New to me
I am the proud owner of a new car. Well, not brand new but new to me. The old one gave up the ghost and ‘sat down’ so to speak. After covering 250,000 kilometers, much of it on pot holed rural roads, it didn’t owe us anything and so when it needed replacing we wished it well and moved swiftly on. The new car is lovely. It greets you like a friend gleaming in the driveway with its shiny tyres and boot you could hide a piano in. It has some gizmos and gadgets which ostensibly make your life much easier but in truth most of them you can live without.
The car has had a few outings but like all new vehicles it takes time to get used to. When reversing out of a crowded supermarket car park today I noticed that I was having difficulty judging how long the car was and when I needed to squeeze in between two parked cars to exit, I seriously wondered how wide it was and felt a distinct lack of trust in my mirrors and myself. Reversing seemed so much easier in the older car. Navigating through the narrow city streets for the past few days has been great but exhausting. I am surprised at how much concentration it has required to avoid damaging it and wondered how long it would take me to get used to it, to the point where I don’t have to think about it anymore.
A fuzzy car map
It was then I thought that my difficulty was, that being new, I had no map of the size of the car in my head. I couldn’t figure out how much space it was taking up. It made me need to concentrate far more than normal maybe even verging on hyper vigilance. After all who wants to sideswipe a car or reverse into a pillar with the new wheels. Before you make any assumptions about gender and spatial awareness … please don’t ! I know self-praise is no praise but seriously my spatial awareness is fine! It’s just with this car the map in my head feels a bit fuzzy.
Navigating the world in pain
It brought to mind a patient of mine who has an ongoing pain state. He told me he keeps bumping into things and has had to over compensate when navigating his way in the world. He described it as “exhausting and requiring great concentration” always being on the lookout for ways to avoid hitting things. When tired or in pain he often manages as he put it to misjudge the space around him. He got me thinking about the amount of energy required to move in a way that keeps you safe when you have ongoing pain and the potential knock-on effects on concentration, attention and memory.
From car maps to body maps
Then it came to me that may be there may be some small parallels between my spatial difficulties and those alterations in body perception experienced by those with chronic pain. In a nice review on the subject entitled Body, Space and Pain Trojan et al (2014) describe the distortions of the affected limb both in size and position that are frequently reported in those with chronic pain states. Those with Chronic LBP have been shown to have difficulty delineating the outline of their trunk, stating they couldn’t find it. In Complex Regional Pain Syndrome (CRPS) those with severe hand pain often describe the limb as larger than it actually is and may even have a distorted perception of the personal space surrounding their bodies. It seems that the sensory perception difficulties are accompanied by distortions in the cortical representations of that body part. A smudging of their map perhaps. Moreover that extra attention the patient’s brain is devoting to the injured limb may in fact detract from other cognitive tasks such as attention, learning and memory retrieval.
While my minor dilemma is easily remedied with time or a new set of parking sensors, the solution for the patient is not so simple. Perhaps the next time a patient tells us they are bumping into things we may reflect on the challenges they are facing merely navigating their way in the world.
Blanaid is a practicing physiotherapist in Dublin, Ireland. Her professional interests include epidemiology, pain and all things brain related.
We’re hitting the road and taking our NOI courses right across this great southern land:
Noosa 17 – 19 June Explain Pain and Graded Motor Imagery (Both courses SOLD OUT)
Wagga Wagga 16-17 July Explain Pain
Perth 15 – 17 October Explain Pain and Graded Motor Imagery
EP3 events have sold out three years running in Australia, and we are super excited to be bringing this unique format to the United States in late 2016 with Lorimer Moseley, Mark Jensen, David Butler, and few NOI surprises.
EP3 EAST Philadelphia, December 2, 3, 4 2016
EP3 WEST Seattle, December 9, 10, 11 2016
To register your interest, contact NOI USA:
p (610) 664-4465