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ABR
FAQs
Would ABR
help a child who is not borned CP?
ABR is not a "CP specific" approach. The
set of principles and techniques that constitute ABR
allows it to address a wide range of conditions from
specific musculoskeletal (CP, scoliosis, joint deformities
etc.) to the ones like autism, ADHD, global developmental
delay.
On the other hand, there are rarely the cases of "pure"
musculoskeletal CP. In 80% of cases we face more than
just physical disorder but a general developmental delay
as well. It is noted that most of the children who follow
ABR show improvement in their alertness and cognitive
level.
ABR is the only approach that is going to give you
the tangible ability to influence the situation -- the
more you would work, the more progress your child is
going to make on all levels – motor skills and cognitive
development.
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What
is the difference between NRT approach and ABR approach?
NRT Strategy: addressing the respiratory system: "Diaphragm"
ABR Strategy: the Cascade effect from the upper airways
Today I maintain that the most efficient way of addressing
the respiratory system is from "top to bottom"
-- starting from the upper airways (frontal and nasal
sinuses, mouth floor, pharynx, trachea -- head and neck
level) rather then focusing specifically on the diaphragm
level (lower thoracic level).
I obviously did not arrive to these ideas of addressing
the head and neck as a primary level and the strategy
of this particular cascade effect in a respiratory system
overnight.
Any textbook on respiration informs you that the diaphragm
and intercostals are the leading respiratory muscles,
therefore as early as in 1990s, when I worked with my
father and later when I came to UK -- the level of diaphragm
has been my main focus of applications.
This strategy has been successful to a great extent,
however, after some time I started to see the limitations
of such a strategy, which, after showing initial success
(quite often a significant one), then slowed down; and
in many cases addressing the diaphragm level did not
bring the designated structural corrections.
As a result, I proceeded with both theoretical analysis
and comparison of practical outputs.
My first comparison question was: "The thorax
has the inlet and the outlet (which have full names
of upper thoracic aperture and lower thoracic aperture)
-- let's find out "who is the boss?" the term
"diaphragm" is more in common use as a shortcut
for cumbersome full term "lower thoracic aperture",
of which the diaphragm is part of). Meaning: "How
are we going to achieve more significant transformations
of the thoracic structure, related structural cascades
and respiratory performance -- by focusing on the upper
level or by focusing on the lower level? Bearing in
mind that both the top and the bottom of the thorax
are structurally affected in a CP case -- what will
be of greater influence: the upper aperture on the lower
(i.e. top of the thorax on diaphragm) or vice versa?
I spent a good year comparing these effects and arrived
to definite conclusions:
| 1. |
addressing the lower part ("diaphragm")
did have direct effect locally plus on the midthorax
but the top of the thorax (level of the manubrium
and 1st and 2nd ribs) shown little response. |
| 2. |
addressing the upper part not only had direct
effect on the top of the thorax but also shown a
lot more significant structural changes both at
the middle and lower thorax (diaphragm itself included). |
The next natural step was to shift within the respiratory
system to the next level "above" -- trachea.
I've realized a weakness, a "bulge" (propulsion)
and an instability of trachea in CP for quite some time,
well before I started addressing it directly.
But the textbook dogma "diaphragm and intercostals"
are the leading respiratory muscles" was quite
difficult to overcome.
And again after the comparison between the influence
of thoracic applications on trachea and vice versa I
received clear evidence that the trachea is the leading
structure, when strengthening of trachea automatically
brings the change in the entire thoracic structure and
respiration. The next natural move was to shift further
up and analyze the influence of the mouth floor and
pharynx; of the palate; of the sinuses etc. -- on respiratory
performance and structure of the neck and thorax.
I must admit that such "shifts upwards" in
ABR strategy were not an easy thing for me. When explaining
the therapy to anyone, particularly to a healthcare
professional, it is a lot easier to appeal to established
dogmas "diaphragm and intercostals" are the
leading respiratory muscles" rather than challenging
them. If it was not for the clear difference in practical
efficiency of these opposite strategies (top to bottom
vs bottom to top) I would have stayed in the "comfort
zone" of established beliefs. However, facing the
conflict of the theory, however "recognized",
and reality I choose to question the theory.
In reality, it turns out that all this "established"
theory is not particularly strong. The moment one asks
the question -- Where does the belief "diaphragm
and intercostals" are the leading respiratory muscles"
come from? -- everything becomes quite clear. The evidence
for this statement is obtained via the EMG (electromyography)
-- measuring the electrical activity of the muscles
during respiration. Indeed, such measurement shows the
overwhelming activity of the "diaphragm and intercostals".
That's where the belief in their dominant importance
comes from. Measuring the pharynx, trachea or the respiratory
smooth muscles (in healthy individual) would show near
zero activity.
At first glance, the "recognized" concept
appears to be true.
However, if we look at this same fact from a different
perspective --everything changes. Trachea has to stay
still (near 0 activity) during respiration --that's
normal.
If trachea starts moving excessively (showing extra
electrical activity) -- that's the indication of a problem,
not of its' normality and not of its' "increasing
role" in respiration. Instability of trachea forces
the intercostals and the diaphragm (skeletal/striated
respiratory muscles) to adjust, to compensate for its
weakness and instability by their extra effort and alters
the mechanics of respiration in the abnormal way.
ABR concept maintains that the skeletal/striated respiratory
muscles are the dependants of the upper respiratory
airways. When mouth floor and trachea are weak and unstable
the intercostals and diaphragm have to adjust and provide
the respiratory drive that would still ensure sufficient
gas exchange . 2 main consequences follow:
| a) |
distorted mechanics of respiration though necessary
for for survival does not provide the basis for
normal development and causes related structural
distortions of the thorax, abdomen, pelvis etc. |
| b) |
any attempts to change the mechanical performance
of the diaphragm and intercostals by direct impact
are limited by their need to compensate for the
weakness of upper respiratory airways (trachea in
particular). |
Therefore, without "fixing" the trachea the
recovery of the normal respiratory function and mechanics
is impossible. But in turn, the position and tone of
the trachea depends largely on the tone of the mouth
floor, which in turn depends on the jaw, etc. etc. --
and eventually we come to realization that without the
change of the head structure the potential for lower
levels' progress is seriously limited both structurally
and functionally.
The role of the pharynx, tracheal cartilage, smooth
muscles of the Respiratory system and of other deep
myofascial structures could be illustrated quite well
by analogy with a house.
The deep myofascial structures are the "ground"
on which the entire "house" stands. When we
compare different "normal" houses we pay attention
to the walls, to the windows, to the roof etc. And indeed
comparing the external respiratory muscles with the
"walls" of such house we would see that they
take the visible main load, providing the basis for
yet further structural components.
If the "ground" stays still we would never
even notice its' presence, however, once the ground
starts shifting or worse "an earthquake" happens,
the "walls" would suffer.
That's quite precisely is nature of the relationship
between the "passive" upper respiratory airways
and the external/voluntary respiratory muscles. The
moment such a shift of paradigm happens the evidence
starts popping up everywhere -- as the very basic take
the embryologic development of respiratory system:
First the so-called pharingeal arches form, then the
trachea and only further division of respiratory system
forms the broncheal tree and further on the lungs as
we know them in adults. The striated muscles of a diaphragm
form quite late in these sequence.
Classic textbook approach focuses on the walls but
misses the ground and that's why it's quite helpless
facing the respiratory mechanics distortions of a CP
child.
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Does
ABR abandon addressing the diaphragm altogether, relying
on a cascade effect from the upper respiratory airways
only.
One has to distinguish ABR strategy -- aimed at long
term structural transformation; and ABR tactics -- immediate
mechanical assisstance by ABR technique when the child
experiences respiratory problems.
For instance, in cases of colds and chest infections
we often recommend direct lower thorax coverage addressing
the diaphragm level in order to help the child who faces
the respiratory problems, which are directly challenging
general health.
One could have also noticed that ABR program very
rarely starts with direct head applications -- we almost
always start form direct chest applications in order
to give a child both the smooth transition to this new
impact and to build up general health via respiratory
system improvements.
However, when there is no emergency the "fundamental"
ABR strategy -- from the head downwards -- is the one
that has the greatest impact on structural improvements.
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Is
ABR being the most effective technique of addressing
"diaphragm" level or it makes sense to use
ABR for "upper levels" and look for something
else for specific "diaphragm" applications?
Obviously, answering this type of question, I am expected
to "toot my own horn". However, talking seriously,
I think that the previous explanations give quite a
lot of insight into this whole issue and would provide
some food for thought for a parent searching for the
best rehabilitation option for a CP child.
On the other hand, you, the parent, is the ultimate
judge of the value of my efforts and the efforts of
the other members of ABR team.
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What
does the technique involve?
| The essence of ABR techniques involves
the followings: |
| 1. |
Child acts as passive recipient of ABR exercise |
| 2. |
Towels are used as air cushion for the transmitter
of ABR movement |
| 3. |
Towels act as pneumatic lens for the transmitter
of ABR energy |
| 4. |
The optimal shape and density of the towels as
pneumatic lens serves to
minimise the loss of energy to the external surface
of the body of the child and manifies the ABR movement |
| 5. |
Slow and smooth movements (what we call the 'quasi-static')
movements
ensure that the towels are not compressed but moves
as one entire volume
complete with air in the towels. |
At every visit, an assessment will be done on the child
to determine the
changes that have happened and plan for the next set
of changes to be seen
in the near future. Exercises will be prescribed and
the providers will be trained by the ABR team to perform
the exercise at home. Prescription exercise involves
all the above principles and the application is on various
areas as determined.
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Is
there a specific timeframe where ABR is no longer effective
or applicable for my child?
ABR seeks to restore the structural deformities by
strengthening the
internal organs and its myofascia system. When Leonid
mentioned a 'window
of opportunity', he was referring to the opportunity
available for a healthy child to develop sponteneously
the proper strength and growth of the smooth muscles
of the respiratory system by breathing against his own
weight. It is only for a very short period of time before
the first 4 to 6 months of the child's life. But the
cp child is deprived of this opportunity because he
is not able to breath against his own weight during
the first 4 to 6 months of his life. What ABR aims to
do is then to provide the cp child this opportunity
again by manually doing the strengthening of the smooth
muscles of the respiratory system for the child. The
earlier you start the therapy, the easier the intervention
will be.
Bearing in mind that the imbalance between the nucleus
(the trunk, the head
and the neck) and the periphery (the hands and the legs)
increases as the
child grows older, as a result, we see greater deformities
and greater discrepancies in development as compared
with other healthy children as the
child grows older. If you start the therapy early, you
have a better opportunity to change `the track` of development
by improving biomechanical nucleus and thus improving
the way that his spontaneous development goes (in less
deviated way). Instead of having the cp child develop
in the same manner as that of a typical cp child, his
strengthened and increased volume of his nucleus change
the development to that less deviated from normal development
of a normal child. The transformation at the early age
allows the child to be able to further capitalise on
the gain he has achieved through the therapy. Once the
child has grown up, we have less of this advantage and
the therapy is much less able to capitalise on the child's
own development but more focus will be on reversing
of what already happened. In other words, we will then
have to focus on changing the past rather than re-directing
what is to happen in the future. In addition, the sheer
volume of what has to be reversed is much greater in
an older child than a younger child.
This does not, however, mean that ABR does not work
on the older child or
even adult. But it does mean greater efforts are needed
for the transformation of the structure to happen.
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My
child vomits a lot so will ABR help in any way?
Vomiting and weight loss are symptoms of weakened digestive
system. Since
ABR works to strengthen the internal organs, the digestive
system will ultimately be strengthened. One of the observations
we often make of the cp kids in the centre is the improvement
of their respiratory and digestive system. In fact one
of the critical signs of improvement is the increase
in volume of the child's body. As the child's internal
organs are strengthen, the food can be better chewed,
swallowed and digested so that nutrients can be absorbed
into the body. Ulitmately, the vomiting should be eliminated
altogether and the child will begin to gain weight and
grow in size.
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My
child is very young right now and her body structure
looks so normal. Will she end up looking twisted and
deformed like those that I see at the special schools?
A CP child always looks better at the very young age.
When they are young, the arms and legs are relatively
short. Therefore even poor absoluteš pneumatic capacity
of "biomechanical nucleus" is not challenged
that much by the sheer size of the arms and legs. However
as the child grows older, the extremities grow at significantly
greater rate in their absolute size in proportion to
the head, neck and trunk. As a result, relative imbalance
between the biomechanical nucleus and periphery gets
more and more pronounced. That is why the older the
CP child gets, the greater are the deformities and the
developmental discrepancy in respect to the healthy
peers of the same age. That is also why they look much
worse at puberty age.
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I
have an 11yr old son with Cerebral Palsy who cannot
walk or speak. Can ABR get him to speak? He can make
some sounds now but no words.
At the onset of brain injury, the tone of the internal
organs drops
tremendously within the first few hours. Internal organs
need to be well
toned to exert sufficient pressure for the development
of the sufficient
internal volumes. Once the tone of the internal organs
drop, the pressure
becomes insufficient to maintain sufficient internal
volume to support the
musculoskeletal structure. Hence structure becomes distorted
and function
becomes impossible. This happens throughout the body,
including structures
of respiratory system, digestive system, speech faculty,
arm and leg
mobiltiy as well as functions such as rolling ,sitting,
crawling, standing
and walking.
There are two faculties involved in speech - the physical
structure
governing the speech faculty and the cognitive faculties.
The main
objective of ABR is to restore the deformed physical
structure but not the
cognitive faculties although we do find that the cognitives
of the child
improves as he progresses along.
Let's look briefly at some of the
structural deficiencies found in CP child
that inhibit speech: |
| 1. |
Weak mimic muscles are evident as
: |
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Tone of facial muscles are weak |
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Skin are loose and non-taut ie skin seems ‘excessive’
ie skin is larger
than the skull and hence skull has 'missing' skull |
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Pulling one part of skin can easily shift the
parts of the skin ie lack of
segmentation between the muscles |
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Movement of muscles are predominantly vertical
and very little evidence of horizontal or circular
movements |
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Weak mimic muscles of the lower face, and weak
circular muscles of the
cheeks and mouth are seen. |
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Mimic muscles need to be well toned
to adjust the raw sounds produced by vocal cords
to create a great variety of sounds for speech production. |
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| 2. |
Tongue of a brain injured child has: |
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Weak intrinsic muscles |
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Weak extrinsic muscles |
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Weak fold of membrane |
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These result in: |
| |
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Tongue not having independent forward and backward,
upward and downward movements as well as rotational
movements, which are necessary for the creation
of a variety of sound |
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Absence of clear and well pronounced groove dividing
the left and the right of the tongue as seen in
the normal child. |
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Uncontrolled tongue and limited tongue movement:
(a) In a healthy child, movement of tongue tightens
the larynx.
(b) In a brain injured child, the larynx is observed
to be soft and weak. |
| |
It is easily compressible
and the trachea can be shifted from side to side.
The tongue is attached to hyoid bone, which is embedded
in the weak larynx.
This results in a wobbly attachment and a difficult
to control tongue. |
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| 3. |
Lack of proper tone and
shape of hard and soft palates, which are
necessary to divide the oral and nasal cavities.
Most often, in a healthy
child, the shape of the palate is triangular with
posterior part going
upwards. In a brain injured child, we would observe
various distortions of
the palate.
Again this hamper the quality of speech production |
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| 4. |
Weak pharynx:
In a healthy child, during speech, the muscles of
the pharynx opens the
epiglottis, thus opening the passageway for the
exhaled air from the lung to pass through the vocal
cords to produce raw sounds. In a brain injured
child, weak muscles of the pharynx will make it
difficult to accomplish the
task of holding the epiglottis in the open during
speaking, without which it will be almost impossible
to allow the effective passage of air involved in
speech production. Weak pharynx makes changing shape
to allow phonation of vowel sounds an impossible
task |
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| 5. |
No independent movement
between larynx and trachea
In a normal child, larynx and trachea movement are
separate and sequential during swallowing.
In a brain injured child, larynx and trachea move
together as one unit,
which in turns move the jaw.
The tongue muscles are attached to the hyoid, a
bone that is imbedded into the larynx.
In a brain injured child, larynx is weak and trachea
is slack and therefore
the mobility of the tongue is greatly restricted.
Together with muscles of
cheek and lips and teeth and other parts of the
mouth, tongue is critical in transforming raw sounds
into words. A tongue with limited mobility affects
the transformation of raw sounds into words. |
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| 6. |
Vocal vibrations happen
not in the larynx of a CP child but much lower
in the trachea. The larynx is silent. That is why
he is able to produce low pitch but not a variety
of sounds. This simple observation shows that the
variety of sounds made possible from the child are
very limited right from the start. Changing the
structure will change the acoustics of his speech.
He will start to create sound from the larynx and
make a variety of sounds. On the other hand, in
a healthy child, these vibrations come from the
larynx. When the child speaks, the lower airways
are relatively still, only having radiating vibrations
coming through them. |
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| 7. |
Good control of air flow
is crucial in quality sound production and a CP
child has poor air control |
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In a cheek ‘puff up’
test: |
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(a) |
A normal child is able to hold the air inside
his mouth without leakage |
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(b) |
A brain injured is either unable to hold the air,
or difficult to do so
without leakage. |
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ABR works at strengthening
the internal organs, it therefore brings
consistent improvement to his phonetic components.
The child will start to
go through the stages of vocalization that a normal
child goes through. The stages of vocalization includes: |
| |
(a) |
The crying sounds different |
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(b) |
The laughing sounds different |
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(c) |
The mumbling starts |
| |
(d) |
There is development of a large variety of different
intensity of sounds |
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(e) |
There is better control of the speed which are
positive indications that articulation is being
established little by little. |
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(f) |
Finally, speech will come when the child begin
to copy sounds addressed to him and to convert sounds
into proper words as true means of verbal communication |
It is important to know that no matter what the age
of the child is, when
the child starts speaking, he has to go through these
crucial steps.
As you can see, ABR is able to help the child in the
area of speech by
correcting the structural deficiencies affecting his
speech function. But
it does not necessarily address the cognitive issues.
In any case, what the child needs to have his structural
deformities corrected first before it is possible for
him to have any speech function.
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My
son has moderate spastic diplegia. He is 3years old
and not able to stand or walk independently. He has
very tight hamstring muscles and calve muscles. He does
not have any contractures. Would he benefit from ABR?
ABR is founded on the prinicple that the internal organs
and the myofascia
of the body form a pneumatic capacity that exerts certain
pressure for the
development of sufficient internal volumes. This internal
volume in turn
supports the musculoskeletal system and makes function
possible. It also
defines the proportions and the alignment of the skeletal
structure and the
quality of the skeletal muscles. At the onset of brain
injury, the tone of
the internal organs and myofascia drop tremendously.
This causes the
pressure needed to sustain sufficient internal volume
drops accordingly. As a result, the internal volume
becomes insufficient to support the
musculoskeletal structure. Since the musculoskeletal
structure is
misaligned and out of proportion, the skeletal muscles
becomes therefore
either too tight or too loose, depending on whether
the distance between the two points of attachement is
too short, or too long. As this muscular
imbalance gets worse, the 'short' muscles result in
severe rigidity or
contractures. It is no wonder why the child is not able
to perform many
normal functions such as standing or walking.
Consequently, what we can see now is a child with poor
pneumatic capacity of 'biomechanical nucleus' (which
refers to head, neck and the trunk) and
therefore imbalance between the biomechanical nucleus
and the perphery (the
arms and legs) begins to surface.
I would also like to highlight that CP child always
looks better at the very young age. When they are young,
the arms and legs are relatively short. Therefore even
poor pneumatic capacity of "biomechanical nucleus"
is not challenged that much by the sheer size of the
arms and legs. However as the child grows older, the
extremities grow at significantly greater rate in their
absolute size in proportion to the head, neck and trunk.
As a result, relative imbalance between the biomechanical
nucleus and periphery gets more and more pronounced.
That is why the older the CP child gets, the greater
are the deformities and the developmental discrepancy
in respect to the healthy peers of the same age. That
is also why they look much worse at puberty age. Severe
rigidity and contractures are often not seen until pre-school
or elementary school age. By the time the child reaches
puberty age, many would have developed scoliosis and
hip subluxation.
The main mission of ABR is to restore the musculoskeletal
structure by strengthening the internal organs and myofascia.
As the strength of the internal organs and myofascia
are built up, the internal volume will be slowly restored
too. With the restoration of the internal volume, the
external musculoskeletal structures will be restored
accordingly step by step in the predictable manner,
thus allowing the spontaneous development of motor function,
including independent standing and walking. This is
made possible because the child now has the right musculoskeletal
structure for movement, and the mechanical transformation
of the musculoskeletal structure changes its electrical
activities and the ascending signal from the muscles
to the brain, which in turn creates an adequate base
for forthcoming descending signals to the muscles.
As your son has very tight hamstring muscles and calve
muscles, it is a sign that the proportion and alignment
of the skeletal structures is not in
order, which can be traced to poor strength of internal
organs and
myofascia. We believe ABR is the answer to your son's
problem of inability
to stand and walk independently. His lack of contractures
does not mean he
is free from structural distortion. Through a detailed
assessment, you will see clearly in what way your child's
physical structure deviates from that of a healthy child
and obtain the blue print for your child's recovery.
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Why
is it that the Caucasians seem to be reporting more
changes in their child than our Asian counterparts?
| 1. |
The Europeans or Caucasians are generally a lot
better at observation --
that's a fact.
Nevertheless, |
| 2. |
The face collapses at European children are more
vertical (loss of width) while in Asian ones --
more horizontal (loss of height). Fill ups as adding
extra width are easier to "catch" one's
eye as obvious change, it is more challenging in
the height direction.
Same thing about the chest -- a European child is
typically collapsed at the chest therefore the fill-up
is more "in your face". The collapse of
the back is more difficult to observe to start with
(concave chest strikes your eye a lot more than
a very flat back though essentially they would correspond
to the same extent of volume and tone loss) and
respectively
requires extra attention to detail as the changes
develop.
However, proportionally there is no difference.
I do not observe that the rate of change with ABR
does not depend so much on the race, more on extent
of overall loss of volume and of hydraulic tone. |
| 3. |
Use of the helpers -- blessing or a curse? Hard
to say -- it is a fact of life. The reality is some
maids deliver great impact and some very little
one. As I mentioned before that sets a higher teaching
and HR management demand on a parent in possession
of hired labor. |
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How
does the hand movement through the towels achieve a
change in the smooth muscles - eg energy, vibration?
There is a saying in physics: When in doubt how to
tackle a tough problem start by writing an energy balance
equation and see where it is going to lead you analyzing
possible conversions from one form into the others.
Basically the same is true about ABR.
| On one hand, obviously, I am not the
first person to ask -- what happens if we try to
apply external pressure to different parts of the
body. Say, for instance the chest. There are quite
a number of techniques that have addressed it mechanically,
to name the few: |
| - |
clapping |
| - |
manual compressions (for example, cystic fibrosis
patients receive hundreds and even thousands of
hours of such chest pressures as a standard physical
therapy procedure over their lifetime) |
| - |
Doman's respiratory machine. |
However, none of them succeeds in any significant structural
chest transformations of CP child even though, the last
two are applied for many many hours.
What ABR claims is that these techniques do not achieve
the structural change because they address the wrong
structures and in the wrong mode. Compression techniques
transfer the kinetic energy elastically into the superficial
rib cage, which then releases it like a bow without
any long term absorption in a deeper structures. Vibration
(clapping etc.) techniques penetrate further but also
lack absorption qualities because they miss the kinetic
energy "absorption" modality.
| I find the example of the clockspring
very helpful: |
| - |
if one squeezes it across the diameter, then no
matter for how long it's being done and how much
kinetic energy has been spent the resultant outcome
is still zero |
| - |
no absorption. |
| - |
And vice versa: when the geometry of the clockspring
is taken intom account and the centre of the spiral
is addressed in rotational mode in and in the right
direction |
| - |
even the smallest amount of kinetic energy spent
on winding is being absorbed by the clockspring
and then being gradually released into useful work. |
That example, shows that there is a lot more to the
issue of absorption of kinetic energy at the designated
structural levels than sheer force, magnitude and duration
of effort. In the wrong modalities of kinetic energy
delivery even the greatest effort is wasted; in the
right modality -- even the minimal impact is being absorbed
and stored for further productive use.
In that sense the use of quasi-static movement modality,
the use of Pneumatic Lens and other essential components
of ABR Technique are specifically designed to strengthen
the internal myofascia (smooth muscles in particular)
maximizing the absorption ratio for kinetic energy provided
by the movement of the therapist.
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Can
anything else achieve the same effect on the deep muscles
- eg
vibrator, magnet etc?
I believe I already answered this with my prior explanation.
The type of impact provided by vibrations (mechanical
force) and magnetic (electromagnetic force) impacts
do not "resonate" with absorption mode of
smooth muscles and therefore their weakness persist.
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Has
Leonid or the others worked with therapists who train
parents in Vojta therapy? ABR and Vojta are different
applications but seem to look for similar outcomes and
have similar conditions, eg don't use artificial supports/AFOs,
standing frames.
The concepts of Vojta and ABR are very different. Vojta
was one of the
members of a generation of Czech manual therapists,
who brought
manipulations into neurology. Let's start with easy
consideration -- Vojta's therapy has been on since 1960s
and comprises part of the standard physical therapy
practice in Germany for the last 25-30 years, however,
I can assure you the CP outcomes in Germany over these
years remained pretty much comparable with the rest
of the world, i.e. not much to speak about.
| By zooming to the essence, I would
say that, Vojta's approach is a big step towards
the patient comparing to "classic drug-based
neurology" and actually it has to be praised
when the doctor leaves the pedestal and finally
touches the patient instead of pure drug prescription,
however: |
| - |
the techniques themselves are purely addressed
to superficial musculoskeletal system. |
| - |
the theory is all based on neurology |
| - |
reflexes, spinal arcs etc. ABR position is straightforward |
| - |
"The moment the word "reflex" has
been used in analysis the transformation of musculoskeletal
system by such therapy is impossible. The very term
"reflex" is just a fancy label that stands
for "biomechanical blackbox". |
| Hundreds of potential biomechanical
nuances are immediately lost under this title and
the whole direction of research goes hopeless."
ABR concept is based on opening those "biomechanical
blackboxes" that paralyzed the development
of CP rehabilitation for many years. |
That pretty much moves to your other question:
Our understanding of brain injury is reasonable as we
have worked with a few very good therapists over the
last 10 years and have done a fair bit of research ourselves,
so would appreciate detailed explanations if possible.
| Unfortunately, due to the circumstances
I mentioned above |
| - |
dominance of neurological doctrine in CP rehabiliatation |
| - |
the moment a parent decides to dig a bit deeper
and develop some understanding one starts sinking
into ever branching mesh of neurological "blackboxes" |
| - |
primitive reflexes are being fine-tuned by more
sophisticated ones, which in turn are being fine-tuned
by even more fine ones etc. |
| ABR invites you to put all this pile
away and face the reality in simple 3 steps: |
| 1. |
ABR Assessment
Clear demonstration of direct structural deficiencies,
which make the normal movement biomechanically impossible
for CP child. (No mystic reflexes, which has been
studied on decerebrate cats and rats, -- tangible,
visible, palpable structural limitations). |
| 2. |
ABR Trial period
Demonstration that ABR works -- local applications
for approx. 200
hours per area deliver visible structural changes
in volume, alignment and strength of musculoskeletal
elements. Applying ABR on the chest --changes the
chest, applying on the face -- changes the face,
applying it on the neck -- neck changes. This stage
is to demonstrate that musculoskeletal system of
CP child has vast reserves of plasticity, which
ABR can deliver. At this stage we demonstrate that
ABR is indeed the tool that would allow you to transform
a CP child's body |
| 3. |
ABR work -- big structural overhaul
Once you have understood that every single element
of musculoskeletal
system is changeable (without the need to sink into
neurological
quicksands), you are entering the actual stage of
"overhaul": musculoskeletal system consists
of hundreds of elements that need to
be transformed in order to build the structure biomechanically
compatible with proper motor functions. Putting
this jigsaw puzzle together and understanding which
pieces to move in which directions -- that is the
ABR journey. |
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|
Where
are the current centers around the world that I can
attend the ABR training?
| Currently, there are centers located
in the following countries: |
| a) |
Montreal |
| b) |
Belgium |
| c) |
Denmark |
| d) |
Singapore |
In US, there are satellite centers in different states.
You can call the Montreal centre to enquire about these
satellite centers there.
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|
I
have an almost 4 year old son who is hypotonic CP and
I notice most of your testimonials are to do with Spastic
CP. Would ABR benefit a hypotonic child?
| Regardless whether your child is hypertonic
or hypotonic, the cause is still traced back to
the occurence of brain injury. At the onset of the
brain injury, the tone of the internal organs and
myofascia drops tremendously within the first few
hours. When the tone of the internal organs and
myofascia is good, they will be then able to exert
certain level of pressure that is necessary for
the development of sufficient internal volumes,
which in turn supports the musculoskeletal strucure
of the individual. Once the tone drops beyond certain
level, the internal volume will be reduced and the
musculoskeletal structure will become collapsed
correspondingly. This happens in pretty much the
same as the tire with a punctured inner tubes. |
| |
|
The collapse of the musculoskeletal
carries a few implications:
|
| 1. |
volume, shape and strength of the neck and trunk
become deficient. That is why we often observe the
brain injured child having weak and bulgin neck
(and trachea) and distorted and deflated chest,
which is often compensation by the use of lower
abdomen. As a result, we have both a very weak abdomen
with tension on the side. |
| 2. |
Misalignment of the joints of the limbs. The distance
between the two
points of attachment of muscles become either too
long or too short. In
the case where the muscles is too long, the child
is said to be hypotonic
while too short a muscles gives rise to hypertone. |
| 3. |
The skeletal muscles become small and weak |
| 4. |
Misalignment of shoulder girdle and arms, as well
as pelvis and leg. |
| |
|
ABR seeks to restore the structural
deformities by strengthening the
internal organs and its myofascia system. Once the
smooth muscles and the
myofascia regains its strength and tone, we begin
to see the change in the
overall internal volume of the child. With that,
step by step the musculoskeletal structure is restored
in terms of its volume, strength, and
alignment. We have to recognise that distorted musculoskeletal
structures
result in functional disabiltiy. Unless and until
the structure is fully
restored, there can be no normal function. |
| |
We can teach the child to develop
certain function using their limited
structure. But once the use of the structure is
maximised and become
limited by structure, the progress of the function
becomes plateau and any
additional function cannot be expected without further
major overhaul of
structure. The reason of the child's muscular condition
ie hypotonic or
hypertonic is the distorted musculoskeletal structure,
which causes
distorted distance between the two points of attachment
of muscles. When
the distance is too long, we have a case of hypotonic
child. When the
distance is too short, we have a case of hypertonic
child. Either way,
essentially they are the result of the deflated
internal volume which is the result of the weakened
internal organs and myofascia system. Consequently
ABR works in the same way regardless whether the
child is hypotonic or hypertonic. Once the musculoskeletal
structure is restored, the muscles tone (whether
it was hyper or hypotonic) would be normalised. |
| |
We can teach the child to develop
certain function using their limited
structure. But once the use of the structure is
maximised and become
limited by structure, the progress of the function
becomes plateau and any
additional function cannot be expected without further
major overhaul of
structure. The reason of the child's muscular condition
ie hypotonic or
hypertonic is the distorted musculoskeletal structure,
which causes
distorted distance between the two points of attachment
of muscles. When
the distance is too long, we have a case of hypotonic
child. When the
distance is too short, we have a case of hypertonic
child. Either way,
essentially they are the result of the deflated
internal volume which is the result of the weakened
internal organs and myofascia system. Consequently
ABR works in the same way regardless whether the
child is hypotonic or hypertonic. Once the musculoskeletal
structure is restored, the muscles tone (whether
it was hyper or hypotonic) would be normalised. |
| |
We can teach the child to develop
certain function using their limited
structure. But once the use of the structure is
maximised and become
limited by structure, the progress of the function
becomes plateau and any
additional function cannot be expected without further
major overhaul of
structure. The reason of the child's muscular condition
ie hypotonic or
hypertonic is the distorted musculoskeletal structure,
which causes
distorted distance between the two points of attachment
of muscles. When
the distance is too long, we have a case of hypotonic
child. When the
distance is too short, we have a case of hypertonic
child. Either way,
essentially they are the result of the deflated
internal volume which is the result of the weakened
internal organs and myofascia system. Consequently
ABR works in the same way regardless whether the
child is hypotonic or hypertonic. Once the musculoskeletal
structure is restored, the muscles tone (whether
it was hyper or hypotonic) would be normalised. |
| |
| This whole process of strengthening
the smooth muscles and myofascia, which restores
the full internal volume, which in turn restores
the musculoskeletal structure does not only mean
normalised skeletal structures and muscles. We also
observe the strengthening of the muscles thereby
increasing their volume, improves their shapes and
strength. |
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|
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