapy special interest group/CPA division in Canada. At the time I thought being able to present a new official category would gradually replace the one listed as "complementary", odious to many because it can mean non-orthopaedic hands-on techniques that include all sorts of anti- and pseudo-scientific hands-on theoretical constructs. Aha, I thought at the time. All these practitioners really need is access to updated pain science and neuroscience, and all will be well in PT land. The practitioners needn't necessarily change what they physically do with their hands, or how well they relate to their patients, but their thinking and understanding will take a big leap forward, and the sort of conversations they have and meanings they convey to their patients will become congruent with all that has been learned in the last decade or two. Eventually PT would be able to drop that compromising, dubious and embarrassing, even, "complementary" category in favor of the much preferable (to my mind, anyway..)"pain sciences" category.

Well, long story short, it seems the physiotherapy beaurocracy in Canada wasn't ready for such a move. Our application to become a division of CPA was rejected, tabled, postponed, moratorium-ed.

So, we decided to plow forth anyway and the Canadian Physiotherapy Pain Sciences Group was born instead. It is doing very well under the combined leadership of Neil (western Canada) and Dave (central Canada), both young with solid academic credentials and teaching experience; Deb, who is from my own era and who has revitalized her PT career by teaching pain seminars; myself, not doing much publically but always working behind the scenes, trying to help the profession get unstuck from the past.

Wednesday, November 15, 2006

November Workshop

I have to say, it went better than anticipated. At the last minute two more people let me know they wanted to come, which meant printing out more handouts and scrounging more chairs, and increasing the size of this class over the size of the last class by 150%, up to 5... plus the photographer made 6. Somehow they all squeezed into my treatment room.

And the best part, I was less stressed and less nervous and less exhausted afterward.

I think I might be getting the hang of this teaching thing. This time I had a white board ready, and some flip charts on which I'd prepared diagrams, a bit smoother flow. I still felt like I rambled around quite a bit, but no one was yawning that I could see.

The next day a few of us including the researcher friend went off to visit BodyWorlds, my second trip there. I lingered over the nerves pointing out each one by name to my participants. It was so much easier to grasp how they flow and penetrate layers when the layers are separated slightly, the way these exhibits are, how muscle structures spiral their way around bones like flower petals, and how the nerves slide through them like corset laces.

To top it off, the researcher friend tutored me in how to make power point slides for the next teaching adventure.

Saturday, November 04, 2006

More teaching

I guess I must be fully recovered from the teaching episode in June, because I am about to do this once more, on Saturday next. The class size has increased by 50%, to three, and Eric, an ex-student from the first class, will be on hand to take pictures for an upcoming treament manual I'm writing. This time there is a name for the technique, discussed in a previous entry, Dermoneuromodulation. So things are looking up.

It's still a free class though. I can't bring myself to charge any money for this work. It's still in such a rough state.

Attending this round will be an old classmate, well, two in fact, who have taken an interest in this work that has defined itself through my two hands and mind and all the various beast brains that have stored themselves in my skull in this particular physical configuration, this particular intersection of life with space-time around it which I call me..

One of them became an academic, who is responsible for an entire PT program in a major university, and whose forte and personal interests happen to lie in research design. She and I have plans to begin a study in the new year.

I know it will be a few more years before anything comes about, but I have high hopes it will be published one day, that it will be a small seed that can grow into something substantial, something that can move PT from the doomed track it is currently on, or that I perceive it to be on, toward something more hopeful, not just for PT itself but for all the nervous systems of all the patients we treat.

It will be a single subject research design. My colleague will handle all the paperwork and analysis. All I have to do is treat the patients, who won't really be patients - they will be "subjects." She will measure their pain before and after, and again several months down the road.

This is all a dream come true. Despite that November and seasonal affective disorder is upon me once again, I still couldn't be more happy with the way life is turning out.

Tuesday, October 10, 2006

Body as "environment"

I happened to see this Go Animal newsletter entry this morning, beautifully written, a plea to adjust the viewing goggles on existance to include the human body in context instead of as object.

I agree, and would go a step farther.. the human body can be viewed as an "environment" built by the nervous system, nervous system "clothing," an organic little "antigravity space suit" it builds through which to negotiate its way through life on the earth planet. Some antigravity suits need more help (maintenance from without, from other people) than others..

How can I say this? Because epiblast gives rise to ectoderm. Ectoderm makes mesoderm, which turns into many many things in the body. Various stages of ectoderm make various levels and types of mesoderm, even the body's endoderm (the original hypoblast or endodermic layer is used to build amniotic structures)in addition to its own infrastructure, i.e., germ cells, brain, spinal cord, nerves and skin. It's all in Gray's if anyone cares to check. Each human nervous system is a community builder with an eye on its own future.

Saturday, September 23, 2006

Missing? Or just cognitive "hemi-neglect"?

It seems most everyone in the orthopaedic branch of my profession is overly focused on mesoderm of one kind or another as if it had control of its own behavior, ignoring the nervous system as simple background noise. I thought this attitude was chiro driven, a memeplex to which PT had fallen prey, but I don't think so anymore - I think it's just naivité/simplistic thinking all round, like drawings of five year old children conforming to a predictable style. Ortho PT bases itself on what it has learned from its roots, the century-ago thinking of army gym trainers, masseuses, and orthopaedic doctors. (Who knows where chiro got its memes from?)

When the nervous system is considered at all in orthopaedic thinking, it seems to me it's only ever in terms of its output, and then only into muscles, that which can be "controlled" through acts of strengthening or will, i.e., "neuromuscular." There is rarely any work done or books written about the other side of the coin, sensory input, or what can happen to actual sensory fibres of nerves, physically, except for Shacklock and Butler. No one ever considers skin, how innervated it is, how sympathetically driven it is, how kinesthetically sensitive all the various levels of brain function are, how completely obedient the various levels of output (including pain output, motor output) are to miniscule amounts of sensory input, how the brain immediately engages with it, interprets it, expresses new output as a result. An understanding of sensory input into an intact NS from another nervous system could make our lives as PTs/professional human primate social groomers way easier and less cumbersome, and abolish a whole lot of excessive trappings/techniques/treatments. Something huge is missing!

My concern is about a significant perspective which is simply lacking in this whole mesodermally mad cognitive world we work in. The ortho part of the profession seems to only recognize half a picture, like the world certain stroke patients live in, those who ignore half the food on their plate because they can't perceive it, just aren't aware it exists. Most PTs have either wittingly or unwittingly decided to accept this state of affairs as normal! Sometimes I despair. That's all.

Monday, September 18, 2006

The Human Organism is a Verb, Not a Noun

The title for this entry is based on Michael Shermer's comment in this Salon.com piece that "science is a verb, not a noun." Thank you for that idea, Michael Shermer. I am going to borrow it for other applications - I hope that's all right with you.

I went to see the BodyWorlds exhibit Sunday morning and was, as I expected, blown away. Certainly there were throngs of people, more than I've seen all in one place at Scienceworld in a long time, more than one would ever see at a science exhibit probably, in Vancouver at least.. the crowds tend to gather for music festivals instead. But here were people, hundreds of human primates all patiently lined up, thoughtfully gazing, murmering to each other in hushed tones, closely examining the most spectacular array of carefully prepared, formerly live human bodies the public has ever seen.

I went to see nerves.

There they were, well preserved and displayed on most of the specimens, flowing downward and inwardly spiralled around the limbs, around and through equally spiralled muscular parts.

The Gunther von Hagen preparations were dynamically displayed. Through the audio device I listened to how von Hagan had decided to place the specimens into lifelike poses after an exhibition in Japan, where people had complained that the standard anatomical positions used made the plastinates look too stiff, "like ghosts."

Regardless of how they came to be in these athletic looking poses, the bodies look amazing. The nerves are clearly visible, especially their relationships at knee and elbow in flexed poses, and through windows strategically cut out of the body wall to permit a view in to the plexuses.

On the body wall the nerves are surprisingly large. I've always thought I could palpate them, but wasn't quite sure until I saw how thick they are, and how they angle downward and obliquely out over the wall, under the skin, in 90Âș angles to the fibres of the latissimus muscle over which many of them pass.

According to the audio program, there are 45 miles of nerves in the human body, running everything. As the peripheral nervous system reaches the lower parts of the extremities the nerves become more numerous, carefully tucked up into hands and feet.

This is an opportunity to see how our human physicality is constructed, while simultaneously beginning or continuing the process of meditating upon the end of personal existance. This exhibit facilitates both. I'm so glad I live in a time when it exists, and under circumstances in which it's possible to see it, contemplate it. Take full advantage of this opportunity. It's a beautiful thing, to be in a human body, being. Doing.

Friday, September 08, 2006

Expert mind

I am currently reading/absorbing this article from Deric Bownd's blog, originally published in Scientific American, Expert mind, which discusses what is involved in a mature mastery of a given skill set of any kind. A chess master named Capablanca, who won 168 matches in a row while on tour in 1909, said, ""I see only one move ahead,.. but it is always the correct one."

When treating a nervous system, when treating "pain", this is all that is necessary. The nervous system is smart enough to unlearn the pain is has been outputting, providing the pain isn't pathological, merely persistent. One can be an "expert" at anything, including human primate social grooming.

Thursday, September 07, 2006

Mindblog: Deric Bownds

I was recently sent a link to this fine site whose author is Deric Bownds.

I'm luxuriously lapping up all his archives these days, which is enough to keep a thinking person busy for weeks. He seems to be interested in providing thoughtful high quality information about the brain, mind, and consciousness from many sources, plus creating a continuous and seamless stream of his own writing and essays. One of my favorites so far is The Beast Within, an overview complete with images of all the layers of brain we have accumulated throughout our evolutionary development, how they function in all of us.

Also linked in his blog is a google video (about an hour long) featuring Alan Wallace, discussing how science might want to get around soon to concerning itself with first person phenomena such as introspection and contemplation.

There is an online book available, called Biology of Mind, for all who deal with people and/or with peoples' nervous systems for a living. I've linked him into the index as well. Enjoy.

Wednesday, August 30, 2006

"I Have a Meme..."

A PT colleague in Nova Scotia just wrote this resounding echo of Martin Luther King's famous speech on a discussion forum called SomaSimple.

It speaks to the effort people on that board (and I'm proud to count myself among them) are making to try to wake up our broader human primate social grooming community to the simple fact that nervous systems run bodies, that manual therapy researcher/clinicians spend far too much time obsessing over mesodermal minutiae and constructing science projects designed to flatter themselves and their mesodermal obsessions, Balnibarian-like. (You might remember Balnibarians from Gulliver's Travels. They specialized in inside-out and backward science:)
After requesting to leave the island, Gulliver is lowered to the continent of Balnibari and enters its metropolis, Lagado, where the crops are poorly managed, people wear ragged clothing, and the houses are in bad condition–except for the house of the governor of Lagado. He tells Gulliver that 40 years before, some Lagado residents visited Laputa and came away with a smattering of mathematics that caused them to undertake bold scientific projects and other heady enterprises. They even built an academy in which to carry out their projects. Now every town in Balnibari has an academy, and the people spend most of their time conducting experiments. For example, at the Academy of Lagado, scientists are attempting to do the following: extract sunbeams from cucumbers, turn human feces back into food, erect buildings from the roof down, plow farmland with pigs, make marbles soft enough to stuff pillows and pincushions, breed sheep whose entire bodies are bald, and have students learn mathematics by swallowing wafers on which formulas are written.
.......So absorbed in these enterprises are the inhabitants that they avoid taking part in almost all other activities.


A lot of the participants on this discussion board, SomaSimple, including me, just shake our heads and wonder what on earth we are doing in this profession that tests our sanity so, a little community of skeptics with the odd true believer thrown in to keep things rolling along (every discussion board needs dissent to keep it alive, I suppose). It's the small version of larger debates going on everywhere among those who like to think and those who want to simply believe.

Sunday, August 20, 2006

Re-membering the Forgetting

PTs go to university to learn what there is to know about the human organism that can be applied to helping it improve its function. We all learn anatomy, physiology, pathology, neuroanatomy..

When we graduate, only those of us who end up having a talent and proclivity for "Neuro", a contracted concept that for us means treating patients who have profound functional deficit, profoundly damaged nervous systems from birth or through trauma ... only these graduates ever stay caught up in neurosciences. Metaphorically we all land on the same beach, then a stalwart few head inland to climb steep mountains.

The rest gratefully exhale post-graduation, allow their info base on neurosciences to drop away, erode, disappear, and turn their cognitive hard drive to learning more about biomechanics. They turn their attention to the stuff of the body, the mesoderm, under a large conceptual umbrella called "Orthopaedics", splitting off from the true functional organizer of the body, the nervous system. Metaphorically, these are all the ones who stay by the water and build piers out into it, preferring beach life, the equivalent of treating a host of issues in tissues that (mercifully) they can classify and reclassify to their hearts' content; the nervous systems of the people they treat are usually intact.

But what is gradually and steadily coming in like a tide is pain science. The pain science advance is forcing the beach boys and girls to pack up all our previous cognitive and conceptual gear and move further inland, closer to where our Neuro colleagues make their livings.

I say "our." I was a beach bum too, for a long time, although I like to imagine I'm already a bit further inland than some. It has only been in the last 10 years or so (out of a 35 year long adulthood as a PT) that I have learned to see pain sciences as a link that will (potentially) one day unite the profession, maybe all manual therapies, into a deeper level of real understanding. There are lots of other PTs on the same path, who have been on it much longer, and are much further along. Some are even working to widen the path.

Of great additional benefit to this whole scientific deepening of the profession would be a much deeper appreciation for EvoDevo, something our hands-on social grooming professions currently lack. If understanding human pain means having to grasp understanding of the human nervous system in all its complex multi-faceted glory, it will also mean understanding the place humans occupy in life itself, not just in multi-varied human culture.

Saturday, August 19, 2006

C fibres and Autonomics

In this short essay, Kevin McHenry of
www.painonline.com
examines a likely culprit in the persistent pain circuit.

Friday, August 18, 2006

DermoNeuroModulation

At last, after several years of probing, searching, trying on and then rejecting one name after another for what I physically do with patients' bodies, trying to encompass the whole of the nervous system and the whole of one's interaction with it within a single name, I've settled on dermoneuromodulation.

It has these main important inclusions:
1. The "neuro" portion is the most important. It provides the concept that the nervous system is central to any treatment interaction, at any and at every level, the whole way from the attempt to include only slowadapting non-nocioceptive stretch receptors (Ruffini endings in the skin), to answering any and every question a patient may have, to providing an overview of how the nervous system works and how pain is generated, as a standard part of every encounter with every new patient.
2. The term "modulation" is what the nervous system is doing in response to an input. It modulates itself in response to any sensory input. It does this continually from its initial formation in utero until the moment it dies, at whatever age one dies.
3. The prefix "dermo" means, sensory input through the skin, kinesthetic sensory input. Other prefixes mean other things. For example "psychoneuromodulation" would lean more toward describing psychological input that could result in modulation delivered to the human organism via the (cultural, social) mind, as opposed to kinesthetic input that could result in modulation delivered to the human organism via the physically sensing brain. Not that both couldn't happen simultaneously, or don't all the time in manual treatment. (If we try to pretend they don't we're kidding ourselves.)

It has these important exclusions:
1. It is a brand new word combination that I've seen nowhere else.
2. It therefore carries no baggage.
3. It will never (as long as I am in control of this new meme I'm introducing) contain anti-scientific or pseudo-scientific ideas.
4. Most importantly, there is not a speck, not one hint of any reference to any mesodermal derivative embedded in this term anywhere. This means;
- no mention of mobilizing of any joints
- no reference to moving bones
- no suggestion of releasing fascia
- no talk of muscle lengthening
If any of these things happen during or after dermoneuromodulation, fine, but any changes in any mesodermally derived tissue will be as a result of the brain/nervous system of the patient in question deciding to modulate itself to allow such a thing to happen, not a direct result of a practitioner's applied force.

I have spent years working my way out of confusing conceptual traps by learning all I can about how the human organism with an intact nervous system actually works, how it can end up in trouble (i.e., pain), how it actually interacts with another system (e.g., mine) to its own benefit. The hits now outweigh the misses by far, because my own nervous system (including my own mind) and motor output has adapted over many years, has become the best possible human primate social grooming nervous system it can be, has learned to be slow and gentle and patient on the one hand, nitpicky and precise and persistent on the other, when treating other nervous systems.

This naming process has been a long time coming, mainly because those exact same personal traits carried over into it. It feels like a long-awaited birth has finally occurred, but (thankfully) not as exhausting as the teaching experience was.

Monday, June 26, 2006

Teaching

I'm awfully tired, pleasantly exhausted actually, after experiencing my very first teaching encounter, yesterday. The whole subjective resistance/inertia I've always felt about assuming the role of "teacher", of all the bits and pieces of personal history, self-esteem/vulnerability issues, simple laziness, conflicting feelings about the profession itself and my personal role in it, deep philosophical questions regarding the point of being here in human form at all, had all ended up jumbled together in a vague inner shadow aspect that I came to recognize and term "the daunt factor." Once I had a name for it, the clear task I faced was to overcome it and free my inner "teacher." Funny how we set ourselves up for deepening into life...

I took a first baby step, by selecting some interested and friendly people to teach, offering to teach them for free the first time, just so that I could practice getting past just the first inner obstacle (the first of many, all seeming insurmountable); that of actually organizing my own thoughts/gleanings on treatment and speaking them in real time while on my feet with people looking at me. Note that these tasks/challenges are motor-cognitive in nature.

It's the first time I had ever put myself in the category of "instructor", standing up in the front with a bunch of markers in my hand, making drawings and explaining things in real time to others who occupied (my previous and much preferred) category of "student." I feel like I've just experienced a trip, not just into, but clear to the other side of The Void. I feel discombobulated inwardly; in retrospect my mirror neurons took quite a beating when I reversed the familiar role play, but otherwise I seem to be fine. I didn't uncover any wellspring of inexhaustible energy, any sudden appetite for external glory and fame, any passion for being in the spotlight, or even any previously undiscovered proclivity or ease with being extroverted. Alas. Attributes such as these may well have more easily flattened both inward and outward obstacles.

I have still such a long way to go. None of this comes easy or naturally to an introvert like me, content for so long to sit, learn from others, ruminate, think and treat. I'm taking the pleasant exhaustion as an inward clue that the experience was growthful in some important way, to me as a person if nothing else; exactly how, I've yet to understand, conceptualize, or be able to explain to myself.

The students were Eric and Cory, thoroughly attentive, never seeming bored and never fidgeting much to my everlasting gratitude. We went straight from 8 AM to 7 PM with just one short break for lunch. I showed them all my best basic moves and they practiced on each other.

These two nice guys were simultaneously supportive, objective, and clear in their feedback about the instruction and material, and Eric even volunteered to be an assistant if I decide to teach again to a large class, so I'm not sure why today I feel like I'm in some sort of subjective dark burlap sack regarding the quality of the job I did or necessity of the role I took a stab at or the value of the material itself in the long run or the overall need of the profession to maintain any connection to its humble hands-on origins. Maybe it will all become clearer to me in days to come. Maybe all 'teachers' feel like this at times. Maybe the only meaning or value of any of this material is what I decide to assign/what the learners of it will assign.

Friday, June 09, 2006

Upside-down tree

One can view the human nervous system as an upside down tree: the "rootball" where "nourishment" is taken in - food for the body, oxygen for cellular respiration, stimulation for most of the senses - is at the top. The trunk is in the center, and has many branches, just like a real tree - an "espaliered" tree at first, then unpruned, expanding everywhere, and then .. some genetic programmed process stops tree's growth /branching and puts it in stasis for a lifetime.

These branches go everywhere, are multiply twigged, with a "leaf canopy" that ends up embedded in skin.

Skin is not “just” a 15-20 pound protective film wrapped round the outside of the body like living saran wrap. It has three dimensional structure. It is a sensitive raft floating on a sea of subcutaneous liquidy fat, tethered to a deeper layer of fascia by means of tough skin ligaments, hundreds of them, dense macroscopic structures that defy gravity (for a few decades anyway..). These ligaments permit movement in every direction, but not a lot of movement in any direction. Many of them are tubular, serving as conduits that convey vasculature and nerve to and from skin.

Skin is filled with varying proportions of different nerve endings, each with specific messaging capacity that can give the sensory cortex a layered perspective of how the skin is being contacted by the environment. The CNS can measure "threat" value, based on this incoming. Skin has palpable "behavior", all of it autonomic outflow in nature, enacted by smooth muscle effector cells. Through skin one can palpate tension in underlying structures. By interacting with skin, one can indirectly affect such tension toward improvement, greater overall relaxation of the organism, deeper breathing.

How is this possible? I maintain that if blind people can learn to "read" Braille, interpret a symbolic language based on a predictable system of raised dots on paper through senstive fingertips, allow their visual cortex to be taken over by kinesthetic interpretation, so can manual therapists use this same brain system to feel through someone else's physiological nervous system functioning by learning to "read" skin/motor response behavior. This has the added bonus of being an interactive form of "reading." Butler says, "Remember that just as you are sampling another's nervous system, their nervous system is sampling yours."

Skin performs many physiological functions, but from strictly a nervous system perspective, in light of what we want to do with it, we could view it as part of the brain’s sensor array, a “periscope” that completely surrounds the submarine of the brain, a window or door directly into the sensory cortex of the brain. To be invited all the way in, we must treat it respectfully and not barge our way right through it as if it did not exist as an organ of sensitivity in its own right. By attending to skin properly we can sway the patient’s nervous system to our intentions easily/effortlessly, and also, and more importantly, to the patient’s own non-conscious corrective mechanisms - correction away from a pain state. In the Melzack/Wall pain paradigm, you can minimize “threat” enormously, by handling skin properly.

It is useful to remember that both skin and brain and in fact all the nervous system, and the initial burst of immortal germ cells, all derive from ectoderm proper. In addition, early on, ectoderm gives rise to mesoderm, which makes everything our system uses to hold itself up and move along.. bones, muscles, blood, tendons, ligaments. Mesodermal structures are forever subservient to those of ectoderm, give ectoderm 'leverage' against the other forces in nature; by themselves, without a living tree existing throughout, they are just meat, matter, material.

Nerves themselves have their own "bark," or equivalent of "skin", a sensor array that protects them, called the nervi nervorum, intertwined with the feeding system to the nerve, called vasa nervorum. This signalling system lets the CNS know about potential problems before they develop, in particular any fall in oxygen levels (hypoxia). It is postulated by Butler and many others that a great deal of benign pain problems stem from simple local hypoxic conditions out in the "bark," about which the brain's alarm system has become sensitized.

Through skin, and by handling actual physical arms and legs and parts thereof, the living tree branches (neural structures) can be tugged, bowed, rolled, even slid through their mesodermal neural tunnels. This physical action changes internal juxtapositions of nerve container to nerve, and improves conditions sufficiently to allow new input to the CNS. The new input must be sufficient to allow the CNS to change its "output" (i.e. pain state) but not sufficient to cause it any threat, which would perpetuate and even compound the problem.

One of the perplexing attributes of the central nervous system is the way it has control of the volume knobs on pain; any little twig anywhere, trapped and hypoxic, can result in a pain state that seems way out of proportion, and which can be felt anywhere else. Furthermore, the CNS can create pain all by itself, as it does in cases of amputations and spinal cord injuries (phantom pain). One of the desireable attributes of a good manual therapist is that she or he knows this, will take a good history, and if the patient seems suitable, will comb through the neural tree, using his/her own developed kinesthetic senses to locate and help restore motion to anything that feels like it has less than adequate slide. S/he will use only enough force to get the job done and no more, all the while realizing that the CNS uses skin as a huge magnifying tool for all incoming, that it has its own perspectives on all incoming based on its own history of encounters with life outside itself. What if the patient is not a good candidate for manual therapy? A good manual therapist who is also happens to be a physiotherapist will have other hands-off ways of helping; listening, movement therapy, education, reframing, and encouragement.


Sunday, March 26, 2006

"Nature via Nurture"

I'm busy with this book at the moment, by Matt Ridley, and am otherwise deep in personal study of embryology, how the body plan starts the unfoldment of its eventual self (once the proctodeum/stomodeum is in place) from the neck down and neck up at once, not in any linear manner but three- dimensionally.

This comment in his book (p. 33) has taken hold at the moment, made in the context of remarks about how few genes we have (30,000) compared to how many we had guessed we had (100,000):

The beauty of the system is that the same gene can be reused in different places and at different times simply by putting a set of different promoters beside it... To make grand changes in the body plan of animals, there is no need to invent new genes, just as there is no need to invent new words to write an original novel... All you need to do is switch the same ones on and off in different patterns. Suddenly, here is a mechanism for creating large and small evolutionary changes from small genetic differences. Merely by adjusting the sequence of a promoter, or adding a new one, you could alter the expression of a gene. And if that gene is itself the code for a transcription factor, then its expression will alter the expression of other genes. Just a tiny change in one promoter will produce a cascade of differences for the organism. These changes might be sufficient to create a wholly new species without changing the genes themselves at all. (Carroll, S.B. 2000. Endless forms: The evolution of gene regulation and morphological diversity. Cell 101:577-80)

I very much like the idea that timing and context are just as important as actual matter or code in this regard, just as much as they are in any regard.

Saturday, February 25, 2006

Rules for flying

(These are from an email, one of those ones that gets sent around.. you know.. usually without any lasting merit. This one however caught my eye. I liked how applicable much of it is to life in an ordinary human antigravity suit.)


"Rules Of The Air"

1. Every takeoff is optional. Every landing is mandatory.

2. If you push the stick forward, the houses get bigger. If you pull the stick back, they get smaller. That is, unless you keep pulling the stick all the way back, then they get bigger again.

3. Flying isn't dangerous. Crashing is what's dangerous.

4. It's always better to be down here wishing you were up there than up there wishing you were down here.

5. The ONLY time you have too much fuel is when you're on fire.

6. The propeller is just a big fan in front of the plane used to keep the pilot cool. When it stops, you can actually watch the pilot start sweating.

7. When in doubt, hold on to your altitude. No one has ever collided with the sky.

8. A 'good' landing is one from which you can walk away. A 'great' landing is one after which they can use the plane again.

9. Learn from the mistakes of others. You won't live long enough to make all of them yourself.

10. You know you've landed with the wheels up if it takes full power to taxi to the ramp.

11. The probability of survival is inversely proportional to the angle of arrival. Large angle of arrival, small probability of survival and vice versa.

12. Never let an aircraft take you somewhere your brain didn't get to five minutes earlier.

13. Stay out of clouds. The silver lining everyone keeps talking about might be another airplane going in the opposite direction. Reliable sources also report that mountains have been known to hide out in clouds.

14. Always try to keep the number of landings you make equal to the number of take offs you've made.

15. There are three simple rules for making a smooth landing. Unfortunately no one knows what they are.

16. You start with a bag full of luck and an empty bag of experience. The trick is to fill the bag of experience before you empty the bag of luck.

17. Helicopters can't fly; they're just so ugly the earth repels them.

18. If all you can see out of the window is ground that's going round and round and all you can hear is commotion coming from the passenger compartment, things are not at all as they should be.

19. In the ongoing battle between objects made of aluminum going hundreds of miles per hour and the ground going zero miles per hour, the ground has yet to lose.

20. Good judgment comes from experience. Unfortunately, the experience usually comes from bad judgment.

21. It's always a good idea to keep the pointy end going forward as much as possible.

22. Keep looking around. There's always something you've missed.

23. Remember, gravity is not just a good idea. It's the law. And it's not subject to repeal.

24. The three most useless things to a pilot are the altitude above you, runway behind you, and a tenth of a second ago.

Sunday, January 29, 2006

"Proprietorship" ?

I came across a chiropractic website recently whose creator, based in Oregon, has decided to appropriate the term "Neuromodulation Technique", own it, and move to protect it, apparently so that he can develop an empire of training and a stable of trained practitioners to help him move forth comfortably well-off into the future. From his site:
Neuromodulation Technique is a proprietary system of health care based upon a method of accessing and assessing the autonomic control system of the patient through muscle response testing utilizing verbal and/or non-verbal semantic questions and statements.

We use a unique form of muscle response testing as one convenient tool to query the ACS, thereby determining the errors in the way the ACS is controlling the body. Specific query statements are codified into NMT clinical pathways that constitute algorithms created to address particular areas of physiology like allergy or sensory/motor function. Based on the information derived by applying this investigation of the patient, these treatment algorithms define corrective information with with which the NMT practitioner is able to semantically reprogram and debug scripts. This process is further augmented and reinforced with percussive, or other stimulation of vertebral segments, specific breathing patterns, and other sensory stimuli. It is based upon widely accepted neurophysiological models. There are no vials, special reflex points, or potions used. It is the NMT proposition that the closest analogy to the human nervous system is the computer.

The NMT method is based on generally recognized principles of neurophysiology, physiology, psychology, linguistics, and anatomy. NMT constitutes a unique and proprietary system of health care protected by applicable laws United States copyright, and trademark laws. Patent is pending for the NMT process.

I have rolled this discovery around in my mind for a few weeks. As I read through the site I noted that his path has been through chiropractic training, and then through various winding "energy" trainings. It seems he did some reading, had a bright idea one day, and is now taking the term "neuromodulation" to mean (as near as I can make out) justification of "energy" techniques by calling them "neuromodulation technique", and furthermore, he wants to lay claim to the term, as if its origin had something to do with him personally. ("Shoehorning" is a word that comes to mind..)

In any case, ahem.. I beg to differ. Neuromodulation is a term that describes something quite specific and scientific, i.e., changing an input into the nervous system to facilitate a change in its output. Period. No one else to my knowlege has ever laid claim to the term especially in order to protect some perceived financial interest.

This article, Reality Check, will help those who are confused about what "energy techniques" are, to gain some perspective. A brief foray into some self-education about what pseudoscience entails, might be of interest. This page contains more information about pseudoscience. In particular, note the blue comparison columns further down the page. Here is another perspective on pseudoscience from Wikipedia. It contains many useful links, including one to Occam's Razor, a pithy term used in science to describe whacking away superfluity and decide what is a worthy basis for further investigation and what is not. Here is yet another link to a page that distinguishes pseudo from actual science.

A point I would like to make is that no one can "own" a term that describes something scientifically specific. This ambitious practitioner may be able to own the term "neuromodulation technique" as defined by himself, i.e. as a catchall term that covers "energy" treatment, e.g., one form of which used to require the purchase of vials of special water for the patient to hold, from which it could be determined (somehow) what the "diagnosis" was... and when the practice to "neuromodulation technique" suddenly purchase of said vials is no longer required..

... but he can't own a clear chunk of English that has a scientific meaning and is used within those parameters.

I will continue to call myself "Neuromodulator" and I will continue to argue for the term "neuromodulation" to be a free word without commercial strings attached. As long as the practitioner in question continues to attach the term "neuromodulation" as an adjective, modifying his own particular methods i.e., a noun, "technique," I will have no further quibble with him.

In closing, I would like to draw attention to this excellent essay, written by a British physician, entitled The Sea Monster and the Whirlpool which may be able to give you a glimpse of the seas science-based and science-respecting practitioners have to navigate.

Finally, I want to state that this chiropractor individual and I have nothing whatsoever to do with each other, and that's how it shall remain.

Monday, January 02, 2006

Homunculus

Why do the sensory and motor homunculi in the brain that represent our bodies appear upside down, scrambled, and distorted compared to how our bodies actually look? By incorporating embryologic information the puzzle can be solved to a large extent.

In general, as an embryo grows the body plan expands forward/upward (rostrally) and backward/downward (caudally) from the bottom of the brain. The area of the top of the neck/ bottom of the brain could therefore be considered a starting point, a ground zero, once the embryo has curled into a three-dimensional form: Certain structures are built there and drop down later, like the heart and diaphragm and beginnings of the gut, while the brain grows up from there.

It is useful to know first, that the brain develops medial to lateral, growing up and forward from its floor and expanding/falling outward to the sides: I propose that the homunculus is a mapping of developmental biology: As the 'unfoldment of the antigravity suit' proceeds out in the periphery, its progress would appear to become “registered” by homuncular “maps” of the body in the central nervous system. Picture the homunculus diagram draped over the cortex; think of travelling along the homunculus from its oldest represented body part on the outside bottom part, up and around to its most recent represented body part deep inside the medial sulcus.

As the gut tube starts to form, the anus end (proctodeum) forms first, then the mouth end forms (stomodeum) and a curtain is dropped down right away to separate the two; the rest of the gut will be built over the next several weeks, and these two end zones that are already in place will become widely separated. If you look at the cortical homunculi the anus is there on the outside of the brain, in number one position, the first (and most lateral) place, 'under' the number two part, the pharynx. The genitalia, bottom of the trunk, and legs form last in the embryo. We see the latterly formed body parts represented inside the medial sulcus. Embryology can help explain why anus and genitalia representations are so far apart on the cortical representative maps.

Anus is ectoderm, and has an obvious place in the sensory cortex. We need to be able to "sense" the process that happens there, and have some sort of conscious motor control of it, so that we can 'hold it' until we're not busy with something else. It likely evolved this way for all sorts of predator/prey, ‘waiting until we got away from danger’ sorts of reasons; however convenience is certainly an important feature in species that are as social as primates and humans, and appreciated in our companion species, e.g., dogs.

Next to develop is the neck and head, a big investment of time and embryonic resources. The neck, throat, mouth, face, rostral sensing apparatus (eyes, ears, nose, tongue), swallowing and breathing parts have to be built right, or survival will be drastically curtailed. Hence the throat and big lips/tongue/face on the homunculus, right after the anus.

At the 'top' of the brain maps are found the trunk and arms. Developmentally the hands poke out the neck zone first, and develop thumb first/little finger last. Then the arms grow longer, distal to proximal. All of this appears in proper sequence of ordinary depiction of the homunculi.

The trunk takes up little space on the homuncular maps. Why?

Anatomically a lot of trunk, the spine at any rate, (both representatively in the homunculus and anatomically in the actual body) is "covered up" by or overlapped with lats which are 'arm' muscles and traps which are branchiomeric (from the neck or cranium) muscles.

(I can't help but think it must be a bit confusing for the motor homunculus when the sensory homunculus has input from little dorsal cutaneous branches sticking out to the surface of the back, feeling the environment just fine, but the muscles that are run by the motor branches of those same nerves are buried completely by superficial sheet muscles. Could that be why back pain is so common?)

Legs come later after arms. My theory develops a problem here: I'm not sure why the knees are depicted curling around the central sulcus; feet and genitals are depicted close together, but feet come some time prior whereas genitalia is last to develop along with the thighs.

The feet actually form before the legs do, two little feet sticking out of the sides of the trunk with some primordial gentalia beween them. Then the feet shoot out from the body, carrying the peripheral nerves with them, and the legs grow to catch up, distal to proximal. Their representation is always shown down inside the sulcus. Perhaps the gentalia belongs there as it develops last of all, but I think on the homunculus the legs/knees should come after the feet, not before.

For my little theory to remain consistent with reality, more advanced future mapping will have to show arms and legs depicted as telescoped concentric rings, maybe ovoid, with the hands and feet in the center, all the rings touching on the lateralmost side. I would expect the representation of genitalia to be overlapped with the thigh representation, the medial side only.

In summary, the representations make more or less embryological sense just as they are. They can be reasonably considered a map of the body in the logical sequence in which it selfbuilds /unfolds, in both the classic sensory and motor cortical homunculi.

Motor activity is believed to be present before sensory pathways are built, so the sensory homunculus either may take its cues from the motor one right from the time of the unfoldment sequence, or possibly a lot of it is hardwired right from the start and simply awaits myelination.