Fish oil may help recovery.

(Sunday, January 6, 2013)

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:
 
1. DHA and EPA may help to reduce swelling in the brain after stroke.
2. Fish oil helps overall function of the nervous system and is considered “neuroprotective” (a substance that protects the nervous system).

Fish oil helps promote the neuroplastic process and appears to help the brain recover after stroke. Fish oil helps restore a neurotransmitter after traumatic brain injury. It may do the same after stroke.

Fish oil "treatment is able to facilitate functional recovery after (stroke)." It probably also reduces mortality after stroke.

Great general discussion of fish oil here. It turns out that cheap fish oil is just as good as the expensive stuff.

Remember, always ask your doctor first!


View the hemorrhagic stroke guidelines article here

Posted in Labels: , 0 comments Posted by Hit Girl at 1:35 PM  

Walking in Rhythm

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

It's why, in animal experiments, you can sever the spinal cord but the back legs will automatically go into walking pattern when they're put on a treadmill. It has to do with neural networks that are in the spinal cord. These networks are collectively called the central pattern generator (CPG). The CPG allows for limbs to communicate from the fingertips of one hand to the fingertips of the opposite hand (or "toe to toe"), right through the spinal cord.

In the arms and legs, bilateral training is relatively straightforward. In the arms you would have each arm trying to hit a target. You could have both hands attempting to alternate to hit a target. You could also have it set up so the "good "hand has to hit a target that much further away than the "bad" hand. You can also do this with a rhythm. The idea would be to use a metronome (click, click, click, rhythmically) or music where the drumbeat would dictate when each hand would have to meet the target.

In the lower extremity it similar: there is a rhythmic component. You would try to take exactly the same step length with the "good" and "bad" legs. A rhythmic component is added the same way as the arms: music, or a metronome is used to establish be in each footfall happens on each beat. It is thought that reestablishing the rhythmicity of gait will help reestablish the symmetry of gait.

As I said in a PT trade mag...

"A simple metronome either heard through headphones or carried by the therapist next to the stroke survivor can be used to promote the re-establishment of rhythmicity of gait. Plugging the ears using standard noise-reducing plugs can boost the volume of footfall to make that obvious to the survivor. The trick is then to match the footfall to the beat."


By: "stroke recovery blog" "stroke blog"

View the hemorrhagic stroke guidelines article here

Posted in Labels: , 0 comments Posted by Hit Girl at 8:51 AM  

Will and imagination

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

Posted in Labels: , 0 comments Posted by Hit Girl at 5:01 AM  

Sen. Mark Kirk has skin in the game. Twice.

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... 



Full article here.

View the hemorrhagic stroke guidelines article here

Posted in Labels: , 0 comments Posted by Hit Girl at 1:56 AM  

E-Stim. If dude can do it, so can you.

(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. 

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.
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: , 0 comments Posted by Hit Girl at 9:31 PM  

What else can I do?

There is an inaccuracy in a recent Amazon review of Stronger After Stroke that I must correct... 

BULL
Here is part of the review:

"I have not read the book, but one of the reasons my father in law suffered a stroke was because he's blood pressure was too high due to alcohol consumption. In this book it says it's ok to have 4 oz of alcohol a day so my father in law has started drinking again. So I'm hoping I didn't start up the drinking with him by giving him this book."

Actually, there is no mention of alcohol at all, any place in the book. But the author of the review hadn't read the book, so how would they know?

Here's a part of the story that may be interesting only to me: I contacted Amazon, asking them to consider taking the review down. Amazon will only take down a review "If it in violation of one of Amazon's posted guidelines." One of posted guidelines is: "Customer reviews should be relevant to the product in question." The reviewer is clearly reviewing hearsay, not a book. In any case, I was amazed that Amazon has declined to take the review down. I'm a huge fan of Amazon! I'm disappointed.

I'm not an advocate of drinking after stroke.

Thank you.S

View the hemorrhagic stroke guidelines article here

Posted in Labels: , 0 comments Posted by Hit Girl at 4:53 PM  

The perfect time to have a stroke?

I'd argue that the "best" age to have a stroke is 27. The entire brain is fully wired (the frontal lobe wires in the 26th year). You're young enough to undertake the rigors of recovery (recovery is statistically better the younger you are). But you're old enough to have your brain wired "normally" (recovery in children is often a mixed bag because the brain is not yet fully developed).

But what is the best day to have a stroke? Any day but the weekend. Turns out the having a stroke on the w/e means lower quality care than during the week. 

View the hemorrhagic stroke guidelines article here

Posted in Labels: , 0 comments Posted by Hit Girl at 12:21 PM  

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