physiotherapy dystonia network meeting 11th march 2016
TRANSCRIPT
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THE CHELSEA EXPERIENCE: THE WHOLE-PERSON COACHING APPROACH
Richmond Stace MCSP MSc (Pain) BSc (Hons)
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How we met
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pain & dystonia met
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shared characteristics Complex biology ‘in the dark’ Emerging in the person Embodied Lived experience – ‘moment to
moment’ Influences
Emotional state Attention Expectation
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complex biology All biology pertaining to sensing and
moving… Experience now: prediction of what ‘this’ all
means And then influences upon sensing and
moving: e.g./ Thoughts Emotions Environment Prior experience
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Biology in the dark Inside the skull, the body Somehow creates our reality pain,
dystonia, vision Action shapes this biology that shapes
our on-going experiences and reality Bi-directional This creates opportunities for change…in
a new direction
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dystonia The person experiences & suffers
unwanted movements and the effects thereof
Movement Planned then executed What is the job in hand? Usually precise ‘Over-steer’
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the story What is the trigger?
Stress, emotion, a context?
That point is not in isolation
Often a backstory stiffness, tightness, gesturing, posturing
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listening to the narrative The story unfolds allowing for a meaning Opportunity to explain what has
happened and is happening They describe their lived experience Our aim (together – cooperation) is to
change the lived experience in a meaningful direction
Where the ‘treatment’ begins
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lived experience Altered movement – observe and test Altered body sense – tactile discrimination World (environment) perceived differently Facing the world Altered sense of self How does the world see me? Impact factor – limitations, avoidance? Self-confidence, self-efficacy
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coaching Person becomes their own coach Moment to moment thinking and action Thinking and action aligned with vision of
healthy self Promote independence, belief in self Growth mindset Practice & quality – take every
opportunity Motivation, effort, resilience
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the context and the mindset Set it up Understanding Environment,
thought patterns, what is happening now?
Practical mindfulness Like ploughing a field
before sowing the seeds
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sensorimotor training: touch Expected in
physiotherapy Develop
relationship Warm touch
(have warm hands!)
Social touch for co-operation
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Sensorimotor: stroke (caress) Signals to
sensorimotor areas
Rapid stroke/caress
Like stroking a dog Sculpting body
sense Use it or lose it
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Imagery Recognise training: left/right judgements Watching others move ** Imagined movements
Planning stages of movement ? affecting prediction of next movement Often see small movements starting –
overspill Often improved quality movement & body
sense
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Visualisation Creates calm with mindfulness Evoke certain feelings and sensations Visualise normal movement – often hard Cultivate ‘confident you’, belief in yourself Helping with the prediction Maintains alignment with healthy vision
and associated good feelings Motivation & resilience
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Tactile discrimination training Develop body sense Body sense key for normal movement Sensorimotor Thick and thin: aka cork and pen Concurrent with stroke + look;
movement training
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Actual movement Best quality Aiming for precision (relies on improving
body sense) Repetitions (practice +++) Feedback -- mirror Integral with sense of body &
environment Context affects movement – where to
practice?
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Self-awareness Awareness towards dystonia anxiety,
more unhelpful thinking, more unwanted movement etc.
Focused attention training aka mindfulness Letting go of unhelpful thoughts Focus on healthy action
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Summary: whole person Focus on the lived experience:
Who they are How they move How they feel What they feel How they envision themselves
Interaction between all – their reality
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contact Richmond Stace Web & blog:
www.specialistpainphysio.com [email protected] Twitter @painphysio T. 07932 689081