Friday, January 24, 2014

Since when is “productive” fun?


When it comes to stroke recovery, no clinician, no matter how skilled, can "do it for them." Recovery from stroke is dependent on repetitive and demanding practice by the owner of the damaged nervous system—the survivor. If done correctly repetitive and demanding practice drives cortical plasticity ("brain rewiring") robustly enough to be evident in increased quality of movement. 
But this sort of repetitive practice is boring! Repetitive practice does not necessarily involve functional activity. For example, a clinician, seeing a deficit in the last 15 or 20° of dorsiflexion, may have the patient repetitively practice dorsiflexion, irrespective of ambulation. At least in that example the end goal, whether it's stated or not, is obvious; walking. In the upper extremity repetitive practice of single joint movements may or may not relate to any particular everyday activity. Instead repetitive practice may be used just to increase active range of motion in those joints. Because it does not involve anything functional, repetitive practice can be inherently boring.  And what makes it even more boring is that stroke survivors aren't even working on anything novel; there relearning movement that they used to do perfectly well. So where's the motivation? 
The motivation ends up being a conjuring. Some of this motivation may come from the minds of clinicians. OTs, PTs and speech therapists should try to make repetitive practice as interesting as possible. But some of this motivation comes from the survivor. The survivor needs the imagination enough to understand how this hard and boring work will help realize potential.

2 comments:

Mike said...

Like in the workplace or school, a dumb, uninspired boss/ teacher with lazy workers/ students is a sure recipe for failure.Same with therapists & patients.My rehab hospita; was full of them; many patients stayed on their wheel chair after 3-5 years later. what can we do; this is the selfie,fastfood era. i give up!

Tamara said...

It's my motivation that keeps me going for almost 5 years now. I'm in stage 3 Brunnstrom now, so spasticity is high (and also painful in my case), but I keep going, because I read in your book I have to go through this awful stage to get better. There is also a clear mind-body link. My spasticity gets worse when I'm anxious. My theory is that my amygdala is in overdrive because of dysthymic disorder (mild depression), which also causes the fight or flight response. And that stress hormones are flooding my body, which causes irritability and pain. Fortunately I'm so exhausted at night, I have no trouble sleeping.

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