ConnectTherapy™ is all about helping therapists and patients understand the construct of Connectedness. How different regions and systems of the body are connected. How the body and mind are connected. How therapists and patients are connected. How we as humans are physically, emotionally and socially connected.
Research across multiple fields highlights the multiple influences on how patients move – their strategies for movement – and how they feel – their symptoms and experience of their body. Clinicians need ways to organize information from tests across multiple domains, and determine the most relevant influences to address in treatment. A robust clinical reasoning process that considers the whole person facilitates a more efficient pathway to design treatment programs.
Created by Dr. Linda-Joy Lee, ConnectTherapy is the evolution of total body assessment and treatment frameworks to understand and treat the whole person. It teaches clinicians how to integrate science and clinical expertise in a functional, outcome-based framework. ConnectTherapy has its roots in LJ’s innovative Thoracic Ring Approach™ and the co-developed Integrated Systems Model (ISM) (Lee LJ & Lee DG 2010).
Continual Change and Advancement
All things new have their foundation in past innovation. With the establishment of their education company Discover Physio (2007), Diane Lee and LJ Lee introduced the System-Based Classification for Failed Load Transfer. Through their individual and collaborative work came continual change and improvement to the model, and in 2010 they co-founded the Integrated Systems Model for Disability & Pain (ISM). After parting company with Diane in 2013, LJ continued to develop and advance the ISM, adding new constructs and making fundamental changes. Over time it became evident that she was no longer teaching the same model. ConnectTherapy™ (Lee LJ 2014) encompasses these new advancements and changes… ConnectTherapy™ is the evolution of the ISM.
The Common Ground
There remain many relevant features from the ISM that are shared by ConnectTherapy. Both models are patient-centred and recognize that optimal function requires the integrated function of multiple systems in the body. Both use the construct of Meaningful Task Analysis (Lee LJ 2008) to “Find the Driver” for the patient’s problem. Both consider the impact of beliefs and emotions and aim to explain the relationships between physical impairments, pain mechanisms, psychosocial features, disability, health conditions and the patient’s values and goals. And both models provide frameworks to organize knowledge from multiple sources to determine the best hypothesis to explain the patient’s whole experience and design a multimodal treatment plan.
New Features and Rationale for Change
One of the most significant developments for ConnectTherapy is the Drivers Diagnostics Chart™ (DDC) and Guidelines, a new clinical reasoning algorithm to diagnose Primary, Secondary, Tertiary, and Co-Drivers in a comprehensive and logical process. The power of the DDC lies not only in the way it directs a logical flow and provides rationale for where next to go in the assessment process – to Find Drivers during Meaningful Task Analysis – but it also integrates with a new Treatment Principles and Exercise Prescription Framework. The DDC also clearly illustrates the relationships between Drivers. Understanding these connections is necessary to most efficiently plan treatment – when to start treating, how much to treat and how to effectively prescribe exercise for each driver.
Another highly significant change is the abandonment of the ISM Puzzle, as a clinical reasoning tool, and the development of the ConnectTherapy Circles of Influence – a much broader framework for organizing knowledge across multiple domains and helping determine what is most relevant for successful patient outcomes. This clinical reflection tool reaches beyond the ISM Puzzle, to include Primary, Secondary and Tertiary Drivers, Co-Drivers and Potential Barriers. It incorporates not only internal, but also external influences, providing physiotherapists with a complete picture of how all factors intersect and influence the patient and their experience.
Just as The Thoracic Ring Approach is an integral part of the ISM, it remains a central part of ConnectTherapy. And ConnectTherapy benefits from all the new material created in The Thoracic Ring Approach, including how to identify dual thoracic drivers early in the assessment process and how to more effectively prescribe exercise progressions to keep the rings stacked from early rehab to full return to functional goals.
These principles for exercise progression have been expanded to create a detailed and definitive framework on how to prescribe and progress exercises for any driver, with key new features such as teaching “Self-check movements” and “Reset exercises” to automatically self-release non-optimal vectors when the system has been overloaded. This creates less reliance on the therapist and empowers patients with control over their exercise progressions as they move through the process of changing the way they live and move in their bodies.
In terms of exercise prescription, ConnectTherapy also incorporates a significant departure from principles of the ISM around training a new movement strategy. The principle in the ISM is that a new strategy is trained based on the Meaningful Task. Through a variety of experiences LJ has recognized that this is an incomplete representation of how she trains movement and prescribes exercise. This is to say, Meaningful Task is insufficient to guide exercise prescription.
The new principle in ConnectTherapy is to Train Control of the Drivers Across Multiple Tasks and Movement Patterns – to train movement variability and enhance retention of new brain maps, considering the wide variety of functional movements required for everyday life. The Meaningful Task still guides overall goals, but it is not the only criteria for exercise prescription throughout the rehab process. Of course, Meaningful Task Analysis remains a key feature of ConnectTherapy as it is in the ISM, but it is distinguished as an Assessment framework to Find Drivers – and is no longer the main criteria behind exercise prescription.
Other new material in the ConnectTherapy model includes integration of research and screening tests related to concussion, and the defining findings to diagnose visual system and dural system drivers.
These are just the highlights of the many new things in ConnectTherapy. Making continual change is an ongoing process that will continue to shape and grow the model in years to come.
What’s in a Name?
In the process of framing the new model, it was important to develop a consumer-focused name. A name that has meaning and relevance for the patients it is designed to help. A name that would be easy for the general public, as well as for Physiotherapists and other Health Practitioners to understand, remember and articulate.
Every day new research supports how essential it is for us to understand how things connect to make lasting change for our patients. The word Connect describes the essence of the whole body, whole person approach. When a foot is treated and shoulder pain disappears, the explanation that everything is connected resonates profoundly with patients and course participants alike. And Therapy captures why patients come to us – for Therapy. Treatment intended to relieve or heal.
Joined together, ConnectTherapy™ creates a memorable name that is a timeless expression of the many ways Connectedness is essential for optimal health for everyone.
ConnectTherapy goes beyond how the regions and systems of the body are connected. It encompasses how the body and mind are connected, how patients and therapists are connected. How we as humans are physically, emotionally and socially, connected.
Watch this online lecture for more in-depth information and clinical application of ConnectTherapy™ & the Thoracic Ring Approach™, recorded at Part 1 of the ConnectTherapy™ Series in Vancouver, Canada, in January 2016.