On ABR and beyond...

9 Valuable Lessons for Cerebral Palsy out of a Single Incident of a Broken Leg

2012-02-27T14:42:15+02:00

This post might seem as a departure from matters of Cerebral Palsy – but it is definitely – not.

On opposite, I hope that you can see this as the opportunity to understand the fundamentals of rehabilitation domain much better once you have the exposure to the other side of the spectrum – how the surgery and physical therapy handle ‘regular’ fractured bones.

It is really important for you to keep in mind that – all the concepts, diagnostic criteria, best practices and tools of both orthopedic surgery and physical rehabilitation were forged and tested in the field of dealing with fractures, bone and joint displacements, muscle tears etc.

For instance I mentioned a number of times before – that deeply ingrained belief of physical therapy in the benefits of stretching and in the ability of a therapist to restore the proper mobility via stretching – stems from the practices of dealing with muscle contractures that follow the immobilization.

That’s where stretching works the best and every experienced physical therapist has an entire collection of ‘victories’ over contractures behind his or her belt. They witnessed with their own eyes how a severely restricted leg mobility consistently gets improved via stretching until full recovery within weeks.

That’s the experience and the expectation they transfer into the Cerebral Palsy field including quadriplegic Cerebral Palsy. What happens then? – First, they see some 10-15-20% of range increase – they celebrate it and reinforce their believe in being on the right course. Second, when the range increase comes to a halt – they start blaming it on the spasticity and brain injury.

Therefore, when a friend of my son had his lower leg bones fractured in the go-cart accident – I waited for few weeks until he got out of pains and decided to seize this opportunity to illustrate the essential differences between the orthopedic handling, physical therapy, rehabilitation and recovery of a healthy person after a typical injury to a musculoskeletal system – in contrast to the most important specifics of the challenges experienced by Cerebral Palsy kids especially in quadriplegic condition.

I hope that you are going to find this being a valuable perspective that will improve your understanding of the priorities for your own child and have a clearer focus of where you need to put the most of your efforts.

P.S. As always – please let me know what you think and whether this perspective is helpful. Don’t forget the ‘Like’ button as well.

Transanatomical Birthday Present – Meeting with Dr. Jaap van der Wal

2012-01-26T04:29:19+02:00

What is the best birthday present a person can get? – Well, there are many facets to that, right?

First of all – I want to thank all of you – my Facebook page and e-mail were full of birthday wishes and cards. I really appreciate that and it means a lot to me…

But today I wanted to talk about a different and very special present. Finally I know the answer to what really is an incredible birthday present :-)

Obviously I can only speak from my own weirdo perspective – but this year I have really got treated to an amazing birthday present… a 2-day long 1-on-1 meeting with a person I consider a bona fide genius – Dr. Jaap Van der Wal.

His insights lifted me out of one of my deepest and longest standing frustrations (obviously without knowing it – I was just one of 100s of people in the audience when he talked from the stage).

What frustration am I talking about? – well, the one that is central to the entire medical and biological discourse of today.

You see, there are two camps out there and the rift between them is of a Grand Canyon size.

One camp is a mainstream medicine and biological science. These people are the ‘sub-anatomical’ camp. Anatomy emerged in 16^th century as the so-called gross anatomy (dissecting the body into “big”, “visible”, “obvious” parts – 600+ muscles; 200+ bones etc., 1 liver, 2 kidneys etc.)then through the centuries and technological advances each of those specific organs were divided further into sub-parts – first into the lobes and regions, then into the specific cells, then into organelles and so on – until reaching the modern day level of biochemical reactions, gene expression etc.

Sub-anatomical camp gave us drugs and surgery, which are the essence of modern ‘scientific medicine’. Modern medicine deserves a lot of credit for its ability to save lives and deal with injuries and infectious diseases – but at the same it is quite obvious that when it comes to the ‘big picture’ this “shredding” sub-anatomical camp has got it wrong – the continuity of the organism is lost in the feverish chopping into yet smaller parts... Chopping goes easy but the connection doesn’t come together very well.

That’s why when it comes to complex chronic conditions –modern medicine is in crisis – not only as extreme as Cerebral Palsy but even as mundane as common back pain, which presents and insolvable problem to modern day medicine.

As a parent of a child with Cerebral Palsy you have the misfortune of frequent communication with one of the most simplistic and aggressive clans within the sub-anatomical camp – orthopedic surgeons who drag your kids into hip, feet and spine chopping…

`On the other side of the divide CAM – Complementary and Alternative Medicine. This is the camp that calls itself –‘holistic’ camp. These people approach the human body from an encouraging starting point – ‘unity’, ‘integrity’, ‘indivisibility’ etc. Sounds really great But, unfortunately these beautiful words and elegant philosophies yield very little when it comes to practical work. The “holistic” CAM camp faces two immense problems.

First problem – they gave rise to all sorts of ‘distant healers’, obscure ‘energies’ or simply escape into the spiritual domain bypassing the earthly matters altogether.

Second problem – when CAM practitioners – from osteopaths to acupuncturists – get into physical contact with their patients they no longer remain holistic but end up borrowing the language and definitions from the sub-anatomical camp.

In other words, there is a lot of lip service around to the ‘holistic’ thinking – but such lip service unfortunately remains only a shell. Sometimes this shell is just empty (‘healers’ who deny the scientific method altogether) and sometimes it houses the same sub-anatomical content as mainstream science (osteopaths, chiropractors etc. ) – philosophies are ‘holistic’ but actions revolve around the same old sub-anatomical notions of organs, cells and molecules.

Don’t get me wrong – I am not mocking anyone –this is an immensely difficult matter to pin down. The ‘holistic’ people can’t come up with one truly ‘holistic’ science – because whenever they try to do ‘science’ they lose the ‘holism’. And the opposite is true – when the science people try to address the problems of a ‘whole body’ – they fail quite miserably – just look at the surging numbers of knee and hip replacements not to mention the inability to “win over” chronic conditions like Cerebral Palsy.

In short, many great minds tried to find the way out of this dilemma but failed...

Dr. Jaap Van der Wal was the first one who came up with the powerful enough paradigm shift allowing to lift the modern medicine out of this trouble of chasing the elusive ‘organismic level’...

First time I heard him speaking was at the 2^nd Fascia Congress (Amsterdam, 2009) and his talk completely blew me away. It was exactly what I was so desperately searching for many years– a voice from within community of anatomists who actually rose above the keyhole thinking of his own profession and urging to move from sub-anatomical (the search of new and smaller parts) to trans-anatomical (new aggregates of well-known ‘parts’).

Now before I proceed to details – do not rush into looking at the recent list of Nobel Prize nominees – you are not going to find him there … Yet…

I am saying a hopeful “yet” rather than “it’s never going to happen for as long as the pharmaceutical and surgical cliques are at power suppressing anything that doesn’t fit their interests” because I think that we are on the verge of some major tectonic shifts in medical-biological sciences.

On the one hand, it is true that the pharmaceutical and surgical industries have a tight grip on where the mainstream science goes; but on the other hand, the new ideas are no longer limited to the ‘new age’ gurus or alternative ‘wackos’ denying science altogether and obsessed with conspiracy theories.

For example, the International Fascia Congresses – these are proper scientific gatherings bringing together 100s of researchers and clinicians. Of course, their profile and budgets are miniscule comparing to the ones that are held on, say, genetic research, or vaccination – but nonetheless these are legitimate if marginal channels that are emerging.

For example, Dr. Van der Wal was a main stage keynote speaker (45 min) at a Congress that held over 400 scientific presentations. In academia world – that’s already quite a badge of honor. It takes a significant credibility weight to get to the keynote speaker position.

On the other hand, there are 1000s of medical congresses that are held around the world every year and there are tens of thousands of keynote presenters – so the public attention is still mainly focused on the mainstream sub-anatomical medical science.

Nonetheless, I am confident that the tide has started to change and within a few years what today is still seen as marginal is going to become a recognized frontier of science…

Dr. Van der Wal’s presentation at 2^nd International Fascia Congress was titled: “The Architecture of the Connective Tissue in the Musculoskeletal System.”

Are you disappointed with a non-flashy title? After all of my introduction – you probably expected something more flashy and indicative of the immense breakthroughs?

Well, that’s what scientists do very well – make exciting things look boring …

Have you looked forwards for the title being “Transanatomical Breakthroughs and how they kick the butt of the old crappy sub-anatomical paradigm?”

Well, that wouldn’t have worked at a serious scientific conference – and that’s the main reason I am taking the liberty of re-wording some of the original ideas of Dr. Van der Waal into a more user-friendly format and providing some context and narrative -– because the original lecture was so jam-packed with amazing insights that it makes one's head spinning…

In essence, he spoke about the most fundamental shifts that the ‘connective tissue -centered’ approach requires – need to start thinking transanatomically instead of ever smaller sub-anatomical digging.

Dr. Van der Wal is researcher – not a clinician. He approached the problem entirely from the position of clear uncluttered reasoning:

Step 1. As classical anatomists we used to call most of the connective tissue (fascia) non-specific and peel it away when dissecting with scalpel and creating the definitions and names for specific anatomical parts (ligaments, muscles, bones, internal organs etc.).

Step 2. We have now realized that connective tissue (fascia) has to be taken into the account at all times and everywhere throughout the body– not only in some specific locations where anatomists used to pay attention to it (aponeurosis, ligaments etc.) Connective tissue has to be seen as the active one – not a passive envelope.

Step 3. BUT – since connective tissue is present everywhere throughout the body whilst being ‘the same’ in its built and since it also has significant plasticity that depends on external conditions – sub-anatomical reasoning is a dead-end road. Sub-anatomical 'chopping' of the unique localized organs/tissues into smaller parts (physically by slicing or virtually via the imaging devices) – made at least some sense because division down to the cell level maintained that uniqueness and specificity.

However, for the universal connective tissue this dividing approach doesn’t make sense. Why? – because cutting a universal tissue into smaller elements reduces specificity – the smaller the parts we get, the less organ- and role- specific they are.

Putting it simply – a cell that belongs to a liver is a unique cell – you can’t confuse it with, say, a cell that belongs to the lungs or kidneys or muscle... But for the connective tissue that’s very different – by looking at its constituents (collagen and other fibers, fibroblasts, hyaluronans etc.) – we cannot say where they belong : to the head or to the toes or to the kidneys…

That’s why the connective tissue/ fascia is special. It doesn’t yield itself to sub-anatomical understanding. It’s an inconvenient tissue. In the past – for many centuries anatomist used a simple way of getting around this “oddness” of fascia – simply by ignoring it an scraping it away.

But now – if one says: “A” –“Yes, we can’t ignore connective tissue any longer”; then one has to say: “B” as well – “We are going nowhere with sub-anatomical methodology”; and then: “C” –“Khhm, we need to change the entire way of our thinking about tissues and functions of organism..”

Step 4. Recognition of connective tissue role is not simply an expansion of sub-anatomical scope (“we did not look at it before – now we will”) but requires much more – the complete reversal of reasoning: getting back to the starting point of gross anatomy level (“big” , “obvious” parts – muscles, bones etc.) but instead of going into sub-anatomical division – start thinking “trans-muscular”, “trans-articular” etc. – in other words thinking in a ‘trans-organ’ way – thinking ‘trans-anatomically’ …

How big is that? – Absolutely huge. Effectively in a short presentation Dr. Van der Wal turned the entire medical quest inside out… Because transanatomical architectural thinking is exactly the way that allows to bridge that Grand Canyon of divide between the sub-anatomical camp of modern medicine –that accumulated lots of knowledge about parts but lost the integrity of the organism along the way – and the ‘holistic’ camp – that has great intentions of complete ‘organismic’ approach but fails to show much of the practical outcome for it.

Transanatomical architectural approach of Dr. Van der Wal is the one that integrates both – allows us to use the knowledge about parts accumulated by mainstream medicine but at the same time put it into proper ‘organismic’ context…

Frankly, I can’t think of many intellectual achievements that could be ranked higher than that…

Let me highlight this once again – most of the Fascia researchers are the sub-anatomical thinking people who are excited by the study of yet another type of tissue, which was overlooked for a long while. They tell their fellow researchers: “Look this substance is worthy of studying as well – not only the neural cells or muscular cells or blood cells or whatever other cells that you guys have been studying…”.

Sure, that’s great – but these ordinary Fascia researchers are not awake to the fact that fascia /connective tissue is not simply ‘yet another’ tissue that can be “studied with sub-anatomical tools of doing lab experiments and observing them though electronic microscopes..” They are so used to the inertia of sub-anatomical thinking that they apply it to the connective tissue as well without realizing how different it is…

Only Dr. Van der Waal was actually able to see that the recent inclusion of connective tissue / fascia into the anatomical discourse in the new status of a “first class citizen” instead of an “underprivileged cattle class pariah” it used to be – changes the entire game... It’s more than just an inclusion of a new member– it’s the inclusion that is going to require the complete revision of the medical reasoning…

Fortunately, I am not the only one who ‘felt the Earth trembling’ and realized the massive consequences of Dr. Van der Wal ideas.

For example, a famous fascia visionary Tom Myers whose “Anatomy Trains” started the ‘fascia revolution’ was among the first ones to react:

Tom Myers Dynamic Ligaments: The Revolutionary Re-vision of Jaap van der Wal. 2011.

Whitney Lowe Does Fascial Research Alter Assessment? 2011

In short – mark my words – in a few years from now Dr. Van der Wal is going to be seen as an absolute giant of medical and biological sciences for this transanatomical realization alone – not to mention his amazing breakthroughs in embryology.

–––

Well, I guess after such a long pre-face I should be allowed to drop few words about the rendez-vous itself…

Actually it was Diane Vinsentz of ABR Denmark who made this private meeting with Dr. Van der Wal possible – for which I am incredibly grateful. In November she attended Dr. Van der Wal’s 3-day course on embryology for bodyworkers and manage to intrigue him enough with the descriptions of ABR approach to entice him to meet privately.

The meeting went absolutely fantastic – we discussed lots of things ranging from methodology of observational studies to the role of embryological knowledge in interpreting the musculoskeletal challenges of children with Cerebral Palsy. Obviously, we had the opportunity to get over some essentials of ABR techniques and the fascia re-modeling concepts that ABR is based on. I know that I sound like tooting my own horn – but I’d dare to say that Dr. Van der Wal was quite impressed… Well it looks like the beginning of some regular collaboration in the future – for which I am both extremely happy and proud of.

Simply watching his lectures in the last couple of years gave me huge insights in the understanding of the human body architecture and hence improved my ability to help your kids with new focus areas and techniques – I am quite sure that the luxury of having a first-hand personal replies to tailored questions is going to bring even more…

Well, I guess that’s it for now… as I said – I had my best and most influential birthday present ever.

Here a couple of pictures to give you the taste of a relaxed atmosphere of the meeting..

P.S. here are the links to Dr. Van der Wal’s article and lecture:

Jaap Van der Wal. The Architecture of the Connective Tissue in the Musculoskeletal System - An Often Overlooked Functional Parameter as to Proprioception in the Locomotor Apparatus. International Journal of Therapeutic Massage & Bodywork. 2009;2(4):9-23.
Jaap Van der Wal Transantomical Architecture of Connective Tissue in the Musculoskeletal System: http://vimeo.com/35667719

P.P.S. I really appreciate the Facebook Likes and Comments :-) -- creates a much better sense of interaction and encourages writing ...

Danger: Hip X-Rays Interpretation Mistakes in Quadriplegic Cerebral Palsy

2012-01-12T02:38:00+02:00

Dear Friends,

Happy New Year. I wish you all the best in 2012,and looking forwards for your kids achievements. The 2011 brought significant improvements to the ABR techniques boosting effectiveness to the new level thanks to improved Super-Soft Ball Rolling Technique and the 'eggs' ... officially labeled as Trans-Fascial Viscoelastic Stimulation Technique (TFVES) ... so I am really eagerly anticipating a major boost in the developmental progress of your kids ...

Most importantly in the New Year I wish you inner strength -- spiritual, mental, emotional, physical -- you name it ... Being a Pro Parent to a child with Cerebral Palsy is not an easy place to be -- but on the other hand it has the potential to be truly rewarding in many instances. After all -- the tougher the challenge the more appreciated is every single achievement.

However, on your journey to super-achievement for your kids -- there are plenty of dangerous rocks, many of which unfortunately come from those who by right should be helping you -- the orthopedic profession.

Today's video is about this -- How to keep your cool and vigilance and not to fall for the dangerous mistakes that the limitations of the surgical mindset creates when looking at the X-Rays of the hips and pelvis. We talked about those limitations before -- keyhole vision and the knife-centered evaluation of options.

The following video is going to walk you through two incredibly dangerous interpretation mistakes that orthopedic surgeons are extremeley likely to fall for everywhere -- from America to Australia.

Keep you cool and never fall for those...

Cerebral Palsy – reverse or re-arrange?

2011-12-17T05:05:52+02:00

Writing for this blog always puts me in a real dilemma – on the one hand, there are lots of things I really want to share with you because I believe that you are missing so much of important knowledge about Cerebral Palsy and on rights and wrongs in dealing with it; but on the other hand –I have to switch on the internal censor and ask a simple question: “With what I am eager to share –am I going to help and improve clarity for the families or is it going to add to the information overload?”

In other words – by pouring down all that information on you – am I doing you a service by giving clarity and making your life easier or am I doing you a disservice by adding to overwhelm and exposing you to more concerns and worries?

These internal dilemmas really bugged me for the things that I have been busy with for the last couple of months. In the preparations to BioTensegrity meeting that took place in Munich few weeks ago – I made a dive into the engineering books on Tensegrity and the original works of Buckminster Fuller (the famous engineer-architect who coined the term “Tensegrity”) and found myself at awe with the depth of his insight… It is really amazing for the person who never really came close to the human body in any tangible sense to have so many remarkable foresights that really lay a perfect framework for the correct interpretation of the Fascia Man…

The Bio-Tensegrity perspective alone is enough to come up with hours and hours of exciting stuff – of how it all ties in and gives a much deeper understanding of Cerebral Palsy and stages of progress and transformation… but then again? – Do you really have time and sufficient interest for all that? …

I must admit that this weighing of the pros and contras turned out into the period of the relatively prolonged silence – it’s 2 months since I made the last post in this blog… So after a lot of such internal discussions – I decided to curb my enthusiasm for all things new and to try to focus on the ideas with greatest “de-clogging” value.

So I am going to try to stick to the more earthly matters and self-censor along the lines of what I think matters the most to you and how I can help you in reducing the information overload rather than adding to it...

I can’t promise that the text is going to be simple – but it is definitely going to be de-clogging: if you work your way through this – then you are really going to know what is your starting point in the quest of maximizing your child’s developmental potential.

So here it is –the question that has absolutely the greatest value and that defines the choice of a path: Cerebral Palsy – reverse or re-arrange?

This question is so essential that it deserves some extra clarification.

1. How can one possibly dare to even use the very word “Reverse” in respect to Cerebral Palsy – doesn’t it sound like a dishonest and misleading “miracle cure” quest?

Well, that’s the key – we have to meaningfully distinguish between ‘brain-injury’ and ‘Cerebral Palsy’.

Injury to the brain is indeed irreversible and there is unlikely anything to be done about that for foreseeable future.

However, ‘Cerebral Palsy’ diagnosis refers to the disorder of posture and movement – not to the brain injury as such.

In practical reality of physical rehabilitation and therapies for kids with Cerebral Palsy the ‘arena’ where all the impacts are aimed at is the body (the musculoskeletal system) not the brain itself.

Therefore when talking about the reversibility vs. re-arrangement strategy for Cerebral Palsy – we discuss how we deal with the musculoskeletal system– do we search for the reversal of elementary fundamental negatives (spasticity, rigidity, muscular imbalance, fascial weakness etc) or do we accept those negatives as inherently irreversible and limit the therapies and exercises to the attempt of minimizing the troubles?

In other words, are we playing to win or are we playing to lose with the score that is ‘not too bad’?

Well, medical approaches are entirely limited to the paradigm of losing by respectable score http://blyum.typepad.com/on_abr_and_beyond/is-cerebral-palsy-in-need-for-the-new-approaches.html

Why? – There is a fundamental limiting belief – the sole reliance on neurology in the explanation of the elementary phenomena that form the movement challenges of a child with Cerebral Palsy – spasticity, ‘primitive reflexes’, rigidity etc.

All these phenomena (spasticity etc.) that are collectively labeled as Cerebral Palsy take place within the musculoskeletal system – but they are being explained exclusively via the damage to the brain.

As a result they are rigidly coupled with the brain injury, hence there is a perceived deadlock: it is impossible to reverse , for instance, the spasticity without the reversal of a brain injury… and since the reversal of brain injury is a pipe dream for now – so does any conversation about the reversal of spasticity, hence any self-respected professional should stay away from such statements...

I hope that you start seeing the gap that is missed by this medical logic: actual troubles of Cerebral Palsy are local but the explanations are central.

Once we realize that – all we need to do is to ask a question: “Can we possibly de-couple the local ‘musculoskeletal’ troubles – such as spasticity, rigidity or abnormal movement reactions – from the issue of a brain injury, i.e. from the Central nervous system? How much can we do at the local level regardless of whether the Central ‘command’ headquarters are damaged or not? ”

This is the key breakthrough that is at the heart of ABR – everything else followed from it.

ABR Techniques evolved over the years into providing better tools of addressing the musculoskeletal system at the level of automatic response – but the key breakthrough originates from this approach – putting apart the issues of brain injury as the damage to central command within nervous system from the issues of the local response within the musculoskeletal system itself.

2. Re-arrangement strategies come in 2 distinct formats:

a) “favorable exchange rate of damages” – doing the limited local damage (surgery, Botox etc.) under the pre-text and the intent of doing a lesser damage in order to prevent a larger one…

Once again I invite you to look beyond the soothing words like “relaxing the muscle with Botox” or “releasing the muscle by tendon lengthening” – these words are misleading since they hide the physical essence of such actions: inflicting damage.

Yes, it is believed by the advocates of these methods (doctors and surgeons) that these damages are done at favorable exchange rates – small damage for the sake of preventing larger one. However, these self-assuring words should not draw the attention away from the hard cold physical reality – damage, no matter how ‘small’ or how ‘beneficial’ is still a damage. It can’t ever be a source of the reversal.

b) “compensation” – attempt to engage the undamaged musculoskeletal structures to do 2 stability/ movement jobs: their own plus part of the job of the affected ones.

This is a re-arrangement strategy that is behind the training protocols – whatever they are (Bobath, conductive education, patterning etc.)…

I am not going to discuss the details here in order to keep your focus clear – any training strategy is set within the limitations of the fundamental negatives that make Cerebral Palsy. Sometimes a child has more reserves for the compensation and then the functional outcome is better, sometimes – less and the achievements are minimal if any…

Both re-arrangement strategies of “favorable exchange rate of damages” and “compensation” – although very different have essential similarity – being locked within the elementary negatives, trying to mitigate the troubles caused by spasticity, rigidity, primitive and abnormal so-called “reflexes” but never really rising to a really big goal: reversibility.

In essence these are just different avenues of ‘losing with respectable score’

3. Does the ‘reverse the negatives’ strategy mean that it is going to bring the results that are instantly (in short-term perspective) better than the ‘re-arrange’ strategy? –

Well, fact is: early cars were crap in comparison to horse-drawn carriages. They had few advantages but tons of troubles as well. Early planes flew a couple of hundred meters only and were far from being reliable means of transportation.

That happens every time when something radically new emerges and has to compete with established mature technology that has been polished over the long years in use. For a while – and that “while” can span a couple of decades, – the glitches of the radically new technology provide the skeptics with a lot of ammunition for criticism pointing out the flaws and shortcomings of what they call “new fads”… However, at the end the new technology that sets more ambitious goals always prevails…

And I am the first to admit that ABR has not been free of those challenges. Every year as I look back – I feel somewhat sad and disappointed with myself for not figuring certain things out much earlier. That’s an unfortunate price to pay – and I fully realize that a lot of families who started ABR over the last 10 years found enough obstacles and negatives to stop and to turn their search elsewhere.

ABR today is a lot more user-friendly and probably 5-10 times more efficient than it was 1o years back – but still there are tons of things to improve.

However, what I really want to pass on to you is the understanding of the biggest question: Are you aiming for reversal and prepared to stick for the long-term transformation or are you looking for a lucky shot in the re-arrangement?

The following video – is an illustration of these ideas in a practical way.

I am intentionally using the case of a relatively milder child after just 6 months of ABR work done at 5-7 hours a week – the very minimum.

Together that makes 200-300h in total. My goal is very simple – to illustrate that even as little as 200-300 h of ABR work is enough to show that the structural transformation of reversibility type is indeed taking place as a result of ABR work.

There are lots of “yes, but… “ sub-clauses – “When is it going to reach the legs?” “How long do we need to work overall?” Etc.

Frankly, I can’t answer these questions – nor do I want to give you any false sense of “ease”.

Even when you get a tool of elementary reversibility of the Cerebral Palsy ‘building blocks’ – still one should remember that there literally 100s of muscles and joints that are affected by profound deficit of strength and severe imbalance and to put all of those in order is a humongous task.

On the other hand, I personally believe that it is better to do some of the things right then do everything wrong. I’ll take a slow and challenging journey in the right direction over the easy journey in the wrong direction any time…

That’s a philosophy behind ABR and I hope that I’ve managed to make this clear.

My goal is not to sway you towards “yes” – ABR is great!” – but to distill things into clarity , to help you to sort through the confusion and information overwhelm by bringing out the really essential and high value questions.

Decision and specific choice is yours – whatever suits your idea of the ‘right way’ – but I hope that I can help you by making clear that fundamental priority questions that you need to answer for yourself and for your child.

Cerebral Palsy and Stem Cell “Therapy”. ABR position.

2011-10-12T02:08:12+03:00

Today I am going to touch a very sensitive subject – the issue of Stem Cell treatments for Cerebral Palsy.

Obviously, I am being asked about it frequently nonetheless, for a long period of time I preferred to keep very neutral – sticking to the explanations about ABR itself leaving it up to the parent to make a decision.

However, recently couple of parents came up with a different perspective – pointing out that this “diplomatic” stance is being of a disservice to the parents because whenever there is an expectation of miracle – it is very difficult to keep a cool head and most of the parents of special needs children vote with their heart only.

Unfortunately, voting with the heart is the sure path to extremely poor decision-making when it comes to Cerebral Palsy.

The most difficult thing for you is to step back far enough and to get a full bird’s eye perspective of what are the fundamentals behind a certain advertised “therapy for Cerebral Palsy”, how exactly does it fit into a larger picture of your child’s long-term developmental progress as well as the context of your resources.

If you limit yourself to the question “Is it a good therapy for Cerebral Palsy?” – if you start your reasoning from such a point – you are guaranteed to be steered away from solid decision-making.

You really need to start much earlier and truly understand the fundamentals in order to judge a Cerebral Palsy “therapy” correctly.

That’s why this video stretched into 3 parts – first 2 cover the starting points of your decision-making and due diligence, which are applicable not only to the “stem cell” issue but to pretty much any therapy for Cerebral Palsy that you might come across.

Only the 3^rd part addresses the “Stem cells for Cerebral Palsy” issue specifically.

I realize that often enough parents tend to be impatient and have this background voice that is saying: “C’mon Mr. Blyum, let’s not stretch the philosophical part too far – give me the specific answer…” – at the expense of sounding boring, paternalistic and even offensive – I’d put it bluntly:

There are 2 strategies that you can take as a parent:

1. Being smart and trying to educate yourself getting a better vantage point and seeing the big picture
2. Being a smartass – fast forwarding through the big strategic matters and skipping them in order to get to the tactical ‘substance’ faster.

I leave the choice to you – that’s why even though I initially wanted to merge the 3 parts into a single video – I am leaving them separate and letting you decide whichever route you’d want to take.

Obviously, comments and feedback an heated discussions are more than welcome. There is nothing worse than silence. This blog’s intent is to discuss important, complicated and controversial matters, which have far more than a single perspective at them.

I do not fool myself on being so explicitly clear and convincing that there are no questions left afterwards – on opposite, if anything – this blog is an invitation to the conversation, to the opening of the ‘brackets’ and to the exposure of dangerous myths.

Part 1

Part 2

Part 3

P.S. On behalf of all of you I want to thank the family who asked me the ‘stem cell’ question this time and was happy to share some of the personal matters to the benefit of the fellow special parents.

“Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces”

2011-09-26T06:11:26+03:00

“Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces”

Introduction of the tactical information into our communication.

After some intro of a larger scale concepts – such as the key division of all therapies of Cerebral Palsy into the clusters it is time to get more tactical and tackle the smaller issues.

Paradoxically enough, I reckon that these smaller “day-to-day” things are what you are looking for – a lot more eagerly than for a larger scale concepts.

I say paradoxical because obviously everything “day-to-day” tactical – like the subject of today’s post – “Analytical review. Cerebral Palsy and forceful devices- orthoses, splints, braces” – are entirely defined by what the root concepts are. So if the concepts – seemingly abstract and removed far from everyday practice – are flawed then the flaw passes down all the way to the tactical everyday decisions, getting worse with every step. And the opposite is true – the new methods can only be considered truly new when they bring different claims at the level of concepts. Otherwise – the new method are just a different remix of the same old song.

The knowledge descent hierarchy is well-known and goes like this:

Concepts (defines the field, the fundamental criteria for defining directions)– descend into
Principles (Why thing Work one way or another – introducing the idea of “wrong” and “right”) – descend into
Processes (how to make it work the “right”) – descend into
Procedures (exact implementation – what model of a splint to use and how to put it on and how long to wear).

Fact is – in your experience you are used to the fact that the PTs and OTs always talk to you at the level of ‘Procedures’. Rarely they bother to present a mini explanation dumbed-down from the “Process” level – and when it comes to Principles – their reply is one and only “Brain injury is at fault”.

This is the typical style of interaction of the Pros (Professionals) to the Amateurs – crumbs of information: “Just do as you are told”…

Well, another fact is that most of the local level therapists that you face in your school and treatments encounters where you live– are the ones that have very vague idea of Principles – they covered a couple of textbooks on those Principles during their studies – but all that is a long gone history. They are the Process people.

The key feature of the process people is expediting obedience – they are the Sergeants and you are the grunts. Why do you have to do certain things with your kids? – Because he/she, the Sergeant told you so. Why? – Don’t ask – just do what you are told. The Officer (who are supposed to be in touch with the “Principles”) knows and that is enough.

I think that you have noticed that very often when you try to move out of this mold – and start questioning what the therapists – especially the ones who practice in schools – do to your child… they become really irritated and often quite nasty and vicious.

Don’t be surprised – medical system is modeled after the army (in fact the current roles were carved into it during the war times ) – imagine what happens in the army if the ‘grunt’ (rookie soldier of the lowest rank) starts asking questions that go to the Officer level?! Chaos and disorder! – That can’t be tolerated by Sergeants – that’s their job description to handle the grunts and to let the Officers be free of menial tasks.

You equally shouldn’t be surprised when you find out that a Doctor is often no different – that’s the Officer who has been so used to copy-paste quotes from textbooks that he grew into those quotes as dogmas without ever asking deeper “Why” question that belongs to level of Concepts.

Ask any doctor – does he see any flaws with the way the Cobb angle represents scoliosis and whether the concept of “scoliosis” accurately represents the 3D deformity of the child’s spine? Ask a doctor – does he see any problems with the way that so-called “hip subluxation” represents the 3D deformity of the pelvis? – He’ll be puzzled and outraged at the same time.

Puzzled – because he never thinks that way – his reasoning ends with the labels “scoliosis” & “hip subluxation” – he never ever questioned the way these labels came to being.

But even more likely he wouldn’t even get to the point of being puzzled – because he is going to be outranged – how could a person with no official qualifications, a grunt – you – dare to question the engraved “Principles”…

What I am trying to do when communicating with you – is to talk to you at the level of ‘Concepts’ – the really big questions that precede the definition of the “wrong” and “right” by setting the reference system.

So effectively I am elevating our conversation to the level of a “General”. Well – often you might feel somewhat lost – because for your entire “service” of being the parent of a child with special needs – you’ve been dealing with Sergeants in a status of a lowly grunt.

Why do I feel that is really important to talk directly to you at the ‘Concepts’ level? – 2 main reasons:

a) I see you as a primary guardian of your child and a primary therapist – so for me you are colleague of an equal statute – a key person. I assume the role of your mentor – but I am definitely not a Sergeant or an Officer.

b) The existent system is logical. It is flawed at the level of the Concepts – if you try to change it at the level of Procedure or Processes or even Principles – things are consistent from one level to another. Wrong principles define the horrid and inefficient Procedures.

But the change has to start all the way from the very origin – the Concepts

But at the same time I understand that often times you might find difficult to see how new Concepts (what I share with you) relate to the outdated Procedures (realities of your everyday interactions with Sergeants) and what do you actually need to do in the situations when you are under pressure.

So, I think that the best course of action for me is to do the mix – I will continue share the new Concepts related to Cerebral Palsy with you – but I will also start doing more of the “Response to Outdated Procedure” level explanations.

Probably it is going to take a certain time for me to find the right format – but I am looking forwards for your replies:

a) Am I reading the social dynamics of your everyday situation correctly;

b) How accessible are my Tactical level explanations – what you’d want to get explained – Clearer? Simpler? Broader?

Therapies for cerebral palsy- the clusters approach. ABR Workshop at Pac Rim Video Part 1.

2011-08-27T05:50:30+03:00

Well, dear friends, the summer is almost over – and it is time to get back to the ABR matters.

I didn’t bug you during the last few weeks with ABR-related food for thought – as parents you deserve some vacation as much as your kids… without me bugging you with large chunks of information to process.

Historically ABR calendar follows the division into the academic/ shool years rather than the calendar ones – so I guess I need to congratulate you with the beginning of the new school year.

More studies are coming your way!... I hope that makes you excited rather than grumpy… :-)

I am not really sure whether my teachings make your favorite subject but hopefully you find my ramblings helpful at least to certain extent. In other words, hopefully the reading of this blog translates into improved clarity about your special kids development rather than into increased confusion.

I do strive to express my views in language that is easily understood even for a person who is far removed from medical and biomechanical terminology, however, sometimes – there is no other way around it.

My goal is to help you with the understanding of Cerebral Palsy kids’ development and to give you the information that allows you to make intelligent choices.

Well, often enough the real ‘insider’ information is coded and wrapped in the cocoon of special terms designed to scare away the outsider and to preserve the monopoly of medical profession on decision-making about your kids treatments and care. Hence, unwrapping it requires some thinking and intellectual effort of being ready to face the ‘fancy words’.

I started with this preamble as a way to introduce the 5-part series of videos that contain the extended Workshop presentation that me and Mark Driscoll did at the Pacific Rim International Conference on Disability on April 18, 2011 in Honolulu, Hawaii.

I published the abridged version earlier but I am pretty sure it is well worth your time to study the full one. Not only the sound clarity is much better but there is a proper pace of presentation with the smooth transition through elementary logical statements.

This workshop was designed for the professionals – most of the audience were PTs and OTs as well as a few of the MDs specializing in rehabilitation. However, you shouldn’t worry about the presentation being too high-brow.

I do believe that the language is accessible enough for a parent – although sometimes you might need to pause the video and look the words up in Google.

The first video covers the introduction/overview that presents ABR in a somewhat new light. My goal was to make sure that you get the big picture of what is the specific place that ABR has among numerous treatments, therapies and rehabilitation methods that you hear and read about.

Often enough, parents as well as professionals, are label-oriented – every therapy is looked upon as another entry in a list where your mindset is set on: “Ok, now we are trying this therapy; if it doesn’t give me the results I want for my child fast enough – I am going to proceed to the next one on the list.” This linear view is unfortunately misleading because by focusing on the individual therapy labels you lose the perspective of therapy clusters.

Let me use and example to clarify this idea. For instance, on the surface, say, Bobath, Voita and Doman are all different labels associated with different personalities and techniques, however, it is essential to realize that all these therapies belong to the same cluster.

They are based on the same underlying idea that it is “all about the signals”. These therapies employ different techniques but the essence is the same: “Send “better” signals to the brain of a child with Cerebral Palsy by imposing the specific movements onto the child’s body”. These therapies imply that the brain injury caused the loss of the “right” signals so enforcing the signals from outside is set to “re-wire” the brain and translate into the improved functions. What is then the common ground underneath of all these therapies? – It is a firm belief that the ‘biomechanical body’ is no more than the passive arena where the electrical signals run the show.

What is the result of such beliefs? – Complete disregard of the direct biomechanical effects that “imposing signals” does to the body. In other words, these therapies share the same underlying principle – the only one who matters is the ‘driver’ (i.e. the brain) – which translates into inevitable abuse of the ‘car’ (your child’s body). Imagine that your house was designed by the electrician who only cares about the electric wires and the easiest access to them. Would he ever care about the walls? – Not really. What about heating? Water installation? Mechanical robustness? Elevators? – none of that matters for a person who looks for signals only.

That’s what I wrote about in the post on “Giving the boot to Neurological Dogmas” – that the focus on the ‘signals’ results in parents doing horrible things to their child’s bodies all in the vain attempt to impose “better signals” by some type of forced movement or positions.

I hope that you are beginning to see why the ability to realize clusters of therapies is really most important for you as a parent who is on the constant search for the better therapies for your kids with Cerebral Palsy.

Without understanding, which cluster does the therapy belong to you end up going from one electrician to another one pulling the wires in different fashions and drilling for them whilst missing the house construction altogether.

Again – the final choice is always yours but you are in a much better position to make an intelligent decision when you see just a few clusters of therapies rather than the endless list of individual labels where the new ones pop up all the time.

This ability to think in clusters is helpful for you not only when you make the “OR” choices: this therapy OR that therapy; but also when you decide upon the “AND” choices of combining different treatments together. In other words, when you are looking for a wholesome comprehensive meal you want to have the entrée, the main course and the dessert instead of ending up with three different fizzy drinks, right?

That’s the context that you’d want to watch this video in: What clusters of therapies exist for Cerebral Palsy children? What clusters have been well drilled in the past with what results? What are the true novelties introduced rather than a camouflaged old serving? And so on…

To help you with creating this map of the Cerebral Palsy therapies field –

I introduce a very simple concept: “Thrifty” rehabilitation/therapy methods (probably “Prudent” is an even better word – but I kind of missed it back then) vs. “Lavish” ones.

“Lavish” rehabilitation/therapy methods are the ones that recruit the most ‘expensive’ structures within your child’s body, the tissues that are extremely demanding on your child’s limited metabolic resources being the ‘luxuries’ of human development.
“Thrifty/Prudent” methods – are the ones that engage the cheapest biological tissues that do not exert a heavy metabolic toll on your child’s body, that contribute to better functions at no extra costs.

“Lavish” /spendthrift methods – “suck the juice” out of your child’s biological batteries sacrificing the long-term sustainability for the sake of a short-lived boost of action.
“Thrifty/Prudent” methods of rehabilitation – charge your child’s biological batteries creating the ability to develop consistently and progressively in a metabolically sustainable manner.

What are the :”Lavish” and the “Thrifty” methods? – Well, I am not much of a thriller writer but hopefully I have managed to create just enough of suspense and curiosity to make the viewing interesting…

P.S. As always I encourage you to leave comments and Facebook likes – the beginning of the school year is always kinda slow – so some kindling is always welcome.

Mind-Blowing Freaking Miracle... Pelvis Transformation in Quadriplegic Cerebral Palsy

2011-06-27T19:51:10+03:00

Usually I am quite reserved in progress descriptions that kids achieve with ABR – trying to avoid the hype and over-expectations. Typically I am more keen on outlining the specifics of the challenges that lie ahead rather than celebrating the achievements already made. And often enough parents find this style not the most motivating … but that’s the way I see the world: whatever has been achieved as of today is already part of the past – so, let’s try to focus on the next step forwards…

By telling you this I just want to draw a bit of extra attention to what I am about to share with you today… because this time it is different… and even I cannot contain emotions … because it is indeed – a mind-blowing freaking unbelievable miracle!

Well, I hope that I have your attention now :-)

… and probably you think that I am going to demonstrate a quadriplegic child who miraculously went from horizontal incapacitation to running around and jumping on a single leg? – Sorry, not this time…

This type of stuff – “a developmental airlift “, or a “developmental helicopter ride”, that allows to skip phases of development – is cut of heavenly cloth. I am much more earth-bound.

Nonetheless the transformation that I am about to share with you counts on a scale of miracle as long as we stay earth-bound and realistic.

What I am going to demonstrate is an exceptionally rapid structural transformation of a classic distorted and merged quadriplegic pelvis following the “egg” work…

Let’s proceed to the video to have the entire case well illustrated…

I hope that I have managed to get you excited enough to sit through a 35 minute video…

First I wanted to charge straight through to the comparison of before and after – but afterwards decided that it is going to be of greater educational value for you to have it done in 3 parts:

Normal pelvis structure and X-ray
Typical pelvis of a child with quadriplegic Cerebral Palsy that ends up under the knife of an orthopedic surgeon with a massive intervention (bone cutting, metal screws insertion etc.)
The “mind blowing freaking miracle” – amazing transformation of the pelvic structure in a severe spastic quadriplegic child following the “egg” rolling work delivered by the ABR superstar man – Alexander “The Great “from Greece :-)

And all that leads to a not so subtle hint – your child’s future is in YOUR HANDS – but these hands have to be skillful to extract the full potential that ABR work has for your child… – so you need to study and practice and pay attention to detail without rushing to “I got it –can I go home earlier?”

P.S. I am going to add a couple of final episodes to the previous video – “Cerebral Palsy and fascia science in a tea cup” – and I hope are going to appreciate the connection that my tea cup simple example of the relationship between a dense film-like membrane and porous underlying gel has with the specifics of skeletal transformations in Cerebral Palsy pelvis…

P.P.S. Comments and likes are most appreciated.

Fascia and Cerebral Palsy science in a tea cup

2011-06-13T04:16:09+03:00

This is a mini-post that illustrates that sometimes valuable insights into the fundamentals of what’s happening to fascia and musculoskeletal structures as a result of challenges associated with cerebral palsy could be gained from most mundane everyday experience – from observations of what’s happening in a tea cup –literally…

Anyone who had a training by me knows that: 1) I am a tea fan; 2) that I have a tendency to leave cups with unfinished tea everywhere opting for the new cup of a fresh tea instead..

Well, I’ve been criticized for this untidy habit more time that I can remember – to no avail I must admit… However, sometimes there are some unforeseen bonuses that come out of it…

For the recent weeks I’ve been thinking a lot of how to visualize for parents the effects of fascia layers adhesion in case where the flow of the interstitial fluid is affected and how we can restore their proper division by means of Thermoplastic elastomers (TPE) as the Force Transfer Medium [well that’s the official title of “egg rolling” :-)]

So couple of days ago I looked at one of my cups with the tea leftovers from a previous day … and found and excellent illustration ..

I hope you are going to find that metaphor/ spatial homology useful and insightful

Thanks …

As usual Facebook likes and comments are most appreciated

"Thrifty" Fascia vs "Lavish" Brain+Muscles approaches to cerebral palsy therapies introduced

2011-06-01T04:13:15+03:00

I came back home a week ago after nearly 3 months on the road ... fortunately my family still recognized me... I guess it's the haircut ... :-)

Tons of materials accumulated during these months -- the teachings, the presentations and the comparisons of before/afters to do...

This year's round of assessment was very rewarding -- the ball rolling indeed works as expected -- probably even better! The improvements of the connections within the vertebral columns and the ability to connect the 'velcro attachments' of the shoulder blades -- are really quite amazing breakthroughs..

So my call to all of you esteemed ABR Parents-Therapists -- please do not skip learning courses... Ball rolling techniques are continually upgraded empowering you to become a lot more effective and efficient... There is one thing that one cannot buy in this life -- it's time... and in the development of the growing child with cerebral palsy -- 1 hour of work done this year is probably worth at least 2-3 hours done next year --from the perspective of developmental yield...

I am going to provide you with a lot more of the technical teachings in a format of videos and practical tips in the forthcoming months -- we already accumulated tons of such teaching material -- and working through sorting it out...

So -- there is going to be a lot more opportunities for you to progress via doing your homework better.

However, direct hands-on teaching by an expert ABR trainer -- is always a major shortcut for you. That's how you can develop your skills faster and get those skills in action -- boosting your kids' development...

I started sorting out the presentations we did with Mark during the visit to Hawaii -- in this post I am offering you the one that we did in the Rehabilitation Hospital of Hawaii.

It is far shorter than the main workshop that we delivered as part of the Pacific Rim Conference on Disabilities -- but maybe there is some advantage to this more compact format.

Couple of preliminary cover notes...

Unlike the main ABR workshop at the Pacific Rim Conference on Disabilities that was filmed with a professional camera by a videographer -- this on is filmed using a good old Flip placed stationary on a mini-tripod with a superwide view of the entire room.

I guess you'd realize that the quality is not supergood. However, it's not too bad either.

First, most of the presentation is based on the powerpoint slides -- so I have inserted them into the video -- making it a lot easier to follow the narrative.

Second, I must say that the Flip is surprizingly good in recording the sound considering the tough circumstances of filming.

So I hope that your viewing experience is going to be reasonable enough to allow you to concentrate on a content...

The really interesting part is the fact that only through the circumstances of this particular presentation I understood how much of routine challenges an immersion of the new paradigm and methods face -- even when there is a genuine interest and goodwill.

Let me paint a broader picture to help you to see the context...

First of all -- the MD who is in charge of a Rehab Hospital team attended the workshop that we did few days earlier and was very positive and receptive. He was the one who actually "send" a group of PTs and OT -- 12-15 people -- to learn from us.

So, there was no resistance -- only goodwill. But... then the reality kicks in..

Every therapsit has a significant workload scheduled days in advance...

Only now I realized how significant are those logistical and administrative constraints within the existent healthcare model..

Frankly, a physical therapist in many instances has no more freedom than a worker at the assembly line -- it's a conveyor belt! Patient after patient, who have to receive a type of therapy that has been pre-aproved by the insurance companies and by referring physicians who are absolutely removed from any hands-on work with the patients..

How on Earth even the most enthusiastic and thoughtful individuals inside this profession are going to progress beyond the routines that they've been doing for decades!?

So to cut the story short -- the only time available was ... the lunch hour..

Well, it's a bit weird -- to introduce the ground-breaking concepts to the chewing crowd... :-)

However, on the one hand, even opera singers sometimes perform in front of the audience that eats and drinks, right? :-)

On the other hand, one can entertain the thought that the digestion of the "food for one's stomach" might facilitate the digestion of the "food for one's mind"....

I do not have much science to bakc this up -- but why not? :-)

On top of that, somewhere half way through the presentation ... the fire alarm went off! ...But as you all know -- I am loud and passionate enough not to be bothered by such minor inconveniences ...

So here we go ... this is a compact version of the presentation that introduces 2 key ideas:

Connective tissue focus instead of the mainstream brain and muscles focus in interpretation of Cerebral Palsy
Transition to the "Thrifty" Rehabilitation and Therapy based on connective tissue emphasis vs. the "Lavish" one that defines the therapies for Cerebral Palsy and brain-injury rehabilitation modalities today.

Part 1.

Part 2

Besides of going through these videos yourself I do encourage you to invite your PT, OT etc. to watch it as well... Hopefully, that will help your future communication with them...

Your comments are most appreciated. The more you say -- the more we'd be able to adjust and adapt the style and emphasis of presenation to help your 'inner game' development the most...

ABR message finally strikes a chord with medical pros

2011-05-01T04:38:53+03:00

Long time – no see… Once again – contrary to my best intentions there was a gap in getting stuff published on this blog. The theorists of blogging say that nothing is more detrimental to the readership than irregularity and unpredictability…

Not that I have run out of the things to share – pretty much the opposite – but casual writing seems to be going for me only when I am out of the field work…

Anyway – I hope that blogging sporadically is still better than silence..

Well, first of all the last 7 weeks have been very packed.

In March I went to Singapore to re-film the last bits of the long overdue extended course on Super-Soft Ball Rolling Massage – the problem is always the same: by the time I finish one version there are so many upgrades to the technique itself and teachings that the entire course starts feeling awkward and outdated. Even though I realize that it could always be labeled as a ‘beta’ release 1.0 with subsequent updates –it doesn’t work for me – to the frustration of my production team I end up with another major overhaul.

However, finally it looks that the Super-Soft Ball Rolling Massage technique enters into the maturity phase with clear distinction between the skill levels – so I am feeling a lot better about the release of the intro course. Hopefully by the end of the summer we’ll get everything finished – as you all know too well – I am not known for lack of thoroughness :-)

Then there was a training session in Montreal. Very encouraging.

On the one hand, excellent progresses related to the evolution of the dorsal compartments (the back; vertebral column etc. ) – and respectively tons of material worthy of quite impressive “before/afters”.

On the other hand – I am very happy to have achieved a next milestone in the development of Super-Soft Ball Rolling Technique – the increased volumetric response, which integrates the benefits of the 3Q and the ball rolling at the same time.

As I am saying that – I realize that I have uploaded the video “ABR Technique Essence” to the Vimeo library but completely overlooked embedding into the blog:

Here it is.

On a practical side – I strongly encourage all of you to learn the recent upgrades of the Ball Rolling – the “Intense Technique” and the “Submerged Technique”.

I recommend it wholeheartedly – go ahead and sign up for the summer trainings if you haven’t done so yet– because these technique upgrades are going to be a major boost in the efficacy of your homework – at least doubling it…

Next big thing – me and Mark Driscoll (our principal research guy) – have conducted a 4-hour workshop at the Pacific Rim International Conference on Disabilities – http://www.pacrim.hawaii.edu/ – titled: “Thrifty” Rehabilitation – Home- Based and Family-Centered Treatment of Cerebral Palsy.

There were about 30 professional attendees – MDs, PTs, OTs – who specialize in Cerebral Palsy.

Frankly, over the years of life at the fringes being labeled as “alternative” I am used to the resistance and certain arrogance of the medical community towards “unofficial” newcomers.

Well, this time was a refreshing difference.

It appears that our duo with Mark finally managed to strike the right chord and engage the medical audience really deeply. Four hours is a long period of time – but the attention never waned.

I think that finally we have found a winning formula

Instead of talking about ABR – our opener and central premise went deeper.

A) Connective tissue/fascia importance for the analysis of Cerebral Palsy, especially the quadriplegic cases.

Basically we did the bridging of introducing the latest in the fascia research and showing how important it is to the understanding of what happens to a child with Cerebral Palsy.

It is important for you to realize that most of the medical professionals are short on time as much as anyone else in today’s busy life and if they manage to read anything – that’ll be narrowly professional, something that preferably gives educational credits.

So the fascia research has very much remained unnoticed in the Cerebral Palsy rehabilitation community.

B) I’ve drawn the dividing line acchording to a simple and easily understood criterion – “lavish” vs. “thrifty” methods of physical rehabilitation and therapy.

The main idea is to evaluate the costs of the therapy to a child’s body.

If a therapy targets muscles and brain – it is “lavish” – because muscles and brain are extremely expensive organs that are the ‘luxuries’, which only the healthy person can afford (they costly a fortune in terms of devouring the metabolic resources and zapping the information processing capacity).

Whilst “lavish” therapies could be of use for healthier people – they are counterproductive for a weaker child – and every quadriplegic child definitely falls into this category

Think of addressing muscles and brain as similar to committing the entire meager budget of a impoverished person who is starving to spending all his money on few sips of champagne and a spoon of caviar instead of providing him with quality staple foods – non-fancy but nutritious and super-affordable.

Well – that’s what the ‘Thrifty’ approach is about – how to contribute to the development of posture, stability and movement via the least expensive avenues…

And what are they? – Connective Tissue and Fascia. They cost nothing, they don’t gazzle resources, they do not produce any waste, they do not zap the computational power of the brain.

In this context everything becomes very clear – look at the top 20 methods that are now used for the Cerebral Palsy rehabilitation – they are all “lavish”!?

No wonder that they sometimes work for milder kids with Cerebral Palsy but they fail completely for the quadriplegic and more severe.

What is ABR? – it’s “thrifty”….

Well – obviously all these are just the conversation openers and definitely I’ll need to return to each and every of these subjects in better detail later on.

However, I hope that I at least provided some news update and managed to convey my excitement at the recent developments…

P.S. Hawaii is really a nice place – idyllic I’d say. Especially the palm trees – they do look like the ones from a “tropical paradise dream” :-)

P.P.S. Nothing encourages a returning blogger more than a flurry of comments and Facebook likes! :-)

Hip Subluxation in Cerebral Palsy-Video 5-Specifics

2011-03-09T04:04:18+02:00

I guess it is more than a time to proceed from general reviews of hip subluxation in Cerebral palsy videos to the specifics.

Video 5 turned out to be quite long -- so I divided it in 2 parts -- but eventually decided to add a summary as well -- that's Part 3.

In these videos I actually go point by point over the original questions, observations and concerns that were voiced in the original 6 min video by Emma's mom.

So even though the videos are quite long I think they are not too difficult to watch since any single topic is covered within a few minutes max. I hope that in these videos I've managed to illustrate how the concepts introduced in the earlier videos blend together and provide a relatively straightforward framework for analysis of an individual case.

Of course, in an individual case of your child there could be some variations of the angles or of the dominant directions of legs mobility response -- however, the essence always remains the same: One needs to use a transanatomical framework to understand the full scope of transition.

I think that the main practical takeaway from these videos is the idea of evaluating your child's evolution through the chart that takes into account multiple aspects of the evolution in the pelvic region and within lower extremities-- including the percentage measurement of femur head alignment in respect to the acetabulum but seeing it only as a single entry in a much larger matrix of changes.

I hope this helps.

I feel that these video series on hip subluxation in cerebral palsy give a comprehensive coverage of the subject -- to the point that "there shouldn't be any questions left"... However, being realistic I am sure there are further questions and I am looking forwards for receiving them -- because from my perspective of a broad "umbrella" I might be overlooking some of the very specific concerns that you might have.

As the final word for these series I want to express my gratitude to Team Emma for their willingness to go beyond "privacy" and to embrace a collective good for all the parents in a similar situation by making these video series possible. I think that some expression of your appreciation in the comments to this post will be much appreciated by Emma's parents.

P.S. Please do not forget to press Facebook 'Like' button --so more people can benefit from getting a little bit of rational outlook influx towards this emotionally charged issue of hip subluxation.

Cheers...

P.P.S. Do not forget that the best way is to actually to click on the 'ABR on Vimeo' link above -- and then you can actually download this and other videos from Vimeo website. Then you do not need to deal with streaming delays and play interruptions 'that some of you mentioned before

Video 4. Hip Subluxation -Why So Much Attention?--The Truths and the Myths

2011-02-12T09:30:51+02:00

It's time for the video # 4..

As I mentioned in the overview I tried to cover some of the most wide-spread worries and concerns addressing them with as much of a bird's eye view as possible.

Unfortunately, too often there is so much hysteria being pumped up about the hip subluxation issue by orthopedic profession -- that at some point one might get absolutely swirled by all the pressure and scare-mongering.

I hope the video 4. "Hip Subluxation- Why So Much attention? -- The truths and the myths" is going to help you to get out of being scared mode and panicked cries for help -- and towards being able to approach this complex issue rationally and consciously.

I assure you that you have all the necessary intellectual capacity and background to be able to figure out the truths from the myths -- all you need is a bit of help.

I hope these videos will bring you closer to this state of having a clear and rational understanding of what's going on with your child and become confident of your own capacity to deal with challenges should they come your way.

In the previous post I already mentioned that it was difficult to keep this video short -- I couldn't keep myself on the rails all the time and took several tangential educational detours as well.

Hope you do not mind.

So frankly -- I do not know which video is better -- so I put both on. Your feedback is most appreciated and is going to help me to do better videos for you in the future.

Well, that's pretty much it...

P.S. Please do not forget to press Facebook 'Like' button --so more people can benefit from getting a little bit of rational outlook influx towards this emotionally charged issue of hip subluxation.

Cheers...

Hip Subluxation in Cerebral Palsy Video Series Overview

2011-02-04T04:37:05+02:00

What is the best way to defuse fear and confusion that you are constantly being exposed to by medical establishment? – Knowledge.
To be precise – not any knowledge but parent-centered advanced knowledge.
I feel it is important to distinguish parent-centered advanced knowledge from a diluted and dumbed down versions of medical textbooks that you find on ‘official’ websites on Cerebral Palsy.

Hip Subluxation Video Series intend to do exactly that –give you a comprehensive perspective on the subject that is exploited most often by fear-mongers.

I have prepared 8 videos – each of them at least 30 minutes long covering a subject of hip subluxation extensively, digging deep and going broad in order to build it into the entire context of your CP child’s development – especially for quadriplegic kids.

Yes, it’s a lot of information and yes, you need to do your homework encouraging yourself on making an effort to absorb and digest it. However, considering all the emotional and financial costs that fear and confusion around hip subluxation and other ‘scary’ issues related to legs alignment and mobility impose on you – I think this homework is going to be a worthy investment of your time.

I wish I could have given you some really simple answers and reassurances to the likes of: “Duh … Dun worry… With ABR you are safe, sound and guaranteed the amazing success without the need to think too much and educate yourself. Just do as you are told…” Unfortunately, I can’t.

To begin with I have no official title or government-backed authority to make this kind of statements. But even if I were – this type of message “don’t think – just do as you are told” is at odds with my own core values. I believe in due diligence, self-education and making choices intelligently by taking into account the true complexity of the situation… I am definitively not the best person to talk to if you are searching simple ‘no-brainer’ recipes.

When it comes to the issue of hip subluxation, legs ‘straightness’ and crossing, spasticity and contractures – you have to understand that the medical authorities have the best intentions.

Yes, they usually use scare tactics when talking to you, and, yes, they are quick with a knife and toxic injections whenever they see your child crossing the marks they have drawn– but they do all this not because of being “evil” but because they honestly believe that their actions is the best way to ensure the best quality of life for you and your child under the constraints set by your child’s Cerebral Palsy condition.

The doctors you meet are logical and consistent within the body of knowledge they have and within the anatomical analytic toolbox they use. They interpret the developments of your child according to the paradigms they learned in medical schools and according to the experiences they have accumulated throughout their professional career…

There is only one problem … although a giant one … their logic is based on a keyhole view that reduces the true complexity of your child’s condition and developmental evolution to a bunch of primitive recipes.

It’s quite mind boggling that at the largest worldwide conference on Cerebral Palsy you find out that 100s of professionals presumed to be the best in the world mull over the same subjects over and over again – surgery, Botox, baclofen; surgery, Botox, baclofen – like a broken record…being apparently oblivious to the futility of these interventions.

Of course, it’s partially due to the fact that manufacturers of Botox and baclofen pay the flight, accommodation and attendance fees for everyone who does presentations about their products… but anyway – seeing seemingly intelligent people being unable to break away from the same three primitive tools is distressing and sad.

In order to understand why this happens, where the systemic flaws in their judgment come from – you need to educate yourself.

I want you to realize that whatever shows up as the product at the end of the funnel is defined by the way the funnel is set and shaped.

I want you to realize that unfortunate lack of progress in Cerebral Palsy rehabilitation is pre-destined by the anatomical analytic toolbox that medical pros use…

Ok, I am jumping a bit ahead of myself here..

Let’s proceed to the overview of the Hip Subluxation in Cerebral Palsy series: Video 1 in the Hip Subluxation Series presents the first fundamental framework: “Cerebral Palsy is a developmental disorder of posture and movement where the key limitations are defined by Transanatomical challenges.

When medical world looks at Cerebral Palsy via simplistic anatomical lens – what I call Anatomical Analytic Toolbox that is based on measuring Ranges Of Motion and evaluating Alignments – they inevitably arrive to flawed conclusions that result in disastrous outcomes especially for quadriplegic kids.

Effectively the usage of simplistic anatomical lens creates the situation where upon seeing a race car made for agile performance but experiencing problems – instead of starting to figure out all the fine parts and gears and balances and how these fine parts work together in the long and complex kinematic chains – they start chopping this wonderfully complex race car trying to reduce it down to a handcar that rolls along the straight rails…

(I know that most of my readers are mothers and I am at risk of not resonating too well with this last engineering analogy – however, I couldn’t help myself. I guess I visited way too many car and engineering museums this summer in Germany where we went with my son during his school vacation.. :-))

Video 1 explains the difference between Transanatomical interpretation of legs mobility vs. a standard anatomical interpretation based on conventional Range-of-Motion (ROM) framework.

In fact you’ve been hearing the ‘Wrong Place/ Wrong Movement’ descriptions from me for a number of years already. Well, Transanatomical framework is more accurate description of this phenomenon.

I think that Video 1 is of substantial extra value for your understanding comparing to the ‘Wrong Place/ Wrong Movement’ framework because the Transanatomical approach is more formal and you can see how the Transanatomical analytic toolbox fully absorbs the classic ROM interpretation.

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During those few days that Video 1 in Hip Subluxation video series was published on the blog but did not have the annotation – I received quite a few comments –here in the blog, via Facebook and via e-mails to ABR centers.

It’s interesting – that there were 2 classes of comments:

‘Wow, thank you’ – now I am starting to understand my child’s condition a lot better by seeing a big picture…
‘Well, yes it’s interesting’– BUT – I want to hear the specifics about the hip subluxation and dislocation…

In the past – the second type of comment used to make me really frustrated: “Gosh, isn’t it obvious that without the change of the entire framework we’ll be back to square one and have nothing to add to the mainstream? I mean, if you put a raw meat pie into the oven – don’t be surprised that you don’t get a sponge cake as the end product…. It’s seems natural to me that if you are unhappy with the outcome – not getting the cake you wanted – it makes perfect sense to re-check what was put into the oven to begin with..

And isn’t it self-evident that once there is a superior analytic toolbox – we are able to go much further in our practical actions?”

However, that was the grumpy old me – the new me is different :-)

I have recently read about the critical differences in learning styles. In short it turns out that some people are “What?” type – whose approach is “Give me a framework that covers the issue and I’ll figure out the practical details myself”. Well, obviously that’s who I am and that’s my natural worldview that could be called ‘descending’ – from theory to practice. However, apparently there are also the “How?” people – the ones who want the practical details and the exact substance first and only after finding comfort in tangible tools and specifics they are ready for the question “What’s the larger picture?”

Well, I don’t belong to this type – but at least now I realize that these people simply have the opposite learning style – ‘ascending’ from particulars to generalities.

So, yes – these series on Hip subluxation do have a lot of the particulars as well – but those are in the last videos … Sorry my dear “How” readers and viewers :-)

As a compromise to “How” viewers who want the video series on “Hip Subluxation in Cerebral Palsy ” to actually talk about ‘hip subluxation’ – I am going to break the order a bit and publish the Video #3. “ ‘Hip Subluxation’– what is it exactly? Clearing the confusion between parents’ perspective and medical interpretation.”

This video explains the essence of very specific narrow ‘X-ray’ based ‘diagnosis’ of hip subluxation as the medical world sees it and then compares it with the extended developmental perspective that I see from the most of parents.

This confusion is absolutely critical – because in reality you and a medical pro look at the same area and the same manifestations; you then agree on the name for those – calling it ‘hip subluxation’ – but at the end it turns out that you and the medical professional on the other side of the table – speak different languages and put completely different meanings into the term ‘subluxation’.

Exposing this confusion it would have been easy if that was a proverbial case of comparing apples to oranges. But in this case the misunderstanding lies deeper.

To give you the idea, I’ll use an analogy: As if both of you were looking at, say, a door – any door. When you are thinking about doors your scope is broad – you think of doors either being wooden or made of metal, large and small, internal and external and so on – very multifaceted. Quite naturally you think that all the other people perceive the idea of ‘a door’ in the same way including the doctor on the other side of the table. But that’s the caveat – without you ever realizing it the doctor has one simple criterion – ”the doors that have a color that is brown and darker are unsafe and have to be repainted” and the reverse one “any door that has a color lighter than brown is a good door”

Anyway – I think the Video #3 is going to be welcomed both by “What?” and “How?” viewers.

Next video is practical as well:

Hip Subluxation in Cerebral Palsy. Video # 4.“ ‘Hip Subluxation’– Why so much attention? The Truths and the Myths.”

This video touches all the sensitive points – the issue of possible pains; leg shortness; risk of dislocation etc.

It’s a lot of subjects to cover – and it wasn’t easy for me to stay on course…

Even though I had very concrete bullet points in front of me I periodically went off onto some more general explanations as well.

So after filming the Version 1 – I ended up thinking that it might be too long-winded for the “How?” viewers – and gathered my enthusiasm to produce the Version 2 hoping to do better.

So the Video #4 .“ ‘Hip Subluxation’– Why so much attention? The Truths and the Myths” exists in 2 versions . I think both are of value for you where Version 1 has more of the larger context references and Version 2 is done with the attempt to be more concrete.

However, I think that the Video that is going to really appeal to my distinguished ‘How?’ viewers is the Hip Subluxation in Cerebral Palsy. Video #5. “Case Review based on a home video” Part 3.

Why Part 3? That’s where I really went into a Question and Answer format taking the actual questions asked by Emma’s mom: “Are the recent transitions being a good thing or a bad thing? Can we fix this? Will her hips and legs ever be straight? Will her leg discrepancy eventually fix itself?” – adding a bit more ‘spice’ to them and giving the answers.

Again, in my personal opinion of an individual with a ‘descending’ learning style where the big picture comes is the key – the best of way to understand my answers is to watch the earlier videos first.

However, I respect the opposite learning style as well and maybe for a “How?” person it is more productive to see the final answers first and to unfold the preceding story afterwards. It’s up to you – whatever suits you better.

Clearly whenever there is a Part 3 there have to be Parts 1 and 2 in existence. And sure there are.

In fact the entire series ‘Hip Subluxation in Cerebral Palsy’ consist of three clusters:

Cluster 1. Transanatomical challenges – the essence of Cerebral Palsy – in any area of the child’s body.

No matter what particular plane or joint or movement we look at – Transanatomical approach is the framework that allows to make sense out of the developmental challenges that your child experiences.

These are the Videos #1 ‘Transanatomical nature of hip problems.’ and #2 ‘Rainbow Principle of Improvements for the lower extremities in Cerebral Palsy.‘

These videos use the particular example of hip subluxation as a bridge to introduce a more general reality – the transformations of the legs in Cerebral Palsy follow the ‘United 12’ principle – all 12 elementary mobilities of the legs (Each of the 3 planes x 2 directions within each plane x each of 2 legs) always respond at once as a connected system.

That’s the most practical outcome of the Transanatomical understanding of Cerebral Palsy.

How more practical could it be?

‘United 12’ (‘U12’) principle points out that when you try ‘stretching’ the leg in a single direction – the one that you think your child should become more mobile in – you end up affecting the remaining 11 mobilities at the same time. Unless you realize – you end up having no clue on what you are really doing and what real consequences your actions are going to have – True Positive or True Negative. Without the understanding of United 12 principle – you lose and connection between cause and effect and just shoot blindly in the dark..

Isn’t it very practical?

To complete this big picture understanding I have also added an extra Video #0 “Cerebral Palsy Deepest Hidden Secret –How the choice of Analytical Toolbox pre-destines your child’s future. ” that goes even further to the origins and explains why the choice of Analytic Toolbox – advanced Transanatomical or conventional Anatomical – holds the key to your child’s future. Wrong choice – simplistic Anatomical Analytic Toolbox – leads to simplistic interpretation, which in turn leads to simplistic and brutal interventions. Try to fix a race car with a hammer and a chisel and you’ll end up never going beyond the starting line.

It’s the Anatomical Analytic Toolbox of ROMs and alignment calculations that pre-destines the unholy trinity – surgery, Botox, baclofen – that defines the mainstream ‘official’ treatments landscape for Cerebral Palsy.

Cluster 2. Videos that dig into the current state of affairs around the hip subluxation problems.

In this cluster I use Emma’s case example to illustrate the most common problems as wells as the truths and myths about hip subluxation.

These are Videos # 3 and #4.

Video #3: “ ‘Hip Subluxation’– what is it exactly? Clearing the confusion between parents’ perspective and medical interpretation.”

Video #4 .“ ‘Hip Subluxation’– Why so much attention? The Truths and the Myths” – two versions. It’s up to you to decide which version is closer to your learning style but I suggest to study both anyway.

Cluster 3. individual Case Review – using the analytical tools and knowledge presented in the Clusters 1 & 2 for the analysis of Emma’s case – specific manifestation of legs/pelvis mobility and alignment.

Video #5 turned out to be long – in this video I am actually going through all of the 23 observations and 18 analytical statements presented by Emma’s mom in the original home video and add my comments linking these specifics to the bigger picture you learned through the previous videos.

Of course, sometimes I go back and forth and sometimes I go on a tangent by adding some extra educational references for you – that’s why the Video #5 ran for more than 1 hour and I had to split it in 2 parts for easier viewing.

But then again – after finishing Parts 1 & 2 I still had a feeling that I can do a better job of being more concrete and compact answering the concerns voiced by Emma’s mom – that’s the Part 3 of Video # 5 where I try to keep on course tightly.

Well, that’s the overview – I’ll try to add some brief annotations of each video contents as I publish them – but that depends on how busy I am going to be.

I think that even with this general overview you are well equipped to know what homework is to plan for.

As always – I am most open for questions and opinions – I hope these videos are going to help raising your “fear-resistance factor” and contribute towards our main goal – assisting you on your journey of becoming a competent and confident therapist for your child.

I hope you’ll enjoy this educational journey…

Hip Subluxation in Cerebral Palsy – addressing the parents concerns. Part 1.

2011-01-29T06:32:07+02:00

Not so long ago I have received a wonderful video with questions about hip subluxation and transitions in the mobility and alignment of the legs. The video is compact – about 6 min long, it shows impressive observational ability of a mother – awareness of all sorts of little details; but at the same time, within these short 6 min it covers the range of questions and concerns that I hear from many of the other parents being asked over and over again.

I’ve been granted a generous permission to use this video and my answers to the questions asked as the teaching material that will benefit a great number of parents.

Obviously, I am going to stretch my explanations and comments much beyond the original 6 minutes – so I’d probably end up dividing it into several parts.

In the review of the video – I have separated the observations from the statements – which in turn are divided into explanations/ analytical statements and focus points of concern /questions

Since there are 23 observations and 19 analytical statements/questions/ issues of concern voiced by Emma’s mom– even if I spend a few minutes of comments per item– my video will end up being really long. But a number of these issues are so important for each and every of you that I have to dig deeper and show you a broader perspective as well. Obviously – that will add up the video length minutes.

Hence my first suggestion to you is to have a look at the original 6 min video in its entirety to have a complete overview of the situation and to align yourself with it.

For your convenience I’ve added the captions and actually labeled all the observations and questions.

Once you have watched the original video – I want to give you some food for thought right away:

I am posting the first video in the oncoming series here in the same blog post right now.

This “Hip Subluxation in Cerebral Palsy. Lesson #1. Rainbow Principle of improvements. Part 1.” video is based on some extracts from the ABR testing done 1 year ago. This return to the beginnings is going to put recent developments Emma’s mom is concerned about into a perspective of the background situation that Team Emma started their ABR journey from.

Once again – I want to congratulate Emma’s mom on her excellent effort when doing this short video.

23 observations and 19 analytical statements/questions during a 6 min video – show the key thing: her Awareness.

That’s the key to get your work with your child in the right order.

Awareness
Understanding
Strategic Plan
Systemic Action
Awareness of the results stemming from Action
Review
Correction
Return to Action

Too many parents limit their performance to the following:

Hearsay/ sweet songs of dream merchants
Irresponsible dreaming of magical fast results
Hectic/ Sporadic Action
Disappointment
Search for a new source of sweet songs and the largest promises…

The habit of doing your homework – is the key!

Sure you have the drive and the desire to help your child to reach the maximum developmental potential possible. But desire alone is not enough– you need to grow both as an analyst and as a therapist – and both of these competences start with keen observation and awareness of transformations. You can’t grow if you don’t do your homework, period…

Well – there is really a lot of ground to cover!

I started to realize it in full only once I have proceeded to doing the actual video:

My initial ambition of making just a single “Hip Subluxation in Cerebral Palsy. Lesson #1. Rainbow Principle of improvements” – was too optimistic…

There is too much of the preliminary definitions and explanations that have to be introduced.

Anyway – I hope that is going to be helpful.

Please share what you think via your comments – hip subluxation is the question that I am asked about really a lot.

I'd be happy to find out– whether I am on the right track with my answers… The more feedback I have – the more I can shape the video lessons towards your needs and your language.

Thanks...

Cerebral Palsy – Giving a Boot To Neurological Dogmas. Part 1

2011-01-10T05:22:33+02:00

In many countries New Year is the time when people throw away everything old and useless that accumulated in a house with the idea of having a fresh start and letting the new things in.

I admire the tradition and decided to follow suite – the first post of 2011 is about flushing down the drain the outdated neurological dogmas that paralyze and lead astray professionals and parents of kids with Cerebral Palsy alike.

Disclaimer – big and bold: everything you are going to read is my own extremely biased opinion that is most unlikely to be supported by qualified medical professionals.

I’d actually go even further and say this – to leave no doubts about my extreme biasness:

In my opinion, “brain-based” approach to Cerebral Palsy that treats ‘brain injury’, i.e. damage to a part of the brain, and ‘Cerebral Palsy’ – disorder of posture and movement/failure in reaching biomechanical developmental milestones -- as the interchangeable synonyms – is the most important obstacle that stifles the progress of physical rehabilitation and freezes current abysmal status quo.

In other words, a neurological paradigm is: a blindfold over your eyes; sticky glue, quicksand and rocky terrain underneath your feet; iron gloves over your hands; plugs in your years and shackles around your feet – all of these in a single nasty package… So you are welcome to figure your chances of success if you are ever lured by

In Part 2, I am going to go over 16 most obvious reasons why neurology leads you astray and why the guidance by neurologists who define the discourse of today’s interpretation and approach to Cerebral Palsy is the worst and most unproductive thing that is responsible for astonishing lack of progress in Cerebral Palsy therapies over the last 100 years.

I’ve been thinking about these flaws for years and collected quite a pile – but in order to spare you from a nearly endless list – I gave myself a time line: I put the kitchen timer on 10 minutes and proceeded to write down as many stubs exposing the fundamental flaws of neurology and brain-centered paradigm for Cerebral Palsy as possible.

By the moment the timer went “Bzzz” – I was on reason # 16.

Well, If I were to give myself ½ hour – I’d probably come up with a list that would have been three times as long– but I think even a basic version will do to begin with.

However, before proceeding to Part 2 – the actual list – I wanted to immerse you in the context of the case – I hope that’ll give you an improved perspective.

I do not know whether it’s my nerdy self but I find this picture incredibly funny and strangely appealing.

This is the cover of Harper’s Magazine and it has been on my office’s kitchen table since October but every time I walk past it – I can’t help smiling… The white-haired man with the badge: “Hello my name is Sigmund”, who is being kicked out from a gathering as an unwelcome trespasser by a muscle-bound security, is obviously Dr. Sigmund Freud.

The cover of the magazine refers to the featured article inside: “The War on Unhappiness” – ‘Goodbye Freud, Hello Positive Thinking’; which reports from the all-American gathering of the psychotherapists which pledged allegiance to positive thinking and happiness promotion instead of a classic Freudian psychoanalysis that studies trauma and misery – all the way from the analyzed person’s early childhood.

I must say that the article is quite interesting and thought-provoking in itself but what gave me the most inspiration is the picture.

You see – when it comes to Cerebral Palsy – pretty much the same has to be done with these two distinguished gentlemen:

You might ask:

Who are these people? What do they have to do with my child’s chances for better function and quality of life?

What influence do they have on Cerebral Palsy / brain injury rehabilitation?

They seem to be intelligent and nice people – why do you want to give them a boot, Mr. Blyum?

These gentlemen are: Sir Charles Scott Sherrington (left) and Ivan Petrovich Pavlov (right) – they lived at the same time as Freud (late 19th-first half of 20th century) and they are of equal stature if not more influential than him for medicine and related practices until these days.

Sherrington and Pavlov are the founding fathers of neurology, both are the Nobel Prize winners, and clearly both were remarkably intelligent people whose profound and influential books shaped the course of their discipline for years to come…

However, these towering figures are the ones inadvertently responsible for the mind-boggling stagnation in the field of Cerebral Palsy where the outcomes have not improved by any sizeable margin for the entire 20^th century.

The unfortunate reality in the field of movement disorders is the astonishing lack of progress – your child with Cerebral Palsy today has very little gain in terms of tangible improvements to structure and function comparing to a child who was born 100+ years ago.

There wasn’t a lack of trying – hundreds of thousands of doctors tried their best and billions of research dollars went down the drain – but all with very little to show for the massive investment of resources.

What is the official explanation? – More funds and new technological breakthroughs needed… The standard mantra…

My humble opinion? – If the wrong path is chosen at the start of the journey –then no matter how much investment and effort is poured in – wrong path always leads to a wrong place…and what initially is seen as perseverance then becomes stubbornness and eventually turns into hopeless dogmatism… That’s where the “Cerebral Palsy science” is today.

So-called scientific conferences in Cerebral Palsy became pitch festivals for brutal and toxic interventions – major surgery, Botox and baclofen…

Who is ultimately responsible for the wrong choice of the path? – These two distinguished gentlemen that you see on those portraits.

Drs Sherrington and Pavlov are the ones who had established the fundamental paradigms of neurology that until these days define where and how the answers are being searched for debilitating conditions related to profound impairments of posture and movement.

They are the ones who came up with definitions of “reflexes” and outlined the main bioelectric “control paths”. Of course, there were quite a few others – but of much lesser stature than these two Nobel Prize winners. They had the fame – so, they should get the blame as well, right?

The essence of neurology is the bio-electric approach – the study of signals: where they originate from, where they go to, and what effects are observed once the signal arrives. Neurology approaches the body with a perspective of a bioelectric nervous system being the puppet master that plays the script via all other organs of the body. The body itself is seen very much both as a medium and a stage for that play. The ultimate control is with CNS (central nervous system) – essentially ‘the brain’ – that has different areas and compartments each of them being “responsible”/ “in charge” of its own domain of subordinates – organs and functional systems of the body. CNS is akin to the ‘ever-seeing eye of the Beholder’ being in control of everything from tissues and individual organs to the organismic functional system.

There is a also an added touch of drama that every schoolchild knows: the nerve cells do not re-generate. Whenever they die – there is no way back by growing the new ones. Respectively the understanding goes that with a loss of neurons in the brain some areas of control are being lost forever. As a result the body structures that lost bio-electrical guidance become unruly, cause mayhem and disobedience that translates into deteriorating functional performance.

In general, ‘the loss of bio-electric guidance’ is the principle framework that neurology has for any disease or chronic condition. There could be plenty of specific ways of how and why such a ‘loss of guidance’ occurs – but the essence is always the same..

Of course, this is just a sketch and an outline of what neurology is – there are plenty of disclaimers, refinements and sub-clauses that were accumulated over the years – however, all those are for the insiders only and do not change the neurological paradigm itself.

The outside product of neurology is what I described – bioelectric paradigm with the brain as the main switchboard that controls everything via signals.

In order to understand the deep appeal of neurology and how did it manage to get a stranglehold on all the other competing lines of thought so quickly and so powerfully – one needs to see a historical context.

I mean, personally the very premise of neurology struck me as fundamentally flawed very early on. In fact, the first 2 books that I ever read on the subject of therapies for Cerebral Palsy were the ones by Bertha Bobath and her husband, Karel Bobath. She was the one who invented the exercises known as Bobath Method for the last 50 years, but actually he – the neurophysiologist – was the mastermind behind it who gave all the explanations and reasoning via neurological descriptions.

I couldn’t really digest the mismatch – how on Earth can one seriously try to justify and develop specific biomechanical interventions, i.e. exercises and therapeutic movements, – which are tangible acts of force transfers characterized by ranges, pivots, distribution of loads, recoils, accelerations and decelerations, velocity within short and long kinematic chains that are hierarchically related to one another etc. – via bioelectrical reasoning that has no built-in sensitivity to these biomechanical parameters at all??…

Imagine an actor expected to perform Shakespeare from stage in English is given the works of Confucius in Chinese as the script he has to learn from… It’s an absolute nonsense. But somehow everyone seemed to be quite contempt with it.

Unfortunately, the more I read the more I saw that no one cared about this mismatch between the biomechanical reality of physical rehabilitation and treatments for Cerebral Palsy versus the bio-electrical reasoning that all the books took for granted .

So I’ve been thinking about the nature of this mass delusion and obsession with electrics for a long while collecting blunders, paradoxes and oxymorons but still I remained puzzled.

The realization came to me couple of years ago while visiting science and transportation museums in England with my son in the summer of 2009. We’ve been to London, Oxford and Manchester visiting technically oriented museums.

All of us today – children of the 20^th century living in the 21^st take a lot of surrounding civilization for granted. Electricity has always been a huge underlying part of our everyday life that penetrates absolutely everything we use and do that it is difficult to visualize life in the pre-electricity era.

(2 weeks in a summer cottage on the remote lake– do not count. That’s a voluntary temporary escape from pressures of city life – but it doesn’t change your civilizational experiences. )

I do not think we can fully realize the breakthrough that the city life took in a span of merely 20-30 years at the turn of the 19-20^th century and the emotional effect of fascination and awe that it had.

Electricity absolutely transformed the everyday landscape and environment – city lights, home lights, telephone, cinema, radio, electric railcars all that together with the installation of new sewage and water supply systems – made a dramatic change in everyone’s life.

Yes, today we live in the age of computer and the Internet and mobile phones etc. – but these are merely upgrades of the original electrical revolution. All the changes that we have faced personally as the 20^th century was turning into 21^st – they absolutely pale in comparison with what took place 100 years before that. Today our cities , electric grids, transportation means are fundamentally the same as they were 30-40 years back (Just watch the movies… ) 100 years ago the perceivable change of everyday city life within the same span of time was many times greater.

Plus we got so used to the technological advances that we pretty much have lost the ability to be amazed by them – they do not capture imaginations anymore.

To really get the feel of how drastic was the change I strongly recommend to visit relevant museums – pretty much any large city museum will do. You’ll see through the artifacts and reconstruction of the scenes of city life how dramatic was the change of everyday environment at the end of 19^th-early 20^th century.

This summer our tour of science and transport museums went through Germany – and it’s the same thing: whether it’s Munich or Berlin – the end of 19^th century was clearly the time of engineering triumph with electricity at the helm of change and innovation…

Why am I telling all this? – Simple reason – it’s exactly the same time when the founding fathers of neurology worked and that was a public sentiment of the day.

The soil was fertile – everyone believed that electricity is “the thing”. Imagine a person who has just experienced the awe and magic of talking to someone distantly via the phone operated via a huge switchboard being presented a similar idea but in respect to the human body? – Obviously, it strikes the cord.

And once the Pavlov’s experiments with the dogs and salivation were made famous – the deal was sealed.

Neurology received the key to the medical kingdom on a silver plate.

Add to this the insatiable desire of a humankind for the ‘magic key’ – where one single switch of a selector into a “right” position is capable of solving a galore of related problems – and voila the neurological quest has been born…

Neurology ran this wave of early promises for several next decades firmly establishing itself as a leading paradigm in medical science until seemingly coming out of breath by late 40s where it seemed that everything that could have been studied by rather crude electrical devices of the day had already been explored without giving much of truly effective clinical answers … but then the technology came to the rescue once again.

First, it was the mass-production of a transistor – as a result all sorts of new devices like EMG, EEG etc. became available with tons of new electrical phenomena to be measured and classified. So no one bothered with re-evaluation of paradigms but jumped on a bandwagon of even more measurements and detection of even finer bioelectrical phenomena in the human body.

Second, soon after, the electronic microscope provided another boost – now it became possible to dig even further into the microstructures that compose the pathways of bio-electric signals – huge new fields opened up for studies… Who’d silly enough to bother with the issues of integration of ever-growing pile of microfacts and re-evaluation of underlying paradigm when there were so many geese to chase?

Meanwhile, the 60s came in – and the computers started to appear. So there was a new powerful way of doing more computations around all these micro-facts.

And then 70s – the MRI – now it became possible to observe the actual nerves as such with unprecedented clarity.

80s – computers got even smaller yet much stronger – so there were more facts to detect and databases to plough…

At the same time emergence of the computer as a driving force of progress at the last decades of 20^th century added an extra conceptual boost to neurology and bio-electrical paradigm.

What was previously perceived as a more or less simple switchboard now evolved into a readily available upgrade: the brain as a supercomputer.

But wait … there is more – computer science brought in the concepts of networks and complex integration of those – so there was even more room to squeeze creative juices from the neurological paradigm.

Until today technology and ever-growing proliferation of computers continues to give the life-saving shots to the old neurological horse that refuses to die…

It all seems so excited and complicated and promising and absolutely impenetrable for the mere mortals BUT … as they say in the movies …– “Show me the goods..”

Well, and that’s the simple question that pierces the armor like a knife through a melted butter…

There are none … Nothing to brag about…

Botox? – a locally applied toxin that brings extra paralysis but short-lived one.

Splints? – Err, aren’t those the same things that we see on the 18^th century pictures. That’s what – nearly 300 years ago

Surgeries? – They keep becoming more and more invasive..

Physical rehabilitation and training? – Clearly unable neither to beat the GMFCS curve in comparison to spontaneous development, i.e. “doing nothing”, nor to prevent the surgical invasions.

Stretching? – Until today nobody knows for sure for how long and how exactly and where at one needs to stretch

What is the highly lauded “greatest achievement in Cerebral Palsy science over the last 50 years” – GMFCS curves…

LINK: GMFCS curves -- what are your child's progress expectations...

Wow!? But what are these curves? – GMFCS ‘curves’ are the official statistical recognition of the fact that all the efforts aimed at improving the functional performance of children with Cerebral Palsy bring , well, –nothing, when compared to “doing nothing” and quantifying the exact extent of these failures… That’s optimistic, isn’t it?!

So, my basic message is simple – with all due respect to Drs. Sherrington and Pavlov – they need to be treated the same way as Dr. Freud on the opening picture:

Of course, these gentlemen deserve respect and they have earned their place in the history books and museums – but for all their brilliance and intelligence they were the products of their times and the path that they have chosen is a flawed one. Whether it’s their fault or the fault of the followers who did not have the same caliber of thinking and preferred to swim with the current – I do not really know or care.

I am looking towards the future… and it’s a collective responsibility of medical science to kids with Cerebral Palsy to perform better than it did over the last 100+ years under the guidance of bio-electrical ideas.

Of course, by today – those are the dogmas and the untouchable idols on the pedestal.

Frankly, I shiver when I think about the dominance of bioelectrical paradigm as today’s chosen basis for treatments and interventions into the musculoskeletal disorders and movement impairments, especially for Cerebral Palsy.

I ask myself a simple question: Do I want to live in a house designed by an electrician? – No roof, no walls, no heating, no sewage, open to the elements but the mesh of wires being lovingly encased… Well, maybe I’ll be able to watch a plugged TV magically floating in thin air but all that is only going to last until the first rain.

So, my answer is a resounding: “No”.

I want the walls and the roof first. Lighting is a nice upgrade but shelter me from elements to begin with.

Now, as the parents of kids with Cerebral Palsy – you are the obvious victims of this bio-electrical paradigm.

Reality bites – whether one chooses to acknowledge or ignore it.

Exercises and therapeutic movements, – which are tangible acts of force transfers characterized by ranges, pivots, distribution of loads, recoils, accelerations and decelerations, velocity within short and long kinematic chains that are hierarchically related to one another etc. – via bioelectrical reasoning that has no built-in sensitivity to these biomechanical parameters at all.

When you put your child to stand – you better know what biomechanical environment you subject him to. When you grab a the leg and decide to “stretch” – you need to be aware of the joint stability, exact distribution of miofascial stiffnesses, safe and damaging ranges, accelerations, loads etc.

If you force a child to crawl utilizing the cheats like inclined plane or plain push at the legs coupled with drag of the arms – you need to be realize what structures are put to work and how and whether your well-intended ‘signals’ are going to come from the right places or from the wrong ones...

The list is long and requires investment on your behalf in studying what biomechanical factors are at play and how to control them.

Arrange them mechanical stimulation correctly and you are able to start building a virtuous cycle of developmental progress.

Screw the mechanical impacts up by loading the wrong structures or by working in a wrong mode – and all your hard work is going to result in nothing else but further aggravation of the vicious cycle that leads to further deterioration…

These are the stakes at play and I hope that you are going to choose wisely….

P.S. A little laugh ...

2011 New Year Greetings --THE OPTIMISM ADVANTAGE

2011-01-02T03:57:48+02:00

The New Year is a very special time – it’s a time of wishes and hopes. There is something about this ‘click’ of the calendar that switches on the inner optimist in us – no matter what type of personality we are in our everyday lives.

And today’s post and my most sincere wish for all of you in this new year is exactly about that – keeping this inner optimism engaged all the time.

In 2011 I wish all of you to turn the internal optimism selector switch into the “On” position and to disable the “Off” button.

I wish you to improve your ability to enjoy the moment, to fall in love with a journey of making life for your kids better without being anxious over the long-term outcome of “final success”.

I wish you to give yourself praise and to celebrate wholeheartedly whatever small achievements and micro-steps of progress your child manages to reach…

I know all these are universal truths perceived by many as banalities and an empty wishful thinking that does not hold water against the storms of the reality…

However, I’d dare to encourage you to make an effort and even when it feels difficult to keep your optimistic stance – still to keep trying and keeping your internal ‘reality perception’ filters switched into the “Positive” mode.

I know it’s not easy. Sometimes the pressures of juggling all the challenges of bringing up a child with special needs and physical impairments mount up to such extremes that it appears impossible to keep looking at ‘the bright side of life’…

I understand it very well.

At the end of the day, I am Russian, right?

And by and large we are one of the most if not the most pessimistic nation on the face of the planet.

Figuring out all sorts of potential scenarios of how the things can go wrong – is our national sport… In a paradoxical way we love when t things go wrong – because it gives the satisfaction of being “right” as an oracle of doom. Glorifying the past and not expecting anything good from the future – is in our blood. We share troubles and failures with our friends – but rarely the successes and achievements. We complain a lot but practically never brag. Giving praise is not part of our culture – we are focused on pointing out the shortcomings in no uncertain terms and details. The greatest works of our famed classic literature are the deep insights into all sorts of misery and dark sides of the human souls… Enough for solid pessimism credentials, right?

So when a Russian encourages you to take an optimism stance – it’s worth giving it a thought… :-)

The basis of my judgment is plain and simple – optimism pays-off; and I am not simply generalizing – I am talking about the ability of special parents to bring the maximum contribution towards the developmental advancement of the kids with Cerebral Palsy.

ABR is a coaching program for parents. The ABR works through you –- the progress of Cerebral Palsy kids depends on the skill and the ability of a parent to deliver consistent day-in day-out work of high technical quality.

So what I am constantly keeping my eye on are the common traits, habits and strategies of the parents that breed the best rate of developmental progress in children.

And this one of the key elements that I can vouch for – optimism helps, and it helps a lot.

There are at least five major elements in play:

Motivation – an optimistic person is more aware to the signs of progress being actively on the lookout for them. Being aware of the progress creates the tangible basis for self-motivation. The tangible outcome of motivation? – Better and more efficient working hours…
Higher energy level – optimists do not pay the tax imposed by hesitance, indecisiveness and anxiety – there is nothing more costly in zapping out your energy than the anxiety, constant worries and mental playback of the gloomy scenarios…
Seeing opportunities rather than obstacles – this is one of the key elements of being able to organize a workable daily routine with consistent working hours. Very few of you have the situation of a child who is always cooperative and other everyday family duties being low enough allowing you to concentrate on the therapy without distractions. Most of the kids’ behavior gives you both – opportunities that could be seized for work as well as the periods of poor cooperation that provide ready-made excuses for “I can’t do it...”. In that sense the factual reality is a mix of ‘black’ and ‘white’ spots – what you see as a prevalent color and where do you shift the spectrum in the long-term – depends entirely on you, not on your child.

If you see opportunities and grab them – the developmental progress is going to take place at the pace that gradually accelerates setting up a positive loop of ‘effort-reward’ for you.

If you see obstacles – the spectrum turns darker and darker eventually becoming a self-fulfilling prophecy: “It doesn’t work”

Higher technical quality of hands-on work – a person who is free of anxiety and mental pre-occupation with all sorts of possible negative scenarios is capable of focusing on a task in hand and develop presence. Mental presence is the key for the continuous improvement of your technical skill and the delivery of the daily ABR applications with attention to detail.
Creating a support network –sharing progress and achievements with the others proves to be very efficient. It pays off double:

o When you radiate optimism to the fellow parents they tend to ‘join the party’ and reflect that positive reinforcement back at you at the same time creating a ‘safety net’ for you that will cheer you up on a ‘rainy day’.

o When you share progress, positives and the strategies that work for you – you get a constructive feedback from the others. You can tap into their knowledge and workflow strategies that might be applicable to your own situation. So not only you get an emotional boost but your expertise improves as well.

I’d be happy if this little post with the praise for the optimism is going to help you in improving your ‘inner game’ even just a little extra bit.

I’ve said it before and will say it many times more:

The better your ‘inner game’ is [your mindset]– the better is your ‘outer game’ [your total ABR skill set and yours child and self- management skill set ] – the more you can help your special child in the lifelong journey of the continuous developmental advancement.

On my part I am going to share more stories and highlight the achievements.

We have tons of examples of really impressive progress achieved by ABR kids over the last 2-3 years that are being hidden under the rug because I am too busy with ‘what other challenges we need to address’.

I need to practice what I preach and to help you in developing your OQ [Optimism Quotient] :-) by doing my part – giving praise where praise is due and celebrating the achievements that we already have…

I wish you all the best in the new 2011, I feel excited about all the new opportunities that the new discoveries/realizations are going to bring for your kids and I want to say ‘thanks’ to all of you for your commitment and dedication…

P.S.

If you look at the right-hand column of the blog – you’ll find a new entry in Recommended Books section.

It has self-descriptive title: “The Optimism Advantage”.

I highly recommend it – you’ll find plenty of good advice and help with developing your ‘optimism lens’.

The book is not thin but it is conveniently divided into 50 separate topics where each of them reads on its own. So you can read it in really small chunks if you feel pressed in time…

P.P.S. I grabbed the opening image from here : Learned Optimism Smiley

New Ideas Avalanche – some unexpected Cinderella stories

2010-12-24T05:46:53+02:00

Merry Christmas everybody!

My thanks and deepest gratitude for keeping up with my writing, which has been sporadic at best this year – I hope I’ll do better in 2011 (no tongue in cheek :-).

My extra apologies for disappearing off the scene for the last few weeks. I want to assure you that my intention/ commitment to keep this blog alive and vibrant is as strong as ever.
But even the strongest of commitments to write regularly had no chance of withstanding the avalanche of new discoveries and realizations that fell on me over the last 3-4 weeks....quite literally...

The flow of ideas has been so intense that until now I am having trouble understanding / figuring out – what is happening ? -Have I stumbled upon an unexpected goldmine or am I going to be swept away by the avalanche of the ever-growing diversity of options?

In short, the new realizations are going to lead to the new pool of strategies, techniques and tools that are as large if not larger in variety then entire ABR arsenal developed until today.

Why?

Because instead of one single Cinderella turning princess– fascia – that ABR has been committed to for the last 10 years, there are 2 more Cinderella stories that suddenly started to unfold really rapidly.

The analogy of the way that fascia recognition flourished over the last 5-10 years to a Cinderella story doesn’t belong to me. Robert Schleip is the one who came with it not so long ago, but I do find the parallel quite appropriate.

After centuries of staying relegated to the lowly ranks of the “wrapping” that serviced some other “really important” active organs and tissues – suddenly there came a realization that fascia is much more than just a ‘shrink wrap’ around the organs but has all these wonderful properties and influences that apparently have the potential for explaining and hopefully solving centuries old stubborn problems.

Isn’t it a Cinderella story? – From lowly servant to a princess and everyone’s darling.

Well, it appears that are more Cinderellas on the way!

In short, there are two more underappreciated processes:

1) “Diffusion” – filtering of the interstitial fluid through the fascial net

2) “Cushioning and lubrication” – the role of hydrogels within connective tissue

I put both in inverted commas because I believe that those ‘textbook’ attributions are overly simplistic and do not do even a fraction of justice to fundamental role that these processes play in the norm and pathology.

Both are related to the flow and filtering of interstitial fluid and its derivatives, on the one hand, and to the role of the ‘hydrogels’ in the composition of the body tissues and organs, on the other hand. I’ll open the brackets in a short while – so far I just wanted to give a bird’s eye view of the matters that I am going to talk about.

Actually it all started rather unremarkably – there were not any ‘forewarnings’ of a forthcoming avalanche.

To begin with I was routinely flipping through the literature extracts on joints performance prepared for me by Dr. I. Semenov (I guess his team should be called ABR Siberia :-)) and suddenly a well-known fact struck me from an unusual perspective…

Well, the fact itself is well-known:

Hyaline cartilage doesn’t have any direct blood supply or nerves connections having the layout of its collagen fibers so dense that nothing can really penetrate through it. The entire life-sustaining process for the cartilage works through the suction and filtering: under the loads the interstitial fluid is being squeezed out of the cartilage and into the joint space, where it mixes with the synovial fluid and being “cleaned” off the metabolites produced within the cartilage itself. After the withdrawal of the local mechanical load off the cartilage the ‘fresh’ liquid is being sucked back into it and whatever small space that is transitory between the cartilage and the bone.

Everyone in the ‘movement therapies’ domain knows about this fact. It’s textbook. However, similar to the most of the textbook facts it doesn’t really bring that much of an attention due to being ‘too basic’. Frankly, I was guilty of the same overlook until just recently when it really struck me.

All of a sudden it was, like… wait a minute… Isn’t it amazing? No blood vessels, no direct neuro-influence … and yet – the system functions perfectly alright through millions of cycles being based purely on the mechanism of filtration and irrigation under intermittent mechanical loads!?

Just try to visualize it – your knee performs at least 2-3 million steps every year, i.e. 2-3 million of loading and unloading cycles at the cartilage…– and all of that functions smoothly without any local blood supply and without any central control!

Isn’t it an example of super-efficiency?!

And frankly, nothing lights up my screen more than an example of energy super-efficiency of a certain biological process, especially an underappreciated one.

When it comes to a human body structure and function analysis – I am a bottom dweller and a bottom feeder. You can even call me a scavenger – I look for the background basics that are left out by all those carnivores who rush to the higher levels of the food chain.

I look for the structures that are the cheapest and try to find out whether there is some overlooked and undiscovered substance left over for me to feed on…

Why? – it’s simple. I deeply believe that Mother Nature is a bargain hunter. I believe that Mother Nature is greener than the Green Peace and Al Gore put together, and that whenever there is a way to do something on the cheap and using the easily reproducible, replaceable elements that can function in semi-automatic mode – that’s the option that a biological system is going to choose in favor of complex and expensive ones.

No disrespect for the blood circulation via the designated vessels and no disrespect for the nerves as the designated bioelectrical avenues , but:

They are expensive – both to produce and to maintain.
They are fragile and specific.
They appeared much later in the course of evolution as the specialized superstructures.

That’s why when I was reading the textbook facts about the functioning of the cartilage with my new ‘pair of mental glasses’ – being on the lookout for examples of super-efficiency – it really struck me.

I think there are really elegant parallels with the way that fascia recognition in the scientific community started its ascent from the lowly rank of the ‘wrapping’ and to the elevated status of the cornerstone of the body architectonics.

It’s very much a similar set of alternatives: muscles are the expensive way of having a weight-bearing support framework , whilst fascia is cheap. By the same token – blood and nervous supply are expensive, whilst direct filtering is cheap.

Muscles are high maintenance structures, fascia is low-maintenance. Muscles are complex and once damaged require massive repair works, fascia is a lot simpler and responds to direct mechanical stimulation.

I hope you can see the similarity of the discourse…

But let’s stack the ‘amazement’ factor up and get back to the cartilage…

Where does that “dry land” and “zero regulation” process happen? – In the area that has the greatest risk of damage and injury because comparing to any other musculoskeletal elements it experiences the greatest mechanical loads!

If you think about it a bit deeper – isn’t it somewhat paradoxical? What appears to be the area of the greatest danger and risk seems to be paradoxically abandoned by specialized supply and monitoring systems of the body… Isn’t it odd?

From an engineering standpoint – if you were constructing a bridge where would you put more focus and monitoring devices– to the area of greatest loads or to the area of minimal loads? – No need to reply – the answer is obvious…

Shall we believe that Mother Nature is being particularly stupid or is it just being ‘lucky’ in this specific instance whilst it shows amazing wisdom of adaptations elsewhere in the body?!

Well, I can’t. I am humble enough to have a simple approach: in case we suspect Mother Nature of being irrational or inefficient – we need to think twice and revisit our own assumptions.

So, we need to dig a bit further.

The entire modern mainstream paradigm of interpreting whatever right or wrong happens in the human organism is extremely ‘vessel circulation centered’ (blood, lymph etc. – everything that has identifiable vessels) as well as ‘nerve-centered’ (i.e. put in context of descending ‘commands’ delivered via the signals).

From this perspective the ‘life of a hyaline cartilage’ is an odd one out – no nerves, no vessels. It’s the strange exception that is mainly used to prove the rule of looking for vessels and nerves elsewhere in studying both norm and failure.

So my logic is quite simple – all it takes is just a little bit of lateral thinking and systems approach. Why don’t we move our vantage point a bit and apply a different lens…

Why don’t we look at the interstitial hydrogel filtering via the cartilage as a precedent that is ubiquitous rather than an exception?

Why can’t we assume that the same filtration mechanism of the interstitial fluid and its derivatives plays the foundational role for the background performance for all of the other elements of musculoskeletal system –since they all stem from the same origin?

Why don’t we approach the situation not from “instead of” perspective but from “as well as” one?

Why the presence of the nerves and vessels in the bones, muscles, and so on shall be the reason to forgo the analysis of the role that the hierarchy of the interstitial flow and filtering plays in their existence and performance?

Yes, sure blood circulation is important and nervous regulation is essential for high level performance of, say, muscles. However, that’s just one way of interpreting the hierarchy of body’s functional systems. There are plenty of examples in physiology of the co-existent hierarchies each one being optimized and depending on its own key factors.

Why don’t we put the nerves and vessels aside for a little while and instead have a look at the other elements and areas of musculoskeletal system purely from the angle of interstitial flow in connection with mechanical loads and build a different hierarchy.

When we see that even the areas of the greatest concentrated mechanical loads such as the joint and cartilage are able to sustain their life cycle based on the filtration of the interstitial fluid and derivatives – Why shall we restrict this mechanism to the cartilage only?

Let me visualize it with a simple scribble:

Again, all it takes is a simple reversal of a the interpretation lens when looking at the fact that cartilage doesn’t have direct blood supply and nervous regulation.

Instead of casting it as an odd one out in the musculoskeletal system that is otherwise circulation and nerve supply dependent, we can put it differently:

Even if a cartilage, this densest structure in the entire musculoskeletal system, the structure that is exposed to the greatest mechanical loads, is capable of functioning just fine without the direct blood and nerve supply using an interstitial mechanical ‘pump’ alone, isn’t it logical to assume that a similar base mechanism has to exist for the less loaded and less critical elements of musculoskeletal system?

However, an attentive reader might come up with a tricky question: ‘Well, but maybe the cartilage is treated as an exception because the fluid that circulates there between itself and the joint space is a very special biochemical substance that is unique to this particular element of the body only? ’

Great question – but the answer only reinforces that analytical lens inversion I have just briefly outlined. The substance responsible for the super-efficient performance and sustainability of the cartilage is called hyaluronan. It is a derivative of a hyaluronic acid and it is as universal as it gets. It is present in the interstitial fluid everywhere throughout the body, it’s a substance that is universal at all the rungs of the evolutionary ladder and it is a key hydraulic component of the connective tissue.

So in fact, as we start digging deeper into the fine mechanism of the way that filtering works and what microstructures facilitate it – we are going to see more and more evidence for another emerging Cinderella story…

However, I’ll cut myself short right here.

Obviously, I am not finished with the description of the “New Cinderellas” – I haven’t even touched the 2^nd one announced in the beginning of this piece – but this post is getting quite long already, so considering the dense packing of information and the relaxed Christmas mood I am not going to overload you right now – however, I am going to extend the explanations in the near weeks.

We still have one more New Cinderella to talk about; we need to cover the way that the new understandings link with the ‘classic’ ABR and , of course, we need to address the practical side.

What does that all mean in practical reality?

Well, in short – a new approach to the old problems plus, of course, the new tools and techniques for the old problems.

As I already said, today when analyzing musculoskeletal impairments everyone is so pre-occupied with the familiar targets – looking for problems with nervous signals and/or blood circulation that the fundamental, base factors of the interstitial flow are completely out of the equation. No one even looks at them with any specific practical perspective in mind.

Examples? – You don’t need to go far – whenever you visit an orthopedic specialist – does he ever look at the circumference of your child’s legs? Does he ever try to record relative distribution of interstitial hydrogel between different layers from the bones to the skin? Does he look for specific topography beyond the familiar borders of the muscles described in textbooks? Does he recommend anything to promote the improvement of the interstitial flow in those obviously depleted legs?

Why? – Because these are believed to be the non-specific and thus unimportant factors.

If your child’s legs were getting blue due to the cut blood circulation – that would have been investigated and the perfusion analyzed – you’d be directed to a relevant specialist.

Neurologist looks at ‘reflexes’ but not at the material tangible legs that carry those abnormal ‘reflexes’… You’ll find heaps of literature discussing the spasticity issue from the neurological perspective but you are not going to find much more than the accidental mentioning of the way the interstitial flow is affected between all the key elements of musculoskeletal system – from the inside of a bone to the surface of a multiarticular muscle to a skin via superficial fascia.

How are we going to do such an analysis? – That’s a separate question.

First, as I said, it is important to realize that we are facing another Cinderella –the process that is completely underappreciated and therefore has never really been studied diligently enough with any practical application in mind. That’s a crucial initial step.

Second, if we talk about ABR as such, and how ABR families can benefit from this insight? – I can’t exactly say: “No worries, I have everything figured out…”, however I have accumulated enough observations and palpation tests over the years that become a lot more valuable in the light of the new insights. Most importantly, this accumulated expertise and tests are good enough to evaluate the validity of the new methods that are going to be introduced. Sure, a lot more fact checking and thinking will be necessary – but at least there is enough substance to begin with.

Over the last 3-4 weeks I’ve been busy with a lot of re-inspection of the past experiences, re-evaluating through from additional new perspectives the developmental transformations that your kids go in different scenarios, and, obviously, I did a lot of experimentation with the new tools and materials as the Force Transfer Mediums.

The response is exciting – I am really pumped up and enthusiastic…

I can assure you that the arsenal of ABR techniques is going to expand really significantly – that’s the reason why I started this post by mentioning that I was overwhelmed because it’s one thing to be able to ‘test drive’ a new technique and it’s a completely different thing to make it into a consistently teachable mainstay.

However, that’s the road well-travelled in ABR… So not without the bumps and bruises – but we’ll make it through :-)

Let me mention just a few of the tools and techniques that are in the making and that I hope to deliver “hot off the press” within 2011:

Intense Ball Rolling techniques
Much increased variety of the rolling tools – both the balls and other materials
Much increased variety of the Force Transfer Mediums – going beyond the good old ABR ‘foam’ and introducing several classes of different force transfer materials
Increased focus on the periosteum; hydraulics of the bones and the syndesmotic joints (like sacroiliac joints or cranial sutures)
New class of head and face applications
New avenues for targeting the extremities – arms and legs

Respectively all these changes will require certain modifications in the individual tactics and strategies marrying the mainstay ABR strategies with the new additions…

Well, I have a lot of head scratching to do... :-) … and at the same time we’ll be asking for much clearer feedback from you guys considering your home performance. With more options to choose from – creating a personal menu might become quite tricky if it’s a one way communication line.

So it is going to be an exciting 2011 with lots of new opportunities…

However, I want to forewarn you that ‘every rose has its thorn’ – well, in our case, it’s 2 classes of thorns:

A) Experience shows that as the new ABR techniques are being rolled out, the feedback and response inevitably lead to modifications and upgrades making it evolve quickly within the matter of months – usually it takes about a year for a raw new ABR technique to get stabilized and the teachings to become more or less settled into the procedure that is performed in a similar way by different ABR centers.

So I am asking for your understanding and the benefit of the doubt. Your kids will be benefiting from the new techniques right “off the bat” but clearly, it’ll take about a year to explore the full potential of a given new technique.

B) Obviously, new techniques and tools are going to bring a new set of challenges for ABR Teams worldwide. We’ll do our best to keep our training up-to-date but with things changing fast and the teaching protocols not being stabilized – it’s a stressful time. So I would very much ask for your understanding and positive approach. ABR Trainers are amazing people who have their hearts in the right place and who really give their best for your kids.

I am not the easiest person to work with and often times I tend to rush the new things out when they are still half-baked and those are the ABR Trainers who have to deal with the double pressure. They do it with class and dignity, never really complaining too much :-)

However, I am asking for your forthcoming attitude and seeing your ABR training sessions as collaborative efforts where both sides have a shared goodwill working towards maximizing your skill output and helping your kids to progress as fast as possible.

Well, obviously this post is just a beginning of the series where I am going to dig deeper in the expanded New ABR developments.

As for now – Merry Christmas to all the ABR families and kids.

It’s an honor working with you… and thanks for finding time to read my ramblings in the midst of festive celebrations ….

No New Year wishes so far – I hope that will keep me accountable for posting at least one more time in 2010.

As always – your comments are most welcome, they help me to shape the thoughts and hopefully to be of greater help to you….

Cerebral Palsy and Biomechanical Diet. 7 Essential Commonalities Between the Biomechanical ‘Feeding’ and Strategic Nutritional Plans.

2010-11-15T20:56:49+02:00

Cerebral Palsy and Biomechanical Diet. 7 Essential Commonalities Between the Biomechanical ‘Feeding’ and Strategic Nutritional Plans.

In the previous post I have introduced the idea of the Biomechanical Diet for the children with Cerebral Palsy together with concepts of ‘mechanical foods’ and ‘biomechanical nutrition’…

I must say, that I was positively surprised by the response and how well this idea connected and took hold. Thanks a lot for your comments and observations – they really help a lot in shaping the ABR educational message.

Today I’ll take these ideas of ‘Biomechanical Nutrition’ a bit further by showing 7 essential commonalities between the biomechanical ‘feeding’ and strategic nutritional plans that might help you to integrate the notion of the Biomechanical Diet deeper and might be helpful on the level of implementing it in practice for your child with special needs.

Of course, the commonalities do not end with these 7 – but this scope provides a good start.

So, in order to make navigation easier –I have arranged the most obvious commonalities between the Biomechanical Diet and Nutritional Metabolic Diet into a numbered list that is by no means exhaustive:

1. Spontaneous doesn’t work. ‘By design’ approach is always superior to the ‘by default’ one.

If you want best results – you need to design the specific diet targeting the specific metabolic needs of a person taking into account the individual aspects of the ability to eat, to digest, to process and to absorb different foods as well as the ability to evacuate of byproducts and ‘leftovers’. As the parents of Cerebral Palsy kids you are very well aware how disregarding just one of these components might cause tons of trouble.

The same thing is true for the Biomechanical Diet – if you want the best results and if you want to stimulate your child’s development to the maximum possible potential – you cannot afford being aimlessly floating and simply hoping that things will turn out to better by themselves or via sporadic ‘treatments’.

Both metabolic and biomechanical nutrition require active intervention and effort on your behalf in order to maximize the outcome for your child.

Active specific intervention is the key mindset both behind the metabolic diet and behind the Biomechanical Diet.

2. You need to know what you are doing. Being strategic – assembling the set of tools and using them wisely as the means towards the goal– not just simply trying every fad that comes your way.

Diet is very much like chess – your game plan could be better or worse but you definitely need one. Without a plan, i.e. the strategy of cause-effect, you are guaranteed to lose.

That’s why the people with the mindset of seeking ‘the new best opportunity’ always end up being the biggest losers.

You have probably met such fad-followers. Today they are on this “great” diet, tomorrow – they hear the hype about another one and switch allegiances altogether. Such people are especially prone to manipulation when they hear of the “hottest opportunity on the cheap ”– that provides and absolutely irresistible pull.

The other day I was made aware of the press release – “the stem cell treatment is now available in Dominican Republic for 40% off the prices elsewhere”. Unfortunately, I am quite sure there will be a bunch of people who are going to fall for this and waste their very limited funds on this useless chase.

However, let’s get back to the diets: What is the result of constantly being on the lookout for the “hidden hottest opportunity” in dieting? – Failure and burn out.

The world of metabolic diets illustrate this principle incredibly well and you do not even need to look at brain-injured kids – just look at the friends and family around you – for sure there would be enough examples of failed ‘opportunity chasers’.

I want you to realize this principle very clearly – ABR is just one of the possible Biomechanical Diets. Speaking about Biomechanical Nutrition I am referring to a high level general concept – not to ABR particulars.

So there are a couple of essential conclusions:

a) All therapies for Cerebral Palsy that includes regular physical inputs – starting from the assumption that “the legs of a spastic child have to be kept forcefully straight in order to minimize their tendency to get crooked and distorted” (obvious bullshit by the way…) to the attempts to “train the walking in a space suite” – are Biomechanical Diets, or Biomechanical Nutritional Plans, whether their proponents realize this fact or not. You need to be aware of this and ask yourself: ‘Does this particular Biomechanical Diet benefits my child the most and why?’

You need to try to make an extra learning step by digging into what exact impacts does any therapy deliver to the musculoskeletal system of your child in order not to be fooled by unrealistic promises.

b) Be strategic – do not fall for chasing “hottest opportunities” – develop a plan, set the pre-determined dates to re-evaluate the progress, but in between those re-evaluation dates – follow the plan.

I remember a few years back in Russia there was a diet that was crazily successful in bringing the weight-loss. People flocked in droves – but few months later it was discovered that the pills actually contained a parasite worm that took life in a body. Sure enough dieters lost weight – but at which cost??

3. The nutritional plan has to be balanced. Compatibility and synergy towards the strategic goal are key to the success.

You, the parent, are the person who chooses from the “menu” of Biomechanical Diets – i.e. therapies for Cerebral Palsy. My message is simple – try to avoid mixing the unmixable and be strategic: learn the cause-effect and compare the underlying assumptions of a given therapy vs. its factual biomechanical effects.

More is not necessarily better. The same ways that the foods have to be compatible to make a sensible nutrition plan – so does the Biomechanical Diet.

I always feel sorry for the parents who pile the incompatible together thinking that firing more guns will bring better results.

If you are doing ABR and at the same time put your quadriplegic child on the “inclined plane crawling” or into any sort of ‘suspended walker’ – that’s nonsense. Telling yourself that one is “for the structure” and the other one is “for the function” just shows the lack of effort in trying to learn about the underlying fundamentals of the methods.

If ABR impact increases the chest capacity and the spacing between the ribs leading to the correspondent release of the spastic pectorals – then forcing a child into artificial drag against the surface –falsely called ‘crawling’ instead of “inclined plane dragging” – does exactly the opposite: it leads to the further stiffening of already spastic pectorals of such a child.

That’s not synergy – that’s having a healthy breakfast with bran, fruit and greens that is followed by a visit to a nearby McDonalds with supersize fries, burgers and fizzy drinks…

I mean – you are welcome to believe that supersize fries are good for your child since they are so full of energy (calories)… As an exercise in formal logic it is not difficult to justify why supersize fries are good for your child: he needs energy in order to move, right? fries are full of energy – so fries are good, the more the merrier.

Logical – yes.

Complete? – Far from, because all the negative aspects associated with those fries are being left out of the analysis.

However, as I said earlier – you are the one who chooses from the menu of Biomechanical Diets. Feel free to choose whatever concept appeals to you more – but, please, be consistent – do not try to mix diet elements that have the opposite cause-effect assumptions.

If a parent believes that supersize fries are good for a child – one should be prepared to face the consequences…

4. There are nutritional elements that could be substituted and there are the nutrients that are irreplaceable.

I’ll start with a historical reference– scurvy. I’ve chosen the scurvy as an example because historically it was the first triumph of the vitamin concept that proved the presence of essential nutritional elements that cannot be substituted.

Short reminder. Scurvy was a disease of the sailors. The sailors ate dry foods for months – so the absence of Vitamin C led to all sorts of horrible consequences. For centuries scurvy was responsible for something like a quarter of all deaths among sailors if not more – until accidental discovery that lemons took care of it. First it was discovered empirically and only much later the presence of the Vitamin C was understood.

The same is true for Biomechanical Nutrition.

The proper development of the musculoskeletal system of your child with Cerebral Palsy depends on the presence of some vital ‘biomechanical nutrients’.

What are the conclusions:

a) Any therapy for Cerebral Palsy that is not biomechanical – misses the essential part of your child’s development completely.

Hyperbaric oxygen, amino-acids, acupuncture, those stem cells, biofeedback, swimming with dolphins – whatever… Without even considering the specific pros and contras of these therapies – they have one thing in common – completely missing the boat on the Biomechanical Nutrition.

It’s simple – if your child’s developmental deficit manifests through deficiency of movement control, weight-bearing inability and other physical limitations that exhibit themselves via the musculoskeletal system –you are wasting your efforts if you haven’t started with fundamentals first …

Choose a program of Biomechanical Nutrition as the starting point, make sure that you are happy with it, and only then start eyeing the potential bonus extras.

Otherwise, you are like a person who goes for a fancy wine tasting once a month whilst starving for the rest of the days.

b) Among the biomechanical nutrients there are some that are more important to your child than the others.

c) Some biomechanical nutrients come land in your child’s body naturally – by virtue of spontaneous interaction with the mechanical environments – and some could only be delivered specifically.

Spastic superficial muscles – feed themselves via the reaction forces in everyday movements.

Deep fascial core – needs to be targeted and get proper ‘Biomechanical Feeding’.

5. There are staple foods – essential nutrients, and there are – palate tingling fancy tastes.

This aspect very much continues the previous one – know what’s important and take care of it first – but from a somewhat different angle.

Before entering the discussion of how does the particular wine “tingles the palate” – take care of the staple foods first.

That refers both to 3 main budgets:

Your mindset budget – where are the directions that you are searching for the maximum return on your investment of your efforts and finances.
Your time budget
You financial budget.

Again, my advice is simple – make sure that you have enough of each budgets allocated for the staple foods/essential mechanical nutrients for Cerebral Palsy Biomechanical Diet before venturing onto some expensive ‘wine tasting tour’ that leaves you broke.

Unfortunately, I see families missing this point completely and chasing miracles all the time.

That’s my main problem with stem cells – not only I do not see any major progress (besides of some sort of awareness improvements) from stem cell treatments but I see families who stretch their funds so thin and respectively put so much hopes on these ‘miracle’ cells – that when the thing doesn’t deliver the expected miracle – families just get completely burnt-out.

At this point one might say that I am tooting my own horn – since ABR is about the ‘staple foods’ – essential Biomechanical Nutrients–mechanical stimuli delivered to the deep fascia core.

True – but I’d invite you to look at the issue from a different perspective – promoting staple foods is far less exciting or rewarding than “all-new magnificent flavor ”. It’s somewhat boring and lacks flair of excitement – but that’s what all the fundamentals are…

So actually with ABR we have to work extra hard to deliver our message to the families of Cerebral Palsy kids comparing to ‘dream merchants’ but that’s what I see as my duty– someone needs to talk sense and remind parents that the foundation of long-term success lies with the essentials – not the fancy tricks.

6. Daily implementation of the diet and the nutritional plan.

Humans need food every single day – your child needs proper mechanical nutrients daily as well.

a) This one is as obvious as it is important.

To begin with it’s simple. One can survive a day without food or two – but that’s not normal – that’s starvation and depletion of reserves. By the same token – your child needs the biomechanical nutrients delivered to the deep fascia core structures on a daily basis.

b) Any plan’s success depends on implementation. Even the most sound and wise strategy is going to fail if it is not backed up by daily action.

The change of the daily routine and the creation of the situations that facilitate proper action are key for the success.

This is true for the nutritional plan and equally true for the Biomechanical Diet as well.

You know it well with your child – if you leave all these tempting sweets and other “palate tingling” foods around – it’s difficult to stay on course of a healthy diet.

The same is true for the routines – being consistent about feeding times establishes the proper response loops within the digestive system and facilitates the long-term success of the nutritional plan.

In essence it’s simple – the people who fail to build a comfortable daily routine around the new nutritional plan – fail with their diets and revert back to the old habits.

It is equally true for the Biomechanical Diet – the families who achieve the most out of ABR are the ones who have managed to organize a new daily routine around it and have found a comfort zone in doing the exercises in pre-determined time slots and in a dedicated place in a house.

7. Nutritional Plan is a part of a new lifestyle – not a temporary measure.

This is where we arrive to the difference between the Diet and the Nutritional Plan.

A lot of people tend to interpret the term “diet” in the narrow sense – as a temporary measure.

A diet “to drop a few pounds” or a “detox diet” or “pre-summer” diet or anything like that.

I tend to use the term ‘diet’ in a broader sense of a ‘Nutritional Plan’.

It is well-known that temporary diets – rarely work. The people who consider a diet as a ‘restriction’, ‘sacrifice’, ‘withdrawal of freedom’ never succeed. Their mindset is focused on the short-term goals and their perception of ‘normal’ doesn’t change.

What I see among the ABR Families the way that most of you organize the food intake for your kids – belongs to the category of well-thought and balanced ‘nutritional plans’.

What I see among people who try to ‘slim down’ – is usually no more than a temporary diet mindset.

Temporary diets – fail.

Balanced and strategic nutritional plans – bring tremendous benefits.

Well, things are exactly the same for Biomechanical Diet, or to be precise Biomechanical Nutritional Plan.

If you think of a temporary therapy for a Cerebral Palsy child – and all the restrictions and sacrifices you are making for it all the while thinking for yourself “When is this going to end and the normal life is going to begin?”– I am sorry to disappoint you: your chances of success are incredibly slim.

Proper Biomechanical Nutritional Plan has a remarkable progress potential for your child despite the presence of the brain-injury but only in the case when you are thinking long-term and when you are willing to make a transformation of your mindset and your lifestyle.

Exercises that deliver the essential mechanical stimuli – providing the mechanical nutrients to the depleted and weak elements of your child’s body – have to become integral part of your daily routine and your new lifestyle. Then and only then the positive ‘seeds’ will take hold gradually growing into better and better ‘roots’ for your child’s development that eventually will start bearing ‘the fruits’ of controlled movements and functions…

So these are some key similarities between the Metabolic Nutrition and Biomechanical Nutrition – I hope these parallels help …

And I am happy to hear about any ideas and analogies that you might have along these lines.

Cerebral Palsy and Biomechanical Diet

2010-11-09T01:33:17+02:00

Cerebral Palsy and Biomechanical Diet.

In my constant attempts of making the ABR message more user-friendly I have recently stumbled upon an interesting angle that I want to share today and bring it to your judgment.

I would appreciate the feedback and responses – indicating whether this angle is worth further pursuing.

I guess the title of the post itself “Cerebral palsy and Biomechanical Diet” pretty much indicates the angle that I plan to take – but let me give you some details.

First of all – some field observations.

I must say that the children with Cerebral Palsy – at least the children of ABR Families – are the best nourished and taken care of individuals that I have ever encountered in my life.

They are given the best organic foods, home-cooked, balanced for a full spectrum of nutritional needs, delivered at regular intervals and with consistent daily/ weekly routine. On top of that – each child receives a complete set of supplements – from iron to aminoacids to vitamins – that target the weakest links in the nutritional chains and take care of the gaps left by the staple diet itself.

Experience shows – such a serious approach to the diet of a child with Cerebral Palsy, especially a weaker quadriplegic one – is vital and essential. Without such attention to detail and installation of consistent routines – things go downhill very quickly: troubles with digestion; stomach pains; vulnerability to infections; constipation; intoxication; weight loss and so on.

What I want to do in this post is to draw some parallels...

First – in order to thrive Musculoskeletal system needs not only regular ‘metabolic’ foods but the special kind of food – mechanical stimuli.

It won’t be too far of a stretch to say that musculoskeletal system at all the levels – from deep fascial core to the superficial striated muscles – feeds of mechanical interactions with external environment.

In other words –mechanical stimuli are food for musculoskeletal system.

Well, and here is the first parallel – such mechanical stimuli could be “nutritious” or “empty”; they could be “staple” foods or “pleasure” foods; they could be “balanced” or “imbalanced” …

Basically everything you know about nutrition and diet principles for the ‘metabolic’ foods very much applies to the mechanical foods as well.

Where is a quadriplegic child with Cerebral Palsy in this picture? – A quadriplegic child in a mechanical sense is in a position similar to those victims of starvation that you regularly see in the news when there is a famine somewhere in the less developed regions of the world.

And which level starves the most? – Deep facial core.

Why? – because in the regular mechanical interactions with environment –hungry and bullying superficial muscles are the ones that take the lion share of the mechanical stimuli that come from the external environment in the form of the reaction forces.

On the organismic level such ‘egotistic’ tendencies of the superficial muscles doesn’t do them any good – because the starvation of the deeper and more fundamental fascial levels leads to further destruction of the larger movement system. However, every single element of the body when ‘grabbing’ their share of mechanical foods is regulated at the level of local autonomous nervous system – so it is ultimately egotistic. It’s the most basic act of mechano-transduction that doesn’t engage the central regulation. It’s very much “every man for himself right here right now” – no matter what happens in the long-run. Local autonomous reactions of the musculoskeletal elements to the direct mechanical stimuli have no consideration of the long-term ‘collective good’ at the organismic level.

The central regulation, i.e. the brain, faces the unfortunate task of dealing with the consequences of such disproportional ‘grab’ of mechanical foods.

So that’s the key idea –a child with Cerebral Palsy, especially a quadriplegic one, needs strategic and targeted Biomechanical Diet in order to overcome these imbalances in the spontaneous ‘mechanical food’ grab by individual musculoskeletal elements and in order to maximize the long-term developmental potential at the organismic level.

What are you doing with ABR? – Exactly that: mechanically feeding the weak but important ones – deep fascial structures

In essence ABR is a highly targeted biomechanical diet that delivers the ‘mechanical food’ in the form of mechanical stimuli to the structures that have been starving since birth – deep myofascial core.

To do so we need to be technically tricky because we need to bypass the superficial layers that out of their own ‘egotistic’ autonomous responses “want” to ‘grab’ whatever mechanical stimuli come their way – no matter whether it’s good for the entire body in the long-term or not.

You have heard that in our articles and in conference presentations we have been pedaling two main terms – ‘stress shielding’ effect and ‘biomechanical homeostasis’ – focusing on the fact that stress shielding inevitably destabilizes biomechanical homeostasis (self-regulation) and leads to the downwards spiral of deterioration for the entire musculoskeletal system and respectively to distortions, deformities, aggravated spasticity and all the other negatives.

The context of mechanical stimuli being ‘biomechanical foods/nutrition’ helps to visualize the ‘stress-shielding’ effect easier.

What happens with stress-shielding effect? – The stronger muscles or fascia (actually any mechanical element in the co-responding pair )– ‘bullies’ the weak one by grabbing the lion’s share of the mechanical stimuli that come from reaction forces. As a result the strong one keeps getting stronger and the weak one deteriorates at ever increasing rate.

The term ‘homeostasis’ is originally a biochemical/ physiological one and refers to the co-dependence and self-regulation of biochemical processes in the human body organized in inter-dependent chains.

So, when you work on balancing your child’s diet – foods and supplements for optimal nutrition – you are trying to improve the parameters of the biochemical (metabolic) homeostasis.

And you know from experience :

How important such bio-chemical balance is;
How difficult it might be to fine-tune it;
How essential is consistency in implementation of the proper diet.

In that light – what are the so-called “therapies for Cerebral Palsy” that compete for your attention? – They are the bio-mechanical diets.

Whether the proponents of a certain training or “correctional” physical method realize it or not – their primary impact always lands directly at the elements of the musculoskeletal system. Whenever you impose any movement onto your child’s body or place him in a specific position – you are delivering some biomechanical foods. That’s a fact – whether you realize it or not. It’s the same as with the digestive tract – whatever falls down the throat is food, period. Whether it’s good or bad – that’s a next question.

The same thing is with the movements as well – your physical impacts are the mechanical foods for your child’s body.

Now the question is: Are these foods really “mechanically nutritious”? and even more importantly: Are these mechanical foods properly balanced and target the weakest link in the biomechanical homeostasis?

There are areas – deep fascial core – that are starving being depleted of mechanical ‘food’ since birth and that in a Cerebral Palsy child get no ‘food’ spontaneously; and there are areas – spastic superficial muscles – that are ‘overfed’ with mechanical stimuli by means of everyday interaction with environment; – are you targeting the right ones with your ‘therapy’?!

So the key message is simple:

Biomechanical diet is as essential as metabolic diet.
Proper balance in biomechanical diet is as important as in metabolic diet – which structures are you feeding: the starving ones or the overfed ones?
Positive experiences from metabolic diet should encourage you to look optimistically at the long-term potential of the biomechanical diet.
Strategic approach and understanding of the weakest links and targets is as fundamental for a biomechanical diet as it is for the metabolic ones.
If you neglect the nutrition and diet or choose it wrongly – there are all sorts of negative consequences…

These are some key ideas of Biomechanical Diet for Cerebral Palsy concept – I’d be happy to get into some extra details in the following posts – but first I’d appreciate some response on whether you find this angle helpful altogether.

Thanks for your time…