CEP 818: Abstracting

Abstraction
My topic is rehabilitation and my abstraction is the very reason for rehab: healing. There are several musculoskeletal injuries that require rehabilitation and many different methods and exercises, though the end goal of healing is stays constant. The body naturally heals itself and therapists and clinicians simply help it along. To understand the abstraction, you'll need a bit of background information. Below you'll find a diagram of a muscle. The muscle is broken down into multiple segments that "fit in" to each other. Imagine a box of drinking straws. The box is the outside of the muscle and all the little straws are essentially the bundles of muscle fibers that make up the muscle.

 

After having a basic understanding of a muscle the abstraction will make much more sense. A muscle strain is essentially those muscle fibers being torn apart. Now, think of a rope. Imagine that rope frayed with all those little individual fibers separated from the singular unit they comprised. An injured muscle presents similarly as the fibers are torn apart from the whole. Now, imagine those fibers coming back together to reconstruct the singular muscle. Rehabilitation assists in this reconstruction process.

 

My second medium of abstractions comes through a painting I found. When an injury occurs, scar tissue (collagen and sorts) comes in to fill in the gaps. This tissue is laid down in a randomized and messy pattern. Through rehabilitation, these fibers are stressed to help them form the proper pattern to better align with the original, uninjured tissue (muscles, ligaments).

Scar tissue goes from messy on the left to more organized on the right 

        

 Take a look at this picture below. The bottom half is messy and seems rather disorganized, such as the collagen and other scar tissue components come in to help heal injured tissue. Through the rehabilitative process, the disorganization becomes organized and the end-stage of healing has been achieved.

 

Discussion

Abstraction to observe an essential quality or characteristic of a subject or topic. While many subjects may have many qualities that are essential, there is always one that, without it, the subject would simply not be the same. 

There are several characteristics to musculoskeletal rehab such as movement or even the use of modalities. But, I chose healing/tissue remodeling as my essential quality because regardless of the injury, healing is always the desired outcome or goal.  

I think this abstraction is well represented through the tangible medium of the frayed rope and the visual medium of the painting. People/students are familiar with both of these things and I feel using them to aid in teaching the topic of injury healing and the role of rehabilitative therapy will aid to further their understanding of such a science-based, data driven topic.

 

CEP 818: How Do I Love Thee- Patterning

Identifying a Pattern

There are several patterns within rehabilitation. To name a few, there is a pattern to the way an injury evaluation is performed, the order certain exercises are performed in and even patterns within how the exercises themselves are performed. Rehabilitation protocols also follow basic patterns. For this assignment, I’ll evaluate the post-surgical and post-injury rehabilitative protocols.

Below, I have selected one non-surgical knee injury and one surgical knee injury. I did so to point out that the rehabilitative process is essentially the same despite the injuries being completely different. The same would hold true for a shoulder surgery compared to an ankle sprain. 

Non-Surgical Medial Collateral Ligament Sprain (complete rupture) Rehab Protocol:

http://www.gundersenhealth.org/upload/docs/Services/SportsMedicine/MCL-Grade-III.pdf

Post-Surgical Anterior Cruciate Ligament Repair Protocol:

http://www.gundersenhealth.org/upload/docs/Services/SportsMedicine/ACL-Reconstruction.pdf

Both these protocols are broken down into phases (weeks) and begin with pain control with gentle range of motion exercises. They then progress light strengthening exercises and proprioceptive activities. Strength and endurance are then improved upon until the patient is considered “functional”. Once functional, the patient may begin more aggressive sport or work-related activities such as running and agility drills.

This particular pattern is the essence of musculoskeletal rehabilitation. This pattern is largely based on scientific data collected through numerous studies to determine healing rates, tissue composition and appropriate exercise selection (just look at the reference pages!). Without this pattern patients may not have favorable outcomes post-injury. 

                                   
     

Re-Patterning

Because this pattern of rehabilitation is scientifically sound, there is not an applicable way to “re-pattern” it. Though, there is a way to teach this pattern in a different way: backwards. Thinking about the ultimate goal of functionality, whether it is work or sports related, requires reaching smaller goals first. Functionality requires basic strength, basic strength requires a certain range of motion to achieve full strength. This range of motion cannot be reached until pain and swelling are controlled. If the student can re-think the rehab process from the end stage back to the beginning, they will have a better understanding why the overlaying pattern is the same for almost any injury. If they happen to be working with a patient or athlete who is “stuck” from reaching a particular goal they will be able to look at the rehab and see if there were any gaps in therapy. Was balance/proprioception not addressed? Was range of motion not restored? In addition, they will be able to come up with better rehabilitation plans themselves (where there is no documented protocol) when dealing with injuries because they will have a better understanding of the importance of each goal. 

Discussion

Patterning is a cognitive tool used to identify a repetition and be able to predict the next “move” or an outcome. My original pattern is the overlaying pattern of the rehabilitative process for a musculoskeletal injury. This pattern is typically broken down into smaller phases or stages in which certain goals are to be achieved i.e. controlled/decreased pain and swelling, weight bearing vs. non-weight bearing, range of motion at a certain degree, strength at a certain percentage of the unaffected limb, improved proprioception and muscular endurance, etc. before moving on to the next phase. These goals are largely based on scientific data collected concerning healing rates, tissue type, tissue remodeling (healing), appropriate and effective exercises and preventative measures.

Because rehabilitation is based on science, it is difficult to re-pattern the process and have it still be sound and applicable. Though, teaching the pattern does not necessarily have to follow the “from beginning to end” principle. Instead, why not identify the desired outcomes and describe, starting from the point of the final outcome, each goal that must be achieved prior to?

It makes sense that you cannot achieve one larger goal (full function) without achieving smaller goals prior to it (full range of motion) and there is nothing wrong with teaching from “start to finish”. Though, I feel if the student has to “discover” each goal by working backwards, their grasp will be more firm than it may have been otherwise. This will especially help them when they have to develop their own rehabilitation plans for patients. Not every injury comes with a documented protocol to follow! Understanding what it takes to reach the final outcome will undoubtedly help them plan a solid rehabilitation program for their patient or athlete. 

CEP 818-Creative "I"- Defining Creativity

Part 1: The Interview Synopsis

I interviewed a close friend, a fellow jewelry maker. She creates jewelry pieces using beads, wire, various components and utilizes many jewelry-making techniques. She believes creativity is “taking materials and using her personality to make it her own”. For her, the process starts with colors. She is inspired by color and she generally has a color in mind for a piece she wants to create and tries to find pieces that fit her vision. She takes many things into consideration once she has a color palette in mind. She tries to envision the piece in relation to clothing it will be worn with. Does she want larger or smaller beads? How many layers or rows will the piece have? Will the earrings be long or short? After she has decided what will best complement what the item could potentially be worn with, she will buy supplies according to this vision. Once she has all the colored components out, she then decides how it should be constructed. Should the beads be strung or should they be wire wrapped? After she has all her supplies in hand, she lays them all out to get a visual of her new jewelry piece. Often times the pieces do not “go” together as well as she had hoped so she then “plays around with them” until she finds a pattern within the beads that fit both her vision of color and stylistic goal. 

 Part 2: Summary

Throughout the reading I realized many things about the creative process that I had never actually thought about before. People are inspired by several things and seem to acknowledge their creative processes.  I had tried to evoke some similar thoughts or acknowledgements from my interviewee though this proved difficult. I feel the individuals mentioned in the book put more thought into how they thought as opposed to somebody whose creativity and mental processes had never been acknowledged in such a way.

Like my interviewee, I also create jewelry. The reading gave me insight on my own creative process and not just within the realm of jewelry. I found it rather interesting to think about my own creative process and realize that I actually make many decisions based on all sorts of sensory information. How do the beads/components look together but also how do they feel against the skin? Are these earrings going to jingle as a person walks? I was not cognizant of these decisions as part of my process.  I am more aware of how my process starts and how I follow it through to the end product and I think being more aware will only help me create more interesting pieces.

CEP 818: Perception

    

Background Information

Therapeutic ultrasound is a modality commonly used in the rehabilitation of injuries. The ultrasound machine comes in various forms, but all deliver high frequency sound waves (via the reverse of the piezo effect) through the metal transducer sound head. These waves penetrate  the skin and stimulate soft tissue in the body to create a type of healing environment. There are several settings, each eliciting a different physiological response. Before entering the body the sound waves must travel through an aqueous medium which is essentially in the form of a water-based gel. The waves may also travel directly through water and when this is done the waves actually appear “visible” through the ripples in the water.

 

Observation

My observation is from the perspective of administering the treatment on a patient. 

Sight: I notice the machine itself, how the face has a backlight and how clearly the settings and “time left remaining in treatment” are displayed. I notice the light blue, transparent gel against the skin of the patient and the thick lines being traced in it over the area being treated by the sound head. I also notice the gel building up around the sound head as it is being glided through the gel. I also notice the colors of the machine which are light grey with navy blue trim and buttons with a light blue backlight on the display screen.

Touch: The buttons on the face of the machine are cool to the touch. They are slightly softer than the rest of the plastic on the machine almost as if they are made of silicone. The gel and sound head are both warm upon picking them up to negotiate set-up of the treatment.  The handle is shaped to ergonomically fit a hand and brings a comfortable weight with it. It’s constructed from plastic, which feels cold but soon warms from the heat of my hand. I also notice the front of my shoulder becoming fatigued from the continued circular motion that needs to take place for proper application of the treatment. I can also feel the sound head gliding through the ultrasound gel with very little resistance. I can feel the patient’s tissue rebounding from pressure being applied through the sound head.

Hearing: I hear the beeping of the buttons as I push them to set up the treatment. The “last ounce of ketchup left in the squeeze-bottle” squirting sound the gel makes as it exits the cap. The machine itself makes a soft hum from all the processes being run within it. The sound waves at a frequency that is inaudible to the human ear so I cannot actually hear them. I hear the chatter within the clinic of various conversations taking place in addition to the beeping of machines that have turned off after finishing treatment.

Smell: The gel has no smell. The only smells entering my olfactory bulbs are the perfume of my patient (which is sweet but has warm vanilla undertones) and the clean and sterilized smell of the clinic.

Taste: Not applicable : ) 

 Re-Imagine and Re-Present of Therapeutic Ultrasound 

Since I am not able to fully appreciate the use of my smell and tasting senses with this particular modality (or visual of what the sound waves are actually accomplishing in the body!) I imagine using it in a slightly different way. Imagine a thick ribeye steak, so fresh it’s still purple. If set on the correct settings, ultrasound can have a thermal effect on soft tissue.  Set the machine up, squirt the gel on the steak then apply the sound head and start treatment. I imagine the smell would smell would be a less intense version of the steak on a grill, without the actual smell of the grill. The tissue should start to turn a greyish-brown color as it heats up. You then can cut the steak down the middle of the treated area and see how deep the waves have penetrated the muscle tissue. You could even use your fingers to feel the difference between the treated and untreated areas. Now this exact reaction of “cooking flesh” isn’t what is done during a treatment on an injured patient, but it offers proof that the sound waves actually exist and a visual of power of the thermal effects of the sound waves. Bon apatite!

 

Discussion 

Perception means to take in all types of sensory information and use known information and prior experiences to make sense of everything.  The person’s own personality and thought processes mold these to make them fit into what makes sense to them at the time. 

My original observation of administering an ultrasound treatment enlightened me to many things I did not actually acknowledge before. I had noticed many of the things I wrote about, but never actually took the time to pay attention to them. I can see the handle for the ultrasound is shaped specifically for a hand based on the location of certain curves and indents, but had never concentrated on how it fit my hand so well and was perfectly balanced in weight. Had it been unevenly balanced I surely would have noticed that!

 I had reimagined this procedure in several ways but thought best to create things that could not be obtained in the original observation such as seeing the meat literally being cooked using something (sound waves) that is neither directly felt by the human body nor can be seen by the human eye. I acknowledge that this demonstration is not all too different from the usage of the original application and many of the same senses are being used in the same way, but I feel that it presents the actual effects of the high-frequency sound waves create within soft tissue. This cannot actually be seen when performed on a human body, though other effects may be evident. This thermal effect essentially primes the tissue for elongation and one effect may be a larger range of motion within a joint. A non-thermal effect of ultrasound is to decrease inflammation. As this cannot be seen, a decrease in pain or edema represents a positive effect. 

I feel this “re-imagined” representation of ultrasound is actually quite useful. It would help students trying to understand certain parameters of ultrasound treatments and have a better grasp on something that is hardly felt and cannot actually be seen. It’s a way to bring all the science they have learned regarding therapeutic ultrasound “to life”.