Friday, September 3, 2010

The Upward Spiral of Recovery

There is a common suggestion among many in the "alternative medicine" industry expressed in the question: "If it means less business, why would your doctor want you to be healthy?” A strict emphasis on healthy lifestyle including diet and exercise would be like the proverbial "Apple a day" – keeping the doctor away. Doctors who do this – who keep themselves away as much as they can – are the best doctors. And therapists who "keep themselves away" are the best therapists.

Many pathologies allow for a definitive discharge point. The patient who has had a knee replacement gets therapy, and then goes home to live the rest of his life. But neurological disorders are different. Many, from Parkinson's to multiple sclerosis, are progressive. But what of non-progressive neurological disorders like stroke and traumatic brain injury? Does this "Apple a day" philosophy work? Is there a point at which these populations no longer need therapists?

Many patients with acquired brain injury believe that they will always need therapists. Most see therapists as essential to the recovery process, no matter how long (months, years, decades) it takes for them to achieve their highest level of potential recovery. But this view is incorrect.

There is a point at which therapists are no longer the fulcrum for recovery. Nor should they be for reasons that range from financial to practical. At discharge stroke survivors are, and should be, in complete control of their own recovery. During the chronic phase of recovery from stroke, the speed of recovery slows. In the chronic stage the physiological action of recovery is based on a lot of self-directed hard work.

Much of what is required is relatively simple, and revolves around the broad concept of repetitive practice. In order to take charge, stroke survivors need the tools to initiate and follow an "upward spiral of recovery.” This term is used to describe the path to the highest level of potential recovery. The "upward spiral of recovery" is driven by real-life demands for everything from coordination to cardiovascular strength.


Linda said...

I don't know if I want to agree or disagree with you over this post. I don't find being argumentative very easy.

I do not believe I will always need a therapist and I so hate to sound like one of the patients you refer to as being wrong about continued need for therapy for years, but here I am-- in therapy for year two.

I do feel fortunate to be in a wonderful hospital outpatient program for people with life changing health conditions. They have a lot of different disciplines working together as a team. We have an occupational therapist, physiotherapist, aquatic therapist, social worker, psychologist, speech therapist and a dietician available if I should need their advice. I think my progress and my expectations for myself are so much greater because of the help I have had on this journey.

Yes, it is up to me to direct my own recovery, but having a little guidance and direction on that upward spiral has been so valuable! I think I would just push and work hard doing the same things over and over and not figure out how to challenge myself next.

I do not see my therapists as the fulcrum on which my recovery rests, but I sure do see them as experts who can guide me in being sure that all my hard work is in a productive direction during this chronic stage.


Peter G Levine said...

Thanks for the great comment! There is one word in the description of your therapy team that makes a difference: physiotherapist. You are Canadian—a great country! (Thank you for Steve Nash, Mike Meyers and Rush, by the way).

Y’alls payment system is radically different than here in the States. What you describe as "a little guidance" would shock most stateside stroke survivors given the economic realities. You are "…in therapy for year two." I know few here who can afford that! In the USA, if you were an outpatient for an hour, 3 days a week, it would cost you about $10k a year. And that would be for just one "arm” (PT) of therapy! The average time for stroke survivors in a rehab facility is just over a month. If you add outpatient time you end up at 3-4 months. Total.

But here is the question at the crux of your comment: Are you are better off with therapists than without for years of therapy? The only possible downside, ironically, is something you describe as part of NOT having therapists. You say without therapists you would work on the “…same things over and over and not figure out how to challenge myself next.” Typically, the limited tools that therapists use (this is often a payment issue, not a reflection of a lack of therapist imagination) is why survivors get frustrated with therapy. But not in your case. Your therapists continue to challenge you in a way that has helped you to continue to recover. Assuming progress has been measured with valid outcome measures and results have been evaluated, ride it to the end!

Good luck!

oc1dean said...

I would love to be able to use more therapy but alas, I can only get 100 visits combined of OT and PT per year. My other concern is that I have yet to find one who knows more than me. This leads to my wifes' comment( She is a PT), What makes you think you know more than those who have been trained in the subject? Oh well, do-it-yourself diagnosis and therapy are my lot in life.

Peter G Levine said...


100 visits, that sounds pretty good actually. You have that DIY attitude and when folks have it, my non-scientific sense is that those folks do better. Probably because they're generally more motivated.
I'm not sure clinicians have a real good handle on what helps chronic stroke survivors. They can go through the usual suspects; stretching, cardio and muscle strengthening, balance training, etc. But most don't plan for the sort of massive rewiring it takes to step up to the next plateau. Sometimes its because they don't have the training. Sometimes they don't have the equipment. Sometimes its other reasons.

Thanks Dean!

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