Philosophy, Neurological Rehabilitation & Espresso

Matt’s been hogging this blog, so over the next while I’ll be piping up to discuss some of the ways we tackle neurological rehabilitation.

We have a very unique way of treating at Aim2Walk. We haven’t necessarily invented anything new, we just learned how to integrate clinical therapies properly. Integrating a variety of clinical therapies is something you might think seems easy enough, but the truth is what passes for clinical integration in most clinics is just a variety of different therapists doing their own thing. Why? Simple. Ego, conflicting medical theories, budget… it all gets pretty messy.

When we started out on this venture, we quickly realized there was no current clinical model in standard healthcare that had achieved what we wanted to do. How could we accommodate so much diversity without conflict arising at every corner? That’s why we left the realm of what’s standard and looked to philosophy for inspiration.

Having a philosophical model guide clinical practice isn’t unreasonable (isn’t science just a branch of philosophy after all?). Inspiration came from a specific branch of Neo-Confucian philosophy known as the School of Principles. The school of Principles uses a 3 step process to interpret all things. That process is: 1) The possibility for something to happen, 2) The motivating force that would make that thing happen, and 3) The manifestation of that thing happening. I could get into more detail, but for the sake of time, space, and your sanity, that’s enough for now (If anyone out there really wants to know more about Neo-Confucian philosophy, ask me when it’s not 12:20am and this blog post is overdue).

We took this 3 step concept and came up with this 3 step model:

1) Structure
2) Intent
3) Action

Ok, we took some liberties (it’s philosophy after all). The thought process is as follows: 1) Structure: You have a body structure that can potentially move. 2) Intent: You have the intent to move. 3) Action: It moves. This all seems very obvious right? Just wait.

This train of thought needed to manifest itself clinically, so we expanded on it and developed these 5 stages:

1) Structure: To free mechanical restrictions and allow the potential for movement.
2) Awareness: To stimulate and develop an awareness of sensory input signals.
3) Intent: To stimulate and mentally project motor output signals.
4) Action: To activate basic motor function and strengthen individual muscle contractions.
5) Function: To coordinate complex movements for functional activity.

Once we had these 5 stages, we worked with whatever modalities, therapies, and clinical applications we had at our disposal to achieve the results needed for each stage.

Clinically our directors and therapists cover a diverse range of therapies. We have neuro-physiotherapy as well as traditional and alternative forms of active rehab. We apply an assortment of modern and traditional styles of acupuncture. Our hands on skill sets cover a broad spectrum of myofascial, structural, and neuro-muscular techniques. We implement standard and alternative forms of nutrition, diet therapy and traditional herbal medicines… the list goes on. We combine these therapies with EMS, FES, IFC, cold laser, and of course lets not forget the Lokomat and other state of the art robotic rehabilitation technologies. We have to wear a lot of hats to make this work. As individual therapists we can’t let ourselves be defined by one position, title, or therapeutic modality. The learning curve at our clinic isn’t just steep, it goes straight up (sometimes it even falls back on top of you!) It’s difficult to learn how NOT to be defined by one idea. We challenge ourselves daily to learn new things (might as well make use of that whole neuroplasticity thing right?). I’ve even taken on the task of mastering the company espresso maker! (hey, a good shot of espresso makes a world of difference sometimes).

The final step in making this protocol work was proper case conferencing. This is where we differ significantly from other clinics. Our protocol model promotes an integrated environment because no one therapist or therapeutic method CAN stand alone. We conference together as a team and design one program for each client. We don’t shuffle clients from room to room to see different practitioners who each do their own thing. We put our heads together, consider the clients needs and goals, and design ONE treatment program from beginning to end that approaches the client as a whole. This way there’s no overlap, no wasted time, no miscommunication, and most importantly the client gets everything they need under one roof.

Is the whole philosophy angle making sense yet? No boundaries, no limitations, no egos. We’re not restricted by any single medical model or method of therapy. As well, no one therapist is limited by their own understanding and no method of therapy is limited by it’s own clinical limitations. It’s a good system. It’s what integration should be about.

In future posts I’ll discuss some case studies and examples of how we specifically treat. For now though, I’ll wrap up with this last thought… Our clinical method, while very effective, is constantly evolving. That’s the beauty of using a philosophical model to guide practice. Change and evolution are built into the model, and the model enlightens us daily.

Ok, now I’m really looking forward to that espresso tomorrow.

Neuroplasticity – There’s hope for old dogs after all!

You may have heard your therapist use this term over the course of treatment – actually, I HOPE you’ve heard your therapist use this term. It is likely the biggest reason you will see improvements if you have had a stroke, brain injury, spinal cord injury or any condition affecting your brain/spinal cord. Yes, your hard work is imperative, and yes, the type of therapy you do is of paramount importance. But without neuroplasticity, the ceiling for recovery would be lower than the one in my daughter’s doll house.

So what is neuroplasticity?

You get an excellent textbook answer here from Dr. Merzenich (a pioneer in studying and defining this subject). Simply, neuroplasticity is our brain’s ability to change. Old dogs CAN learn new tricks….and this is not just a theory. There are countless academic studies confirming this fact – under the right circumstances, the wiring in our brain can be transformed.

Think about how we often refer to a child as a “sponge” of information. My 3 year old is easily becoming fluent in both the Polish and English languages, just by listening to other people speak in her daily life. Infants and toddlers learn and develop without much conscious effort. Kids and young adults have much more ‘neuroplastic’ brains than adults and the old thinking was that after adolescence, our brain was hard-wired and unable to change its function. Science tells us otherwise.

Dr. Norman Doidge wrote an excellent book called The Brain That Changes Itself. He is able to eloquently demonstrate the physiology behind neuroplasticity, shedding light on the effect of changes in the brain for issues such as stroke and brain injury, drug addiction, love, depression and many other psychological, emotional and physical issues affected by the human brain.

A common phrase in the book, “nerves that fire together wire together” is an easy way to think of neuroplasticity in adults. As an example, if you were to tape together your index and middle fingers on your right hand so that whenever one finger moved so would the other, eventually the brain will change its wiring so that even after the tape is removed, those two fingers will move together. Not an experiment I recommend trying, but for those with copious amounts of free time and an urge to develop some “party tricks”, why not?

Neuroplasticity is an incredible skill our brain possesses, allowing us to recover from injury and learn new things even after the critical periods of childhood – but it can also cause many unfortunate negatives. Obsessive compulsive disorders, chronic pain, phantom limb pain, distorted body image…the list goes on. Luckily, the same neuroplastic changes that cause these negative outcomes can be the clue to treatment through the proper rehabilitation techniques (intensive rehabilitation, psychotherapy, etc.). The brain, although a solid mass, can be considered a fluid environment. Parts of the brain programmed for specific function can be reprogrammed – either purposefully as with therapy, or over time as a result of lack of use or changing demands on the body.

This is where our therapy protocol comes into play. We are literally trying to change the brain (and/or spinal cord) and how it communicates with the body for people with neurological injuries or diseases. The exciting part is that we know it can be done – evidenced by both the literature and our own experiences. But what we want to do is optimize the neuroplasticity in each individual. Over the next few months, one of the many topics you’ll read about at Neurochangers is the research taking place at Aim2Walk – case studies and control trials in collaboration with industry leading neurologists and universities – all focused on harnessing the power of Neuroplasticity, changing the lives of our clients, and pushing the boundaries of neuro-rehabilitation.

Greetings from the team at Aim2Walk!

From left to right: Jesse Lown, Matt Sanchez, Norbert, Aaron Stiller

Welcome to neurochangers, the neuro-rehabilitation blog by neuro-rehabilitation specialists. My name is Matt Sanchez, a Physiotherapist that has joined up with a team of creative, passionate, and moderately well groomed therapists with aspirations of advancing the field of neuro-rehabilitation.  Aim2Walk is our clinic (learn more here), but it is more than just a building – Aim2Walk is our brain child. We want to change what the therapy world considers the “standard” for neurological rehabilitation.

Our approach involves the combination of several therapy realms AND some very cool, state-of-the-art technology.  We are not the first clinic to use the Lokomat, Armeo, or any one of our FES devices nor are we the first multidisciplinary neuro-rehab facility. We didn’t invent any of the therapies we provide either. What our team has done is developed a therapy protocol that incorporates technology, physiotherapy, alternative therapies, nutrition, cognitive therapy (and more!) in a way that will optimize the neuroplastic capabilities of our brain and spinal cord. Exciting, right?

We want to use this blog to discuss the latest in the world of neurological rehabilitation. We want to be thought-provoking and educational. Most importantly, we want you, the reader to follow us, and challenge us, as we continue to seek new ways to push the limits of neuro-rehab and offer comprehensive care to those in need.

Please send us your topic suggestions and stay tuned for posts from the rest of our team!