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The Neuroscience of Guilt Uncovers the Origin of Cooperation #research #forbes

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Breaking Free of Sample Size Dogma #research

A call to recognize the value in starting small.

Breaking Free of Sample Size Dogma to Perform Innovative Translational Research

DOI: http://dx.doi.org/10.1126/scitranslmed.3001628 (Abstract)

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Finally!!! Bipolar Disorder and Postural Control: Mind-Body Connection Suggests New Directions for Treatment, #Research

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Shiny pictures, poor outcomes: Spine MRI, Back pain, and surgery #feldenkrais #Physicaltherapy

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Bones for Life Classes Improve Function and Balance in Community-Dwelling Adults

By C. A. Montgomery, MSPT, GCFP, BFLT/T;
C. M. Allen, GCFP, BFLT/T;
S. D. Farber, PhD, OTR, FAOTA, BFLT

Initially this study was designed by Allen/Montgomery with consultation by Farber in the area of data analysis and manuscript review. The purpose of this study was to determine the efficacy of Bones for Life® as a method to facilitate improved functional status in a group of community-dwelling elderly adults at the City of Cincinnati Dunham Recreational Center in Cincinnati, Ohio.

Participants were randomly divided into two groups in which Group One received baseline testing followed by a 6-week Bones for Life course, and post-testing. Group Two received baseline testing followed by 6 weeks of routine activity, a second round of baseline testing to control for the passage of time, a 6-week of Bones for Life course and then post-testing. Quantitative measures were used to assess differences in participant’s functional status (Timed Up and Go, Standing On One Foot, 360 Degree Turn, 20-Second Step Count). Qualitative measures of perceived change in Balance, Posture, Pain/Comfort, Awareness, Function, and Emotion(1) were assessed.

The study is in the final stages of statistical analysis of quantitative data and initial stage of manuscript preparation for publication. Analysis of the raw qualitative data suggest a 68.2% improvement in Function, 50.0% improvement in Balance, 40.9% improvement in Posture and 31.8% in pain reduction.

Target date for Journal submission is June 2010.

(1) These terms are based on how subjects defined their experience during the study and/or were derived/modified from definitions.net and the Merriam-Webster Dictionary.

Awareness: The kinesthetic knowing about one’s self and one’s relationship to the environment.

Balance: The dynamic state or condition where all regions of the body are functionally aligned so that the center of gravity is over the base of support and the body is able to adapt to the changing conditions of the environment. There is equilibrium among the parts.

Function: Improved performance or a newfound capacity to perform an activity for a specific purpose.

Pain/Comfort Continuum: The self reported description of bodily sensation ranging from acute or chronic distress to comfort/ease.

Posture: The arrangement of the body and limbs in relationship to gravity.

For future upcoming classes please check out the following link:
 http://www.futurelifenow.com/class-schedule.htm

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Case Study: Gait as an Assessment and Intervention Tool

Case Study: Gait as an Assessment and Intervention Tool by Cynthia M. Allen and Carol A. Montgomery Download Abstract [PDF] Graphs related to key tests and sketches of Feldenkrais Functional Integration® lessons are also available for viewing in post: Case Study Results: Judy

BACKGROUND AND PURPOSE It is our belief that the primacy of gait has been vastly overlooked both in identifying its vital components as well as understanding its effect on human health. We have developed a theory called Integral Human Gait(tm).  Integral Human Gait (IHG) probes unexplored lines of thought in the kinetic analysis of gait including ground reaction forces (GRF) in various positions, the uncoiling/spring power of counter rotation throughout a closed system, and the value of using sensory experiences. In this case study, IHG theory was used to guide the assessment and intervention with a client who had underlying musculoskeletal dysfunctions from long-standing scoliosis and more recently, a full thickness rotator cuff tear, both of which contributed to significant functional limitations.

METHODS Judy referred herself to Improving the Gait, a 3-day workshop, due to an increasing undesirable feeling of “dragging my body around” and an increasing need for rest. The workshop was on Integral Human Gait(tm) using a didactic and experiential format that included Awareness Through Movement® lessons, Bones for Life® processes, and physical therapy exercises. IHG explores ground reaction forces using the vertical power line of the heel and its impact on spinal alignment and counter rotation at various points from foot to head. Post workshop Judy received five Functional Integration® (FI) lessons. Tests administered included Timed Up Go (TUG),One Legged Standing Test with Eyes Closed (OLST) and several tests selected from the Berg Balance Scale. Tests were not specifically selected for this case study but used because directly prior to the workshop, Judy volunteered as a participant in an inter/intra reliability pilot. Videotape of Judy’s gait was also recorded.

RESULTS Improvements were measured at 3 days and sustained at 1 week in the following tests: Timed 360° both directions (360x2); Timed Alternate Placement of Foot on Step (STEP); Timed Tandem Stance (TS); and Timed Standing on the Left Foot (FOOT). No significant changes were measured in TUG, OLST or Right FOOT. Improvements in standing rotation were demonstrated. Her gait displayed subtle but increasing levels of counter rotation between pelvis/lower extremities; pelvis-lower ribs/shoulder girdle; and head/shoulder girdle. Counter rotation of the arms was increasingly generated by trunk rotation instead of movement at the glenohumeral and elbow joints in the sagittal plane. Judy’s need to rest “on a regular basis” decreased from 2-3 hours to no more than ½ hr daily. She reported depression over the decline of her physical body lifting. “I know it is possible to move securely even if I get up in the morning and feel out of alignment. I know the path I can use for moving forward confidently.” Judy further reported standing longer in choir performances without having her “back go out.” Results related to her shoulder have been variable.

DISCUSSION With the intervention Judy learned how to recognize and transmit GRF from the vertical power line of the heel to the head. We theorize that the transmitted GRF served both as feedback and feedforward input into the nervous system allowing decompression of the scoliotic spine. The decompression restored the biomechanical possibility for counter rotation, both locally between the vertebrae, and globally with the head, shoulder and pelvic girdles. Both decompression and counter rotation are needed to perform well in 360x2, TS, STEP and FOOT. The lack of improvement in TUG and OLST seems appropriate. The components of rising from a chair quickly, fast walking, and peripheral proprioceptive balance input were not specifically addressed in the Gait Workshop. Using gait as an instrument to assess change and design interventions, Judy experienced improvement in stamina, emotional outlook and back comfort with standing and walking. She is currently continuing with FI lessons and open to surgical intervention if needed.  While the Feldenkrais® community understands gait from a broader perspective as compared to a traditional model, IHG theory creates a template for discovery of previously unexplored aspects of gait, thus enabling the practitioner and client to experience more focused outcomes. Additionally, people with scoliosis have more difficulty and energy expenditure in moving than is commonly understood. It is a novel idea to consider that a person’s scoliosis could contribute to a rotator cuff tear; and how, if left unaddressed, it may lead to a change in function. Innovative and less observed in the health care community, is the examination of “how” a person walks, and the impact that this “how” has on one’s overall health and sense of well being.  

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Case Study Results and Intervention Review: Judy

This page is designed to give a little more detail to those that are interested. In this post find:

• Sketches of Functional Integration session elements;
• Test results in graph format;
• and Videos

The abstract for this case study can be viewed at our post: A Case Study: Gait As an Assessment and Intervention Tool

	Watch and Listen: Judy Walking Pre and Post with commentary . . .

	Watch and Listen: Interview with Judy about her experience. . .

The following are some of the tests administered preworkshop, directly after the 3-day workshop and then at 10 days (during the 3-10 days, there was no additional intervention)

Feldenkrais Functional Integration Lessons

In follow-up to the workshop, Judy received five private sessions.  In each of these session Integral Human Gait theory was used to assess her progress, form that day's lesson plan, and then again in reassessment at the end.  These sketches and provide a brief glimpse into the ways the practitioner worked with Judy in gait.  None of these sketches represent complete lessons.  Because each Functional Integration is created specifically for each client, the ways in which a lesson can be constructed are nearly limitless.  Therefore, these are simply some ideas.  The core of Functional Integration as a learning and awareness building tool with respect toward each client's needs (that is without time or achievement pressures) are a tremendously important part and deserve to be pointed out for those that are not trained in the Feldenkrais Method. The practitioner has been deleted in some cases to provide a clear view.

	Sidelying: Pelvic Girdle/Lower Ribs retract left; cloth pulling forward suggests Shoulder Girdle/Upper Ribs rotation left while C7-C2 is held undifferentiated /w right hand.
	Supine: Arrows show right foot pushing down rotating Pelvic Girdle/Lower Ribs left; while Left foot pushes through the vertical power line of the heel into the wall; practitioner hand is pulling the cloth to suggest right rotation of the Shoulder Girdle/Upper Ribs. .
	Supine: Arrows suggest cloth rotates femur inward and left hand suggests counter rotation of Pelvic Girdle/Lower Ribs as the right foot pushes down.
	Supine: Half foam ball placed mid-heel to mid-arch; Arrows suggest hand assisting right leg to push down into ball; other hand suggests inward rolling of extended leg. .
	Sitting: Cloth can be tied many ways to facilitate each client’s unique needs. Arrows suggest cloth pulling to give Shoulder/Girdle Upper ribs right rotation while pressing down through foot facilitates Pelvis Girdle/Lower Ribs left rotation.

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