I’d like to talk about a client of ours at Aim2Walk, his name is Fabio. Fabio has been coming to us for treatment for about a year. Five years ago he suffered a traumatic brain injury (TBI) and his life has not been the same since. Luckily, Fabio has a caring and supportive family, as well as the will to be strong and optimistic despite the new challenges he faces in life.
One of these challenges is spasticity.
Symptoms of spasticity include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated reflexes, muscle spasms, and fixed joints (contractures). The degree of spasticity can vary from mild to severe.
Aside from standard rehabilitation, some conventional treatments for spasticity include drugs, surgery, and localized injections like botox. There is still no clear-cut approach to treating spasticity. In most cases all that can be done is to ‘take the edge off’.
Fabio’s neck was severely affected by hypertonicity, essentially a constant muscle spasm that kept it locked in the side-bent and forward-flexed position (as seen in the photo below). In fact, it left him unable to look at anything except his left foot! His reflexes also became so hyper-sensitive that attempting to straighten or stretch his neck triggered his other limbs to spasm and curl up with extreme force. This was a very painful experience for Fabio that would set off more pain induced spasms.
In the 5 years since Fabio’s accident, his rehabilitation had shown minimal improvement. Essentially his therapy had plateaued and it wasn’t looking like conventional therapy was going to break the pattern. Fabio and his family are a stead-fast and dedicated bunch who simply refuse to quit, but regardless, it takes more than just dedication to see results… it takes a method that works.
Have you every played with a Jack-In-The-Box? You wind and wind and then finally… out it pops! Your hard work pays off! Ok, so imagine if you just kept winding and waiting and winding and waiting and winding and waiting and winding and waiting and winding… well, you get the idea.
Bottom line, if your tools have failed you… what then? (You know, using the same approach again and again and expecting a different result every time not only gets you nowhere, it’s also the definition of insanity! Oh my!).
This leads a therapist to question: At what point, when conventional treatments are showing minimal to no improvement, is it time to stop playing with the tools inside your current box, and take your brain OUT OF THE BOX.
This is when it’s time to stop relying on what you already know (or think you already know), and let those creative and inspirational Alpha brainwaves kick in.
Here are a few guidelines we use at our clinic to help us think outside the box:
1) Reassess the client as an individual. Rather than lumping clients into general diagnostic categories, look for details in their condition that make them unique to other clients with similar conditions. Every client is different, and their neurological symptoms will likely be as well. The more clearly you can recognize the unique particulars to each client’s condition, the better equipped you will be at implementing what each individual needs to improve.
2) Take the time needed to ‘learn’ about your client. When I tell clients that it will likely take me some time to learn how to treat them, I always get a funny look. It’s important to remember that therapy is like using spice when you cook. A chef never uses the exact same spices in the same quantities right off the bat… a good chef knows to taste and adjust as they cook! So, just like every dish is uniquely spiced as it cooks… a good therapist will observe and learn how a client is responding to their therapy on an ongoing basis. You need to know a client’s mind, muscle and nervous system better then they do, before you can hope to make any lasting change. This takes time, patience, detailed observation and ongoing analysis.
3) Consider the client’s condition strictly from a physiological/pathophysiological perspective. What I mean is, rather than viewing the client’s condition from the mind of a therapist (with a pre-set box of therapy tools), try and understand what’s happening in their body without preconceived ideas of how you’re going to treat them. Go back to the basic building blocks of physiology, biology and mechanical reality. It’s those basics that helped create treatment protocols to begin with, so if those protocols fail, it makes sense to start over from the beginning, right?
4) Research research research. Experiment experiment experiment. Seems simple, but I’ve seen too many medical practitioners, be it modern or traditional, spending more energy on rationalizing the validity of what they’re already doing, instead of contemplating other potentially more effective possibilities.
These are just some of the ways to keep therapy innovative and adaptable. It’s harder than you might think. The boxes we build for our brains are usually very well made. They’re meant to give definition and order. Unfortunately they also sometimes keep you in the dark. While it would be nice if, like a Jack-in-the-Box, we all had cranks on the side of our head to ‘pop’ our brains out when needed, we don’t. If you want to free your brain from the box, you’ll have to do it the old fashion way. Use it.
As for Fabio, it only took one session of thinking outside the box to be pleasantly surprised. His neck began to straighten! After just a few more sessions he was no longer just starring at his left foot, he was looking you straight in the eyes! It was more change then he had seen in 5 years.
Fabio still has a long way to go, but this is a great ‘new’ inspiring start to his therapy. I’d like to take this opportunity to thank Fabio for giving all of us at Aim2Walk the chance to grow as therapists, and for reminding us that there’s a much larger world of possibilities outside the box, if we dare venture there.