Monday, November 24, 2014

BRAINS! (get used to it)




 
     Out of all the organs in the human body we know the least about the brain. Every other organ in the body and we know to the cellular, if not the molecular level.


But the brain... You've heard the clich├ęs, I'm sure; given the interdependence of neurons, the human brain is the most complex structure in the known galaxy, including the galaxy itself. The estimate of planets in the galaxy is upwards of 1 trillion. The most conservative estimate of the number of synaptic connections in the human brain is 1000 trillion! 


"But," you may think, "I can't even figure out which socks match my shoes." That maybe true, but remember: while you're trying to figure that out, your brain is keeping every one of the trillions of cells in your body in relative harmony.

We need to start looking at the brain. Yes, its squishy, yes its bloody, yes it is huge and pulsates in aliens from Mars. But we need to get over this "Its too weird!" posture, or we, its owner, can't really understand the darned thing.

Here's a place to start... Below is a video of the surgery for a subdural hematoma. This type of stroke is the least common (about 7%), but the most deadly.

Warning: this video is graphic. Frankly, I had a hard time sitting through it. I would suggest watching just one portion – a few seconds, from 1:32 to 1:39. This is the good part, where the surgeon rids the brain of this sort of cap of blood that has accumulated between the skull and the brain. If this sort of surgery is not done, the brain will continue to compress, furthering damage.

Enjoy!




Tuesday, November 4, 2014

Resistance Training After Stroke

Got a good question the other day about resistance training the other day. Please see the Q&A, below...
Q
     I am a 43 year old stroke survivor(2010).  I walk ok(not too pretty), can do light manual work, and can't run.  My left affected side is considerqbly weaker than my dominnant, nonaffected right side.
    I want to return to higher impact activities one day, but I just don't think I have the physical strength to do so.
  I have read several articles by Sroke survivors who benefitted greatly from barbell-base systematic weight training as a  means to advance recovery.  
    One writer mentioned (book) as a good place to begin.  It emphasizes combination weight exercises that employ multiple muscle groups and run through a full range of motion.
    Do you have any opinions or clinical experiences on the subject  of Strength Training following Stroke or could direct me towards some materials to get started?
A
     I did a quick review of the literature (example) and found that there's a general consensus that resistance training is a good thing post stroke. A really good thing. But there seems to be no consensus on what type of resistance training it should be. 
    Keep in mind: Resistance training can injure. There are a ton of questions before you begin, like...
  1. How stable is your "bad" shoulder?
  2. Will you have the strength and coordination to hold whatever (barbell, band, etc) and not drop it?
  3. Do you have sensation enough to know if you are injuring the limb?
    One concern that therapists mistakenly have is that if you use muscles that have spasticity you will increase the spasticity. This is wrongheaded, and not true. So don't worry about using spastic muscles to help move you.
    I have seen people who've had a stroke run again. They're almost always young (younger than 60). I would think that as long as you are okay with "a new normal" the sky is the limit.
   
The hard part, of course, is putting the work in.
Previous article I wrote about this subject.

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