Tuesday, March 12, 2019

Early Walking After Stroke is Good, No it Isn't

There has been a debate for many years about early rehab. Should stroke rehab in the first 1-7 days be intensive? Intensive is a buzzword that means "hard"; more repetitions, more weight, longer distances, etc. Some people suggest you should do a lot very early after a stroke, some suggest (I'm in this camp) that you should wait until the subacute phase.

Within this "early-more-better" argument is a sub-category: Walking. The survivor should walk within 24 hours of their stroke, they say.

I've written about this before. Note that the following link has clickable links so you can have a look at the actual article yourself. Here.

Here's the bottom line: Early is not better. Introduce intensity during the subacute phase, not the acute phase. 

Bottom line: If you have the survivor get intensive during the... 
  • acute phase (1st 7 days), you can make the infarct (stroke) worse
  • hyperacute phase (1st 6 hours), you can kill them.
There was a long, large study that was done on walking very early after stroke. Note their bottom line for walking early: Fewer patients in the very early mobilisation group had a favourable outcome than those in the usual care group.

Want to know whats going on early after stroke in the survivors brain? Have a look at this.

Friday, March 1, 2019

Don't waste your $$: There's No School like Old School Stroke Recovery

There are a lot of virtual reality/ gaming stroke recovery systems out there. And a ton of folks that try to convince you that, because its a gaming glove, or VR, or even a robot... its just better. Because, haven't you heard? New is better.

Except its not. Motor learning-- the kind of learning stroke survivors have to do to recover-- has been going on in humans forever. So the stuff that always worked to move better, still works. 

Don't take my word for it. In this article the authors looked at the difference in motor learning after stroke in 2 groups:
1. Virtual Realty training with the Nintendo Wii system
2.  Playing cards, bingo, Jenga, or a game with a ball

After collecting the data on the two groups, this was their conclusion:

The type of task used in motor rehabilitation post-stroke might be less relevant, as long as it is intensive enough and task-specific. 

Other studies (see below) say the same thing: Normal activities work as well as machines, as long as its as long as it is intensive enough and task-specific."

32. Lo AC, Guarino PD, Richards LG, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2010;362:1772–83.[PMC free article] [PubMed]
33. Duncan PW, Sullivan KJ, Behrman AL, et al. Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med. 2011;364:2026–36.[PMC free article] [PubMed]

Sunday, January 27, 2019

Wanna move better after stroke? Watch the Super Bowl.

There's this thing called "action observation" and you can use to promote your own recovery. 
     In simple terms, action observation (AO) is what humans use to communicate with each other. We had it (evolutionarily) even before we had the ability to speak. Let's say, you and I are in the same tribe and we're hunting big game, and we can't yell for fear of spooking our next meal. We can communicate a lot through facial expression and body movement. Humans used AO in hunter-gatherer tribes to be able to communicate intention, movement, pain, sadness, excitement, etc. This survival tool allowed us to express our human experiences quickly and accurately. 
     In some ways AO can be expressed in one word:
Empathy. You feel what I feel, I feel what you feel. Most of this is processed in the much-discussed mirror neurons; specialized nerve cells in the brain that  allow us to feel what others are feeling. 
      If I observe you burning your hand, my mirror neurons activate, and I'll wince. If I observe you throwing a tight spiral, my neurons will feel that movement.

How can you use AO in your recovery?
      Let's say you're a survivor trying to make you walking beter, faster, and with less fear of falling. Observe other people walking. Feel them walking. There is quite a few researchers yelling from the tallest buildings: This helps people recover! 
       Listen to them!

Here are some links to action observation in stroke:

Thursday, January 3, 2019

Some Good News: New Guidelines will help Ischaemic (block) survivors.

This month the American Stroke Association issued new guidelines that will help people who have had a stroke. Unfortunately, for most of the readers of this blog, "that ship has sailed" because these recommendations cover the first 24 hours post stroke. Still the guidelines are good news; they  will lesson the severity of stroke going forward.

And they come with a cool graphic!

Original article in the Journal of stroke here.
Simplified version here.

Tuesday, December 18, 2018

So. You want to get into Clinical Research. Here are some suggestions

I do a lot of talks to clinicians. Every couple of talks I get "How did you get into clinical research? And, how do I get into it?"

This is the lab where I worked early in my career. 
(Kessler, West Orange, NJ)

Here are some suggestions: 
  • Typically, a PhD is more important in research, while the DPT is important in teaching. There is a doctorate of OT, but again, the PhD is helpful in research.
  • Cast a wide net. Find folks doing research in your area and volunteer or ask for a job. Where can you find such a list? Go here and find the list under Find Stroke-Recovery Research in Your Area. Look for email address/ contact info and make contact.
  • Be willing to take a pay cut. My first job I took a 1/3 pay cut to get into research. It was a temporary pay cut, but I didn't know that it would be at the time. You'll tend to get paid on the back end. In a variety of ways.
  • Hitch your wagon to dynamic (and smart) folks. Once you're in, that's not the end. Find the folks who are actually getting funding and align yourself with them. Of course, you can start on your own grant-getting journey, but even then you need a mentor to begin with. Also, don’t judge expertise on degree, base it on conversations. There are a lot of PhDs in research who are not dynamic, get little funding, have little vision, etc. Find the good people.
  • Don’t listen to the road more traveled. Everyone in my class suggested I not go into research. "How long will it last?" they asked skeptically. 20 years, so far.   
  • Know stuff that no one else is willing to learn. Once you learn that machine or program or outcome measure, they'll need you because every grant that is funded that involves that thing, well, you are qualified and often the only option. Boom, job security.

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