(Wednesday, January 9, 2013)
So this is weird.... I've been thinking a lot about what would happen if I had a stroke. I'm not the only one in the "stroke recovery game" that has these thoughts. It's an occupational hazard. I had a conversation with another researcher a while ago. He smokes. I said, "Dude: smoking causes stroke." And he said, "Yeah, but if I had a stroke I'm gonna know what to do." Good luck with that.There actually is a way that allows for certain portion of the brain to be temporarily "stunned." Transcranial magnetic stimulation (TMS) can be used to give a sort of fake stroke. That would be the best way to do it. "Stroke: it's a nice place to visit but I wouldn't want to live there."So who would be the perfect stroke survivor? Let's put it this way: You already know this person...The perfect stroke survivorThe perfect stroke survivor would be male. Outcomes are better for males. Depression hits men less after stroke, and they tend to be both younger and in better shape prior to the stroke. The perfect stroke survivor would be well educated. Folks who are well-educated get more recovery than the less educated.
The perfect stroke survivor would have significant economic resources. The well-off recover more than then moderate or low income folks.
The perfect stroke survivor would be African-American. African-Americans recover more than Caucasians and/or Puerto Ricans.So, Who would be the perfect person to have a stroke?
View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
3:17 AM
(Tuesday, January 8, 2013)
This is a special promo for the 1st ed. Remember, the 2nd edition is available for pre-order (See link on the right hand column). View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
10:59 PM
What works and what doesn't work to help recover after stroke? Research has revealed three broad categories:
1. It works
2. It doesn't work
3. We don't know yet
There is tons we don't know about stroke recovery. Stroke recovery is a million different puzzle pieces, with no picture on the front of the box to help out. But there are some resources to help answer some of the questions (at least)...
There is one website that answers, in layman's terms, what works and what doesn't work. Although the list is far from complete, it's a start. Thank you Canada!
View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
6:44 PM
Bill a stroke survivor has trouble putting on headphones. He he is able to get the headphones on using just his "good" side. Here's how he does it: First an earpiece on the "good" side and then use the same hand to move the other over to his "bad" side ear.
Now let's say instead of using only the "good side" he uses both sides. His "good side" hand picks up the headphones, and then his "bad side" hand grasps the other side of the headphones and he puts them on. But in order to get the "bad side" involved he has to do a bunch of weird movements. He hikes up his shoulder, pulls his arm away from his body, and uses an awkward grasp to put the headphone on his ear.
Which do you think would be better? Which would be better in the short run? Which would be better in the long run?
In the short run it may be better to do it with just the "good" arm. It might be quicker, and take less effort.
But in the long run what would be the effect? First of all he'll never learn how to use both arms for that skill. Also, since he's only using the "good" side for that movement, all the other tasks that use similar movements would not be practiced. And a lot of things use that same movement (Brushing teeth and hair, shaving, feeding, etc.) So he'd have less practice specific to putting on headphones, and then less carryover of that task to other tasks.
But here's the funny part: There are a lot of therapists who believe that he should do it one-handed. The thinking is this: The movement needed to complete the task of both arms is "bad" movement.
And, so the thinking goes, more "bad" movement that you use, the more that "bad" movement will be ingrained. Like a bad habit.
This idea, that "bad" movement should not be encouraged always struck me strange on the face of it. This is the thinking: "The more you move the worse you'll get."
But everything we know about the brain suggests exactly the opposite. The more you practice something the better you get.
There is a weird assumption that is made: You will never try to move better, you will only use the "bad" movement forevermore. The idea is, survivors don't know what good movement is. Because survivors don't know what good movement is, you need a therapist there to correct you. Which... I don't know about you... sounds like it'll cost you a lot of money.
But let's say they're right. Let's say that if you do the task with both arms you would never do it "correctly." Now you have a decision to make. Do you do it "incorrectly" for the rest of your life, or do you not try to use the "bad" arm?
It was me, I would make the decision to use the "bad" arm. Why? Well first of all I stand a much better chance of learning to move the "bad" side better if I use it in every day tasks... every day. Second, movements from one task can feed forward to other tasks that used similar movements. So I might retrain not just for one task, but for a whole bunch of tasks. Third, I don't let the whole portion of my brain "lie fallow" and not do anything. The brain hates not doing anything. The brain goes through what's called "a pruning of the dendritic arbor." It's a fancy way of saying "use it or lose it." If a portion of the brain is not used, the neurons in that part of the brain start to shrink -- or "prune."
But there's another important reason to use any movement you have. Maybe, at the "end of the day" the task remains awkward and uncoordinated. So what? How many people play golf, enjoy it, but don't play perfectly (all of us)? How many people ski, and enjoy it, and don't have perfect form? What about music, or painting, or writing...
Bart: You make me sick, Homer. You're the one that told me I could do anything if I just put my mind to it.
Homer: Well now that you're a little bit older I can tell you that's a crock. No matter how good you are at something, there's always about a million people better than you.
Bart: Gotcha. Can't win, don't try.
This is my suggestion: Continue trying to do everything. And every time you do it try to make it a little bit better.
Everybody wants to be an expert before they start. But to become an expert involves a lot of hard work. May as well begin now... By: "stroke recovery blog" "stroke blog"View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
3:08 PM
I do a lot of talks on stroke recovery. From Alaska to Florida, from New Hampshire to San Diego I'm all over the place all the time. I do these talks for therapists; OT, PT, speech. Survivors and their caregivers show up as well. Also, medical device people, nurses, physiatrists, etc. So I get to talk to a lot of people about stroke. I always do the best I can to make things as simple as possible. Here is a really simple but profound way to look at stroke recovery...
That's it. Repetitive practice of the movement or sound or walking or skill or whatever. Of course repetitive practice has the habit of doing two things: 1) causing people to repeat things that they can do pretty well, over and over. 2) Plateau. People plateau (don't get any better) because they keep doing what they can do pretty well over and over.That's where demanding comes in. Repeatedly practice the skill in a way that "nips at the edges" of your current ability. Repetitive without demanding and progress will slow to a crawl.Demanding without enough repetition will halt progress."the stroke blog" "The stroke recovery blog" View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
11:12 AM
 |
| Recovery Badass |
A great article in the British newspaper The Telegraph. The article is by a stroke survivor who recovered well after an ischemic (block) stroke. He's hit on some very core ideas. Here are the most important points (comments in red are mine):
- "...nobody in the hospital was going to tell me how to get better ..."
- "I had to get out of hospital and cure myself."
- "...found that major strides had been made in America in treating stroke victims." (USA! USA! USA!)
- "Research there showed that damaged neural pathways could be re-routed" (Taub! Taub! Taub!)
- "The key was speed. After three or four weeks, the brain seemed to start a permanent shut-down on these pathways." Not true. But the guy is a "High Master" which I think is a principal. He can be forgiven.
- "I decided to bounce a tennis ball 2,000 times a day off the kitchen floor, missed catches not counting." Obsessive repetitive practice. I love it.
- "The first day it took four hours to reach the target." Ambitious repetitive practice.
- "...wrote out the alphabet, one line per letter, for two hours a day." Brilliant, I think the British say.
- "I vowed to (type) 10 pages a day, typing out my corrections on my latest book with one finger. The first 10 pages took three days." I love this guy.
- "I decided to recite the poems of Andrew Marvell for two hours a day..." Fighting aphasia by using something meaningful. This guy may have missed his calling: neuroscience.
- "I marched up and down the stripes on the lawn for two hours a day." Very Monty Python.
- To reestablish I coordination he used "a computer game flying a virtual F15 jet - or, in my case, crashing it thousands of times on the runway before finally landing it - after 40 hours' "flying" time." I think this is great. The idea of doing something fun to recover. When else in the middle of somebody's career are they allowed to play 40 hours of any game?
- "I came close to giving up the grind of rehab. But by choosing tasks like writing the alphabet or counting how many times I could walk down the lawn without crossing a stripe, I could monitor my own progress." Okay, two things: close to giving up. But not giving up. And second: being able to "monitor progress" is essential to recovery because if you don't monitor things closely how do you know if you are getting any better?
- "The difference between success and failure was...a deep anger that I was not offered more help to start with" You know, even Gandhi was not against anger. He just said you should use it wisely because it's very powerful. I'd say using anger to recover from stroke is using anger wisely.
- Gandhi on Anger "I have learned through bitter experience the one supreme lesson to conserve my anger, and as heat conserved is transmuted into energy, even so our anger controlled can be transmuted into a power which can move the world."
Bravo High Master of stroke recovery!Find the article here. View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
7:01 AM
Show me a neurologist or physiatrist who does not know that recovery can continue after a year and I'll show you someone who should lose their license.
In some ways doctors are forced by the Hippocratic Oath to lowball any estimate of recovery. If a doctor says you won't recover, and then you do, they can say “Great!” If a doctor says, "You can expect a great recovery” and you don't, they have done you harm.
In terms of having a doctor understand rehabilitation per se, it's probably not going to happen. The responsibility for rehabilitation is offloaded to therapists. The one exception to this may be physiatrists. However, although they may be very aware of various recovery options, they are not trained in rehabilitation techniques.
Of course, MDs can be a driving force towards recovery. Each clinician (MD, therapist) has a unique role to play. Some MDs are not very well versed in all things recovery. If you want to find aggressive MDs and therapists, click this link >>> View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
3:55 AM
