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Primary Care and integrative medicine: helping place patients with Cerebral Palsy at the center of their care. A patient’s perspective.

Jess Silver

April 24, 2014

The medical field today is increasingly driven by a notion where a physician is motivated by the need to implement a new approach, medicinal compound, or methodology into an umbrella of alternative types of treatments, to aid in a patient’s care. This growing model of analysis and treatment; defined as Integrative Medicine, considers the implications of the environment and one’s lifestyle on the health and rehabilitation of the symptomatic concerns associated with the complex systemic impairment subject to a neurological condition like Cerebral Palsy (CP) (1).The condition affects the cerebral and frontal cortex of the brain due to damage sustained during fetal development or after birth, causing impairment of speech, movement, and motor control (1).

By placing the patient at the centre of understanding and directing their care based on qualitative, experiential knowledge of their condition, the Integrative approach to medical care differs from other conventional approaches to treatment (2). Conventional models of treatment and diagnosis would typicallyattribute the condition to one major organ system not functioning properly such as a neurological abnormality, and/or musculoskeletal problem in patients with cerebral palsy (2). In this alternative model, factors such nutrition and exercise are evaluated against the neurological abnormalities with the goal of providing therapeutic approaches to both complement and manage symptoms (2).

Analyzing a number of factors that are interrelated as having a contributing effect on one’s health, integrative medicine assesses the relationships of systems in the body and external influences such as the environment, and level of activity as they influence one’s quality of life (3). The model is practical for healthcare practitioners in Canada and the United States, because it allows for a more comprehensive analysis of the condition, but importantly, it also provides the patient with the ability to make choices as to the various alternatives for pain management (3).

As an individual with CP experiencing pain associated with spasticity and difficulties with mobility, I can recount the times in my life where I felt like I ran out of options for treatment, or ways to improve my quality of life. Conventional Physical Therapy did not allow me to increase my flexibility, agility and strength the way that working with a physician whose expertise utilizes an Integrative Medical approach has. The ideas on which the Integrative approach is based, have helped me to become actively involved in my rehabilitation. This model of care has allowed me to understand the interconnected nature of my muscles, nerves, and tissues and to ultimately achieve improvements in strength and flexibility while reducing the pain associated with the Scoliosis. It has provided me with ways to become stronger and manage the pain associated with muscle spasticity and atrophy. In contrast with the traditional ‘no cure’ diagnostic methodology commonly asserted in addressing CP; the Integrative model considers the many variables that influence one’s ability to ambulate.

Implementing the Integrative approach into my rehabilitation has given me a degree of control over the exercises and treatments that I pursue. It functions as network of different factors which has allowed me to understand that engaging in as many different exercises and alternative treatments such as Prolotherapy injections, will help me to feel better. By understanding how each environmental, lifestyle and biomechanical factor is interrelated, I have been able to better understand the origin of my pain, muscle fatigue and nerve- related symptoms, and communicate my needs more effectively to my doctor. Looking at Primary Care through the integrative multidisciplinary, approach has provided me with new, refreshing lens into rehabilitative medicine. It reinvigorates a sense of optimism and fight to achieve optimal results in individuals like myself.

Compared with conventional methods that recommend medications and assistive equipment to control pain, manage spasticity and assist with mobility, the integrative model of primary care is more comprehensive and liberal (2). The model presents the patient with methods of rehabilitation to suit their needs and choices as to what works for their individual bodies. For example, treatments such as chiropractic medicine and acupuncture, have helped me to reduce muscular contractures by increasing blood flow, and have thus improved range of motion in my extremities.

Based on my personal experience, the integrative approach provides individuals with greater autonomy in managing complex conditions and establishing a positive quality of life. It has inspired me to both understand my condition, and make informed decisions on the types of care that I wish to receive. Most importantly, it has helped clarify the interconnectedness of the body, and to manifest control over improving muscle tone, nutrition, and overall physical awareness.

References

1) Rosenbloom, Lewis. Diagnosis and management of cerebral palsy. Arch Dis. Child. Apr. 1995; 72 (4): 350-54. Date Accessed March 31: 2014. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1511245/?page=1

2) Bell, Iris, R. MD, MD (H). PHD. Opher Caspi, MD. Gary E.R. Schwartz, PhD. et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model of primary healthcare. AMA. 2002. Reprinted in ARCH. INTERN. MED. January 26, 2002. Vol. 62. 133-34. Date Accessed March 31, 2014. Available from: http://oncotherapy.us/pdf/Integrative.Medicine-Systemic.Medicine.pdf

3) Hofman Laurie, MPH, Jones, David S., MD, Quinn Sheila. 21st century medicine: a new model of education and practice. IFM. Fountainhead Foundation. 2006. Date Accessed March 7: 2014. Available from: http://www.marthaherbert.org/library/IFM-White-paper-21stCenturyMedicine.pdf

4) Mckay, Naomi D., Jennifer Langworthy. A survey of accessibility and the utilization of chiropractic services for wheelchair users in the United Kingdom: what are the issues? Chiropractic & Manual Therapies 2011, 19:20 doi: 10.1186/2045-709X-19-20. Date Accessed March 31, 2014. Available from: http://www.chiromt.com/content/19/1/20