A Sense of Things
Barrett L. Dorko, P.T.
In 1992 I did a presentation for The International
Federation of Orthopedic Manipulative Therapists about the potential effect of
manual care upon the therapist. I spoke of stretch activated ion channels in the
therapist�s hands, reflexive effect and my personal experience of increasing
sensitivity as I remained in the clinic year after year. Geoffrey Maitland, the
highly respected founder of manual care in
The Task
Imagine being given this task. Before you is a shape of
some sort and you cannot see beyond its surface. The object has a covering which
is pliable to various degrees in different areas. You�re told that there is a
certain, silent activity within and that the shape itself might change at any
moment. Your job is to sense and interpret the internal activity while
permitting a change in the shape no matter how subtle or dramatic. How would you
go about accomplishing this? How would you describe what you eventually came to
sense?
The handling I do when treating patients is guided by my
thoughts about the task I have described here. I am not referring to specific
tests of provocation.
The Synesthetic Experience
A few years ago I reviewed a book entitled The
Man Who Tasted Shapes by a neurologist, Richard E. Cytowic. It concerned
Cytowic�s study of synesthesia, a
specific neurologic phenomenon defined as �Joined sensation-the rare capacity
to hear colors, taste shapes or experience other equally strange sensory fusions
whose quality seems difficult for the rest of us to imagine (From Synesthesia; A Union of the Senses also by Cytowic).� In the
review I said in part, �After an exhaustive study of the limbic system using
various methods to highlight the releasing of its normal processes to the
conscious mind, Cytowic concludes, �...synesthesia is a very fundamental
mammalian attribute. I believe synesthesia is actually a normal brain function
in every one of us, but that its workings reach conscious awareness in only a
handful.�� The idea that we might all be experiencing some melding of the
senses though we are not all aware of it is also mentioned in the forward to
Cytowic�s first book written by
neurosurgeon Ayub K. Ommaya: �After all, synesthesia is what we all do
without knowing that we do it, whereas synesthetes do it and know that they do
it.�
�We don�t see with our eyes, we see with our brains.�
The speaker is Paul Bach-y-Rita, a physician and neuroscientist at the
It appears that while naturally occurring synesthesia and
the neurologic adaptation induced by means of Bach-y-Rita�s training and
instrumentation are not precisely the same, the difference is primarily that of
control and the end result, the translation of one sense to another, is much the
same. The lack of simultaneous
experience, i.e. the blind person has no sense of their hand, may be at the root
of its distinction from the naturally occurring condition.
Can You See With Your Hands?
Bach-y-Rita has proven that it is possible to create a
controlled form of synesthesia with enough of the proper training. The
implications for rehabilitation are enormous and for this he was awarded the
Coulter Award from The American Congress of Rehabilitation Medicine in 2002. What
I�m proposing here is that manual care often does this as well. In the clinic
synesthesia is created by prolonged manual contact combined with verbal feedback
from the patient concerning the nature of their sensory response. The therapist
is certainly blind to the inner activity of the patient, and, the information
they gather regarding the location of the mechanical and reflexive effect of
their handling would be processed by the therapist�s brain in much the same
way the blind person learns to create internal images once given a little
practice and feedback.
For many years I have employed what I call Simple
Contact, a method of manual care that gently makes the patient aware of
their inherent self-correction, also called ideomotor
activity, and allows its fullest expression. This handling does not involve
coercion, direction or provocation and the therapist exerts a pressure designed
to do no more than slightly deform the patient�s skin. I typically maintain a
distinct stillness after I�ve landed somewhere with my hands and focus my
attention on the patient�s response. I�m referring here to their reflexive
reaction some distance from my contact. Long ago I noticed that I could tell
where the patient sensed their changing (feelings of warmth, internal movement
of one sort or another and alterations in symptoms) before they told me. This
began to occur after asking many times, �What are you feeling and where?� I
began to know where they would describe their change because, well, I was
getting an image in my head. Often this was a distinct impression of the body
part though often it was not quite as clear as that. I still check my accuracy
several times with every patient during the course of any treatment but long ago
concluded that I had somehow acquired this odd ability. It has never been what I
would call infallible. My sense of things as I employ Simple Contact is an
unintended consequence of my method and technique. As you might imagine, the
dialogue it generates with the patient can be quite useful.
Bach-y-Rita�s work and the theories regarding the nature
of synesthesia provide a theoretical explanation for the images in my head. I
wouldn�t have predicted that this would happen but, knowing what I now know,
it makes sense that it would. After all, a blind person acquires a sense of
their environment in the same way I gained a sense of my patient�s internal
activity. Neither one of us can see what it is we sense in the usual manner but
instead extract a meaning from tactile stimulation that is reinforced by
repetition and reliable feedback. No one questions the blind person�s ability
to do this-why wouldn�t it happen to me?
Bach-y-Rita suggests that the central processes involved in
the acquisition of this skill include glial cell activity. The free-floating,
nonelectrical neurotransmitters now known to emanate from the glia, he believes,
would constitute the necessary mechanism for the learning displayed by his
subjects. Such a model is rapid and more energy efficient than the synaptic
model commonly used in learning theory. This sort of learning is also known as
�unconscious integration� or �implicit
learning,� meaning that the acquisition of knowledge takes place largely
independent of the learner�s awareness of either the process of learning or
of the knowledge ultimately attained. The
�controlled synesthesia� enables the extension of sensibilities by providing
the user with new senses. Since the
therapist adapts sensor data passing through their hands, it should be possible
for them to experience the data stream by direct experience of perception. As
discussed in the preceding section, what the mind abstracts from the hand is the
meaning of the data stream rather than the data points themselves. Sensory
information registered without awareness in this way is known as blindsight. Such unconscious integration is much faster than
interpreting data by conscious cognition. As for the manner in which the
therapist experiences this, a quote from David Bohm�s Wholeness and the Implicate Orders seems relevant to me: ��thought
itself is an actual process of movement. That is to say, one can feel a sense of
flow in the stream of consciousness not dissimilar to the sense of flow in the
movement of matter in general.�
Finally, I want to speak of the task I described at the beginning of this essay. I was, of
course, describing a human body. Perhaps it would better to state the answer
about handling in terms of what a therapist wouldn�t
do in an effort to sense the internal activity while permitting spontaneous
change. They wouldn�t rub, poke, prod, coerce, grip or control with their
hands. The hands would instead be used as a primary sensory organ, now known to
be fully capable of sensing the patient�s movement and leading the
therapist�s brain to a new sense of the activity before them. This sense of
the patient�s internal activity, in my opinion, will not mature when the
therapist�s hands are busy doing the things previously listed, and therapists
practicing in that manner will always wonder at the sensibilities I have
acquired. The technique of Simple
Contact will make this sense possible.
Geoffrey Maitland knew what I was talking about, and now
perhaps others will come to understand it as well.
Suggested reading:
Bach-y-Rita, Nonsynaptic
Diffusion Neurotransmission and Late Brain Reorganization,
P. Bach-y-Rita, Volume transmission and brain plasticity, Evolution and Cognition, 8: 115-122, 2002
.