Psychology and Physical Therapy Textbook

The Mind is a Powerful Tool

The Nerve which becomes damaged due to some type of injury is not just at the site of the injury, the nerve is a line which runs from the nerve through the body to the brain. Every major injury to the body is also a major injury to the brain, the brain itself reacts to the pain of the injury in a variety of ways. The more damage the more the brain and thinking patterns of the brain itself change. Which also brings up the application of does a severe injury to the body cascade into brain injury. Since shock can and does kill, the answer is in various degrees yes.

This book is an exploration of exactly what and how said brain injury can be identified, classified, measured, categorized, etc so a start of a healing process can begin.

The hardest and most difficult direct reference regarding a physical trauma cascading into a mental trauma is a miscarriage. Some woman will literally be so emotionally devastated by a miscarriage they are never able to get over it. Others shake off the mental damage and move on with life as if everything is normal.

Mental

In the movie “G I Jane” the Drill Instructor kept quoting poetry, about the will to continue. Special operations training requires pushing the body, mind, and spirit to the brink on a constant basis. What exactly is the brink and how well is it defined is the point to special operations boot camp.

Physical therapy is much like special operations boot camp. With its 60% drop out request rate. How many clients cannot mentally work through their issues in order to bring their body back to full function. How many therapists are so locked into their own mental garbage they are unable to help their clients. Both sides are simply going through the motions, hoping for the best outcome without actually understanding they are the problem.

Grief and the Mourning process

When an injury occurs which requires PT in order to start the road to recovery, every patient will go through some level of grief. A few seconds to let go of the old life up to and through they are stuck thinking they are still capable of their old life despite the facts that old life is gone for good. The patient stuck in the grieving/mourning process will have the most profound impact on their healing process.

The more they are stuck wanting their old life, the more they will not be able to cognitively accept what needs to be done in order to heal properly.

Awareness Equation

Every person has a temper. That temper can be defined within the strict parameters of the following equation.

Awareness of Temper grid

0 is when the person’s temper is finally starting to show in either physical manifestations of anger and or mental signs.

Somewhere between 0 and around positive 7 deviations the person will become aware they are angry. Depending on of course how much or hard they are trying to suppress a wide variety of issues and situations which directly affect the person’s temper.

From the negative numbers leading up to the 0 can be a large number of deviations where the person is beginning to become upset, frustrated, annoyed, something is on the person’s nerves, etc. the width and breadth of the definitions and words used to describe the emotions which lead up to actual anger are many and varied.

For example, this is the subject of the book and numerous movies “Jekyll and Hyde” where the main character of Dr Jekyll based on being a rich Doctor living in Victorian England but within the framework of the City of Edinburgh. During the Victorian age, each class were subject to the strictest laws regarding proper conduct. Mr. Hyde was a way for the internal positive 7 or higher deviations of anger, frustration, rage, annoyances, etc to come out. But the culture was so suppressed that it was impossible for Dr Jekyll to express or even allow himself to become conscious of said feelings and emotions. The experiments allowed his inner “ID” as Freud described to come out and express itself; those expressions were in the form of Mr. Hyde.

The most relevant example is when a regular dinner guest of Dr. Jekyll; Mr. Hyde tracked him down and killed him. That man was of a higher Hierarchal station, he was a titled HRH and therefore his annoying insults and qualities had to be put up with and constantly on the top of everyone’s invite list in order to stay within the framework of polite society. But Dr Jekyll hated that man with a passion. He was stupid, insulting, rude, and above all pompous. He did absolutely nothing to earn or achieve said title, he used it to have friends. Most of his friends hated him, but he could not actually show it. Proper Royal upbringing in said societies, just because you are born with a title and are subject to making those under your social standing respect you, does not mean you have a free pass to be a jerk. You have more responsibility to be a nice, good, charitable, and above all honorable person. Taking advantage of your station is the first sign of a bad person. Mr. Hyde took care of that persons “un-honorable” behavior by killing him. Which Dr. Jekyll had in his sleep dreamed about many times, but would never allow himself to be aware of it.

The Jekyll and Hyde balance is a solid fictional benchmark regarding the sub-conscious minds struggle through the healing process. The Dr Jekyll is the perfect image of how the person wants to perceive themselves, Mr. Hyde is the unconscious positive seven to 15 deviations which cause bad behavior and inappropriate words/actions to occur. Every PT needs to be keenly aware that everything they do is a balance between Dr Jekyll and Mr. Hyde when dealing with a patients struggle to heal. For the patient wants to be themselves but they have societal pressures (Dr. Jekyll) and the suppression of said pressures reactions (Mr. Hyde) to balance in order to move through the healing to achieve some level of health.

Some cultures only allow specific types of anger and bitterness to be presented. So the person will be angry and resentful long after internally they are past 0 and are technically angry/frustrated.

The farther into the positive number deviations with the patient unaware of how upset, frustrated, angry, etc. they are the more uncontrolled of their behavior they are.

What triggers said dissociative state, when the patients and sometimes therapist’s reality is questioned. Especially when being treated for Physical Therapy the more their temper will come out and come out uncontrollably.

Oftentimes the more unconscious the person is of their temper at say step 5 to 7 deviations past the 0 of anger, the less they are aware when their temper is triggered and the rules of social graces are no longer feasible to be complied with. Or worse the person thinks they are following the rules of social order but the deviation between reality and their illusions forces them to think they are ok when in reality they are screaming at the top of their lungs throwing things around. This is a good bench mark for the beginning of chemical dependency. Instead of using an injury cascade to produce the necessary endorphins and adrenaline, many turn to either external chemical dependency or religion chemical dependency. The high associated with convincing someone their path is wrong and bring them into your philosophy. the euphoria which comes with a religious experience can be similar to the euphoria a con-man achieves after they are able to take whatever they wanted from their victim. Same basic equation, especially if the “converted” person and the converter are both running from external chemical dependency.

This same equation also applies to patients who achieve the high from intimate encounters. Both sexes are subject to inappropriate adult encounters, be them with willing participants or be them with to varying degrees unwilling participants. A similar high and associated deviations from the 0 of mental and physical health; using the described experiences as a coping mechanism in order to achieve functionality despite living in a cognitive dissociative state.

The following scenario illustrates the point

“why is everyone reacting so badly. Everyone is performing actions which are so far outside the realm of acceptable behavior.

Why am I hearing loud noise around me? I just cannot figure out where that really loud noise is coming from.

For some reason I cannot fathom, my hand hurts but it is probably nothing I will think about the unexpected pain in my hand at another time. No big deal.

Why is everyone reacting so badly still, do they not know this is an inappropriate place to act that way. Come on now people, we are all adults, we can at least pretend to be polite to each other.

What is that loud noise? It seems to be getting louder.

Why are my ears ringing?

That loud noise is really starting to bother me, is there a motor close, did someone leave a door open, where is that really loud noise coming from.

Wait a second, that loud noise are words. Someone is saying something. But it does not sound like a song, it sounds more like screaming. Who is screaming. Is it coming from a TV, a radio, or someone around me.

A quick scan of the people around, the only people with raised voices seem to be directing them at me. But I have not done anything to warrant said type of response. Although I cannot hear what they are saying, the only thing I can hear is a very loud sound which still sounds a bit like words. But only remotely, the words are not all that intelligible. The sentence structure is hardly present, lots of short bursts of loud sounds which are loosely words in small sentences.

I do not understand what is happening. What is going on, my body hurts, this very loud sound, people around me are very angry, that anger seems to be directed at me. I simply do not understand”

This continues until the person regains sufficient faculties in order to realize the loud sound is their own voice screaming, incoherently at not really anything. The people around are reacting to the verbal and physical nature of the violence the individual is all but entirely dissociatively not aware of.

Temporary Insanity

Temporary Insanity grid

This is in a way “temporary insanity” but said mental condition occurs a great deal within the framework of a physical disorder. Believing there is nothing wrong but everything is wrong, discounting the grief, discounting the physical limitations, discounting the functionality, discounting the mental strain. Some people can spend their entire time they are “otherwise abled” in some level of a dissociative state. Said dissociative state 0 being understanding reality, the positive variables being the positive side of thinking, where the outlook is rosy but the farther away from the 0 the less connected to the reality of the mental, physical limitations. The negative variables are the same as positive but swayed to negative thought patterns and depression.

Where both morally and legally they have little control over their mental faculties and more importantly their physical reactions. But when it comes to mental health and PT, a lower level of temporary insanity can last for a longer period of time and affect the healing process for weeks, months, or even years. Where the patient is 8 positive and negative and is entirely unable to pull out of a self destructive head space and the mental and emotional state suffer into a cascade effect of really bad actions and reactions.

Relativity comes into play in these specific situations.

In brief perception, one hour in a new conversation with a person of your dreams an hour is a minute. But touch a boiling hot pan and a minute is an hour.

How many patients when instructed to perform an exercise state that 10 minutes seemed more like half an hour or more.

Every culture teaches there are serious and substantial problems within the realm of balancing between personal freedom and cultural identity. To live in a culture requires various levels of cooperation and emulation of behavior patterns. In some cultures, the rules are stricter, in other cultures the rules are just as strict but in different areas.

The Victorian era culture compared to the 1990s Hip-Hop culture, the rules are equally as strong but applied different. Both have rather extreme levels of violence and a hierarchal structure. But each culture interacts with mental health and worse “Physical Therapy different”. Those rules of acceptance of physical health and mental health are the first step in being able to treat a patient. Because in the above described scenario, at some point the patient either needs to realize they are screaming and having an adult temper tantrum or they need to be separated from the society because they are in the middle of causing harm to themselves and the world around them. Even after they realize it, it does not solve the problem regarding their “Cognitive dissonance” not being able to process the facts they were entirely out of control for x amount of time. They were entirely unaware they were the one screaming, they were being violent, they were the one being loud. They had injured themselves while throwing the temper tantrum. But they had disassociated so hard, the patient was entirely unaware of their actions.

, which is a standard issue with people of every culture. Their mental image of themselves differs in different and various degrees from reality. Which is in part taught based on the culture they live in. every culture in order to function can and will literally build in some level of dissociative disorder in order to be able to have a cohesive internal operation societal structure.

Autism

With all the negative responses and issues which come up to, through, with, and related to physical injuries which can at times drastically alter the mental status and conscious responses from the patient. Comparing a “non” responsive patient using the scales of autism is not entirely outside the realm of realistic.

Previous to the injury similar to Phineas P. Gage, his personality changed radically after his traumatic brain injury. For some can produce autonomic nervous system symptoms similar to the autistic spectrum. Said symptoms include low to no communication behaviors, extreme hypersensitive nervous system responses, a need to be not touched in almost any way, isolation reactions similar to instead of being able to communicate the patient responds with autistic like grunts and screams. But similar to the example of the Screaming man above, is entirely unaware or partially unaware of their behavior. Or are aware but are in a mentally altered state where their normal reactions and mental processes are severally altered, but their awareness of how altered they are being entirely a mystery to the patient. They think they are reacting like they used to, but they are reacting entirely new and their perception cognition has altered to the point they are still thinking they are reacting in the old way. But their cognitive dissonance will not allow them to realize how much of their existence has changed.

Based on a century and a half of the history of psychology, from when Wilhelm Wundt published his book circa 1860, based on translating the essence of psychology buried in ancient writings with the opening of the Holy Roman Empire’s Library circa 1806. The concepts of there are measurable and distinct patterns and reasons for the mind and perception to alter. Those alterations can be identified and measured. Such measurements can and do lead to therapy which can alter the person from “unhealthy” behavior back to some form of “mental Health.”

But adding to the field of PT the scales and measurements of autism might be a very good way for both the therapist and patient to know how they are reacting. Does the pain response from the trauma of the injury affect the patient, how does it affect the patient, does the affect alter the patients conscious mind into an autistic spectrum? The basic what, when, where, why, how questions need to be asked and answered. Since more than a few patients shut down and have a visible to the outside world similar behavior pattern which is at times indistinguishable from autism. the question becomes, instead of trying to force a “Dr Jekyll” reaction to “act normal” treat the injury to the mind just as much as the injury to the body.

The nerves at the injury site are directly by a dozen neuropathways connected to the mind. So in a very real medical and gray’s anatomy way, a physical injury to the body can be laboratory tested and confirmed by any type of brain scan are literally trauma to the brain. Neurons control the body . The brain is not just in the skull. The brain has “limbs”/ “fingers”/ “toes”/ ? extensions which connect to virtually every single cell in the body . If the body is injured there is no reason other than perception to assume the mind is not also traumatically injured.

an injury to the body based on the nervous systems will be an injury to the brain. The more traumatic the physical injury the direct association with a traumatic brain injury. The evidence is beyond obvious, the results have been mostly ignored. That needs to change and immediately. “Do no harm”, ignoring the traumatic brain injury from physical injuries is doing a profound amount of harm to both the body and the mind. The patient’s injury is ignored and all the medical provider’s jobs are that much more difficult because a real injury is in the way of the healing process. Just bullying the patient into “get over the traumatic brain injury” is almost disgraceful.

For direct and hard core evidence of the nerves in the brain can and will directly affect the function of the mind and mental awareness. Ever hit your “funny bone” on something really hard and your entire world shrinks down to laughing without being able to think about anything other than how much the pain in the elbow hurts. Hitting your funny bone is a form of a very low end traumatic brain injury.

Treat the mind correctly, not just ignore the mind hoping the mind improves based on when the body heals the patient will “snap out of it”. That is inappropriate hypothesis, which is based on hard evidence is a real response than it is the definition of malpractice. Performing harm by refusing to treat an underlying mental trauma, which cascades directly from the physical injury.

Placebo effect

Previous to the USDA, AMA, the FDA, etc. snake oil salesmen were plentiful. People who would create extremely dangerous concoctions and sell them, the advertising on the label told of how miraculous this specific “potion” was. That it would cure all that ails you. But the potions were either poisonous, or mostly a drug (cocaine, heroin, alcohol, etc) designed to create an addiction not actually cure anything. Some entirely unethical apothecary working in a specific city would create addicts, which would guarantee years of income based on the middle and upper class society’s large bank accounts and them becoming addicted to the potions. Since it was under a doctor’s care, the medicine was acceptable. President Roosevelt based on the standard “group think” model of peer review references was still being prescribed Cocaine for his lungs in order to improve his health. He was prescribed several grams of Cocaine several times over the course of some of the most important dates in American history; December 6, 7, 8^th 1941. In the present every six months or so there is another “Wonder Drug” which the pharmaceuticals throw millions of dollars on TV ads to obtain those patients going to their doctor to obtain said prescription. Years later those drugs are found to be to the extreme level of bad, causing in some cases catastrophic medical conditions up to and in some cases including death. The “potions” of the past have changed slightly but not sufficient to warrant a removal of several regulatory agencies. Too bad the psychological field is not as strongly regulated, Skinner devotees are still in the present entirely convinced (no amount of evidence will convince them otherwise) that human do not actually have natural behavior patterns. Everything is nurture and emulation behavior. That no matter how much conditioning is performed, those behavior patterns will simply find a different more destructive path, if several of their more natural pathways for expression are blocked. Other drugs, potions, therapies, etc are still being created and sold as if they are to improve health not slowly destroy it. A similar equation regarding pharmaceuticals exist within the realm of Physical Therapy. But since the mind is a primary tool, trying to get the patient and or the therapist to understand they are perceiving wrong or they are operating from a sequence of Placebo effects. The therapy in part works not because the treatment is working but because the patient or the therapist have a placebo effect perception problem. The mind is an extremely powerful tool, the mind can and will alter the body as needed. If the mind believes something hard enough, the mind will alter the body to match. Believe as in literally cognitive dissonance, but directly toward making the body work better instead of making the body un-functionable. Or alter the reality perception sufficiently in order to create a large enough gap between reality and the way the person perceives reality. A sugar pill given in a scientific study of a new drug, the patients in Group A (placebo) depending on how much interaction they have with Group B (real drug) can and will emulate said progress. In the waiting room before each patient’s x timed check up will see the patients just finishing and the patients scheduled either at the same time or just after. The doctors who are bad with their schedules, sometimes have 10 patients in the waiting room for an hour before they are called back. That hour will seriously influence the drug trial. Because the patients on the placebo will in some degree emulate the patients receiving the real drug and vice versa. None of that is a factor without the equation of a drug test. the best thing in said case is to have patients have absolutely no contact whatsoever with other patients, but for a doctor’s office that absolutely zero contact is beyond unrealistic.

In the realm of physical therapy similar concepts exist in the present, since the mind is the primary tool which moves the body. The mind needs more attention than the physical body does. But just having a mandatory psychological counseling in addition to P.T. can be just as much of a waste of time. A psychologist who is a Skinner Devotee will try and either CR, or OC the client into submission. Suppressing someone’s nature is worse than a society suppressing an individual’s or a group’s nature. A group will take a while to respond to being suppressed, and unless that group operates inside a tyrannical dictatorship, the individuals with the largest problem will simply leave to find a better community they can function within. For an individual a society or therapy forcing them into a Skinner Box of a CR or an OC will eventually produce the above described scenario. Not necessarily that long, but some version of “why I am so angry” or after a few seconds to minutes of screaming “wow, what is wrong with me.” Each different sub-discipline in Psychology will interact and react to the medical condition different. Some therapies are great for x physical issue; some x therapy will cause more harm to y conditions. Although the arguments within the realm of Psychology are vitriolic. E.g. never question the authority if a skinner devotee regarding their sub-discipline, cross comparing Skinners work with Lighteners work is a recipe for a very long argument which will end with both sides at an impasse. The academic discussions and violent disagreements within the realm of psychology are a huge portion of why treating Physical Therapy patients is difficult. Each patient requires their own approach, to healing the mind, body, and spirit. One size in PT just like Psychology does not fit all; no matter how hard or strong the therapist or the patient want it to.

The mind can create disease, create health, create a sense of “everything is ok” when the body is literally breaking, or create a sense of “impending disaster” when in all reality close to great physical health is present. “I cannot, I cannot” when the only limitation is the person’s mind set, there is little wrong with the physical body, it just needs to have x therapy to obtain just 5% better function to have a 100% working system. But the person’s mind thinks they are at 30% function.

Psychology Sub-Disciplines

The field of Psychology is itself literally one of the most ancient fields known to academics but the long and winding road of academics itself post the end of the 18^th Amarna Egyptian Dynasty the field of Psychology was slowly removed from academics. It has taken more than 3300 years for academics to reintroduce and accept the field of Psychology again.

Along with the reacceptance of Psychology carried at virtually the same time is the field of Physical Therapy. The rehabilitation of the body after a trauma has rendered the body less than 100% functionable. But the field of PT has determined as a matter of the hardest clinical fact that a large percentage of the field of PT is psychology. Every patient a PT deals with has some form of mental trauma to go with their physical trauma.

For the field of PT, it is beyond essential to include more training with Psychology from the most basic of Associates degree level PT training all the way up to those with decades of experience. Since PT treat mental disorders anyway, for example.

Asking a patient “What is wrong, describe the pain” is itself both a psychological question and answer. The less a patient can answer the more psychological trauma they have suffered.

General Psychology

Clinical

Neuro

Behaviorism

Behaviorism Skinner Devotee

Early Childhood development: infancy up to late teens.

Lifespan Development: the entire lifespan from infancy to the last breath.

Royalty

When people get sick, there are in basic two ways they react. They either want to be taken care of, or they want to be left alone. Most patients fall in the moderate grey area between the extremes. A little bit more or less of independence versus dependency becomes the therapists job to work on creating a healthy balance.

Those that want to be taken care of, can easily slip into turning their caregivers into virtual servants/minions to wait on them hand and foot.

Those that want to be left alone can easily let injuries and things fester until the mental issue or the physical issue consumes them. They think they are getting better or can manage their pain based on the facts, when they do hurt themselves the rush of adrenalin surges in and they feel temporary release. The person in this specific type case will adjust their lifestyle to be in a constant state of pushing adrenalin to stay functionable. They become experts in pain management by constantly pushing their body harder and farther in order to function through layers and layers of injuries. The aforementioned HRH character from the Jekyll and Hyde novel had a family history of PTSD. He did not come about his inappropriate behavior based on just being a snob, he came about said behavior based partially on generations of his family being destroyed by bloody battles. Both losing several members as well as the survivors being changed by the horrors of war. The males being battle field traumatized, the women being widows and other worse war traumatic issues. Royalty are the ones who form and command the armies. Those armies the peasants are usually expected to literally be mostly killed in the conflicts. Generations upon generations of families raising children where all the adults around are suffering from both physical and mental traumas. Added to these facts are the family members who want to be waited on hand and foot until they are better, and then the other members who become stoic and in some cases violently stoic, refusing all help. Those people are usually almost entirely unaware of how bad their injuries are and want to play through the pain until they are better. 500 years of constant battle will drive most families into some form of insanity; they were not being treated by qualified personnel for either their physical or mental trauma. The pompous jerk killed by Hyde, was not entirely at fault for his inappropriate behavior. He had to take responsibility for his own actions, but his own actions were in part created by his elders working through their trauma. Each injury setting off a different rush and shock throughout the day. They keep themselves numb and on brain and body generated pain killers; endorphins and adrenaline. But that will only last so long before it becomes necessary to supplement the body manufacturing said to external source e.g. alcohol, OxyContin (Heroin), etc.

Both are equally as bad, since both mask both the mental and physical injuries to a degree which can only lead to further self destructive behavior.

Interacting with Disability and PT

One of the worst aspects in Western culture is the mental issues surrounding the concept of Disability. Some people who are “Handicapped” are only slightly physical not very function able, while others are severely handicapped but want to function as if they are perfect, or close to it. The more there is a disconnect between the reality and the fantasy the more the person’s temper will grow to ever increasingly out of control proportions.

Western culture has taught that being “disabled” or “handicapped” is a bad thing, that those people have fewer rights than everyone else. Several hundred years ago in western culture handicapped children and adults were usually kept out of the public eye. They would stay in an attic or a basement, or sent to institutions so far away no one would know “that family had one of those members” handicapped used to be more of a stigma than a suicide. It is a common thing in almost everyday life to have disabled people be bullied by those that either are or assume they are fully able bodied. The whole I hate something about myself that I see in others, so I will be various levels of violent against myself by using others (projection) as a foil. I will hurt them as a surrogate for hurting myself. Most bullies are so afraid and insecure they have no ability to understand their own pain.

That bullying has a direct and measurable reaction in the actual PT work.

Psychological aspects of disability

Synapse Fires in the Brain control the body, which means the majority of the healing which takes place in the body comes directly from the mind.

The resistance from patience about disability

Physical resistance, the body refuses to cooperate

“Let me catch my breath” were the last words of Truman Capote as he lay dying. His mind was still strong, his will was still present, but his body could no longer keep up with him. Some people give up and their body takes a long time to die, ala the St. Crispin's Day speech Henry V.

A coward die 1000 deaths until his real one years later. The body refuses to cooperate no matter how hard the mind pushes the body to work.

Mental resistance the patient cognitive dissonance thinks they are better than they are. They maintain an illusion of health long after all but the critical variables are ignored. The same phenomena can be found in cold blooded creatures, place frog in cold water, slowly warm the water to a boil, the frog will sit in the water until they are boiled to death. The CR of normal changes slowly and the patient ignores more and more of the variables until those variables either become so apparent that the patient is in critical condition or some external force brings the patient to the realization the water they are in is about to boil.

Which brings up a very interesting quote “it is easier to convince someone of a lie, than to convince that same person they have been lied to” Mark Twain. Which is really interesting since one of his greatest books was not about the Mississippi but about the Nooksack river and the struggles the confederate south had with trying to rise again in Whatcom County. Part of his Huck Finn book was written in the Hovander Estate Ferndale Washington. The south attempted to rise again in two places, Whatcom county Washington State and Colorado Springs, Colorado. Both attempts failed but both attempts left a permanent mark on the cultures in the present. Mental/Physical trauma just because something appears to be x does not make that assumption of the definition of x correct or even mildly true. Previous to the bridges being constructed over the Nooksack, steamboats ran up and down the Nooksack for decades.

Mental resistance; the pain or other illusions are far stronger in the patients head than health can overcome. “it hurts too much” when in reality the pain is mostly an illusion.

How the pt views those with disability and injuries

The perception of an injury from the professional is more important than the patient’s perception. First and foremost because most humans require approval from those around them. For example, ever take your car to a mechanic and say “fix it”, the mechanic will say describe what is wrong.

Trying to recreate the sound using the voice is not as effective as allowing the mechanic to hear the sounds something is wrong themselves. But added to that problem is the general facts that when you take the car to the mechanic oftentimes the sound is not present. The “there is nothing wrong” will come and some drivers feel like idiots when the mechanic tells them nothing is wrong.

The same equation holds true when a patient deal with the medical industry. If the doctor does not see the problem and they test for the wrong thing, the medical provider is unable to fix that which is an unknown.

Sure the patient is refusing to cooperate

There are any number of reasons a patient refuse to cooperate. The therapist is being difficult, the patient does not understand the instructions, the patient’s culture will not allow those actions, the therapist is playing power games and the patient is not interested in playing those games, the patient is playing a power game and the therapist is approaching wrong, etc. the list is long and complex as to what is happening and how to fix it.

Each scenario

But the point is that patients are uncooperative for an infinite number of reasons which are both the patients and therapist fault. The only real solution is to dig into the patient’s mental state to determine what and why the patient is refusing cooperation. The chances the patient is aware they are refusing cooperation is almost guaranteed no. The patient is very likely operating from a -7 on awareness of their own anger scale, so they have little understanding they are in the beginning stages of anger. Referring a patient to a psychologist is literally a waste of time, because the PT can directly measure mental changes with the physiology. The patients mental state directly regarding the condition of the health of their body is an entirely different subject than a generalized counseling session. The PT does touch on all manner of different mental phenomenon when working with the body. Those phenomena are directly connected to and with the PT itself. In essence the road map described above, the PT has a direct physiological bench marks they can work with in order create adjustments in the body to bring the body back to health as well as in the mind and improve mental health. A therapist without access to said mind/body reactions and heath bench marks and measuring points will have no idea how to address those issues. To be able to measure the mean, mode, and median directly with the body and the mental health at the same time is almost beyond measure important. Muscle memory and reflect while asking questions, allowing the mind and body to seek health through reflexes. Specifically, in areas where trauma has occurred, testing those muscles and of course the closest affected joints. Now after the PT has worked with the body and mind over several sessions and started to improve, a physiological road map can be created and handed to a psychologist to work on deeper and more penetrating therapy when the variables of mental health are no longer forcing physical injury to manifest. The body is on the road to health, that road map is perfect for clinical therapy to work from and built years of mental health therapy with.

Sure the body will respond different than it is

Everything which occurs within the human body is always controlled by the nervous system. The core of the nervous systems is the brain which tells the body what to do and how to do it.

Psychology in PT

It is not outside the realm of possibilities that for all levels of PT, it would be a good idea to add at least one overall psychology class. For the associates, adding a single class will work. For the 4-year degree adding at least 3 classes to address specifically the different psychological aspects which can and will directly affect PT. Skinner, Clinical, neuropsychology (working with the neuropathways, instead of against them), and of course lifespan development (when does the human body change at what time, based on what the brain tells the body to do). More than half of the field of Physical Therapy is about dealing with the Mind itself.

References

Saper, C. B. (2002). The central autonomic nervous system: Conscious visceral perception and autonomic pattern generation. Annual Review of Neuroscience, 25, 433-69. Retrieved from http://search.proquest.com/docview/198861111?accountid=35812

Curtis, B. M., & O'Keefe, J. H., Jr. (2002). Autonomic tone as a cardiovascular risk factor: The dangers of chronic fight or flight. Mayo Clinic Proceedings, 77(1), 45-54. Retrieved from http://search.proquest.com/docview/216884245?accountid=35812

El-Sheikh, M., Keiley, M., Erath, S., & Dyer, W. J. (2013). Marital conflict and growth in children's internalizing symptoms: The role of autonomic nervous system activity. Developmental Psychology, 49(1), 92-108. doi:http://dx.doi.org/10.1037/a0027703

El-Sheikh, M., & Erath, S. A. (2011). Family conflict, autonomic nervous system functioning, and child adaptation: State of the science and future directions. Development and Psychopathology, 23(2), 703-21. doi:http://dx.doi.org/10.1017/S0954579411000034

Greenfield, J. R., & Campbell, L. V. (2008). Role of the autonomic nervous system and neuropeptides in the development of obesity in humans: Targets for therapy? Current Pharmaceutical Design, 14(18), 1815-20. doi:http://dx.doi.org/10.2174/138161208784746716

Shiota, M. N., Neufeld, S. L., Yeung, W. H., Moser, S. E., & Perea, E. F. (2011). Feeling good: Autonomic nervous system responding in five positive emotions. Emotion, 11(6), 1368-1378. doi:http://dx.doi.org/10.1037/a0024278

Kushki, A., Drumm, E., Mobarak, M. P., Tanel, N., Dupuis, A., Chau, T., & Anagnostou, E. (2013). Investigating the autonomic nervous system response to anxiety in children with autism spectrum disorders. PLoS One, 8(4) doi:http://dx.doi.org/10.1371/journal.pone.0059730

Shimizu, H., & Okabe, M. (2007). Evolutionary origin of autonomic regulation of physiological activities in vertebrate phyla.Journal of Comparative Physiology, 193(10), 1013-9. doi:http://dx.doi.org/10.1007/s00359-007-0256-4

Rubio, A., Van Oudenhove, L., Pellissier, S., Ly, H. G., Dupont, P., de Micheaux, H. L., . . . Bonaz, B. (2015). Uncertainty in anticipation of uncomfortable rectal distension is modulated by the autonomic nervous system -- A fMRI study in healthy volunteers. NeuroImage, 107, 10-22. doi:http://dx.doi.org/10.1016/j.neuroimage.2014.11.043

Jones, G. (2010). Heart rate variability and the autonomic nervous system. Journal of Critical Care, 25(3), e4-e5. doi:http://dx.doi.org/10.1016/j.jcrc.2010.05.015

Dulleck, U., Ristl, A., Schaffner, M., & Torgler, B. (2011). Heart rate variability, the autonomic nervous system, and neuroeconomic experiments. Journal of Neuroscience, Psychology, and Economics, 4(2), 117-124. doi:http://dx.doi.org/10.1037/a0022245

Travers, P. L. (1999). Autonomic dysreflexia: A clinical rehabilitation problem. Rehabilitation Nursing, 24(1), 19-23. Retrieved from http://search.proquest.com/docview/218266911?accountid=35812

Sugarman, L. I., Garrison, B. L., & Williford, K. L. (2013). Symptoms as solutions: Hypnosis and biofeedback for autonomic regulation in autism spectrum disorders. American Journal of Clinical Hypnosis, 56(2), 152-73. Retrieved from http://search.proquest.com/docview/1562028291?accountid=35812