Tuesday, February 28, 2017

Drink Up!

I got an interesting question from a therapist at a recent stroke stroke talk: "What is the effect of dehydration on stroke recovery?"

I said what I often say when interesting questions come up that I don't have an answer for: "Email me that question… We'll look at it together"

It turns out the dehydration is thought to be a cause of stroke.

Further, if a stroke survivor is dehydrated when they're admitted to hospital, worse recovery can be predicted. And dehydration when admitted is predictor of discharge to long-term care (read: nursing home).

So, drink up! because, more than one third of all survivors will have another stroke.

Saturday, January 14, 2017

Can Stress Cause a Stroke? You bet!

If you've had a stroke you have ~35% chance of another stroke. Finally proof: Stress can cause a stroke. 
(Stress= ↑ Blood Clotting = Stroke)
Debbie Reynolds died recently just one day after her daughter, Carrie Fisher died. The press says she died of a "broken heart." And that is probably true. There is now science that shows that stress can cause stroke and other cardio vascular diseases. 
(The Lancet abstract to this research here. Non-nerd take here.)

But the connection between stroke and stress is indirect. Here's the story:

The amygdalae (plural; there are 2 of them. Singular: amygdala) are small marble sized structures responsible for emotions.

In folks who have cardiovascular disease (like stroke) there is more activity in the amygdala.

This increased activity causes more C-reactive protein in the blood. C-reactive protein you guessed it— clots blood

Blood clot in the brain = stroke.

Saturday, November 19, 2016

Stroke Shoulder Pain........ More drugs? ............................. Maybe not.

Shoulder pain after stroke, its causes and some treatments I plan to post about soon. However, there is one treatment I want to focus on up front, because its new and has tremendous potential.

It's called the StimRouter. Its made by the company Bioness which you know because of their electrical stimulation (E-Stim) machines:...

But they have a new treatment for pain. But we're talking shoulder pain, so allow me to focus on that...   

Briefly: Small electrodes are implanted under the skin, right next to the nerve that is sending pain signals. The actual reason e-stim block pain is unknown, but its thought that the nerve is confused by the e-stim. Basically (it is thought) that the e-stim "out-competes" the pain signal as the pain goes from (in this case) the shoulder, to the spinal cord and brain. The StimRouter is placed under local anesthesia, usually in an outpatient setting- takes about 15 minutes.

Cool vid here:

Saturday, October 8, 2016

$troke $urvivors: YOU COST TOO MUCH-- GET OUT!

Hospitals cost big bucks. So managed care (insurance companies) want survivors out of the hospital ASAP. Because of this rush, doctors and therapists are forced to push the survivor into the next step of rehab. 

The problem is that there is no way to tell what the survivor actually needs. To put this a research-y way "There are varying degrees of spontaneous improvement in arm paresis over the first 6 months after stroke."

Making the "where should they go" decision during the 2-5 days survivors are typically in the hospital a problem. The survivor’s brain has not even begun to reveal what its capable of. In the hospital the survivor's brain has not revealed what it is going to be in one week, let alone one month or one year. Still, therapists and doctors are forced to push the survivor out of the hospital to the next step. And the "next step" choices matter. The "next step" impacts now and for the rest of the survivor's life.

Thursday, September 1, 2016

Overchallenge for Stroke Recovery

Overchallenge. I'm not sure its a word, but it is essential to stroke recovery.

Overchallenge forces something to change. The word forces is important. Some of the best strategies for recovery involve forcing the survivor into something that challenges them towards recovery.

That last sentence has a lot to unpack. So lets unpack...
First, "forcing the survivor" is not really correct. The survivor forces themself. No one likes to be "forced" to do anything. Plus, it won't that way. When it comes to relearning movement after stroke, no one can force you. I can't force you to learn movement. But you can, and do, force yourself to learn. That's the way it works: The brain changes according to the owner's wishes. So, survivors self-force their own overchallenge.

Second, the word forced is accurate because that's exactly what is done. Take forced use. Forced use is when the survivor uses their "bad" side for a certain amount of time. 

(Note to nerds: Forced use therapy (FUT) and constraint induced therapy (CIT) often get confused. 

FUT: The survivor uses only their "bad" side for minutes to hours per day, at home.

CIT: The survivor has their behavior "shaped" by a clinician with repetitive practice of component parts of a skill. It is usually done with 3-6 hours of practice in the clinic with a therapist, as well as FUT done at home)

Third, overchallenge requires a forcing into an area that the brain is uncomfortable. Usually, the concept of overchallenge is associated with muscle building. But with regard to stroke recovery, overchallenge has to do with brain building. And the brain does not want to build. It does not want challenge. Because here's how the brain looks at it "Why should I challenge myself? If I do, I will change. And what if I change into something I don't like?" 

But overchallenge is exactly what the brain needs to recover. Here are a few of recovery strategies that use the overchallenge concept:
1. Constraint induced therapy
2. Forced use therapy

But overchallenge could be walking longer distances, challenging your balance on uneven surfaces (safely, of course) not relying on aids of various kinds, etc. Even something like reaching...even ...further, across a table for something has the ability to overchallenge. 

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