Thursday, December 13, 2007

Mobilization (walking) in the 1st 24h: Good or bad?

Mobilization in the 1st 24h

Tuesday, November 13, 2007

Mirror Therapy Suggestions

Some general suggestions: 
1. Be guided by a clinician who understands brain function. 
2. Presuming there is no jewelry on the affected side, remove wrist watches and rings. Try to make a total illusion. 
3. Depending on the pain and disability state, decide on an appropriate activity(ies) to perform with the good hand. This could range from just looking at the mirror image to finger movements, or taking weight through the hand. 
4. In general, the more severe the problem (eg. Severe Complex Regional Pain Syndrome), small movements, performed often, may be more appropriate. 
5. Feel comfortable with the selected movements(s)’, ie. ‘conquer the movement’ before progressing to a more challenging movement 
6. Once you feel comfortable with a movement, try and perform it in a different context. For example, do it with a song in your head, or with altered emotions by thinking of something good or bad. Overall, you will need to repeat movements, grade the movements and then context enriching the movements for best neurone health. 
7. Take care. If the hand in the box hurts or sweats, you may have taken the brain exercises too far even though the hand has not been moved. 
8. Move the painful hand in the box to the point where it starts to hurt a little and then move the good hand which is outside the box a little bit further. 
9. Do it simultaneously or reciprocally. 
10. By placing a mirror between the feet, a similar therapy can be performed for the for foot and leg problems.

Thursday, October 11, 2007

Sensation Recovery



Smania N, Montagnana B, Faccioli S, Fiaschi A, Aglioti SM. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Arch Phys Med Rehabil. 2003 Nov;84(11):1692-702. PubMed PMID: 14639572.

Training Procedure

The treatment protocol consisted of exercises aimed at recovering somatic sensation and motor control of the affected hand. At the beginning of the training session, each patient was asked to perform a series of 25 exercises belonging to 1 of 9 main types of activity. A detailed description of the 9 groups of training activities is provided below. Next, the operator adjusted the protocol to the patient’s specific impairment by choosing exercises that were more challenging for the patient. After this preliminary selection phase, treatment was performed with only the selected exercises. If the patient was unable to perform a given exercise, the operator provided the patient with facilitations. At the end of each trial, the patient was given feedback about her/his performance (eg, number of hits or errors, details about execution, comments). Each patient underwent a total of 30 training sessions. Each patient was required to perform 1 daily hour of exercises at home that were similar to those of the training session. The patient was asked to record in a home diary each day the number and the type of exercises executed, as well as the difficulties encountered.

Tactile discrimination. We used 3 tactile discrimination tasks: sandpaper surfaces of different grains, surfaces made of different materials (eg, rubber, cloth, paper), and grating orientation. All exercises were performed without visual control. In the case of the sandpaper exercises, the operator passively guided tactile exploration to avoid possible skin lesions. 
Object recognition. This group included 3 tasks of tactile object recognition. In it, the blindfolded patient was requested to perform these tasks: manipulate a target object and discriminate it visually among 3 objects; manipulate a group of small objects (eg, rice, bolts, stones) and then discriminate visually among the 3 groups of objects; and manipulate 2 objects simultaneously with the affected and unaffected hand and then report whether the 2 objects were the same or different. 
Joint position sense. For these training activities, we used the same box as in the testing procedure for the joint position sense testing. This group included 3 tasks of proprioceptive discrimination. The operator moved the patient’s wrist or metacarpophalangeal joints at different angular positions by using the same methods previously described for the joint position test. The patient was required to choose which of 3 suggested positions of the protractor scale above the box corresponded to the real hand position. Using the affected hand, the patient was requested to actively reproduce the position indicated by the operator on the angular scale. The patient was asked to reproduce a gesture shown by the operator with the affected hand (ie, gesture of OK) while keeping her/his arm inside the box. 
Weight discrimination. The blindfolded patient was required to weigh an object with the affected hand. Then, he/she was required to weigh 3 objects with the unaffected hand and choose which of them corresponded in weight to the previous object. 
Motor sequences. This group included 2 tasks of finger motor sequencing. The blindfolded patient was asked to drum his/her fingers on the table according to a previously shown sequence. The blindfolded patient was required to play a sequence of notes on a piano keyboard. 
Reaching and grasping. The blindfolded patient was required to reach and grasp a common object placed on a wood board after having seen its position. The dimensions of the object varied to elicit different kinds of grasping (eg, pinch, whole-hand grasping). 
Item grouping. The blindfolded patient was required to separate several small objects (eg, buttons, paper clips) into homogeneous groups. 
Grasping strength grading. This group included 4 tasks. First, a cylindrical wood stick was used (70_4cm; 500g). The stick had several marks spaced at 5-cm distances. While holding the stick, the blindfolded patient was required to let the stick slide down, skipping 1 or more marks. Second, the blindfolded patient was required to move a plastic bottle filled from 30% to 60% with water from 1 side of the table to another. During the exercise, patients were asked not to produce any noise that could derive from compression of the plastic. Third, the patient was required to pick up and move objects of different dimensions and frailty (eg, crackers, paper cubes) by using ice pliers, without either compressing or breaking them. Last, the patient was required to squeeze a tube containing gel with the affected hand to obtain strips of variable length. 
Daily life activities. This group included 7 tasks: (1) grasping several toothpicks and putting them into a box; (2) stacking up several checker pieces; (3) folding up a sheet of paper and fitting it into an envelope; (4) making a braid with 3 cords made of soft material; (5) hooking up a spring catch to a metal ring while blindfolded; (6) fitting the affected hand into a glove; and (7) picking up several playing cards that had been laid on the table and turning them over while blindfolded.

In the upper limb:
Carey L, Macdonell R, Matyas TA. SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation: a randomized controlled trial. Neurorehabil Neural Repair. 2011 May;25(4):304-13. Epub 2011 Feb 24. PubMed PMID: 21350049.

Experimental intervention.

The experimental intervention (EI) applied the principles of generalized sensory discrimination training14 to 3 sensory tasks: texture discrimination, limb position sense, and tactile object recognition. Training employed a variety of stimuli within each sensory dimension trained, graded progression of discriminations from easy to difficult, attentive exploration with vision occluded, anticipation trials, cross-modal calibration via vision, feedback on sensation and method of exploration, intermittent feedback and self-checking of accuracy, feedback on ability to identify distinctive features in novel stimuli, tuition of training principles, and summary feedback and intensive training.14 During each EI session, subjects were trained on each sensory task, in random sequence, for 15 to 20 minutes at a time. Texture discrimination training used graded stimuli with varying surface characteristics.14 Limb position sense was trained across a wide range of limb positions of the upper limb. Tactile object recognition training focused on discrimination of shape, size, weight, texture, hardness, and temperature using a range of multidimensional, graded objects.





In the lower extremity:
Lynch EA, Hillier SL, Stiller K, Campanella RR, Fisher PH. Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial. Arch Phys Med Rehabil. 2007 Sep;88(9):1101-7. PubMed PMID: 17826453.

Sensory Retraining Intervention Ten 30-minute sensory retraining sessions were provided by the primary investigator over a 2-week period. The total treatment time was divided evenly between: education regarding sensation and sensory retraining; practice in detection and localization of touch at 7 points on the soles of the feet; hardness, texture and temperature discrimination by placing the feet on a variety of floor surfaces while sitting and standing with vision obscured; and proprioception training of the big toe and/or ankle (analogous to proprioceptive training at the wrist used in upper-limb sensory retraining8). The principles of sensory retraining were similar to those used in previous research8,9,12 and included education regarding the nature and extent of sensory loss; specific, graded stimulation tasks with an emphasis on tasks the subject was able to do (in this case, light touch detection and localization training was tailored for the individual to focus on areas of sensory deficit); attentive exploration of the stimuli by the subject; prevention of visual dominance; comparison with the nonaffected side; quantitative feedback.

Thursday, August 16, 2007

where's pete shadow page











Where is Pete?
Email: strongerafterstroke@yahoo.com
2016   
July 12, 2016 – Colorado Springs, CO
July 13, 2016 – Boulder, CO
July 14, 2016 – Cheyenne, WY
July 15, 2016 – Denver, CO
 

June 21 – Columbus, OH
June 22 – Lexington, KY
June 23 – Cincinnati, OH

May 3 – Gulfport, MS
May 4 – Baton Rouge, LA
May 5 – New Orleans, LA
March 1 – Asheville NC
March 2 – Johnson City, TN
March 3 – Knoxville, TN

February 16 – W. Palm Beach, FL
February 17 – Miami, FL
February 18 – Ft. Lauderdale, FL

February 2 – Albany, GA
February 3 – Tallahassee, FL
February 4 – Panama City, FL

January 20 – Appleton, WI
January 21 – Madison, WI
January 22 – Brookfield, WI

January 5 – Wilmington, NC
January 6 – Raleigh, NC
January 7 – Charlotte, NC

2015  
December 16 – The Woodlands, TX
December 17 – Sugar Land, TX
December 18 – League City, TX
September 18-19, San Diego, CA. Private talk- Stroke Outcome Measures; Dart Neuroscience
12/13/12 - Pensacola, FL
09/24/12 - Islip, NY 
09/25/12 - Hempstead, NY 
09/26/12 - White Plains, NY 
09/27/12 - Laguardia, NY
11/15/11 Charlotte, NC. 
11/16/11 Winston-Salem, NC. 
11/17/11 Raleigh, NC.
Hartford, CT (Institute of Living) 4/15-4/16
Austin, TX 4/5/11 

San Antonio, TX 4/6/11  
 
Houston, TX 4/7/11  
Athens, GA 3/22/11   
Augusta, GA 3/23/11    
Atlanta, GA 3/24/11 
  Herrin, IL (Southern Illinois University Herrin Hospital ) 3/26-3/27 
 Baton Rouge, LA. 03/08/11 
 Jackson, MS. 03/09/11  
New Orleans, LA. 03/10/11 
 Harrisburg, PA. 02/22/11  
Allentown, PA. 02/23/11  
King of Prussia, PA. 02/24/11   
Green Bay, WI. 02/08/11 
 Milwaukee, WI 02/09/11  
Bloomington, MN. 02/10/11  
Chattanooga, TN. 1/25/11  
Huntsville, AL. 1/26/11  
Birmingham, AL. 1/27/11  
Charlottesville, VA. 1/11/11 
Richmond, VA. 1/12/11  
Norfolk, VA. 1/13/11
2010:________________________________________________________________________
Dallas, TX. Medical City Dallas Hospital 12/10-13/10
Baptist Hospital of Miami: Miami, FL; 3/13-3/14/10
Other Selected Invited Professional Talks
1.      Levine, PG. Driving Neuroplastic Change in Stroke Survivors: Leading-Edge Treatments, Tools and Strategies. Provena Health Inst and Therapy Ctr. Aurora IL. 6/3-6/4/11
2.      Levine, PG. Driving Neuroplastic Change in Stroke Survivors: Leading-Edge Treatments, Tools and Strategies. Herrin, IL (Southern Illinois University Herrin Hospital ) 3/26-3/27/2011
3.      Levine, PG. Philadelphia, PA. Magee Rehab Hosp 10/15-16/10
4.      Levine, PG. Saint Francis MC, Cape Girardeau, MO 9/30/10
5.      Levine, PG. The Neuroplastic Stroke Survivor: Rewiring For Recovery. The University of Michigan, Ann Arbor, MI 11/13/10
6.    Levine, PG. Driving Neuroplastic Change in Stroke Survivors: Leading-Edge Treatments, Tools and Strategies.
a.    Baptist Hospital of Miami: Miami, FL; 3/13-3/14/10
b.    St. Luke's Rehabilitation Institute Spokane, WA; 4/23-4/24/10
c.    Scottsdale Healthcare, Scottsdale, AZ; 6/11-6/12/10
d.    Catholic Medical Center, Manchester NH; 8/27-8/28/10
e.    Magee Rehabilitation Hospital, Philadelphia, PA; 10/15-10/16/10
f.      Medical City Dallas Hospital, Dallas, TX 12/10-11/10

Levine, PG. Stroke Rehabilitation Update: New Effective Reimbursable Treatments, Including Modified Constraint Induced Therapy
g.    Casa Colina Hospital for Rehab. Pomona CA 12/11-12/12/09
h.    Tully Health Center. Stamford, CT 10/16-10/17/09
i.     Braintree Rehabilitation Hospital. Braintree, MA 5/1-5/2/09

Levine, PG. Page, SJ
j.       Baylor All Saints Medical Center Ft. Worth TX 8/28-8/29/09
k.     Frazier Rehab Institute Louisville KY 4/4-4/5/09
l.       Truman Medical Center Lakewood Kansas City 27-Mar-09 3/27-3/28/09
m.  John Heinz Institute of Rehabilitation Medicine Wilkes-Barre Township PA12/12-12/13/08
n.     Mount Sinai Medical Center. Miami Beach, FL 11/14/08
o.    Inova Mount Vernon Hospital Alexandria VA 5/31/08
p.    New England Sinai Hospital & Rehab Center. Stoughton, MA 4/25/08
q.    Mt. Sinai Rehabilitation Hospital- Center for Sports Medicine. Hartford, CT. 12/8-12/9/07
r.      St. John's Health System Springfield, MO. 11/17-11/18/07
s.     Atlanta Medical Center, Atlanta, GA. 8/11-8/12/07
t.       Braintree Rehabilitation Hospital, Braintree, MA 12/1-12-2/06
u.     Main Street Physical Rehabilitation Center, Danbury CT 8/11- 8/12/06
v.     Staten Island University Hospital, Staten Island, NY 11/18-11/19/06
7.      Levine, PG. “Unlocking Their Brains: Keys to Neuroplastic Rewiring After Stroke” Chinook Regional Hospital, Lethbridge, Canada and simulcast to Alberta Health Services sites in Bow Island, Camrose, Grande Cache, Grande Prairie, Medicine Hat, Red Deer, Brooks, Crowsnest Pass, and Pincher Creek. 11/30-12/1/10.
8.      Levine, PG. “The Roadmap to Recovery: New Effective Strategies for Recovery from Stroke, Ohio Occupational Therapy Association, Canton, OH. 9/10/09.
9.      Levine, PG. Dunn, L. “Testing Stroke Recovery:  An Introduction to Practical Outcome Measures” The Kentucky Occupational Therapy Association Annual Conference, Prestonburg, KY. 9/17/09.
10.  Levine, PG. Panel discussion participant, American Society of Neurorehabilitation, Goods and Bads of Technology-Clinical Translation and Payment/Reimbursement Considerations, Kari Dunning, PhD, PT (Host). Accelerating Use of Technology in Stroke Rehabilitation: Opportunities & Challenges. Drake Center, Cincinnati Ohio. 6/19/09.
11.  Levine, PG. Dunn, L. Hill-Hermann, V. “Testing Stroke: An Introduction to Practical Outcome Measures”, Accelerating Use of Technology in Stroke Rehabilitation: Opportunities & Challenges. American Society of Neurorehabilitation, Cincinnati, OH 6/19/09.
12.  Levine, PG.  “The Stroke Toolbox: Stroke Recovery Treatment on the Cutting Edge” at the request of Ohio Occupational Therapy Association, Ohio State University, Columbus, OH. 12/5/08
13.  Levine, PG. “The Story Of Modified Constraint Induced Therapy: From Narrative To Application.” Ohio Occupational Therapy Association State Conference. 10/26/2007
14.  Levine, PG. Panel discussion participant, American Society of Neurorehabilitation “Neuroplasticity: Changing Minds and Changing Function.” Drake Center, Cincinnati Ohio. 6/22/07
15.  Levine, PG. “Neuroplastic Therapies and Modified Constraint Induced Therapy:   Transforming the Art of Evaluating and Treating Stroke Survivors.” Ohio Occupational Therapy Association State Conference, Cincinnati Convention Center. 9/30/06
16.  Levine, PG.  “Study of the effect of Mentamove training on foot elevation after stroke” Georg-Brauchle-Haus, Munich, Germany. 3/31/06
17.  Levine, PG.  “Messing With Their Minds: Neuroplastic Modalities and the Stroke Survivor.”  University of Cincinnati PTA program. 2/23/06
18.  Levine, PG. "All the Potential In the World: How stroke survivor's big brains can provide big gains." Drake Center Stroke Survivors Support Group. 1/18/06
19.  Levine, PG. “Stroke: A Primer.” Cincinnati State OTA program. 10/28/05
20.  Levine, PG. “Evidence-based stroke rehabilitation” (Day 1) “Modified constraint-induced therapy.” (Day 2)
a.      Manatee Memorial Hospital, Bradenton, FLA; 12/2/05.
b.      Medical City Hospital, Dallas Texas; 11/18/05.
c.       Grossmont Hospital, San Diego, CA; 10/22/05.
d.      Northeast Executive Conference Center, Columbus, OH; 8/27/05.
e.      Akron City Hospital, Akron, OH; 5/20/05.

Selected Professional Seminars

1.   Levine, PG. Crowne Plaza, Indianapolis, IN 2/17/10  “The Roadmap to Recovery: Essential Tools for Driving Neuroplastic Change in Stroke Survivors.”
2.      Levine, PG. Casa Colina Hospital for Rehabilitation, Pomona, CA; 12/11-12/09. “Driving Neuroplastic Change in Stroke Survivors.”
3.      Levine, PG. Carespring Healthcare, Fairborn, OH; 9/12/09. “The Stroke Recovery Toolbox: Mental Practice, Modified Constraint-Induced Therapy, and Other Promising Strategies.”
4.      Levine, PG. Baylor All Saints Medical Center, Fort Worth, TX; 8/28-29/09. “Driving Neuroplastic Change in Stroke Survivors.”
5.      Levine, PG. Northwest Hospital, Seattle, WA 5/7-8/09. Stroke Rehabilitation Update: “New & Effective Reimbursable Treatments Including Modified Constraint - Induced Therapy.”
6.      Levine, PG. Braintree rehabilitation Hospital 5/01-02/09. Braintree, MA “Driving Neuroplastic Change in Stroke Survivors.”
7.      Levine, PG. Frazier Rehabilitation Institute, Louisville, KY; 4/3-4/09. “Driving Neuroplastic Change in Stroke Survivors”
8.      Levine, PG. Truman Medical Center, Kansas City MO; 3/27-28/09. “Driving Neuroplastic Change in Stroke Survivors”
9.      Levine, PG. Good Samaritan Hospital, Baltimore, MD; 2/1/09. “New And Effective Strategies For Stroke Rehabilitation: From Flaccid To Functional”
10.  Levine, PG. Good Samaritan Hospital, Baltimore, MD; 2/2/09. “Modified Constraint Induced Therapy: An Efficacious, Reimburseable Outpatient Protocol For Stroke.”
11.  Levine, PG. Mt Vernon Hospital, Mt Vernon VA; 5/31/08. “Evidence-based stroke rehabilitation.”
12.  Levine, PG. Mt Vernon Hospital, Mt Vernon VA; 6/1/08. “Modified constraint-induced therapy.”
13.  Levine, PG. Mt Sinai Hospital, Boston, MA; 4/25/08. “Evidence-based stroke rehabilitation.”
14.  Levine, PG. Mt Sinai Hospital, Boston, MA; 4/26/08. “Modified constraint-induced therapy.”
15.  Levine, PG. Good Samaritan Hospital, Baltimore, MD; 3/7/08. “New And Effective Strategies For Stroke Rehabilitation: From Flaccid To Functional”
16.  Levine, PG. Good Samaritan Hospital, Baltimore, MD; 3/8/08. “Modified Constraint Induced Therapy: An Efficacious, Reimburseable Outpatient Protocol For Stroke”
17.  Levine, PG. Lakewood Hospital, Lakewood, OH; 2/2/2008. “Evidence-based stroke rehabilitation”
18.  Levine, PG. Baptist Hospital, Miami FL; 12/13/2007-12/14/2007. “Modified constraint-induced therapy”
19.  Levine, PG. Mt Sinai Rehabilitation Hospital, Hartford CT; 12/6/2007. “Evidence-based stroke rehabilitation”
20.  Levine, PG. Mt Sinai Rehabilitation Hospital, Hartford CT; 12/7/2007. “Modified constraint-induced therapy.”
21.  Levine, PG. St Johns Hospital, Springfield, MO; 11/16/2007. “Evidence-based stroke rehabilitation”
22.  Levine, PG. St John’s Hospital, Springfield, MO; 11/17/2007. “Modified constraint-induced therapy.”
23.  Levine, PG. Integris Jim Thorpe Rehabilitation Hospital, Okalahoma City, OK; 10/23/2007. “Modified constraint-induced therapy.”
24.  Levine, PG. Atlanta Medical Center, Atlanta, GA; 8/10/2007. “Evidence-based stroke rehabilitation”
25.  Levine, PG. Atlanta Medical Center, Atlanta, GA; 8/11/2007. “Modified constraint-induced therapy.”
26.  Levine, PG. Jim Thorpe Rehabilitation Hospital, Oklahoma City, OK; 4/10/2007. “Evidence-based stroke rehabilitation”
27.  Levine, PG. Braintree Rehabilitation Hospital, Boston, MA; 12/2/2006. “Evidence-based stroke rehabilitation”
28.  Levine, PG. Braintree Rehabilitation Hospital, Boston, MA; 12/3/2006. “Modified constraint-induced therapy.”
29.  Levine, PG. Staten Island University Hospital, Staten Island, NY; 11/18/2006. “Evidence-based stroke rehabilitation”
30.  Levine, PG. Staten Island University Hospital, Staten Island, NY; 11/19/2006. “Modified constraint-induced therapy.”
31.  Levine, PG. Sheraton Danbury Hotel, Danbury, CT; 8/11/2006 “Evidence-based stroke rehabilitation.”
32.  Levine, PG. Sheraton Danbury Hotel, Danbury, CT; 8/12/2006. “Modified constraint-induced therapy.”
33.  Levine, PG. Manatee Memorial Hospital, Bradenton, FLA; 12/2/05. “Evidence-based stroke rehabilitation.”
34.  Levine, PG. Manatee Memorial Hospital, Bradenton, FLA; 12/3/05. “Modified constraint-induced therapy.”
35.  Levine, PG. Medical City Hospital, Dallas Texas; 11/18/05. “Evidence-based stroke rehabilitation.”
36.  Levine, PG. Medical City Hospital, Dallas Texas; 11/19/05. “Modified constraint-induced therapy.”
37.  Levine, PG. Grossmont Hospital, San Diego, CA; 10/22/05. “Evidence-based stroke rehabilitation.”
38.  Levine, PG. Grossmont Hospital, San Diego, CA; 10/23/05.
39.  Levine, PG. Northeast Executive Conference Center, Columbus, OH; 8/27/05. (Modified constraint-induced therapy)
40.  Levine, PG. Akron City Hospital, Akron, OH; 5/20/05. (Modified constraint-induced therapy)

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