We are ready to head into the summer break. If you’re a physical therapist or another health professional, you can probably relate to how challenging the last few months have been and, in some ways, still are. If you look back, we’ve been through the rise of a pandemic with an infectious agent many countries and states went on lockdown or stayed home orders. Along with that, there was social distancing, mandatory mask-wearing, schools and businesses closed, things came to a halt. As professionals, we had to deal with clinics closing and the decrease of new patients and existing patients that weren’t coming in.
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My guest is Hannah Johnson. She is a clinician as well as an educator. She earned DPT in 2013, as well as a Geriatric Clinical Specialist certification in 2016. In 2018, she published her book, Psychosocial Elements of Physical Therapy in effort to fill the gap in mental health education for physical therapists and physical therapy students. Her PhD research explores how to improve interdisciplinary quality care in nursing homes. In this episode, you'll learn about the biggest obstacles in physical therapists management of complex patients. You’ll learn how residents of long-term care facilities can keep up their physical activity, as well as evidence-based supported practical strategies for managing behavior such as agitation, aggression, refusal of care and inappropriateness that are often associated with various medical, psychological and social conditions. I highly recommend you check out Hannah's book. It's an excellent resource for physical therapists and other health professionals. Without further ado, let's begin and let's meet Hannah.
In this episode, we're discussing the neuroscience and treatment of focal dystonia. My expert guest is Dr. Nancy Byl. Dr. Byl has been a practicing physical therapist for many years. She assumed leadership as Department Chair and participated in academic development, teaching, and administration at the University of California, San Francisco's Graduate Program in Physical Therapy. As a clinician and researcher, she's an expert in the cause and treatment of focal dystonia. Working with collaborators in neuroscience, she designed an animal model to study the etiology of focal hand dystonia. She created a paradigm shift in the understanding of focal dystonia as a case of neural maladaptation of sensory and motor processing.
Using imaging techniques, her team demonstrated that learning-based sensory-motor training for patients with focal dystonia, not only improved sensory discrimination and accuracy but modify the topography of the sensory cortex, improve neuronal firing patterns and improve motor control. In this episode, you'll learn all about the cause and the treatment of focal dystonia as well as Dr. Byl's evolution as a physical therapist, both in research, academia and clinical practice. Let's get started and let's meet Dr. Nancy Byl and discuss focal dystonia.
As always, it's an honor to be spending this time with you. If you read episode 187, then you met psychologist, Louise Sharpe, who shared her research and discuss these central components of psychological therapy for effective pain management. Her research distilled over 50 components of psychological treatment for pain into three essentials, which were psychoeducation, cognitive approaches and strategies to increase physical activity. In her paper, she named these three as the gold standard for pain care. I enjoyed this episode with Professor Sharpe. I believe her research and interview is useful and can help inform clinical practice. Make sure to give it a read before you dive into this episode.
While I was doing some research, I came across a commentary in response to the paper Professor Sharpe published. This commentary was written by Professor Lance McCracken and published in the European Journal of Pain. For those of you who may not know Lance McCracken, he is a professor of clinical psychology and Head of Division of Clinical Psychology at Uppsala University in Sweden. He has worked as a clinician and conducted research into chronic pain treatment for more than 30 years. He actively contributes to the evidence base on Acceptance and Commitment Therapy for chronic pain.
The title of his commentary was Necessary Components of Psychological Treatment for Chronic Pain: More Packages for Groups or Process-Based Therapy for Individuals. In his commentary, Professor McCracken proposes that instead of studying the components of psychological treatment, if we want better treatments for pain, what we mainly need to identify is the processes of change known to have an impact on outcomes. I was interested in Lance's commentary and his perspective, so I invited him to come to speak to us. This leads us to the episode where Professor McCracken discusses Process-Based Therapy.
Process-Based approaches have been growing. Some say that Process-Based Therapy should be the new gold standard of care because they can target a broader range of problems. In diagnosis-based protocols can target multiple problems at once and a more easily individualized and minister to the client. In this episode, you'll learn all about Process-Based Therapy, the science and evidence behind Process-Based Therapy, how it can help clinicians more effectively treat pain, and how it differs from protocols that focus on specific syndromes. Without further ado, let me introduce Professor Lance McCracken, and learn all about Process-Based Therapy.
Thanks for joining me for this episode. If you’ve been following along with each episode, you know that we often speak about the psychosocial variables that are effective for the management of chronic pain. Why do we spend so much time on this? Study after study confirms that psychological interventions alone are more importantly combined with interventions such as physical therapy are effective for the management of chronic pain. Theories and methods such as Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness-based Stress Reduction, mindfulness explained pain and pain-neuroscience education all have supporting evidence and are a part of a comprehensive program for the management in chronic pain. With many treatments to choose from, a wise clinician may ask, “Which one works best?” Perhaps a better question, “Which components that are embedded in these methods are most effective for the management of chronic pain?” There has been little research to answer these questions or guidance to help the clinician choose the most important components as they’re creating a plan of care for people living with pain.
Joining me to discuss the necessary components of psychological treatment in pain management is Professor Louise Sharpe. She is an expert in health psychology with a particular expertise in Cognitive Behavioral treatments for patients with chronic pain and physical illness. She’s particularly interested in the way in which people adjust to illness and the interventions that prevented development of psychological problems and increase physical disability. On this episode, you’ll learn all about the efficacy of Cognitive Behavioral treatments for the management of chronic pain, the three essential components that should be a part of every Cognitive Behavioral approach and if we should shift our approach away from focusing on components and more toward process-based therapy. There’s a lot to unpack here in this episode with regards to which components are necessary for the treatment of chronic pain. Let’s begin and meet Professor Louise Sharpe.