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The News from Cuyahoga Falls This Forum tells a story, meanders, but never strays too far from what clinical life might teach us.

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Old 02-10-2008, 12:50 PM   #1
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Default Cattle Call

It’s been a quiet week in Cuyahoga Falls…

Nothing like the right words in the right place at the right time. Nothing.

Today I noticed the words Natural Magic on a silver colored case in a small room at the skilled nursing facility where I’ve landed this week. Just reading it I felt better. I thought, “Maybe I can work those words into some marketing…” I mean, what’s more popular than those two concepts today?

Eddie Arnold’s Cattle Call was huge cross-over country western hit over fifty years ago and I remember my father mentioning it several times but I never heard it until I sat in a Starbucks one morning this summer. It captivated me and after I’d spent the $.99 to download it I added it to the playlist I’d been quietly enjoying in my tiny corner of the office. In amongst all the Art Tatum jazz piano and Livingston Taylor covers of classic tunes (great harmonica accompaniment) Cattle Call stands out.

Therapy, such as it is in these buildings, seems to be something that takes place at a certain time and in a particular location. It is something given from the therapist to the patient and consumed as is possible by individuals with wildly disparate abilities. I know you could make the case that all of this is true on some level and that the way this thing we call therapy is delivered can be justified in any number of ways. Before you do, let me say that I already understand that.

What troubles me is the repetitive and mindless nature of the work when approached in that way. I’ve long had the sense that therapy can emerge from the patient and that a few minutes of authentic and thoughtful interaction without any emphasis on goals, repetition, effort or exhortation might be all that’s needed for an enduring transformation in function and feeling. Maybe I’m wrong. After all, a lot of this stuff is hard to measure.

Somehow, playing Cattle Call for a few patients seemed to help. They all remembered it and swayed to its lullaby-like rhythm. I suggested making it the official theme song of the PT department but it didn’t happen.

Maybe it was the song title the boss didn’t like. Go figure.

Maybe something like Natural Magic Call would have worked a bit better.
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Old 02-10-2008, 01:17 PM   #2
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This post comes at an appropriate time for me, Barrett. I work 2 days per week as a per diem homecare PT for a visiting nursing service in my area. I started last February, at which point I had to go out on visits with other therapists to "observe."

On these visits, I was struck at how much of the routine revolved around the therapist mindlessly counting out the reps as the patients performed their exercises. I sat off to the side struggling to keep my eyes open and my interest from wandering. I knew I couldn't possibly do things in that manner, so I made a pact with myself to be different.

I follow an approach similar to what you describe. When I first meet a patient, we discuss their reasons for homecare, their families, past work situations, etc., followed by a look at their current abilities.

I then briefly run over some exercises, but I tell them that my purpose is not to count reps like some kind of humanoid pedometer. I have them tell me what they would most like to accomplish with our time for that session together. Whatever it might be...attempting stairs, perhaps a little trick to help with getting into the shower...whatever. I've even spent time at a kitchen table with a woman as she cried about the stresses she felt trying to care for her epileptic brother while she recovered from her surgery. I just sat and listened...I think I could even feel her relief when she let out a long, slow sigh at the end, and we laughed a bit about some trivial things afterward.

To me, this is part of the therapy, and I think your post touches on that gracefully.
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Old 02-10-2008, 09:55 PM   #3
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Barrett

I haven't heard Cattle Call for a very long time; I grew up with US hill billy records every night, coming from Shreveport, Louisiana.
Cattle Call was one of my sister's and my favourites, along with all of Slim Whitman's doleful songs.
Recently I was in a music shop where they were playing Johnny Horton; suddenly I noticed the teeny boppers, the oldies and in-betweens come alive, swinging and foot tapping quietly to the profound beat of North to Alaska, Sink the Bismark and Battle of New Orleans.
I bought the CD. I might even look for Eddie Arnold.

Nate,
The very idea of any PT doling out repetitive exercises day after day is mind-numbing. Doesn't matter if the recipients are aged or teenagers; it is so far from therapy it is scary.
And they get paid for doing this!


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Old 02-10-2008, 10:02 PM   #4
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Thumbs up

Nate, you're a therapist first, a physio second.
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Old 02-10-2008, 10:58 PM   #5
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Thanks for the kind words, Mary.

What a unique opportunity this has been. I've always believed that orthopedics was my primary interest, but I find my few homecare clients to be very interesting, engaging and appreciative beyond what I see in the outpatient clinic where I work full-time. And it's a two-way street--I gain from my time with them as I hope they do with me.

One of my clients this afternoon mentioned her anxiety over her living situation, her boredom with her lack of stimulation in her apartment and her disappointment in her physician at her mention to him that the pain meds weren't working.

We climbed the stairs to the ground floor several times as she requested, each time she was gaining in confidence and in spirits.

Back in her apartment, we talked about why she was bored and what bothered her about her doc. She mentioned the lack of back soreness and a nice tingling of relaxation in her legs now that she was relaxed.

On my way to the door, she quietly said, "I'll see you Tuesday. And Nate, thanks for the talk."

It's nice to have those times.
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Old 02-10-2008, 11:30 PM   #6
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Welcome to the wonderful world of the chronic chrawler. They are such marvelous people. Making a change in their lives, no matter how small, just makes your day.

I can remember the physio who dismissed me as "just looking after chronics" to the md's in our area. I've since moved and the attitude of the physios around me is the opposite. I'm the daring one now. I'll tackle anything (or just about.)
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Old 03-10-2008, 04:52 AM   #7
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Great posts so far.

Barrett, do you know what was in the silver colored case?
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Old 03-10-2008, 05:11 AM   #8
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[moo]Cattle Call .....[/moo] (Jason, cover your vegan eyes and ears.)

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Old 03-10-2008, 01:11 PM   #9
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Diane,

Thanks for the video. I knew I could count on one of you guys to make up for lack of "linkees" on the computer,

Jon,

Natural Magic is a brand of air freshener, which, by the way, seemed to be working pretty well, which is more than I can say about a few aspects of the rehab philosophy I’ve seen in action lately. Perhaps “philosophy” isn’t the right word. I’m not sure what the right one would be though. Not today anyway.

Often I’ve wanted to stop my colleagues and ask them to explain to me why they are doing whatever it is they appear to be doing. I don’t do this, of course, and I’ve no real concerns about any of them reading these words. The effort required to visit this site much less register and participate seems well beyond their capacity. A number of them would watch me work but what I did and thought had no evident impact on the thinking or actions of others. Soon after I started working last February everyone knew that I taught and wrote here but Soma Simple remains a mystery; a rumor; something insubstantial and irrelevant.

I’ve left one facility for good and will soon depart from another as my teaching begins again. I’m fairly certain that it is and will be as if I were never there.
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Old 03-10-2008, 01:45 PM   #10
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Quote:
I’ve left one facility for good and will soon depart from another as my teaching begins again. I’m fairly certain that it is and will be as if I were never there.
Well my personal philosophy suggests that this simply can't be true and I'm sure that there were probably at least a few people there that would agree with me for one reason or another. Still, I get what you're saying, especially that "as if" part. Sociofacts can be sociopathic.
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Old 04-10-2008, 01:19 AM   #11
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Jon,

I know I'm a bit cynical about the impact I make, but I should remember when I visit Soma Simple's threads past that I've asked some pretty good questions and raised some important issues. What I want, of course, is for the therapeutic community to discover us. I've done 3 tours for Summit Professional Education so far and, as far as I can tell, no one from these classes has said a thing on this - the site I flog all day long.

I've got 54 therapists signed up for next Wednesday's program in Portland Oregon and about 40 more in Tacoma and Seattle after that.

I think I'll put Cattle Call on a loop and have it in the background at the break.
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Old 04-10-2008, 02:39 AM   #12
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Apparently online learning is a stronger disincentive than the "freeness" of the learning. It's one of those "it's not you, it's me" kind of things.

Maybe PTs just have a bad case of Misology
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Old 04-10-2008, 02:54 AM   #13
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Quote:
Maybe PTs just have a bad case of Misology
Now how would you sway that?
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Old 04-10-2008, 02:56 AM   #14
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Perhaps PTs could be referred to as "misologists" or "misotherapists". Has a Japanese ring to it which may not be appreciated in that country.

I'm not sure Cattle Call would enhance online learning but one never knows what stirs the brain to think outside an unmisological box.

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Old 04-10-2008, 02:10 PM   #15
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I think that misology is so widespread that we cannot see it - kind of like water to a fish.

Here's an idea: I play Cattle Call several times during the day and then say, "If you'd like to know why I'm doing this you'll have to go to Soma Simple to find out."

Perhaps this presentation of a mystery to be solved will gather a few around us.
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Old 04-10-2008, 02:27 PM   #16
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And/or, maybe you could selectively play the yodel when it's time to come back from breaks.
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Old 04-10-2008, 02:36 PM   #17
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Jon,

That is both a great and dangerous idea.
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Old 04-10-2008, 03:49 PM   #18
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That yodel would present a sharp contrast with those highly polished black shoes.
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Old 04-10-2008, 04:22 PM   #19
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Yes Mary, as I once wrote: "Surrealism as a form of art was “the juxtaposition of remarkably disparate elements." That seems to fit here.

Perhaps the course can become this rather jolting trip between intricacy and simplicity; between comedy and passionate emotion; between the ubiquity of ambiguity and the importance of uncertainty. Perhaps it already is.

Now I'll add Cattle Call to the mix and see what happens.
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Old 04-10-2008, 04:26 PM   #20
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This thread makes me laugh out loud.
Quote:
Somehow, playing Cattle Call for a few patients seemed to help. They all remembered it and swayed to its lullaby-like rhythm.
This is really the point, right? Whatever can help/motivate people move is a good thing, usually, in this profession.

The notion of starting a whole PT movement with something called "Cattle Call" is deprecating, yet oddly fitting.
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Old 04-10-2008, 04:33 PM   #21
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Diane,

You're right. It is both dangerous and appropriate. I'm hopeful that most will get the joke and understand the nature of nuance and multiple meaning. If we can all just agree that this is a pleasant tune, well, that would be something.
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Old 04-10-2008, 04:43 PM   #22
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I do not think PTs have a sense of humor that can easily adapt itself to something known as "self-deprecating" ... they/we are far too earnest and naive. It would just be seen as mean, probably. Maybe the whole concept of playing this at your seminars to get people laughing at themselves should be evaluated/reconsidered.. Most will NOT get the joke - they'll just feel humiliated.
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Old 04-10-2008, 04:46 PM   #23
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This is precisely why I may say, "This was Jon Newman's idea."
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Old 04-10-2008, 04:59 PM   #24
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Quote:
I've done 3 tours for Summit Professional Education so far and, as far as I can tell, no one from these classes has said a thing on this - the site I flog all day long.
Argh! And those of us that are on the site still hoping to get to your seminar, but haven't had the chance yet.

I keep checking your website for the new courses, Barrett. I see you're swinging back toward the southest...I'm hoping the trade winds of Summit push you up to the Northeast again.
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Old 04-10-2008, 05:04 PM   #25
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Quote:
This is precisely why I may say, "This was Jon Newman's idea."

Be sure to tell them that it's good to break down all the sociofacts of a situation, and mentifacts, before accepting any emotional reaction they may have as being real or valid..
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“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

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Old 04-10-2008, 06:14 PM   #26
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Nate,

I haven't yet addressed your comment:

Quote:
I keep checking your website for the new courses, Barrett. I see you're swinging back toward the southeast...I'm hoping the trade winds of Summit push you up to the Northeast again.
Feel free to Contact Summit Professional Education here and suggest a location or an "onsite" program.

Thanks for asking.
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Old 04-10-2008, 06:34 PM   #27
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Barrett, you may want to add (at the very beginning of your course) the admonishment to "Sit up straight now - all of you!" Then let them hold it.......hold it.......hold it....Ask: How does it feel?" .... hold it.....wait for it....hold it.....Then: "OK, you're free - do what you like". Now, "How does THAT feel?"

Maybe it is a bad idea, but it appeals to me when I visualise myself as I was back 10 years ago, attending a course - on ME it would have made a good impact, and you'd have gotten my attention.....

Cattle call?....No, I wouldn't have had the insight or self-confidence to appreciate the humour....
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Old 04-10-2008, 06:35 PM   #28
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Hi Nate,

Does Nova Scotia fit your definition of Northeast? Barrett will be up here next month. It's only a 12 hour drive from Albany.

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Old 04-10-2008, 07:12 PM   #29
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Quote:
This is precisely why I may say, "This was Jon Newman's idea."
Make it the non-poetic, inelegant, unadorned Jon Newman and you've got a deal.
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Old 04-10-2008, 07:48 PM   #30
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Bas,

I'm way ahead of you here. After the first break I take everyone through a Feldelkrais exercise I call Improving your sitting posture. Ironic, huh?

During the course of this I have the opportunity to show them what you've suggested and then have it change for the better in two minutes time. Then I show them where they might find the handout and instructions for patients in the back of the course manual.

What more could you ask for during the first hour?
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Old 04-10-2008, 09:07 PM   #31
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Quote:
Feel free to Contact Summit Professional Education here and suggest a location or an "onsite" program.
I've contacted Randy a few times...I'm hoping something comes of it.

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Does Nova Scotia fit your definition of Northeast? Barrett will be up here next month. It's only a 12 hour drive from Albany.
Thanks for the invite, Nick. I wish I could make it there. I'm going to a class in NJ next month, and with the Thanksgiving holiday (U.S. version ) and the fact that I'm working the 2 other Saturday mornings, I'm out of luck.
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Old 05-10-2008, 01:35 AM   #32
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Barrett, I couldn't ask for more indeed. We must be rare - this group here - for such stuff to resonate considering the lack of post-course traffic here.
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Old 05-10-2008, 02:25 AM   #33
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How many of us have taken Barrett's course? Nick was at the course I took in Moncton. He's the only other one I know of.
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Old 05-10-2008, 04:28 AM   #34
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Mary,

I went to Barrett's course in 2005 in BC, along with Luke Richards, Jon Newman and Diane.
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Old 05-10-2008, 04:30 AM   #35
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Let's see.... me, Luke, Nari, Eric, Chris, Jon were there. Cory on some other occasion. Jason in a different context. I don't think Bas has been. Nor have the Europeans (that I know of).
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Old 05-10-2008, 04:36 AM   #36
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2005. Seems like such a long time ago now.
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Old 05-10-2008, 05:15 AM   #37
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I'll be lucky enough to see the updated version next Wednesday across the river in Portland, OR. Last time was 2 years ago in LA.
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Old 05-10-2008, 10:04 AM   #38
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Nick, Jason, Jon, Chris, Nari, Luke, Cory, Diane, Eric and me only makes 10. + Julie
I see what Barrett means about not getting through.
Gary does SC
As of 8-10-08, We are 11. Add Brian to the list.
9-10-08 and Sara makes 12. She's gone again.
PTee Time, too, and gorgept all from the Portland course
23-10-08: Michelle and Lindsay from Iowa
Erica in 2007, cathyph =19
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Old 05-10-2008, 11:29 AM   #39
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Well, I've never been to Barrett's seminar. We've met once at an APTA conference in I think 2005 and he handled my wife and I and we talked about ideomotion.
It was definitely what I needed to get my mirror neurons engaged with how to do this sort of work. I still don't claim to be very good at it, however, but I have my moments.

I recommend his course to everyone I can - but given what we know about the failure of most CME courses to produce actual behavior change, I don't think that what Barrett refers to as failure in this regard (to motivate students, change their practice, or convince them to come here or grow) is in any way unique to him.

I have experienced this same phenomenon with other PTs - things like SIJ upslips and static posture holding exercises continued to appear in notes for peer review despite the relevant education, etc.
Even the use of manipulation - as attractive as it is for some in theory, it just isn't being used at anywhere near the frequency it should be, for the one group it's proven to be so beneficial for.
If we can't get people to change by reinforcing a treatment that already exists, that reinforces some existing therapy memes, and has been associated with more advanced practice - then you know what that makes Barrett?
Yup, dead man.
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Old 05-10-2008, 02:26 PM   #40
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Jason,

Coincidentally, my new power point presentation repeatedly features a photo of me being counseled by Buckeye, my beagle, while I lie sleeping in my recliner. I’m not kidding.

I appear dead.

This is my latest attempt to engage our colleagues in some sort of enduring and compelling fashion and the jury’s still out as to whether or not it’s working – not because I haven’t tried, but because the trial isn’t over yet.

In Kafka’s classic The Trial something similar occurs and I’d suggest to everybody that they read the short synopsis in the link provided. The book itself is really thick – and I mean in more ways than one.

In any case, the protagonist, Josef K, is (spoiler alert!) executed in the end and his final words describing his own death are, “Like a dog!”

Gives you chills, doesn’t it?
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Old 05-10-2008, 09:21 PM   #41
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It’s also a fact that the vast majority of attendees show up having prepared in no way whatsoever for the day. In response to my gentle inquiry as to why they’re there I almost never hear anything about the actual subjects I’m supposed to teach. I note that they’re wary and express some very low expectation. They’ve never been here or to my own site. They don’t know my name. They’ve endured some perfectly awful days at workshops before so I have my work cut out for me.

I’m reminded of an old vaudeville routine: “The act before me was so bad the audience was still booing when I got off the stage.”
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Old 06-10-2008, 05:01 AM   #42
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Let's see, what are my PT colleagues doing right now?

The owners are probably doing their patient notes from Friday after spending the weekend at various family-related events and dropping by the clinic to finish payroll.

The other staff PTs are either: a) working out feverishly on their treadmills or ellipticals while watching "Dancing with the Stars" b) nursing their babies while watching "Dancing with the Stars" or c) studying for their next AAOMPT practical exam and taking study breaks to watch "Dancing with the Stars."

Talk about the "juxtaposition of remarkably disparate elements."

Such is life these days: flitting from intensity to frivolity- the whole damn country's got a bi-polar disorder that would make Freud gag on his pipe. Certainly, there's no room in such an existence for quiet, calm, reasoning and thoughtfulness. No time to punch "Soma Simple" into one's google search box. Misology, indeed.


There was a time when I would have rather divined John Barnes' aura than have attended Barrett's workshop. Now, I stand there with a patient's body part in my hands and wonder, "How the hell does he get these people to feed that need to move?"

That question is causing me some angst these days.
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Old 06-10-2008, 12:46 PM   #43
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John,

I really need to make a videotape. You'd find that I just land and wait. If within three seconds movement doesn't emerge I land elsewhere. It's so easy that Jason began to laugh, as I recall.

Ask these guys about scheduling an onsite course. Maybe I'll end up in Ft. Wayne, a place I once thought was okay with the exception of your presence.

I've changed my mind.
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Old 06-10-2008, 01:31 PM   #44
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I have never been to Barrett's seminar, yet.
Like Jason and John and others here, that wasn't necessary to make us change our view points and approach to pain; other factors helped, but mostly - we were at some level, ready to change.
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Old 06-10-2008, 03:49 PM   #45
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I attended Barrett's course in Alabama many years ago. Also, heard his presentation to IFOMPT in Vail CO. Thing is, I've always worked in pediatrics, and have not had the opportunity to treat chronic pain. Have utilized SC with family with varying success.

Barrett's coming back to town in November, and my wife and I may attend his course. There is a need for this in my geographic area.
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Old 06-10-2008, 04:51 PM   #46
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So, based on the themes of this thread, i.e. that most PT's aren't "ready" to look at pain differently, and that continuing education courses have shown repeatedly an inability to change therapists' clinical behavior, then the logical next question is, how is the threshold of "readiness to change" elevated? What momentous event or events need to occur in order to get PT's off their butts so that the old orthodigm-ic memes can be overcome?

My personal view on this gets into a discussion of human nature, and what motivates us. I think it boils down to a fundamental issue of freedom: freedom to choose to keep doing things the way you've been doing them without consequences, which is what most PTs choose (why shouldn't they if there aren't any consequences?), or to try something else because your conscience won't allow you to lie to yourself on a daily basis.

That latter group exists here, but it is obviously a very small, however earnest group. We are various combinations of strong-willed, eccentric, iconoclastic, visionary, petulant, and pissed-off. The vast majority of our colleagues just aren't like that, no matter how we wish it otherwise. They are bond within a system that does not require them to reach beyond the safe borders of their culture and values to achieve their true potential. Not unlike our "locked-in" patients in persistent pain, they are in a need state and have no idea how to get out of it.

For some inexplicable reason, they are comfortable there- or at least they perceive their misery as perversely comfortable. Lives of quiet desperation, flitting between frivolity and intensity.
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Old 06-10-2008, 05:27 PM   #47
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Should filling in a readiness to change questionnaire become a prerequisite for the course? or for course certification of participation?

Is there a team somewhere interested in measuring readiness to change in professionals of various types.?

Would this make an appropriate research project for a masters?
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Old 06-10-2008, 05:34 PM   #48
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John,
Quote:
then the logical next question is, how is the threshold of "readiness to change" elevated? What momentous event or events need to occur in order to get PT's off their butts so that the old orthodigm-ic memes can be overcome?
I think you might mean "lowered"?

Age can be of help, but not necessarily.
A need to feel more secure, more "correct" or on track possibly. That one's life/memplexes have not been a complete waste of cognitive capacity/oxygen.
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Old 06-10-2008, 05:36 PM   #49
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Hi John,

I agree with your post with just a couple of modifications. I think you want the "readiness to change" threshold lowered, not raised.

Quote:
I think it boils down to a fundamental issue of freedom: freedom to choose to keep doing things the way you've been doing them without consequences...
I think there are consequences to acting as people do and it is these consequences that help sustain the acting. Although, I suspect, that by consequences you mean the type that should otherwise alter their behavior. The consequence of NOT getting paid to do something you used to get paid to do might be an example.. That may work but I think hot and cold pack use, for example, is still widely used despite lack of reimbursement. Not that I'm against hot or cold packs but no longer reimbursing their use hasn't eliminated the behavior.

Edit: I see Diane saw the same issue with thresholds.
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Old 06-10-2008, 05:49 PM   #50
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I see we are discussing two quite different broad manners in/by which change might be driven in PT behaviour/thinking.

One is to change the outside context, i.e., stop paying people for implementing unsustainable memeplexes, which as Jon points out, doesn't work so well out in the real world. The other is to point out alternatives, ideas that encompass more variables or account for more variables, which are therefore cleaner hypotheses, which is what science is supposed to be about.

But as we know, misology runs rampant through this and most other human primate social grooming professions. In fact ours looks to be less tattery than most in this regard. So I don't know what we can "do" except just keep doing what we are already doing, which is at least heading in the right direction (I think) and hope that others will get it.
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