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Blindness and Manual Assessment

 
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Blindness and Manual Assessment - June 9, 2005 8:34:00 PM   
Barrett

 

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Anne Bancroft passed away recently, and with this came the inevitable reports of her remarkable acting career. Of particular interest to me was her preparation for the role of Annie Sullivan, the ?Miracle Worker? who introduced Helen Keller to the world, and vice versa. Bancroft spent hours with her eyes and ears taped shut in order to gain some sense of what this teacher might find in her student. Understand, she wasn?t preparing to portray someone who was blind and deaf; she was preparing to portray such a person?s teacher.

Geerat Vermeij is one of the world?s foremost evolutionary biologists. His special interest and expertise revolves around the nature of sea shells. By examining their shape and texture and relating these factors to their age and location Vermeij has managed to espouse theories of origin and evolution and transformation through conflict that had never occurred to any other researcher; theories that have withstood the crucible of the biologic community for decades. He did this without ever seeing a shell-his eyes were removed at the age of four.

I heard these stories about the actress and the scientist on National Public Radio, a place where I have obtained a phenomenal amount of information the past twenty years. I?ve never seen this place, of course, but I sense it otherwise, and my sense of it has grown steadily without its transmission significantly altering at all.

So why all this talk of blindness? Not long ago I fell into conversation with another therapist nearly my own age. He had made an effort to get to my lecture early, hoping for an opportunity to speak with someone he?d heard quite a lot about and he was also a fan of my writing. His own history as a provider of manual care was pretty impressive. From early in his career he?d worked at a large and well-known institution visited regularly by those in my profession who have personally developed methods of management he came to understand intimately. Students from around the world came there as well, bringing with them their own ideas about examination, theory and treatment that kept him academically astute and clinically flexible. He regularly taught others what he knew. Given all of this I grew a little uneasy about what I might have to teach this man-but then he said something that I knew provided me with both an opening and, ironically, a way of altering significantly our conversation about manual care. He said, ?The German students don?t even have the equivalent of a college degree but they have great hands.?

I could feel a shift in the back of my head. It probably didn?t show up on the surface but I knew I was in trouble with this man.

If you?ve an idea why, please join in. More in a day or so.

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Barrett L. Dorko P.T.
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Re: Blindness and Manual Assessment - June 10, 2005 10:41:00 AM   
Diane

 

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Probably there will be less trouble if you are used to treating with your eyes closed.

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Re: Blindness and Manual Assessment - June 10, 2005 10:53:00 AM   
Barrett

 

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Diane,

Eyes opened or closed-you'll never see the things you need to sense with your hands. Closing your eyes helps because of Weber-Fechtner, but aside from that it wouldn't help you sense what you might with a fundamental change in your attitude toward what it is your handling.

More about that soon.

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http://barrettdorko.com

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Re: Blindness and Manual Assessment - June 10, 2005 10:58:00 AM   
Jon Newman

 

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I'm not sure for certain but perhaps you sensed the "Machiavellian module" had kicked in. Not being practiced at such a thing I would only be taking wild guesses at anything further.

jon

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Re: Blindness and Manual Assessment - June 10, 2005 11:01:00 AM   
Barrett

 

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Jon,

For some reason I don't get what it is you mean by that. Since it comes from you I feel that would be a loss. Please explain.

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Re: Blindness and Manual Assessment - June 10, 2005 1:48:00 PM   
Jon Newman

 

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Hi Barrett,

My thoughts here come on the heels of finishing "Why we lie" and therefore may be duly influenced by that. My understanding is that the "Machiavellian module" is the aspect of our existence that allows us to deceive and to detect deception in others. During social interactions in which there is some ambiguity plus a danger of losing some level of dominance (for lack of a better word at this point), the subject matter and exact word use of the interaction may have some unconscious code to help determine what others in the group think and feel. I would consider that the fellow you describe demonstrates this instance of deception. On the other end, the module also allows for the potential for someone to detect when they are being deceived.

Further, the ability of the detector of deception to decipher what is being hidden is a skill that, like any skill, can be enhanced with practice up to some point. Not having practiced as such, my skills this way are poor. I don't know why this fellow would have pick German students versus students in general for example. His remark is actually disparaging as it pertains to credentials but softened or veiled by the compliment of "good hands".

Then again, I could be self-deceiving.

jon

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Re: Blindness and Manual Assessment - June 10, 2005 2:09:00 PM   
Barrett

 

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Jon,

Now I understand, though I think that reading the book you mention is essential for that. Fortunately, I have.

As you'll see, my concern was not the deception of my colleague, but for the thing he was so very obviously proud of-his own hands. I feel this is misplaced and not conducive to the sort of care I espouse. This is a complex subject so I'm going slowly with my explanation, mainly so that I don't screw it up.

_____________________________

Barrett L. Dorko P.T.
http://barrettdorko.com

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Re: Blindness and Manual Assessment - June 10, 2005 5:34:00 PM   
Randy Dixon

 

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My answer, which is nothing more than a shot from the hip, is that you continually preach about knowing why you are doing something and why that works. That you treat with your brain and the hands are a tool, a valuable tool perhaps. A bad carpenter with the best tools in the world can't compare with a master carpenter with a few chisels and hand tools.

I'm not sure how the blindness aspect plays into that, except that sighted or blind, the mind is what makes the difference.

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Re: Blindness and Manual Assessment - June 10, 2005 7:09:00 PM   
Barrett

 

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Randy,

Nice shot.

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Re: Blindness and Manual Assessment - June 10, 2005 9:33:00 PM   
Jon Newman

 

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That **** book has me seeing code everywhere now and in my opinion I don't think I was too far off in my first assessment but that isn't interesting or helpful to this topic.

Randy,

Your post and Barrett's first post reminded me that Helen Keller used her hands for communication. Rodney Cotterill reminded me that
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11250060]"Muscular contraction is the nervous system's only externally directed product, and the signaling routes which pass through the various brain components must ultimately converge on the motor areas."[/URL]

Everyday we speak using primarily the muscular contraction of our tongue, diaphragm, and vocal musculature but we also use the rest of our body. Helen Keller used her hands primarily but also used everything she could.

This makes me wonder if someone actually has good hands, which is yet to be defined, wouldn't they necessarily have a good mind?

jon

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Re: Blindness and Manual Assessment - June 10, 2005 9:34:00 PM   
srcase

 

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Hmmm, again I am reminded of my massage therapist, since I had a session with her just today. She does not have the kind of background of any of those "well-educated" manual therapists you speak of (in terms of physiology, biomechanics and kinesiology) but she has practiced for many years, and "felt" many different tissues. I won't underestimate her education, as she is very knowledgeable about anatomy; however, I think what makes her a successful therapist is a small part education and a large part experiential and intuitive. Certain people have a natural tendency toward listening with their hands and others don't, and never will, no matter how much education they receive.
I agree that it is useful to have a foundational understanding for what it is one is trying to affect in the body, but I don't think that is the whole picture. If the body already knows how to correct, than it only needs permission, not full disclosure/comprehension from the therapist to do so.
For example, today she told me about her boyfriend's chronic back pain and how she would like to help him, but would like him to get an MRI first just to "know" what (if anything) is going on. I asked, "would you treat him any differently if he did have, say a disc bulge?" She didn't really know how to answer, but I would guess that she wouldn't.
Does that mean she couldn't help him?? Not at all.
Basically, I see the issue of education vs. experience as two sides of the same coin, and one's attitude as the thing that gives the coin value.
Sarah

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Re: Blindness and Manual Assessment - June 10, 2005 10:11:00 PM   
nari

 

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jon

I would challenge the 'good hands'/ 'good mind' theory. I was trained as a remedial masseuse (18 months worth) as part of my diploma in PT. I think my mind is OK, but I barely scraped through massage; and the tutor told me I looked and felt as though I was patting a sack of potatoes. Which is exactly what I figured I was doing...and I wasn't much better with Maitland mobs.

But it didn't let me down - in the days when I did heaps of hands-on, patients loved it.

Randy, you are right, I think the mind wins out each time...and maybe language, voice, tenor and all that stuff.


Nari

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Re: Blindness and Manual Assessment - June 10, 2005 10:28:00 PM   
Jon Newman

 

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Nari,

I think the question remains, what defines "good hands". Perhaps you have them and don't know it. I understand that the phrase "good hands" has a common meaning of sensing asymmetry or applying forces to specific spots in specific directions. My opinion, however, is that good hands are those that communicate.

Also, just because one doesn't have "good hands" doesn't mean one has a poor mind. My comment was that those who do have good hands have a good mind. But you are correct, I could be wrong. If someone punches me in the face, their hands have communicated quite well but I may not find their mind to "good".

jon

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Re: Blindness and Manual Assessment - June 11, 2005 12:58:00 AM   
gary s

 

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Barrett,
I'll take a stab. I believe that the phrase "skillful hands" somehow implies that the therapist is providing the "cure". There can be a lot of ego tied up in this. Simple Contact is about providing an atmosphere that permits the patient to solve the problem. We provide just enough light for them to see the path out of the forest. When I see rapid, positive change, I feel awe for the process, not for any supposed skill that I have. Perhaps the true skill is in cultivating patience. This might be totally foreign to your therapist's paradigm.

Gary

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Re: Blindness and Manual Assessment - June 11, 2005 8:27:00 AM   
Jon Newman

 

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Hi Gary,

Good points. I think you should give yourself credit for creating that atmosphere. That is, I think being able to do so is a skill. Once it becomes who you are, it may be hard to see it as a skill but when one is not that way, it becomes obvious that it is indeed a skill.

Do you remember when patience was a virtue? If our culture still thinks so I have a hard time finding cultural instances of it. Or perhaps we still see patience as a virtue but no longer value being virtuous.

jon

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Re: Blindness and Manual Assessment - June 11, 2005 11:23:00 AM   
Barrett

 

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In Geerat Vermeij?s memoir ?Privileged Hands? he describes his tactile sense of things, shells specifically, and how he may come to know even their ?regular intervals of asymmetry? with this sense, knowing that sighted experts have missed this mainly because they can see. In other words, vision smoothes things out in a way that our hands cannot. He also decries the emphasis on visual acuity in education and how this leads to a prejudice in testing and achievement scores that simply do not take into account how we might learn about things otherwise. He speaks of how he can manually assess things that he can move in his hands (like shells) but cannot similarly appreciate statues because they are typically fixed and stable. He wants to move something across the stillness of his other hand in order to learn about it. When I heard him interviewed he spoke of how people imagine blindness as something dark or even black. He doesn?t sense it in this way at all-especially when he touches something moving in his hand.

I understand that at the PT Convention in Boston ( I wasn?t able to attend) a session was devoted to more accurate and reliable methods of measuring the surface contours of our patients (read posture) in order to finally discover what?s wrong with them. Many still live in hope that the dysfunction we seek to ablate will one day reveal itself in this way-in a way our eyes can see it. And what would Dr. Phil say about this decades old effort?

Every reply to this thread has yielded more insight (pause a moment and think about that word) from people who are blind to the patient?s internal activity and seek to sense it with their hands-mainly because they have no choice. They have done this not by using their hands as agents of their will, but as organs of perception. The following is from ?The Use of Simple Contact? on my site:

Charles Brooks? "Sensory Awareness: The Rediscovery of Experiencing" (The Viking Press Inc. 1974) contained a chapter titled ?Simple Contact? that described touching people (and objects) in a fashion that, to me, was remarkably reminiscent of my own thoughts on the subject: ?We are actually working when we touch another-working to try out our hands not as agents of our will but as organs of perception. Indeed, however we may touch him, we may somewhat disturb our partner?s freedom. Our hands may feel hard to him, or heavy, or light and fluttery. He may feel ?handled,? restrained, pressed, or-sometimes a very disappointing experience-not really touched at all. Accordingly, one might expect such contacts to be downright unsatisfying, if not downright inhibitive. But in a great majority of cases it is exactly the opposite. The mere fact that one comes to the other quietly and without overt manipulation is normally very moving to the person touched. He feels cared for and respected. And the one who touches, if he is really present in what he does, is apt to feel something of the wonder of conscious contact with the involuntary, subtle movement of living tissue.?

I came across a line from John Griffin?s new book ?Scattered Shadows,? the story of this man?s ten year ordeal with blindness. Early on, he has a conversation with another blind man, a monk in fact. The monk says, ?You are too nervous my son. You must develop heroic patience.? Sound familiar?

Is there any science behind manageing to see things though we are blind to these things in the usual sense? Yes, there is.

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Re: Blindness and Manual Assessment - June 11, 2005 11:57:00 AM   
Diane

 

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[QUOTE]Charles Brooks? "Sensory Awareness: The Rediscovery of Experiencing" (The Viking Press Inc. 1974) contained a chapter titled ?Simple Contact? that described touching people (and objects) in a fashion that, to me, was remarkably reminiscent of my own thoughts on the subject: ?We are actually working when we touch another-working to try out our hands not as agents of our will but as organs of perception. Indeed, however we may touch him, we may somewhat disturb our partner?s freedom. Our hands may feel hard to him, or heavy, or light and fluttery. He may feel ?handled,? restrained, pressed, or-sometimes a very disappointing experience-not really touched at all. Accordingly, one might expect such contacts to be downright unsatisfying, if not downright inhibitive. But in a great majority of cases it is exactly the opposite. The mere fact that one comes to the other quietly and without overt manipulation is normally very moving to the person touched. He feels cared for and respected. And the one who touches, if he is really present in what he does, is apt to feel something of the wonder of conscious contact with the involuntary, subtle movement of living tissue.?[/QUOTE]This is moving just to read through an ordinary visual cortex. Barrett, is that where you got the name for your work?

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Re: Blindness and Manual Assessment - June 11, 2005 12:38:00 PM   
Barrett

 

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Yes.

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Re: Blindness and Manual Assessment - June 11, 2005 12:49:00 PM   
Jon Newman

 

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[URL=http://www.butterfliesandwheels.com/articleprint.php?num=130]Wallification or paranoia I[/URL]

I thought the above relavant.

jon

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Re: Blindness and Manual Assessment - June 11, 2005 9:53:00 PM   
nari

 

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jon

A good link, worthy of reading a few times occasionally. I thought of city folk, who are surrounded by barriers of their own making, and who dream of a quiet place with spas and massages to escape to. What are they after? Time to think or read and be touched...yet many end up undergoing retail therapy and parties, and arrive home no better off in many cases.

What are good hands? I think Diane and others understand this phrase better than I. Hands-on certainly meets patients' expectations better than hands-off....and maybe this is a good thing in some ways.

Gary, I agree that acknowledging a process and not a tool which results in good outcomes is most important. I think too many PTs think that their specific technique that they chose from the text book or course is what works, not themselves: the tool and not the carpenter, the song and not the singer.

I wonder if we could do a study where x PTs were blindfolded and y were not during a hands-0n session? Might be difficult to interpret the results...

Another useful ploy is to practise doing everyday things (eg making a cup of coffee) in darkness. I dislike bright light and always have; and I have noticed, with no light I know exactly when the level of the water in the cup is about 2 cm from the top. Sharpens up the hearing no end...and putting away the linen at work in a totally dark room livens up proprioception....

Does anyone else avoid switching on lights as far as possible or is it just me??

Nari

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