Spatial Awareness

Why Can’t I: A Spatial Awareness Problem

Why can’t I touch my toes? Why can’t I lose weight? Why can’t I read without getting a headache? Why can’t I get off my right leg? Why can’t, why can’t, why can’t? This is what I hear a lot of within the walls of my clinic. Patients tend to present with a hyperfocused mentality on their inabilities. They are sure to inform me as to what they can’t do rather than what they are still ABLE to do from day to day. But why? Is it because my patients are the select few of the human species that are destined for failure? Or is it that they lack a sense of spatial awareness? I choose the latter and ask them,”Do you know where you are?”

Now this tends to get me that deer in the headlights look, so let me explain. First, spatial awareness can be defined as the ability to perceive where the body is in space at all times. However, body space is not only comprised of the physical body, but also the body schema and body image.

What is Body Schema?

Body schema is critically important in understanding where we are in space. It can be defined as the immediate space around the body that is generated through multisensory integration. Furthermore, this space represents a continuously updated sensorimotor map of the body that is important in the context of action, informing the brain about what parts belong to the body, and where those parts are currently located. This can occur via the response to proprioceptive input through our posture. However, this is just one role of the body schema. The neurons creating the body schema also respond to tactile and visual input in addition to the proprioceptive input.

Vision is often not considered in physical therapy clinics, but it should be as it is one of the greatest influences on how we move and interact with our environment. Visual inputs affect our sensorimotor systems through the superior colliculus, which only receives peripheral information. If peripheral vision is altered, the movement system may be as well. But why? When we lose horizontal vision we accommodate with an increase in our vertical visual capacity (an extension compensation). This, in turn, creates more rigidity throughout the body and limits our environmental interactions (more on vision in a later post).

Now that we understand the importance of the body schema on our spatial awareness, let us debunk the Motor Moron title often given to these patients. First off, this term does absolutely nothing for a patient's body image, which is defined by the patient’s attitudes and beliefs. This will create more cortical smudging and further disconnect the patient from their body. Now, not only can they not connect with their body, but now they believe it to. Congratulations you have just become the world's worst clinician because you were trying to be cute. Okay, getting off my soap box.

Multisensory Integration Matters!

How do you help this patient rather than hurt them? We must consider what is going on is the result of sensory mismatching. If there is sensory mismatching, the input they are receiving is not providing an accurate description of where they are or what their surroundings may be. Answer; increase spatial awareness through proper positioning. My concepts of positioning come from the Postural Restoration Institute and refer to the ability to own a zone of apposition (ZOA) (Article to come for sure!). As aforementioned when spatial awareness is reduced, extension compensations are likely to occur to try and create stability. These patients are seeking stability for their spatial insecurities. (Check out Seth Oberst's lovely diagram that illustrates this concept)

Now, when a patient feels spatial insecurity it is likely due to sensory mismatching and the body perceives a threat. If this threat exceeds the body’s stress threshold, compensation begins and they become reactive to their environment rather than predictive. We store behavioral response memories that we rely on each day to appropriately anticipate different stressors we may encounter. If we become insecure, however, we stop trying to predict our necessary movements and begin reacting after it is too late. As you can see in the Seth’s diagram this is going to eventually lead to altered posture and system tension. It is my belief that this, in turn, ultimately leads to pain, movement dysfunction, and low and behold the “I can’t” patient.

Conclusion:

So, in conclusion, it becomes easy to see how these “why can’t I” patients may not be “Motor Morons” but simply spatially unaware individuals. So, instead of kicking them while they are down and degrading their body image, provide them the appropriate input to position themselves and succeed in their environment. We will discuss how to position these patient’s in an upcoming segment.

Take care and remember you have to position to perform.

References:

Robert Sapolsky: Why Zebras Don’t Get Ulcers

Sandra and Matthew Blakeslee: The Body Has A Mind of Its’ Own

Joseph Trachtman: The Etiology of Vision Disorders

Zac Cupples: zaccuples.com: course notes

Seth Oberst: sethoberst.com: articles

#spatialawareness #bodyschema #senses