Saturday, October 14, 2017

SAS blog: In the Top Ten stroke blogs online

The Stronger After Stroke blog was named one of the top ten stroke blogs online by Medical News Today (MNT).



Up against The National Stroke Association, The American Stroke Association and The World Stroke Association. 

So. 


Tuesday, September 12, 2017

Movement is good full stop.

When I worked at the Kessler Institute in NJ, there was an idea for a study that bounced around for a few weeks. The study would involve answering this question: 

What would be the effect of a swift kick in the butt on stroke recovery? 

I'm pretty sure that study would never pass the ethics board. But(t) it is a joke that got to a fundamental truth: Clinicians make the process of recovery too complicated.

There is this notion among many clinicians that there should be a constant striving towards "function." That is, that the survivor should work towards some particular goal (i.e.: walking, dressing, eating, toileting, etc.)

I disagree. Movement, irrespective of function, is important. Here's an example…

Constraint induced therapy (CIT) for the upper extremity (arm and hand) involves working the arm and hand – a lot.

At the end of CIT, the survivor may, or may not be any more "functional." But maybe the wrong things are tested. If you're working with the upper extremity, then you'll test the upper extremity. But here's a weird side effect of CIT: better walking. Why? Because arm swing is made better. We may not think about the arms with regard to walking, but they are important in balance and timing.

And other things that are often not measured very often get better. Things like a reduction spasticity, less shoulder pain, more active range of motion. Movement, irrespective of function, is good.

Sunday, September 3, 2017

What are your chances of having a stroke? Where do you live?

 
Your chance of having a stroke may be influenced by where you live. Click on the map or the list and it will take you to the full interactive site.
Keep in mind: ~1 in 3 survivors will have a second stroke. If this map also reflects subsequent strokes, you may be able to modify whatever behaviors inherent in your geography.

Monday, July 31, 2017

Better movement through beer.

cutris.blogspot.com
When you build a house you want to build a strong foundation. When it's a tree grows, it doesn't grow from the leaves inward, it grows from the seed outward. For every process of growth, there is a beginning, a foundation, a germinal point.

What is the foundation for movement after stroke? If you ask most therapists they will say it is trunk (torso) control. 
Trunk Control

Focus on trunk control is the analog to building a good foundation for a house. Trunk control, so the thinking goes, will provide a good foundation for the arms and legs to do their thing. 

Therapists will often continually talk about the trunk as being the most important foundational part of the movement. The way it is taught in therapy school is "proximal stability for distal mobility". And this idea-- to work from "the inside out" is not wrong per se. It's just not particularly right.

Some therapists obsess about the trunk. But what if we flipped it? What if the driver foundation of learning movement is the hand? Or the feet? But I actually don't think it is those, either.

The foundation of movement is the will of the mover.  
  • Mind: Expressed as intention (I want to do something)
  • Brain: Starts the movement (Expressed as an electrochemical command) 
  • Muscles: Move the limb (muscle contraction)
  • Hand: Expresses the original intention (grab a beer)
So the driver here is beer. Or sex. Or chocolate. The driver of motor (movement) control is the will of the person. The trunk will follow what the will decides.

Imagine an infant. They reach because they want something. There is no one there to hold them and they may be a little unsteady, but their intention to reach makes their balance better. 

The “will” of the hand drives the changes needed in the trunk. The trunk will learn, in a natural way, to get the hand where it needs to be. 

Blog Archive