tag:blogger.com,1999:blog-81748809374517687072024-03-17T20:00:13.576-07:00Stronger After Stroke Blog (THE STROKE RECOVERY BLOG)Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.comBlogger357125tag:blogger.com,1999:blog-8174880937451768707.post-89331966537282256932021-10-26T10:52:00.012-07:002021-10-30T18:10:59.997-07:00Hemorrhagic (bleed) Stroke, Simplified (but its still complicated)<p><span style="font-family: arial; font-size: large;">Hemorrhagic stroke: </span></p><p><span style="font-family: arial; font-size: large;">Bleed in the brain or brainstem.</span><span style="font-family: arial; font-size: medium;"> </span></p><p style="text-align: justify;"><span style="background-color: white; color: #202124; font-family: arial; font-size: medium;">These two are the two types of hemorrhagic (bleed) stroke: </span></p><p style="text-align: justify;"><span style="font-family: arial; font-size: medium;">1. <a data-preview-itemid="8d2f7e1501ff4c8ba0d33ab1a46a9065" href="https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/stroke-cva/intracerebral-hemorrhage" style="background-color: white; box-sizing: border-box; color: #b12e32; cursor: pointer; letter-spacing: 0.01em; margin: 0px; outline: 0px; overflow-wrap: break-word; padding: 0px; text-size-adjust: none;">Intracerebral hemorrhage</a><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;">: In the "meat" of the brain (cerebrum)</span><span style="letter-spacing: 0.01em;">.</span></span></span></span></p><p><span style="clear: right; float: right; font-family: arial; font-size: medium; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="438" data-original-width="505" height="368" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLQFAg65CFoiFWrExdeyqFaGipucNhZwYLRAzeca83TcC2CVzH1sN63WgCqtORJOt07tkMyalhf3f4KEY7acAM7Y8SyhCBrVjYOKEQRuHwH0Lm-0Hf_XYPw1wO8Td-RoamrKP3tuPdlVo/w436-h368/menegies.jpg" width="436" /></span><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;"><br /></span></span></span></span></p><p><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;"><br /></span></span></span></span></p><p><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;"><br /></span></span></span></span></p><p><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;"><br /></span></span></span></span></p><p><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;"><br /></span></span></span></span></p><p><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;"><br /></span></span></span></span></p><p><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span face="Open Sans, Fallback, sans-serif"><span style="letter-spacing: 0.01em;"><br /></span></span></span></span></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p style="text-align: justify;"><span style="font-size: medium;"><span style="font-family: arial;">2. <a data-preview-itemid="6a88d199968a4213bd6898286fbfbfc5" href="https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/stroke-cva/subarachnoid-hemorrhage-sah" style="box-sizing: border-box; color: #b12e32; cursor: pointer; letter-spacing: 0.01em; margin: 0px; outline: 0px; overflow-wrap: break-word; padding: 0px; text-size-adjust: none;">Subarachnoid hemorrhage</a>: Between the brain and the meninges (</span><span style="background-color: white; font-family: arial; letter-spacing: 0.14px;"><i>meninges</i></span><span style="background-color: white; font-family: arial; letter-spacing: 0.01em;">, the layers of "brain wrap" and </span><span style="background-color: white; font-family: arial; letter-spacing: 0.14px;">surround</span><span style="background-color: white; font-family: arial; letter-spacing: 0.01em;"> the entire brain).</span><span style="font-family: arial;"> </span></span></p><p style="text-align: justify;"><span style="font-size: medium;"><span style="background-color: white; font-family: arial;">Approximately 25% of patients with subarachnoid hemorrhage </span><span style="background-color: white; font-family: arial;">die</span><span style="background-color: white; font-family: arial;"> within 24 hours, with or without medical attention. </span></span></p><div class="list" style="background-color: white; box-sizing: border-box; margin: 0px; outline: 0px; overflow-wrap: break-word; padding: 0px; text-size-adjust: none;"><ul class="bulleted" data-mmanualobjecttype="List" style="box-sizing: border-box; margin: 0px; outline: 0px; overflow-wrap: break-word; padding: 0px; text-size-adjust: none;"><li class="topic__listitem" style="box-sizing: border-box; margin: 0px 0px 5px 2.5em; outline: 0px; overflow-wrap: break-word; padding: 0px; text-size-adjust: none;"><div class="para" style="box-sizing: border-box; margin: 0px; outline: 0px; overflow-wrap: break-word; padding: 0px; text-align: justify; text-size-adjust: none;"><span style="font-family: arial; font-size: medium;"><span style="letter-spacing: 0.14px;">Other disorders that involve bleeding inside the skull include </span><a href="https://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/intracranial-hematomas#v740117" style="box-sizing: border-box; color: #b12e32; cursor: pointer; letter-spacing: 0.14px; margin: 0px; outline: 0px; overflow-wrap: break-word; padding: 0px; text-size-adjust: none;">epidural hematomas</a><span style="letter-spacing: 0.14px;"> and </span><a href="https://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/intracranial-hematomas#v740124" style="box-sizing: border-box; color: #b12e32; cursor: pointer; letter-spacing: 0.14px; margin: 0px; outline: 0px; overflow-wrap: break-word; padding: 0px; text-size-adjust: none;">subdural hematomas</a><span style="letter-spacing: 0.14px;">, which are usually caused by a head injury. These disorders cause symptoms that sometimes resemble those of a stroke.</span></span></div></li></ul><div><span style="font-family: arial; font-size: medium;"><img border="0" data-original-height="768" data-original-width="1200" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoriRu2w9bpfv_tGxSjch7rwFlHbQEsND5Vmw5wyFXsIK5YDzdMX-1SjJY-M4nWW6y2uurLMSjKJY0wHdT24UwHXLPiWaNyrvdlBbXfRQ_4SpQ58ZqsaFRgLDw35of_7rsNqkv_h2dXHE/w315-h201/types+of+brain+hemorrhage.jpg" width="315" /></span><div class="RqBzHd" style="padding: 0px 20px;"><div><span style="color: #202124; font-family: arial; font-size: medium;">Credit: Wikimedia Commons</span></div></div></div></div>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-35488905853827867492021-10-02T08:32:00.009-07:002021-10-06T11:30:25.007-07:00Vocal Music Listening Helps Recover Language<p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><span>Everyone knows that listening to music is good
for your brain, staves off dementia and Alzheimer's, and </span><span style="background-color: white;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464962/">may be beneficial for gait, the timing of upper extremity function, communication outcomes, and quality of life after stroke</a>.</span><span style="background-color: white;"> </span></span></p><p style="margin: 0in; text-align: justify;"><span style="background-color: white;"><span style="font-family: arial; font-size: medium;"><br /></span></span></p><p style="margin: 0in;"></p><span style="font-family: arial; font-size: medium;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-CNiC-HhV3CLt39TuoVCpx5TQh7Ho6xlKPeHgBfY1q7mDfEJhEjJMas9fvfJkHPFkaC00Y8-DjVshGC-U6zJ7GFwNxEslFKn3mRO_SSGSoaGHi4_TYiJzqeNk76WhGdCu4Bnn8WqRyPY/s1073/Clipboard01.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="822" data-original-width="1073" height="490" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-CNiC-HhV3CLt39TuoVCpx5TQh7Ho6xlKPeHgBfY1q7mDfEJhEjJMas9fvfJkHPFkaC00Y8-DjVshGC-U6zJ7GFwNxEslFKn3mRO_SSGSoaGHi4_TYiJzqeNk76WhGdCu4Bnn8WqRyPY/w640-h490/Clipboard01.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><b style="font-family: "Times New Roman";"><span style="font-family: arial;">myc.com</span></b></td></tr></tbody></table><div style="text-align: justify;"><br /></div></span><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">And it may help <a href="https://recoverfromstroke.blogspot.com/2010/07/rockin-recovery.html">people with aphasia recover language</a>. But the same question always comes up: <i><b>What kind of music is the
best?</b></i></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"> </span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><span style="background: white; color: #1d2228;"><a href="https://www.eneuro.org/content/8/4/ENEURO.0158-21.2021">Kinda a cool study</a> from the great country of
Finland may have answered that that question (for survivors with aphasia, at
least).</span><o:p></o:p></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><span style="background: white; color: #1d2228;">They had three groups:</span><o:p></o:p></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">1. Listened to music with a singer singing<span style="background: white;"> lyrics </span><o:p></o:p></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">2. <span style="background: white;">instrumental music (with no
sung lyrics) </span><o:p></o:p></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><span style="background: white;">3. narrated audiobooks.</span><o:p></o:p></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"> </span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">The winner? “Vocal music”—music that included
sung lyrics.</span></p><p>
</p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">But there was another thing they did: They interviewed the participants to find out their favorite music.<o:p></o:p></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">So...</span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">1. Listen to music to help language recovery</span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">2. Choose music that has sung lyrics</span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;">3. Choose music you love</span></p><p style="margin: 0in; text-align: justify;"><span style="background-color: white;"><span style="font-family: arial; font-size: medium;"><br /></span></span></p><p style="margin: 0in; text-align: justify;"><span style="background-color: white;"><span style="font-family: arial; font-size: medium;"><b>Dosage:</b></span></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><span style="background-color: white;"><span> </span></span>✔️ <span style="background-color: white;">1 hour a day</span></span></p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><span style="background: white;"><span> </span></span>✔️ <span style="background-color: white;">2 months</span></span></p><p style="margin: 0in;">
</p><p style="margin: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><span style="background: white;"><span> </span></span>✔️ <span style="background-color: white;">Keep a diary to make sure you stick to it</span></span></p>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-75694491636046232752021-07-25T15:47:00.005-07:002021-10-22T19:29:24.576-07:00STROKE DEPICTED IN A CARTOON!<!--Facebook share button Start--><div style="text-align: justify;"><span face="Arial, Helvetica, sans-serif" style="font-size: medium;"><b>This is a re-post of an earlier blog entry. Still pertinent</b>!</span></div><div style="text-align: justify;"><span face="Arial, Helvetica, sans-serif" style="font-size: large;"><br /></span></div><div style="text-align: justify;"><span face="Arial, Helvetica, sans-serif" style="font-size: large;">Have a look at this cartoon. In poor taste, yes. But it manages to raise awareness and it does it in a way that is comically accurate. </span></div><div style="text-align: justify;"><span face="Arial, Helvetica, sans-serif" style="font-size: large;"><br /></span></div><div style="text-align: justify;"><span face="Arial, Helvetica, sans-serif" style="font-size: large;">Here is your quiz: Watch the vid and then do this: Just below the cartoon, highlight the invisible text by left clicking and dragging to the bottom of the post. Therein lies my observation of what the cartoon gets right. If you'd like me to add anything I've missed, put it in the comments or email me.</span></div><div style="text-align: justify;"><span style="font-size: large;"><br /></span></div>
<br /><div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/EPIGEQkSK5k" width="480" youtube-src-id="EPIGEQkSK5k"></iframe></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><br /></span></div><div style="text-align: justify;"><span style="font-size: large; text-align: left;"><span><b>Highlight text below</b></span><span><b><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span><span face="arial, sans-serif" style="background-color: white; color: #545454; line-height: 18.2px;">↓</span></b></span><br /><span style="color: white;"><b>1. Drop foot </b></span><br /><span style="color: white;"><b>2. Inability to clear ground during swing phase of gait </b></span><br /><span style="color: white;"><b>3. Flaccid left upper </b></span><br /><span style="color: white;"><b>4. Lack of sensation left upper </b></span><br /><span style="color: white;"><b>5. Caregiver concern regarding driving </b></span><br /><span style="color: white;"><b>6. Difficulty with spacial issues while driving </b></span><br /><span style="color: white;"><b>7. Left hemiparesis, no aphasia! </b></span><br /></span><div style="text-align: left;"><span style="font-size: large;"><br /></span></div><div style="text-align: left;"><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><span style="font-size: large;"><br /></span></div><div style="text-align: justify;"><span style="font-size: large;"><span>In the comments section Jim Sparks points to a part in the episode where </span><a href="In the comments section Jim Sparks points to a part in the episode where a treatment that is not proven to work, works!">a treatment that is not proven to work</a><span>, works!</span></span></div></div></div></div>Unknownnoreply@blogger.com8tag:blogger.com,1999:blog-8174880937451768707.post-85294285751723773712021-07-11T09:38:00.009-07:002021-07-14T22:08:04.098-07:00A Show For Survivors<h2 style="text-align: left;"><span style="font-family: arial; font-size: medium;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgravH8_hfKSQq1izhVZX6FD0bxAx92xGj0EOvstxBujP54QYKYZW7RCkSxLmhUdzKMak2QNeHUCyFVaE8GIL5lOaFL6qFkVBUVgS95GyL-KvA9wBftRwgwMJDOBlgCR3zVl49qpETXHNc/s490/new+logo+4.jpg" imageanchor="1" style="background-color: #ffa400; clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: left;"><img border="0" data-original-height="490" data-original-width="490" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgravH8_hfKSQq1izhVZX6FD0bxAx92xGj0EOvstxBujP54QYKYZW7RCkSxLmhUdzKMak2QNeHUCyFVaE8GIL5lOaFL6qFkVBUVgS95GyL-KvA9wBftRwgwMJDOBlgCR3zVl49qpETXHNc/s320/new+logo+4.jpg" /></a></div></span></h2><div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /><div style="text-align: left;"><span style="font-weight: 700; text-align: right;">Hi Survivors </span><span style="font-weight: 700; text-align: right;">(and caregivers, clinicians and clinical students:)!</span></div></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">An <a href="https://www.linkedin.com/in/debra-battistella-83006798">OT friend</a> and I recently launched a "radio show" (the kids call it a podcast:). </span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">Its all about stroke/brain injury recovery.</span></div><div><br /></div><div><span style="font-family: arial; font-size: medium;"><b><br /></b></span></div><div><span style="font-family: arial; font-size: medium;"><b><br /></b></span></div><div><span style="font-family: arial; font-size: medium;"><b>Below are link to some episodes you may find helpful...</b></span></div></div><ul style="text-align: left;"><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/stop-falling/">Stop Falling!</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/mirror-therapy/">Mirror Therapy<br /></a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/learned-non-use/">Learned Non-use</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/what-does-work-i/">What <i>Does</i> Work I</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/what-works-ii/">What <i>Does</i> Work II</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/what-doesnt-work-i/">What Doesn't Work I</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/what-doesnt-work-ii/">What Doesn't Work II</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/sensation-recovery/">Sensation Recovery</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/measuring-recovery/">Measuring Recovery</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/neuroplastic-beats-spastic/">Neuroplastic Beats Spastic</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/how-repetition-rules-recovery/">How Repetition Rules Recovery</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/subluxation-and-shoulder-pain/">Subluxation and Shoulder Pain</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/">Constraint Induced Therapy: Part I</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/constraint-induced-therapy-part-i/">Constraint Induced Therapy: Part II</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/bilateral-training-for-the-arm-and-leg/">Bilateral Training for the Arm, and Leg</a></span></li><li><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/super-survivor-kathy-spencer-on-successful-recover/">Super Survivor Kathy Spencer On Successful Recovery</a></span></li></ul><p></p>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-63991283440944039062021-07-05T07:00:00.000-07:002021-07-05T07:49:26.293-07:00The Feel of Recovery<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif">Below is an article I wrote in a PT trade magazine years ago. It describes, theoretically at least, how to get sensation back after stroke. Turns out, nothing new under the sun. Getting back sensation is the same as getting back movement. Repeated attempts at feeling </span><span face=""arial" , "helvetica" , sans-serif" style="text-align: justify;">drives </span><span face="Arial, Helvetica, sans-serif">the brain<span style="text-align: justify;"> </span></span><span face=""arial" , "helvetica" , sans-serif" style="text-align: justify;">to be better at feeling. </span></span></div>
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<span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4PykswDwu2QfdILJ5RLGmtr1Mydej7t0TZ4kYIrPcm1EpHgRTrFJKai2gkXVng4q5_omUv79pCOnWsuGuSqplPC8dLbqZKOGRQf4a-Wv2NVbTBfCZi5R1yBfqwkIZWP-a0f51mo57ha_8/s1600/feel.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: arial; font-size: medium;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322086282267188258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4PykswDwu2QfdILJ5RLGmtr1Mydej7t0TZ4kYIrPcm1EpHgRTrFJKai2gkXVng4q5_omUv79pCOnWsuGuSqplPC8dLbqZKOGRQf4a-Wv2NVbTBfCZi5R1yBfqwkIZWP-a0f51mo57ha_8/s320/feel.jpg" style="height: 300px; margin-top: 0pt; width: 199px;" /></span></a><span style="font-family: arial; font-size: medium;">There are 2 ways of retraining feeling: active and passive. Passive seems to be more for tactile stuff, active is more for proprioception (the feel of movement).</span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;">But movement and sensation double back on each other. Movement affects sensation because if you can't move the brain stops listening for movement. And if you can't feel, your movement goes haywire.</span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;">
<div class="MsoNormal" style="text-indent: 0.5in;"><b style="text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">Rehab clinicians have seen it all... from the proprioceptive deficits of the apraxic survivor, to the hyper-sensitivity of survivors with
shoulder/hand syndrome (RSD), stroke deals an unpredictable hand of sensory dysfunction
to many survivors. Approximately 60% of stroke survivors have some sort of
sensation loss. Of all the squealae after stroke, loss of sensation is the most
perplexing for researchers. Most research focuses on the effect of interventions
on recovery of movement and function. There
are reasons that research focuses on movement and not on sensation.</span></b></div>
<div class="MsoNormal" style="text-indent: 0.5in;">
<b><span style="font-family: arial; font-size: medium;">For instance,
movement is considered more important. In some ways it is. Edward Taub, the
developer of constraint induced therapy (CIT), proved that primates could move
limbs they couldn’t feel before he was out of graduate school in the 1960’s. So
if movement can be relearned without sensation, there is less focus on that that relearning. Also, any gains in recovery of movement are easily
seen, and we focus on what we can see. Sensation is much more difficult to
measure. But any therapist worth their salt knows that sensation impacts on
movement. Movement is the Ying to movement’s Yang; neither does well in
isolation. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-indent: 0.5in;">
<b><span style="font-family: arial; font-size: medium;">If a therapist wanted
help a client relearn sensation, how would they go about it? First, understand
that sensation would, in fact, be relearned--in much the same way that movement
is relearned. The same rules apply. We know that repetitive practice
reestablishes movement. Although much more research needs to be done,
repetitive <i>feeling </i>seems to help
reestablish sensation. Also, movement itself seems to drive increases in
sensation. The more the survivor moves, the more the sensation of movement
becomes ingrained into the neurons of the brain and the more the brain
“listens” to the feeling of the movement. The more the brain listens, the more
neuroplastic rewiring occurs to make the brain more perceptive to the
sensation. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-indent: 0.5in;">
<b><span style="font-family: arial; font-size: medium;">There are two
veins of inquiry that researchers are following that promote repetitive feeling;
passive and active training. <o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: arial; font-size: medium;"><br /></span></div>
<div class="MsoNormal">
<u><b><span style="font-family: arial; font-size: medium;">Passive Training of Sensation
(PTS)<o:p></o:p></span></b></u></div>
<div class="MsoNormal" style="text-indent: 0.5in;">
<b><span style="font-family: arial; font-size: medium;">PTS usually involves surface electrical stimulation.
This would be delivered in much the same way transcutaneous <em>electrical</em> nerve <em>stimulation</em> (<em>TENS</em>)
is. That is, there is no muscular contraction. The hypothesis is that
continuous signals sent from the peripheral
to central nervous system reallocate neurons
to feeling the limbs. Stimulation sessions ranged from one session for one day
to one session per day for several weeks. Other PTS paradigms have used
pneumatic compression, thermal stimulation and vibration to a portion of the
body. <o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: arial; font-size: medium;"><br /></span></div>
<div class="MsoNormal">
<u><b><span style="font-family: arial; font-size: medium;">Active Training
of Sensation (ATS)<o:p></o:p></span></b></u></div>
<div class="MsoNormal" style="text-indent: 0.5in;">
<b><span style="font-family: arial; font-size: medium;">The research in this area has used a variety
of training techniques. ATS involves having the stroke survivor actively
involved in training. Included has been practice determining where limbs are in
space with eyes closed (for proprioception) and practice with localizing
sensation (“Where do you feel this?”). Also used is repeated challenge to stereognosis
(the ability to perceive the form of an object held in the hand). <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-indent: 0.5in;">
<b><span style="font-family: arial; font-size: medium;">Ultimately, the
best paradigms for reestablishing sensation involve the blending of ATS and
PTS. Since the more movement that is
done the better the brain becomes at listening, anything that compels the
survivor to move will tend to drive sensory recovery. Repetitive practice paradigms,
including CIT may be helpful in the recovery of movement and the sensation of
movement. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-indent: 0.5in;">
<b><span style="font-family: arial; font-size: medium;">Much more research is needed in this important
area. Every study and systematic review of sensation after stroke
agrees: The testing and treatment of post-stroke sensation deficit lags well
behind the testing and treatment of movement.</span></b></div>
<div class="MsoNormal"><span style="font-family: arial; font-size: medium;"><br /></span></div><div class="MsoNormal"><a href="https://pubmed.ncbi.nlm.nih.gov/31114472/"><span style="font-family: arial; font-size: medium;">Serrada I, et al. Does Sensory Retraining Improve Sensation and Sensorimotor Function Following Stroke: A Systematic Review and Meta-Analysis. Front Neurosci. 2019 Apr 30; PMID: 31114472</span></a></div><div class="MsoNormal"><p class="MsoNormal"><a href="https://recoverfromstroke.blogspot.com/2007/10/blog-holder.html"><span style="font-family: arial; font-size: medium;">Rehabilitation
of Somatic Sensation and Related Deficit of Motor Control in Patients With Pure
Sensory Stroke<o:p></o:p></span></a></p>
<p class="MsoNormal"><a href="https://www.sralab.org/sites/default/files/2017-07/nsainstructionsrevised.pdf"><span style="font-family: arial; font-size: medium;">NOTTINGHAM
SENSORY ASSESSMENT</span></a><o:p></o:p></p></div>
</div>
Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-8174880937451768707.post-56162872547024405832021-06-28T15:07:00.001-07:002021-06-28T15:07:56.697-07:00The perfect stroke survivor.<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1kdw8RJt0NBDC9IgztrPSeNc1HuKP6RzDrfVq3ColwGNv0BBSkBI_39CstICphyJd7wROjKChdPqTffu4ugiZXmMRSKk8lTsksDYDTiJVnLnsudp8RXqmXriyXkA-VV0Cr84CsK6irE8/s461/walking+speed+3.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="461" data-original-width="459" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1kdw8RJt0NBDC9IgztrPSeNc1HuKP6RzDrfVq3ColwGNv0BBSkBI_39CstICphyJd7wROjKChdPqTffu4ugiZXmMRSKk8lTsksDYDTiJVnLnsudp8RXqmXriyXkA-VV0Cr84CsK6irE8/s320/walking+speed+3.jpg" /></span></a></div><div style="text-align: justify;"><span style="font-size: medium;"><span style="font-family: arial;">The perfect stroke survivor would be </span><b style="font-family: arial;">male</b><span style="font-family: arial;">. </span><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1364522/" style="font-family: arial;" target="_blank">Outcomes are better for males</a><span style="font-family: arial;">. Depression hits men less after stroke, and they tend to be both younger and in better shape prior to the stroke.</span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">
<span face=""arial" , "helvetica" , sans-serif"></span><br />
<span face=""arial" , "helvetica" , sans-serif">The perfect stroke survivor would be <b>well educated</b>. Folks who are well-educated get more recovery than the less educated.</span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif"><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">
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<span style="clear: right; float: right; font-family: arial; font-size: medium; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="287" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhV0RJ3KKnKjGftsRaengoyDXXJ3ipFxMOXkwChcgf4B4hh1vsjsHsYKV_1qdH4M-ERnAPbfAO5WiUeKwm_1ZH_qHxHW6LCXcFxd89e1HBQLroQHtnmZS1olLYvXV9JF565Kg16OYTlKih4/s320/education+and+stroke.jpg" width="320" /></span></div>
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<span style="font-family: arial; font-size: medium;"><br />
<span face=""arial" , "helvetica" , sans-serif"><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif">The perfect stroke survivor would have significant <b>economic resources</b>. The well-off recover more than then moderate or low income folks.</span></span></div>
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<span style="clear: left; float: left; font-family: arial; font-size: medium; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="276" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtSXSWXaXsBTENNJvjgGoGICV-9BC7pcD68RVVqpDQLbhsRF_epCe4ChpLkMw01TACL7yuTu_SeoYjyStwI0-8Tr6xOyicK1aY2X4nfroc7RLizqtwbMjnq-C-DHWsGCwZ5cfcT2bCziQl/s320/income+stroke.jpg" width="320" /></span></div>
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<span style="font-family: arial; font-size: medium;"><br /></span></div>
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<span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif">The perfect stroke survivor would be <b>African-American</b>. <a href="http://www.rehab.research.va.gov/jour/09/46/2/pdf/page223.pdf" target="_blank">African-Americans recover more</a> than Caucasians and/or Puerto Ricans.</span><br />
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<span face=""arial" , "helvetica" , sans-serif"><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif"><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif"><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif"><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif">So, Who would be the perfect person to have a stroke?</span></span></div>
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<span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><a href="https://goo.gl/images/PY9mPF">Click here to find out! </a></span><br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-47171848222692617852021-06-11T07:12:00.019-07:002021-06-22T16:25:42.996-07:00◉◉◉◉◉Where do I start?◉◉◉◉◉ Lemme give you a hand with that.<h4 style="text-align: justify;"><span style="font-size: medium;"><br /></span></h4><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif"><span face=""arial" , "helvetica" , sans-serif">I've done a ton of talks to rehab clinicians. Sometimes I get a simple but perplexing question...<i> I have </i></span></span><span face=""arial" , "helvetica" , sans-serif" style="font-style: italic;">a stroke survivor on my caseload. W</span><span face=""arial" , "helvetica" , sans-serif"><span face=""arial" , "helvetica" , sans-serif" style="font-style: italic;">here do I start</span><i>?</i></span><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyiX6vSpqANL0y-OAQC-nQq77X52LYWMl4TQcxcwA_Mp7CJyCyFe1nKyBQ6FaOogVq5yXbo9HyMC8urlIiTSnewWPDVxpZlKuuEKgRM0agbooC9igyzujK5ePWd-nz1A5Tcx0vhcywwEM/s1600/confused+therapist.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: arial; font-size: medium;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyiX6vSpqANL0y-OAQC-nQq77X52LYWMl4TQcxcwA_Mp7CJyCyFe1nKyBQ6FaOogVq5yXbo9HyMC8urlIiTSnewWPDVxpZlKuuEKgRM0agbooC9igyzujK5ePWd-nz1A5Tcx0vhcywwEM/s200/confused+therapist.jpg" width="200" /></span></a></div><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif"><br /></span><span face=""arial" , "helvetica" , sans-serif"><span face=""arial" , "helvetica" , sans-serif">When I meet a survivor, the first thing I check out is the hemi-side hand. The hand tells you a ton: </span></span></span></div><div style="text-align: justify;"></div><div class="separator" style="clear: both; text-align: center;"></div><ul><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAjnXRfxA17zpFXTq13U-NL52DWL4S0172wJHNwoYXBQyTDNKXZcGajPRp19AHx_zmUCr63bIhSEytEYQGD278SQtgiVMBZ2OPMsTVow3p5MgfxzvlF3kg87FW_ODFDzA7ay7RMBxgh8A/s1600/spas+hand.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: arial; font-size: medium;"><img border="0" height="163" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAjnXRfxA17zpFXTq13U-NL52DWL4S0172wJHNwoYXBQyTDNKXZcGajPRp19AHx_zmUCr63bIhSEytEYQGD278SQtgiVMBZ2OPMsTVow3p5MgfxzvlF3kg87FW_ODFDzA7ay7RMBxgh8A/s200/spas+hand.jpg" width="200" /></span></a><li style="text-align: justify;"><span style="font-family: arial; font-size: medium;">Is spasticity an issue? If it is, spasticity will show up in spades in the hand. <span face=""arial" , "helvetica" , sans-serif">A</span>ll those little joints, and those little muscles pulling those little appendages. And the massive strength difference between the muscles that close the hand against the muscles that open the hand. Let's put it this way, you can hang from one hand. Your <span face=""arial" , "helvetica" , sans-serif">e</span>ntire body weight through those little appendages. The muscles that open the hand have the strength to do one thing: open the hand. <span face=""arial" , "helvetica" , sans-serif">There is a huge</span> <span face=""arial" , "helvetica" , sans-serif">difference</span> <span face=""arial" , "helvetica" , sans-serif">in strength</span> bet<span face=""arial" , "helvetica" , sans-serif">ween the t<span face=""arial" , "helvetica" , sans-serif">wo</span> groups of muscle<span face=""arial" , "helvetica" , sans-serif"> <span face=""arial" , "helvetica" , sans-serif">groups</span>. S<span face=""arial" , "helvetica" , sans-serif">o if the <span face=""arial" , "helvetica" , sans-serif">question is</span>,<i><span face=""arial" , "helvetica" , sans-serif"> Is <span face=""arial" , "helvetica" , sans-serif"><span face=""arial" , "helvetica" , sans-serif">spas</span>ticity</span> a problem </span></i><span face=""arial" , "helvetica" , sans-serif">the hand will usually be the first to reveal it</span><i><span face=""arial" , "helvetica" , sans-serif">.</span></i></span></span></span></span></li><li style="text-align: justify;"><span style="font-family: arial; font-size: medium;">Is the survivor paying attention to that hand? Many survivors will play with the affected hand constantly grabbing it and opening it. This is a good sign; <a href="https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects-of-stroke/physical-impact/one-sided-neglect">unilateral neglect </a>is probs not an issue.</span></li><li style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span face=""arial" , "helvetica" , sans-serif">Are they able to squeeze the hand shut from and opened position? A lot of people, even clinicians, think opening is a good thing, but closing is a bad thing. I think closing is a good thing and opening is even a better thing! You need both. It kind of like the joke: "How you feeling?" "I'm alive!" "Well that beats the alternative!" (OK, its a dad joke. But I'm a dad—so its OK!) So, being able to close the hand beats the alternative. </span>The alternative is nothing. The dreaded <a href="http://recoverfromstroke.blogspot.com/2011/05/after-stroke-spasticity-is-bad-thingbut.html">flaccidity</a>.</span></li><li style="text-align: justify;"><span style="font-family: arial; font-size: medium;">Are they able to open the hand? Can they "relax-open" the hand. That is, can the survivor relax the flexors so much that, while there is not contraction of the muscles that open the hand, there is at least a relaxation of the muscles that close the hand. <span face=""arial" , "helvetica" , sans-serif">T</span>hat relaxation is important<span face=""arial" , "helvetica" , sans-serif">. The first thing needed to open the hand is the ability to shut of the muscles that close the hand.</span></span></li><li style="text-align: justify;"><span style="font-family: arial; font-size: medium;">How does the hand look? Is it swollen? Is it the same color as the unaffected side? Does it have the same<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZn7slhi40j1YQaIXS3CQw1OhP-BDSCElRn5d1K1r2NiUXeVX3jBR3J6uBND3baii3Utw6DiR9gHp6CrajtPL9EJn2ys4AH9lNHZSOU79f1L6n3VXVk3GMYOAfyLLjYpbhW0llDu72oYM/s1600/shoulder+han2d.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="121" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZn7slhi40j1YQaIXS3CQw1OhP-BDSCElRn5d1K1r2NiUXeVX3jBR3J6uBND3baii3Utw6DiR9gHp6CrajtPL9EJn2ys4AH9lNHZSOU79f1L6n3VXVk3GMYOAfyLLjYpbhW0llDu72oYM/s320/shoulder+han2d.jpg" width="320" /></a></div>amount of hair. Is it painful. <a href="https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome#/media/File:CRPS_002ms5.jpg">All those can tell you something (esp. in someone who has a post-stroke shoulder dislocation).</a></span></li><li style="text-align: justify;"><span style="font-family: arial; font-size: medium;">What's going on globally? The hand takes up huge swaths of the brain. In some ways the most visible reflection of the brain is the hand, so the hand gives you global perspective on the brain.</span></li></ul><span face=""arial" , "helvetica" , sans-serif"><span face=""arial" , "helvetica" , sans-serif"><span style="font-family: arial; font-size: medium;">So as a <span face=""arial" , "helvetica" , sans-serif">clinician</span><span style="text-align: justify;">—</span>or survivor, or care<span face=""arial" , "helvetica" , sans-serif">giver<span style="text-align: justify;">—</span>the fi<span face=""arial" , "helvetica" , sans-serif">rst thing to ask is, how is the hand doing<span face=""arial" , "helvetica" , sans-serif">?</span></span></span></span></span></span>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-53815116337832713852021-05-20T15:57:00.002-07:002021-05-20T20:17:22.520-07:00Audio: Stop Falling!<p> https://nogginsandneurons.podbean.com/e/stop-falling/</p><p><br /></p><div class="separator" style="background-color: white; clear: both; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; text-align: center;"><div class="separator" style="clear: both;"><a href="https://nogginsandneurons.podbean.com/e/stop-falling/" style="clear: left; color: #d52a33; float: left; margin-bottom: 1em; margin-right: 1em;"><img data-original-height="94" data-original-width="398" height="95" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimcdiARufJl692Us-mIG01o5daaV2BYMjH2kTxvndG-LYoHdNcxm-Y4MGQj4jd2gGy5Wl4wLf_qgOjevpeJ7jOGsVZKx0YlsevoNCRokM0q9QL3IRdCgvp_RYHOI3tpOmPJJxOSVPIi1o/w400-h95/image.png" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border-radius: 5px; border: 1px solid rgb(204, 204, 204); box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 20px; padding: 8px; position: relative;" width="400" /></a></div><span style="font-family: arial; 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background-size: initial; border-radius: 5px; border: 1px solid rgb(204, 204, 204); box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 20px; padding: 8px; position: relative;" width="400" /></a><br /><div><span style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b style="color: #3d85c6;"><br /></b></span></span></div><div><span style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b style="color: #3d85c6;">✨</b><a href="https://nogginsandneurons.podbean.com/" style="color: blue; text-decoration-line: none;">Find the website with all the episodes here</a>.</span></span></div><p><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="text-align: justify;"><span style="font-family: arial; font-size: medium;">Find all episodes on your fav podcast provider: <br /></span></span></p><div><div style="text-align: justify;"><span style="color: #3d85c6; font-family: arial; font-size: medium;"><b>✨</b></span><a href="https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkLnBvZGJlYW4uY29tL05PR0dJTlNBTkRORVVST05TL2ZlZWQueG1s?sa=X&ved=0CAMQ4aUDahcKEwi4sefKwrXwAhUAAAAAHQAAAAAQAQ" style="color: blue; font-family: arial; font-size: large; text-decoration-line: none;"><b><span style="color: #3d85c6;">G</span><span style="color: red;">o</span><span style="color: #ffd966;">o</span><span style="color: #6fa8dc;">g</span><span style="color: #6aa84f;">l</span><span style="color: red;">e</span></b> Podcasts</a><span style="font-family: arial; font-size: large;"> </span><a href="https://tools.applemediaservices.com/podcast/1562571340?country=us" style="color: blue; font-family: arial; font-size: large; text-decoration-line: none;"> </a></div><a href="https://tools.applemediaservices.com/podcast/1562571340?country=us" style="color: blue; font-family: arial; font-size: large; text-align: justify; text-decoration-line: none;">✨iTunes</a><span style="font-family: arial; font-size: large; text-align: justify;"> </span><br /><div style="text-align: justify;"><span style="color: blue; font-family: arial; font-size: medium;">✨</span><a href="https://open.spotify.com/show/59LdkuvthqcGOmn1hgtSB5?si=WFdaKaIcS4Ku94CvMPDM4w" style="color: blue; text-decoration-line: none;"><span style="font-family: arial; font-size: medium;">Spotify</span></a></div></div></div>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-7110570629774435192021-05-16T08:45:00.002-07:002021-06-11T12:58:10.715-07:0010 things that work against survivors.<div class="tab-content" data-tid="yui_3_16_0_1_1446065396744_45843" data-title="Blog post" id="yui_3_16_0_1_1446065396744_45922" style="text-align: justify; visibility: visible;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUiDM9qjSJlx7Nrlv52-EVHk_thUENums5_SXq10NvBxaE2EfFkMYw_xWETcNfqpXju_kzLMbB3nylPLcJN9pACykWvherTKdPtoDjEQQue8QJtbSawvKABvjIN8VFeveKc5w0lHmi59o/s1600/bad+dog.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUiDM9qjSJlx7Nrlv52-EVHk_thUENums5_SXq10NvBxaE2EfFkMYw_xWETcNfqpXju_kzLMbB3nylPLcJN9pACykWvherTKdPtoDjEQQue8QJtbSawvKABvjIN8VFeveKc5w0lHmi59o/s200/bad+dog.jpg" width="185" /></a><span style="font-size: medium;"><b>1.
Fault: survivors, caregivers. </b>Most stroke survivors don't get to the
hospital nearly soon enough. A lot of stroke </span><span style="font-size: medium;">survivors, as they are having the stroke, feel overwhelmed with fatigue-- so they go to sleep. And this delays getting to the hospital. Many other symptoms of stroke are either ignored, or passed off as completely separate issues.</span><br />
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<span style="font-size: medium;"><b>2. Fault: MDs.</b> Once in the hospital stroke is often misdiagnosed. For instance: I cannot tell you how many young survivors have told me that-- once they got to the hospital-- all anyone asked them about was their drug use. Over and over again. Sometime that's germane; you want to know about potential meds interactions and/or if a drug may have caused the stroke. But often MDs will see the young survivor and jump to the conclusion that the symptoms are caused by illegal drugs. This can delay treatment, or reduce the change of getting a particular treatment.<br /><br /><b>3.
Fault: managed care.</b> Survivors are often rushed <i>from</i> the hospital
without the clinicians involved being able to take the time to figure
out what the next best step is. How </span><span style="font-size: medium;">rushed? After stroke it is not uncommon for the survivor to be discharged from the hospital within a few days (2-3)! The mean length of hospital stay for stroke survivors in the US? </span><span style="font-size: medium;"><span style="font-size: medium;">5.2 days.</span> In the <a href="http://stroke.ahajournals.org/content/28/1/137.full">Netherlands its 25 days! </a> </span><br />
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<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIcLyYZZob-yxw6weZV02H_XGymNL7qmGd8MY5al5KDHaNGL51bqTtDe3ztrwei5BQI8SFH4wc16fqUTMdXxsJ_WMFfBTV1iwCyruuu8Hr188-nPeADNsOfWXLgonvzpKYuj3ecWaXZVM/s1600/avg+length+of+stay.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="345" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIcLyYZZob-yxw6weZV02H_XGymNL7qmGd8MY5al5KDHaNGL51bqTtDe3ztrwei5BQI8SFH4wc16fqUTMdXxsJ_WMFfBTV1iwCyruuu8Hr188-nPeADNsOfWXLgonvzpKYuj3ecWaXZVM/s400/avg+length+of+stay.jpg" width="400" /></a></span></div>
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<span style="font-size: medium;"><b><br /></b></span></div><div class="email-wrapped" id="yui_3_16_0_1_1446065396744_46032"><span style="font-size: medium;"><b><br /></b></span></div><div class="email-wrapped" id="yui_3_16_0_1_1446065396744_46032"><span style="font-size: medium;"><b>4. Fault: managed care,
clinicians.</b> Survivors are often sent from hospital to sub optimal
situations. And where survivors are sent next will impact not only
recovery, but also </span><span style="font-size: medium;">is predictive of how much longer they'll live. </span><span style="font-size: medium;"><a href="http://www.managedcaremag.com/archives/1001/1001.stroke.html">Ref1</a></span><span style="font-size: medium;"> ... </span><span style="font-size: medium;"><a href="http://www.medstarnrh.org/2014/07/10/study-individuals-treated-in-inpatient-rehabilitation-hospitals-have-better-outcomes-live-longer/#q=%7B%7D">Ref2</a></span></div>
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<span style="font-size: medium;"><br /><b>5. Fault: managed care,
clinician. </b>Too much therapy too soon within rehabilitation hospitals can
be dangerous to the recovering brain. Survivors are often discharged from hospitals to rehab hospitals. Rehab hospitals require a minimum of 3 hours a day of rehab. Because survivors are discharged soon after their stroke (see #4., above) they are forced to do "too much, too soon" and this can hurt the recovering brain.<br /><br /><b>6. Fault: managed care,
clinicians. </b>Survivors, especially within the first week of their stroke,
are often not given enough opportunity and tools to get decent sleep.
Decent </span><span style="font-size: medium;">sleep is absolutely </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Sleep+Disturbance+Impairs+Stroke+Recovery+in+the+Rat" style="font-size: large;">necessary</a><span style="font-size: medium;"> to post stroke recovery. Noisy environments, sleep interrupted by clinical visits, visiting family.. many things work against the survivor getting the ZZZs necessary to recovery to the fullest potential.</span><br />
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<b style="font-size: large;">7. Fault: clinicians.</b><span style="font-size: medium;"> Rehabilitation clinicians are
sometimes very well trained in the best treatment for stroke recovery.
But they are often not trained nearly enough. Clinicians treat many pathologies – and stroke is only one of them. Survivors would be best served
by being sent to </span><a href="http://www.strokecenter.org/trials/centers/" style="font-size: large;">facilities designed and trained to be the best for stroke</a><span style="font-size: medium;">.</span><br />
<span style="font-size: medium;"><br /><b>8. Fault: managed care, clinicians. </b>Stroke survivors are
often discharged from therapy once there is a perceived "plateau". But
this <a href="http://recoverfromstroke.blogspot.com/2013/03/hell-yes.html">plateau</a> is often more an artifact of poor outcome measures than
actual potential for progress.<br /><br /><b>9. Fault: clinicians. </b>What
survivors will do "with the rest of their life" after they are discharged
from therapy is often left to happenstance. Clinicians would serve
survivors well by working with the survivor immediately "from the first
session" as to what the plan should be once their discharge.<br /><br /><b>10.
Fault: stroke survivors. </b>Survivors often do not work particularly hard
after therapy ends. This is usually because the
survivor doesn't believe that they can get any better. They don't
believe that they can get any better for two reasons: <span style="color: #999999;">a.</span>
Because they've "plateaued" the survivor does not believe they can get
any better <span style="color: #999999;">b.</span><span style="color: #999999;"> </span>Clinicians often lead the survivor to believe that once
they are discharged from therapy – partly because they plateaued and
partly because they're no longer under the care of the therapist –
they won't get any better. How to combat that <a href="http://recoverfromstroke.blogspot.com/2011/11/do-it-yourself.html">here.</a><span id="goog_1169078698" style="font-size: large;"></span><span id="goog_1169078699" style="font-size: large;"></span></span></div>
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Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-76112809719429759912021-05-13T15:33:00.002-07:002021-05-13T17:17:25.051-07:00Audio: Super Survivor Kathy Spencer On Successful Recovery<p> </p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://nogginsandneurons.podbean.com/e/super-survivor-kathy-spencer-on-successful-recover/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img data-original-height="94" data-original-width="398" height="95" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimcdiARufJl692Us-mIG01o5daaV2BYMjH2kTxvndG-LYoHdNcxm-Y4MGQj4jd2gGy5Wl4wLf_qgOjevpeJ7jOGsVZKx0YlsevoNCRokM0q9QL3IRdCgvp_RYHOI3tpOmPJJxOSVPIi1o/w400-h95/image.png" width="400" /></a></div><span style="font-family: arial; font-size: medium;"><div style="text-align: left;"><br /></div></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: arial; font-size: medium;">Kathy Spencer is a survivor who had a stroke. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: arial; font-size: medium;">Then she kicked its ass.</span></div><br /><div class="separator" style="clear: both; text-align: left;"><a href="https://nogginsandneurons.podbean.com/e/super-survivor-kathy-spencer-on-successful-recover/" style="margin-left: 1em; margin-right: 1em;"><img data-original-height="572" data-original-width="1769" height="129" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoXWWwPhxH5XU6wzWPuwolGF5xg_fmQWyRScBxXZVocIeoAniIRbXi19UpuzfDfW1ol8FAR1boj3YQPdAJtRjkZiLzkn_qdQGnq0_NZbgWwZVIskXrtHYkpJXdYp0ddCBjWCpzOJG5LUQ/w400-h129/image.png" width="400" /></a><br /><div><span style="background-color: white; color: #333333; text-align: justify;"><span style="font-family: arial; font-size: medium;"><b style="color: #3d85c6;">✨</b><a href="https://nogginsandneurons.podbean.com/" style="color: blue; text-decoration-line: none;">Find the website with all the episodes here</a>.</span></span></div><p><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: white; color: #333333; font-size: 13px; text-align: justify;"><span style="font-family: arial; font-size: medium;">Find all episodes on your fav podcast provider: <br /></span></span></p><div style="background-color: white; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;"><div style="text-align: justify;"><span style="color: #3d85c6; font-family: arial; font-size: medium;"><b>✨</b></span><a href="https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkLnBvZGJlYW4uY29tL05PR0dJTlNBTkRORVVST05TL2ZlZWQueG1s?sa=X&ved=0CAMQ4aUDahcKEwi4sefKwrXwAhUAAAAAHQAAAAAQAQ" style="color: blue; font-family: arial; font-size: large; text-decoration-line: none;"><b><span style="color: #3d85c6;">G</span><span style="color: red;">o</span><span style="color: #ffd966;">o</span><span style="color: #6fa8dc;">g</span><span style="color: #6aa84f;">l</span><span style="color: red;">e</span></b> Podcasts</a><span style="font-family: arial; font-size: large;"> </span><a href="https://tools.applemediaservices.com/podcast/1562571340?country=us" style="color: blue; font-family: arial; font-size: large; text-decoration-line: none;"> </a></div><a href="https://tools.applemediaservices.com/podcast/1562571340?country=us" style="color: blue; font-family: arial; font-size: large; text-align: justify; text-decoration-line: none;">✨iTunes</a><span style="font-family: arial; font-size: large; text-align: justify;"> </span><br /><div style="text-align: justify;"><span style="color: blue; font-family: arial; font-size: medium;">✨</span><a href="https://open.spotify.com/show/59LdkuvthqcGOmn1hgtSB5?si=WFdaKaIcS4Ku94CvMPDM4w" style="color: blue; text-decoration-line: none;"><span style="font-family: arial; font-size: medium;">Spotify</span></a></div></div></div><p></p>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-27881280390762000432021-05-09T08:48:00.008-07:002021-05-09T15:18:21.781-07:00Audio: The Best Ways To Measure Recovery<p><a href="https://nogginsandneurons.podbean.com/e/measuring-recovery/" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="259" data-original-width="800" height="129" src="https://mcdn.podbean.com/mf/web/5fzay2/good_final9e0le.jpg" width="400" /></a></p><p><span style="font-family: arial; font-size: medium;"><a href="https://nogginsandneurons.podbean.com/e/measuring-recovery/">Here is a short discussion</a> on how to measure small (but important!) changes towards recovery.</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://nogginsandneurons.podbean.com/e/measuring-recovery/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="234" data-original-width="993" height="94" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSxHdu6OSBoMw9REfTRLJ8viyxMaeBiZjJRGjyUYcP5Ynki1ZUfua9l0BYwII00QVYJjLcE-lvXRn-iNp5_KhkzPVMkYBtIUZYBKQUtfQ2EKsi1RYHgpGYGQJDioNSeunv0LXsn36v_OI/w400-h94/Spotify+logo+for+N%2526N+2.jpg" width="400" /></a></div><p><br /></p><p><br /></p><p><br /></p><div><span style="background-color: white; color: #333333; text-align: justify;"><span style="font-family: arial; font-size: medium;"><b style="color: #3d85c6;"><br /></b></span></span></div><div><span style="background-color: white; color: #333333; text-align: justify;"><span style="font-family: arial; font-size: medium;"><b style="color: #3d85c6;"><br /></b></span></span></div><div><span style="background-color: white; color: #333333; text-align: justify;"><span style="font-family: arial; font-size: medium;"><b style="color: #3d85c6;">✨</b><a href="https://nogginsandneurons.podbean.com/" style="color: blue; text-decoration: none;">Find the website with all the episodes here</a>.</span></span></div><p><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: white; color: #333333; font-size: 13px; text-align: justify;"><span style="font-family: arial; font-size: medium;">Find all episodes on your fav podcast provider: <br /></span></span></p><div style="background-color: white; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;"><div style="text-align: justify;"><span style="color: #3d85c6; font-family: arial; font-size: medium;"><b>✨</b></span><a href="https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkLnBvZGJlYW4uY29tL05PR0dJTlNBTkRORVVST05TL2ZlZWQueG1s?sa=X&ved=0CAMQ4aUDahcKEwi4sefKwrXwAhUAAAAAHQAAAAAQAQ" style="color: blue; font-family: arial; font-size: large; text-decoration-line: none;"><b><span style="color: #3d85c6;">G</span><span style="color: red;">o</span><span style="color: #ffd966;">o</span><span style="color: #6fa8dc;">g</span><span style="color: #6aa84f;">l</span><span style="color: red;">e</span></b> Podcasts</a><span style="font-family: arial; font-size: large;"> </span><a href="https://tools.applemediaservices.com/podcast/1562571340?country=us" style="color: blue; font-family: arial; font-size: large; text-decoration-line: none;"> </a></div><a href="https://tools.applemediaservices.com/podcast/1562571340?country=us" style="color: blue; font-family: arial; font-size: large; text-align: justify; text-decoration-line: none;">✨iTunes</a><span style="font-family: arial; font-size: large; text-align: justify;"> </span><br /><div style="text-align: justify;"><span style="color: blue; font-family: arial; font-size: medium;">✨</span><a href="https://open.spotify.com/show/59LdkuvthqcGOmn1hgtSB5?si=WFdaKaIcS4Ku94CvMPDM4w" style="color: blue; text-decoration-line: none;"><span style="font-family: arial; font-size: medium;">Spotify</span></a></div></div>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-26487807914743255682021-03-01T16:03:00.006-08:002021-03-01T16:19:50.769-08:00A short discussion about stroke recovery with Ron Clark from Chat and Spin Radio.<p> </p><p><span face="Roboto, Arial, sans-serif" style="background-color: #f9f9f9; color: #030303; font-size: 14px; white-space: pre-wrap;"></span></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="304" src="https://www.youtube.com/embed/hVbELnecBc0" width="405" youtube-src-id="hVbELnecBc0"></iframe></div><br /><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br />Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-65625640415238637642021-02-14T17:40:00.007-08:002021-02-14T18:55:54.523-08:00What Works (and what does not): Movement, Spasticity, Contracture<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><a href="https://link.springer.com/article/10.1007/s11910-020-1022-z">Here is a great article</a><span> on what works—and what doesn't—for movement, spasticity, and contracture. It's in CP, and tracks well with similar reviews in stroke recovery for all ages. </span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-size: medium;"><span style="font-family: arial;">Its a <a href="https://guides.temple.edu/c.php?g=78618&p=4178713#:~:text=A%20systematic%20review%20is%20defined,The%20methods%20used%20must%20be">systematic review</a>. Here's the good news: This'll be as simple as possible and no simpler. </span><span style="font-family: arial;">There is a great "State of the Evidence Traffic Lights" chart </span><span style="font-family: arial;">that makes the whole thing simple. At the very bottom is the full chart. </span><span style="font-family: arial;">Also note: W</span><span style="font-family: arial;">hat this review says does not wor</span><span style="font-family: arial;">k.</span></span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><span style="font-family: arial;"><b><span style="background-color: #01ffff;">What works: </span></b></span><b style="background-color: #01ffff; font-family: arial;">Movement</b></span></div><div><b style="background-color: #fff2cc; font-family: arial; font-size: large;"> </b><span style="font-family: arial; font-size: x-small; text-align: justify;"><i><span style="background-color: #fff2cc;">Click any image to make it larger</span>.</i></span></div><div><span style="background-color: #01ffff; font-family: arial; font-size: medium;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvplU-QLSxI-cW1SwfJqppB26vA7_g-deYpTrW8nfm7rVXDnKi0kS1J-35Lmo9Mo7U59klLuS3s5WoTg78e3sCj-NlTFqv8JyrEwHNfyAlVzka1GoP4CVr-53xgVq0ws1iWpZX9D-pqJY/s1068/Motor.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="303" data-original-width="1068" height="182" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvplU-QLSxI-cW1SwfJqppB26vA7_g-deYpTrW8nfm7rVXDnKi0kS1J-35Lmo9Mo7U59klLuS3s5WoTg78e3sCj-NlTFqv8JyrEwHNfyAlVzka1GoP4CVr-53xgVq0ws1iWpZX9D-pqJY/w640-h182/Motor.jpg" width="640" /></a></div></span></div><div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial; font-size: medium;"><br /></span></div></div><div><div><span style="background-color: #01ffff; font-family: arial; font-size: medium;"><br /></span></div><div><b><span style="background-color: #01ffff; font-family: arial; font-size: medium;">What works: </span></b></div><div><b><span style="background-color: #01ffff; font-family: arial; font-size: medium;">Spasticity</span></b></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGK2nqAeJW40IafvVmRQioHyjGAut7WhbBCqG7eIEdhjti547kwtSuTlOn0rocZbkv2aHfgmv3BBiuqXqZSZlSnkY4N5_JoRkr1-akgtet9XHUemscPEBEiFxH6BRsUd14Su0S28L3fiQ/s315/Spasticity+Tone.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: arial; font-size: medium;"><img border="0" data-original-height="315" data-original-width="286" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGK2nqAeJW40IafvVmRQioHyjGAut7WhbBCqG7eIEdhjti547kwtSuTlOn0rocZbkv2aHfgmv3BBiuqXqZSZlSnkY4N5_JoRkr1-akgtet9XHUemscPEBEiFxH6BRsUd14Su0S28L3fiQ/w363-h400/Spasticity+Tone.jpg" width="363" /></span></a></div><span style="font-family: arial; font-size: medium;"><br /><b style="background-color: #01ffff;"><br /></b></span></div><div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div><b><span style="background-color: #01ffff; font-family: arial; font-size: medium;">What works: </span></b></div><div><b><span style="background-color: #01ffff; font-family: arial; font-size: medium;">Contracture</span></b></div><div><span style="font-family: arial; font-size: medium;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitf-5kskR6uC04JRbQmFT6nkiLlKhl8WPh8lx63PIALP6ycd30WgLLMrUgq03ak0nuOEeP1N9wzFJVeNmz1glFpvpW7Cqe9CVzJb5PmCQjPfpTTLVqTFhZguAQwY8I-3fV76u_1NVBbiI/s207/Contracture.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="207" data-original-width="205" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitf-5kskR6uC04JRbQmFT6nkiLlKhl8WPh8lx63PIALP6ycd30WgLLMrUgq03ak0nuOEeP1N9wzFJVeNmz1glFpvpW7Cqe9CVzJb5PmCQjPfpTTLVqTFhZguAQwY8I-3fV76u_1NVBbiI/w396-h400/Contracture.jpg" width="396" /></a><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihUUzELzhHSTy6qbA3p2nPNi7qcdRVL0LNW8KODbmx2gsm1o-A0j3JNwBQrhWTMWphQRxh-N5-mptTHF_ajfvGhIjtQcQNLGZNC9r5ATO8wizN58hrMUSJ9mvnQUMs45BTqCI0jJjnezQ/s2048/NDT+sucks+full.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1207" data-original-width="2048" height="378" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihUUzELzhHSTy6qbA3p2nPNi7qcdRVL0LNW8KODbmx2gsm1o-A0j3JNwBQrhWTMWphQRxh-N5-mptTHF_ajfvGhIjtQcQNLGZNC9r5ATO8wizN58hrMUSJ9mvnQUMs45BTqCI0jJjnezQ/w640-h378/NDT+sucks+full.jpg" width="640" /></a></div></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-weight: bold; text-align: left;"><a href="https://link.springer.com/article/10.1007/s11910-020-1022-z">Novak I, Morgan C, Fahey M, et al. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020;20(2):3. Published 2020 Feb 21. doi:10.1007/s11910-020-1022-z</a></span></div></span></div></div></div>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-55801958213066559882021-02-11T17:16:00.002-08:002021-02-11T17:16:39.980-08:00Connie Smiley, Super Survivor<p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial; font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5RCDw4xCqVnaLo1MkYyumCGINlhME4p78VaDCwXmMNXtR1Eo9lFf0ZiE6YeUPAKjMfeIT97ffCpjOh6oa4oS6R5JSMh3CwtNGNmTJKwSX91mioP1TZJ7J7laLZl3pB46YEi8liAXK0No/s602/connie+cropped.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="602" data-original-width="474" height="425" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5RCDw4xCqVnaLo1MkYyumCGINlhME4p78VaDCwXmMNXtR1Eo9lFf0ZiE6YeUPAKjMfeIT97ffCpjOh6oa4oS6R5JSMh3CwtNGNmTJKwSX91mioP1TZJ7J7laLZl3pB46YEi8liAXK0No/w334-h425/connie+cropped.jpg" width="334" /></a></span></div><div style="text-align: left;"><span style="font-family: arial; font-size: medium;"><span style="font-family: arial; font-size: medium; text-indent: 0.5in;">Connie Smiley, one of my favorite people and a survivor who was a friend to our lab for years, passed </span><span style="text-align: left; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">August 6, 2019; I just found out. </span></span></span></div><p></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="text-align: left;"><span style="font-family: arial; font-size: medium;">Connie was zero-nonsense and smart, and exemplified what a super survivor is</span></span><span style="text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">. </span></span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;"><br /></span></span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><br /></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><br /></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">From an <a href="https://recoverfromstroke.blogspot.com/2011/02/26-months.html">earlier post</a>:</span></span></p><p class="MsoNormal" style="background-color: white; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; text-align: justify;"><span style="font-size: medium;"><span face="Arial, sans-serif">A super survivor is “…someone so unwilling to let go of their career, their independence, or a personal passion that they are compelled to recover. They intertwine recovery with what they love to do.” </span></span></p><p class="MsoNormal" style="background-color: white; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; text-align: justify;"><span style="font-size: medium;"><span face="Arial, sans-serif"><b>When somebody can use their life's passion to drive recovery everything is made easier.</b></span></span></p><div class="" data-block="true" data-editor="bcjb8" data-offset-key="1j4i2-0-0" style="background-color: #f0f2f5; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="1j4i2-0-0" style="direction: ltr; font-family: inherit; position: relative;"><ul style="text-align: left;"><li><span data-offset-key="1j4i2-0-0" style="font-family: inherit;"><span style="font-size: medium;">It's easier for the therapist because they don't have to motivate.</span></span></li><li><span data-offset-key="7fruo-0-0" style="font-family: inherit;"><span style="font-size: medium;">It's easier for the stroke survivor because they have a cherished task which drives recovery.</span></span></li><li><span data-offset-key="csa8r-0-0" style="font-family: inherit;"><span style="font-size: medium;">It's easier for the survivor’s brain because when it comes to driving plastic changes "the power is in the focus.” And we tend to focus on what we care about.</span></span></li></ul></div></div><p class="MsoNormal" style="background-color: white; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; text-align: justify;"><span style="font-size: medium;"><span face="Arial, sans-serif"></span></span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">Rewiring the
brain in a way that is robust enough to reestablish control over wayward
muscles takes a concentrated focus on the affected-side of the body. The focus needs
to be near total. This level of focus is <i>only</i>
accessible to stroke survivors who have a passion or avocation that drives them
to the highest possible level of recovery. Connie <a name="OLE_LINK1">Smiley</a> was a survivor who used her avocation to drive her nervous systems
towards recovery far beyond any expectations.</span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">Smiley had her
stroke "The day before Easter," as she remembers it, 1991. The stroke
was on the right side of her brain, affecting her left, non-dominant side. Prior
to her stroke, Smiley was fully aware of the absolutely devastating impact
stroke. “My husband lived for almost 6 years in a nursing home following his
stroke. The damage was too severe to recover—even though he tried. One of the
things that motivated me was seeing the restrictive life he led. I realized
that the same could be true for me, but I decided that, if there was anything I
could do towards recovery, I would do it.” </span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">It is not unusual for stroke
survivors to use the fear of a “restrictive life” as a powerful motivator. Fear
of isolation, fear of falling, fear of dependence–all can motivate. And
motivation is vital to overcoming one of the hardest parts of recovery from
stroke: there is often little interest in relearning how to move. There is none
of the inherent joy of learning as the stroke survivor relearns movement that
they used to do perfectly well. But fear of a “restrictive life” was not Smiley's
only motivator. It was not even her primary motivator. <o:p></o:p></span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">Smiley has a master’s
degree in education and has been a teacher of one sort or another, since. For
more than 30 years she taught primary school. While she was teaching school she
began volunteering at the Cincinnati Zoo, eventually landing a paid full-time
position managing the Zoo’s community outreach program. Her job involved bringing
small animals local schools and introducing the kids to the animals. She has the war wounds to prove it! Smiley
has been bit by every type of mammal she has handled. She sports scars from
snakes, alligators, bearded dragons and was once taloned by a hawk. Although
she was forced into retirement by her stroke she almost immediately went back
to work at the zoo. <o:p></o:p></span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">As Smiley got
back to work, a remarkable neuroplastic metamorphosis took place. In
order for Smiley to be able to handle the animals she was forced to use the
limited dexterity in her affected left hand. Because she was powerfully
motivated by her avocation, the amount of neuroplastic rewiring was remarkable.
But what was more remarkable was where the rewiring took place. Smiley enrolled
in a series of clinical trials at our lab; at the time at University of Cincinnati. All of the clinical trials involved
brain scans; functional magnetic resonance imaging (fMRI) of Smiley's brain.
Traditional MRI provides a static picture of the brain. Functional MRI involves
doing something, in Connie's case a finger tapping task, in the MRI machine.
The fMRI machine measures change in blood flow in the brain as the task is
being done. <o:p></o:p></span></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: arial; font-size: medium;">Usually, the
fingers of the left hand are controlled by the motor cortex that is on the right
side of the brain. But Smiley had rewired her own brain in a rather curious
way. When her fMRI was analyzed it was found that she was controlling her left
hand, not with the right side of the brain, but with the left side. What made
it even more curious was that the scan showed that the left hand had
essentially "borrowed" neuronal firepower from the area of the brain
usually controls the right-hand.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="text-align: left;"><span style="font-family: arial; font-size: medium;">Neuroplasticity</span></span><span style="font-family: arial; font-size: medium;"> happens. The brain decides where it happens. Connie showed us that the brain can do the right thing in the "wrong" part of the brain. That's what super survivors do.</span></p><p class="MsoNormal" style="text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9JXzITo6uqPW_ZwZ5flJKnuy0lICxDy51Sth-hCUaY-kaZlz-SUvah9OMmliGGIfOOpDP5jUQb3Rc3cPTVX_y1jvhbP81ZzOukxFn5Sqcq1t9F5nwVS01TD0_BL-WlYuec-HDmyeQqCE/s610/connie2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="396" data-original-width="610" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9JXzITo6uqPW_ZwZ5flJKnuy0lICxDy51Sth-hCUaY-kaZlz-SUvah9OMmliGGIfOOpDP5jUQb3Rc3cPTVX_y1jvhbP81ZzOukxFn5Sqcq1t9F5nwVS01TD0_BL-WlYuec-HDmyeQqCE/w400-h260/connie2.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial; font-size: large; text-align: justify;">Thank you Connie!!</span></div><br /><span style="font-family: arial; font-size: medium;"><br /></span><p></p>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-91913782112028192002021-01-30T19:43:00.009-08:002021-03-07T16:00:58.807-08:00My interview on the ReneMarie Stroke Of Luck TV Show.<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="text-align: left;"><iframe allowfullscreen="" class="BLOG_video_class" height="322" src="https://www.youtube.com/embed/jaPfQPsU-FI" width="553" youtube-src-id="jaPfQPsU-FI"></iframe></div><div style="text-align: left;"><br /></div><div style="text-align: left;"><span style="text-align: justify;"><b>My interviews starts at about five minutes in...</b></span></div><div style="text-align: left;"><br /></div><div style="text-align: left;">I was interviewed a while ago and peppered with questions from one of the great interviewers of all time: <a href="https://en.wikipedia.org/wiki/Mark_McEwen">Mark McEwen</a>. </div><div style="text-align: left;"><br /></div><div style="text-align: justify;">ReneMarie's show is great to check out. She has <a href="https://www.youtube.com/results?search_query=stroke+of+luck+renemarie">a ton of great content</a> geared towards stroke survivors and recovery.</div></span></div><div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">These guys let me go on and on about a bunch o' stuff including how much its <b>costs to have a stroke</b>, using <b>mental practice</b> as a recovery tool, why <b>empathy is an occupational hazard for therapists</b>, how the <b>medical system in the USA hurts stroke survivors</b>, why <b>athletes and musicians may recover more</b> than most people, why <b>gains are easier early in recovery</b>, and more!</span></div><p></p></div><div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">A couple of days after this show, Mark called me and told me amazing stories about interviewing presidents and other famous people, his career, and his recovery. He said that when his sons (twins, Miles and Griffin) were young he'd talk to them about his career and they would be like, "Old dude reliving the boring old days." But then they came into his office one day and realized the photographs were of Jordon, and Ali, and a whole bunch of other famous athletes and musicians.</span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">"<i>That</i> was a good day."</span></div></div><div style="text-align: justify;"><div class="separator" style="clear: both; text-align: center;"><span style="clear: right; float: right; font-size: medium; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1252" data-original-width="1252" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNNqEjXGuHywYXE_u2KBo3-jQoNx0-lU3OfdWi8QKnD3MWpHOxQMedM2VQIztNfEeAS2Eir4hqZhdww2LsRCk6LE4EN71GQF9B4HTtBHnJdKY7wR8YAHxmE652gjp_y3oFjk0W0MCrObU/s320/4444.jpg" /></span></div><br /><span style="font-family: arial;"><br /></span></div><div><br /></div>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-23551255530346302692020-12-23T16:45:00.010-08:002021-02-11T13:06:47.539-08:00"𝗜 𝗳𝗮𝗹𝗹 𝗼𝗳𝘁𝗲𝗻. 𝗪𝗵𝗮𝘁 𝗱𝗼 𝗜 𝗱𝗼?"<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje5GCMnKQaej_cqwb1uGvPhUsSr2Dlr0WYZ0hc9s7cunjY4y1VSVBZa4e69zgteWxjaOHNk6Xv90uZZKqLz08CtLmD6Fj03c-6gY2Gv57ktwI-X2UrVvgEg9J3KqgWB4v1QBjMDdaC9A8/s320/walking+balance+2.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="311" data-original-width="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje5GCMnKQaej_cqwb1uGvPhUsSr2Dlr0WYZ0hc9s7cunjY4y1VSVBZa4e69zgteWxjaOHNk6Xv90uZZKqLz08CtLmD6Fj03c-6gY2Gv57ktwI-X2UrVvgEg9J3KqgWB4v1QBjMDdaC9A8/s0/walking+balance+2.jpg" /></a></div>Bottom line: You can make your balance better, and have less falls (and have less fear of falling). But it takes a lot of work, because of course it does. And, don't work on the wrong thing. OK, New Bottom Line: It's hard work, and a fundamental mistake (</span>BOOMER JOKE ALERT) may trip you up. </span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b>Is it a balance problem?</b></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">The outside world sees the cause for unsteady walking as a <i>balance</i> problem. If somebody falls they go to therapy for <i>balance</i> training, because they lost their <i>balance</i>. </span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">But, you may say, I don't have bad balance. <i>I know what upright is, but my muscles won't fire when I tell them to, so I fall! It's a muscle problem, not a balance problem. </i>If that's the way you look at it, you're not wrong.</span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">I'm going to say something pretty radical here, so make sure you check with the appropriate healthcare worker before buying into this... </span></div><div style="text-align: justify;"><b><i><span style="font-family: arial; font-size: medium;"><br /></span></i></b></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b><i>You may not have a balance problem.</i></b><span> </span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">Balance problems come form a loss or deficit of one or more of the following:</span></div><div style="text-align: justify;"><ol><li><span style="font-family: arial; font-size: medium;"><b><span>P</span>roprioception</b>: the ability to imagine where your body is in space without looking at it. </span></li><li><span style="font-family: arial; font-size: medium;"><span style="text-align: left;"><b><span>E</span>yesight</b>: </span><span style="text-align: left;">the ability to find "true north" and/or where the horizon is.</span></span></li><li><span style="font-family: arial; font-size: medium;"><span><span style="font-weight: bold;">V</span></span><span style="text-align: left;"><span><b>estibular sense:</b></span></span><b style="background-color: white; text-align: left;"> </b><span><span>the </span><span>ability</span><span> to sense </span><span>movement</span><span>, and know where your head and body are in space. When the vestibular system is not working it's the </span><span>classic</span><span> inner ear problem: </span><span> Meniere's disease, d</span><span style="text-align: left;"><span>izziness, vertigo.</span></span></span></span></li></ol></div><div style="text-align: left;"><span style="text-align: left;"><span style="font-family: arial; font-size: medium;"><br /></span></span></div><div style="text-align: left;"><span style="font-family: arial; font-size: medium;"><span style="text-align: left;"><span><b><span>P</span></b>roprioception, <b><span>E</span></b>yesight,<span> <b>V</b></span>estibular sense. </span></span><b><span>Let's just call them:</span><span> </span><span><span>PEV</span></span></b></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">It's only a <i>balance problem </i>if you have a problem with one or more of <b style="text-align: left;"><span>PEV</span></b>.</span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">And a lot of survivors have problems with <b>PEV</b>, no doubt. But lets say you're a survivor that does <i>not</i> have these problems, why do clinicians and everybody else say you have balance problems? Because: From the outside it looks like you have poor balance. And you <i>do</i> lose your balance. So how is that not balance problem? In any case, you might say: <i>Who cares what the cause is? Even if there's another cause, its a distinction without a difference. I'm still a fall risk.</i></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><i><br /></i></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;">It's important to know what is causing the "balance problems" because you don't want to bark up the wrong tree. And, it is true, there may be multiple trees. What's another tree? Muscles.</span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span>You may have fine </span><b>PEV </b><span>(</span><span>u</span><span>nless you drink a lot, it which case you need another kind of rehab:) So its something else: Muscles. Maybe you know damned well where you are and what you need to do to retain your balance. But the stroke stops you from moving your muscles correctly to "catch" yourself. </span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span>But again, so what? Well, here's the thing. </span><b>PEV</b><span> stuff has a "neoplastic model"</span><span style="text-align: left;"><span>—a way of changing the brain to lesson or fix the problem.</span></span><span> And if you have problems with them, then focus on <span><b>PEV</b></span>.</span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span>But if you don't have balance problems related to </span><b>PEV</b><span>, but have muscles that won't cooperate, then the best recovery option is repetitive practice. </span></span></div><div style="text-align: justify;"><span><span style="font-family: arial; font-size: medium;"><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span><span>I've been in stroke-specific research for a long time. And one of my fav quotes in clinical research is also one of the most obvious and most hilarious: </span></span><i style="background-color: white; text-indent: 48px;">T</i><i style="background-color: white; text-indent: 48px;">ask-specific gait training improves gait post-stroke.</i><i style="background-color: white; text-indent: 48px;"> (<a href="http://www.ebrsr.com/">EBRSR</a>)</i></span></div><div style="text-align: justify;"><span><span style="font-family: arial; font-size: medium;"><br /></span></span></div><div style="text-align: justify;"><span style="text-align: left;"><span style="font-family: arial; font-size: medium;">Walking</span></span><span style="font-family: arial; font-size: medium;"> makes walking better. Hmmmm. Whoda thunk?</span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span><br /></span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span>But what if you can't practice walking because you're afraid you'll fall? Here's some ideas (ASK A QUALIFIED HEALTHCARE WORKER ABOUT THESE SUGGESTIONS!)</span></span></div><div style="text-align: justify;"><span style="text-align: left;"><span style="font-family: arial; font-size: medium;"><br /></span></span></div><div style="text-align: justify;"><span style="text-align: left;"><span style="font-family: arial; font-size: medium;"><b>Treadmills.</b> Treadmills are never ending parallel bars. They expand the size of the gym with a very small footprint. Put a mirror in front of them and they become instantaneous feedback machines. They also provide an essential bit of quantifiable data: speed of gait. </span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b style="text-indent: 24px;"><i><span>Recumbent, 4-limb bilateral trainer</span></i></b><span style="text-indent: 24px;">. Recumbent trainers do not have to break the bank. <a href="https://www.amazon.com/Body-Champ-Trio-Trainer-Elliptical-Stationary/dp/B07GNVC2H4/ref=sr_1_9?dchild=1&keywords=recumbent+stepper&qid=1608769155&sr=8-9">Inexpensive ones</a> can be found for $350 or so. These are essential not only as a pre-ambulation device, but also because they develop cardiovascular and muscular strength. </span>The thing is, fatigue leads to falls. And if your walking has been compromised by stroke, walking takes <i>twice</i> as much muscular and cardio strength as it takes someone who walks "normally." <span style="text-indent: 24px;"> "banking" both muscle and cardio strength are essential to doing the hard work of recovery.</span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span style="text-indent: 24px;"><b><i><span>Some sort of harnessing system for gait training</span></i></b><span>. Stroke recovery works best with over-challenge. Challenge drives neuroplasticity and neuroplasticity drives recovery. It's impossible to over challenge with standard gait training (a gait belt and guarding). The fear of falling on the part of the survivor and the therapist runs headlong into the challenge that needs to be realized. If the survivor is harnessed, falls are impossible and challenge flourishes. Partial weight sported walking is but one option that requires harnessing. Speed intensive treadmill training (also known as speed dependent treadmill training) has shown stellar efficacy in increasing speed of gait. <a href="https://recoverfromstroke.blogspot.com/2010/12/speed-is-good.html">And speed is good</a>. The usual suspect in this category is the <a href="https://www.litegait.com/product/lg-300p">LiteGait</a>. Over ground systems may be a better option for some gyms. </span></span><a href="https://neurogymtech.com/products/bungee-mobility-trainer/" style="text-indent: 24px;">NeuroGym</a><span style="text-indent: 24px;">, </span><a href="https://www.biodex.com/physical-medicine/products/pbws/nxstep/unweighing-system-suspension-and-stabilization" style="text-indent: 24px;">Biodex</a><span style="text-indent: 24px;"> and other companies make over ground systems that provide an inexpensive harnessing option.</span></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="background-color: #ffe599; font-family: arial; font-size: medium;">One last important note:</span></div><div style="text-align: justify;"><div><span style="background-color: #ffe599; font-family: arial; font-size: medium;">Falls very often happen in four situations:</span></div><div><span style="background-color: #ffe599; font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-family: arial; font-size: medium;"><b style="background-color: #ffe599;">• Starting walking</b></span></div><div><span style="font-family: arial; font-size: medium;"><b style="background-color: #ffe599;">• Stopping walking</b></span></div><div><span style="font-family: arial; font-size: medium;"><b style="background-color: #ffe599;">• Turning</b></span></div><div><span style="font-family: arial; font-size: medium;"><b style="background-color: #ffe599;">• Uneven surfaces</b></span></div><div><span style="font-family: arial; font-size: medium;"><b style="background-color: #ffe599;"><br /></b></span></div><div><span style="background-color: #ffe599; font-family: arial; font-size: medium;">So if you find yourself in one of those four situations (and it may happen hundreds of times a day) stop, consider, and then go.</span></div></div>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-88542567485680894372020-12-13T10:00:00.017-08:002020-12-15T14:21:45.989-08:00You've had a 𝙢𝙖𝙨𝙨𝙞𝙫𝙚 stroke? Hold her beer!<div style="text-align: justify;"><div><span style="font-family: arial; font-size: medium;"><span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6kWXrKNmcuPboYnNh-H18yo-qhZcAVSQIX_JZm6I7LHpzknCw8oo54DwUq4B8Q1KNEsVGVpjA-8lRVysUhPtl6XAk-_Xf6pjppxy92jLVwIv80P4NCSPJLBSJsiI_NTOrc4dlVmrJoWc/s2048/michelle.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img border="0" data-original-height="1897" data-original-width="2048" height="409" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6kWXrKNmcuPboYnNh-H18yo-qhZcAVSQIX_JZm6I7LHpzknCw8oo54DwUq4B8Q1KNEsVGVpjA-8lRVysUhPtl6XAk-_Xf6pjppxy92jLVwIv80P4NCSPJLBSJsiI_NTOrc4dlVmrJoWc/w530-h409/michelle.jpg" width="530" /></a></div>Michelle Mack has been a celebrity among brain-obsessed ubernerds (like me <i>hello </i>¯\_(ツ)_/¯) for two decades. She had her stroke before she was born.</span><span> Not only that, but her stroke obliterated an entire hemisphere (and more) of her brain. In a case of <i><b>she didn't know that she wasn't supposed to so she went ahead and did it anyway, </b></i>Michelle has done quite well with a stroke so large it would have killed anyone else. </span></span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-family: arial; font-size: medium;">A while ago I got in touch with Michelle Mack's mom, Carol Mack. Here's what I found out...</span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-family: arial; font-size: medium;"><b>A Misdiagnosed Savant</b></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><span>Michelle was born in 1973 (47 as of 2020). Carol could tell something was wrong when Michelle was a baby: she couldn't roll over—a skill that is usually developed at four months old. Doctors didn't know what was wrong, and misdiagnosed her with a variety of syndromes. </span><span>Carol pointed out that Michelle was traumatized by a lot of her medical treatment. "In her early years she</span><span>—</span><span>unknown to us</span><span>—</span><span>felt traumatized by all the doctor visits and lab work that was done on her," Carol told me in one of our conversations. "Because she rarely forgets anything, all of these memories remain with her." <i>She barely forgets anything</i>. With half a brain. This is a grand example of </span><span style="text-align: start;"><a href="https://www.agnesian.com/blog/acquired-savant-accidental-genius#:~:text=Acquired%20savant%20syndrome%2C%20in%20contrast,such%20CNS%20injury%20or%20disease.">acquired savant syndrome</a>. The brain injury itself unveils some hidden talent. Michelle is also amazing with dates. Carol told me that Michelle watched a lot of Wheel of Fortune. <i>"<b>S</b></i></span><i><b>he plays the game against the TV and wins every night.</b>"</i></span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-family: arial; font-size: medium;"><b>Teach the Teachers</b></span></div><div><span style="font-size: medium;"><span style="font-family: arial;"><span>One of the things that Michelle asked me to remind the world was this: <i>Teach the teachers to do not horrible to people like me. </i></span></span><span style="font-family: arial;">School was tough for Michelle.</span><span style="font-family: arial;"> In school teachers and students ridiculed her and call her a behavior problem. In their defense, teachers were not particularly well trained for any sort of cognitive issues until quite recently. This was true with ADHD, dyslexia, as well as any sort of brain injury. I am dyslexic and I have ADHD, and even with those</span><span style="font-family: arial;">—</span><span style="font-family: arial;">relative to Michelle</span><span style="font-family: arial;">—</span><span style="font-family: arial;">mild issues, most (not all) teachers were pretty horrid back in the 60's and 70's. It wasn't until 1975 that congress mandated that schools provide kids with <a href="https://www.mcrel.org/differences-not-disabilities/">learning differences</a> (trust me that's what they are) with "appropriate public education." Before that it was mostly just <i>You're dumb, or you're lazy, but I suspect both. Sit down, shut up, and don't disturb the smart kids.</i></span></span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b>Finally: The Diagnosis</b></span></div><div style="text-align: justify;"><span face="Arial, sans-serif" style="font-family: arial; font-size: medium;">Michelle was
misdiagnosed and sent into a schooling system that treated her badly. Then in
1997 something changed: Her brain was scanned. Here is the scan: </span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl8CWF3G0qJmWvqGJor2OUNkVrTaTF1u_orjCRSWHkm1KV7XQ-1x_wixBst-E0kWb7PiwBg2902QssqrHeTbnCztI7wuIaN5Skd6RQ8Yf7mKXQURbwMPn0r8dljLXSoTJQZWF_59CYT_A/s141/michelle2.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img border="0" data-original-height="141" data-original-width="95" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl8CWF3G0qJmWvqGJor2OUNkVrTaTF1u_orjCRSWHkm1KV7XQ-1x_wixBst-E0kWb7PiwBg2902QssqrHeTbnCztI7wuIaN5Skd6RQ8Yf7mKXQURbwMPn0r8dljLXSoTJQZWF_59CYT_A/w173-h256/michelle2.jpg" width="173" /></a></div></span></div><div style="text-align: justify;"><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face="Arial, sans-serif"><span style="font-family: arial; font-size: medium;">This image<i> looks like </i>right
side of Michelle's brain is gone. But this this image is taken in <a href="https://www.blogger.com/blog/post/edit/8174880937451768707/8854256748568089437"><span style="color: blue;">radiological convention</span></a>. What
is radiological convention? Imagine you've entered a patient's room.
You are at the foot of the bed looking at them. That's radiological
convention: As if you're standing at the foot of their bed.</span></span><span style="font-family: "Times New Roman", serif; font-size: 13.5pt;"><o:p></o:p></span></p></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-family: arial; font-size: medium;">In the cartoon below, you are person A.</span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: arial; font-size: medium; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAZDophz7_O7ABw2m0jD0nRAm97fbFolN8ZcPm9bWyNSEQ0QSGyzy2lv-eBQiBhdygOiYXpKAwpRa8eZrQCvZnnVfe-3xKOMsOTKkqPut4dotod4s3XNhm58YcMd2UGkKHEOf7E-twKJI/s952/radiological+convention+scan.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="670" data-original-width="952" height="273" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAZDophz7_O7ABw2m0jD0nRAm97fbFolN8ZcPm9bWyNSEQ0QSGyzy2lv-eBQiBhdygOiYXpKAwpRa8eZrQCvZnnVfe-3xKOMsOTKkqPut4dotod4s3XNhm58YcMd2UGkKHEOf7E-twKJI/w389-h273/radiological+convention+scan.jpg" width="389" /></a></span></div><span style="font-family: arial; font-size: medium;"><span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl8CWF3G0qJmWvqGJor2OUNkVrTaTF1u_orjCRSWHkm1KV7XQ-1x_wixBst-E0kWb7PiwBg2902QssqrHeTbnCztI7wuIaN5Skd6RQ8Yf7mKXQURbwMPn0r8dljLXSoTJQZWF_59CYT_A/s141/michelle2.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img border="0" data-original-height="141" data-original-width="95" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl8CWF3G0qJmWvqGJor2OUNkVrTaTF1u_orjCRSWHkm1KV7XQ-1x_wixBst-E0kWb7PiwBg2902QssqrHeTbnCztI7wuIaN5Skd6RQ8Yf7mKXQURbwMPn0r8dljLXSoTJQZWF_59CYT_A/w125-h185/michelle2.jpg" width="125" /></a></div>The scan shows that the stroke took the left side of Michelle's brain. And for those of you that have had stroke on the left side of your brain, you know there's one really important function there: Language. Broca's area (thinking of words to say) and Wernicke's area (understanding words you hear) are both on the left side.</span></span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-family: arial;"><span style="font-size: medium;">But what about Michelle? Did she lose language? Nope. Michelle could always talk. And her ability to speak has always been appropriate for her age. She would sometimes perseverate quite a bit (I want, I want, I want...), and was not able to be subjective; everything was black-and-white. A big day came when Michelle was sarcastic to Carol. <i>Bottom line</i>: No left hemisphere, spoke and understood language perfectly.<br /></span></span></div><div><span style="font-family: arial;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: arial;"><span style="font-size: medium;"><b>A North Star for folks with brain injury</b></span></span></div><div><span style="font-family: arial;"><span style="font-size: medium;">Michelle Mack is an inspiration, straight up. I'm sure she doesn't feel like one, but she should. She's an inspiration for people with brain injury. But she's also a North Star for people like me. We all think we're dumb sometimes, but we're not. Our disabilities can reveal greatness.</span></span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-family: arial; font-size: medium;"><b>Coda</b></span></div><div><span style="font-family: arial; font-size: medium;">When people have a brain injury—including stroke—during the first year of life its called cerebral palsy, or CP. Most cases of CP are in utero strokes. That's what happened to Michelle. </span></div><div><span style="font-family: arial; font-size: medium;"><br /></span></div><div><span style="font-family: arial; font-size: medium;">Stroke survivors often describe their stroke as massive. But the term is pretty useless. What is generally meant is that the stroke was big; so big it was massive. But there is no scientific definition of how big a stroke has to be to be "massive". One thing I suggest to survivors is this: </span><span style="font-size: medium;"><span style="font-family: arial;">If you've had a stroke, there's an image. Get it.</span><span style="font-family: arial;"> As painful as it may be to look at, get a copy of any post-stroke image of your brain. This may actually be good news. You may imagine the infarct (the "dead zone") as much larger than it is.</span></span></div></div>
Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com1tag:blogger.com,1999:blog-8174880937451768707.post-66402013971126062452020-11-10T17:57:00.006-08:002020-12-09T19:17:39.880-08:00Pete On a Podcast <p><br /></p><p style="text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://strokecast.com/2020/11/10/ep-115-stronger-after-stroke-with-peter-g-levine/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;" target="_blank"><span style="font-size: medium;"><img border="0" data-original-height="132" data-original-width="590" height="90" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgc41crVaUiMZPTuFhJQLDYBtBqXJ-73Whh7OPN-UxWj89KUG0DhJpQIwxJ0lEL4xLSwo6d9xDsD-lUrRCQhLR-trVO2918h89mtYCfSnTldMylwU_3t8MPvvVrCvOLtSqm0RnWxUKSCqM/w376-h90/strokecast.jpg" width="376" /></span></a></div><p></p><p style="text-align: justify;"><span style="font-family: arial; font-size: large;"><br /></span></p><p style="text-align: justify;"><span style="font-family: arial; font-size: large;"><br /></span></p><p style="text-align: justify;"><span style="font-family: arial; font-size: large;"><br /></span></p><p style="text-align: justify;"><span style="font-family: arial; font-size: large;">I was interviewed on the </span><b style="font-family: arial; font-size: large;"><i>Strokecast</i></b><span style="font-family: arial; font-size: large;"> podcast by Super Survivor Bill Monroe. </span></p><p style="text-align: justify;"><span style="font-family: arial; font-size: large;">We talked about stroke recovery while touching on everything from Malcolm Gladwell, to the po</span></p>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-67923685262343768002020-10-30T13:18:00.011-07:002021-08-23T17:59:36.492-07:00Get better movement without moving a muscle<p style="text-align: justify;"><span face="Arial, sans-serif" style="font-size: 14pt;">Let me come straight to the point: There are three ways to
drive changes in your brain to help you move better. All three effect
very similar parts of the brain. And here is something that warms my lazy
heart: <i>Two of them you don't have to move a muscle!</i></span></p><p><b style="text-align: justify;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKVaUftU81M4gRYUFRWPicDO6A1LMjL-RaK4mUS2vfsNESOMWKY0SCbxsgNNqIKvYNaWAnP3cb1TG1_LbRPqpfpChyd6v5D-k0SnldWVWcXMT5teS51PG8VEac-noBQ1T2BiHHj6I6UD0/s705/action+observation.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="517" data-original-width="705" height="294" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKVaUftU81M4gRYUFRWPicDO6A1LMjL-RaK4mUS2vfsNESOMWKY0SCbxsgNNqIKvYNaWAnP3cb1TG1_LbRPqpfpChyd6v5D-k0SnldWVWcXMT5teS51PG8VEac-noBQ1T2BiHHj6I6UD0/w400-h294/action+observation.jpg" width="400" /></a></b></p><p style="text-align: justify;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKVaUftU81M4gRYUFRWPicDO6A1LMjL-RaK4mUS2vfsNESOMWKY0SCbxsgNNqIKvYNaWAnP3cb1TG1_LbRPqpfpChyd6v5D-k0SnldWVWcXMT5teS51PG8VEac-noBQ1T2BiHHj6I6UD0/s705/action+observation.jpg" style="margin-left: 1em; margin-right: 1em;"></a></b></p>
<p style="text-align: justify;"><span face="Arial, sans-serif"><span style="font-size: 14pt;">The </span><span style="font-size: 18.6667px;">image</span><span style="font-size: 14pt;"> above is from</span></span><span face="Arial, sans-serif" style="font-size: 14pt;"> researchers Robert M Hardwick, Svenja Caspers, Simon B Eickhoff, and Stephan P Swinnen. (</span><span face="Arial, sans-serif" style="font-size: 14pt;"><a href="https://www.biorxiv.org/content/biorxiv/early/2017/10/10/198432.full.pdf">Reference</a>)</span></p><p style="text-align: justify;"><b><span face="Arial, sans-serif" style="font-size: 14pt;">What moves your body? It always starts with the brain!<o:p></o:p></span></b></p>
<p style="text-align: justify;"><span face="Arial, sans-serif" style="font-size: 14pt;">We all know that muscles move us.
But the brain moves muscles. This idea is lost on a lot of clinicians
in rehab. They'll talk about muscle strength, range of motion, quality of
movement, etc. etc. etc., but not talk about the brain. Why don't they talk
about it? They can't see it. They can't measure it. And really, they can't help
it. <o:p></o:p></span></p>
<p style="text-align: justify;"><b><span face="Arial, sans-serif" style="font-size: 14pt;">How do you get the brain to
change to move better?<o:p></o:p></span></b></p>
<p style="text-align: justify;"><span face="Arial, sans-serif" style="font-size: 14pt;">There's a bunch of ways to get the
brain to rewire for better movement. <o:p></o:p></span></p>
<p style="text-align: justify;"><b><span face="Arial, sans-serif" style="font-size: 14pt;">1: Move</span></b><span face="Arial, sans-serif" style="font-size: 14pt;"><b>.</b> </span><i style="font-size: 18.6667px;">This is called<b> repetitive practice. </b></i><span style="font-size: 14pt;">"We
are we repeatedly do. Excellence, then, is not an act but a habit.” (</span><a href="http://www.universalethics.org/Ideas/Virtue_as_a_habit.htm" style="font-size: 14pt;">Will
Durant, paraphrasing Aristotle</a><span style="font-size: 14pt;">). The more you do a movement repetitively,
the more the part of the brain that controls that movement is activated.<span style="color: red;"><b>*</b></span> Note: No one else can do
if for you, it has to be you doing the work. Musicians know it, athletes know
it, dancers know it, martial artists know it, and now you know! More info</span><a href="https://recoverfromstroke.blogspot.com/2013/09/repetitive-practice-stroke.html"><span style="font-size: 14pt;"> here</span><span style="font-size: 14pt;">. </span></a></p><p style="text-align: justify;"><b><span face="Arial, sans-serif" style="font-size: 14pt;">2: Imagine a movement</span></b><span face="Arial, sans-serif" style="font-size: 14pt;">. </span><i style="font-size: 18.6667px;">This is called <b>mental imagery</b>, or<b> mental practice. </b></i><span style="font-size: 14pt;">If you imagine doing a movement the way you did it prior to your brain injury, the part of the brain that controls that movement is activated.</span><b style="color: red; font-size: 18.6667px;">*</b><span style="font-size: 14pt;"> </span><a href="https://recoverfromstroke.blogspot.com/2019/09/"><span style="font-size: 14pt;">More </span><span style="font-size: 18.6667px;">info</span><span style="font-size: 14pt;"> here</span></a><span style="font-size: 14pt;"><a href="https://recoverfromstroke.blogspot.com/2013/09/repetitive-practice-stroke.html">.</a> </span></p>
<p style="text-align: justify;"><b><span face="Arial, sans-serif" style="font-size: 14pt;">3: Watch someone else do the
movement.</span></b><span face="Arial, sans-serif" style="font-size: 14pt;"> </span><span style="font-size: 18.6667px;">This is called </span><b style="font-size: 18.6667px;"><i>action observation</i></b><span style="font-size: 18.6667px;">. </span><span style="font-size: 14pt;">If you watch someone do a movement, the part of the brain that
you use to do that movement is activated.</span><b style="color: red; font-size: 18.6667px;">* </b><a href="https://recoverfromstroke.blogspot.com/2019/01/" style="font-size: 14pt;">Find
instructions here</a><span style="font-size: 14pt;">. </span></p><p style="text-align: justify;"><span style="font-size: 14pt;"></span></p><p style="text-align: justify;"><span style="font-size: 18.6667px; text-align: left;"><b>About this image:</b></span></p><p style="text-align: justify;"><span style="font-size: 18.6667px; text-align: left;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifScV9x19plg2EgPY4qnKnJ52q4JFavIFSvlitmAzr91saBCEU2YLYIkBTODmYnR6ZnueF-G4JsAC3JrOGuV5tpfhQNfxOZyIexE1KX8qRwH12bfcEDGuF9QzjAHCix6fdC1L4KhKNN_A/s705/action+observation.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="517" data-original-width="705" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifScV9x19plg2EgPY4qnKnJ52q4JFavIFSvlitmAzr91saBCEU2YLYIkBTODmYnR6ZnueF-G4JsAC3JrOGuV5tpfhQNfxOZyIexE1KX8qRwH12bfcEDGuF9QzjAHCix6fdC1L4KhKNN_A/s320/action+observation.jpg" width="320" /></a></div><span style="font-size: 18.6667px; text-align: left;"><div style="text-align: justify;">This three-pane image above shows the parts of the brain activated during movement, action observation, and mental practice. </div></span><div style="text-align: justify;"><span style="font-size: 18.6667px; text-align: left;"><br /></span></div><div style="text-align: justify;"><span style="font-size: 18.6667px; text-align: left;">There <i>are </i>differences. For instance, in action observation the part of the brain that is used for vision is activated because the observer is seeing someone else do the movement. But overall, there is a lot of overlay between the three activities!</span><p></p><p></p></div><div style="text-align: justify;"><span style="font-size: 18.6667px; text-align: left;"><br /></span></div><div style="text-align: justify;"><span style="font-size: 18.6667px; text-align: left;"><b style="color: red; text-align: justify;">*All three of these techniques will activate movement centers in the brain. </b><span style="text-align: justify;">If they are activated enough, that part of the brain gets bigger. How much is enough? </span></span><span style="font-size: 18.6667px;">I'll argue <a href="https://www.google.com/books/edition/Stronger_After_Stroke/Vt1JDwAAQBAJ?hl=en&gbpv=1&dq=%22pick+options+that+use+repetitive+practice%22&pg=PR17&printsec=frontcover">at least 1200 repetitions</a> in a single-joint movement. </span><span style="font-size: 18.6667px;">All three also add more blood vessels, and more connections in the brain. </span></div>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-83478599769561731012020-09-29T15:33:00.033-07:002021-06-24T21:56:20.309-07:00tPA: 𝙎𝙩𝙞𝙡𝙡 Not Used Enough <p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;"><span style="font-family: arial; font-size: medium;"><b></b></span></p><div class="separator" style="clear: both; text-align: center;"><br /></div><span style="font-family: arial;"><div class="separator" style="clear: both; font-size: large; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2KFy7M1P1F1LwKTtA2xk_No-t5oyStPjmjnhAM0Sf9-4CIIIWUGi_4mj6TzdyX540AaRXr7_ppZCG1OS_QBA6Wz-aaxdqmk2FgsQFbx1o-E_Sxdpx39jOYE2M5eTXo-2-WOi5hbJ-GA8/s544/tpa.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="544" data-original-width="372" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2KFy7M1P1F1LwKTtA2xk_No-t5oyStPjmjnhAM0Sf9-4CIIIWUGi_4mj6TzdyX540AaRXr7_ppZCG1OS_QBA6Wz-aaxdqmk2FgsQFbx1o-E_Sxdpx39jOYE2M5eTXo-2-WOi5hbJ-GA8/s320/tpa.jpg" /></a></div><span><div style="text-align: justify;"><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face="Arial, sans-serif"><span style="font-size: medium;">I'm reading the book <b><i>tPA
for Stroke: The Story of a Controversial Drug</i></b><i>*</i> about the
clot busting drug that's used in "block" (ischemic) strokes.<b> </b>It
was published in 2011. </span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span face="Arial, sans-serif"><span style="font-size: medium;">The book tells the long, winding,
political, and controversial path <b>tissue plasminogen activator</b> (tPA)
took to get to market, and then be—somewhat at least—accepted as a treatment
for ischemic (block) strokes. Is TPA still controversial? For some
reason, <i>yes</i>.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: medium;"><b><span face="Arial, sans-serif">Interesting Facts About TPA</span></b><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: medium;"><span style="font-family: "Times New Roman", serif;"><a href="https://www.ahajournals.org/doi/full/10.1161/JAHA.112.000071"><span face=""Arial",sans-serif">•A study by the American Heart
Association</span></a></span><span face="Arial, sans-serif"> looked at data from 300,000+
ischemic stroke patients, TPA was administered to 3.3% of patients. </span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">2.2% of patients at regular
hospitals got tPA</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">6.7% at hospitals with <a href="https://www.strokeinfo.org/differences-between-a-primary-vs-comprehensive-stroke-center/">PrimaryStroke Center Certification</a>. </span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">Survivors are three times more
likely to get tPA if at a certified stroke center.</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: medium;"><b><span face="Arial, sans-serif">•In 2019 the journal <i><span style="background: white;">Stroke</span></i><span style="background: white;"> did a<a href="https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.025352"> </a></span></span></b><span face="Arial, sans-serif"><a href="https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.025352">review
of malpractice suits</a> relating to treatment of stroke in hospitals</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">Almost 30% of the cases were failure
to treat with tPA.</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">The average payout for pre-trail
settlements was $1.8m. The average payout for court verdicts was almost $10m.</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: medium;"><b><span face="Arial, sans-serif">•A 2020 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067546/">article</a></span></b><span face="Arial, sans-serif"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067546/"> in the <i>Journal
of the American Academy of Neurology</i></a> found <i>“Overall, about
one-quarter of eligible patients with AIS (‘block stroke’) presenting within 2
hours of stroke onset failed to receive tPA treatment.”</i></span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">The article points out that women
and minorities are undertreated with tPA because of course they are.<o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-family: "Times New Roman", serif;"><span style="font-size: medium;"> </span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -67.5pt;"><span style="font-size: medium;"><b><span face="Arial, sans-serif">•Speaking of women</span></b><span face="Arial, sans-serif">: Another 2020 article in the Journal of the American Academy of Neurology found…</span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">Compared to men, women were 30% less
likely get tPA.</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">Sidenote: Women are also less likely
to receive aggressive treatment when it comes to heart attack.<o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-family: "Times New Roman", serif;"><span style="font-size: medium;"> </span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-size: medium;"><span face="Arial, sans-serif">•<b>Weird Science</b>: tPA is never
safe for hemorrhagic strokes. <i>Except sometimes</i>.</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.75in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Times New Roman", serif;">
</span><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif">There
are multiple studies (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356690/">1</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525480/">2</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154627/">3</a>)
showing that tPA can be used to increase longevity, decrease incrainial
pressure (pressure on the brain inside the skull), and reduce injury to neurons
from hydrocephaly (brain swelling). Note: t-PA in "bleed" stroke
shows efficacy in ongoing <i>clinical trials, </i>not yet in clinical
practice. The data we're waiting on is from the<a href="https://pubmed.ncbi.nlm.nih.gov/32075571/"> CLEAR
III trial</a>. </span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-indent: -0.25in;"><span style="font-size: medium;"><span face="Arial, sans-serif">
•<b>Can tPA be given for a second stroke? <i>Yes!</i> </b>About
25% of survivors will have a second stroke. So its important to know two
things: </span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122; font-family: "Cambria Math", serif;">⇒</span><span face="Arial, sans-serif" style="background: rgb(248, 249, 250); color: #202122;">You
should know the FAST test. Better yet, know A <a href="https://recoverfromstroke.blogspot.com/2018/09/a-problem-with-fast-test-yes-and-no.html">better version of the test</a>.</span><span style="font-family: "Times New Roman", serif;"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span style="background: rgb(248, 249, 250); color: #202122;">⇒</span><span face="Arial, sans-serif" style="background: rgb(248, 249, 250); color: #202122;">tPA is safe and just
as effective for a second stroke. Or, if you want it more science-y: <a href="https://n.neurology.org/content/90/15_Supplement/S21.007">"</a></span><span face="Arial, sans-serif" style="color: #202122;"><a href="https://n.neurology.org/content/90/15_Supplement/S21.007">Repeated
use of IV-tPA was not associated with an increased risk of intracerebral
hemorrhage or death in patients with recurrent acute ischemic stroke."</a></span><span face="Arial, sans-serif"><a href="https://n.neurology.org/content/90/15_Supplement/S21.007"> </a><b><a href="https://n.neurology.org/content/90/15_Supplement/S21.007"> </a><o:p></o:p></b></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-family: "Times New Roman", serif;"><span style="font-size: medium;"> </span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -76.5pt;"><span style="font-size: medium;"><b><span face="Arial, sans-serif">•Is tPA effective and safe if you're over 80? Yes! </span></b><span face="Arial, sans-serif"><o:p></o:p></span></span></p><p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 63pt; text-indent: -9pt;"><span style="font-size: medium;"><span face="Arial, sans-serif"> </span><span face="Arial, sans-serif" style="text-indent: -9pt;"> </span><span style="font-family: "Cambria Math", serif; text-indent: -9pt;">⇒</span><span face="Arial, sans-serif" style="text-indent: -9pt;"><a href="https://www.acc.org/latest-in-cardiology/journal-scans/2020/07/14/11/48/alteplase-for-acute-ischemic-stroke">Patients
>80 years do better with IV tPA than without it</a></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 1in; text-indent: -0.25in;"><span style="font-size: medium;"><span face="Arial, sans-serif"> </span><span style="font-family: "Cambria Math", serif;">⇒</span></span><span face="Arial, sans-serif"><span style="font-size: medium;"><a href="https://www.acc.org/latest-in-cardiology/journal-scans/2020/07/14/11/48/alteplase-for-acute-ischemic-stroke">tPA
is effective in survivors of advanced age whether in large academic
centers or in community hospitals</a></span></span></p></div></span></span><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;"><span><span style="font-family: arial; font-size: medium;">*<a href="https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.021264">The author,
Justin Allen Zivin, MD, Ph.D</a>., passed away in 2018 at age 71. He dedicated his career to identifying treatments for stroke, specifically
the use of tissue plasminogen activator, or tPA... He encouraged the National
Institute of Neurological Disorders and Stroke to change the paradigm for
clinical stroke research, organizing a study that required a complete
rethinking of how stroke care is managed.</span></span></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;"><span><span style="font-family: arial; font-size: medium;">This book was co-authored by <a href="https://lareviewofbooks.org/contributor/john-galbraith-simmons/">John Galbraith Simmons</a>.</span></span></p><p></p>Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-22799724667008079182020-08-27T19:01:00.011-07:002020-09-08T19:31:12.860-07:00F$#^R& The Plateau!<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br />
</span><div class="separator" style="clear: both; text-align: center;">
<span style="font-family: arial; font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiApVHNe-Qpj7N-KztHJyYvAJfCyBrUhJaBp6HuQEIudsm5r5J0CYSH91nffoaVcqhxRTkfNtrj_askdMM4fNCvltxw9NH0gV6jnKzNnwPak8G4uxR5tNa6MfZVn_UaAb8RqP8qc7BLJnY/s1600/get+out+the+rut.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="415" data-original-width="680" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiApVHNe-Qpj7N-KztHJyYvAJfCyBrUhJaBp6HuQEIudsm5r5J0CYSH91nffoaVcqhxRTkfNtrj_askdMM4fNCvltxw9NH0gV6jnKzNnwPak8G4uxR5tNa6MfZVn_UaAb8RqP8qc7BLJnY/s320/get+out+the+rut.jpg" width="320" /></a></span></div>
</div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b>Three quick suggestions to continue breaking though plateaus: </b></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b>Change things up</b>. Do not fall into what athletes call habituation; doing the same thing and expecting better movement. Work (within sane limits of safety) <i>beyond</i> your ability. In other words, the same old will get you more of the same old movement. New, done correctly, will get you new movement.</span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><b>Let an athletic trainer help you be a better athlete</b>. Explore the option of working with an athletic trainer (AT). (Note: In the USA an AT is a Masters degree. They understand what a stroke is, and safety concerns). The AT may help unleash your inner athlete. Therapists sometimes focus on reducing deficits. They have to: They're trying to get you safe, "functional," and back home. ATs tend to focus on better movement, and will look at survivors the way they look at any athlete. To them, you'll just be another athlete. A <a href="https://recoverfromstroke.blogspot.com/2008/09/good-excuse-to-watch-football.html">"low level athlete playing a higher stakes game."</a></span></div><div style="text-align: justify;"><span style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><b>If you don't work out, plan on weakness.</b> Never underestimate the value of the hard work you are doing in the gym (<a href="https://recoverfromstroke.blogspot.com/2020/06/space-to-recoverthe-home-gym.html">home gym</a>, place where you exercise/ meditate/ stretch, etc.). Survivors take twice as much energy as aged-matched couch potatoes to do every movement (i.e. dressing, walking bathing). So survivors need “banked” energy to live their life. On top of that, survivors need even more energy to do the hard work of recovery. </span></div><div style="text-align: justify;"><br /></div>
Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com1tag:blogger.com,1999:blog-8174880937451768707.post-58068100896794976362020-06-19T18:01:00.008-07:002020-09-07T14:10:40.189-07:00SPACE TO RECOVER—THE HOME GYM <div style="text-align: justify;">
</div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><span face=""><i>(Note: Having a place to
work out at home is essential when COVID-19 makes it hard to attend
therapy. Here is a free chapter from my book
<a href="https://www.amazon.com/Stronger-After-Stroke-Third-Recovery/dp/0826124135/ref=cm_cr_arp_d_product_top?ie=UTF8">Stronger After Stroke</a> that offers suggestion for an at-home stroke recovery
gym.)</i></span><span face=""><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><br /></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><img border="0" data-original-height="1200" data-original-width="1600" height="375" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhssENg9pMxemJcfrJb-cL7WzzDhwfZ-X2Yx7gm-FYUCJLrPFAVJBtHI2J05fY8AE2T1hYNY2fBo_K-vGz1UYsVI52ss2FL2fpZedkSPR0JuhkXU51VZM6apXc3Dgv7OMj1cB2mekXh6eY/w500-h375/IMG_20200423_151434463_HDR.jpg" style="margin-left: auto; margin-right: auto;" width="500" /></td></tr><tr><td class="tr-caption" style="text-align: center;"><b><span style="font-size: medium;">My kids in our home gym</span></b><br /></td></tr></tbody></table><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
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</v:shape><![endif]--><!--[if !vml]--></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhssENg9pMxemJcfrJb-cL7WzzDhwfZ-X2Yx7gm-FYUCJLrPFAVJBtHI2J05fY8AE2T1hYNY2fBo_K-vGz1UYsVI52ss2FL2fpZedkSPR0JuhkXU51VZM6apXc3Dgv7OMj1cB2mekXh6eY/s1600/IMG_20200423_151434463_HDR.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="color: black; font-size: medium;"></span></a><span style="font-size: medium;"><!--[endif]--><span face=""><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;"><br /></div>Clearly, it’s easier to study at the library, do
paperwork at your desk</span><span face="">, and cook in the kitchen. Every
stroke survivor also needs a space within his or her home dedicated to
recovery. It should be a space where you can focus on recovering from your
stroke. Like a library, it should only have the distractions you want; like a desk,
it should be organized; like a kitchen, it should have all the recovery tools
you need. Some stroke survivors prefer to pursue at least some of their
recovery effort in a community gym. Even if one joins a community gym (see the
section Space to Focus—The Community Gym, later in this chapter), there are
great reasons for having a home gym as well. <span style="color: black;"><o:p></o:p></span></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><b><span face="">How Is It Done? </span></b><span face=""><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><span face="">Your home gym can be a
basement, an extra bedroom, or a corner of a room. It does not have to be big
and does not have to have any more equipment than you need.</span><span face=""><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><span face="">It should have what is
necessary to facilitate recovery. This may include exercise equipment, a TV,
VCR, DVD player, a stereo, and inspirational art. Build your gym as a place of
sanctuary and a place of work. Ideas for equipment include: </span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><img border="0" data-original-height="1600" data-original-width="1200" height="313" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQYgTS-BNdwxEgjJEIMpMXkOuY7y4R6HbQsLBn38Sp-B-0Zzf48AIh-Mq6ki3iZ8KcB4jnNzUfSb2Atg3hj871SSgSUoCFYL0_guhBjZiDzFWBCE8FQfpJCdI2crwEOxpR91e2clOd4NY/w235-h313/IMG_20200524_200005413.jpg" style="margin-left: auto; margin-right: auto;" width="235" /></td></tr><tr><td class="tr-caption" style="text-align: center;">Seven buck at Goodwill!</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQYgTS-BNdwxEgjJEIMpMXkOuY7y4R6HbQsLBn38Sp-B-0Zzf48AIh-Mq6ki3iZ8KcB4jnNzUfSb2Atg3hj871SSgSUoCFYL0_guhBjZiDzFWBCE8FQfpJCdI2crwEOxpR91e2clOd4NY/s1600/IMG_20200524_200005413.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="color: black; font-size: medium;"></span></a></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><br /></span></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">A treadmill </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">A recumbent cycle </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">An upper body ergometer (hand cycle) </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">An exercise mat </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">something used to maintain balance (sturdy chair, etc.) </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Weights </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Resistance bands </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Electrical stimulation devices </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Balls, decks of cards, or other “toys” </div></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span face=""><span style="font-size: medium;"><b><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">A mirror</div></b></span></span></div></blockquote><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><ul type="disc">
</ul></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;"><span style="font-size: medium;">
<span face="">This
list can be as long or as short as it needs to be. A small amount of simple
equipment that is well thought out and well used is better than a lot of
expensive equipment left in a corner. Doctors and therapists can help compile a
list of needed equipment. </span><span face=""><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><b><span face="">What Precautions Should
Be Taken? </span></b><span face=""><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in; text-align: justify;">
<span style="font-size: medium;"><span face="">Be prudent when
assembling the gym and think safety first. Any exercise or therapy equipment
has inherent dangers. For instance, a treadmill provides a moving surface that
may be inappropriate for some stroke survivors. Even something as simple as a
ball can facilitate a loss of balance that can cause a fall. Consider
installing grab-bars for any balance exercises you do. Make sure the floor is
nonslip given the footwear you expect to use. Doctors will tell you if an
exercise or therapy is safe, and therapists will explain how to do the exercise
or therapy in the most effective way possible</span><span face="">.</span></span></div>
Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com1tag:blogger.com,1999:blog-8174880937451768707.post-75939946586446285652020-05-09T13:16:00.000-07:002020-05-09T13:39:12.380-07:00Stroke evaluations drop by nearly 40% during COVID-19 pandemic<div style="text-align: justify;">
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">The New England journal of medicine published <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2014816">an article on May 8th</a> that said the number of people being evaluated in hospitals for stroke has dropped by 40% during the pandemic.</span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGVqBgeaii_qLENZhTN045fhj0v93bDPIglmRaoY1YTv65w1EyE_wxgUBwDdCTMLnAIBGe8sNOFdM9DD7fayHKLPYbaMFDKgxhNwYxn246uaEXRYAQ4we7LYc6P2YbNNV0vYJWlEV8Uh0/s1600/stroke+covid2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="415" data-original-width="1024" height="129" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGVqBgeaii_qLENZhTN045fhj0v93bDPIglmRaoY1YTv65w1EyE_wxgUBwDdCTMLnAIBGe8sNOFdM9DD7fayHKLPYbaMFDKgxhNwYxn246uaEXRYAQ4we7LYc6P2YbNNV0vYJWlEV8Uh0/s320/stroke+covid2.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="background-color: #cccccc; font-family: Arial, Helvetica, sans-serif; font-size: small;">What Covid <i>really </i>looks like</span></td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Here is the study's visual description of that drop.</span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFgGUYUmGvPtEgPs0QaXnw1QL7tqAaQlr-FOAAYJELJCeP8fDJBUZW2p5mJ7yhpOcWH4Up63HgnfV7YOPmfV3nFXlRTGQn0Yd2WCZvF7kiU4YhvPyBr8aCL-svpvFubePtzHePeyYaA04/s1600/stroke+covid.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1194" data-original-width="1600" height="297" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFgGUYUmGvPtEgPs0QaXnw1QL7tqAaQlr-FOAAYJELJCeP8fDJBUZW2p5mJ7yhpOcWH4Up63HgnfV7YOPmfV3nFXlRTGQn0Yd2WCZvF7kiU4YhvPyBr8aCL-svpvFubePtzHePeyYaA04/s400/stroke+covid.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="background-color: #cccccc; font-family: "arial" , "helvetica" , sans-serif; font-size: x-large;">Click to make larger</span></td></tr>
</tbody></table>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Not only are they not being tested, stroke survivors don't even come into the hospital, or wait too long to see treatment. And in a situation where time is brain, that is not good.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">You can find a layman's perspective of this study <a href="https://www.eurekalert.org/pub_releases/2020-05/wuso-sed050820.php">here</a>.</span></div>
Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com0tag:blogger.com,1999:blog-8174880937451768707.post-36493346056436717602020-02-15T18:28:00.012-08:002021-02-05T08:31:54.589-08:00Spasticity: Can ANYTHING be done?<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><span face=""><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4jUI8WVE5DTFkmu4uPxcN762zLCfMhoXOo0VKsuBZcld5SzLkCOLfxwyEpy38f_SfkEEMMejvEJfouH4n6v3KkGrP1SVvYtZvh_K0HzboH04sOFrjk3tyN0aPMM95VObwYvelPyW6dWs/s618/Clipboard01.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="469" data-original-width="618" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4jUI8WVE5DTFkmu4uPxcN762zLCfMhoXOo0VKsuBZcld5SzLkCOLfxwyEpy38f_SfkEEMMejvEJfouH4n6v3KkGrP1SVvYtZvh_K0HzboH04sOFrjk3tyN0aPMM95VObwYvelPyW6dWs/w232-h176/Clipboard01.jpg" width="232" /></a></div></span><span face="">What reduces spasticity?</span></span></div><div style="text-align: justify;"><span face="" style="font-family: arial; font-size: medium;">Does anything <i>eliminate</i> spasticity? </span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><span face=""><br /></span>
<span face="">Below is an outline of various spasticity-reduction treatments.</span></span></div>
<div style="text-align: justify;">
<span><span face="" style="background-color: #fff2cc; font-family: arial; font-size: medium;"><b><br /></b></span></span></div>
<div style="text-align: justify;"><span><span style="background-color: yellow; font-family: arial; font-size: medium;"><b>Treatments that will permanently reduce or eliminate spasticity.</b></span></span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><span><span face=""><b><i><br /></i></b></span></span>
<span><span face=""><b><i>The neuroplastic model of spasticity reduction. </i></b></span><span face="">I developed this one years ago. You can find an outline of it from my <a href="https://tinyurl.com/Nplastic-model">book here</a>. It is the only non-surgical, permanent option on this list. Here is the emerging e<span style="background-color: white;">vidence for the "neuroplastic model of spasticity reduction."</span></span></span></span></div>
<div style="text-align: justify;">
</div>
<ul>
<li><span face="" style="background-color: white; text-indent: -0.25in;"><span style="color: blue;"><span style="color: #464ab0; font-family: arial; font-size: medium;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101928/">Motor learning therapy increased spastic muscle's
contralesional cortical motor regions leading to decreased spasticity</a></span></span></span></li>
<li><span style="font-family: arial; font-size: medium;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/15596776" style="background-color: white; text-indent: -0.25in;">Intensive
training in patients with increased muscle tone improves function without
exacerbating spasticity</a><span face="" style="background-color: white; text-indent: -0.25in;"> </span></span></li>
</ul><div style="text-align: justify;"><span face="" style="font-family: arial; font-size: medium;">Note: there is a lot of other clinical evidence that this model works, but it is typically wrapped up in research of other therapies that use a lot of repetitions. Here are some of them:</span></div>
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</div>
<ul>
<li><span face=""><span style="color: blue; font-family: arial; font-size: medium;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/29200616">CIT reduces
spasticity 2017</a></span></span></li>
<li><span style="font-family: arial; font-size: medium;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22078779" style="text-indent: 0in;"><span style="text-decoration-line: none;">CIT reduces spasticity</span></a><span face="" style="text-indent: 0in;"> <a href="http://www.ncbi.nlm.nih.gov/pubmed/22078779">2013</a></span></span></li>
<li><span face="" style="background-color: white; font-family: arial; font-size: medium; text-align: justify; text-indent: 0in;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958081/" style="background-color: white; text-align: justify; text-indent: 0in;">CIT reduces spasticity and
increases functional use</a></span></li>
<li><span face="" style="color: black; font-family: arial; font-size: medium; text-decoration-line: none;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/15706544">CIT increases strength and decreases spasticity</a></span></li></ul>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><span><span face=""><b>Dorsal root rhizotomy (or selective dorsal rhizotomy). </b></span><span face="">The one "medical" thing that does reduce spasticity in a long-term way is the one that nobody ever talks about. <a href="https://www.youtube.com/watch?v=lsaNdElpmQw">It's neurosurgery— this is in children</a>, but they do it <a href="https://www.youtube.com/watch?v=OPIN1aOrkuI">in adults</a> as well. For the right person, its perfect and permanent. </span></span><br />
<br /></span></div>
<div style="text-align: justify;"><span><span style="background-color: yellow; font-family: arial; font-size: medium;"><b>Treatments that will temporarily reduce or eliminate spasticity.</b></span></span></div>
<div style="text-align: justify;">
<span face="" style="font-family: arial; font-size: medium;"><br /></span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><b>Ice</b><span face="">. <span style="font-weight: normal;">If you ice the spastic muscle for about 20 to 30 minutes you'll get about 20 minutes to a half an hour of a reduction in spasticity. (Technical: It slows the monosynaptic reflex.)</span></span></span></div>
<div style="text-align: justify;">
<span><span face="" style="font-size: medium;"><span style="font-family: arial; font-weight: normal;"><br /></span></span></span></div>
<div style="text-align: justify;">
<span face="" style="font-family: arial; font-size: medium;"><b>Heat.</b> Don't do it. It exacerbates spasticity (Technical: It speeds up the monosynaptic reflex.)</span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><span face=""><b><br /></b></span>
<span face=""><b>Weight-bearing.</b> This is one that a lot of therapists love. Whether you're standing on the leg that's spastic, or putting weight through the upper extremity that spastic, there is a reduction in spasticity. That reduction will last until the next big volitional movement and the spasticity comes back. But it is a great short-term strategy that helps set the survivor up for treatments that are more permanent. </span></span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><span face=""><b><br /></b></span>
<span face=""><b>Stretch. </b>Always the first line of defense. There's a lot of good reasons to stretch, but it does absolutely nothing to reduce spasticity in the long-term. This was established by not one but two <a href="https://www.cochrane.org/CD007455/MUSKEL_stretch-effective-treating-and-preventing-joint-deformities">Cochrane reviews</a>. It didn't even reduce contracture formation. </span></span></div><div style="text-align: justify;"><span face="" style="font-family: arial; font-size: medium;"><br /></span></div><div style="text-align: justify;"><span face="" style="font-family: arial; font-size: medium;">Stretch and weight bearing have the same effect, but also give the same head fake; They work immediately, but stop working after the next big (effortful) movement. </span></div>
<div style="text-align: justify;">
<span style="font-family: arial; font-size: medium;"><span face=""><b><br /></b></span>
<span face=""><b>Botox (and other neurolytics).</b> Back in the day there were a couple of formulations of Botox. Eventually you would become immune to one so they'd use the other one. You'd become immune to the second formulation, and that was the last time it would be effective. Now they have so many formulations that you can be on Botox for the rest of your life. It's a Band-Aid. When it wears off, it's done. It's also an expensive, and often painful Band-Aid. Oh, and it gets in the way of my neuroplastic model.</span><br />
<span face=""><br /></span>
<span face=""><b>Electrical stimulation (</b></span><span face=""><b>E-Stim)</b></span><b>. </b><span face="">Typically this involves </span><span face="">reciprocal</span><span face=""> inhibition of the spastic flexors. Put simply: You E-Stim the muscles opposite the powerful flexor muscles that cause the problem. Example: E-Stim the elbow extensors (triceps) to relax the elbow flexors (biceps, etc.). Various doses will provide a temporary reduction is spasticity.</span></span></div>
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</ul>
Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com6tag:blogger.com,1999:blog-8174880937451768707.post-41261384590483367292020-01-06T20:48:00.002-08:002021-02-22T08:22:27.008-08:00Sorry not Sorry: Stroke Recovery is NOT Proximal to Distal.<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="font-size: medium;"><br />
</span><div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg45m7PEXSB28Qfrd-QvdHnDuaxmP6uunEi6rOAyYcz1Qe7Fbh3Tqw_vbzLihY4wGwLVnV92w3w6zVVqFkkwb3pI-naWSxD5vs2pw56HWs0PBBZP4Zx5txwGAKUvnQ4CJXJFxlvkg8pwWM/s1600/proximal+to+distal.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: medium;"><img border="0" data-original-height="560" data-original-width="448" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg45m7PEXSB28Qfrd-QvdHnDuaxmP6uunEi6rOAyYcz1Qe7Fbh3Tqw_vbzLihY4wGwLVnV92w3w6zVVqFkkwb3pI-naWSxD5vs2pw56HWs0PBBZP4Zx5txwGAKUvnQ4CJXJFxlvkg8pwWM/s320/proximal+to+distal.jpg" width="256" /></span></a></div>
<div style="text-align: justify;">
<span style="font-size: medium;"><span face=""arial" , "helvetica" , sans-serif"><b>There's an old saying among clinicians: Recovery from stroke is proximal to distal. That is, there is a predictable pattern of recovery: proximal (closer to the body) to distal (further from the body). </b></span><br />
<span face=""arial" , "helvetica" , sans-serif"><b><br /></b></span>
<span face=""arial" , "helvetica" , sans-serif"><b>Assuming this may hurt recovery.</b></span><br /><span face=""arial" , "helvetica" , sans-serif"><b><br /></b></span>
<span face=""arial" , "helvetica" , sans-serif">The 'proximal to distal' crowd would say recovery in the arm/hand would be in this order:</span><br />
<span face=""arial" , "helvetica" , sans-serif"><br /><ul><li><span face=""arial" , "helvetica" , sans-serif">first to come back are the muscles in the shoulder and shoulder blades, </span></li><li><span face=""arial" , "helvetica" , sans-serif">then progress to </span><span face=""arial" , "helvetica" , sans-serif">the elbow, </span></li><li><span face=""arial" , "helvetica" , sans-serif">then to the forearm, </span></li><li><span face=""arial" , "helvetica" , sans-serif">then to </span><span face=""arial" , "helvetica" , sans-serif">the wrist, </span></li><li><span face=""arial" , "helvetica" , sans-serif">then the hand, </span></li><li><span face=""arial" , "helvetica" , sans-serif">then </span><span face=""arial" , "helvetica" , sans-serif">the finger joints close to the hand, </span></li><li><span face=""arial" , "helvetica" , sans-serif">then </span><span face=""arial" , "helvetica" , sans-serif">the finger joints furthest from the hand.…</span></li></ul></span>
<span face=""arial" , "helvetica" , sans-serif">But proximal to distal is not accurate any more than assuming that the sun circles the earth because it always rises in the east and sets in the west. Both are based on observation, but neither is based on what is actually happens. </span><br />
<span face=""arial" , "helvetica" , sans-serif"><br /></span>
<span face=""arial" , "helvetica" , sans-serif">Here's what actually happens:</span><br />
<span face=""arial" , "helvetica" , sans-serif"><br /></span>
<span face=""arial" , "helvetica" , sans-serif">1. You have a stroke; one side of your body is affected</span><br />
<span face=""arial" , "helvetica" , sans-serif">2. The proximal muscles (i.e. shoulder) have <a href="https://www.ncbi.nlm.nih.gov/pubmed/15316706">bilateral innervation</a>; both sides of your brain control the proximal muscles.</span><br />
<span face=""arial" , "helvetica" , sans-serif">3. Your shoulder comes back first not because of the "proximal to distal rule" but because your brain never ceded control over the shoulder muscles.</span><br />
<span face=""arial" , "helvetica" , sans-serif">4. The clinician sees the shoulder coming back before everything else and figures, "That's the proximal to distal rule!"</span><br />
<span face=""arial" , "helvetica" , sans-serif"><br /></span>
<span face=""arial" , "helvetica" , sans-serif">You might argue, "If the shoulder comes back first, then maybe the reason is wrong, but its a distinction without a difference. Survivors will still see proximal to distal return."</span><br />
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<span face=""arial" , "helvetica" , sans-serif">But what if the fingers are coming back first? Clinicians may not think to test the hand because the shoulder is not back. Or they may focus on shoulder control even though the hand can drive shoulder control if hand movement is recognized and encouraged.</span><br />
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<span face=""arial" , "helvetica" , sans-serif">In the lower extremity, the problem can be even worse. Proximal muscles would move the hip, and those are what are focused on. Meanwhile, an AFO (ankle brace) is routinely put on the survivor even though the ankle (a distal moment) may be coming back on its own.</span><br />
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<span face=""arial" , "helvetica" , sans-serif">And AFOs are easy to walk into, but hard to get rid of.</span></span></div>
Peter G Levinehttp://www.blogger.com/profile/12585356059363005619noreply@blogger.com4