N=1

N=1 has turned into a symbol,  a representation meaning to treat a person as an individual, as a unique complex being that has personal factors and history that make them who they are. (see the mountain stream analogy via Aaron Swanson.) When we speak about treating the person in front of us we can say “N=1.”

This is being championed by many groups. The “Pain Science crowd” certainly incorporates individualism and biopsychosocial constructs.  Cause Health is bringing awareness, and I’ll also recommend Neil Maltby’s blog: Becoming More Human.

Split brains and causation

There’s gotta be a reason. You can’t have an event pass by you without knowing why, right? Right.

“Well, you know, the weather made it hurt. It’s all that rain…”

“My back is hurting today, I was at a family BBQ and I stood for an hour yesterday, so…”

“The knee feels much better, I think it was the tape you put on there.”

Post Hoc Ergo Proctor Hoc. After that, therefor because of that.

Making a reason for things is not conscious, often. We always see cause and effect as a truth. If we’re wrong, it’s confabulation, not a lie. It’s “only human.” See a quote below from some of the Split Brain research:

What is that, wet?

One of the most real, shared experiences that we have as humans is non-existent in the true sense of cause-and-effect reality. The sense of wetness.

There is no “wet receptor” or nerve fiber type devoted to the sensation of wetness. No indeed. Insects have “humidity receptors” but we lack the ability to feel the water that so defines our planet. The human sensation of wetness is the complex, near magical (if you don’t mind me saying so) confluence of pressure change, light touch change, motion direction, speed and pattern, temperature change, and visual input.

Cervical Artery Dissection: Implications for the Physical Therapist A Case Report from a Direct Access Environment

http://2.bp.blogspot.com/-mayPxpjVzes/U-y_PpjFEzI/AAAAAAAABA0/9NntkiP_fsk/s1600/A9RBABA.jpg

Intro:

You receive a call from your friend and fellow DPT classmate to evaluate her neck… the patient herself is a physical therapist by occupation. A healthy and fit 29 year old female, 5’0″, 115lbs. She reports she is having some cervical musculoskeletal issues going on. She has an achy pain in the bilateral upper traps., levator scapula, and peri-cervical muscles. She is limited by pain with the following cervical motions: right side-bend, right rotation and extension. No signs of central or peripheral neurological issues.

You are an experienced PT and have completed many cervical manipulations on a patient like this and it’s the end of your day. So you are going to do a quick favor for a friend and manipulate her neck, complete some STM, and maybe some PROM/SNAGs/isometrics/METs or whatever your favorite manual therapy technique is. What could go wrong? She’s a therapist herself so she wouldn’t miss anything serious. Being that you are friends you want to do some “magic” giving her some relief of symptoms. So… snap, crackle, manip. You move into some PROM and she reports severe vertigo, nausea, double vision, and you notice hemi-facial asymmetries as she talks about her onset of symptoms. Now what?  Your table, your hands, your patient.

Five Days of Fallacies: Day 2, Complex Question

Five Days of Fallacies: Day 1 here, Day 3 here, Day 4 here, Day 5 here. I am discussing some common mistakes we humans make in reasoning, in the hope that you can 1) Understand what they are 2) Recognize them when others speak 3) Recognize them when you think this way 4) Attempt to correct your thinking on old, current and future ideas.

The Complex Question Fallacy is in the family of Fallacies of Presumption. It makes assumptions, thereby defining the conversation and the result of the outcome, when asking a question.

An easy example of this is seen here: “When are you going to admit that you lied?” You cannot say “Right now” because that is an admittance of lying. If you say “Never!” you uphold the assumption that you lied, and that you are just not admitting it. Lose lose.

How does this show up in the clinic?

Does the weather make pain worse?

People say it all the time: “Oh, it’s gonna rain, I can tell in my knee” or “My knees really hurt over the weekend… they do that with bad weather.” What is it with these magical knees? From my personal vantage point, there is no logic to this… it’s simply psychological mis-attribution of causes… but it is heard so often, is there something to it?

Well, I asked on Twitter and fully enjoyed the convos that occurred…

So here is a summary of what was shared:

Let’s take a look at your X-Ray: A Case Story

It was his 3rd visit in for his back pain, but it was the first time I had seen him. I ask how he’s feeling that day.

“I’m hurting, not much different since last time. I’ve had back pain for 5 years, it’s gotten worse in the last 3. I had an X-ray by a gastroenterologist done a few years ago and she saw my spine on the image. She asked if I had back pain.  I said ‘yes, yes I do.’ She said she could tell, because my lower vertebrae were fused together, L4 or 5 or something. She said I’d have back pain for the rest of my life because of it. I’m about a 5-6/10 pain today.”

It was the same story he’s told to every practitioner, over and over again. I know because

The Punnett System

Oh Lord, I have heard the claims!

I have listened to the persuaders, the charmers, the charismatics.  Most of their ideas make sense and can follow logical patterns. (see How To Fool a Smart Person by Erik Meira)  I have a thirst for knowledge, and for universal truths… so I’m listening!

But I have one helpful tool that I use to quick-check these fantastic claims: The Punnett Square. The marriage of factors combined to make truth babies.  Hypothetical genotypes producing theoretical phenotypes. (I don’t know what all that means…)

The punnet Square is commonly used in biology (I’ll let Khan Academy teach you about that here,) but we can use it in our own evidence based practice.  Here’s how: Let’s take the claim that poor posture = pain and make a Punnet Square.

You Should Be Using Music with Your Patients with Brain Injury

Image: Xiao-Xuan Yang Dancigers

Music has the ability to go deep and move us.  We have all been on the dance floor when “our jam” comes on and you just have to pick up the pace and move with the music.  You had no choice.  Contemplate that for a moment, why is that?  Why does it feel so good to match your movements to the beat?  Let’s dive in…

We will use the research study: Interactions between auditory and dorsal premotor cortex during

synchronization to musical rhythms, by Joyce L. Chen, Robert J. Zatorre, Virginia B. Penhune, 2006 in NeuroImage to explain the premise.  (open source!)

To start off- some background information on

How to start a Journal Club

I had the awesome experience of starting and coordinating the ODU DPT Journal Club over the past year.  I started it wanting to know what was being put out there in research (the First Pillar), and that was certainly valuable.  I found out, however, that the most valuable aspect of Journal Club is the conversation.  Everyone has different perspectives, reads the same line in a different way, asks different questions and can see what you don’t see.  I learned a ton from participating in this process and you certainly will too.

So, without further ado, here are my tips on how to start a PT Journal Club (J-Club):