(Saturday, January 5, 2013)
Everyone needs a plan. At work we have schedules and care plans and goals. During our education we have schedules and syllabi and tests. Athletes, with the aid of coaches, have a plan for every practice, and benchmarks are built into every practice.
Most stroke survivors don't have a plan. Sure, therapists set a plan with goals during therapy. But once discharged, survivors tend to drift, hoping not to lose what has been recovered. Instead, the most recovery is achieved when the focus is on further gains.
Upon discharge from traditional therapy, survivors enter a new chapter in recovery. Their recovery plan is essential in optimizing their recovery. This is true for the short-term, and for the rest of their lives.
There are three aspects to every successful recovery plan.
Measurable benchmarks. Gains made during the chronic period after stroke are hard to see because they tend to be modest. Specific goals should be stated and strived for. If the patient says, "I will walk 500 yards by September," then a 500-yard route should be mapped out. The total goal should be chunked in a way that the survivor sees incremental gains toward the entire goal (i.e., 50, then 100, then 200 yards and so on).
Focus on what YOU can do. For recovery to continue beyond the traditional therapy period, the survivor has to drive his own therapy. This dovetails well with the concept that for the brain to rewire, neuroplastcially, the patient has to drive his own nervous system. The recovery plan should emphasize self-reliance. Not only should survivors be able to do most of the therapy themselves, but they should also understand how to progress their efforts.
Make the plan flexible. Stroke recovery research is galloping along. What comes of this research? New treatment options. All these new treatments dictates that the survivor be flexible enough to incorporate new ideas into their plan. But there's something else that requires flexibility: the survivor changes. One thing that every researcher agrees about: Intensity rules. So if the survivor chnages and intesity rules, the foucs must change while the level of intesity increases.
Otherwise you're just spinning your wheels.
View the hemorrhagic stroke guidelines article here
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stroke,
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Posted by
Hit Girl
at
1:11 AM
(Friday, January 4, 2013)
That's all you ever hear. "We're trying to get the patient functional."
Why? 2 reasons:
1. You want survivors to be functional. You want them to be able do every day, real-world tasks. When therapy ends, the therapist wants the patient to be able to do as much for themselves as they possibly can. Function is a good thing, no doubt.
2. Generally, function is paid for. Lets say the goal is walking. If the patient is not walking, at some point, you have to end therapy. And with the ending of therapy comes the ending of payment.
But there's a problem with this "focus on function." I can be functional and walking, but require a cane an orthotic on my ankle. The cane is used to overcome the weakness of the affected leg. The orthotic on the ankle is used to overcome the inability to lift the foot. Focusing on function means overcoming a deficit. Sounds good, right? But if you are using a cane an orthotic have you really overcome the deficit? Maybe we shouldn't chew. We can put everything in a blender.
I've long been an advocate of a focus on recovery, not function. Think of recovery as a game of soccer. Function is a score of 1 to 0. You win. But there are two ways to win. One way to win is to pick up the ball with your hands and throw it in the goal. The other is training hard, practicing with your team, getting in good shape, practicing skills, getting in the game, and putting all the practice into, well, practice. Using the "good" extremity to accomplish goals (known as compensatory movement), orthotics, assist devices, etc. etc. does not lead to recovery.
Very often function flies in the face of recovery area. For instance, a person may very well have some dorsiflexion (the ability to lift the foot at the ankle). But the movement is often weak and incomplete. Therefore it is "nonfunctional." And so it is ignored. And if a movement is ignored the portion of the brain representing that movement will get smaller.
And so the ability to lift the foot will decrease. And so the movement is ignored even more. And so there is less brain involved, and so on and so on and so on. This process is known as learned nonuse. By: "stroke recovery blog" "stroke blog"
View the hemorrhagic stroke guidelines article here
Posted in
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stroke,
stroke recovery
Posted by
Hit Girl
at
9:36 PM
Stroke survivors are given such a short time to recover. For everyone "motor learning" takes repeated attempts in order to rewire the brain. How much more effort must motor learning take in folks who have billions of neurons killed by their stroke? The numbers get very large. I've heard "2000 for a single joint" and " 140,00" "and "10,000" and "Tens of thousands" and" millions." But guess what? Every stroke is different. So the numbers for you and how you are trying to move are different than her and what she is trying to move. I think I've come up with the perfect number for everyone. This is based on my dozens of peer-reviewed coauthored studies, and clinical research at both the Kessler Institute and the U of Cincinnati. But the number is algorithmic and gets very complicated. Ready? Here's the number..."A lot."It is commonly and scientifically accepted that that it takes at least 10 years to become an expert in any field. We ask stroke survivors to relearn difficult tasks such as walking within a few months to a few years of their stroke. And all this difficult motor learning is done against a backdrop in which portions of the brain that is usually used for walking is deceased. And then there's all the other variables like other health issues, depression, lack of energy, natural aging and on and on.Anyone who has children and has gone through boxes and boxes of Band-Aids and knows that motor learning is a challenge. Skinned knees and elbows attest to this. It takes years for children to learn how to walk. How much time do we give stroke survivors whose primary neuronal circuitry for walking has been taken off-line —6 months? Stroke survivors are best served through a combination of personal empowerment and guidance from therapists. No matter how ugly, no matter how synergistic, no matter how submerged in spasticity, each volitional movement should be encouraged. People with acquired brain injury will only drive their own neuroplastic rewiring through repeated volitional attempts, that “nip at the edges” of their ability. Therapists have traditionally focused more on quality of movement and functional relevance than on a confluence of gained active range of motion. No matter how incremental, increased active range of motion in all pivots and planes provides a template for any and all future movements.
View the hemorrhagic stroke guidelines article here
Posted in
Labels:
stroke,
stroke recovery
Posted by
Hit Girl
at
5:26 PM
Keeping it challenging...
Whatever is practiced, it must be challenging. In research, an 80-percent threshold is generally used. For instance, if a stroke survivor can successfully turn the pages in a magazine 80 percent of the time, the challenge can be increased by turning the pages of a newspaper. Since turning pages of newspaper requires increased excursion of the shoulder and elbow, the increased AROM will "trickle down" to easier tasks such as turning pages in books and magazines, card flipping and laundry folding.
What is usually done
Faster and cheaper
Faster and cheaper is good because its faster and cheaper. You could go to a State University. Or you could get a degree from a degree mill. You could make a a salad, but you could get the same amount of calories from a pop tart. But even as fast and cheap as they are, you'll still feel gypped.
~
View the hemorrhagic stroke guidelines article here
Posted in
Labels:
stroke,
stroke recovery
Posted by
Hit Girl
at
1:22 PM
A test of mental ability after stroke can predict how long a survivor will live (Find the study
here.)
Poor performance on these tests can predict mortality in stroke survivors, a full decade before death. Previous tests have shown a link between heart disease and dementia after stroke and mortality. This is the first to show small amounts of cognitive decline correlating to mortality.
Here are the tests that they used.
The longer it takes to do the tests the more "impaired psychomotor speed." Participants that were the slowest third of the group for both tests were more likely to die.
In this study, the mean result for TMT A was 47 seconds and for TMT B, 119 seconds.
Also a decline in mental function before a stroke can be an indicator of an impending stroke.
View the hemorrhagic stroke guidelines article here
Posted in
Labels:
stroke,
stroke recovery
Posted by
Hit Girl
at
8:57 AM
(Sunday, December 30, 2012)
"When I first started having
symptoms (not realizing I had a bleeding tumor) I thought I could "exercise
away" all the bad feelings...it only made me worse. I was sure I would feel
better after pushing myself, WRONG."
RIGHT! In both human and animal models, too much exercise
too soon can make things worse! You should not put "the pedal to the metal"
until the sub-acute phase. Its a long story, and a bit more nuanced (and
detailed in the 2nd ed. of Stronger). Wait for the MD and therapists to say "Go!"
After day 14 just about everyone is ready for intensity. But for some survivors
it may be significantly earlier. And you don't want to wait too long, because
then learned non-use sets in.]
There are two kinds of survivors
who recover from stroke faster than others: Athletes and musicians. (Anyone who
has been a high level athlete, dancer, musician, etc.)
And while the manifestation of
individual strokes would make my hypothesis near impossible to test, there are
three reasons to believe that it may be true.
Reason one: There may
very well be hypertrophy of the motor portions of the brain in both athletes and
musicians. We know that massed practice will reconfigure the brain, with new
neurons recruited and new pathways developed. And which populations are, by
definition, involved massed practice? Athletes and musicians.
Reason two: As anyone who
is either an athlete or a musician knows, both these populations know how to
train. And I don't mean just, "Yeah, I did my therapy today" kind of training. I
mean the "I dream about therapy, wake up and plan my day around therapy and
dedicate most of my time to therapy" kind of training.
Reason three: Athletes
and musicians are often extremely motivated to get back to their instrument or
their sport.
Both athletes and musicians
understand all the factors that are important to stroke rehab. They know how to
practice with vigor and focus. They know the commitment of time and resources
that such practice involves. And they know that if their practice routine
changes, they will get different results.
Successful survivors are true
athletes. Their "level of competition" is somewhat limited, to be sure. But, on
the other hand, they have the most devoted fans in sport: Their loved ones. And
their families and friends have every reason, both altruistic and self-serving,
to coach, cajole, encourage, support and embolden their athlete towards
success.
View the
hemorrhagic stroke guidelines article here
Posted in
Posted by
Hit Girl
at
11:03 PM
