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Old 18-10-2006, 06:50 AM   #101
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An interest to Kandel, with his focus on memory, were some discoveries involving the hippocampus. Long-term potentiation and place cells.

Long-term potentiation was interesting to him because it involved a mechanism for learning that was located deep within the brain in an area involved in explicit memory. It turned out to involve gene regulated protein synthesis in a similar way that he had discovered implicitly encoded in neurons.

We talked about place cells earlier when we discussed the hippocampus (see inside-out modulation).

From p. 282 In Search of Memory:

Quote:
the pattern of action potentials in these neurons is so distinctively related to a particular area of space that O'Keefe referred to them as "place cells." Soon after O'Keefe's discovery, experiments with rodents showed that damage to the hippocampus severely compromises the animals' ability to learn a task that relies on spatial information. This finding indicated that the spatial map plays a central role in spatial cognition, our awareness of the environment around us.
Through studies in genetically altered mice, Kandel's group was able to demonstrate that long-term potentiation was the process responsible for maintaining the representational maps of spatial awareness.

I wanted to include this because it demonstrates consistency through the mechanical units that make up both implicit and explicit memory.
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Old 18-10-2006, 07:01 AM   #102
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One other finding from Kandel's lab that I wanted to mention. They found a prion-like molecule called CPEB, responsible for local protein synthesis involved in sensitivity, in the synapses that can be converted to an active state by seratonin.

from p. 273:
Quote:
the second way the prions differ from other proteins is that the dominant form is self-perpetuating
p. 274:
Quote:
Self-perpetuation of a protein that is critical for local protein synthesis allows information to be stored selectively and in perpetuity at one synapse, and not, Kausik soon discovered, at the many others that a neuron makes with its target cells.
What I thought about when I read this was, this prion-like protein, while I'm sure it is very useful in memory, may be responsible for the persistance of pain in many of the tough patients. I thought of the folks Nari sees day to day.
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Old 18-10-2006, 07:11 AM   #103
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Cory,

The prion apparently is more important than usually thought, and there is a long section in a magazine about the effects of prions and altered sensitivity.
All I need to do is find that reference....

Christof Koch is working along the same lines as Kandal; Koch proposes that short term memory and consciousness are intricately linked and one cannot exist without the other. However, moderately severe ST memory loss does not mean that a person cannot learn...so I've yet to link all this stuff together.
Koch's theory suggests that animals have consciousness as well...

Re complex pain patients - it would be good to find out more on prions, even thought it may not change our approaches.

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Old 20-10-2006, 05:22 PM   #104
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I found this article, and thought it might find a home here: Left and Right Hands Rely on Different Senses. It immediately struck me that if this is true, part of the job of being a manual therapist is to synchronize one's own brain to be able to feel the same way and do the same thing and compare the feedback coming in through both hands, symmetricalize them for the patient's benefit. I'm a single-handed (visual) typist, but a reasonably bi-manual (kinesthetic) therapist. I'm not sure what to make of any of this, or if any of it is the slightest bit important in the long run.
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Old 20-10-2006, 07:08 PM   #105
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Diane,

This is proof positive that therapists should become jugglers - not to "juggle their pain away," as they continue to suggest on the NOI site, but in order to enhance their manual sensitivities (and consequent skills) to a higher degree.

You may recal that in Nanaimo I performed Mills Mess without a drop, which impressed even me. I'm waiting for just the right venue and class to do that again, but I find such a thing very rare.
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Old 20-10-2006, 07:38 PM   #106
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Barrett, I think learning to play a musical instrument will do the same thing as learning to juggle.
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Old 21-10-2006, 09:33 AM   #107
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For anyone who hasn’t noticed, I’ve had a bit of writer’s block recently. But, as usual, I can always count on Barrett’s writing to get me going again. I’ll reveal which essays in a bit (they’ll probably be obvious to anyone whose read them).

I knew that I wanted to write about Kandel’s findings, but couldn’t figure out how to go on to what I wanted to say in this section. So, I’m going to abandon that line of thought for the moment. Maybe I’ll meander back to it later.

Let’s think about typical testing in our evaluations. When we do a seemingly simple test, such as range of motion for example, what are we actually testing? The obvious answer is, of course, the movement of a joint through space. What does that movement depend upon? As we’ve discussed in the previous sections, our motions are non-consciously generated, and carried out dependent upon context. So, with a simple ROM test, we are actually testing the movement through space for a person in an environmental contest (ie. therapy clinic, standing in front of a therapist), overlaid with the explanatory context of the patient.

An argument may be made that you are testing the various mechanical properties of the involved tissues. In terms of tissue stress theory, theoretically, we should be able to tell a lot about how a person tends to move, or even the trauma they have been through based on their tissue architecture. Our tissues adapt/remodel based upon the stresses that are imposed upon them. But, how can we test tissues in their relation to movement without testing motor control at the same time? Any motor control is going to be context dependent, and we’re back to the same problem. I can think of very few tests that in a conscious patient that would test pure tissue property.

Provocative testing, you might say, is meant to tell us what movements are related to the person’s pain. I would agree. But they still are going to be context dependent, and the therapists presence is always going to affect that context. If we were holding ourselves in the clinic as accountable as we like to hold outcome studies accountable, we would be at very low validity for all of these tests.

So what does this have to do with treatment? This is, after all, a thread about treatment, not evaluation.

One method of testing, even within the therapeutic context, will give some insight into common threads between treatment techniques. The concept of the comparable sign (I think Maitland coined that term?). I’m not advocating for this as the testing method of choice, but instead am hoping to draw some information from its use.

More in the next post. Please read Barrett’s essay The End of Evaluation, and the thread the Five Questions.
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Old 21-10-2006, 09:42 AM   #108
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The comparable sign is when a test movement, which causes pain, is able to be changed in a way that causes less pain.

An example would be painful shoulder flexion, which is reduced when a posterior force is applied to the front of the shoulder. The mulligan technique is pretty much built on this principle.

Remember the 3 ways that I envision of reducing the threat level from posts 48-51: non-threatening environment, novel stimulus, graded exposure.

I want to think from the periphery how these might look and I'm going to start with the comparable sign to (hopefully) help.
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Old 25-10-2006, 06:38 AM   #109
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I like using the comparable sign as a way to think about why certain therapies are effective, because it gives an immediate feedback that there is less pain with the intervention just applied, and it remains within the same context as the testing. So, even though it falls into the same problem of overall validity, it does at least give a certain bit of validity for that person, within that context.

To stay simple, I'm going to stick with Wall's descriptions of the sensory nerve fibers.
A beta are sensitive to gentle pressure
A delta are sensitive to heavy pressure and temperature
C are sensitive to pressure, chemicals, and temperature

Lucky for me (and anyone who reads it) the five questions thread discusses the origins of pain. So, I'll not repeat it here.

From that discussion, 4 origins of pain were introduced:
1) Mechanical deformation
2) Chemical irritation
3) Abnormal axonal impulse generation sites
4) Central deaferentation

Remember, if pain is the output, real or potential threat is the culprit. The above can be present in the absence of pain. One of my favorite quotes, which I have seen in both Lorimer Moseley's, and Nicholas Lucas' writing is "nociception is neither necessary nor sufficient to cause pain."

We can look at the 4 origins as those which have the capacity to generate a threatening stimulation.

Going back to one of the original generalities, successful treatments are those that reduce threat level, we can now attempt to apply this to the origins of pain.

By definition, 1 and 2 would be the only ones that could be changed rapidly, and likely 2 (chemical irritation) only in the case of ischemia. From Barrett's The Origins of Pain essay:

Quote:
Mechanical deformation beyond any tissue’s tolerance-and this can vary from tissue to tissue and moment to moment-is certainly painful and that pain will rapidly change right along with the amount of deformation present. (I’m rather conveniently ignoring centrally mediated influences here) Thus the patient with this sort of problem will describe distinct alterations in their discomfort dependent upon position and use. In other words the origin of the problem becomes clear on history-it’s mechanical deformation. Similarly, if movement doesn’t alter the pain the origin is chemical irritation. It’s history then that reveals the origin of the problem. Simple as that.
Thinking back to the comparable sign now, we can apply this thinking to state that the reduced pain is a result of reduction of threat by either a reduction in mechanical deformation, and/or a reduction in tissue ischemia, and/or placebo mechanism.

How we doing so far? Comments please.
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Old 25-10-2006, 07:05 AM   #110
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Cory,

Sounds fine to me.

In:
Quote:
Remember, if pain is the output, real of potential threat is the input...
..did you mean to say reality?

I suspect that reduced mechanical deformation, tissue ischaemia and placebo/nocebo response are all strongly correlated.

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Old 25-10-2006, 07:28 AM   #111
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Nari,
Oops. Real OR potential threat. I changed it in the post. Thanks.

Quote:
I suspect that reduced mechanical deformation, tissue ischaemia and placebo/nocebo response are all strongly correlated.
I agree.
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Old 25-10-2006, 01:01 PM   #112
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Ian sent me this book review just recently. It offers philosophical opposition to Damasio's stance. It seems that the process of unification might be harder to come by and the disunity extends further than simply PT.
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Old 25-10-2006, 01:03 PM   #113
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Cory,

Great stuff. Pointing out that threat alone is sufficient to elicit a painful response (along with a rise in sympathetic support, I presume) relates perfectly to the ways in which I see many therapists relate to patients. They ask, “What if they don’t like what I’m doing? What if they want something else?” They understand that their current methods make little or no sense and are well-aware of their ineffectiveness but are even more concerned about some future confrontation - so concerned in fact that any proposal to change in their approach is rejected immediately. I was recently told by the supervisor at a large hospital who had closed two outpatient clinics so that 16 of his staff could attend my workshop that by the end of the next day most weren’t using anything they’d learned. He said, “They have already explained it away.”

To me, this is the power of fear, especially of future difficulty.

Keith Olbermann’s recent “special commentary” was related to this as well. He pointed out that, “The dictionary definition of the word ‘terrorize' is simple and not open to misinterpretation: "To fill or overpower with terror; terrify; coerce by intimidation or fear." Note please that the words ‘violence' and ‘death' are missing from that definition. For the key to terrorism is not the act-but the fear of the act.”

These days many of us are surrounded by perceived threats from a number of angles. No wonder the rise in chronic pain.

Therapists can offer in return two things: education and movement. I contend that in order to do that well they have to first become consumers of those same things.

No small task.
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Old 25-10-2006, 01:33 PM   #114
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From Garrison Keillor today:

"We are engaged in a struggle between freedom and the forces of terror, my little macacas, and mostly I side with freedom, such as the freedom to look at big shots and stick out your tongue and blow, but of course terror has its place too. The dude strolling down our street at night does not break into our house to see what's available because he is terrified that if he's nabbed, his girlfriend Janine will run off to Philly with her ex-boyfriend Eddie who's been hanging around. She's the best thing in Benny's life right now. So he walks on by and leaves our stereo be.

The terror of everlasting hellfire kept me away from dances until I was 12 years old and away from smoking cigarettes until I was 15. So that's good. Dancing was briefly thrilling, and then I caught sight of myself in a mirror and I haven't gone to a dance since. Fear of ridicule is powerful too."

This "not dancing" Keillor does is precisely the absence of full and free ideomotion that I have often contended contributes to chronic pain. In an earlier post on this thread Cory come up with the following and it's something I now show every class:

Options and Considerations for motion:

Avoid Pain

Resolve Pain

Don’t get laughed at

Clearly, Keillor has chosen the third when it comes to movement. Fortunately for him he's found other ways of personally and creatively expressing himself.
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Old 26-10-2006, 05:54 AM   #115
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Jon,
Thanks for posting that book review. After reading it, I'm curious if the author actually read Damasio's book. He is clearly confusing Damasio's definitions of emotion and feeling, as demonstrated by his examples. So, if he did read it (and I'm sure he did) then his problems would be with those definitions, which are not addressed in the criticisms. Additionally, he faults Damasio for ripping off William James. Damasio repeatedly gives credit to James as originating ideas that he expands upon, and then goes on to describe where they differ.

The key to this review may come at the end, where the author has 2 books named. It is evident from the review that Damasio's views and findings are not in concert with the thoughts of this author... thoughts which are likely spelled out in his books. I am even more inclined than usual to be skeptical when a review is done by an author with something to lose.

I really like the quote from Nicholas Lucas' interview : “when a man who is honestly mistaken hears the truth, he either ceases to be mistaken or he ceases to be honest"

I could of course be wrong about his motives...
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Old 26-10-2006, 06:26 AM   #116
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I was searching to see if Damasio had himself written any responce to the review posted by Jon. Haven't found one yet. I did come across the Second World Conference on the Future of Science where video files of some notable speakers can be found (including one from Damasio). All relevant to this discussion. Charge up the iPod Jon.

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Old 26-10-2006, 07:09 AM   #117
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I would like to discuss further the concept of mechanical deformation as an origin of pain.

The concepts of tissue stress are fairly well spelled out. PTs in general are pretty familiar with this stuff, so I won't spell it out here. One tissue, however that the appllication of tissue stress model is actually less commonly understood in the PT world, and that is of course neural tissue.

One neural tissue stress model that I want to emphasize is that of neurodynamic sequencing. Michael Shacklock has been able to show that the amount of strain on a portion of neural tissue is affected by the order in which the body parts adjacent to the nerve are moved. For example, in an ulnar nerve neurodynamic test, the most tension is placed on the neural tissue at the wrist, if the wrist is the first body part moved.

While Michael, Butler and others have made great strides in describing the mechanics and neurodynamics of the nervous system, their descriptions are limited to the large trunks. This gives a certain amount of predictability to movements and the nervous system. However, as the nervous system continues to branch as it approaches its terminal ends, it continues to gain in complexity. While there is no reason that I know of to doubt the consistency of the concept of neurodynamic sequencing throughout each level, this increasing complexity makes predictability much more difficult. Most have heard that saying that there is like a gazillion miles of nerve in the body. Well, most of those miles fall within this increasingly complex zone between the larger branches, and their terminus.

Barrett actually asked Michael Shacklock about this in the live chat.

For mechanical deformation to communicate with the brain in a way to cause an output, like pain, it must signal an impulse through the nervous system. It must cause nociception. I'm going to sound like a broken record, but I think it's important to keep this clear. Nociception must be considered threatening for it to cause an output of pain. Nociception does happen without causing pain. Many believe that movement patterns are the cause of nociception. Others believe that nociception is the cause of altered movement patterns.

I believe that a case could be made for both depending on the situation. There is no doubt, however, pain causes peripheral sensitization (an increase in sensitivity, or lowering of firing threshold) through changes in the nerves such as changes in density of mechanoreceptors, and descending excitation, that, through the concepts of neurodynamic sequencing, would change the ways in which we move. Put simply, peripheral sensitivity will make the neural tissue be more easily stimulated and thus more easily painful.

Here it is very important to make an observation. Peripheral sensitivity from descending excitation occurs when pain is present. Therefore, we must be careful to know that there is a difference between movement patterns that are tagged to pain output, and their often identical looking, non-painful counterparts.

For this reason, we cannot assume that a movement pattern is reponsible for, or even associated with, a persons pain even if it is consistent with increased tissue stress. However, since movement patterns can indeed result from a pain output, through the effects of neurodynamic sequencing on a nerve that is peripherally sensitized, changing movement patterns could be an intervention that would decrease mechanical deformation.

Comments?
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Old 26-10-2006, 04:04 PM   #118
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Cory,

I think that this issue of specificity in testing and movement toward recovery is the great shadow of the neurobiologic revolution. In fact, David Butler seemed to address it specifically in the What is a neurodynamic test? thread recently featured on his site. Nothing was resolved there, as far as I could see.

I’m always asked about “compensatory” patterns of use that many therapists are convinced “cause” the problems they see in their patients. Long ago I saw this as a great black hole of rationalization that simply delayed treatment, justified treatments that didn’t work especially well and perpetuated mesodermal fantasies of function/dysfunction. Other than that it’s really quite useful.

When we begin to understand and use two things: evolutionary reasoning and ideomotion, then we’ll begin to make some progress toward resolving the abnormal neurodynamic rampant in our clinics.

I think. I’m almost sure.
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Old 26-10-2006, 06:51 PM   #119
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Hi Eric,

I think the opposition comes down to philosophical issues (not necessarily scientific ones)--specifically the issue of representationalism.
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Old 27-10-2006, 02:19 AM   #120
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Cory I've been considering your comments regarding nociception, I can't disagree. A few years ago there were a couple of excellent discussions on noi concerning nociception that might come in handy. here and here.

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Old 27-10-2006, 09:15 AM   #121
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Eric,
Thanks for posting those here. I read through much of the 1st link and will read through the rest soon.

I'd like to go forward with some concepts that have only recently been brought to my attention, but I think are very applicable here.

I'm going to start off with by introducing some new (to this thread) terms, and work my way back towards nociception and ideomotion.

In the Pain is an emotion thread, this paper was posted by Luke. In the paper, the term exteroceptive is used to describe sensation that is attributed to something that is non-self, something we are touching or the environment. Interoceptive is used to describe sensations that are attributed to arising from within the body.

From p. 304 of "A New View of Pain as a Homeostatic Emotion" (the article mentioned above):
Quote:
The interoceptive system is distinct from the exteroceptive system associated with touch and movement, although there is overlap (in area 3a of the sensorimotor cortex) with respect to pain.
This got me to thinking about how a person in pain with an origin of mechanical deformation would respond to these 2 scenarios.

Exteroceptively, which would correlate with something being done to you from the outside (coersion) would correlate with a lot of techniques, if not most in PT. If a person is in pain, and something is done to them, it would make sense that it would be less threatening if it decreased nociception. My understanding is, that once a person is in pain and the peripheral sensitization has occurred, the brain tends to listen to its nociceptors very carefully at that point. So, if you are hoping to reduce threat level by touching your patient, your chances are going to be highest if it reduces nociception. It will be higher still if done in a way to reduce sympathetic tone. A novel stimulus that is also non-threatening.

There are many, many ways in which this can be accomplished, and thousands of treatment methods claiming to decrease nociception through use of one tissue or structure or another. Let me attempt to apply a description to encapsulate what all of those different techniques are doing. We often use the terms meso and ectoderm on this site. Mesodermally derived tissues include bones, muscles, tendons, ligaments, blood, pretty much all connective tissue (see Diane's embryology threads). Ectoderm involves the nervous system and the skin. All of these live together in the periphery. Now, in any given body part the various tissues of the meso and ectoderm co-exist and must move relative to eachother but the signalling to the brain about these various movements is done by the nervous system (and also hormonally in the blood for slow communication). As an example, lets consider an elbow extending. As the forearm drops, the various bicep fibers and bundles are sliding and contracting relative to eachother, the brachial plexus is moving toward the hand ever so slightly, both bicep and nerve are moving in relation to the humerus, and all are moving relative to the skin. Most importantly the complex branching of the nervous system is present at every spot. I'm just trying to make an example here of everything moving in relation to eachother, and remember that the brain is good at detecting changes.

Now, use this thought process to think about what is happening during a neurodynamic test like the straight leg raise. To make it simple think of tubes moving within tubes. The inner tube (bone) moves relative to the middle tube (muscle) which moves relative to the outer tube (skin) and the nervous system is present at every level. In concert with neurodynamic sequencing, we can effect the tension and therefore mechanical stress on the nervous system at any level. Neurodynamically speaking, rolling the skin inward on the thigh produces the same effect as externally rotating the thigh.

Appying this (finally) to exteroceptive physical therapy: we are always touching the skin when we touch a patient, and the various ways in which we are able to reduce nociception from mechanical deformation manually must all be working on this neurodynamic, tube within tube, mesoderm relative to ectoderm, concept. And for it to be successful, it must be done in a way that reduces threat, and/or fullfills expectation.

Whew! I havn't even gotten to interoception yet!
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Old 27-10-2006, 09:48 AM   #122
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OK. If I do a good job, there is a chance I can wrap up my thoughts for this section, and therefore finish the thread on this post.

Interoception.

To discuss this we need to introduce more terms. The first come from the Motor ontology paper that Jon posted in the mesoderm vs. ectoderm thread. Not an easy read, but very interesting.

I would place some qoutes from the paper here, but since I took me a dozen readings to follow their writing style I'll try to summarize.

The authors speak about "goal-related" neurons which, similarly to place cells, represent reward-producing actions as seen from no particular perspective. The movement parameters are not coded, but rather the goal outcome, and very generally. For example, when a monkey grasps an object these neurons fire regardless of whether they use their hand or thier mouth.

They go on to elaborate into what are called "goal-states" (which a lot like need states) which represent a successfully terminated action pattern.

I am going to use one quote about a goal-state to dine. P. 369:
Quote:
The distal goal-state therfore seems to be attained through a series of multipurpose (I can phone my partner, I can drive to go see a move, I can eat at home) action schemata, which nevertheless have to be chained within a highl specific temporal sequence. Such a possibility to diversify the procedural sub-components while simultaneouwsly filing them within the same distal goal-state representation could be interpreted as the result of an incredibly higher intergrative capacity of the human brain.
On a similar note is the concept of the "end-state comfort effect" which Luke introduced in the exploration as a context for pain thread. It has been shown that a person will assume an ackward position to start a task in order to be able to end in a comfortable position. Movement wise, it is apparent that our brain is thinking towards the state it want us to eventually be in.

Now, I'm not sure if this is really appropriate to the term interoception, but it created a bridge for me. When an action is allowed to be generated internally, from the self, toward a goal state that is consistent with pain resolution, it would make sense that an action would arise which is meant to bring us to a certain end state, and would have as many options as we can create to get there. When the body is allowed to advance in this way, focusing on the end state, the need to advance in a way that always reduces nociception may not be necessary as long as the goal state (resolved threat) is being approached. This, to me, makes a lot of sense in terms of ideomotion towards pain resolution, and would be consistent with the surprising, creative motion that Barrett describes that he sees in his patients.
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Old 27-10-2006, 09:51 AM   #123
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Well, I'll wait for any comments that might arise before I officially call the section finished. Of course, my being done with my "presentation" or whatever you would call this, wouldn't mean the discussion has to end.
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Old 27-10-2006, 11:17 AM   #124
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It makes sense to me. It goes a long way to explain why nociception isn't needed for a pain experience; the goal state and end state comfort effect seem crucial to resolution. It also explains better my belief, right or wrong, that PT-determined actions (as opposed to patient-determined) are rather hit and miss in effect, as we are not their brain.

Cory, are you an insomniac or does it just seem that way?

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Old 27-10-2006, 04:33 PM   #125
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Gosh Cory, that #121 post sums up everything I think, as an ectodermalist and outside in treater... How do you do that! What a synthesizer you are. Thanks again for this thread.
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Old 27-10-2006, 06:23 PM   #126
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Cory,

I've already taken a couple of lines from your last two posts and placed them in my Power Point presentation. When you come to my class in Sherman Oaks CA in December I'll be sure to give you credit for them. I can't make any promises otherwise (ha,ha).

Remember, dinner's on me.

I should also congratulate you on being asked by Nari if you ever sleep. I've been getting this same question for years, and I tell you, I sleep a lot more since Soma Simple has grown.

Thanks. As far as I'm concerned, this is The Mother of All Threads
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Old 27-10-2006, 07:18 PM   #127
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I found this this morning, and while I don't think the title does anything toward burying Descartes outdated ideas about the nervous system, the content is interesting:

Quote:
A neuroscientist from Indiana University and a roboticist from the University of Tokyo have created a new way to objectively quantify an idea that philosophers, educators and psychologists have discussed for decades -- that the many ways in which our bodies interact with our environment produces better information that helps the brain.

Olaf Sporns, associate professor in the Department of Psychological and Brain Sciences at IU Bloomington, and UT's Max Lungarella used real and simulated robots in Sporns' Computational Cognitive Neuroscience Laboratory to create this mathematical framework, which they consider the first step toward the development of an explicit quantitative framework that unifies neural and behavioral processes.

Their findings, published in the journal Public Library of Science Computational Biology on Oct. 27, could provide insight into how the brain operates and shed light on how it may have evolved, Sporns said.

"Really, this study has opened my eyes," Sporns said. "I'm a neuroscientist, so much of my work is primarily concerned with how the brain works. But brain and body are never really separate, and clearly they have evolved together. The brain and the body should not be looked at as separate things when one talks about information processing, learning and cognition -- they form a unit. This holds a lot of meaning to me biologically."

An example of this union is how body morphology (the structure of sensors such as the eyes, for example) played a role in the kind of sensory information produced by Sporns' robots, a role that could be precisely measured. The production of good information and how an organism acts on it ultimately could mean the difference between survival and extinction. Sporns can see the mathematical framework, as it develops, being used for designing more capable robots and as a tool in basic research on how organisms have evolved.

A classical view of cognition is one of inputs and outputs -- the brain receives information to process and then produces an output -- all independent of the rest of the body as if the brain were a machine or computer. Philosophers such as educational reformer John Dewey have argued long ago that "doing" is a key part of learning, espousing the influence of a person's engagement in his or her environment on cognition. Any living thing with a nervous system is continually interacting with its environment, Sporns said. He and others in the growing field of embodied cognition think this interaction leads to better and more information. Quantifying this neural-behavioral relationship, however, has been difficult, if not impossible, until recent mathematical advances let Sporns and others begin to create critical measurement tools.

Sporns and Lungarella measured the information flow from the environment to a series of robots, and then from the robots back to the environment by recording what the robots saw and what they did. They altered the robots' visual sensors during the study by changing the density and spatial arrangement of their photoreceptors. At times, they also disrupted the coupling between the robots and their environment. They also looked at it in a simple learning context by including a "rewarding object" component to the study design. Sporns and Lungarella consistently found that well-coordinated and learned actions of the robots created additional structure in their own sensory inputs. This additional structure may be used by the brain to more efficiently process information.

"When it comes to information processing, brain and body work together. If this insight is correct, there is a strong message here for how we might understand the human mind, and for how we might go about designing artificial intelligence," Sporns said.

The research was funded by the Japanese Society for the Promotion of Science and by the James S. McDonnell Foundation.

The study will be available at http://dx.doi.org/10.1371/journal.pcbi.0020144 on Oct. 26 at 5 p.m. PST.

"Mapping information flow in sensorimotor networks," PLoS Computational Biology, vol. 2, no. 10.
Really when they say "body" they mean neural crest sensory info gathering capacity - it's still all ectoderm doing the sensing.

Butler says the nervous system "learns" I think he means at any level even at a cord level. After all, even tunicates can "learn" to spit out "that which is not food." Their nerves aren't very "advanced." But the human nervous system is built up of such components and simply rewired in ways that act as step-up transformers and amplifiers. It ties in a bit with Cory's latest synthesis on intero- and exteroception in his Unifying Theory thread..

It made me wonder about "kinesthetic" images (images in the Damasio sense) that might become established. These would be entirely pre-non-verbal perceptions that might present themselves to the higher order processing levels as raw material for the "neuromatrix" Melzack introduced. Only after they've been processed would they become "neuromodules", and the outgoing action the "neurosignature" the brain uses as shortcut action, at least to the soma motor control areas, be they "voluntary" to striated mesoderm or "involuntary" to striated, smooth, or glandular mesoderm, or even other levels of ectoderm. We come prewired for some of them, the "survival" modules like breathing and swallowing, but the rest must be learned on the fly because of our neotenous state.
Just some thoughts.. still quite jumbly.

The other thing is, I'm re-reading Butler's Mobilization of the Nervous System to prepare for my next little workshop adventure, and refreshing my memory of all the bits of padding around nerve trunks, all stuffed with nociceptors, all permiting sliding and sideways movement of neural stuctures while still anchoring them, at intervals providing openings for capillaries to come and go. That nerve trunk anatomy is truly a world within a world within a world. Just thinking of all the input the brain must downregulate from these alone is making me slightly dizzy.
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Old 30-10-2006, 05:11 AM   #128
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Nari,
I was a bit of an insomniac a ways back. Not anymore though.

Barrett,
I can't wait.

Thanks to everyone for reading along and discussing.
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Old 30-10-2006, 06:01 AM   #129
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Cory,

I reckon you will find Barrett's class enlightening, intriguing and answering a lot of why-type questions. But, be prepared for the temptation to ditch a lot of what you have learned over the years since first year undergrad!

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Old 30-10-2006, 10:54 PM   #130
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I think a link to this Deric Bownds essay definitely belongs on this thread. In it, he explains how our conscious mind is always a bit behind our nonconscious action. He has a flow chart here too. Enjoy.
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Old 22-12-2006, 01:31 AM   #131
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Found this link today, written in 1988 and published in PT Forum.
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Old 22-12-2006, 03:26 AM   #132
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1988!?

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Old 22-12-2006, 03:42 AM   #133
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Frank Wildman isn't a PT but rather a bodyworker specializing in Feldenkrais. His educational background is elusive.

I met him on a couple of occasions in the 80s and he always wanted me involved in his teaching but never figured out how to pay me for that.
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Old 22-12-2006, 03:58 AM   #134
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I think he offered good advice. I think 18 years went by without much of a ripple because of mesodermal bedazzlement.
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Old 25-12-2006, 11:56 PM   #135
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This thread that started out being about do-it-yourself ideomotion and turned to a new topic, what is and what isn't essential minutiae to learn/know, has made me think.

Usually when something makes me think, the startup part of the process activates my sympathetics - then, as the process of thinking continues I start to get more parasympathetic about continuing the process. (If that makes any sense to anyone.) Re: the intrinsic value/non-value of learning minutiae about ectodermal tendrils (nerves), Barrett wonders,
Quote:
I'm wondering if we can prioritize its usefullness. As you say, the names don't mean much, but given that the nervous tissue all terminates in the skin, and in every part of it, does it make a difference in the clinic to know where the major trunks run close to the skin?

Isn't the nature of the cellular structure of the skin (membranous tautness specifically) more important when it comes to touch?
I don't think the question is answerable from the perspective of what we do or think might be important to know for application of "technique", in this case monkeying around with direct physical contact (and I used the word "monkeying" deliberately).

In physiotherapy we do not seem to have any sort of scaffolding yet for our information and how we use it. It's as if we have not yet decided what we're going to be when we grow up, as human primate social groomers. Cory, whose thread this is, seems to have a knack for developing systems, or for applying logic, or for building containment around concepts and then hooking them together. (I nodded along when I read his post about interoceptive versus exteroceptive differences/ forms of treatment.)

I'm seeing this from a few different sides now. In no particular order, randomly generated thoughts I'm having on the topic are as follows:

1. We are and always have been human primate social groomers. But who is the troop? There are always two troops at the same time, the one we treat and the one we are. We seem to have gotten perpetually stuck in how we will define who or what our (PT) troop is, and what it should stand for and against, what it should know or what it shouldn't have to worry about. (I say, don't take any chances on trusting any HPSG profession, even your own, to know for a fact what is or isn't necessary to know. Learn everything your brain can take on and be ready to pitch without hesitation anything that proves to be useless in the long run.)

2. Mostly we know who our troop isn't, and easily move away from other HPSG troops that don't share the same values our particular one does, but we can't seem to get over the hump into defining what we DO stand for. I think the issue under discussion falls into this longstanding conundrum.

3. The world needs our services, that much we know. Doors at every level fell open to us, and continue to fall open to us, money falls into our laps (not a ton, but ample amounts), universities strive to create programs and compete to have us come to be educated by them, whereas other HPSGs (mostly the self-defined ones) are not permitted. So, have we traded something important, like self-understanding/self-definition, for the privilege of being admitted to halls of learning and societal approval? (E.g.: At least we avoided becoming a spinal manipulation cult for a very long time, and waited until we were vast enough and established enough to take SMT on board, for those who wanted to, without it coming to define or dominate the entire profession. Although sometimes I think the ones who take it on would like to have their particular HPSG worldview come to dominate.. ...)

4. One way HPSGs are defined or define themselves is by who they will or can or want to treat and how. We can't do that because we must have agreed, somewhere along the line, to take on every kind of HPSG problem that comes our way. This left us free to develop ways of interacting that could evolve. There was never any right or wrong way defined by some sort of cult identity or word from on high. We've always been experimental, and socially permitted (within proper personal boundaries) to be so. This original humility gave us access and freedom to roam in very wide pastures indeed. But roaming must result in trails; trails must lead to patterns that form networks of cognitive conclusions, not just to good grazing and ponds of clean water.

5. Neuroscience was always the frontier. I think PT (on the whole) was always frontier-minded. I still think this is the best place to be, as a PT, as a profession, as an individual. Our core has always been neuro. When I look at the profession, the orthopaedic (mesodermal) types usually make the most noise, but the neuro types, who have always been quietly toiling away, represent (IMO) the best the profession can offer to the rest of humans.

6. Pain science is upon us all, and can be a real connector. It can:
  • connect what our patients "feel" with the constructs we use to treat them;
  • bring back together the ortho people with the neuro people again (someday);
  • connect practitioners who are non-orthopaedic with patients who were mis-labeled as orthopaedic outpatients or else crazy for having pain with no discernible (image-able) tissue lesion;
  • provide endless ways to vary the therapeutic container, to allow it to become whatever it needs to be in the moment to accommodate any given patient - this is pure freedom for a HPSG;
  • provide endless amounts of mental fodder/opportunities to compost/ chance to grow new varieties of treatment ideas based solidly in science.

7. The thing I like most about nerves, about learning about them, about teaching about them, is the way that this information can help people/patients learn to help themselves, by improving the intraBONDING mechanisms amongst the different parts of the human brain. What do I mean?

Here's the thing.
a) We all know there is no split, that the mind is not separate from the brain or the body, that there is no such thing as an objectively detached "mind" part.
b) Somehow our task as PT HPSGs is to help the patients we see to plug into their own resources to get themselves better. I think we can all agree that we don't want to encourage dependency (a PT value), that we want to see people learn to look after themselves, become independent of any need to see HPSGs at all.
c) By teaching people about pain, pointing out that these body bits (nerves) are connected to their own brain, and mind, how the brain makes pain, how it ends up being about them, but also about these bits out in the periphery, how it's all connected, people really do seem to take on a different level of relationship to their pain, not as a nuisance any more, but ownership of dealing with their pain as if it were a desirable project, like raising a baby - babies can be a dominating force in one's life but a reasonable parental attitude (fueled of course by oxytocin or vasopressin) will contain good will and willingness to sacrifice and optimism. They can learn to interpret pain's nuances differently by paying the right kind of attention to it at the right times. Maybe they even produce a bit of oxytocin or vasopressin in the process! Wouldn't that be fun to study some day?

In any case, I think this is a useful bit of factual info to give people to CBT them away from their hopeless/helpless attitude and into getting more active and self-reliant, at an emotional level, without having to get all psychologically educated or adept, or without having to know anything about their personal lives or without prying into their personal "stuff". I think it taps into a perfectly real primate proclivity that we have, for free, a nurturing capacity that is lying around in there anyway. Getting people to apply that to themselves is, I think a good way of being a good PT HPSG, going one better than mere tissue manipulation for its own sake (the ritualness of it, or attempt to turn it into cash-cow-dom).

Back to the take-off point here.. where this info fits in, into our PT frame.. I think we won't really know for sure until the frame is finally built. And I hope I never live to see that day. Because our freedom to practice our craft, profession, whatever it is that we think we do, i.e., give individual human primates back to themselves, restored and whole or with the means to become so, within the bounds of science, however we might choose, seems like an ongoing miracle to me. I'd hate to see this sweet deal get screwed up by some frame that doesn't really fit the bigger picture (and danged if the picture doesn't just keep getting bigger and bigger as more is learned!)

I see this has turned into a bit of a ramble. Sorry about that. I expect the ramble will clarify itself better some day.
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Old 26-12-2006, 01:21 AM   #136
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Diane, everything in this post I agree with; and in many ways we have lost perspective of what is important and needed for our patients with symptoms.

I think this is why Barrett always refers to caring for patients' authenticity rather than treating their various symptoms in fits and starts. GPs used to do that and then got lost in the maelstrom of technology.

You have echoed the thoughts I've had for years - neuro physios are quiet, they get on with the job of trying to make sense out of neural function,often undervalued, usually misunderstood and yet they have a far more complete refrain to sing about than the mesodermalists have had and ever will have.

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Old 26-12-2006, 02:32 PM   #137
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No man or woman will ever unfold the capacities of their own intellect who does not at least checker their life with solitude.

De Quincey

I got this quote from a book recommended by our friend Ian Stevens. It’s titled Solitude: A Return to the Self by Anthony Storr. On page 74 Storr refers to an essay he once wrote titled “The Concept of Cure” in which he wrote the following:

The first factor is that the patient adopts some scheme or system of thought that appears to make some sense out of his distress. The second is that he makes a relationship of a fruitful kind with another person.

In other words – what Diane just said. Perhaps truly effective and/or rational therapy begins by teaching the patient that the first task is possible given what we’ve learned and the second part defines the therapeutic relationship as it progresses toward its formal conclusion.

In order to practice reasonably (perhaps for the first time) and to make sense PT has to become ectodermal on several levels. Back when care (read time and proper attitude) was available to us we didn’t understand neurobiology as we do today. Our appreciation for the mesoderm overwhelmed us and the various mutations of that knowledge misled us; all while a culture bent on controlling us nodded approvingly. What I see around me today is the result of that irritating alchemy. When this is made clear to therapists many actually behave as if they are just victims of poor basic schooling and subsequent fealty to departmental decrees of protocol and productivity. Trying to change any aspect of that carries too high a price, so nothing changes.

Returning to the quote at the top of this post, I see among many of the regular contributors here the regular pursuit of solitude, even if that solitude must be purchased at a great cost. Perhaps it is no coincidence that we ask our patients to “checker” their life with something similar when it comes to their self-care. No large classes, no exercise regimens dominated by choreographed movements and unique realizations regarding function as they progress.

We are our ectoderm, and I’ve no problem knowing that at every available level – anatomic, physiologic, embryologic and philosophic. Some of us individually resonate with different aspects of that, but here we can all display our passion and share it. For a few moments at a time we are not completely solitudinous, and then we return again.

Our patients might be better off learning how to do something similar with their painful sensation, and therapists should be perfectly positioned to teach them that.

Almost without exception, they aren’t even close.
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Old 26-12-2006, 08:48 PM   #138
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Quote:
We are our ectoderm, and I’ve no problem knowing that at every available level – anatomic, physiologic, embryologic and philosophic. Some of us individually resonate with different aspects of that, but here we can all display our passion and share it.
Yes, that is why Somasimple exists.

So, in summary, I'd say that one can definitely treat physical nerves/the nervous system through/via skin, almost as if one were a mesodermalist, and thereby help tissue change itself. Nerves stand out remarkably when they are not happy (feel like clothesline cords), but change relatively straightforwardly and rapidly, becoming homogenous with everything else once they are no longer "cranky". Usually all the mesodermal mirages vanish in the process, and subsequent functional tests indicate all is well.

Learning about nerves and teaching about them and learning to treat them and teaching other therapists how to treat them, might look like promotion of the use of leeches, but that isn't quite the same thing as using more leeches. I think instead, it's a matter of using the right sort of metaphorical and physiotherapeutic leeches to do the right thing at the right time, as in hirudotherapy, the modern medical application of actual leeches.

I am looking forward to the arrival of my copy of the book Solitude this week.
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Old 21-01-2010, 02:31 AM   #139
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I saw this Secret Life of Scientists video (featuring Gavin Schmidt) today and knew I had heard of Mills Mess before and specifically, here at SS. A quick search revealed that it was this incredible thread and specifically post 105. Sorry about the stream of consciousness here. Consider it a long over due bump of an important thread. Serendipitously, the previous post in this thread also happened to answer a question I posted in another thread.

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Old 13-11-2011, 05:51 PM   #140
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Really enjoying this Cory. I have just one question regarding the last statement. I cite this passage from Wall several times when doing inservices or in explaining pain with patients. To be clear, do people without pain, who are similarly in states of non-movement, not show any activation of motor planning areas? Or if they do, are these studies showing that the patterns of activation are sufficiently different? Is anyone familiar with the finer details of these studies?

eric
I've read that premotor and motor planning areas are active even in thought. Which would be why meditation would be a different form of brain (non)activity.. "stills" the mind. One wonders however if meditation can "still" pain. Maybe Ian will have some info on that.

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Old 27-01-2012, 12:44 PM   #141
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This is going to take some time to assimilate. Does anyone have a link to a condensed presentation of Cory's themes within this thread? It is tricky one scrolling page at a time to follow a complex thread like this. Are there highlights as a pdf or doc to download? I want to read this lots and make notes!
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Old 27-01-2012, 12:49 PM   #142
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I'm not aware of any doc's or pdf's. You'll lose yourself for months reading up on past threads.
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Old 27-01-2012, 01:37 PM   #143
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This is going to take some time to assimilate. Does anyone have a link to a condensed presentation of Cory's themes within this thread? It is tricky one scrolling page at a time to follow a complex thread like this. Are there highlights as a pdf or doc to download? I want to read this lots and make notes!
FWIW I've been following this site for about a year and think i'm just starting to get the idea.

Be patient.
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Old 27-01-2012, 01:50 PM   #144
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I recommend this writing to every student. There's some amazing stuff here and an entire workshop could be built around it quite easily.

Oh wait...
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Old 27-01-2012, 03:40 PM   #145
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....How long shall I wait?
Is there a workshop out there in the SS site that presents this in a handy format? If not then it is going to be a cut and paste session which I would then attach to the thread. Just don't want to chisel myself a wheel only to find one around the corner.
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Old 27-01-2012, 03:45 PM   #146
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I don't think there is a shortened version of the info in this thread. If there was I think I would have found it by now, as I think I have read and absorbed this thread more than any other on the site over the years. Would enjoy seeing your notes and thoughts about it. That is the fun of bringing up some of these old threads with new eyes looking at them.

Barrett, is referring to his Simplifying Manual Care course. If you want to fly him to the UK I bet he might come.
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Old 28-01-2012, 12:38 AM   #147
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I will pull it together over the weekend and post it up when it is done. Deep stuff.
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Old 15-02-2012, 11:46 AM   #148
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Default Down, down, Deeper 'n' Down.

It turned out that this was more than a weekends toil. Still think it is worth it and I am plugging away at it. For those, who like me, find the thread difficult to follow and are willing to print it out (double sided and two sheets to a page) so they can highlight, annotate and scribble (and doodle slug cats) and aid in the understanding here is the thread as a word.doc
Enjoy.
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File Type: doc On the Cusp of a Unified Field Theory .doc (252.0 KB, 71 views)
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Old 16-02-2012, 07:29 AM   #149
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Wow, Ste5e. Thanks for doing this! Hard to believe this is now 6 years old.
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Old 16-02-2012, 02:37 PM   #150
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Cory, does it kind of feel like watching one of your kids grow up? It's amazing sometimes how they get older, while we don't.
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