I have witnessed plenty of burns patients cry. I made them cry because of what I do. But have I ever made someone cry without touching them? Maybe… though not like this.
This is a story about the power of the mind. This is a true story about the tenacity of the brain in its effort to protect us from pain in body, and mind. In 2013, I completed the Explain Pain Course along with 60 or so others in Perth. The week after that, I did what all good clinicians do after a bit of PD, and applied my new found knowledge to everything that moved and some chairs that didn’t. One patient really challenged me and confirmed that I still have a lot to learn in this area.
The story starts with NOI laterality recognition cards for shoulder / neck complex. My burn patient, injured over18 months before, worked to become familiar with the cards for a few minutes, then progressed to timing herself to examine accuracy of recognition and record a baseline of speed for separating the deck. No drama.
I neglected to explain that she had suffered a severe and deep burn injury with nasty hypertrophic scarring of her left arm and flank, maximum active shoulder flexion to about 110deg and partial amputation of all digits on that side. So, now sitting her in front of a full length mirror, I asked her to look at only the cards which had shoulder movements above 90deg flexion, close her eyes and attempt to place her arm in the same position, then open her eyes to see how close she was to the pictured position. I turned my back to attend to another patient briefly in the gym and when I turned back, she was crying buckets. When I asked why she was crying, it was not because of the pain of moving her scarred shoulder to the end of its ROM, it was because she had an epiphany…… she realised that when she closed her eyes she could not picture her arm at all.
She had ‘lost’ her body part completely. Today, three months later, we are still struggling to improve her function appreciably in that arm because (I think) she is so afraid of ‘finding’ that arm again because it means attending to the original incident and rocking that supportive world she now finds herself in. A world that didn’t exist before. A world with far less expectations of self and one’s outputs.
My epiphany – The bigger picture is obvious to the brain, but not always obvious to us…….changing behaviour is far harder than changing range of movement – Physios!
– Dr Dale Edgar
Senior Physiotherapist
Fiona Wood Foundation Clinical Research Manager, Perth, WA
Check out all of the upcoming Explain Pain and Graded Motor Imagery courses over at noigroup.com
This is such a beautiful story and demonstrates the bravery of our patients so well. When a patient has been in a chronic state of pain, the surpression of the body area is a coping mechanism and by using Explain Pain techniques we are challenging those mechanisms, often with the most wonderful outcome. But – it is a frightening concept for a patient and why we should ensure that we also give our patients the tools to manage their emotions such as mindfulness and CBT either by ourselves if trained or with a suitably trained practitioner. The biopsychosocial model means that we can open up the deeper aspects of what the brain has surpressed, it is powerful and we should remember this.
Thank you for sharing this DrEdgar and all the best wishes for your patient 🙂