Book Handbook for Somatosensory Rehabilitation by Claude Spicher

[Diane]

A few months back, Mike Sangster sent me this little book to read and review. I have now done so, and here is my take for what it's worth.


Disquiet

It's an impeccable book, impeccably written, carefully and clearly laid out. As I read it I had a strange sense of disquiet. Here's why:

It is a brilliant little manual for how to help people regain normal sensation - without ever having to touch them. Ever. Well, except indirectly with tools that help the practitioner to visualize and map someone's sensory array and its working condition.

It is definitely not a book for manual therapists, unless, by virtue of the fact that it spells out clearly enough the need for skin contact to right the nervous system's input, it ends up including and supporting manual therapy by default. Otherwise it could go a long way toward supporting its elimination, its extinction.

If human beings, human skin, and human sensory cortices can all be convinced that they do not need contact from another human nervous system to right themselves, then robots will easily be able to perform somatosensory rehabilitation some day in the future.

We the human primate social grooming people will be crowded into ever smaller zones that consist of systems management of the culturally applied sort rather than the biologically intrinsic sort. Oh.. wait a minute..


Appreciation

The sections of the book worth reading if you are a HPSG who pays attention to skin and cutaneous innervation are those which describe the tactile sense and how it weaves into the kinesthetic sense. A quote from A. Le Meur (2000), Le Toucher, in Kinésithérapeute scientifique (404, 58-59) appears on p. 22. It could be part of a manual therapist's manual on manual therapy, and was what kept me exploring the book:

The hand is often described as a tool. To consider it so would be restrictive. What differentiates the hand from a tool is that the former is covered by living tissue provided with a delicate and precise sensibility, which permits the execution of gestures, as well as adapted and precise holds. Yet sensibility is a generator of emotions, of feelings. To be sensitive does not only signify having a vibrotactile sense. Sensibility by touch goes beyond the palpable, beyond simple physiology. Touch transcends the palpable and measurable to access the interiority, to the sources of the individual themselves. A caress soothes, comforts, it is the taken of an understanding beyond words. It gives access to the interiority of others. Through the skin, the body expresses the sensation of warmth by letting sweat leave through the pores, but also that of cold, by making goose pimples appear. These sensations, admittedly physiological, can also be associated with feelings: Fear sends shivers down the spine and emotion gives warmth, to the point of causing changes in the cutaneous coloration in embarrassing situations (blushing). Contrary to the vibrotactile sense, touch has no limits apart perhaps from that of the psyche. With touch we are in close contact with the elusive.

Another aspect that kept me coming back was the effort the author has made to collect and cohere basic information about the peripheral nervous system. For example, he states:

Very frequently, patients in traumatology present small axonal lesions that are sources of complication or that simply slow down rehabilitation. Year in and year out, this occurs as a rule in approximately 60% of patients referred to rehabilitation because of traumatic lesions. If these disorders are not documented right from the start, it could be claimed at the end of rehabilitation that thet treatment has had no influence on the degree of sense, and that there was only a temporary peripheral neurological dysfunction: a neuropraxy.

I couldn't agree more. In fact I would suggest that treating these problems first and getting them out of the way, is a more sensible way to go about being a manual therapist.

He goes on to elucidate the means by which small axonal lesions can be identified, visualized, made intelligible to those outside the treatment situation, people such as insurers and others in society who are in control of a patient's future with or without disabling sensory disturbance. In fact his whole book is all about this. I very much appreciate that he is turning elusive verbs into nouns, that will stand still and can therefore be counted by those who count things for a living. Such awareness, generalized out into a society which still discounts the impacts on individual lives created by poorly functioning somatosensory systems, will help manual therapy - help it, that is, if manual therapy can prove itself to be as or more effective in this arena called somatosensory rehab than a robot or zombie enactment of detached testing and protocol treatment. To compete favorably, manual therapists must understand the tools then implement them, as controls in studies perhaps.

I have nothing but admiration in general for all the brilliant work done in Switzerland to enlighten understanding of the nervous system in all its different capacities. I am not at all surprised that this individual happens to have worked and written his book in a Swiss context. I swear there's something in the water there - so much recent work has poured out of that country - virtual body experiments, etc.

It's a very tidy and comprehensive little book, and, as I say, disquieting in some ways to a manual therapist's sensibilities.


Links

1. Handbook for Somatosensory Rehabilitation by Claude Spicher.

2. Another link to the book.

3. Claude Spicher's profile on Linked In.

4. Picture of Claude Spicher.

[emad]

Good topics within the chapters.

cheers
Emad

[Adiemusfree]

'It is definitely not a book for manual therapists, unless, by virtue of the fact that it spells out clearly enough the need for skin contact to right the nervous system's input, it ends up including and supporting manual therapy by default. Otherwise it could go a long way toward supporting its elimination, its extinction.

If human beings, human skin, and human sensory cortices can all be convinced that they do not need contact from another human nervous system to right themselves, then robots will easily be able to perform somatosensory rehabilitation some day in the future.

We the human primate social grooming people will be crowded into ever smaller zones that consist of systems management of the culturally applied sort rather than the biologically intrinsic sort. Oh.. wait a minute.. '

Let me preface my comments with this statement: I am not a hands-on therapist.

I can't agree with this statement though, because even though people have been able to read about psychological approaches to pain management for years and years - there is something about discourse, interaction, being with another person that a 'robot' cannot do.
I don't think it's necessarily about the 'hands-on' nature of manual therapy, or the verbal nature of psychotherapy that is the essential ingredient - it's about humans being with other humans.

I don't fear for manual therapy, and I don't fear for psychotherapy - books like these are fabulous for people like us who read and enjoy the written word and can use this information to enhance our understanding. BUT there are many many people who can't, don't, or won't use information in this form, and that's where WE come in!

That set of comments apart, this is a fabulous book review, makes me really want to read it!
Thanks

[Diane]

Bronnie, for the moment it's moot.. but the area of human responsiveness to robot liveliness is being madly investigated lately. Here is an article Jon linked to in his robot thread, Gort! Klaatu barada nikto! , about studying the response of children to robot dogs. The elderly patients in Japanese nursing homes are being supplied with cute fuzzy cuddly robot seals that respond to stroking by blinking and changing facial expression.

I was being a little bit extrapolative, but not necessarily off the wall. It seems to me that just as surely as there have been streams and flavors of manual therapy through the ages, keeping physical treatment contact between nervous systems alive, a primate social grooming proclivity, there has been just as strong if not stronger current in the reverse direction, toward total hands-offness. I wouldn't call somato-sensory rehab "psychological" - it isn't at all. When you read the book, in fact there are bowls of lentils and so on, to run one's hands through, heavily involved.

Did I mention the author is an OT?

It's brilliant, what he's done. He has separated somatosensory rehab from the need to have it be by manual therapy, and at the same time has provided a means by which it can be made measurable and reproducible without all that pesky inter practitioner reliability be a perpetual confounding factor. Simple: use Occam's Manual Therapist Deleter to get right around the problem.