There are no
miracles, only unknown laws. - St. Augustine
Chronologically
controlled developmental therapy (CCDT) has considerable potential for
treating physical disability, including spinal cord injury (SCI) and
post polio syndrome. Because CCDT consists of a combination of fairly standard,
widely accepted physical therapy techniques, it really should not be
considered an alternative medicine treatment. CCDT’s uniqueness is
related to how these techniques are applied, the sequence in which they
are applied, and the patient’s passive involvement. Futures Unlimited,
a clinic in Columbus, Miss., carries out this treatment.
The facility’s director is Ed Snapp, a physical
therapist who acquired polio at the age of 18. His
impressive
credentials include extensive experience with most commonly used
physical therapy techniques. He has been a member of many national and
regional committees and has made numerous presentations at professional
meetings. Early in his career, he had a key role in establishing the
nationally recognized Texas Institute of Rehabilitation and Research (TIRR)
in Houston.
Snapp has an almost Zen-like appreciation of the
human body. Through assessing the subtlest aspects of one’s movement
and reactions to stimulus, he obtains an array of valuable diagnostic
information. His abilities remind me that in this era of impersonal
high-tech medicine, true healing skill is more than a science learned in
books or a classroom. It is
an art that is learned through experience and, more importantly,
receptivity to the experience.
Perhaps due to the understanding acquired through
his own disability, he is a compassionate man with great empathy towards
his patients. He combines this compassion with a sharp, eclectic
intellect that is consistently attempting to integrate and expand
concepts from a variety of disciplines. Through a why-not,
”just-do-it” attitude, hope seems to re-emerge like a Phoenix from
the ashes - even from cynics.
Columbus is the birthplace of Pulitzer Prize
winning playwright Tennessee Williams. Although some airlines serve this
small city, visitors often fly to other cities, such as Birmingham or
Memphis, and drive to the clinic. Columbus’s
relative geographical inaccessibility is offset by a low cost of living,
which facilitates a much more affordable treatment program.
The
Treatment:
The clinic targets a wide-ranging variety of
neurological disorders, including post polio syndrome (PPS), spinal cord
injury, head injury, cerebral palsy and various developmental disorders.
The clinic has been especially successful treating post polio
syndrome symptoms and claims that 85% of the patients have had some
functional improvement. In some cases, progress has been profound,
including individuals who no longer need ventilators or scooters. Even
when improvements are modest, Snapp notes that they can result in
greatly increased independence and quality of living.
Chronologically controlled developmental therapy
consists of a number of physical therapies performed in a specific,
defined sequence. These include, but are not limited to, pressure
stimulation, hydrotherapy, light-touch massage, movements on an oil
table, and rest in a sling apparatus that mimics a fetal position.
People carry out the program twice daily for two-weeks. To
further build on progress made at the clinic, a home-therapy program is
designed that does not require technical expertise. Periodic visits to
the clinic will further augment the progress.
Unlike many rehabilitation programs, the therapies are
passive - the therapy is done to
you; you exert no effort. You receive encouragement to let go of any
conscious effort to control the situation. To keep your nervous system
from being distracted from non-therapy stimulation, the procedures occur
in an environment that minimizes distractions (e.g., under dim light, no
talking, etc.).
Firsthand
Experience:
To get a better feel for the process, I subjected,
myself, to some of the program. The hydrotherapy was especially
interesting. With the support of virtually imperceptible harnesses and
slings, I became immersed, floating in a tank with only my face out of
body-temperature water. With
the exception of a gentle flow of water that would periodically change
directions, my body was deprived of virtually all sensations. Under
these conditions, I was soon adrift in the twilight between
consciousness and sleep. I
can only imagine how I would feel if I did this for two weeks. As
discussed below, these conditions are meant to mimic the womb’s
environment.
Patient’s
Reactions:
During my visit, I interacted with several
patients. Julia, a charming seven-year old girl with haunting blues
eyes, has cerebral palsy. She has been coming to the clinic since she
was two. Her mother, Marilyn, indicated that before starting the
program, Julia almost seemed to be regressing (e.g., becoming more
spastic). Once Julia started therapy, she made tremendous progress.
Marilyn is convinced “all improvement is due to the treatment.”
Julia achieved more balance, more dexterity, and flexibility. She had an
overall personality change: for the first time, she “started
giggling.” She enjoys her
visits to the clinic because she is the center of attention.
Nancy, a photographer and teacher, has post polio
syndrome. Before the treatment, she used to wake up late and feel tired.
“Now I am in the habit of getting up at 6:00 a.m.,” she says.
She says that her improvement is in places that
only she can see, such as the back and hips. “I can keep my balance in
my wheelchair much better than before. And I can keep going day after
day, unlike recent years when I had to take every other day off.
That’s the best.” Although
enjoying her treatment, she missed sunlight
“The staff had lunch on the patio overlooking the woods, but we
were inside in the dark with blue lights and instructions not to
talk.”
Regarding Snapp, Nancy states “This guy has his
whole heart and soul in his work. He's
charismatic - and a genius at his theory.”
Nancy says, “[I am] appalled at how little
interest there is back home from the medical community.
I am now getting an education in the schism between traditional
and alternative medicine. This
seems so unnecessary and blind. When something works, it ought to be
emulated and investigated, not just shrugged off as a fluke.
Although I have not seen my physiatrist yet, I hope he will
accept my results.”
During my visit, several individuals with spinal
cord injury were being treated at the clinic, but I did not have the
opportunity to speak with them. Although progress is often slower, Snapp
has had some notable success treating SCI. For example, Nick fell 25
feet from a hunting platform and crushed his spine in the
thoracic/lumbar region. Although two years later his legs were jammed
with extreme spasms, after several years of treatment, Nick was walking
with crutches and short braces.
Measurement
of Improvement:
These examples, of course, do not proof
effectiveness according to scientific standards. A frequent criticism of
any potential treatment concerns how improvement is measured. Snapp
recognizes that this is a tough, but valid issue. However, he says that
the restored function that he sees is often so overt, (e.g., patients no
longer needing scooters or ventilators) that effectiveness cannot be
denied. To ensure objectivity, he ideally would prefer that the
patient’s own neurologist independently measure improvement after
treatment.
He also says that the use of extensive
sophisticated assessment procedures would greatly increase the treatment
costs. “My foremost goal is to help people, not to do a scientific
study.”
Treatment
Theory:
Although the clinic’s procedures are relatively
straightforward, the theory behind them is not. Snapp emphasizes that
restored function is not due to neuronal regeneration. Basically, he
focuses on activating intact - but dormant - neurons and pathways.
A growing base of scientific knowledge indicating
that the nervous system is much more complicated and sophisticated than
previously thought supports this focus. In the case of spinal cord
injury, scientists now conclude that most non-penetrative injuries
(i.e., other than gunshots or stabbing) that have been classified as complete
in terms of physical function are neuronally
incomplete injuries. In
other words, usually there are intact neurons that cross the spinal cord
injury site that have been turned off by the injury process. In animal
models, the spinal cord needs only about 5% neuronal functioning to have
substantial physical function. Theoretically, if we can activate even a
small percentage of dormant, intact neurons, considerable function could
potentially be regained.
Snapp speculates that more regeneration may occur
after injury than previously thought, but the regenerated neurons have
not been turned on. As a consequence, even if successful, current
research efforts that target neuronal regrowth may have minimal benefit
if activation is not considered.
Paraphrasing the famous movie line, the prevailing
scientific assumption that “ if we build it, it will conduct” may be
fundamentally flawed.
Snapp’s program for activating neurons is based
on a rather complicated thought-provoking theory encompassing concepts
of evolutionary development. He believes that turning on dormant neurons
requires a sequence of cues that mimic events from our early fetal and
infant development. In
turn, these developmental cues reflect a genetic memory of our
evolutionary development.
If a fully developed neuron has been turned off,
its reactivation requires that it receive and sense external cues in a
defined sequence that are correlated to the neuron’s initial
development. There is no avenue to deliver these cues except through the
peripheral senses - the basis of Snapp’s physical therapy program.
Out-of-sequence cues will not work. This, according to Snapp, is why
many standard physical rehabilitation programs are so limited in
outcome. As a professional with a disability, he believes “most
standard rehabilitation policies make robots.”
Snapp compares his process to pulling a
computer’s plug. The computer’s circuits remain intact, but the
program is lost. To be reinstated, the program must reboot, which
involves a sequential series of steps.
Likewise, Snapp believes that a significant
proportion of neurological dysfunctions result from a deprogramming of
specific portions of the central nervous system. In the same fashion
that a disk can reboot a computer program, an appropriate external cue
will trigger information residing within a nervous system’s genetic
code. This information will then be reprogrammed back into the operating
system in the same order as it was learned in the embryonic nervous
system.
For further information on the treatment check out www.futuresunlimited.com.
Adapted from an article appearing in the July 1998 issue
of Paraplegia News (For
subscriptions, contact www.pn-magazine.com).
