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E-mail: nwoseeu@gmail.com ABSTRACT Background: During a neurophysiology lecture in a physiotherapy class, a philosophical statement “psychologist is a physiotherapist who specializes in physiological manipulation of the limbic system” was presented to students for reflection and the first response was “physiotherapy is not psychology” Objectives: The aim of this case report is to contribute to the evolving discussion regarding cultural competence and how psychological tool of ‘listening’ may be physiotherapeutic in diabetes rehabilitation Materials and methods: A case of new diabetes emergency is presented: client was unresponsive to drug and anxious to change medication as well as the staple meal. Intervention involved listening to the client, which led to (1) identification of psychosociocultural stress as potential cause, and (2) successful further intervention by removing the feeling of pressures. Results: An important outcome that blood glucose level was non-responsive to drug got stabilised, client went back to work in the following week and remained stable during the one month follow-up. Conclusion: Theory is formulated – albeit a re-articulation of known idea that the limbic system is linked up to the hypothalamus-pituitary-adrenalin axis is in part possibly the basis of diabetes and unresponsiveness to drug. Overall, this article identifies that empathic listening is more than just a necessary communication skill, but also a physiotherapeutic regimen that involves manipulating the limbic system to stop release of e.g. glucocorticoids. On the corollary, not listening to a client is not only poor communication skill, but also a cause of pathophysiology that can cause disease and/or exacerbate existing diabetes.

Bio-psycho-sociocultural basis of diabetes rehabilitation: case report with implications for cultural competence and physiotherapy