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Flooding treatment of phobia to having her feet touched by physiotherapists, in a young woman with Down's syndrome and a traumatic brain injury. Neuropsychol Rehabil. 2006 Apr;16(2):230-6
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This case study describes the treatment of a 32-year-old woman with Down's syndrome and a recent head injury, for phobia to treatment of her feet by physiotherapists. The phobia had the potential to severely limit rehabilitation progress in terms of the client regaining the ability to stand, assist with transfers (including to and from a car), and walk. A single session, in vivo, flooding intervention was used. The treatment resulted in a substantial change in tolerance of physiotherapists' touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident. Benefits were maintained at multiple follow-ups. The results of the case study extend the evidence for the utility of such behavioural interventions to people with complex disability and unusual phobias in neurological rehabilitation systems.
Flooding = a behavioural approach which is contrary to counseling. In flooding client is presented with the feared stimulus until the associated anxiety disappears. http://www.etherapy.com.au/whatis.php
Not one to kiss and tell, but many moons ago I had a dear girlfriend who would vomit if her feet were tickled. Short relationship. But interesting to note she took up the calling of dietition.
I have seen a patient who would go into uncontrollable giggles when treated by the podiatrist and sadly I have also seen a eldery gentleman die as a result of a heart attack brought on by foot tickling.
Not one to kiss and tell, but many moons ago I had a dear girlfriend ..........
When the kids finally manage to have you committed to the Ocean View Residential Home, I can see there will ne'er be a dull moment for your fellow guests! I guess you were just plain unlucky with the vomiting lady. I once had a liason with a madmoiselle of French/Creole origins - a jazz singer in New Orleans - who used to orgasm violently when the arch of her foot was raked with long fingernails. A very energy-efficient girl. Probably see one or two patients every month who are 'foot sensitive' in that respect, but rarely cultivate the thoughts these days.
Yours in trepidation.....
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"citing an indisposition due to special circumstances"
Anyone have a problem with the method of "flooding" to treat the phobia in the case above. Imagine have a spider phobia and "flooding" them with exposure to spiders or snakes
It sounds to me it could be more of a sensory integration issue rather than a phobia (based on the minimal info in the abstract) which has been well documented (especially in the occupational therapy literature). ... I have seen several cases where kids who are tactile defensive (one of the types of sensory integration dysfunction) are not able to tolerate wearing foot orthoses. I know Bug has done a lot with kids with this.
This is the lecture notes I give students on this:
Quote:
Sensory integration is the ability of the brain to organise and process sensory information from the visual, auditory, vestibular, tactile and proprioceptive sensory systems. A sensory integration dysfunction occurs when there is an inability to adequately interpret these sensations. Based on initial work by Jean Ayres (1972) as a theoretical framework for occupational therapy that has practical implications . It provides an alternative explanation for deviations in function, learning and behaviour
Sensory integration is a natural part of development and occurs dynamically throughout development. Children are typically sensory seeking – they seek out sensory information. It appears that sensory input is capable of enhancing neural connectivity.
The three major postulates of sensory integrative theory are
1) Learning is dependant on the ability to take in and process sensation from movement and the environment and use it to plan and organise behaviour
2) Individuals who have decreased ability to process sensation also may have difficulty producing appropriate actions, which, in turn, may interfere with learning and behaviour
3) Enhanced sensation, as a part of meaningful activity hat yields an adaptive interaction, improves the ability to process sensation, thereby enhancing learning and behaviour
Sensory integrative approaches are used in a number of developmental disabilities such as autism, cerebral palsy, fragile X syndrome, premature birth, prenatal drug exposure and hearing impairment.
Identification of defects in sensory processing (adapted from Blanche & Nakasuji , 2001):
Tactile defensiveness/hyper-responsiveness to tactile input:
• Object to being handled when not wearing clothes
• Struggle against being held
• Object to light touch
• Startle easily when being touched lightly or unexpectedly
• Push the clinicians hand away
• Rub or scratch the part of the body that has been touched
• avoids touching certain textures or surfaces
• unwilling to wear foot orthoses
• avoids barefoot on grass or sand
• dislikes finger/toe nails being cut
• walking on tip toes to minimise contact with ground
Proprioception processing:
• fails to adjust the body in response to changes in position
• bumps or crashes into objects
• grinding of teeth
• likes shoes or buckles tightly fastened
• has difficulty going up or down stairs
• leans into clinicians hands when being examined
• can’t stand on one foot
Vestibular Dysfunction:
• objects to having feet leave the ground
• fearful of swinging, spinning and sliding
• overreact when moved in space
• dislikes sudden or quick movements
• sits in ‘W’ position to stabilise self
• unable to catch self from falling
• poor gross motor skills – frequently trips
• difficulty moving hands and feet together such as jumping or catching
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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Mark and fellow foot observers
(sorry for the cross posting)
I did work with a colleague who participated in a ligitimate scientific experiement to observe the curling nature of the lesser toes during peaks in coital activity. They eventually had to abandon the experiment because the male went into excruciating leg cramps as he consciously focussed on the neuro-feedback from his digits.
Wasn't their similar research with females that was ultimately discredited after it was reported that some of the subjects were found to have participated in the experiment without first removing their tights?
Apologies for the late reply.
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"citing an indisposition due to special circumstances"
Patient with phobia to having foot touched
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