Tag: Treatment Planning

Experimenting with the Berg – 13. Component 12

Submitted by: Jeremy Nelson PT

12.0 Place Alternate foot on Step or Stool While Standing Unsupported

This component examines the capacity of the patient to perform a weight shift to unload the extremity that is going to perform the step up motion. The goal of the component is to be “able to stand independently and safely and complete 8 steps in 20 seconds”. The time part of the test provides an insight into the overall coordination power that exists in the neuromuscular system. The first task is to perform the weight shift and maintain center of gravity over the base support of the foot into a single limb pattern. The more difficult task comes next, supporting of the stance limb of the stepping up of the contralateral side.

As the lower extremity flexes at the hip and knee to place the foot on the stool, the posterior moment must be countered by the stance limb with an anterior moment. The stance hip must be strong enough to support the COG and BOS relationship in the single limb position as well a counter the posterior moment.
If the performer “needs assistance to keep from falling/unable to try” then presumably the first task was not completed. Without the initial weight shift the stepping lower extremity is unable to be unweighted to perform the motion. This is likely from inadequate control of COG to perform the weight shift or an inadequate BOS in terms of poor foot posture. Reviewing the asymmetrical stance critical tasks into the single limb critical tasks will provide the desired outcomes to measure current reality against.

Again, similar to the other Berg components time is an element to investigate and record speed as function of strength, coordination and power. In order for the extremity to successfully step up there needs to be adequate time for that to happen. The time is developed through the shifting of the body weight to the extremity that is going to be in a close kinetic chain into a single limb position.
As is described in the Component 14 discussion, the single limb position has been involved in many of the movements being examined at the end of the test. With improved single limb support, the control of the step is developed. The strength and control of the extensors and abductor’s are being examined as if there is an inadequacy in either one there will not be enough time for the patient to step up without assistance.

When the performer is “able to complete > 2 steps needs minimal assist” what type of and what degree the assistance is needed is important to identify. When using the upper extremities to assist in stabilizing the COG over the BOS to complete the weight shift points to inadequate gluteal strength or posture of the hip and knee. Assistance required to step up maybe related to the poor knee mobility.

When the performer is “able to complete 4 steps without aid with supervision” and “able to stand independently and complete 8 steps in > 20 seconds” both indicate that the critical tasks are present and the body is able to produce. The difference is a matter of speed and coordination. As the speed increases the size of the weight shift begins to narrow. The larger weight shifts in the lower scores are replaced with small shifts. However this is not to indicate that the forces that the muscles produce to counter are less important. In fact the opposite is true. As the hip strength and power increases the COG is suspended over the BOS for shorter periods of time and the return to the start position. Better control is developed and the performer is able to respond to the demands of life safer and with more confidence.

Experimenting with the Berg – 14. Component 13

Submitted by: Jeremy Nelson PT

13.0 Standing Unsupported One  Foot in Front

The goal of this component is to be “able to place foot tandem independently and hold 30 seconds test hip abductor control as now in relative adduction”. Although not typically part of the function of life (unless your occupation is a tight rope walker) component 13 does provide useful information to assist in developing the overall plan of care. This component is evaluating the capacity of the performer to weight shift, establish new bases of support and maintain the COG in relation to the new BOS. First task is to establish an asymmetrical base of support by stepping forward. In maintaining foot position 1 foot for the other so again was looking at weight shifting in the capacity to control that weight shift with the close kinetic chain lower extremity in addition once the asymmetrical base support is established were examining control the center of gravity over narrow base of support along and diagonal pattern

As the performer demonstrates “Loses balance while stepping or standing” there exists profound inability to control static balance. If the loss of balance comes when stepping then the weight shift did not happen and gravity won the day before the performer was able to establish a single limb BOS. As discussed in the previous articles, any time the performer demonstrates such a low score, the approach would be to step down to the lower level positions and critical tasks. With a review of these supportive tasks, the areas of inadequacies can be improved towards the desired level of the critical task. Having completed the lower level task, the performer will be on a firm foundation for advancement.

Even if the performer “needs help to step but can hold 15 seconds” an examination of the supportive critical tasks are in order. As organized in the hierarchy of movement, the asymmetrical and single limb positions would be supportive to this more complicated task. An inability to weight shift to single limb to establish a new BOS could be present for a number of reasons. What at first looks like a separate test are really the prior critical tasks revisited.

Similar to component 12, time is an element in the test as well as understanding what is required to accomplish the task. It takes time to position the advancing lower extremity into the position that is desired. The scores imply that time for the step to occur is adequate or not. For example when the performer is “able to take small step independently and hold 30 seconds” the weight shift was not likely adequate and the step is a quick step as the brain rapidly attempts to reestablish a BOS before a loss of balance occurs. The time is increased by the strength and power of the stance hip. When the performer has been “able to place foot ahead independently and hold 30 seconds “ an adequate weight shift to during the single limb position has occurred resulting in the establishment of a new BOS, and a capacity to demonstrate to maintain control of COG over BOS.

Experimenting with the Berg – 1. Introduction

Submitted by: Jeremy Nelson PT

The purpose of the following series of articles is to provide the interested professional specializing in the study and improvement of human motion, the opportunity to examine each component part of the Berg balance scale. The Berg Balance test, as well as being a widely measure of a persons’ capacity to avoid falling, it also provides a framework for an interesting experiment in plan of care and treatment planning. As a structure for treatment planning as within each component part the sub-component parts in terms of the descriptions of the observations, it also provide a goal for progression of the patient through their treatment plan. Absent in the testing is an explanation of why the persons is having difficulty at one level. This is the role of the clinicians, to observe, examine, evaluate and understand cause and affect relationships. Now the clinician can develop a change effort through treatment planning. How the Berg is used will be a critical factor in how the change effort succeeds.

Often the Berg is used clinically as form of snap shot in time. Like a photo it describes something that happened at a particular moment. Over the course of a plan of care, the test is used at regular intervals to document change over time. The implication is that if progress is being made, it must be the result of the interventions performed. Often the plan of care is not related to the Berg test other than as the snapshot previously described. Where then is the evidence that the interventions are in fact causative? If good things are happening, it would be nice to be explicit about the relationship between the functional change and the interventions rather than remaining implied.

However another approach would be generate the plan of care as a derivative of the functional outcome tools being used. In this way, as change is documented there is a direct relationship between the change observed and the actions taken to cause that change. It would also be valuable to know if the interventions are not effective, resulting in a measurement indicating a lack of change. For the clinician this valuable information and provides real data for the clinical decision making processes that are the hallmark of skilled care.

In order for the Berg components to act as jumping off points into treatment planning, it is helpful to examine each component for the bio mechanical tasks that support functional movement. Each of the Berg balance components is a well-diversified evidence-based functional outcome tool in of itself. As a whole it has acceptable reliability and validity as an assessment tool. It measures what it says it measures, consistently between uses. As a starting point for a change effort it provides a firm foot hold. In the following articles we will explore in what way structures influence which way the treatment goes from there. The approaches suggested are simply that, suggestions and are not recommendations. Each is up to each clinician to choose the interventions that are correct for the patient at that time. Only through the skilled capacities of a clinician can real change be developed to restore and enhance a patients capacity to be involved in a life as they desire.

Click on the link below to download a copy of the Berg Balance Test.

Berg Balance Scale

Movement Professional as Educator: 2. The Students Mind

To have a deeper insight into how apparently disparate parts of information impact each other is one of the hallmarks of real learning. Relationship seeking, cause and effect driven structures as they are our minds can use this information to take action on desired results and make the outcomes that did not previously exist. And yes, old dogs can learn new tricks. However learning something new can be fear producing in many students. A student by definition is beginning at a place of not knowing. And as was discussed in the first article of the series, the mind does not care for this state. In fact it will make things up to alleviate the discomfort of not knowing. Good students typically have developed a tolerance to this state of the unknown. A competent educator knows how to use the potential energy available to support the change effort that the student is presenting.

The task of the educator is to create a new structure for the mind to explore cause and effect. An underlying structure of a clear outcome and an adequate understanding on the student’s current knowledge and capacity levels in relationships to the outcome produces a clear path to learning. Structure is causal. It has tendencies and the use of different structures in the plan of care will result in specific outcomes. It is the educators’ choices that will determine the structure to be used and the forces in play generated by the structure.
In this way, the educator is an architect, building the structure for the mind to step into, to begin exploring. The new structure, like a jungle gym provides the mind with the chance to begin to see new possibilities, learn new skills and shift its perspectives. The curriculum is more than just a collection of facts and knowledge to be presented. A well-developed curriculum is three dimensional, with internal relationships. It is hierarchical in that there is complexity at that top that is supported by lower levels of complexity and difficulty. It explicitly and implicitly demonstrates cause and effect. With this insight the learner is able to become the causative factor in their lives, as they seek to make choices to reorganize the materials on hand towards more of what is desired and take actions that are measurable in terms of their impact.

What differentiates competent educators with the newbies and wannabies? Is it the grasp of the knowledge they were presenting? Maybe a background rich with experiences to highlight and explain the content presented in the real wold? All helpful, but what really is the key the skill to assess the state of learning of the student. It takes the educator to have not only a clear understanding of the curriculum and its component parts but also how to assess the state of learning of the student in relation to the behaviors, skills, and aptitudes within the curriculum. With these two complimentary data points of where the student wants to go in terms of the curriculum and where they are now, a real dynamic is produced to activate the change effort. The quality of the measurement tools used by the educator will impact the clarity of current reality. Standardized screening and assessments produces reproducible and credible data that supports the change effort to come.
Again, the movement professional will see similarities when teaching lessons of movement. Whatever philosophy the curriculum is rooted in, whether yoga, Pilates, biomechanics, or insert your favorite approaches here, it must include an effective assessment component. Otherwise the learning loses steam when things get tough. Focus is lost and the mind does what the mind does. In this case find something else easier to try and the collaborative effort is lost as the learner becomes unavailable for learning.

Through the collaborative effort the student has the opportunity to examine the sequencing and role that there clinical decision making made on the outcome with the instructor. It is the student’s role to do the heavy lifting in thinking it through. This is sometimes an insurmountable task and always a task that is challenging. When it is too much it is the educator’s role to know how to reorganize the learning in a way that the learner will develop the knowledge, skill, aptitude necessary to move to the next step. Sometimes it requires stepping down and re-consolidating to form a more firm foundation to take the next step up. As movement educators we need to know how to regress the movement lesson into a lower level of complexity and find the area that is in need of remediation. This is done through the ability to produce smaller components and granularity in your movement curriculum.

Here is the good news. In education, much of the designing of learning as change efforts has been researched and understood. There are a number of different approaches, such as Blooms Taxonomy and many others, which organize actions and behaviors into hierarchies. In much the same way, the movement curriculum presented in the Structured Motion courses is organized to present a clear outcome and how it relates to higher more difficult levels of movement. As stated earlier, curriculum is not of much use unless the student and instructor activate it through the assessment of the student’s current level of learning. Through using both data points, the learner is well positioned to gain the skills and knowledge to be involved in their life.

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.

 

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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.