Saturday, May 14, 2016

Extry! Extry! I was kinda wrong!

Passive stretching has been used by therapists on survivors forever. Does stretching do anything to help recovery? So far as we know- no.

But there are therapists who don't want to hear this. I do a ton o' talks on stroke recovery and if you tell some therapists that stretching does not help survivors, therapists can get feisty. "If that doesn't work what am I supposed to do - they're tight and can't move."

Typically I tell them that they're probably not doing harm but they're not helping much either.

The thing is, I'm always reading research to update the message. I found an article that says that if a survivor is stretched, it may help. There are a couple of flys in the ointment, however... In this case, a therapist did not stretch them. Here's what they did:
  • What moved the survivors: Subjects wore an actuated glove orthosis that cyclically moved their fingers and thumb
  • How the survivors were moved: From a relaxed/flexed posture into neutral extension 
  • How long were they moved: 30 minutes on 3 consecutive days
  • What they gained: Improvement was observed immediately after the stretching (this is to be expected- stretching does have a short term effect, although any long-term effect is questionable). Here's the potential new news: largely maintained up to 1 hour poststretching, with significant carryover for the 3 days for some outcomes. That was true for what they called "subacute" survivors (defined as "2 to 6 months"- which is a misrepresentation of "subacute" after stroke) but not true (it did not work as well) in "chronic" survivors.
So, what have we learned? Stretching a survivor passively with a computer-driven actuated glove orthosis-- if they are 2-6 months after the stroke-- provides some short term benefits.

And they wonder why everyone outside of research hates research...


oc1dean said...

Sometime in that 2-6 month period the spasticity to my fingers kicked in. After that occurred there is almost no way a glove could be put on my hand. Can't tell from the drawing if the glove had complete fingers or not.

Peter G Levine said...

Dean! Sometimes spasticity is so profound that none of these things will work (from the saeboflex to this thingy). It is tough when there is true "spastic paralysis".

Kristina Hodgdon said...

I had your book on my Amazon wish list for awhile. Someone just recommended it to our FB group so I looked it up again. I ordered it. Can't wait to get it. I hope there is info about AFO's. I think I know which one will work best for me but the therapists think a little differently. I also wonder why it takes so long for therapists, doctors,etc. to even suggest it. I have had Botox in my left arm twice. No spasticity but no closing yet. Can't wait to see the recommendations or that. I'm using my "downtime" to get ,y Master's degree in psychology. I don't give up easy so your book sounds like it will be great for me. I want to do research and I want to help other people with their recovery
Thank you, Kris

Peter G Levine said...

Kristina- masters degree in your "downtime", huh? I can't tell you how many survivors I've met who are smarter than me even after their stroke. seems unfair! In any case, you've given me an idea: write something, and algorithm if you will- or a decision tree- for folks to figure out what the best "dorsi assist" option is best for them... is it an AFO? A strap? Nothing? Thanks for the idea!

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