Friday, February 27, 2015

There are two ways to recover from stroke

There are two ways to recover from stroke. And they correspond to two of the four phases of stroke.
 

Let me start with four phases of stroke:

1. Hyperacute
2. Acute
3. Subacute
4. Chronic

For the sake of brevity let's cross off the top two:
 
1. Hyperacute
2. Acute
 

Recovery doesn't really happen during those two.
 
(I'll put why those two phases are important - outside of recovery per se- at the bottom of this entry).

Recovery – broadly defined as "getting better" – happens during the subacute and chronic phases.
 
The subacute phase: (from approximately the first week to approximately the third month –although this can vary wildly from survivor to survivor)

Most recovery during this phase is what would be called "spontaneous recovery" or "natural recovery." Recovery during this phase is driven by healing in the brain. Specifically it has to do with neurons that are temporarily "stunned" by the stroke becoming "unstunned" and coming back online. As they come back online recovery happens. That is, it's "spontaneous." It is true that people who get therapy during the subacute phase will get better than people who don't get therapy. In fact, people who get intensive therapy – therapy that involves a lot of work and a lot of repetitions – will get better than people who just get regular therapy. But even with no traditional therapy, survivors will almost always have some significant amount of recovery during the subacute phase. Let's put it this way...

The subacute phase: Recovery Happens
 

The chronic phase (from approximately three months to the end of life). 

During the chronic phase a lot of recovery can happen. This phase was traditionally known as the phase in which nothing could happen – but that has been proven to be broadly untrue. What confuses people is that recovery doesn't happen as easily during the chronic phase as it did during the subacute phase. There is (usually) no "spontaneous" recovery during the chronic phase. The survivor has to claw and scratch for every bit of recovery. And while during the subacute phase spontaneous recovery is driven by neurons flooding back, during the chronic phase brain plasticity (rewiring) comes into play. And brain plasticity during chronic phase is just as difficult for the survivor as it is for the rest of us. It involves a lot of hard work, a lot of dedication, a lot of repetitions, and a lot of  focus.
 

The hyperacute and acute phases.
Important things happen during these two phases, to be sure. Things like saving lives and saving brain. But these two phases are not conducive to the effort needed to drive recovery. In fact, if too much effort is made, you can enlarge the area damaged by the stroke. So during these two phases, listen to the healthcare professionals around you, and convalesce. But once the subacute phase starts, its time to "put the pedal to the metal." 

How will you know when the subacute phase starts? Spontaneous recovery happens!

6 comments:

oc1dean said...

What I dislike about this model is that it assigns no real responsibility for the doctor in helping survivors get better. Nothing on stopping neurons dying in the first week.

Peter G Levine said...

Dean! Wouldn't the MDs have exactly that responsibility during hyper- and sub acute phases?

John Short said...

So to ask the big question then that nobody has ever dared to ask before: Is it a bad idea to masturbate during the subacute phase?

Peter G Levine said...

John, great question. I would encourage masturbation during the subacute phase. During the acute phase, however, given the amount of exertion, it may not be the best thing for the brain; the brain is vulnerable during the acute phase. I would however suggest masturbation during the subacute phase with the affected arm/hand to promote recovery. I'll tell you what, if we could somehow bring sex into recovery, people would work TIRELESSLY!

John Short said...

Thats an interesting and to me unexpected viewpoint. when I masturbate with my good hand the spasticity finger flexion in the bad had increases all the way up to orgasm. It would be very hard for me to enjoyably masturbate with the affected hand, as nails embedded in my reproductive organ doesnt feel that good.
masturbation has the same effect as yawning, scratching an itch, rubbing an eye or pooing, uncontrollable movements and increased spasticity,
thats why I thought you wouldnt endorse masturbation, in case of bad spasticity.

Peter G Levine said...

John, thanks for being so candid. What you've said is incredibly interesting, and I'll bet its never been studied. Thanks again-pete

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