Dr TONY TRANFIELD
Osteopathic Neurorehabilitation
Philosophy

As clinicians we tend to view the nervous system in terms of ‘hard lesions’; we look for pathology.

I think that for a musculoskeletal clinician it is also important to look for function, quantify ‘dysfunction’ and look for ways of establishing a greater capacity for the nervous system to adapt, learn and repair itself; – whether within the context of a significant pathology, (for example, Parkinson’s Disease) or in terms of a change in function such as an aberrant motor program which may cause a patient to present with a musculoskeletal complaint.

Posturography

For a musculoskeletal clinician posturography is an excellent way of assessing and quantifying function. Posturography enables us to measure movement in a vertical plane using recognised protocols with normative data. We are also able to test our patient’s functional capacity under a variety of conditions. You can read more about posturography and the testing I do here.

Postural Control

When I did my osteopathic training in the early 90’s a large proportion of undergraduate education was placed on the spine in terms of understanding morphology, biomechanics and function. The spine was seen as the ‘central pillar’ of the musculoskeletal system, and in osteopathic philosophy the musculoskeletal system is seen as the window into restoring function and health to the patient. Manual treatment was based around local joint release with a variety of methods dictated by a biomechanical assessment of aetiology.

Credence was given to spinal cord segmental influences in understanding how spinal dysfunction occurs, and to how treatment effects local autonomic, motor and sensory output on corresponding skeletal and visceral structures. However, no credence was given to the central control of the spinal column as a unit, or the importance of postural reflexes in maintaining upright posture and prevention of spinal dysfunction.

My shift in thinking and treatment approach has been to take a step back and evaluate postural dysfunction in terms of stability of the individual and the strategies that they use to maintain upright posture when standing still and when challenged. The question I ask is:

Where is this patient’s centre of gravity, and how is it affecting them in terms of their biomechanics and their ability to shift their weight sufficiently to generate momentum for the activity they wish to perform?

Whether this be turning over in bed, getting out of a chair, walking, running, or performing a complex acrobatic manoeuvre.

In clinical terms I assess centre of gravity (CoG) by measuring the centre of their relationship with the ground when standing still (centre of pressure) and their limit of stability (how far they can move their trunk in all directions without moving their feet and without falling over) or to put it another way, their static and dynamic stability.

My evaluation therefore in not just biomechanical but neurological. I assess vestibular, visual and proprioceptive systems and the efficiency of postural reflexes by stimulating them and measuring changes in stability.

My interests are in:

  • Changing resting centres of gravity (static posture);
  • Improving the ability of a patient to shift their weight more efficiently (gait rehabilitation);
  • Improving timing, coordination, and motor learning (cerebellar rehabilitation); and
  • Restoring aberrant patterns of movement, motor planning, rehearsal and execution (Cortical rehabilitation).

I work with patients who have chronic spinal pain, patients with balance disorders, or deteriorating stability, patients with movement disorders such as Parkinson’s Disease, children with the development of their posture, balance, coordination and motor learning and elite athletes who wish to improve control and stability.

View a complete summary of my Services for more information.