Sunday, July 31, 2011

Motor deficits beware: Wolf on the hunt.

Okay, I'm a "stroke recovery nerd". But this is cool... so Stephen Wolf, the PT PhD that ran the big constraint induced trial back in 2005 has a really cool trial going on...

Of course, there's the whole repetitive task specific thing -- just like constraint induced. But what I really like about this is the focus on the survivor figuring out what the next step in motor learning is. That is, the survivor is the most important part in the process of recovery. And to his credit this is something Wolf has been promoting for a really long time. Even constraint induced, really, is all about the survivor driving their own nervous system towards recovery.

A couple of funny things about this video; the fact that he did it not in some sort of sterile looking environment but in an area that's typical of an OT workspace. Tons of stuff, vaguely categorized, piled on top of each other. A thing of beauty if you appreciate it. The other thing that pops is the level of movement he's suggesting. Have you tried to take the cap off of meds lately? I'm not hemiparetic but I struggle a lot with those safety bottles. And then he suggests that the stroke survivor would use a very delicate "three jaw chuck" grasp to pick up pills... that's just about the highest level of motor recovery that you could pretty much possibly have. "Enough finite movement" indeed!

Of course, they would probably tell me that they are making sure that tasks are within the ability of even their lowest level participants.



oc1dean said...

Even Dr. Wolf is taking the easy way out by using patients that have some movement, this has been proven repeatedly that recovery of the penumbra or bleed damage drainage area is relatively easy to recover, Easy neuroplasticity. I would challenge all researchers to start working on the hard work of moving functionality to a new location from a dead area. Hard neuroplasticity, that would be something to crow about. I have to do this myself so maybe I should get a grant to study myself. Sorry about the snarkiness Pete.

Peter G Levine said...

Dean, snark away! Yeah, he uses "high level" survivors... I'm assuming. I know some folks there, maybe I'll email 'em and ask what the inclusion is. You have a great point. Of course, there is good reason to believe that the basics of CIT (repetitive task specific practice) may show benefits in "lower level" folks. Of course, all this theoretical stuff is just a jumping of point. Give us another 100 years and we may figure it out. It'll be a combination of virtual reality, an enriched environment and wearable robotics along with an injection of BDNF and stem cells wrapped together in a decision tree that works.

Mike said...

I observed patients receiving locomotor training who are able to arm-swing regain the arm/hand function pretty quickly.Though I walk at 2.8 mph on the treadmill, my arm does not swing because my scapula is pretty much stucked since 2009.I'm having a hard time increasing the shoulder's range of motion.

Blog Archive