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.

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