jueves, 14 de febrero de 2013

What is INN?

Statement of Nora Kern, founder of INN

My speciality is the Integration of the knowledge of Neurodynamics into the concepts of Neurorehabilitation (INN) , equally for physiotherapists, occupational therapists and speech therapists.

You can use my ideas for patients after a stroke, bleedings, hypoxic brain damage, traumatic brain injury, patients with para- and tetraplegia, multiple sclerosis, parkinson, GBS or critical illness polyneuropathy.

It will work with new born children with CP as well as on the intensive care and in later stages of rehabilitation - but the best would be to follow the ideas of INN right from the onset of the lesion to the central nervous system.

The reason is, the reaction of the nervous system to a lesion is not dependent on which lesion it was, more on how long it has been there and what has been done since the onset. The most natural state  for human beings is moving - therefore we have muscles and joints and ligaments and capsulas and discs to avoid any kind of misuse and overuse, to distribute forces and develop adequate strength related to the task.  Non use would be the worst, and that is exactly what happens  after a central lesion to all people, no matter how old they are and how fit they have been before. They struggle hard to overcome their limitations, because they want it themselves or because therapists and relatives push them to do so, many times with no or only little success.

Additional to their lack of control over their now different body, people around them are explaining the negative impact of a stroke to their life, to private, to financial and to professional concerns. So they are full of fears themselves about their future, and having got pessimistic information from the whole medical team. Therefore aim of treatment can never be only a mechanical intervention, but has to consider all those mechanisms, that are creating a disability or handicapped-matrix, similar to the pain matrix, described by many authors.

To understand when a patient needs which amount of help, or support, or encouragement, or just understanding, the knowledge of the mechanical reactions of the nervous system to getting moved is the guideline. We can experience similar  strange reactions, as the patients are sometimes showing, within ourselves, when being in a specific situation that is a limit position for our nervous system, either limit of pressure or limit of pulling. The only difference is, our brain knows that it is only a momentary situation, it will end soon, we will get back the control over ourselves within some minutes.

The patient is well aware (explicitly or implicitly) that it will not end soon but stay perhaps until the end of his life. Furthermore he has not only one problem, but many at the same time, and after some time - of course that differs from person to person - they loose their confidence in the future and therefore loose their energy to work hard and actively against started structural changes.

We have to start right from the beginning with offering a supportive ambiance, to encourage the patient's self esteem, his ideas, his creativity. We have to avoid all kind of structural changes, within the connective tissue (also and especially that within the nervous system), the muscles, the joints. That means, as long as the patient cannot move himself, we have to do it for him, in a functional way, accompanied immediately with manual techniques for joints, if we find slightly changes there. Later in rehabilitation, or after some years, it will need much more power to work against those restrictions.

With children, the difference is not mainly their not yet fully developed brain, and their lack of understanding, but their different hormon situation. All their bones and other structures are genetically disposed to grow by growth hormons. If there is a lesion to the central nervous system, followed by less experience with their body, f.e. no-fingers-and toes-into-the-mouth, they do not develop a normal trunk uprighting with good balance reactions. If the brain has to struggle hard with keeping the balance, it is occupied with this task and therefore has no capacity to learn abstract topics in school. With an even worse situation, if the child was never able to get into contact with the world around with his hands, the brain will not develop, will not grow, and therefore the head bones do not grow.

The whole body does not grow, or if, into scoliotic deviations because of the pulling within the connective tissue of the nervous system. The whole child looks like a preschool child, even with 14 years of age.Comparing those children, either with CP or after a brain lesion in early childhood, with healthy children, the most obvious difference is: the amount of moving. A two year old child is on tour the whole day, jumping around, running, falling, hiding: That is training his body muscles, keeping the joints mobile, learning about his or her body's possibilities and limitations, getting a good body perception. Not moving therefore means, no body awareness, no creative ideas, no praise and dispraise, no challenges, only dependence. So again we end up with the disability matrix as mentioned above.

What to do? The same as with adults, but moving them even more, with the knowledge of what could hurt - because the youngsters cannot give a definitive feedback. We have to get very sensitive hands to detect even slightest changes and to feel restrictions. Offering them toys is not at all sufficient, they need guidance to experiment the world with their whole body, not only with their eyes or ears. By the way, they love it! They can work harder than I ever expected.

What is INN? A certain style to meet neurological patients, a humane philosophy, lots of specific techniques for mobilization of all kind of structures in the body, based on a firm theory originated from neuro-orthopedic science mainly introduced by David Butler, adapted to the special needs of patients after a central lesion in cooperation with Gisela Rolf, combined with knowledge of body language, using handling and facilitation skills from the Bobath Concept, integrating the background of how perception develops, open to any other treatment aspect that is necessary to overcome additional limitations, and open to any further scientific support.Nora Kern, Munich 2/13

domingo, 10 de febrero de 2013

Novedades en cursos y aportaciones profesionales

Incluímos dos nuevos cursos introductorios que tendrán lugar en el centro Sinapse de Coruña y una nueva sección en la que profesionales afines a INN aportan su particular visión de éste y otros métodos coherentes.