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The analysis of movement is
traditionally done by first describing the anatomy in terms of rods linked by
joints to which muscles and ligaments are attached. Then using a variety of
techniques, a 'best' solution for a task is obtained and validated using EMG
techniques. This results in a representation of the function of the musculo-skeletal
system which is then used to diagnose and treat patients.
This approach is rooted
in the desire to find a unique "best" solution ("best"
stable posture, "best" gait sequence etc.) to circumvent the
redundancy inherent to mathematical models. However, a close examination
reveals that the attractive concept of a single best solution fundamentally
disregards the visco-elastic nature of collagen and other biological material
and contradicts the second law of thermodynamics.
It is proposed that
structural stability is not necessarily a desirable property of most living
systems. There are considerable evolutionary benefits in being an unstable
machine in a relentless gravitational field. Indeed, what kind of stability do
we have when the loss of the central nervous system will have us collapse in the
gravitational field? The various representations of the function of the spine
have serious implications on the diagnosis and treatment of patients.
Clinical data can no
longer be interpreted through that narrow structural stability lens, and the
many less than successful back surgeries are, amongst many factors, a vivid
testimony that something is not right.
To compound the
problem, the clinician's performance analysed by blind studies demonstrates that
the diagnostic of low back pain assumes that the patient will describe his
condition in an objective way. When a contradiction arises between the clinical
examination and the physical examination, clinicians are overwhelmingly swayed
by reported pain. It seems reasonable to ask if there are better ways to
integrate the patient's measured function and symptoms with the reported pain.
Technology that permits
an unprecedented access to musculo-skeletal information will be discussed
together with a model of using artificial intelligence techniques that can
integrate clinical information. This mix of rigor and experience can be shown to
compensate for the inherent limitations of the clinician natural sensors.
These ideas generated a considerable amount of
unsolicited criticism. But peer review is the essence of academic work, and it
is hope that a reasonably controlled discussion would help to clarify the merit
of that approach and the direction of future research.
Outline of the course
Sunday morning - The Theory: What is the function
of the cervical and lumbar spines in flexion-extension (with and without
weights) and locomotion? How can the head (as a sensory platform) be stabilised
at minimum energy expenditure regardless of the motion of the shoulders? What is
the cycle of energy transfer during gait and how does the gravitational field
control the transfer and storage of energy liberated by the hip extensors to
propel the body forward? How important is the coupled motion of the spine in the
energy recovery and distribution process? What is the role of collagen in
slowing down the rate of increase of entropy and the degradation of energy? How
can we integrate the entire musculoskeletal system into one energy efficient
functional unit? The presentation will be followed by a 60 minute discussion.
Sunday afternoon - Application of the Theory: How
to measure the function of the spine? What to measure? What are the invariants
of movements that are dependant upon the pathology and not upon the voluntary
decisions of the patient? How to avoid the standard statistical mistakes in
interpreting the differences between the average responses of the normal and
abnormal ? How to define a Range of Normality versus the Range of Motion? How to
integrate the objective measured data in order to reach a diagnosis? How does
the technology perform with respect to the clinician in blind controlled
studies? What is the real impact of reported pain in the clinical diagnosis of
low back pain? Examples of diagnoses and patient follow up. The presentation
will be followed by a 60 minute discussion.
Teacher: Serge Gracovetsky
See "Science & Humour with Dr
Serge Gracovestky"
Part 1 at http://www.youtube.com/watch?v=qgh2C8M50Iw
Part 2 at http://www.youtube.com/watch?v=8810_CpLRlI
This lecture is being
re-run in Autumn 2011 - keep an eye for date as soon as it is finalised. Contact us at info@bodyworkcpd.co.uk
to note your interest.
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