Thursday, August 22, 2013

The Skin as a Social Organ: Part 1: Dual nature of touch: as PTs, do we "get" this?

The paper, The skin as a social organ
Previous introductory blogpost to this series.

Preamble: Random thoughts on spas

The first paragraph of the introduction is as follows:
"The sense of touch helps us to discriminate the location of a stimulus on the skin surface, to explore objects haptically, and to identify and manipulate objects. It also contributes to an integrated sense of our own body (see Serino and Haggard 2009). However, the research emphasis on these wide-ranging functions of touch leaves out a very essential fact: touch can also be pleasant. This aspect of tactile sensation is at the heart of the social domain, allowing positive hedonic experience ranging from the reassurance of a pat on the back to the rills of a sensual caress."
You really think this wouldn't need to be spelled out so clearly, yet, when I look at what my profession has become, what its human primate social grooming has turned into, I can totally see the point of how necessary it is to be firmly explicit on this: Touch says things to brains. Brains soak up all sorts of impressions from touch. Be kind. Have kind touch. 

The first reference goes to: 
Serino A, Haggard P (2009) Touch and the body. Neurosci Biobehav Rev. Volume 34, Issue 2, February 2010, Pages 224–236.

I found the authors. 
Andrea Serino is in Bologna, Italy, in the Department of Psychology. His research focuses on 
"multisensory integration, with special interest for visuo-tactile interaction; representation of body space and peripersonal space; relationship between tactile sensation and body representation; plasticity of spatial representations due to experience; brain plasticity following brain lesions and cognitive rehabilitation; rehabilitation of hemi-neglect with prism adaptation; rehabilitation of cognitive deficits following traumatic brain injury."
I don't know if ALL these papers are to do with him.. a quick search yielded 1750 results. There may be more than one guy with the same name publishing.. but if it is this one guy, he has published or co-authored 87 papers this year alone. Rather prolific, to say the least.
Wow. That is just one guy. 
There is an absolute TON of research out there on how the brain puts its inputs together. 

As therapists, even if we are physical, we should at least know this kind of research exists. No? 

Maybe we should even read some of it, some day, instead of being overly reductive in our so-called "science," too biomechanical, trying to re-invent the wheel by shaving even more of it away until it's square and won't even roll. 
(By me, Aug 22/2013. No copyright)
My point is, there are rafts of research on how the nervous system takes care of itself and its own organism just fine. We don't have to turn our profession into a huge make-work project. Or if we do, we could do it an easier way. 

Yet, I suppose it's necessary to test all these assumptions even if only to show that they don't work. Not when facing an opponent as wily as pain. 

But I digress.



The other author is Patrick Haggard. He works at Institute of Cognitive Neuroscience & Dept. Psychology at University College London. Assuming Pubmed knows the P. Haggard I'm talking about, the list of papers he has contributed to comes to 245, not too shabby. His list of research interests include "Voluntary action. Motor cognition. Touch. Somatosensation. Self-representation"

Pretty succinct list, vast amount of room to manoeuvre. 

Anyway, let's take a peek at the paper itself, Touch and the Body, at least the abstract. 
Abstract"The dual nature of touch has long been understood. The sense of touch seems to carry information at the same time about the external object touching our skin, and also about our body itself. However, how these two interact has remained obscure. We present an analytic model of how tactile information interacts with mental body representations in the brain. Four such interactions are described: the link between the body surface and the maps in primary somatosensory cortex, the contribution of somatosensory cortical information to mental body representations, the feedback pathway from such higher representations back to primary tactile processing in somatosensory cortex, and the modulation of tactile object perception by mental body representations."
Goodness me. 
Look how complex simple touch is. Just in this one abstract, 4 interactions right inside the brain of the person being touched!

Dual nature. Information about an external object and the body itself, being touched. Exteroceptive input and interoceptive input, from a single touch. 
That's huge, right there. 


Here we are, the profession most accepted as therapists who touch people. Why are we not grounded from day one in information like this? Yeah.. I know. There is only so much time, curricula have to be delivered,  exams prepared, students taught, exams corrected, people who are considered "safe" (or at least not overt hazards) cranked out into the world every few years with a license to touch people. 

Yeah. I get it. The world needs us, or at least people like us. I just wish we were cranked out better prepared to handle actual alive awake people with pain, not merely prepared to jiggle joints, stretch limbs, worry about posture, biomechanics, etc., as if they were the primary problems.. They are just nervous system output. They aren't really "things" to be "fixed" the way we are encouraged/brainwashed to think of them. 

Shouldn't we be given glimpses of this situation? What are we? Aren't we being sheltered as a profession from the very information that could, if we let it, turn us into better kinder more comprehending therapists? Make us more ... therapeutic maybe? 

OK, rant over for now.

Next, back to The Skin as A Social Organ, second sentence. 

EDIT: Back in to add a link to a blogpost by Kenny Venere, REDEFINING ‘EVIDENCE’ IN EBP: WHY “IN MY EXPERIENCE” DOESN’T CUT IT. His reference list is extensive and fabulous. His post points out (in the literature!) everything I was trying to say in the cartoon I built, about how useless square wheels are. 

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