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Physiotherapy Dystonia Network Meeting 11th March 2016

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Richmond Stace MCSP MSc (Pain) BSc (Hons)
Richmond Stace MCSP MSc (Pain) BSc (Hons)

A brief overview of my neuroscience-based coaching approach for cervical dystonia; presented to the Physiotherapy Dystonia Network in Birmingham on 11th March 2016

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THE CHELSEA EXPERIENCE: THE WHOLE-PERSON COACHING APPROACH Richmond Stace MCSP MSc (Pain) BSc (Hons)
How we met
pain & dystonia met
shared characteristics  Complex biology ‘in the dark’  Emerging in the person  Embodied  Lived experience – ‘moment to moment’  Influences  Emotional state  Attention  Expectation
complex biology  All biology pertaining to sensing and moving…  Experience now: prediction of what ‘this’ all means  And then influences upon sensing and moving: e.g./  Thoughts  Emotions  Environment  Prior experience
Biology in the dark  Inside the skull, the body  Somehow creates our reality  pain, dystonia, vision  Action shapes this biology that shapes our on- going experiences and reality  Bi-directional  This creates opportunities for change…in a new direction
dystonia  The person experiences & suffers unwanted movements and the effects thereof  Movement  Planned then executed  What is the job in hand?  Usually precise  ‘Over-steer’
the story  What is the trigger? Stress, emotion, a context?  That point is not in isolation  Often a backstory  stiffness, tightness, gesturing, posturing
listening to the narrative  The story unfolds allowing for a meaning  Opportunity to explain what has happened and is happening  They describe their lived experience  Our aim (together – cooperation) is to change the lived experience in a meaningful direction  Where the ‘treatment’ begins
lived experience  Altered movement – observe and test  Altered body sense – tactile discrimination  World (environment) perceived differently  Facing the world  Altered sense of self  How does the world see me?  Impact factor – limitations, avoidance?  Self-confidence, self-efficacy
coaching  Person becomes their own coach  Moment to moment thinking and action  Thinking and action aligned with vision of healthy self  Promote independence, belief in self  Growth mindset  Practice & quality – take every opportunity  Motivation, effort, resilience
the context and the mindset  Set it up  Understanding  Environment, thought patterns, what is happening now?  Practical mindfulness  Like ploughing a field before sowing the seeds
sensorimotor training: touch  Expected in physiotherapy  Develop relationship  Warm touch (have warm hands!)  Social touch for co- operation
Sensorimotor: stroke (caress)  Signals to sensorimotor areas  Rapid stroke/caress  Like stroking a dog  Sculpting body sense  Use it or lose it
Imagery  Recognise training: left/right judgements  Watching others move  ** Imagined movements  Planning stages of movement  ? affecting prediction of next movement  Often see small movements starting – overspill  Often improved quality movement & body sense
Visualisation  Creates calm with mindfulness  Evoke certain feelings and sensations  Visualise normal movement – often hard  Cultivate ‘confident you’, belief in yourself  Helping with the prediction  Maintains alignment with healthy vision and associated good feelings  Motivation & resilience
Tactile discrimination training  Develop body sense  Body sense key for normal movement  Sensorimotor  Thick and thin: aka cork and pen  Concurrent with stroke + look; movement training
Actual movement  Best quality  Aiming for precision (relies on improving body sense)  Repetitions (practice +++)  Feedback -- mirror  Integral with sense of body & environment  Context affects movement – where to practice?
Self-awareness  Awareness towards dystonia  anxiety, more unhelpful thinking, more unwanted movement etc.  Focused attention training aka mindfulness  Letting go of unhelpful thoughts  Focus on healthy action
Summary: whole person  Focus on the lived experience:  Who they are  How they move  How they feel  What they feel  How they envision themselves  Interaction between all – their reality
contact  Richmond Stace  Web & blog: www.specialistpainphysio.com  painphysiolondon@gmail.com  Twitter @painphysio  T. 07932 689081

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Physiotherapy Dystonia Network Meeting 11th March 2016

  • 1. THE CHELSEA EXPERIENCE: THE WHOLE-PERSON COACHING APPROACH Richmond Stace MCSP MSc (Pain) BSc (Hons)
  • 4. shared characteristics  Complex biology ‘in the dark’  Emerging in the person  Embodied  Lived experience – ‘moment to moment’  Influences  Emotional state  Attention  Expectation
  • 5. complex biology  All biology pertaining to sensing and moving…  Experience now: prediction of what ‘this’ all means  And then influences upon sensing and moving: e.g./  Thoughts  Emotions  Environment  Prior experience
  • 6. Biology in the dark  Inside the skull, the body  Somehow creates our reality  pain, dystonia, vision  Action shapes this biology that shapes our on- going experiences and reality  Bi-directional  This creates opportunities for change…in a new direction
  • 7. dystonia  The person experiences & suffers unwanted movements and the effects thereof  Movement  Planned then executed  What is the job in hand?  Usually precise  ‘Over-steer’
  • 8. the story  What is the trigger? Stress, emotion, a context?  That point is not in isolation  Often a backstory  stiffness, tightness, gesturing, posturing
  • 9. listening to the narrative  The story unfolds allowing for a meaning  Opportunity to explain what has happened and is happening  They describe their lived experience  Our aim (together – cooperation) is to change the lived experience in a meaningful direction  Where the ‘treatment’ begins
  • 10. lived experience  Altered movement – observe and test  Altered body sense – tactile discrimination  World (environment) perceived differently  Facing the world  Altered sense of self  How does the world see me?  Impact factor – limitations, avoidance?  Self-confidence, self-efficacy
  • 11. coaching  Person becomes their own coach  Moment to moment thinking and action  Thinking and action aligned with vision of healthy self  Promote independence, belief in self  Growth mindset  Practice & quality – take every opportunity  Motivation, effort, resilience
  • 12. the context and the mindset  Set it up  Understanding  Environment, thought patterns, what is happening now?  Practical mindfulness  Like ploughing a field before sowing the seeds
  • 13. sensorimotor training: touch  Expected in physiotherapy  Develop relationship  Warm touch (have warm hands!)  Social touch for co- operation
  • 14. Sensorimotor: stroke (caress)  Signals to sensorimotor areas  Rapid stroke/caress  Like stroking a dog  Sculpting body sense  Use it or lose it
  • 15. Imagery  Recognise training: left/right judgements  Watching others move  ** Imagined movements  Planning stages of movement  ? affecting prediction of next movement  Often see small movements starting – overspill  Often improved quality movement & body sense
  • 16. Visualisation  Creates calm with mindfulness  Evoke certain feelings and sensations  Visualise normal movement – often hard  Cultivate ‘confident you’, belief in yourself  Helping with the prediction  Maintains alignment with healthy vision and associated good feelings  Motivation & resilience
  • 17. Tactile discrimination training  Develop body sense  Body sense key for normal movement  Sensorimotor  Thick and thin: aka cork and pen  Concurrent with stroke + look; movement training
  • 18. Actual movement  Best quality  Aiming for precision (relies on improving body sense)  Repetitions (practice +++)  Feedback -- mirror  Integral with sense of body & environment  Context affects movement – where to practice?
  • 19. Self-awareness  Awareness towards dystonia  anxiety, more unhelpful thinking, more unwanted movement etc.  Focused attention training aka mindfulness  Letting go of unhelpful thoughts  Focus on healthy action
  • 20. Summary: whole person  Focus on the lived experience:  Who they are  How they move  How they feel  What they feel  How they envision themselves  Interaction between all – their reality
  • 21. contact  Richmond Stace  Web & blog: www.specialistpainphysio.com  painphysiolondon@gmail.com  Twitter @painphysio  T. 07932 689081