08-13-13 - Dental Biofeedback

Got my teeth cleaned the other morning, and as usual the dental hygienist cut the hell out of my gums with her pointy stick.

It occured to me that the real problem is that she can't feel what I feel; when the tip of the tool starts to go into my gum, she doesn't get the pain message. It's incredibly hard to do sensitive work on other people because you don't have their self-sensory information.

But there's no reason for it to be that way with modern technology. You should be able to put a couple of electrodes on the patient to pick up the pain signal (or perhaps easier is to detect the muscles of the face clenching) hooked up to like a vibrating pad in the hygienist's chair. Then the hygienist can poke away, and get haptic feedback to guide their pointy stick.

I should make a medical device so I can get in on the gold-rush which is the health care raping of America. Yeeeaaaah!

This reminds me how incredibly shitty all the physical therapists that I saw for my shoulder were.

One of my really tough lingering problems is that after my injury, my serratus anterior basically stopped firing, which has given me a winged scapula. I went and got nerve conduction testing, as long thoracic nerve dysfunction is a common cause of this problem, but it seems the nerve is fine, it's just that my brain is no longer telling that muscle to fire. When I do various movements that should normally be recruiting the SA, instead my brain tells various other muscles to fire and I do the movement in a weird way.

Anyway I did lots of different types of PT with various types of quacks who never really listened to me properly or examined the problem properly, they just started doing their standard routine that didn't quite apply to my problem. (by far the worst was the head of Olympic PT, who started me on his pelvic floor program; umm, WTF; I guess the guy is just a molester who likes to mess around with pelvic floors, I could see half of the PT office doing pelvic floor work). When someone has this problem of firing the wrong muscles to do movements, you can't just tell them to go do 100 thera-band external rotations, because they will wind up losing focus and doing them with the wrong muscles. Just having the patient do exercises is entirely the wrong prescription.

Not one of them did the correct therapy for this problem, which is biofeedback. The patient should be connected to electrodes that detect the firing of the non-functioning muscle. They should then be told to do a series of movements that in a normal human would involve the firing of that muscle. The patient should be shown a monitor or given a buzzer that lets them know if they are firing it correctly. The direct sensory feedback is the best way to retrain the muscle control part of the brain.

A very simple but effective way to do this is for the therapist to put a finger on the muscle that should be firing. By just applying slight pressure with the finger it makes the patient aware of whether that muscle is contracting or not and can guide them to do the movement with the correct muscles. (it's a shame that our society is so against touching, because it's such an amazing aid to have your personal trainer or your yoga teacher or whatever put their hands on the part of the body they are trying to get you to concentrate on, but nobody ever does that in stupid awful don't-molest-me America).

Everyone is fired.

A related note : I've tried various posture-correction braces over the years and I believe they all suck or are even harmful. In order to actually pull your shoulders back against your body weight, you have to strap yourself into a very tight device, and none of them really work. And even if they do work, having a device support your posture is contrary to building muscle and muscle-memory to train the patient to do it themselves. I always thought that the right thing was some kind of feedback buzzer system. Give the patient some kind of compression shirt with wiring on the front and back that can detect the length of the front of the shirt and the length of the back. Have them establish a baseline of correct posture. The shirt then has a little painful electric zapper in it, so if they are curving forward, which stretches the back of the shirt and compresses the front, they get a zap. The main problem with people with posture problems is just that they forget about it and fall into bad old habits, so you need to give them this constant monitoring and immediate feedback to fix it.


Noah Fredriks said...

Have you tried back taping? I found that it wasn't actually strong enough to hold the posture, but the tug on my skin was enough to remind me to do it myself.

cbloom said...

Yeah, I have done that and found the same thing (it's a good cue), I think it is pretty effective.

My brief research led me to "KT Tape" which is a cultish methodology of taping for physical therapy corrections. The mainstream medical community says that KT Tape is a load of shit, because taping the skin can't do anything significant to the muscles - the skin just moves.

My personal experiences indicates that is correct - the taping in fact does nothing functional or structural for the body.

HOWEVER it does do something for the mind, and the mind does something for the body. You can feel the tape and it changes how you move and hold yourself, which is really what you want - to get the patient to use their own muscles correctly to fix the problem.

The problem is that the KT Tape cult claims that somehow magically it does actually transmit through and pull the muscle.

If you recognize it as a way to give the patient a postural or usage cue, I think it's legitimately useful.

old rants