(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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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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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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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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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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11:12 AM
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| 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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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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3:55 AM
(Monday, January 7, 2013)
A recent article showed that sex was at least "least somewhat important" in approximately half of men 75 years and older. Odds were reduced in interest and participation in sexual activity the higher the age, if the partner had physical limitations and the use of antidepressants and beta blockers.
So what is the effect of stroke on sexual activity?
Almost 75% of strokes occur in folks over 65. Added to the advanced age of most stroke survivors there is also usually add increase in medications as a result of a stroke. There are also the mental and physical impacts of stroke that take a toll on sexuality. Included reasons are to believe that the stroke may affect the relationship, financial issues and low self-esteem.
Stroke is not usually cause sexual dysfunction.
But there are a variety of us psychological issues that do impact sex after stroke. The new challenges that stroke survivors and caregivers have to go through when they get home block out everything else. Scheduling health care workers, dealing with managed care and paperwork, as well challenges of getting to and from all the appointments are just some of the problems that get in the way of other, more fun, things. There is a period after stroke in which sex usually doesn't take place. But this little is usually temporary. For instance, 80% of men with erectile dysfunction after stroke regained the ability to have sex a few months later. And that change was spontaneous.
There is a general belief that after stroke sex can cause another stroke. This hardly ever happens (although it may be true in people with parallel heart disease -- consult your physician). Despite the fact that sex is safe after stroke as many as half of all survivors fear that sex may cause harm. Many partners of survivors also have fear that sex will cause another stroke in their partner.
By: "stroke recovery blog" "stroke blog"
View the hemorrhagic stroke guidelines article here
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11:23 PM
I got an email from an author the other day. He’s written a book about stroke recovery. He said that he’d heard that I did “...not like presenting other peoples' work as helpful for stroke survivors." I explained to him my position this way:
I work in rehab research; have since the 90's. All of that research has been stroke-specific. One of the things I've learned is that clinicians had made the mistake over and over and over (for decades) of buying into completely ineffective treatment options. They did this for 2 reasons:
1. The treatment had/has a charismatic leader
2. Clinicians in rehab don't typically read research.
So even if large studies came out and say "Those things don't work" clinicians just kept/keep on doing (and promoting, and selling books about, and teaching) them. And then there are categories of "treatments" that have no research (standardized, controlled trials) at all supporting them. So in my talks (I do many) I start by saying "Most of what has been used for stroke recovery is ineffective or untested. Here's what we think we know…” And most clinitians get it. They're pros. They want better tools.
I actually promote (when appropriate) a bunch of people and ideas. But anything endorsed is evidenced based and what that means is very specific: Has the treatment option reached meta-analysis and did that meta-analysis show efficacy? If it has and it does I'm all in.
If not, I let people know.
What I find from survivors is that they want us to hash this stuff out. They want us to have these discussions and not just stick with the same old because it’s what we feel comfortable.
View the hemorrhagic stroke guidelines article here
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7:20 PM
I'm a fan of one of this blog's advertisers, Saebo. The two guys who started the company are brothers, both occupational therapists. (Find another set of brothers that are both occupational therapists and I'll send you a free copy of my book.) I like the culture that Saebo brings to stroke recovery. Everything they make has a commonsensical perspective engineered in.
Saebo makes the SaeboStretch. Unlike static splints which hold the hand in a static position, the SaeboStretch allows the fingers to flex when they need to (often to protect the joints of the fingers). The 'Stretch then slowly pushes the fingers back to the desired position.
And, as it turns out, Gabrielle Giffords sports one!
View the hemorrhagic stroke guidelines article here
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3:36 PM
Stroke recovery involves neuroplasticity. You can slice it and you can dice it but the bottom line always comes back to stroke as brain injury -- and how to overcome it. If you can't get the brain to reorganize around the injury, recovery is toast.
• Spasticity: caused by brain damage.
• Inability to feel the movement: caused by brain damage.
• Unilateral neglect (decreased attention to the “bad” side): caused by brain damage.
• Lack of control over the affected arm and leg: caused by brain damage.
• Aphasia: caused by brain damage
• Vision problems: caused by brain damage
• And much more!: caused by brain damage
So the answer to the question “… how might movement problems be overcome?” is simple: Rewire your brain.
And it is good that it is simple because only the stroke survivor can do it. A therapist could have a double major physical and occupational therapist PhD from Harvard school of Super Duper Rehab summa cum laude with postdoctoral training as a Rhodes Scholar and they still can't do it for you. You know the old Smokey the Bear poster: "Only you can prevent forest fires"? For stroke survivors the poster should say: "Only you can drive neuroplastic change". Fortunately, the rules for rewiring your brain are very, very simple. Unfortunately, rewiring takes a tremendous amount of hard work.
And what does it take? Repetitive practice.
 |
Repetitive practice is boring.
So try spicing up with a video game yay! |
|
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10:42 AM
As stated before, I'm not a big fan of drinking after stroke. I found some interesting statements here about the issue:
The effects of alcohol may put you at further risk after a stroke, and you will need to review your drinking and consider cutting down, especially if you were a heavy drinker beforehand.There are a number of factors you need to consider – talk to your GP for more advice:
- Following a stroke you may be more vulnerable to alcohol and its negative effects such as sleep disturbance, poor balance and impaired speech.
- Alcohol may worsen mood swings and depression, which are common after a stroke. It may affect your memory and thinking, making you forgetful and less able to make sound judgements.
- If you are out after dark, you should remember that alcohol can reduce night vision by 25 per cent and slow down reaction times by 10-30 per cent.
- Alcohol acts on the kidneys, creating excessive amounts of urine, which may make you dehydrated. If you are suffering from headaches, the dehydrating effect of alcohol is likely to make them worse.
- Alcoholic drinks are high in calories that have no nutritional value. If you are less active than before your stroke, you will need to reduce your calorie intake (especially these ‘empty’ calories) to avoid becoming overweight. Alcohol may make it harder for your body to absorb essential nutrients such as vitamin B1 and calcium. If you are less active and not absorbing calcium properly, your bones may become weakened.
- Drinking alcohol may be harmful when taking medicines that are sometimes needed after a stroke. Ask your GP or pharmacist about whether you may drink at all and if so, what the sensible limits are for you. You may be advised to stop drinking for the first month or two after starting a new medicine so that your body can get used to its effects.
- If you are taking blood-thinning medications such as warfarin, it may be important to establish a routine of what you eat and drink. If you do drink you should ask at your anticoagulant clinic about your alcohol intake and how much you can safely drink on a regular basis.
By: "stroke recovery blog" "stroke blog" View the hemorrhagic stroke guidelines article here
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7:36 AM
I often get questions about ankle foot orthoses (AFOs), and how to get out of them. I'm not a big fan of AFOs because they encourage a sort of "learned nonuse." It's actually more like "learned disuse." (Learned disuse: You're not learning to not use the body part, but you learning to use body part incorrectly.) And keep in mind, every movement you make changes the way your brain is wired. So it's very easy to get used to an AFO. Let's put it this way:It's easy to walk into an AFO. It's hard to walk out.In any case, I get a lot of e-mails about this subject. Here's an example:
I wear a big brace on my right leg. I am paralyzed on the right side. I walk with a one-point cane. I walk with an open hinge (articulating) AFO.
They opened the hinges on my old brace several years ago. I walk around my apartment with the old one. But when I go out I use the bigger brace which isn't open at hinges.
I read on Deans' Stroke Musings that you recommend the Air Cast. Which one for stroke survivor do you like? They have a lot of different ones on their website. Here's my answer:First of all, the disclaimer:(Warning: ENDING THE USE OF AN AFO CAN LEAD TO FALLS AND INJURIES.Never discontinue the use of an orthotic without first consulting the appropriate health care provider. Then call your doctor. Then have your doc talk to any other providers as needed. Then discuss it some more. Thank you.)Wear a brace on the ankle that satisfies two things:1. Keeps you safe2. Challenges* you*Challenge: Walking naturally challenges you to lift your foot. If you can lift your foot up and down to stay safe (not trip) then you might consider questioning an orthotic that helps lift the foot. Gradation would usually be something like this:1. Rigid AFO2. Articulating AFO (where the ankle joint moves just a little bit)3. A stirrup (stabilizes both sides the ankle but allows the ankle to move up and down freely)4. A high top shoe (like a basketball shoe)5. NothingOften the manufacturers are the best people to ask specific questions. One of the advertisers on this blog X-STRAP (see link on the sidebar) has a variety of products. Some help bring the ankle up during gait, others support the ankle. The stirrup is usually associated with one particular company: AirCast.~
View the hemorrhagic stroke guidelines article here
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2:51 AM
(Sunday, January 6, 2013)
I do a lot of talks about stroke recovery. About 100 per year. I learn so much from the therapists I talk to. Many of them are committed, caring, bright and motivated. I like the fact that I'm doing my talk to good people.
But there is one segment of therapists that can be tough to love. 
Attending my seminars have been lots people from a variety of companies. These companies usually represent products. Sometimes they represent services, clinical trials, organizations, etc. But usually it’s products. And for me, these people can be very dangerous. They either want to know what I'm saying about their product or want me to promote their product. Those who want to know what I'm saying about their product never voluntarily tell me where they work. Those that want to promote their product are just the opposite. At some point in the seminar they'll approach me and talk up their product. And it's always uncomfortable. 
Many of the products have little or no scientific evidence behind them. Doing the research to provide evidence for a product is expensive and laborious. It's quicker, cheaper and less fraught with danger to put your product to market, and promote it. And I become a part of their promotion. So when I'm approached, it usually feels like hucksterism. It feels like I'm being sold on a product so that my seminar might become a platform for promotion.
People will hand me their card, and talk about the product. That card will become a reminder to look at product up. So how do I look it up? I try to strip away the product name in order to get to the core of the product, and then research core. For example, let's say somebody is selling Stroke-A-Way. If I look up Stroke-A-Way all I'll find is what Stroke-A-Way wants me to find. So instead, I look up the "active ingredient" (concept, or exercise, or whatever). I try to see if the active ingredient is scientifically based.
But what if it doesn't work? A lot of times I can go straight to clinical research sites during the seminar and look the "active ingredient" up. I can also send out a quick e-mail to experts in the field (I've been in research for a long time; lots of contacts) and ask their opinion.
So: What if the product sucks?
If the product has no evidence, I don't advocate it. And if you're a vendor, and I say your product has no evidence, you'll be pissed. But you shouldn't be. You're at the course, you read the course description, and you know I'm in research. So... I'm going to do the research.
I wish these folks would read their diploma. On there some place is the word "science." It'll be an Associate of Science, a Bachelor of Science, a Masters of Science, or Doctorate of Science. When you got your license you dedicated yourself to providing treatment options based in... science.
So bringing it up in the seminar is not just dangerous for me, it's dangerous for the vendor. They try to sell me on a product, and make me aware of the product. Then I do the research. What if there is no evidence it work? The next time somebody asks me about the product I'll say there's no evidence behind it. I have to. It's my job. It probably would have been better had they not talk to me about it at all.
You know what the most widely read entry in this entire blog is? The entry on neuroaid. I only became aware of the product because they copped the name of this blog; The Stroke Recovery Blog. The theft got my attention, and made me do the research to find out that it... - had a very low level of evidence behind it
- was available in a less expensive form
- used researchers who had a clear conflict of interest to promote it.
So if you get my attention, be prepared for the inevitable question: Is it evidence-based? This is my job. And I talked to a lot of stroke survivors who want it to be the job of every clinician. Figure out what works, and then do it. And the stuff the doesn't work. Don't do it.
BTW: Frankly, I don't necessarily advocate the products advertised on this blog. However, I will not accept advertisement for products A) that clearly don't work or B) competing products exists which better provide the "active ingredient."
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View the hemorrhagic stroke guidelines article here
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9:55 PM
When a survivor first has their stroke the brain is very vulnerable. And because it's vulnerable the survivor shouldn't do very much. The first few days after stroke is a time to convalesce. There is a time to add intensity to the recovery effort. But during the first few days, generally referred to as the acute phase, is not when intensity should be attempted. There are more important things to do. Like saving as much brain is possible (the domain of medical doctors).
So what do therapists do during acute phase? Most therapists involved in acute care will tell you the same thing: "We do whatever they can." That is, whatever the patient is physically able to do is encouraged. But there is often not very much the stroke survivor can do. Yet therapy immediately after stroke is generous. There is often hours per day slated for acute care therapy. But that's not when hours are needed. Hours are needed during the subacute phase.
The subacute phase is usually defined as "seven days to three months." But this is actually a misrepresentation. The fact is, like anything with stroke, it's different for every survivor. Each phase, in fact, happens in a different time for each individual survivor. In any case, it's the subacute phase when intensive efforts towards recovery should begin. Yet for many stroke survivors there's actually a reduction in the number of hours of therapy during the subacute phase as compared to the acute phase. In this way, therapy for stroke survivors is upside down.
By: "stroke recovery blog" "stroke blog"
View the hemorrhagic stroke guidelines article here
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6:10 PM
Note: With regard to any supplementation -- Ask your doctor first. Ask your doctor first. Ask your doctor first. Thank you.
Fish oil may help many aspects of recovery from stroke. In my book (now in the second edition, available for pre-order, just sayin') I put it this way:
Fish oil may help stroke survivors in two ways:
Remember, always ask your doctor first!
View the hemorrhagic stroke guidelines article here
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1:35 PM
During stroke recovery "the good trains the bad." This is known as "bilateral training." In anyone, stroke or not, it is true "the good trains the bad." Here's an example: I'm a drummer. I'm right-hand dominant. If I try to tap my left hand as fast as I can it is not as fast as if I tap it alternately with the right dominant hand. Research has found that my left hand will not only be quicker, but it will be more accurate when I do the movement with my right hand. So I will be both faster and hit the drum where it should be hit.
In stroke survivors bilateral training can be used to begin the recovery process. And it can be used to help stroke survivors with very little movement. Survivors with very little movement are sometimes called "lower-level." (This designation says nothing about the ability to think, only the ability to move.) The reason bilateral training works for lower-level stroke survivors is because the way bilateral training may work. And I say may, because nobody's really sure. Bilateral training may work because the two limbs communicate with each other even when that communication does not go through the brain. It's the reason infants step even before they can walk.  |
| Click here: See a baby walk before it can walk |
By: "stroke recovery blog" "stroke blog"View the hemorrhagic stroke guidelines article here
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8:51 AM
I do a ton of talks on stroke recovery. I come from the world of research. So my perspective is a bit different to the rehab clinicians I talk to. I do my best to ease them into the world of research. I explain where they can find leading edge stroke rehab info for themselves. I describe where we are in researching stroke recovery (not very far I’m afraid). I explain how the stuff from research can be used with their patients.
And there’s the rub. Therapists and other folks in rehab sometimes have a bit of difficulty imagining how to transfer the research to their practice.
"I'm in acute care (or skilled nursing, or an outpatient clinic, or in home care, or in long term care, etc.). I can't implement this stuff. It takes too much time (or we don't have the equipment, or don't know how to bill for it, or nursing won't follow through, etc.). This stuff can't be used on my patients because they're not motivated enough (or have too many other medical problems, or are too "low level", or are too old, etc.)"
The core concepts of relearning how to move after stroke are simple. These concepts don’t have to be done clinically the way they’re done in research. In fact, they are often more effective in the clinic. They may be more effective because clinicians can change the treatment to fit individual survivors. Research involves a one-size-fits-all implementation. Therapists can add and subtract, slow down and speed up, skip or add more treatments. In research all those screw up consistency.
Some therapists have no problem with implementing this stuff. Some go well beyond what I suggest. For instance, they may dovetail suggested treatment options in a mix that is beyond anything researched. (Note to clinicians who do this: make sure you use valid and reliable outcome measures to prove to yourself that these things work.)
Whats the difference between those who can and those who can't?
Will and imagination.
View the hemorrhagic stroke guidelines article here
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5:01 AM
Below is a video of Sen. Mark Kirk. He had a stroke back in January. He appears to have left hemiparesis, and some dysarthria. He seems like a really hard worker who deserves to get every bit of recovery he can. He's a great inspiration. But.... He has this line at the very end of the video:
"I can't wait to go back to work to vote to spend less..."
He is a fan of the way health care is being run now. And I guess he should be. It seems as if no expense was spared in his case. He probably has money, and that doesn't hurt. But much of it was paid for by his congressional healthcare plan. And here's some funny...
View the hemorrhagic stroke guidelines article here
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1:56 AM
(Saturday, January 5, 2013)
Electrical stimulation after stroke is the single most important modality there is for recovery. A modality is...application of something therapeutic like a hot pack or cold gel or...e-stim. Part of the reason e-stim is so important is that it does so many different things.
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Drunk smoking guys use e-stim for fun! |
But here's some funny: Some OTs (occupational therapists) cannot do e-stim clinically. Why? It turns out that in some States OTs have to get a special post-secondary education certification to do it. Which was always weird to me. You know that ad where you can use the stim "ab-exerciser" that’s supposed to give you ripped abs while you lounge around because the e-stim builds muscle? And who’s ordering that? Some drunk guy at 2 in the morning. HE can do it, but OTs can't? Weird.
E-stim does so much that its lack of use clinically for survivors has flummoxed me for years. The reasons given for not doing it clinically tend to be of the "Its too complex to set up" variety. "It’s too expensive." is another thing. Some e-stim machine are expensive. But even the cheap gizmos can do the job. Most of the reason it’s not done is because no one wants to figure out the machine.
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Jesse says:
E-stim is not just for
drunk folks and kids! |
Enter my 10 year old son, Jesse. I have a lot of e-stim machines stored in my basement. I've accumulated them over time in various ways. And boys will be boys and boys (and their friends) will go into the basement and put electrodes all over themselves and turn up the stim and see what pops. And they figure the machine out. Because e-stim works like this: Put on the electrodes (they stick to your skin) and turn up the stim. And see what happens. And that’s it.
And yet many clinicians shy away from e-stim. They shy away from something that can do everything from help recovery of sensation, to stretching to building muscle to starting the neuroplastic process. So talk to 'em. And if they have any questions, tell 'em to email me.
Note: There are some serious contraindications to doing estim in some folks. i.e., they can mess up pacemakers and other electronic devices. So always ask your doc first!
View the hemorrhagic stroke guidelines article here
Posted in
Labels:
stroke,
stroke recovery
Posted by
Hit Girl
at
9:31 PM
