Saturday, May 16, 2015

Developmental Exercises for Improved Arm Function: The Fascia Therapy Techniques

One of the most overlooked and under-appreciated aspects of any rehabilitation strategy is paradoxically the most important:  the human developmental process. 

Although people generally have some intuitive understanding about development and developmental stages, it often gets clouded and blurred when we are dealing with complex conditions characteristic of many neurodevelopmental disorders.  This is understandable...if a parent is presented with some level of distortion in their childs arms, extreme muscular tension, reduced fine motor skills, or even complete lack of gross motor skill, this will be the object of much attention, focus, and intervention.

As it should be.

However, beyond these valuable interventions, it is important to remember that alot of these manifestations are in reality symptomatic.  In other words, they reflect the underlying condition of developmental delay.  Therefore, an added strategy of "re-starting" and potentiating the developmental process is a direct way of addressing the root as well as the symptoms.  This may sound relatively straightforward, but the next logical question is:  what is the specific developmental process and HOW do we actively re-start it?

To put this into complete context, we would need a much more comprehensive exchange than is permitted within the context of a "blog" format...however, I will deliver the fundamental tenets of the Fascia Therapy philosophy which is that the key to efficient and effective rehabilitation of neurodevelopmental disorders is to follow and adhere to the fundamental laws of human development.  In essence, the human organism (and, in fact, all biological organisms) go through a specific process of developmental evolution...the result of which is a fully formed, fully functional person.  When there is an alteration / injury / event that influences the developmental process (regardless of whether they occur in utero or after birth) there will always be a delay or cessation of said process. Therefore, children with neurodevelopmental disorders (Cerebral Palsy, Miller-Diekers, West Syndrome, etc...) are often never exposed to the environmental triggers that facilitate and potentiate healthy development.

To put this into a more specific context (and to keep within the mandate of this particular post), a significant part of the reason there are so many complex (and progressive) challenges with the arms and arm function is that the shoulder girdle itself (the space where the arm sits and is made up of the collar bone and the shoulder blade) was never properly and sufficiently exposed to the two main mechanical catalysts for development:  Traction and Compression.

Traction and Compression

Traction is the term used to express a tensional (pulling) stress that attempts to separate one element from the other.

As illustrated in the adjacent image, a tractional stimulus is something we have seen and experienced ourselves throughout our lifetime...and most likely never paid any attention to (the formal term is called 'brachiation').  WHY do children like to hang from things?  This is a multi-layered answer that generally extends into the exploration of motor and sensory limits...but there is a very IMPORTANT stimulus being imposed on the shoulder joint.

Children with neurodevelopmental disorders have either very limited or NO exposure to this type of stimulus.  Tractional (tensional) integrity is essential, not only for gross motor and fine motor skill, but for those "lifestyle-essential" skills that involve pulling (either objects or oneself).

Compression is a term that can be considered the polar opposite of traction...meaning that there is some external stress (force) that attempts to bring two elements much closer to each other.

Although both tractional AND compressional stimulus are essential, the compressional stimulii is the most other words, it is the one that comes FIRST in the developmental process.  The act of crawling / creeping generates vital micro-stimulus directly into the shoulder joint which ultimately potentiates and develops shoulder integrity and strength...which then get re-activated during the tractional phase a little later on.

Once again, neurodevelopmental disorders limit (and in more severe cases, eliminate) the exposure of the shoulder joint to this critical form of stimulus.

To capsulate all of this information into a more practical narrative, beyond the more common and familiar interventions designed to improve arm function, there are specific techniques that have the specific goal of mimicking the fundamental tractional and compressional stimulii in a safe and passive way with the explicit objective of re-initializing the developmental process.  Of course, these techniques require some basic level instruction, but they are fundamentally user-friendly and can be taught to both professionals as well as parents...but beyond the knowledge of knowing WHAT can be done and HOW you do it, it is fundamentally critical to understand WHY it is done. 

More technical rants to come!