Gray matters—the really big picture

Abstract

Because I was born in Hollywood, I feel it is my birthright to rewrite the Academy Awards. So, let’s do three hours in 30 minutes! And the Oscar for Best Picture goes to Gray Matters—The Really Big Picture. Why does this gray matter matter to us hand therapists? Because that is where executive function resides and rehabilitation research has identified executive function as the most critical factor in a successful outcome. Last year the Journal of Hand Therapy published a paper entitled ‘‘A Research Agenda for Hand Therapy,’’ which identified outcome studies to be the second most commonly required research. We are not alone in this quest. Even the cash-strapped federal government is funding qualitative research in the outcome arena—studying self-advocacy, selfefficacy, and strong work ethic versus dependency, co-dependency, and entitlement. So how can we wring the performance of a lifetime from our patients’ inscrutable and sometimes recalcitrant brains? Like any four-star flick, Gray Matters—The Really Big Picture should generate more questions than answers and stir meaningful and controversial post-movie discussions. How do we engage executive function? Why was this picture made and who cares about outcomes? Here’s the scoop.