Apr 07, 2009
Bill Gallagher PT, CMT, CYT, Richard Sabel MA, MPH, OTR, GCFP
Over the past decade, health professionals and their patients have been redefining rehabilitation to include unconventional therapeutic techniques drawn from disciplines such as Tai Chi Chuan, Yoga and Feldenkrais. Practitioners of these disciplines have long realized the preventative and restorative benefits of mind-body practice (systemic physical and mental activity) and compelling scientific evidence is emerging to support their beliefs. In response, consumers and employers increasingly seek rehab clinicians who integrate these approaches with conventional rehabilitation. A recent study reported 66% of elders with arthritis used some form of complementary or alternative (CAM) therapy. Another study found a similar percentage with the general population and detected a continued upward trend. This translates into big money. Americans already spend upwards of $27 billion a year, mostly out of pocket, for complementary and alternative interventions. This shift is also reflected in the funds the National Center for Complementary and Alternative Medicine (NCCAM), a component of the NIH, appropriates for research, which increased from 50 million in 1999 to $121.6 million in 2008.
The National Institutes of Health states “integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness.” Using the same framework, the integrative rehabilitation practitioner studies conventional and alternative practices, finds what works, and discovers new and often idiosyncratic ways of bringing them together. Rather than focusing exclusively on disease and disability, integrative rehab focuses on healing—specifically the patient’s ability to heal him or herself. Emphasis is placed on the relationship between mind and body with regard to well being. Concentrated on promoting health and the prevention of pain or disability, the integrative practitioner neither rejects conventional medicine nor accepts alternative medicine without serious evaluation.
This blog will examine the evidence (or lack of it, in some cases!) for the integration of mind/body/spirit disciplines into rehabilitation. Approaches addressed in this blog will include: Tai Chi Chuan, Reiki, Yoga, Relaxation techniques, Feldenkrais, Cognitive-behavioral training, Alexander technique, Biofeedback, Meditation and breath-work, Shiatsu, Guided Imagery/visualization, Tuina, Qigong, Acupressure, Osteopathy, Cranio Sacral Work, Therapeutic Touch and we hope, as time goes on, readers will also contribute suggestions.
The blog will also consider the following questions:
How can I improve my effectiveness as a clinician by integrating these disciplines into practice?
How can I apply one or more of these disciplines into my own lifestyle to promote well being and avoid burn-out?
What are the financial realities of using this type of work into my practice?
How do I document my treatments?
Are there ethical dilemmas??
What practical & legal issues should I be aware of?
What complementary and alternative therapies are supported by direct or indirect evidence?
What are my options if an approach I find clinically effective is not supported by the scientific literature?
We will draw on our experience of providing integrative physical and occupational therapy, in a wide range of environments, to a broad spectrum of clients. We will place a strong emphasis on helping you evaluate the best practice and in particular, we will share with you the experience of working to change attitudes.
Conventional physical and occupational therapy includes an immense array of effective evaluation and treatment techniques – although not all of it is supported by evidence based research. PNF, an entrenched, mainstream, conventional (and in our opinion potent) approach has a surprisingly weak evidence base. Many people assume complementary and Alternative approaches have no supportive research, yet there is an impressively broad and deep body of scientific literature supporting the practice of Tai Chi Chaun. The bottom line is that both worlds offer an immense array of useful tools. It’s easy to get mired in a bog of confusion. This blog is meant to engage the critical thinking we all need to sift through these issues and maximize the comfort, function and well being of our clients.