(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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Posted by
Hit Girl
at
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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Posted by
Hit Girl
at
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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Posted by
Hit Girl
at
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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View the hemorrhagic stroke guidelines article here
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Hit Girl
at
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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Posted by
Hit Girl
at
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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Posted by
Hit Girl
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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."
By: "stroke recovery blog" "stroke blog"
View the hemorrhagic stroke guidelines article here
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Posted by
Hit Girl
at
9:55 PM
