Critical Thinking

Considering the Noise


In our presentations and writings on the M.I.P Algorithm, we introduce the concept of how  providing a meaningful afferent INPUT, likely influences an output (diminished pain, altered action programming).  As Physical Therapists, we often view “input” as “manual interventions” and we suspect that we can push, pull, thrust or scrape a tissue, to change the output.   We often engage in dialogue with each other on which input is better.  Heck, there are even rules telling us when certain types of input work.   But how often do you consider the individual patient’s beliefs when determining the input?  How often do you consider utilizing the patient in determining a treatment approach?

The self-determination theory (SDT) states that humans have basic psychological needs for autonomy, perceived competence and relatedness (feeling safe and cared for in one’s personal relationships).   When a patient feels these needs are being met, their participation in treatment will be more autonomous and willing.   A recent video posted by ForwardThinkingPT contributor Adam Rufa comes to mind when considering how to provide INPUT that takes into account the SDT.

Input is likely just that…Input.  We must always consider that the input, which may influence pain and motor control, must be interpreted by an individualized brain.  A brain must find that input meaningful to respond with a favorable output.  And we must understand all of the “noise” being heard by the brain when we provide an input.  The brain must ultimately sift through, not only the somatosensory input you provide, but a barrage of other externally regulated information.  When was the last time you considered the prosody of your speech during a manipulation?  Or the lighting in the room?  Or the sound of a radio playing in a background?  All of this “noise” (ie. sensory input) likely has an effect on how that manipulation is interpreted.  They are all additional numbers added to a complex equation. It is never a “no brainer”.

Moving forward, we mustn’t argue over how many tricks we know or how deep our toolbox is, because the tool does not matter.  The skillful ability to interact with our patients complex nervous system, does.

Don’t be a victim of The McGurk Effect (see below).

– Joseph Brence


Categories: Critical Thinking

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6 replies »

  1. Just commenting on the substance, without thinking about the research, this makes perfect sense. It also makes me even more aware that there is more than one way to do things to achieve good patient outcomes.
    Interesting comments on the placebo effect at AAOMPT by folks that have looked at alterations in pain with manipulation.

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