Using language in rehabilitation

One of the most interesting aspects to keeping an on current science is the application of the findings to the rehabilitation process. A recent article in the New Scientist by David Robson discussed the effects of language upon perception. It seems that the words we use have an impact upon what we see. The example used describes words related to up and down movements such as ‘climb’ and ‘drip’ have an impact upon the eye’s sensitivity to vertical motion. This is based upon the work of Gabriella Vigliocco at UCL who found that individuals were more likely to determine the direction of moving dots when accompanied by a verb that described the movement.

Robson suggests that words prime the visual system, further evidenced by a studies that show when we hear a word we are more able to find obscured images and letters. Creating a mental image from the word may allow us to identify the object more rapidly. It seems that the sounds could also be important and further enhance our perception.

Clearly there is a huge integration and scrutiny of the massive input of information from within and around us to create our sense of self. Many people have spoken about this including Melzack who describes the sentient hub and Bud Craig who discusses interoception. Our representation is known to be altered with pain and injury as demonstrated in many fMRI studies but also from descriptions that patients give of their experience of their body. For example, joints feel ‘out of place’ and hands feel bigger (‘sausage fingers’). Lorimer Moseley has done some interesting work where he asked individuals with chronic low back pain to draw their perception of their trunk and spine. The results demonstrated altered awareness and quite distorted images.

I see a role for perceptual tasks within a rehabilitation programme and most definitely in a multimodal sense. Working with our mental representation of the body whilst performing motor control exercises seems to enhance the quality of the movement. We know about graded motor imagery and imagined movements and how this can be really effective as part of a programme of care for complex regional pain syndrome (CRPS). Applying these principles to altered perception of body shape, size and position with mental imagery is an interesting application and potentially reconfiguring the neuromatrix. Adding language and sounds to the process may enhance this process on the basis that any additional and ‘normal’ input can reduce the threat value and restore function. Clearly this need to be studied appropriately to discover whether the idea is tangible, however in the meantime, if the individual’s perception of their body and its motion can be enhanced with a few simple words, it is a simple application.

The Voice of Reason. Robson, D. New Scientist 4th September 2010

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