Thursday, September 17, 2015

A sprain a day

I played many sandlot sports growing up as a kid. There was a period where it felt like I was spraining my ankles daily. The NY Times has an article that I found interesting as to the functional cost of this minor injury. The soccer team at my college had several players that had to bandage their ankles almost into a cast to keep playing.  On a subconscious level I feel I adapted strategies to keep playing without re turning my ankle. Some of the brilliance in the work of Moshe Feldenkrais I felt was to allow safe play in many of the actions that I long forgotten or never knew.

In the extreme I often saw in the nursing homes patients who became a fall risk were then limited to the bed and wheelchair. He or she would only be allowed to transfer and walk with someone assisting. It could go rapidly downhill from there as then the patient became fearful of trying to walk and then later any mobilizing.  A 90 year old 90 pounder might be the most difficult transfer in the world if they extended backward to stay in the wheelchair at the pelvis and having a death grip on anything stable in the vicinity. Many times just rolling side to side in bed would provoke the fear response of falling and the patient would resist simply resting on either side to be changed. Nurses and staff frequently hurt their own backs helping these patients.

Occasionally I had some limited success working on the mat and having the patients coaxed gently to their stomachs. Having the orientation with the face down and trunk supported with pillows relaxed them in with the fear of falling while rolling. A patient who could not sit independently at the edge of mat because they extended backward would then would be able to sit normally without assistance. Almost all the time the improvements would be temporary as the next day the process would need to be repeated. As soon as the patient's therapy came to the end because of insurance any residual change would be lost rapidly.

Similarly with spinal cord patients their transfers would often improve after getting them prone. As most had lost control of the trunk musculature coming forward to allow for an easier transfer was scary. They needed to sense that the change in orientation could be safe  before they could allow themselves the greater control the arms and shoulders required for the loss of the trunk. It seemed cruel at times to put someone prone and have them attempt modified pushups but it was very functional in a not very apparent way to the patient. The main difference is once the patient understood the improvement they kept the functionally as compared to the nursing home patient.

To tie this in with my blog theme with most of my own patterns of movement reside in the varied subconscious decisions that either felt safer or more functional. If any approached a conscious level they were then soon forgotten after habitualization.  These preference define my posture and actions.

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