|
Hirsch -> Re: Treatment ideas for adult ataxia (December 10, 2001 4:38:00 AM)
|
Guru Bobcat,
FYI, Political correctness is a waste of time, IMHO. Nothing I say in this or other posts regarding DS's question was meant to be rhetorical. Why not ask me if it was menat to be rhetorical instead of telling me?
I appreciate you taking the time to give me your opinion on ball exercises. I meant no disrespect by referring to therapeutic ball exercises as "ball gymnastics".
My point is still: is there any -- scientific -- evidence from studies that working with a "ball, or a cycle, or a loop suspended at the end of a sling" actually improves function in persons with ataxia?
Your logic is appealing on an intuitive level, but since it's an opinion based on years of clinical experience -- I respect that! -- I'm even more skeptical now because there's apparently no hard evidence (other than your opinion/theory) that working with a ball either as a diagnostic or as a "therapeutic" tool improves short or long term function in persons living with ataxia. One or two studies wouldnt be enough to make me a believer anyway. At least we have your statement claiming that/how ball exercises might affect function and your challenge to present/future generations of PT's to find out.
My original intent in responding to DS's original querry was to encourage DS to experiement with therapeutic modalities allready validated scientifically (forced-use and biofeedback using foam or a movable platform being two I suggested), conduct a literature search on medline which she said she allready did -- and NOT bow to another opinion...mine or even from the allmighty Guru Bobcat.
If you re-read my original post you'll see that there are a few studies that have looked at PT for ataxia but working with a ball has not been looked at (at least it didnt come up on a MEDLINE search). So now we have your opinion, my opinion, and the opinion of other Rehabedge members to help DS. But ultimately DS will have to make his/her own experiences, and hopefully will not become another physical therapy foot soldier.
"evidence-based research is not necessary [in this case] because the mechanical principles combined with principles of control systems is adequate, because the cause-effect relationship between use of a ball, or some object, and improvement in motor control and function, is not occult, subdued or obscure"
Are you serious, Guru Bobcat? Help! Translation please!
Guru Mark has a different point of view. You may think something is cause-and-effect but you won't know that with certainty until you put the therapy (and your opinion/theory) to the test of science and I dont see any science on ball exercises for the treatment of ataxia, so you might as well be doing anything that sounds logical, or nothing at all, or let the patient decide on the mode of therapy...so as far as I'm concerned, it may be the ball thats helping or it may be any number of variables and a well-educated "guess-therory" backed by years of clinical experience just doesn't cut it with me anymore without, at least, one or two well designed randomized trials, and neither should it for DS.
You know as well as I do that EBM is necessary to validate the use of therapeutic modalities, especially ones which are used so often in daily practice such as a ball or cane or brace. Dare I say, more EBM is necessary to validate the entire field of neurological rehabilitation, including Physical Therapy, Chiropractic care and most surgical and medical procedures? Burn me at the stake!
Back to the Ball:
"But getting back to the ball...to test the effectiveness -- simply establish a targeting pattern on the floor with tape, or on the wall as with a dartboard pattern. Test the accuracy of foot placement with some functional task before use of the ball, or whichever device selected, then test afterwards"
A test...Thats a great idea. The test should be repeatable and have ecological validity too. Why not test in the persons actual environment...like out on the street in front of the clinic. It's not enough to recreate an abstract environment in an artificuial laboratory setting (like a PT facility).
"The critical need for balance for standing and walking is dependent upon the control of the axis or column of the somatic mechanism which for upright locomoting chordates is the spine."
Textbook?
Visual, vestibular and proprioceptive mechanisms are critical as well.
"Once on the ball, it is possible to determine if the axis is having a difficult time both sensing and responding to changes in perfect upright alignment with gravitation and if its response, righting and recovery motor patterns are normal, abnormal, poorly coordinated dominated by synergy or some otherwise masked perceptual impetus which does not emerge except during single leg stance."
It sounds good. Bobcat, there is no well documented evidence that working on or with a ball transfers to walking, standing, sitting, or any other functional movement. Unless there is well documaented evidence that postural control diagnostic tests on a ball tell you something meaningful about a persons postural control mechanisms/behavior while standing and/or walking it is a waste of time for the therapist to be doing this, unless it is for research purposes or personal inquisitiveness and the client has been informed about this experiment.
"The answer would be that to just sit in a chair most people don't have to have any balance at all. "
Guru Bobcat has THE ANSWER! I meant people living with ataxia and not "most people". People with Parkinson's disease or following stroke have difficulty with sitting balance. I'm not sure what you mean here, anyway, and I just dont have enough time right now to list the sources of evidence showing that you are mistaken about sitting balance. Perhaps I meant equlibrium and postural control and used the term balance rather loosely...Anyway, Peace and look forward to your response.
Mark Hirsch
[This message has been edited by Hirsch (edited December 10, 2001).]
|
|
|
|