Saturday, August 22, 2015

ANGER: It helps recovery!

Quick funny stroke survivor story. This comes from an OT who told it at one of my stroke recovery seminars.

"I had this guy, he was a right hemi and totally expressively aphasic but could understand everything. I kept telling him that he had to move his right arm. "You gotta move it or it wont get better.' 

He got so frustrated with me he would just keep giving me the finger. "It wont get better unless you use it!' Finger. 'How are you going to get it back if you don't use it?' Finger.

So finally I said, "Tell you what: You can give me the finger all you want, but you got to do it with your right hand."

So, apparently he goes home and spends all night trying to get that finger up and sure enough... the next day he walks in to the gym and gives me the finger with the right hand! And I was like, "THAT'S GREAT! Now we have something to work with!'

And everyone looked at us like we were crazy."

Saturday, July 25, 2015

Shortened Achilles? Here's an option.

There are 3 reasons drop-foot happens:

1. Stroke is a brain injury. The brain injury no longer provides enough "brain power" to  activate the muscle that lift the foot (tibialis anterior).

2. Survivors often have spasticity of the calf muscles. The job of the calf is to cause a "toe down" posture at the ankle. A spastic calf muscle is one that contracts too much, forcing the "toe down" position.

3. Because of both #1 and 2, above, there is often a contracture (permanent shortening) of the calf muscle and the Achilles tendon.

There are a number of aids and shots and exercises and so on to help drop-foot, but I'd like to focus on one option. Its called Percutaneous Achilles Tendon Lengthening.

Quick hits:

  • It is a surgery, often done outpatient and under a local. 
  • Healing takes 6-8 weeks
  • GRAPHIC video here 
  • Its permanent
  • Its effect is (after healing) immediate

Wednesday, July 1, 2015

Do doctors know?

Medical doctors. MDs. They can be your best friend. If you’ve had a stroke they spent a lot 
A great MD/Scientist
that advanced stroke recovery
of their decade-plus of schooling training to save your life and save as much of your brain as they possibly could. When some MDs show up at the Pearly Gates, St. Peter is going to provide velveteen pathways to the VIP room.


Let’s be clear about this, your doctor is probably not a scientist. Very few are. The ones that are usually work at major academic institutions. Think Johns Hopkins.

A few quick points here…
1. Without a doubt, a rare few MDs do great, great scientific work that promotes medicine. 

2. Almost all medical science is developed by neuroscientists, biologists, chemists, etc. Scientists develop treatments (from x-ray
A great
psychologist who
advanced stroke recovery.

to antibiotics) and MDs make it illegal for anyone beyond themselves to prescribe them. Sometimes they make great gatekeepers, but they often screw it up. 

Most MDs don’t do science, don’t do clinical trials and are not qualified as scientists. Many MDs are not qualified to interpret the science they need to do their jobs, especially if they are not specialized in the area in question. Asking a GP about leading-edge rheumatoid arthritis treatment is like asking a soccer player about basketball’s triangle offence; they may know, but they probs don’t. Even asking, say, a neurologist about, say, migraine is a mistake. How many pathologies do neurologists treat? Countless, that’s how many. Will they be an expert on migraine? Maybe.

So what does this mean to you, dear survivor? It means you have to do your own research, and find your own experts.

There is a bit of good news…if you are willing to work a bit. If you go to PubMed and ask it your questions (i.e.: aphasia stroke recovery) articles by scientists who are experts will bubble up and from there it’s just a hop-skip and jump to their email address. Ask the scientists on the bleeding edge your question. (Hint; be clear, specific and respectful for the best results.) Hack through the pseudo-scientific gobbledygook of medicine (haven’t you exhausted that already anyway?) and get to the extraordinary.

Off you go… 

Sunday, May 31, 2015

C'mon baby...

Here is a flowchart used to guide recovery of walking after stroke...

Boy, that's complicated! 

How do we learn how to walk in the first place- as infants? Does it involve "treatments" that span from "Task Specific Training" to orthotics?

Stroke recovery is hurt by complexity. When rehab options become too complicated the stroke survivor is separated from their own recovery because they don't know what to do. 

Forget survivors for the moment... At some point stroke recovery can become so complicated that even clinicians don't understand it. Or they don't understand the technology in the complicated system because they never interface with that complicated technology. 

Have a look at the algorithm above. I would argue the whole thing is not only way too complicated, it's also incorrect.

I would like to rewrite the entire algorithm like this...

Post-stroke ambulation most benefits from task specific training. Translation: Walking more improves walking.

Tuesday, May 26, 2015

Socializing, Play and Moving Helps Drive Recovery

Part of your recovery may depend on how much fun your having while you recover.
Enriched environments (EE) are what we all want. It's why we send our kids to good schools, why we seek out new experiences and why we travel.  It turns out that enriched environments are very good for the brain. One of the main enrichments of environment that humans have is social interaction.

What do enriched environments have to do with stroke recovery? A ton.

What hurts social interaction? A stroke.

It turns out that there's pretty good evidence that stroke survivors engaged in enriched environments recover more. More than what, you may ask. Survivors involved in environments rich in social interaction, physical activity, and interesting experiences recover more than survivors who are not in enriched environment.

There is one caveat… Most of this research has been done on animals. The reason was done in animals is that it would be impossible to do the same sort of research and humans. Imagine a human study like this would go…

You would have to groups:

The control group: survivors would be involved in a highly social environment in which there were a lot of games played, a lot of conversations and a lot of physical activity.

The experimental group: survivors would be put in a cell where they were fed well, but did not engage any other humans in anyway.

A study like that on humans would be considered… What's the word? Unethical. That's the word: Unethical.

How do you find rats that have had a stroke? You give them one. Researchers surgically cause a stroke in the rats. (video here

They then separated the rats into an experimental 
and control group. 

(Note: the idea of enriching environments is beginning to be tested in human survivors. It is made ethical by letting one group do what they normally would do while the experimental group got an increase in physical, cognitive, and social activity.)

What does the research show about the effect of enriched environments on stroke recovery? The rat stroke survivors in the enriched environments had better proprioception (sense of movement) than the rats that were left to themselves. 

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