Thursday, July 15, 2010

It's the whole enchilada.

Stroke. The leading cause of long-term disability. It's not the leading cause of short-term disability. That's probably headache or back pain. And it's not, like, the fifth leading cause of long-term disability. It is the LEADING cause of LONG TERM disability. It's the big kahuna. It's the whole enchilada.
Figure stroke recovery out and it will inform you about everything that the brain does. Insights into cortical plasticity? Done. Recovering after dramatic brain injury. Done. Learning? Done.

Here's some irony:

There is only one treatment option for recovery from stroke that has the same level of testing as any drug on the shelf of a drugstore. One. Constraint induced therapy (CIT).

So you would think that every rehab hospital would do CIT. But, not so much.

Part of the problem is the foggy perception that many clinicians have about what CIT is. Read this article, and then have your therapist read it.



Dean said...

Peter, I fully believe in CIT, my only quibble with it is that in order to use it you need some movement to start with. And with the amount of dead brain I have that leaves me in a catch-22 situation. I don't have enough movement to use the training and I need to use either passive movement or mental imagery to start that movement. I will get there even if it takes 40 years.

Peter G Levine said...

Dean! Thanks for your comment (as always).

I do talks on modifications of CIT. It is true that certain elements have to be done- that's what my article (the link) in the blog is all about. But clinicians have been modifying it for years. So you can keep the basic rules but use it for folks that have much less movement than the "original" rules.

The prime example is a case study in which a very low level survivor got CIT commiserate with her abilities. The testing revealed she got better, but, so far as I can tell, she did not get as much change as folks that have the "original" inclusion criterion.

Google: "Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia" to find the free article.

My thinking, and that of others in the field, is that CIT, in some form, might be available for 90% of all survivors. Other researchers, including my boss, Stephen J Page, disagrees and thinks it closer to 20-25%.

But there are things you can do to get yourself to the point to "qualify" for CIT. But you know those.

Thanks Dean!

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