Suppose this were true

[Barrett Dorko]

Suppose this were true:

Pain and body image are closely related. We always experience pain as projected into the body. When you throw your back out, you say, “My back is killing me!” and not “My pain system is killing me.” But as phantoms show, we don’t need a body part or even pain receptors to feel pain. We need only a body image, produced by our brain maps.

Norman Doidge M. D.

In the thread to follow I’d like to explore what I consider a major shift in my thinking. As usual, this shift wasn’t the result of a single experience, bit of reading or event in the clinic. I think that shifts of this sort are the consequence of many things, and not all of these events have anything at all to do with therapy – unless you think everything actually does. And I do.

The two books leading to this shift are The Body Has a Mind of Its Own: How Body Maps in Your Brain Help You Do (Almost) Everything Better by Sandra Blakeslee and Matthew Blakeslee and The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge.

These books are written in a conversational manner and both contain leading edge neuroscience, or, perhaps more accurately, brain science. I feel that what they teach us has enormous implications for both our theory and practice, and that’s what I want to explore here.

More soon.

[Diane]

I look forward to deconstructing this relatively recent info (first heard about virtual bodies from Butler) about the human antigravity body/brain here.

The books are both good.

There are brain science podcasts for with interviews of the writers of both books; #26 is Doidge's interview and #23 is Blakeslee's interview.

[Barrett Dorko]

Thanks Diane. If not for your guidance toward Ginger Campbell’s site I’m not sure I’d know about any of this.

Belief is an essential function of the brain designed to extend our senses.

From Why We Believe

What I’m suggesting here is that Doidge’s statement about pain be taken seriously, mainly because he has supported it with a wealth of excellent evidence from wonderful sources. And if this is true (“…we don’t need a body part or even pain receptors to feel pain. We need only a body image, produced by our brain maps), then why are we focusing on the peripheral tissues and biomechanical implications of movement to such a great extent?

It’s a huge question, and I think that we may find some part of an answer if we look in any number of places. Despite their number, I doubt we’ll ever answer the question completely.

Today I’ve chosen belief as a starting point, and though I could easily say that this choice is random, I rather doubt that anything I write is all that random on an unconscious level – and that’s where my writing begins.

In Blakeslees’ book page 39 is devoted largely to the nature of belief as it relates to what we each feel about our body’s shape, also known as body image. This is opposed to body schema. The former is learned, and body schema arises from a felt sense – and these two things may be wildly dissimilar. I’ll speak later of what a disparity might create, but right now I’d like to focus on the connection between learning and belief.

I’ll quote again from Why We Believe:

Gregory W. Lester PhD., a psychologist on the faculty of the University of St. Thomas in Houston, suggests that belief is an essential function of the brain designed to extend our senses (Why Bad Beliefs Don’t Die Skeptical Inquirer November/December 2000). We use belief to create a model of that part of the world we cannot sense simply because our senses have limitations. For instance, I believe my house is where I left it before I came to work this morning. I can’t sense it in any fashion, but in order to efficiently find my home after I leave work tonight, my brain has to create an internal “map” composed entirely of belief and independent of my senses. Without this, my senses alone are inadequate when it comes to finding my home. My belief “knows” where it is though my senses have no clue that it currently exists.

Understood in this way, belief is seen as an important and necessary way of sensing the world. If the brain’s primary function is to assist in our survival (and it is), something like belief’s tendency to extend our senses serves a biological purpose. In short, belief enhances our tendency to survive, and as such it will form neurologic patterns that prove remarkably resistant to change.

So, to recap:

• Belief serves a biological purpose.
• The primary function of the brain is survival.
• Our senses seek to insure our survival.
• Beliefs extend our senses.
• Because of their connection to our senses, beliefs are resistant to change.

Assuming that Lester is right, any discussion of practice that relies upon a belief system will be perceived by many as a threat to their personal survival mechanisms. To put it another way, it is extremely difficult to question anyone’s belief system without getting into personal issues that have no real bearing on the problems inherent to any practice that is not based on evidence or accepted methods of reasoning. My own experience with alternative medicine practitioners certainly indicates that Lester is on to something. (end of quote)

Now let’s turn from the way many therapists choose to order their practice and look at the presence of painful sensation. If a therapist believes that a painful problem should look a certain way, and if this aspect of its appearance cannot be found in the therapist’s senses, what will happen if the patient continues to insist that they hurt?

Here we see a clash of beliefs, and until they can be understood as survival mechanisms very little progress can be made in the clinic.

Body image is learned, and everything we learn is wrapped completely in a web of belief that is as complex as you might imagine.

How can we sort out what we believe from what we know to be evident as the end result of careful study? And how does our belief about our own body effect the way we practice? Isn't the patient's body image something we should take into account? Can we manipulate it with certain therapies? Can we sense how our personal images enter into this equation?

Many questions, I know.

More soon.

[Nick]

Great stuff, Barrett.

A question re: your example about believing your house is where you left it - is this type of belief constructed based on sensory experience? and what role does memory play in belief? And how does the persistence of memory shape this? And, finally, what about beliefs that are not connected to some sensory experience - or is there always some connection to a felt sense of something???

More questions...

[Erica]

This is good. Ironically I just ordered those books! Listened to the podcasts on Blakeslee's book-really good stuff. From what I remember, she said that the alternative therapies like Feldenkrais use successfully the body scheme awareness map. One wonders if someone has poor body awareness, how does the map change or morph, so to speak? Or how can we as therapists use other maps to enhance the awareness map? I wonder...
Erica

[BB]

We use belief to create a model of that part of the world we cannot sense simply because our senses have limitations.

This is a very interesting way of looking at belief. In terms of representational maps, could belief be the map of the world that we must navigate? Not only physical, but culturally, socially? It would make sense. Belief in neural terms could be the construction of everything that is non-self in order to guide our interactions with it.

How can we sort out what we believe from what we know to be evident as the end result of careful study?

Keeping in theme with maps, I tend to navigate by landmarks. When I look at an actual road map I must first find a landmark I'm familiar with and then work my way through the map in relation to something I already know.

And how does our belief about our own body effect the way we practice?

Profoundly, as is evident for me in the significant change in my practice in the past few years.

Isn't the patient's body image something we should take into account?

This is pretty much how I conceptualize what I'm doing these days. It makes things so much simpler.

Can we manipulate it with certain therapies?

Belief? I believe so. Moseley's work seems to indicate that you can. I think that you can't help but manipulate belief with any therapy, whether you are reinforcing it, adapting it, or tearing it down.

Can we sense how our personal images enter into this equation?

I think of this too quite a bit while I'm treating. I think about all the non-verbal non-conscious clues that are being passed back and forth and that I better be peddling out explanations that I confident in or they will pick it up in a heart beat.

I'm not sure if you were looking for an actual list of answers from anyone, but I always really enjoy the exercise of answering your questions.

An anecdotal side note from a second visit with a patient that occurred this week:

I have been using the representational maps in my explanations more and more. I have a patient right now with a complicated history, childhood sex abuse, anorexia, substance abuse. He has pulled himself through quite a bit and tells others of his stories now I believe because it is therapeutic to him. He has come to see me for his chronic pain. As we were talking about the maps, and he had made it clear that he was glad to talk about his past even if I myself was not necessarily comfortable hearing it, I mentioned the passage in the Blakeslee book about anorexia and body maps (body image of a large person with a distorted body schema as well). He immediately replied that he knew this to be true. He said that victims of rape often take on the body image of their attacker (he said this was true of himself and of many others he had talked to whose attackers had been large) and felt certain that this is why many victims of sexual abuse later develop anorexia. Also of note with this patient, I showed him ideomotion for about 10 minutes at the first visit, limited in time by the length of the subjective history and my caution in doing too much with him given his pain state. He came back this visit stating he was pain free for about 3 hrs after that first visit for the first time in 20 years.

[Diane]

Patients have so much to teach. It's hard to learn what they can teach unless you can build a space where they can share out what they need to. Sounds like you built a safe space there Cory.
Hat's off.

[Barrett Dorko]

Wonderful replies, as usual, and I suppose that some who only read have some thoughts of their own. We’d all like to see them.

I'm not sure where belief ends and understanding begins except to say this: understanding is malleable, much in the same way the brain maps have been shown to be. Belief, well, not so much. But I must regularly remind myself that belief in various things provides many people with a level of comfort they simply cannot relinquish.

The problem, I think, is when therapists begin to throw the word “belief” around without considering what it implies. How many times have I been asked, “Do you believe in chiropractic/manipulation/core strengthening/strain-counterstrain/unwinding/postural correction?

Last I heard, none of these methods were immune to scrutiny by the scientific method. This makes them distinct from religion and therefore no real “belief” is required.

Often enough I am also told something like this: “Well, I believe in [insert any number of “energetic” therapies here] because I’ve seen it work."

Ironically, explanations for this “working” are now available, and I’ll be getting to them soon, but if a therapist begins with belief rather than understanding it’s very hard for them to hear and consider anything rational.

They are more likely to defensive and angry than grateful. I would know.

[Barrett Dorko]

Believe nothing, no matter where you read it or who said it, not even if I have said it, unless it agrees with your own reason and your own common sense.

Buddha

If you’ve 15 minutes to watch a video on your computer today I can’t recommend the following any more highly. Go here and type Michael Shermer into the search function. There you’ll find at the top of the list Why people believe strange things, and you won’t be disappointed. I only hope to one day speak as well and present my ideas with as much clarity.

Consider these quotes from Blakeslees’ book: Your body schema is a physiological construct…(and) your body schema expands with the clothes you wear.

Remember that the body schema (as opposed to body image) arises from a felt sense, and that it isn’t learned or believed in so much as it is a function of our awareness, and we all know that awareness is remarkably variable. The range of awareness is dependent upon learning as well.

I see all of this deeply connected to what we now know as peripersonal space. Thanks to Diane, I have found a great link to a definition of this here. Take a moment to read it and then consider this question:

If any tool I hold expands the peripersonal space I possess, are there any obvious limits to this expansion?

[Diane]

I don't know that there are any limits to the expansion of personal space, especially if one of the associated values is greed..

I think there are big implications in treatment, because it seem pretty obvious based on this information that our brains have the ability to include patients in our own peripersonal space, and patients' brains will include manual therapists in theirs, which is precisely why developing good, well-maintained treatment boundaries is important.

The plus side of it is that one can learn to feel all sorts of things that don't feel quite "right". Images of these will form visually. It's important to not "believe" what your inner eye "sees" too much; it IS important to feel the things that can "change", stay on these things until they do, then move on. Style is important, not in terms of fashion or good looks, but kinesthetically, in terms of gentleness, in terms of how kind you can make your touching be. (The patient's insula will be in there taking notes on how skillful you are at not perturbing it.)

The down side of it is that mythical treatment constructs can be easily maintained, things about which Michael Shermer would gasp at if he knew, myths about treatment of structure.

[Line M]

Maybe it's a language thing, it seems to me that in the context of the above written the word assumption gives a better description than the word belief.

The limits of in the peripersonal space holding a tool are set with the degree in which a person is able to control and handle the tool one is holding. I can imagine holding a tool for the first time it is not part of your peripersonal space and learning to adapt to it it becomes part of your space.

[Jon Newman]

Hi Line M,

The limits of in the peripersonal space holding a tool are set with the degree in which a person is able to control and handle the tool one is holding.--Line M

I think you're onto something here although I'm not sure that "control" is necessarily the focus even if it might be necessarily involved. What I'm suggesting is that perhaps it is the action effect that is responsible for changes in the mapping. Notice this from the Blakeslee link in Barrett's last post.

The moving tool was incorporated into the monkey's body schema, Dr. Iriki said. When the monkey held the tool passively, its body schema shrank to normal size.

[Barrett Dorko]

While grocery shopping this morning I noticed that there was a large display of sauerkraut and it got me thinking a bit more about the significance of peripersonal space. I know that the grocer had something else in mind, but I hate sauerkraut, and despite the Pennsylvania Dutch tradition of eating it for luck on New Year’s Day I’m not gullible enough to stomach it. I know that others who hate it as much as I will eat it though. The issue here is the absence of superstition on my part, and I’d like to think that my naturalistic worldview pretty much eliminates that. I’m sure there are others here who feel the same.

But let me ask you this: I hand you a sweater, just your size. It’s attractive; it’s clean and seemingly new. I ask you to simply put it on, and just as you drop an arm into the first sleeve I tell you that it was once owned by a famous serial killer. What are you going to do?

The power and variability of peripersonal space is exposed with something like this, to say nothing about what it may reveal about our deepest and most irrational fears.

[Nick]

From Blakeslee - page 43:

"But while the schema is largely a function of body parts in motion, your body image draws on a a larger web involving your lifetime's library or personal experiences and memories. Your body image is an amalgam of beliefs - attitudes, assumptions, expectations, with an occasional delusion thrown in - that are likewise embedded both in your body maps and in the parts of the cortex that store your autobiographical memories and social attitudes. Your family, peers, and culture provide the content; you provide the interpretation." [emphasis mine]

This passage jumped out at me more than any other in the entire book. I have been thinking a lot about how different experiences, particularly traumatic ones, can deconstruct the sense of self and also the role of reinterpretation. What difference does it make when one actively examines their beliefs and experience rather than being a passive participant of the what the culture endorses? It is also interesting in light of the relatively rapid and dramatic shifts in culture and how new technology facilitates fragmentation of group experience (think broadband vs. broadcast).

Back to Blakeslee:

"For most people, important beliefs about the body begin to bubble into consciousness in early adolescence. By the end of the teenage years, these beliefs have congealed into a coherent body image, right along with religious beliefs, political attitudes, and stereotypes. All are highly resistant to change in later life."

These may be resistant to change, but they certainly can and do change. Not without MUCH anxiety - at least in my experience. I think this relates to a certain tolerance for uncertainty and the willingness to be lost. And it most certainly relates to the cognitive dissonance thread.

The Blakeslees state that the potency of belief can drown out body sense. I would add that it can also block understanding - in a way that is probably less willful than it often seems. "...being at war with yourself, even when it is all happening beneath the level of your conscious awareness, is a miserable experience." Am I alone in sensing this war within my patients? Within myself?

[Barrett Dorko]

Nick,

I don't think you're ever alone here (I underlined the same passage in the book), but I can't speak for the rest of your life. I've my own issues with this, as you know. Too often in the midst of my peers while speaking I feel completely alone.

"Creating a culture between your hands" is something I suggest while teaching. I know that this may be difficult in the face of so many opposing messages, but I think it's easier than might be predicted if the understanding of the therapist is sufficient and the education of the patient is done well enough.

[Nick]

"You can't miss it when I tell you what's there." Michael Shermer

This is just like when they tell you what you're feeling in OMT.

Great link, Barrett.

Also from Shermer:
"... a common thread that runs through beliefs of all sorts, he says, is our tendency to convince ourselves: We overvalue the shreds of evidence that support our preferred outcome, and ignore the facts we aren't looking for."

[Nick]

A similar theme can be found in Brain and Culture by Bruce Wexler. I have not read this yet, but have added it to my list. I would like to hear from anyone who's delved into it more deeply.

From Dr. Wexler's introduction:

"...Individuals seek out stimulation that is consistent with their established internal [neural and psychological] structures, and ignore, forget, or attempt to actively discredit information that is consistent with these structures. Things are experienced as pleasurable because they are familiar, while the loss of the familiar produces stress, unhappiness, and dysfunction... Since individuals develop internal cognitive structures that are consonent with their own culture, the appearance in their environment of individuals from a foreign culture, thinking and acting differently, creates an uncomfortable dissonance between internal and external realities."

"Because of the neurobiological importance of the fit between internal structure and external environment, cultures will fight to maintain control over the symbolic environment in which they live and which shapes their children."


"...individuals from a foreign culture, thinking and acting differently..." Barrett- I suppose this is how you're experienced by some of your students. I am now wondering about the symbolic environment of physical therapy...

[Barrett Dorko]

I certainly sound foreign enough I suppose, and can see how difficult it must be to assimilate if you’re of another mind and mired in a practice based upon belief.

The point I was hoping to make with the original quote here is that now I need to change again. I need to fully acknowledge the reality that Doidge describes and relinquish my emphasis on the notion that movement is necessary to resolve the problem as I imagine it to be.

Is it possible that the condition I’ve assigned to the mechanical deformation in the nervous system is more commonly an alteration in the brain?

[Diane]

Change is healthy.
I think there can be problems at both 'ends' of the nervous system simultaneously. It's a mobius strip-like enigma after all, with info ascending and descending at the same time, ten times as much sensory coming in as there is motor going out, but with 100,000 times as much processing going on meanwhile. However, unless those maps and schemas can be persuaded to change, not much else will, as far as pain is concerned. This I'm now quite sure about.

[Barrett Dorko]

So, is schema a consequence of input/ascending signals and image output/descending signals? Or is that too simplistic?

[Diane]

I don't know what is input or output about either.. I don't understand them very well. I think both are subject to neuroplasticity though (isn't everything?).

[BB]

In Phantoms in the Brain, Ramachandran speaks of illusion quite a bit. He suggests that the illusion precedes the input. The then suggests that the illusion we ultimately perceive is the one that best matches the sensory input describing it.

My copy of the book is out on lone, so that is from memory. Maybe is someone else is familiar with this they could provide the passages.

In this context, I would think that the schema are the illusions and the image is perception built out of the comparison between illusion and input.

[Nick]

It seems to me that image might be the preconceived (and less likely to change) illusion and schema more plastic based on inputs. Belief is may be challenged by disparity, but distress creates resistance to change???

Pure speculation on my part and I'm no neuroscientist.

Barrett, I'm not sure about more commonly, but I think mechanical deformation certainly alters brain maps, but is not required to experience pain.

[Barrett Dorko]

Okay, I’ve begun to confuse myself. Both schema and image can be changed. Elements of awareness, belief, learned behaviors, cultural values and illusion are all involved in this change or the lack thereof. No wonder my confusion. Perhaps approaching this from a different angle will help.

He believed in magic, or, at least, magic tricks.

Steve Carell while introducing Steve Martin at The Kennedy Center Honors, December 2007

“Therapeutic illusions” may be found in the index of Doidge’s text between pages 186 and 190. The quote that begins this thread is on page 188. Regarding Ramachandran’s work with mirror box therapy here he writes: “(He) then hit on the wizardlike idea of fighting one illusion with another.”

Perhaps in this sentence alone we can see why the whole notion of brain mapping, schema and image, phantoms and placebo is something therapists commonly look at suspiciously and often run from. Biomechanically-minded ones will be especially scornful of all this stuff they can neither measure nor easily control.

But when it comes to the issue of pain in the absence of frank pathology this is what we’re left with – illusions in conflict.

Of course, understanding this is the first step toward dealing with it effectively.

Maybe that’s what this thread is becoming.

[Line M]

Reading the last replies, the word incorporation comes to my mind.

Jon,
Does passively mean in this way that you (consciously or not consciously) do not incorporate the tool.

Barrett,
In your example of putting on a sweater with the illusion which doesn't 'fit' your system of beliefs it's impossible to incorporate it in your body scheme and you feel uncomfortable with it. This illusion interferes negatively in your peripersonal space.
Try the sauerkraut with raisins, pineapple, potatoes and chicken, makes it more tastfull !

[Nick]

Originally Posted by Barrett Dorko

“(He) then hit on the wizardlike idea of fighting one illusion with another.”

Sounds like another Wizard of Oz reference.

[Jon Newman]

Hi Line,

At the end of this post I've posted one of the article abstracts from the researcher (Iriki) referenced in the Blackslee article. My take on this is that if the tool is not associated with any effect then no change in schema takes place. My take is further supported by the aspect of the experiment where a 60 cm pole that only had effects at 30 cm produced changes similar to the 30 cm pole.

I find the opening line from the Blackslee article more interesting and more closely related to Barrett's post about the "sweater test".

A century ago, neurologists noticed that when ladies wearing big feathered hats ducked through entryways, they would align their bodies just so. It was as if they could feel the tops of doors with the tips of the feathers.

I think that this behavior did not need to be directly experienced. That is, it is conceivable that the ladies could exhibit this behavior without ever having worn the big feathered hat before but a number of things would likely have to occur. They would either have to have imagined the effect or have witnessed the effect. It seems to me that if the effect is imagined then it is likely registered consciously but I could be wrong. If the effect is witnessed and imitated it may very well not be registered consciously.

Neuropsychologia. 2005;43(2):238-48. Epub 2005 Jan 7. Links
Shaping multisensory action-space with tools: evidence from patients with cross-modal extinction.

Farnè A, Iriki A, Làdavas E.
Dipartimento di Psicologia, Università degli Studi di Bologna, Viale Berti Pichat, 5-40127 Bologna, Italy. alessandro.farne@unibo.it
Recent findings from neurophysiology, neuropsychology and psychology have shown that peri-personal space is represented through an integrated multisensory processing. In humans, the interaction between peri-personal space representation and action execution can be revealed through the use of tools that, by extending the reachable space, modify the strength of visual-tactile extinction. We have previously shown that the peri-hand space whereby vision and touch are integrated can be expanded, and contracted, depending upon tool-use. Here, we show that these dynamic changes critically depend upon active tool-use, as they are not found after an equally long, but passive exposure to an elongated (hand+tool) body configuration. We also show that the extent of the peri-hand space elongation, as assessed at fixed far location (60 cm from the hand), varies according to the tool length such that a 30 cm long tool produced less elongation than a 60 cm long tool. This reveals for the first time that the distal border of elongated area is not sharply limited to the tool length, but extends beyond its physical size to include a peri-tool space whereby the strength of visual-tactile integration seems to fade. Remarkably, a similar amount of peri-hand space elongation was found when the effects of using a 30 cm long tool were compared with those produced by using a tool that was physically 60 cm long, but operationally 30 cm long. By dissociating with this 'hybrid' tool, the amount of space that is globally added to the hand (60 cm) from the one that is actually reachable (30 cm), we provide here the first evidence that the extent of peri-hand space elongation after tool use is tightly related to the functionally effective length of the tool, and not merely to its absolute length.

[Barrett Dorko]

Jon,

Wonderful, and I've a thing or two to say about it in a subsequent post, but just now:

“I’m writing a book on magic,” I explain, and I’m asked, “Real magic?” By real magic people mean miracles, thaumaturgical (miraculous) act, and supernatural powers. “No,” I answer: Conjuring tricks, not real magic.”

Real magic, in other words, refers to the magic that’s not real, while the magic that is real is not real magic.”

The preceding comes from yet another video podcast every therapist should watch, or, at least, that’s my opinion. Here Daniel Dennett asks the question, Can we know our own minds?, and answers it by referring to his friend’s book Net of Magic and optical illusions that have been connected to specific alterations in the brain.

Dennett says, (paraphrasing here) “Consciousness is a bag of tricks (and) you must forgive me for the imposition of clarity to these matters. I know that a certain percentage of those listening really don’t want to know how a trick is actually done.”

This is essentially the theme of the very popular Manual Magic thread of a few months ago. In fact, I feel like this thread is simply a continuation of that one.

[Diane]

This is essentially the theme of the very popular Manual Magic thread of a few months ago. In fact, I feel like this thread is simply a continuation of that one.

Definitely.

By the way, sauerkraut is delicious casseroled in tomato juice and cabbage rolls.

[Nick]

Does it make sense to think of pain as a contraction of peripersonal space? If handling a tool expands the body schema, perhaps being stuck in a withdrawal response causes it to contract. I often describe pain as being stuck in a box - it hurts when the person contacts the box so they minimize their movement to avoid discomfort. Treatment aims to break the person out of the box; ie. expand their peripersonal space.

I am also thinking that part of the experience relates to the disparity between the body schema and the body image. For example, post-MVA clients often report things like "I just don't feel like me" or "this is not me."

I find the hardest job is often changing the person's beliefs about pain, especially when those beliefs have been reinforced through contact with the medical system.

[Barrett Dorko]

Nick,

I’m not sure. I think that an important aspect of dysfunction/pain is the disparity between maps. There’s a passage on pgs. 51-52 of Blakeslees’ text about “flooding the brain with full body stimulation” and “(creating) a powerful input of touch sensation (to) help overcome (a) distorted body image.” They’re talking about anorexia here.

Might we speculate now about how manual therapy of various sorts reduces the disparity in maps we assume is common in painful states – especially chronic ones?

[Diane]

Nick,

Does it make sense to think of pain as a contraction of peripersonal space? If handling a tool expands the body schema, perhaps being stuck in a withdrawal response causes it to contract.

Moseley is working with maps and fMRI, mostly the regular S1M1 map, the homunculus with which we are more familiar. He has learned that indeed, with regular sort of persisting pain (such as pain contributed to by mechanical deformation signals, for example), S1M1 expands, while paradoxically the physical body part feels as though it has contracted, is physically smaller.

In CRPS the opposite occurs: instead, S1M1 contracts while the part feels enlarged, bigger than it should, is sensitive and feels vulnerable/easily dinged. Patients resort to spatial neglect, possibly just to cope. Double paradox.

In any case trying to figure out how maps plasticize in presence of pain is what he's busy doing these days.

[Erica]

Nick and all,
I also find one of the hardest tasks, so to speak, is changing a patient's belief regarding their pain. Depends on the person's past experiences and their trips through the medical system, as you say, especially when no one has given them the time of day much less an "explanation of their pain". I have in mind, a current patient, who is so focussed on his symptom, no matter what type of education or other intervention - he is so intent of the location of this pain-that I think his brain blocks out, literally, everything I tell him.
Interestingly, to relieve his symptoms, he "withdraws", makes his space small, child pose, fetal position, squat. Sort of like Hanna's Red Light Reflex, or startle as I think he calls it.
Have a Happy New Year everyone!
Erica

[Barrett Dorko]

I’m thinking now about how the things that actually touch us - and thus enter into the closest aspect of our peripersonal space - might potentially change the maps within the brain.

Of course, the hand of another comes to mind, but I’m thinking at the moment of inanimate objects. What happens in the brain of a boxer when he or she puts on their gloves? How about a football player donning shoulder pads or a basketball player when they hold a ball? I can tell you that when I hold a juggling prop in my hand I change in ways that are obvious to me and often surprising to others. This includes the things I think to say.

But suppose that I’m in my home and I feel through the floor a large truck rumble by on the street. In my neighborhood this is very rare, and I’m certain my sensibilities would change at that moment. Does this mean that my peripersonal space has extended to the street? Wouldn’t it include things I only hear but can’t feel otherwise?

An appreciation for the potential size of another’s peripersonal space and the many ways we might enter into it, manipulate it, communicate with it and affect the brain maps associated with it might enhance your therapeutic presence. In fact, it might explain why yours is so different from a colleague’s given the same patient.

I never take another’s clothing off when I handle them because I found that it simply wasn’t in the way. The skin is sufficiently sensitive to convey accurately the pressure of my hand and how that might change as I stay some distance from it but attached to something that’s attached to it. After all, with Simple Contact I’m communicating, not coercing.

Is it possible that the most important aspect of manual care is our relationship to the patient’s peripersonal space?

[Jon Newman]

Does this mean that my peripersonal space has extended to the street?

This is one of those moments where I have to decide whether to engage in pendantry. As you can see, I've decided to proceed.

I've seen peripersonal space being defined by the space in which the limbs can reach. Extrapersonal space is that which extends beyond reach (to the street for example). At this point in the conversation I don't think it impacts much but it might as the thread develops.

[Barrett Dorko]

Jon,

A good point, but I'm wondering how arbitrary these definitions of "peri" and "extra" are, and if the brain makes any real distinction. If it did, how would we know that?

Imagine this: I’m seated in the front of a conference room, reading, writing and listening to some jazz piano by Art Tatum. This is in fact the way in which the vast majority of therapists are first introduced to my presence.

As soon as we are in some way aware of each other, usually a visual awareness with some audio on the side, the peripersonal or extrapersonal spaces we possess are affected and each of us manipulates that effect in ways that increase our comfort and survival.

Now, if the therapist playing the part of student for the day wants mainly to hide – and this isn’t at all unusual – I can tell by where they choose to sit, how they move toward that spot and how readily they respond to any welcome I might devise. I’m completely wrong about all this at times, of course, but I do what I can.

I presume that the common disregard for unconsciously generated movement possessed by most therapists makes it easier to see what they truly want to do. In effect, when they enter my peripersonal space we begin to play poker, and, as yet, they don’t know that they are revealing a “tell.” But my approach to therapeutic movement is all about that and has been for decades. I can sense things others don’t and can interpret them with a certain amount of accuracy.

What effect do you suppose my skill at this might do to the mind maps in the student who wants first and foremost to hide?

[Jon Newman]

Hi Barrett,

A good point, but I'm wondering how arbitrary these definitions of "peri" and "extra" are, and if the brain makes any real distinction. If it did, how would we know that?

I haven't read the books referenced at the beginning of the thread so there may be updates to the study I've attached. If not, and if the findings are valid then there does seem to be real distinctions.

In summary, evidence from brain-damaged patients and monkey neurophysiology suggests that the brain constructs multiple representations of space. Given that the brain represents personal and peripersonal space distinctly, how are these representations bound together to give a coherent phenomenological awareness of space? We suggest that cross-modal and sensorimotor integration are two mechanisms that bind personal and peripersonal space.

and

Evidence for the segregation of peripersonal and extrapersonal space comes from reports of left neglect within one or the other of these sectors of space. Halligan and Marshall (1991) asked a patient to bisect lines of equal visual angles located either in peripersonal or in extrapersonal space. Their patient showed left neglect in peripersonal space but not in extrapersonal space. Cowey, Small, and Ellis (1994) reported patients with the opposite dissociation, finding more severe neglect in extrapersonal than in peripersonal space.

[Diane]

Maybe the disctinction Jon has made relates back to the question you raised earlier Barrett, about what is sensory and what is motor. It makes sense to me that peripersonal would be motor (extendible by incorporating a tool into the map, like a blind person's cane that comes to feel like part of their body, so they feel they are touching the sidewalk with their hand, not the cane), and that extrapersonal space is sensory (one can see across the room and intuit things/form ideas based on what is incoming).

I suppose the primate brain however has learned to overcome distance, will try to send messages through facial muscles, smiling or glaring through space toward that upon which its binocular vision has landed. So there will be motor action involved in extrapersonal mapping (looking/hearing) and sensory intake involved in peripersonal mapping (tool using).. still however I think a distinction can be made and the territories in the parietal or temporal lobes are likely overlapped but perhaps distinctive in terms of cells. Like place cells and grid cells are in the hippocampus. Which share space but map slightly different things.

[Barrett Dorko]

Jon and Diane,

Oh. Good find.

[Barrett Dorko]

“But every phenomenon begins as a small, small thing, and its eventual nature is vitally dependent upon what that thing is and what it’s capable of doing. We sense an inability to both measure and control the things that form the basis of our world, and a patient in pain - in our hands - is one of those things. Many therapists fear it."

Me, from the thread We’re looking for a movement

I am, in my imagination, an offensive lineman. I say “imagination” because I was actually in the high school marching band. But still, I see myself in this role and wrote of this rather recently here.

Consideration of another’s peripersonal space along with our own must precede any form of manual care, and I think that therapists know this on some level even if they’ve never heard of the term. As always, ignorance leads to fear, and it is that fear I see expressed by so many after I invite them to touch another in the Simple Contact courses.

If I’ve the sensibilities of an offensive lineman, especially a pulling guard (you’ll have to read the thread to understand that well), what might be the end result of my contact with a certain number of therapists? With certain patients?

[Diane]

If I’ve the sensibilities of an offensive lineman, especially a pulling guard (you’ll have to read the thread to understand that well), what might be the end result of my contact with a certain number of therapists? With certain patients?

I think it would be a function of the "nonverbal" part of the "therapeutic contract" one makes and remakes every second that one is involved in touching another person's body. I think the therapist (hopefully) learns to shift smoothly between self/other, "allo(other)centric" and "ego(self)centric" parts of his/her own brain or at least hippocampus, between place cell/grid cell combinations. All of this brain shifting in one brain is also going on in the other brain simultaneously. After awhile it all seems to come into phase; once the patient's brain has checked out you, on all its levels, and has decided it can trust your contact enough to ignore it in some places and use it in others, then it can get busy changing itself.

I think this is what must be the magic at the core of any successful intervention, regardless of type of "technique" or "construct". This is, I'm guessing, what the actual meaning is of "when you sample someone's nervous system it is sampling yours as well."

I continue to be struck by the opening sentence in Buzsáki's book:

The short punch line of this book is that brains are foretelling devices and their predictive powers emerge from the various rhythms they perpetually generate. At the same time, brain activity can be tuned to become an ideal observer of the environment, due to an organized system of rhythms.

In treatment we are adding, essentially, another brain to the mix. Another 100 billion neurons. Another pulsating, phase producing, rhythm producing nervous system. Something new forms for a short period of time - a new entity, a doubling. The patient's brain will continue to form its own responses, but at some point it will decide to adapt. At least we hope it will. Something that was formerly part of its "environment" will now form part of its "function", as it "simulates"... something it does all the time anyway..
Then it will express its new adaptation outwardly, so its system can practice new output/benefit from immediate positive feedback. If it likes its new function it will retain it.

I can see how this can manifest therapeutically; I can't extend this sensorymotor visioning to include students or a teaching situation, however. While I'm sure it could be ultimately deconstructed and parallels drawn, to me it is still social interaction, over "there" in nonconscious/cultural/troop interaction/ behavior stuff that I'm less interested in for now.

[Diane]

This article, "Perception and production of biological movement in patients with early periventricular brain lesions", might belong on this thread... just for the bolded part if nothing else:

Recent neuroimaging and psychophysical findings suggest that perception and production of human body motion share a common representational network. In the present study, we address the issue of whether early disorders in production of biological movement correspond to impairment in biological motion perception. By using the simultaneous masking paradigm, we examined visual sensitivity to biological motion in adolescents (aged 13–16 years) who were born very preterm (at 27–33 gestational weeks). In a confidence rating procedure, the presence of a point-light walking figure embedded in a moving mask was judged. The participants differed in their locomotion ability, ranging from normal to a complete walking disability exhibiting signs of leg-dominated bilateral spastic cerebral palsy (BS-CP) caused by periventricular leukomalacia (PVL). Irrespective of an ability to produce movement, patients with a similar extent of PVL in the parieto-occipital complex exhibit nearly the same sensitivity to biological motion. Sensitivity correlates negatively with the extent of PVL over the parieto-occipital complex, whereas neither the severity of motor disorder nor the severity of pyramidal tract affection relate significantly to the sensitivity index. The data suggest that perception of biological motion is not substantially affected by an observer’s early restrictions in body movement. Instead, the findings favour the assumption that the common network for perception and production of biological motion might be inherent for the brain. Motor experience per se does not appear to be necessary for the visual analysis of human movement.

[Jon Newman]

I don't have access to the full text of this yet but it looks interesting and related to this thread.

1: Cognition. 2007 Jul;104(1):73-88. Epub 2006 Jul 12. Links
Self-attributed body-shadows modulate tactile attention.

Pavani F, Galfano G.
Department of Cognitive Science and Education, University of Trento, via Matteo del Ben 5/b, 38068 Rovereto, Italy. francesco.pavani@unitn.it
Our body-shadows are special stimuli in the visual world. They often have anatomical resemblance with our own body-parts and move as our body moves, with spatio-temporal correlation. Here, we show that self-attributed body-shadows cue attention to the body-part they refer to, rather than the location they occupy. Using speeded spatial discrimination for tactile or visual targets at the hands, or for visual targets delivered near the hand-shadows, we demonstrate that mere viewing of task-irrelevant shadows can selectively facilitate tactile discrimination at the body-part casting the shadow (Experiment 1). In addition, such facilitation only develops through time for cast-shadows that have no resemblance with the body-part, but move in spatio-temporal correlation with it (Experiment 2). Conversely, facilitation fades away rapidly for shadow-like images that resemble the stimulated body-part, but are in fact static pictures (Experiment 3). Thus, recognising oneself as the owner of a shadow affects distribution of tactile attention.

[Jon Newman]

I requested this article last month (from work) but have yet to receive it. I'll have to check on that because I did receive another article requested at the same time.

Cognition & Instruction; 2006, Vol. 24 Issue 4, p387-437, 51pNoble, Tracy DiMattia, Cara Nemirovsky, Ricardo
Barros, Apolinario


Abstract:A group of high school students created a drawing of a circle using a device called the Drawing Machine. To describe their experiences, we propose an alternative to the idea that to master a tool one must create a mental version of the tool. We suggest, instead, that as students change their relationships to a tool over time, their lived-in spaces change. Drawing on studies of practice, we explore the roles of past experience, planning, and communication in the development of students' lived-in spaces as they increase their competence with the tool and with the mathematics of drawing a circle.

[Barrett Dorko]

Time to recap:

1) How we feel is, ultimately, a function of what our brains decide.

2) The more closely you study it, the more what the brain tells us is obviously an illusion altered in a variety of ways, many of them well beyond our awareness and control. Sometimes this illusion is more helpful than others.

3) That being the case, understanding all of this is far more important than trying to overtly control it or judge it – especially that second one.

4) Our instinctive awareness of the patient’s perception is probably more reliable than anything we can easily measure as is our instinctive awareness of our own.

5) Any real foray into brain processes as we currently understand them is mind-boggling, especially if a therapist has some rock-hard notion of what should hurt, what shouldn’t hurt, and how all of that should appear on the surface of the patient.
(See Nick’s Blog for some more comment about this)

Okay, I kinda made #4 up as I went along there. But it seems to me that the truth about how simple modalities of movement – passive or active – used to relieve pain is this: The patient’s brain knows what’s best, not the therapist. What’s best is a function of instinct far more so than some cultural imposed idea of what is “proper,” and as long as therapists look to the culture for answers first they run the risk of having no real effect or making things worse. Because of this, we need to work to raise our instinctive awareness to a higher than normal level if we are to become effective providers of manual care.

And so I’ve returned to an idea I’ve had for decades now, and the idea is this: Given the appropriate environment the system will self-correct when mechanical tension in the nervous tissue is the primary peripheral problem. I see nothing in the newest revelations regarding brain science to refute that though it’s increasingly clear that any rule I devise to wholly predict how this will take place can be broken in an instant.

Remember, I don’t believe any of this – I understand it.

[Ken Jakalski]

Originally Posted by Barrett Dorko

I’m thinking now about how the things that actually touch us - and thus enter into the closest aspect of our peripersonal space - might potentially change the maps within the brain.

This is an interesting observation. Before the '96 Games in Atlanta, I hosted a 'last chance' trials qualification meet here in Lisle. Several of the top national pole vaulters came to my high school track in hopes of achieving a qualifying mark. While they were warming up, one of the vaulters came up to me and said: "Your plant box is too high. We can't use our big poles."

I was stunned, because the vault boxes were cemented in place back in '82, and no athlete had ever complained. During that time, we had several excellent high school vaulters, but nobody at an elite level capable of going over eighteen feet.

I asked one of the vaulters how much higher he thought the box was placed, since most coaches and athletes, from a visual glance down the runway, couldn't possibly tell the box was high at all. He said he thought it was about three quarters of an inch off.

Since I live a block from our track, I went home and got a level. Sure enough, the box was just under three quarters of an inch high. When I asked him how he and the other vaulters "knew" it wasn't right, he said they had just '"felt it" when they tried warm-up jumps on their longer poles.

A similar experience happened to a friend of mine who is a former national class hurdler. He was practicing at a high school track in California, and after his training session, he went up to the school's coach and told him that the hurdle markings were off on the last three flights.

The coach couldn't believe it, because the track had just been re-striped the previous season. He took a measuring tape, and the hurdle markings for the last three flights of hurdles were seven centimeters off.

The coach asked the same question: how did you know? The reponse was almost the same: it just didn't "feel right" as he was going over the last three gates. Despite numerous meets featuing talented hurdlers, none had ever complained.

Why do certain individuals, in this case, the elites of their sport, have more accurate 'maps' of their experiences than the rest of us? Like the women with the high feathered hats, they clearly have a unique 'feel' or sense for height and distance.

[Diane]

Ken, look up grid cells and place cells. Athletes have more of these, or better functioning ones, or something.. (see here also).

It may be that elite athletes are set up with great sets of these, similar to the way elite musicians or singers are set up with perfect pitch.

[Diane]

Barrett, I think this article belongs here: "Skepticism" and Ignorance - By George M. Felis
Excerpt:

... when it comes to some pet belief they don't want to give up – some conclusion at odds with a vested personal interest or emotional conviction – a vast proportion of people feel free to just toss that whole process out and stick with the flimsiest rationalizations imaginable for their preferred beliefs. Faced with the weight of all the evidence and arguments provided by all the experts who know a hell of a lot more than they do about a given subject on one side – and the weight of what they personally want to be true bolstered by some bullshit arguments generated by some guy on the internet who shares their prejudices on the other side – a frightening majority of people seem to go with their wishful thinking and against all the expertise in the world every damned time. (Don't believe me? Go look at polling data about belief in creationism, astrology, psychics, and other patent nonsense.)

[Ken Jakalski]

Originally Posted by Diane

Ken, look up grid cells and place cells. Athletes have more of these, or better functioning ones, or something.. (see here also).

It may be that elite athletes are set up with great sets of these, similar to the way elite musicians or singers are set up with perfect pitch.

Hi Diane!

Thanks for the insights! It may very well be that these athletes are "programmed" with movement/perceptual templates, and they most often end up 'selecting' the right template for specific situations.

It's sort of like throwing a ball high in the air for younger kids to catch. Some will move to where they think the ball will come down, but then back away, cover their heads with their gloves, or let the ball bounce on the ground.

Others will effortlessly drift under the ball, extend their arms, and catch it with no difficulty or fear. Yet they can't 'explain' how they did it.

I've seen a younger and very gifted catcher once tell his coach that second base was placed a little too far to the first base side. When the coach asked the kid how he knew, he simply said it just didn't 'feel right' when he threw the ball to second base.

[BB]

I know of many similar reports of basketball players and heights of the rim. I myself have experienced this as my role on my high school team was that of the outside shooting threat. I remember distinctly one gym we played in that the rim "felt" 1/2 inch low. I kept this to myself, knowing they would not do anything about it, and also knowing the mind games such knowledge would play on my team mates. Everyone on the team went on to have their worst shooting night of the season during the half we were on that side of the court and then recovered our shooting touch in the next half at the other end.

This was always a bit of a problem at the many outdoor courts I used to frequent as well, but I also learned how to adjust my reference point when shooting to adjust for such things.

It always used to seem I could "feel" the rim instead of the ball when shooting and I always could tell where I was on the court in relation to the rim. This allowed for some pretty cool "no look" H-O-R-S-E game shots.

Unfortunately, I never learned this skill in relation to the person I was defending, making me a clumsy defender.