Suppose this were true

[nari]

A case of nonconscious conflict (though a gentle one) with the conscious?

Nari

[Jon Newman]

This might not be interesting to anyone but me but I'm going to quibble a bit with the term elite. Noticing the small differences described requires significant experience and the right genes. However, elite performance, to my mind, is being to adapt to the condition. Just noticing there is a difference and being unable to adapt is specialization.

[BB]

Good point Jon. You can be an elite shooter and not an elite player, or even a good in-game shooter.

The Seattle Seahawks currently have a middle linebacker who if he were to be recruited today would likely not have been drafted. He is slow, small, can't jump. But, he has made a significant impact on the team because he has a "knack for being in the right place."

He is not elite in the basic athletic skills of football, but has an elite "football sense." He is able to use what he has very dynamically within the context of the game. Carryover to performance with its ever changing environment is the crucial aspect of being in this category of elite and this is also notoriously difficult to test for, hence people such as Joe Montana and Tom Brady being drafted so late. (although as a lifelong Colts fan I feel it is my responsibility to point out that Brady likely had to sell his soul to the devil (aka Belichick) for such a disparity to have occurred.)

[Diane]

Kind of like Gretzky?
(He was quick at hockey and good at scoring, good "hockey sense", but small by comparison with others, a definite handicap in hockey - he was protected by other team mates from the brute collision sort of sport mentality that comprises the game. His larger team mates warned others on other teams, in sombre tone, "Leave Gretzky alone".. with the implication that if Gretzky were banged into or elbowed or stick handled or neck broken or anything else that is still "legal" in hockey, there would be some serious payback of an extremely amplified sort.. which is the only way he survived intact.)

[Nick]

Originally Posted by 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.

Barrett, I want to come back to the shift in your thinking and, in particular, ask how you think this affects the distinction made between chemical and mechanical pain / sensitization?

[Barrett Dorko]

Nick,

Thanks for asking. There are several things here and perhaps listing them in some way will order my thinking.

What Doidge did in that sentence, in his podcast and with tons of supporting evidence was to make it clear that no matter how much I might understand about the actual origins of a patient’s pain, no matter how much experience I brought to bear and no matter how conducive to improvement the environment I worked in, if the patient’s brain wasn’t ready to change all of that didn’t matter.

He also made it clear that no matter how irrational, ignorant and badly motivated I might be, if the patient’s brain changed appropriately I would seem to be an excellent practitioner.

For all my efforts to understand the workings of the body, the subtlety and importance of physiologic shifting during movement and the use of my highly trained sensibilities regarding touch, I am helpless when it comes to the decisions made by another’s brain. (That’s pretty much my first point made in another way)

I read this book at the same time I watched my job with Cross Country crumble and the parallels are, to me, obvious. The vast majority of my students (over 6000) saw me as a benign, innocuous, occasionally funny and mildly irritating interruption in their clinical life. Others were inspired but only until they reached their car. Still others could see that these ideas were a distinct threat to their belief system and they grew very angry. The latter group was the most active and thus the most powerful. I realize now that I could not possibly have altered their reaction and actually taught anything at the same time.

In short, what we do pales in comparison to what the patient/student chooses to perceive, and when these two things do not resonate in any way perception takes precedence. Doidge makes it clear that this is more powerful than I ever imagined.

[Luke Rickards]

Barrett,

You wrote,

I think that an important aspect of dysfunction/pain is the disparity between maps.

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?

As Nick alluded to, I think we may need to differentiate between cause and consequence here. I haven't read anything yet to suggest that substantial reorganisation of brain maps occurs in the absence of substantial alteration in peripheral input. In most cases, I think it is still safe to say deformation and irritation play a role. Further, it has been shown remapping occurs almost immediately after injury, however, from the editorial by Moseley, discussed here, "The model advocated by McCabe et al. may apply to some pain states, but discordance between motor intent and movement seems insufficient alone to cause pain." Of course I can't be sure, but I think it would be safe to say that it is not unlikely that this applies to discordance between other brain maps in relation to pain. The maintenance of chronic pain might be another story though- a consequence of the remapping process when unresolved.

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.

If we consider many of the amazing examples in these two books, it is clear that input to map representation at various levels may be sufficient to convince the brain that threat has been resolved, eg, CRPS is reduced by both higher level motor input and visual input representation. The existence of placebo would rule out the claim that any aspect of therapy, other than expectation, is necessary, but that doesn't mean that input into the motor representation maps is not sufficient to resolve a discordance (if that is truly the problem).

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?

We have discussed previously how non-threatening input to the somatosensory cortex via skin contact may help in resolving map disparity, as well as the effects of novel (ideomotor) movement, but I also think it is worth discussing the repercussions of this for stronger forms of manual/physical therapy. We saw in these articles that there is somatotopic representation in the insula for non-cutaneous somatic input (none of us need a reminder of the importance of the insula in pain). During deep massage, acupuncture, stretching, neural tensioners and spinal/joint manipulation we become consciously and acutely aware of sensation from internal tissues that is not possible otherwise. As Barrett noted above, the Blakeslees have described “(creating) a powerful input of touch sensation (to) help overcome (a) distorted body image.” Could a powerful (and non-threatening) input of sensation through the somatic map in the insula do the same thing for pain.

[Diane]

Beautiful post Luke.

it is clear that input to map representation at various levels may be sufficient to convince the brain that threat has been resolved, eg, CRPS is reduced by both higher level motor input and visual input representation. The existence of placebo would rule out the claim that any aspect of therapy, other that expectation, is necessary, but that doesn't mean that input into the motor representation maps is not sufficient to resolve a discordance (if that is truly the problem).

My bold.

The brain needs very little to get itself out of pain, maybe just a "consummatory movement" or maybe even just a consummatory movement illusion, along the lines of a perceptual illusion as per Ramachandran/mirror therapy.

I recommend the Hardcastle book for a long lingering deconstructionist look at pain as a felt phenomenon to be dissected neuroscientifically.

[Barrett Dorko]

Yes Diane, another Luke classic. I was just about to highlight the passage about the distinction between what is necessary and what is sufficient when you beat me to it.

So much of what we need to understand and express to our colleagues is right there.

[Chancellor Mobley]

Hi Barrett. Thanks again for another great thread. In post #45 you wrote,

Originally Posted by Barrett Dorko

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.

If I'm not mistaken, the main way you deduce that mechanical tension in the nervous tissue is the primary peripheral problem is through movement. I am still a bit confused about central and peripheral issues in regards to pain and it may be because I have been viewing the issue as an 'either or' one with regards to non-pathological persistent pain. With the maintenance of chronic pain could the movements that lead to analgesic responses be due to the smoothing out of incongruencies within the brain's maps rather than resolving some chronic mechanical tension?

Chance

[Barrett Dorko]

Chance,

I think you’re on the right track. Perhaps we can see the peripheral and central considerations as two hands that are forever clasped. Their relative strength cannot be seen or sensed very easily but without question the configuration of one has a very strong effect on the other. As therapists we seek not to “bring them into balance” or make them appear symmetrical in some way, but only to acknowledge the potential power of each. If you want to carry the metaphor a bit further, I think it’s important to recognize that we cannot see what these hands might hold hidden within.

The mapping disparity and its potential to cause trouble reminds me of something a philosopher once said: Pain is the result of plans thwarted and hopes dashed.

It seems to fit perfectly here.

[Jon Newman]

I thought of this thread as I observed my dog (Taber), now sporting an Elizabethan Collar, ramming furniture, door frames, stair steps, and people with the collar.

p.s. Taber is just fine although I'm worried he may not be if his schema doesn't change soon.

[Jon Newman]

Mo at Neurophilosophy blog has a post focusing on somatosensory mapping after a hand transplant. I'm sure this person who had the transplant had other priorities and concerns but as long as they are studying what happens in the brain it would be informative (I think) to include the sort of concepts considered in this earlier post (in this thread).

[Jon Newman]

BPS digest has a new blog entry up concerning body schema and tool use and, well, this thread deserves a bump.

[Barrett Dorko]

You're right Jon. This turned into a remarkable thread and many issues remain unresolved yet important. There's even a reference to "too simplistic" in post #20, prescient of this new thread.

[Jon Newman]

Mo has a relevant (well I think so anyway) blog post up at the Neurophilosophy blog

The virtual body illusion and immersive Second Life avatars

[Diane]

Some day maybe there will be applications for virtual manual therapy.

[Jon Newman]

I think mirror therapy and laterality training, etc are steps in that direction and I'm glad to see PTs working with these ideas and developing a database from which sensible practice can be based. While early adoption has its problems, I sometimes worry that PT will miss the boat in integrating these ideas into our practice.

[Barrett Dorko]

Norman Diodge says:

Pain and body image are closely related.

This is from the first line in post#1 of this thread, and it explains, predicts and dictates so much about clinical life. Maybe the high tech stuff will help to finally bring our attention to it.

"Virtual manual care" is, in effect, what you can do with your voice at times. The "Sound like touch at a distance" thread speaks of this. I don't have time to hunt down the link.

[Diane]

Originally Posted by Barrett Dorko

Norman Diodge says:



This is from the first line in post#1 of this thread, and it explains, predicts and dictates so much about clinical life. Maybe the high tech stuff will help to finally bring our attention to it.

"Virtual manual care" is, in effect, what you can do with your voice at times. The "Sound like touch at a distance" thread speaks of this. I don't have time to hunt down the link.

You're right. Sound falls on receptors (hair cells) that are much like skin receptors. I think they even use the same neurotransmitters.

[Jon Newman]

Reach Adaptation: What Determines Whether We Learn an Internal Model of the Tool or Adapt the Model of Our Arm?

[Jon Newman]

Plenty to read here for the duly motivated. Hat tip: BPS Digest.

[EricJames]

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.

[Jon Newman]

I'm bumping this thread as appeal to bridge a gap. I think it's abundantly clear that we discuss that anatomy/structure interacts with the nervous system. That they are interdependent.

Another structure/anatomy interdependence argument comes from Frank R. Wilson in his book The Hand. For an interesting summary, as well as some digressions, see The Hand: at the Heart of Craft by Bruce Metcalf.

On a tangent, consider also the Creative Instinct thread.

On an even longer tangent, for those offering ideas for a logo consider Handoc.com for a resource for hands including hand/brain related art.

[pht3k]

Barrett, i was reading your belief explanation using the location of the house and i was at the same having images of the movie the matrix in my head. so many points in common with what we would like to acheive. maybe we could simply say to our patients: take the red pill!
No seriously, talking pills, i am pretty sure using hallucinatory drugs in a medical context within a controlled environment, with highly trained personnal to explain pain and related stuff in a calm and safe manner, it might be easier to change the mind, the way we see things and think, the belief. Timothy Leary always said LSD removes some brain inhibition and allows some obscur brain function, like telepathy. I am not saying i beleive in telepathy but i think an other brain state might help to change the way the brain perceives things. belief are resistant to change, because of their connection to senses. Well let's allows some change at the sense level. Also, I was reading a few months ago that psylocybin is now used as a treatment for depression.

[Jon Newman]

Janet Kwasniak, author of the Thoughts on Thoughts blog, has a new entry considering a study of "The neuroscience of primate intellectual evolution." I'm bringing it here because the following selection caught my eye:

When our rake-trained monkeys wielded the rake in order to retrieve food, these same neurons’ visual receptive fields extended outwards along the axis of the tool to include the rake’s head. In other words, it appeared that either the rake was being assimilated into the image of the hand or, alternatively, the image of the hand was extending to incorporate the tool. Whenever a monkey was not regarding the rake as a tool and just held it passively as an external object, the visual receptive field withdrew from the rake head and was again limited to the space around the hand.

[Barrett Dorko]

Jon,

I've read through this a couple of times and find it perfectly suited to the thread.

Do you think it's fair to say of our relation to our primate relatives,

"Though dormant in terms of use and our recognition of it, we have what they have and a good deal more."

?

[Jon Newman]

"It" can cover a lot of ground but I think your statement is very fair.

[Barrett Dorko]

According to all the research on unconscious processes, "it" does cover a lot of ground.

[Jon Newman]

Fair enough.

[Jon Newman]

While it was never mentioned in the Iriki/Sakura article, the ideas expressed seemed related to the Baldwin Effect (note: the first link in the link no longer directs people to the right page). It makes me uneasy to suggest that tie-in knowing that it wasn't mentioned in the article.

[Jon Newman]

I thought of peripersonal space when I saw the pictures linked to in this Thoughts on Thoughts blog entry--Making the Vague Visible.

[Barrett Dorko]

Jon,

The size and popularity of this thread reminds me of how hard so many have worked to make sense of what we do. In fact, my favorite definition of science is that it seeks to make sense of things, not prove them.

Peripersonal space certainly fits here, and so does embodied cognition, something I'm working to read more about.

[Diane]

Originally Posted by Barrett Dorko

my favorite definition of science is that it seeks to make sense of things, not prove them.

I think this backs up that statement very well: Science without method from Neuroskeptic blog.
Excerpt:

When scientists sit down to work, we don't use "the scientific method" to make discoveries. We use microscopes, brain scanners, telescopes and particle detectors, all of which are just ways of looking at things. They're special in terms of what they let you look at, but that's it. Science is looking.

It's true that in order to do good science, you need to be careful. You need to avoid falling into various traps that lead to misleading data and false conclusions. You could call the care taken over scientific observations "The Scientific Method", and some people do, but that's misleading, because none of it is specific to science.

[byronselorme]

That is a great blog.

you just have to stop now. There is no more time in the day.
I like the debating Greenfield post very much as well

If the brain is plastic and adapts to the environment, as Greenfield argues, then surely the fact that it is adapting to the information age is neither surprising nor concerning. If anything, we ought to be trying to help the process along, to make ourselves better adapted. It would be more worrying if it didn't adapt.