Tuesday, October 28, 2008

Chicks dig smart...

I am currently reading the Cambridge handbook of expertise and expert performance. I do this all the time; I buy really fat books (this one has almost 900 pages) mostly to impress my wife. Then I find myself drawn into them bit by bit. It turns out that this book has quite a bit of information that relates to stroke recovery.

I do a lot of seminars talking to therapists about stroke recovery. I generally push neuroplasticity (“brain rewiring”) as the foundation for all recovery from stroke. And the easiest way to rewire the brain is to do repetition of whatever movement the stroke survivor is trying to recover. The therapists, curious lot that they are, always ask, “How many repetitions of the movement have to happen before the brain rewires?” The problem is that this question cannot be answered with a-one-number-fits-all answer. The number of repetitions needed depends on how much movement there is to begin with, how focused the stroke survivor is in the practice, how complicated the movement is, etc. etc. The very fat book I'm reading says that there is general agreement that to become an expert in anything takes 10 years. We also know that to become a very high-level athlete, musician, or acquire a skill like carpet weaving takes more than 1 million repetitions of the movement(s).

So the question I have is, when does recovery end? After 1 million repetitions? After 10 years? If either of these is in the right ballpark, another question follows, “Why are stroke survivors discharged from therapies within a ye
ar or so of their stroke?”

Tuesday, October 21, 2008


Stronger After Stroke is one of the highest ranking books on stroke rehabilitation or stroke recovery. Luminaries such as Janet Carr (who I have a post about, further down) and Joel Stein, MD (a well known stroke recovery expert/physiatrist) have books out that are ranked a bit lower than Stronger. Jill Bolt-Taylor (A Stroke of Insight) is going to be on Oprah today. My book shows up on the same page as hers on web sites, so I fully expect to be able to buy a boat before the day is through.

Check out the screenshot for rankings.

And here's a photo
of my new boat...


Tuesday, October 7, 2008

The Splint That Bounces Back

The wrists and hands of stroke survivors are
always a challenge. In human beings the powerful muscles that close the hand and bend the fingers are essential for everything from climbing to carrying to to pulling. But after stroke, just like many of the muscles on the affected side, these large wrist and finger bending muscles get spastic. And when they do they overpower the much smaller muscles that extend the wrist and fingers.

After stroke the fingers and wrist are flexed almost all the time and these muscles shorten and the wrist and fingers become even harder to straighten.

The way occupational therapy has traditionally dealt with this problem is to splint the wrist and fingers. Occupational therapists (OT's) use a material called thermoplastic which is shaped into what is considered a good position for the wrist and fingers.

But there's a problem with these splints. First of all, the splint is only as good as the OT's skill. Second these are static/rigid splints; that is, if the fingers get more flexible these rigid splints don't take advantage of these gains. Conversely if range of motion is lost and the fingers get tighter the splint does not reflect that change either. This can be damaging to the tissue around the fingers and wrist as the hand is forced into a rigid splint that's too "small".

You could hire an OT every few months to fabricate a new splint, but that gets costly.

I'm actually a big fan of a product called the SaeboStretch. This split is not static. It moves as your hand moves. If you want to bend your fingers, you can. This splint is made out of material that is flexible but elastic. That is, it can be bent but it always wants to return to its original position. This provides low-load pressure into the proper position. In this way this splint takes advantage of any increased elasticity in muscles and other soft tissue. I've had experts on splinting tell me point-blank that this is the only off-the-shelf splint that they'll recommend.

You can find information on the splint here.

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