On Demand Learning Level 2

This post has the links to the on demand level 2 courses from LMS

Course Name:
Advanced Lumbar Spine
Cervico Thoracic Complex
Lower Quarter Complex
Lumbo Pelvic Complex
Upper Quarter Complex
CLMS
Clinical Decision Making
Safety
Compassion/Caring
Procedures: Soft Tissue Preperation
Procedures: Mobility Training
Procedures: Stability Training
Procedures: Functional Training
Interventions: Equipment
Plan of Care
Prevention, Health Promotion, Fitness, and Wellness
Screening
Structured Motion Intermediate
Gait
Balance
Geriatric Mobility Advanced

On Demand Learning Level 1

This post contains links to all of the other courses from the LMS courses.

 

Course Name:
Geriatric fractures and joint replacement
geriatric mobility
Lumbar Spine introduction
Multiple Sclerosis
Parkinsons
Stroke
Establishing the Base
Foot and Ankle
Knee
Hip
Lumbopelvic
Thoracic and Ribs
Cervical Spine
Shoulder
Elbow Wrist Hand
Accountability
Cultural Competence
Communication
Self Assessment
Clinical Reasoning
Documentation Skills
” Health Care Administration”
Health Promotion and Maintenance
Altruism
Integrity
Professional Duty
Diagnosis
Education
Evaluation
Evidence-based Practice
Examination
Intervention
Management of Care Delivery
Outcomes Assessment
Prognosis
Social Responsibility and Advocacy
Structured Motion Intro
Structured Motion Basic
Understanding Pain

In the Groove – 6. Creating Momentum

How does one create this type of momentum?

Creating momentum and it roles in advancing the motor learning process is also one of the least understood aspects of how to produce increased performance in a short period of time.  Rhythm can be used for motor learning within an individual lesson. This rhythm can be sustained from exercise to exercise using progressions within bases of support. The impact is a lesson of motor learning that includes adequate repetitions and multiple learning iterations of “make a mistake, learn the lesson, try it again.”

How can this momentum can sustained during the plan of care cycle over weeks and months, consisting of multiple unique appointments. Individual single session can be linked together to create sustained change over time with a technique borrowed from music composition.
We have already seen in other articles how the use of form assists in structuring of changes efforts over long periods of time. These internal relationships generate momentum. The momentum developed through organizing the internal relationships can be sustained over time by arranging the sub components in relation to the larger goals.   This strategic arrangement of goals, sub goals, current reality of those goals and actions create an internal framework of change.  Actions taken on behalf of bringing the two data points closer together create the rhythm that established the groove. Rhythm is the result of carrying that form in varying dimensions of time. Each very small dimensions of time is related to another through form, to create components that relate over longer periods of time, resulting in sustainable change efforts.

Arranging time and sound has been the life’s work of Hugo Norden who taught music composition.   Again the arts have something to teach us about how to create consistent results. From the book Form: The Silent Language, Norden describes the misconceptions students of music composition must dismiss in order to effectively design music.  He describes it as a basic misunderstanding of how the symbols of music and math have undermined the design process.  The concept of music produce a misunderstanding of the relationships of notes, and the mechanics of relating and arranging musical notes together into a comprehensive creation that communicates the desired expression.

He describes how most children are taught in their music lesson to “count time” from bar line to bar line, thus:

Notes 1234

As a result the music composition student, as they are learning to design music naturally follows the same sequencing.   In this way, the first note written is followed by the sequence above.  In this way it was the preceding note that the following note is based on.  However, this burdens the making of the composition as each segment of music becomes isolated and lacks continuity and integrity with the rest of the composition. One stanza is isolated from the overall movement.

Norden further drives the point home as he writes,
“This is a gross misconception which many students never outgrow!” He completes his thoughts by describing the frustration that is common for the musical composer using this approach.  Momentum is non existent in the music and the act of creating the music.

We have observed something similar in students of physical therapy, athletic training and in practicing clinicians. In the process of creating results that impact movement, the relationships between components of the plan of care can become categorized. That is they are isolated into silos such that a treatment plan to produce improved sitting to stand function becomes generalized. The internal relationships are lost and as a consequence momentum is undermined. The result is a sense of starting over each time the patient or client arrives for their appointment.  The choices made today does not relate to the overall goals of the program.

Progression towards the desired result is lost. Squat pattern training does more than just improve a sit to stand transfer. A squat pattern creates the needed strength to master the increasing complexity of a stride stance balance and wt shifting in asymmetrical stance. And without an adequate foundation in the squat pattern, single limb pattern is very difficult to progress.  In this way an opportunity to increase the clients desired involvement in life is missed and the impact of the change effort is temporary as the underlying structure of the approach is to provide only temporary change.

 

Have a question on this topic, please feel in the box below

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In the Groove – 5. Rhythm

Rhythm is the result of organizing the relating parts in a way to generate energy. In change efforts in which a result is created, there may be many sub results that are necessary and must precede the overall result. Returning to the example of making a cake we see that sequence does indeed matter.   The dry product is mixed with the wet product to form the cake batter.  The sequencing of putting the contents together is just as important as the quality of the contents itself.  When seeking to create a treatment that produces accelerated motor learning the parts of the treatment need to be organized to generate the different rhythms desired.

In the rehab world this looks like sequencing the treatment planning towards movement related goals. Each functional movement is composed of many sub component movements. Shoulder flexion includes flexion at the glenohumeral joint as well as external rotation and abduction. Miss one or more of the movements and the shoulder will not flex. Flexion is primary, abduction supports flexion, and external rotation supports all the above. To miss this relationship results in shoulder exercises that unspecific and lack an impact on functional improvement. The best joint mob, the perfect execution of stretch, the perfectly timed trigger point release will not have an impact if performed in the wrong sequence. Yes, sequence does matter.

Changing perspectives and backing up to see how the shoulder impacts and is impacted by the rest of the body, we can use the progressing scale of center of gravity and base of support pairs to increase or decrease the functional demands on the shoulder.  We can also, knowing that the position of the thoracic spine will be determinant on how the scapula will move, change our perspective to examine the hierarchically arranged parts.  The shoulder will also behave differently due to the change in the behavior of the thoracic spine in sitting or stride positions, or standing on one leg.

How do we as movement specialists organize the actions of the change effort? It is a question with a variety of different stylistic answers depending on your field of study, the time frame of your practice, etc. However, if it is human movement that is the subject, there are constants. The styles of practice are a spectrum, from a free flowing impromptu jazz style, to a rigid classical approach. Whatever your technique of choice, you can learn to design a program that has an underlying groove to it. In music, the groove, refers to the underlying bass line that supports the free styling, harmonizing, and melody of the other instruments. It’s palpable in funk, Rand B, rock, and other forms of blues derived music. It is also present in classical music. In jazz, the groove, is what allows the individual musicians to solo off into the outer regions and return home without losing their way.  No matter what they play it seems to work.

The groove is also obvious when it is absent. No groove means no life, no soul of the music, and without the groove no matter what the musician creates it will seem flat.  Without a well organized, scalable, integrated treatment approach you will find that impact made on your patients function is at most temporary.  To use rhythm to generate in conjunction with the groove is to be well positioned to create what is uniquely required for level of involvement your patient or client would like in their life.

In the Groove – 4. Specific Consistency

In this article, we’ll explore the way movement specialists work, and the way we think. The decisions making process used by the clinician will produce and support the change efforts and the results created… or not. Although the fields of improving movement through exercises, hands of techniques, teaching, all have similarities, there outcomes are dependent not on solely the technique applied but the development of the groove. We will explore the fundamentals of observing the causative relationships, and then the process of designing, implementing, and progressing a change effort to produce the desired results.
Whether it is PT, chiropractic, massage, or any of the sub styles of each profession, there are shared commonalities. The motivation for both experienced and novice movement experts are the same. Namely, to impact their client’s life by the interventions provided. The impact of improving someone’s movement cannot be overstated. At the beginning of the session the client could not achieve a desired time, movement, skill, task. At the end of the session, in just a short period of time, they have achieved it. Through the decisions made by the clinician and the teaching and learning the client has gone from a level of physical capacity to more options for involvement in their own life. Wow. To support your client on this level seems to be motivation enough. However consistency in results seems to be available for some clinicians easier than others. Why?
There are many notions about what is happening. It was the diet they are on, the medications they are taking, the affirmations, the psychology, a lot of different ideas. Maybe it just happens, we got lucky. If this was the case, then it would be a game of chance. The best you could hope for is that it would magically appear. Statistical number games would be the strategy employed. Make a lot of something and the quantity of the results will increase as to would be the failed efforts. However statistics would not explain why some practitioners are more consistent in getting results than others. For this we need to understand .
What do top professionals do different? One observation is that they consistently get results. They consistently have new clients, patients that want only their unique skills. They are always busy. Continuing the investigation of the arts let’s consider a few possibilities. What if U2 or the New York Philharmonic or Steven Spielberg or Qunicy Jones showed up for work, and just waited for something good to happen? Imagine going to a U2 concert, and it was a roll of the dice whether or not it was going to be a good show. How about Quincy Jones collaborating with musicians, if the time with him was chance. Is he just that lucky? Steven Spielberg or George Lucas? Is it chance that there movies are block busters. It seems that they know something about creating results that we can learn from. These true artists understand how to focus the process and their mind towards the results.
You can create sessions that generate their own internal energy, creating dynamic motor learning and satisfaction for both you and your client. Notice that these artists and professional creators do so in a variety of disparate and unrelated fields of study. Within the same field different creators may have radically different techniques, and styles. Well if is not about the technique is must be about something else.

In the Groove – 3. The Role of Form

If we step back from just watching the creator and observe the patterns the creator uses we will see distinct repetitions of sequences. One action follows another, resulting in a defined outcome. However unlike a distinct process where the same action always follows the same step, these directed actions are open. This is called a form. Forms are generalized areas that are in relationships to each other. An example is a tax form. The areas are generalized, income, expense, deductions etc, but the amounts, and types of content may be vastly different from person to person, or the same person from year to year. The result is each section provides the relevant result through a series of actions to produce a sub-element of the overall result.

In music there is a form that produces momentum, unlike the tax form which produces for most vertigo and nausea. The Sonata form is a specific form. Each form has component parts that are in relationship to each other and when combined, provide a place holder for a variety of notes to be organized. In this way, the music is always different as it contains different notes, but those notes are held in relationship to each other in a way to sustain the development of momentum.

It is the use of form as an organizational approach that promotes the ongoing production of results, and also allows those results to be different or the same. In producing improved function, the form is to first identify the what level of involvement and what specific activities the client or patient would desire. Then their current abilities are assessed in relation to that master goal. The process of assessment and evaluation involves multiple iterations of the telescoping form. In this way, the parts maintain a consistent relationship with each other and support components can be evaluated in context of the overall master goal. Functional tasks that are present in a desired activities are then assessed as well as the demands each task requires for the center of gravity and base of support relationship that is primary to the human form. For here, further assessment of the desired position, strength, flexibility, coordination to produce the requirements of the functional task are once again related to the current reality.

In this way, multiple iterations of the same form are used and organized into a telescoping structure to produce a powerful underlying structure to support an ongoing change effort. In the case where the initial approach has not made a change in current reality that was desired, the clinician can return to each component part, re-assessing and re-evaluating. In this way the momentum that was produced can still be utilized to turn around the change effort. It is easier to turn a car around that is moving then to try to turn a car that is not moving even when the car is going the wrong way.

During this revisiting of the actions and steps taken, the clinician will be evaluating the required specific critical tasks, weight shifts, muscle contractions that all support the functional outcome desired. The current ability to perform these motions are assessed in relation to the end result and specific. Relevant actions are generated that are understood as necessary to impact the specific part at the local level of joint mobility, arthrokinematics, osteokinematics and how that will impact the overall behavior of the body in terms of control of the center of gravity and base of support relationship.

In change efforts in which a result is created, these many sub results are necessary and must precede the overall result. With the use of the telescoping form, these sub results maintain their relationship to the overall end result. In making a cake, the dry product is mixed with the wet product to form the cake batter. The quality of the cake is dependent upon the many steps that happen during the dry and wet product mixing. Different proportions, ingredients, time, skill of the baker, decisions, etc, mix together to yield the resulting cake. With mastery of treatment plan design and clinical decision making your collaborations with patients and clients will be just as sweet.

In the Groove – 2. What Artists Know

As rehabilitation and sports performance professionals our roles is to produce the outcome that will support the patient/client in being involved in their life as they desire, through improved physical performance. If this is the focus, then why not learn from the professionals whose focus is on producing the specific unique outcomes? Those in the arts have a skill set that promotes the creation of outcomes over varying time frames. It’s an orientation, skill set, and approach that are present in both the arts and those in the sciences that have developed successful careers of getting the result.

What do those in the arts know that maybe useful for the professional working with human movement and its impact on function? Artists learn to organize change through the manipulation of structure using a variety of subject matters including materials, time, and space. Artists understand choice. Tens to hundreds to possibly thousands of individual choices and actions are taken on behalf of creating the desired outcome. The choices are focused. These choices result in the establishment of internal relationships within the piece that creates dynamic tensions or stability. The way these choices are organized produces a groove that makes subsequent choices easier to make. In this way the artist can compose many different outcomes consistently.
As rehabilitation professionals, the compositions produce include plans of care, treatment plans, movement lessons, and more, all of which also have their internal structures.

This groove that is created will cause a tendency towards actions, or more specifically behavior. Take for example the way the groove is used by the visual artist in causing the audience to follow a train of thought. The groove can be recognized in the visual as in a painting, or in a photo, or a movie, in which the viewer’s eye follows a certain trajectory. Information is presented in a sequence in this way, which informs the mind of what is being expressed. If the visual path was to be different, the sequence of information would be different, resulting in new relationships, new information and a completely different set of information for the brain to relate.

In a plan of care how the information is organized also supports behaviors as each underlying structure produces tensions that the brain seeks to resolve. In a treatment to improve dynamic balance, the use of the groove can produce improved motor learning, skill acquisition and prepare for future learning to be more easily attained. In music, the groove is often found on the base line. The groove is the result of a choice of rhythm, sequencing of notes arranged in such a way that the bass line supports upcoming selections. It’s found in the toe tapping beats and rhythms that allow the rock musician to impromptu free flowing guitar solos, and the rap artist the confidence to free form when the groove is present. Without the groove the brain loses interest and the body is still.

Professionals who have mastered their craft have this ability to generate their own momentum. They do not rely upon circumstances to produce results. They have learned through mentor ship and practice, how to create the groove, and use its benefits to consistently create results with their clients. What is the role of experience? Experience definitely helps, however It is not simply the amount of time spent in the clinic that develops these skills. There are many seasoned clinicians that continue to have intermittent success. And what about commitment to certain style or approach? Each clinician has unique talents that styles can support, but again it is not just a certain style or approach. If one style did the trick then there would be no need for other approaches.

In the next article we will continue to examine how the groove provides a focus towards treatment planning, implementation and supports the change of direction when the initial approach has not produced the level of involvement that the patient or client desires.

In the Groove – Improving Functional Movement with Rhythm and Momentum

It really has been one of those days at work, and the day is not even half over, still a few more clients to see. Paperwork is piling up, phone calls, billing, it seems like there is never enough time.
And then it happens. Something special happens with a client or patient. It’s clicking. Both focused, the movements and instructions combine into collaboration. Even poorly executed moves are quickly improved on and there is energy in the session. There is a real momentum towards the clients’ goals as the actions taken have been specific and focused. Compliments are exchanged: “Great work out, I really feel great, I didn’t think I could do it.” “Yeah, you did great, way to really go for it.” “We did great.”
Given that it was unexpected what caused the change? Wouldn’t it be great if every session went the same way?
What happened?

You found the groove.

The following series of articles is an exploration of how to develop the momentum to initiate and sustain change efforts over the time required for the change to occur. This is done through the organizing of complementary data points into relationships. Depending upon the starting point of the change effort, the needed time will be different, as each outcome is a specific occurrence, unique to its circumstances and situation. Here is an example: Same patient, same shoulder, same rotator cuff tendonitis may be present in your office. However these are two unique times on the calendar, points in time. To consider that the previous approach is all that is required to restore the shoulder to function is to miss the essential data points of current reality. This assessment of current reality in relation to the desired result is the fundamental value pairs that will be the building blocks for the architecture of the “groove” building to come.

The groove may not be tangible but you can experience it. The groove is the time when all actions support the results that are wanted. A sense of momentum, building towards a result. The actions are sometimes familiar, rout movements and recognizable approaches. Other times, invention is called for as a different unexpected, unanticipated approach produces the desired result. And like a good dance team, someone needs to lead the collaboration. The practitioner is the leader. One who has mastered the skills of using structures and strategy is well positioned to improvise on the fly while maintaining the groove is leading the collaboration with the client.
By taking two complementary but different pairs and arrange them together, a cause for change is established. In biology this is seen in the action potentials generated in nerve tissue, as the potential for change is created by the difference in charge on opposite side of a membrane. In physics this is seen with the seeking of balance between hot and cold. What is the underlying dynamic here is for a structural arrangement of different pairs to seek equilibrium. This force can be organized to produce the needed dynamic over time to sustain changes.

What about clinical decision making and the plans of care that are products of this strategic process? Do they have component parts, parts that are complementary but different? And if so can they be arranged to produce a groove towards a functional outcome? As a rehabilitation or sports performance professional you value getting results. Great news is that other fields are experts in making things, creating, producing consistently.  Read on to learn how the capacities of the arts are being applied to the restoration and improvement of human function.

Structured Motion Approach – 7. Professional Collaboration

The BOS will give rise to tendencies of movement, however in human form, it is not the BOS that is dominate, it is the COG position that determines the use of anterior or posterior chains. An example of this confusion is the use of the wall slide to promote improved sitting to standing, or squatting. Certainly this exercise seems to look like sitting to standing as the body appears to be in a squat like position. However this exercise is ineffective in promoting improved sit to stand as it does not include the Continue reading Structured Motion Approach – 7. Professional Collaboration