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Any psychomotor skill can be improved and developed by suitable practice. It is not pos- sible to practise every technique or method sufficiently to become skilled enough so that the process is automatic without a consider- able quantity of time and effort. However, there are some exercises or drills that may help to shorten the learning time for students and I have included a few here. It is un- fortunate that it is extremely difficult to find activities that are similar to the skills needed for osteopathic technique. There are many things that can be done to improve mechanical handling skills for dealing with inanimate objects. These do little in helping the student to appreciate the subtle differences in tissue states that exist in patients. We are dealing with living structures in real people and the psychology, age, weight, size and nature of the problem all subtly alter the approach and forces necessary. With this in mind it must be said that the best exercise is constant practice with a willing fellow student who is em- powered to give constructive feedback as to handling, comfort and effectiveness.
Not all exercises or drills will be of equal benefit to all individuals. We all have our own personal model of learning and some systems of skill development will feel more natural than others. Osteopathic skills can be divided into palpatory skill and technique skill although one is not really possible without the other.
From a general viewpoint, anything that improves hand and eye coordination should be useful. Most people, at some time in their life, undertake sport of some sort or another
if they are physically able. As experience and practice develops, they gradually improve their skill to a certain level dependent on the amount of time and effort used. If a student is going to be an osteopath, their whole life's work is going to be concerned with perform- ing osteopathic treatment. It would seem to make sense therefore to practise the skills until they are efficient. For many reasons some are unwilling to do this. Although life places many demands on our time, without sufficient practice it is fair to say that a student is unlikely to become an efficient technician. The practice must, nevertheless, be of the correct methods. Bad habits, par- ticularly regarding posture, can be very difficult to correct later.
The best sports are going to be those that the student enjoys and will, therefore, partici- pate in regularly. Racquet sports help in coordination, but dance and contact sports are probably better for posture, balance and the psychomotor development necessary for osteopathic technique. Physical strength is not a requirement for an osteopath. How- ever, a reasonable level of stamina and fitness is useful. A high proportion of students who become good technicians have done some training in martial arts. It seems that the discipline, fitness and body awareness have many uses in their subsequent osteopathic career. Team games seem to have less to offer in terms of the future needs of an osteopath, but that is not to say that they do not have their use in general fitness.
Exercises for developing technical skill 67 1. Face a partner and take up a posture with
one leg forward of the other. Place a foot- ball between one of your outstretched hands and that of your partner so that it is sandwiched between you. Take turns in pushing and pulling. If you coordinate with your partner, the football will remain between your hands. If you do not co- ordinate, you will drop it. Responding to the subtle cues of your partner's move- ments will help develop coordination and response to motion. It will also help in developing the feel for 'setting' the hand in slight isometric tension which is necessary in many techniques. Reverse hands.
2. Pull a toilet roll gently until the tissue is taut. Apply a sharp tug, aiming the force at the perforations of the sheet. Avoid simply unravelling the roll. Practise mov- ing the force to the next row of perfora- tions while missing the nearer one. This drill improves the ability to sense tension and to direct force beyond one point to another.
3. Stand facing a partner and place one leg in front of the other. Extend one arm slightly and place the back of the hand against the back of your partner's similarly extended hand. Decide who is to be the mover and who is to be the follower. Take turns in moving the hand at different rates, and in different planes and directions. The fol- lower must try to remain in contact at all times. This is similar to exercise 1, but uses direct contact rather than via the football. Alternate hand and leg positions.
4. Stand facing a partner with one leg in front of the other. Grip each others' wrists and gently assume a rhythm of push and pull. Attempt to pull or push your partner from his firm stance, but be aware that he is doing the same with you. Force will not work; you must use balance and transmission of energy and rapid change of direction to be effective. This will improve balance, coordination
and sense of tissue resistance. Alternate legs.
5. Acquire some bubble wrap as used in protective packing. Place it on a table and use your heel of hand or pisiform to burst one bubble at a time. Draw an ink line around one bubble and try to burst the bubble within the line and no others. Examine your hand and see if you have a neat ink circle around your pisiform or only an arc of a circle. Progress to doing the same thing on your thigh so that there is normal tissue underneath the bubbles and not the firmness of the table. Progress to performing the same task on a partner's back to see how little force you can apply and yet still achieve the objective. This will develop skill and accuracy in minimum force technique. 6. Have a partner place a single hair under-
neath a single page of a smooth tele- phone book without you knowing where it is. Use light pressure and scanning of the surface with your fingers to locate the hair. See if you can do the same with the heel of the hand. Try with eyes shut or open and standing or sitting to see which is your personal best method. When you become adept at this, have your partner place the hair under several pages of the book rather than just one. See how deep you can still feel it. This improves palpat- ory perception and trains you in which part of the hand is best to use in palpation. 7. Perform a similar exercise to 6, but use a coin instead of a hair. Have your partner place the coin at varied depths and try to judge the depth. Have him vary the size of the coin and try to estimate the size by palpation. This palpatory exercise is similar to the previous one but it develops different aspects of your skill in estimat- ing size and bulk.
8. Perform the magician's trick of snatching the tablecloth from under cutlery or crock- ery. Use unbreakable crockery at first! Once you have acquired the skill to pull
movement as if you are a mirror. Gradu- ally make the movements more complex and see if you can follow his mime. This will improve your ability to learn tech- nique by watching and copying. 13. Sit at a table with your forearms hori-
zontal. Relax and then try to contract your brachio-radialis muscle alone on one side. You may find that this is difficult, but with practice it should be possible to isolate this one muscle alone. When you have achieved this, move on to specifically contracting part of your forearm extensor group. To do this, lift one finger and watch and feel the muscle contract. Try different fingers. Progress to contracting specific parts of the muscle group with- out moving the fingers. Try to contract your biceps muscle without visibly con- tracting brachio-radialis. These exercises give you the ability to use your muscles in a controlled fashion. This is a very useful facility when performing thrust techniques that require accurate use of de- fined parts of your structure for specificity. With a little ingenuity it should be possible to develop most daily activities into suitable practice for some aspects of technique skill. When vacuuming, swivel from foot to foot to practise weight transfer necessary in many articulation techniques. When washing a car try different directions of circling the hands to find the variety possible in addition to the most natural directions. Try placing a few pieces of fruit or vegetables in a bag and identifying each one by feel. Trace the out- lines of the bones of your own wrist; see how much pressure is comfortable and how you can deflect the tendons out of the way to get to the deeper structures.
Until it is possible to develop some form of thrust meter or pressure-sensing device to objectively measure forces and directions, these simple drills should help in a small way to aid understanding, palpation and skill. away the tablecloth without disrupting
the articles on the table, try the same exercise sitting, or with varied leg positions. Try it bent over or straight to find the optimum posture necessary for the sharp pulling action. This exercise should improve your fast movement and acceleration skills.
9. Play 'red hands' with a partner. Have your partner extend his hands in front with palms facing down. Place your hands, palms upward, lightly under his so that they are just touching. Keep very slight movements going and try to extract your hands fast enough to gently slap the back of your partner's hands before he has had a chance to snatch them away. If you manage to slap him, you repeat the move until he manages to anticipate your movement and snatch his hands away so that you slap the air. When this happens, you reverse roles. Try not to snatch the hands away at every move; wait until the slapper is committed. This improves response to motion and reaction time, but will give sore hands if continued for too long!
10. Have a partner suspend a crisp banknote between finger and thumb. Place your finger and thumb on either side of it near the bottom, without touching. Have him drop the note and try to catch it before it passes through your hand. As you im- prove, gradually widen the gap between your finger and thumb and raise your hand nearer the top so that there is less time to react. This is another exercise in response to motion and improves your ability to move only at the right speed when necessary.
11. Learn to juggle with suitable juggling balls. This teaches you to relax and yet remain alert and responsive to moving objects. This is extremely good for co- ordination and hand-eye reactions. 12. Have your partner mime a simple move-