Sunday, January 29, 2012

To PT or not PT: Part 2

In To PT or not PT: Part 1, Cory developed his theory from the perspective of "inside-out" neuromodulation. He finishes his discussion of placebo:
"The "as if body loop" provides a way in which the neural representations are present "as if" a body change has happened. The placebo, must be considered an appropriate action, because it creates a neural representation that is "as if" that action did in fact take place. As far as the neural representations are concerned, it did. This is why it "cancels and terminates" pain."

He introduces the phenomenon of "learned helplessness"; in treatment of humans, he argues that our explanations are contextual, and therefore very important - this transitions nicely into the perspective of "outside-in" neuromodulation, starting with Kandel, and synaptic plasticity.

1. "they found that synaptic connections can be strengthened and weakened based different patterns of activity. The analogs of classical conditioning and sensitization strengthened a synaptic connection, while habituation weakened it."

2.  (Quoting Kandel): "This suggested that synaptic plasticity is built into the very nature of the chemical synapse, its molecular architecture."

3. "This is important for us clinically. The mere presence of a signal going through a synapse strengthens its connection." (Also this on chemical substrates and DNA changes in memory formation/long term change, long term potentiation)

4. Motor control as context dependent, comparable sign as immediate feedback

5. Mechanical deformation of nerve tissue

6. Exteroception

7. Interoception

The thread trailed away, as so many do, without fanfare or summarization. Yet it contains a solid skeleton for further development.
It is the only one to date, anywhere, that I am aware, to tie in:
1. what is going on in the nervous system of a patient, in terms of awareness and responsivity, from skin cell to sense of self, with;
2. what is being done to that patient/patient's nervous system by a therapist, simultaneously aware of everything in point 1.

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