Sunday, May 31, 2015

C'mon baby...

Here is a flowchart used to guide recovery of walking after stroke...

Boy, that's complicated! 

How do we learn how to walk in the first place- as infants? Does it involve "treatments" that span from "Task Specific Training" to orthotics?

Stroke recovery is hurt by complexity. When rehab options become too complicated the stroke survivor is separated from their own recovery because they don't know what to do. 

Forget survivors for the moment... At some point stroke recovery can become so complicated that even clinicians don't understand it. Or they don't understand the technology in the complicated system because they never interface with that complicated technology. 

Have a look at the algorithm above. I would argue the whole thing is not only way too complicated, it's also incorrect.

I would like to rewrite the entire algorithm like this...

Post-stroke ambulation most benefits from task specific training. Translation: Walking more improves walking.

4 comments:

Jim Sparks said...

In my case an added complication would be spasticity, which is not uniform and static; rather it is variable and reactive, increasing in strength the more I walk, seemingly in order to prevent me from walking.

John Short said...

I can attest to the fact that walking more leads to more endurance, even though my foot muscles been paralyzed the whole time and i have to compensate by shifting my weight more to the other side, simply the act of walking more has allowed me to able to stand peeing, stand brushing teeth and walk without a cane. and my foot is still paralyzed! I do need to wear an AFO though. and Im gonna try electrical stimulation next year to see if foot muscles come back, but that seems to be the only "full cure" available and its not even guaranteed. sad.

Im jealous of the people whose foot muscles came back early and they just have bad control of them, all they have to do is walk alot and full recovery for walking is within sight.

Jim Sparks said...

Walking more improves walking. That I agree with. I walk better now than I did soon after I had my stroke 31/2 years ago. However, because of my spasticity, it is actually harder to walk now than it was then. As my strength, control, and coordination have improved, the spasticity has strengthened. It is a constant battle to stay ahead of it. I'm afraid that as I age and my strength fades, it will overwhelm and incapacitate me. Or perhaps it will fade away too as I become less active. Who the hell knows.

Dogon Sirius said...

Frequent treadmill use has helped me considerably in the year since my stroke - my leg no longer swings to the outside, my foot rarely scrapes the ground going forward anymore, and my limp is considerably less noticeable. I wish there was a similar exercise that would help my hand and arm. Standing in static Chi Kung postures has kept the tendons from shrinking up, but spasticity frequently kicks in, contracting the bicep particularly and causing the arm to come up as if in a sling. Whenever I feel a yawn coming on I try focusing on keeping it relaxed, to no avail.

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