By Gavin Broomes of One Giant Leap
I have devoted a great deal of time and words to specific topics, issues, and protocols and have strayed slightly from my overall central message. Although I resist cliches as much as possible, ¨seeing the forest through the trees¨ is one that is unescapable when dealing with rehabilitation or any issue related to health care and health-seeking. From a more ¨tangible¨ perspective, the central message should be very clear: Continuity of all tissues is the overwhelming fundamental understanding that all formulation should be based on. In other words, it is impossible to ¨dis-entangle¨ muscle from tendon, ligament from joint capsule, periosteum from aponeurosis…although most textbooks conveniently separate them with different colours, they are synonymous with each other and therefore function in unison. Despite this seemingly inuitive statement, I am consistently baffled at the lack (or disregard) of common sense when applying this to the formulation and implementation of treatment protocols.
With this in mind, I introduce a more global and philosophical discussion on continuity and how it relates to any and all those who are directly or indirectly affected by disease or disability (which, by the way, includes almost ALL of us).
Disease and disability are such complex and comprehensive states that it is nearly impossible to objectively navigate oneself while keeping a solid focus on ¨the big picture¨…therefore, society and the medical community have conveniently ¨cleaved¨ off 3 essential branches off of the developmental tree: Physical Development, Social Development, and Cognitive Development. I have already stated that the overall magnitude of disease and disability is quite overwhelming, therefore I do not fundamentally disagree with this convenient division…in fact, it permits more efficient ¨digestion¨ of information and priorities. My main point of contention is the following: Most consider each of these branches as seperate and distinct objectives. This applies to both the healthCARE and healthSEEKING population. Quite often, development strategies are implemented without any consideration as to how it affects the other 2 domains…and the naive assumption is that if you simply add three strategies together, you will get an obvious summation of benefits. In reality, most people evaluate physical development strategies based on age-appropriate ¨standards¨ while attempting to shield themselves (or their loved-ones) from undue social challenges, and base cognitive strategies on some professionals percieved impression of cognitive performance. I understand that this may all be dizzying…therefore I will make my central point: Physical, Social, and Cognitive development are intimately linked with each other and reside within the same continuity.
Again, for some this may still be intuitive and well understood…therefore I will deconstruct this message further and explore, not only a fundamental reality of existence, but how each relates to the other and how effecting change in one cascades to the others.
I think it is important for me to point out that I assign EQUAL importance and relevance to all three components…however despite this, the reality and understanding of some fundamental hierarchy should be understood and accepted. To be precise, the physical state (or status) plays a critical role in the development potential of social and cognitive skills.
I consider the relationship between social and cognitive development to be much more symbiotic and intimate…meaning that each are very much dependant on each other, whereas physical development exists more as a ¨catalyst¨ for improvement potential as well as sustainability. In other words, physical ¨competence¨ serves as the environmental and ¨nutritional matrix¨ for the others.
To expand on this philosophy further, we will need to enhance each of the three relationships further.
Social-Cognitive: As mentioned before, this is the most intertwined and inimate interaction of all. Much of the cognitive potential resides in the ability to effectively assimilate into some level of social acceptance or recognition. In addition, the climate / environment on a social level (regulation, social stigma, etc) must be well established and in place in order to promote active cognitive development in a healthy and productive manner. Conversely, cognitive improvement and success contribute to the development of social parameters such as self-esteem and self-confidence.
Physical-Social: This relationship is perhaps the most tangible one simply due to the fact that it is quite ¨visceral¨ in both the positive and negative way. From a negative perspective, physical disability is unfortunately still quite often stigmatized and therefore has detrimental effects on the development of fundamental social skills and confident. In addition to this, the varied physical limitations themselves often limit the accessibility to social opportunity. The positive perspective is more straightforward in that physical performance, confidence, and improvement contribute directly to the cultivation of social acceptance, opportunity, and development.
Physical-Cognitive: This is by far the most elusive realtionship. Many disabilities, despite the current plethora of information and apparent ¨understanding¨, are associated with some level of cognitive deficiency…or to be more precise, it is perceived that there is some lower level of cognitive function. There are many examples that could be highlighted, but I think it is more productive to elaborate on some nuances that are often overlooked and under-appreciated.
-The fundamental ability of proper head control can not be overstated. In order to concentrate and apply effective focus, the head needs to be consistently level with the horizon…even if the rest of the body is moving. In other words, the absorption of information is dependant on the ¨stillness¨of the head which permits effective tracking of the eyes.
-Management of fine motor skills is essential for the use of both standard or technology assisted devices in order to tap maximum potential for learning. More importantly, the establishment of consistent gross motor function is a fundamental precursor and requirement for basic performance at all educational levels.
Although quite simple in nature, these two examples still go underappreciated. Engaging in reading and writing activities (at any level) while expending large amounts of focus on maintaining eye contact, head position, and balance is extremely disruptive…and therefore unfairly challenges learning performance and potential.
The final step is to then consider all three as a conglomerate…and therefore base your long-term rehabilitative strategy on the cultivation of the continuity as opposed to addressing each on its own. When this relatively under-appreciated approach, it becomes much easier to establish short, medium, and long term objectives…formulate some form of ¨roadmap¨ for each person and immediate family to follow…and enable a positive impact that is of IMMEDIATE value as opposed to a ¨defered life plan¨ or objective (¨when he/she is better, things will be ok¨).
I hope this small rant has been helpful and helps to establish a fundamental philosophy that everyone can understand and resonate with.
One Giant Leap: The Science of Physical Rehabilitation is a blog dedicated to presenting, discussing and debating scientific concepts in the field of Cerebral Palsy, Physical Rehabilitation, and High Performance Training. The Blog can be found on the web at http://thescienceofphysicalrehabilitation.blogspot.com.ar/ and on Facebook at http://www.facebook.com/pages/One-Giant-Leap-The-Science-of-Physical-Rehabilitation/247330191983662