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Using motor activation strategies to activate intrinsic foot musculature…

June 25, 2013

In this video I demonstrate what, in and of itself, can be considered no more than a ‘parlour trick’….however this ‘trick’ can be used from a rehabilitative standpoint. In the first frame of the video you are watching my initial assessment of the patients foot function. Notice that the patient completely lacks the ability to produce independent toe movement. Focus on the command for her to plant the lateral four toes and extend the first — nothing. In the second frame (which was the patients second visit) I demonstrate how a simple manual biofeedback and alter neural drive…TEMPORARILY. What is being demonstrated is that one can utilize ‘tricks’ to play with neural drive…however what is most important to note is that tricking the nervous system into doing something on the spot is not a lasting phenomenon. Imagine how vulnerable we would be if we evolved with a nervous system that adapted patterns instantaneously…that would mean that every movement pattern deployed incorrectly would solidify a new pattern…which does not happen. The nervous system, like the rest of the bodies systems, is best thought of as being “stubborn.” That means that any ‘corrections’ that we make MUST be solidified with persistent rehabilitative/training techniques in order to sustain pattern alteration.

With this patient, there are two main issues pertaining to this finding (one the causative factor for the other). First, as is found with the large majority of patients, she displays a complete lack of intrinsic foot strength (thank you civilized society with your insistence on shoes and other methods of ignoring/countering human evolution). Second, due to the sustained signal to the foot musculature that there is no need to support the articulations as we have replaced you with shoes…neural drive to the tissues is absent. By utilizing the manual biofeedback technique with the pen, we are providing additional afferent feedback to the dorsal root ganglion and post central gyrus (sensory cortex – location of the primary somatosensory cortex) thus allowing a temporary re-surgence of a primitive movement pattern…namely “lift big toe.” However, unless I plan on following this patient around with my pen on her toe, this effect will not last. What is needed is training coming in the form of frequent (again, FREQUENT) practice which will serve to 1. Strengthen the intrinsic foot musculature – and 2. FORCE the CNS to improve neural drive to the tissues (Note: although we are making a distinction between 1 and 2, they are inherently coupled).

Frequent x 2 – I said “frequent” twice for a reason. Good rehabilitation strategies must focus on inundating the nervous system with conscious stimuli in order that the resultant pattern be employed by it unconsciously.

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