Monday, September 22, 2008

A Good Excuse to Watch Football

When I worked at the Kessler Institute, a big rehab hospital in New Jersey, I worked with exercise physiologist Quin Bond. He changed my perspective about stroke recovery. The way athletic trainers and exercise physiologists look at stroke recovery is different from the way therapists typically view it. Therapists generally view recovery from stroke as a finite proposition. There is a beginning and an end. Most of scientific medicine views stroke recovery the same: finite. Exercise physiologists tend to see stroke recovery is infinite. Athletic trainers, the same. If you're used to working with athletes you're used to people who see progress is infinite. Athletes are always trying to make themselves better at their sport, stronger and faster. There is no difference between athletes and stroke survivors. Stroke survivor simply lower-level athletes playing higher stakes game. There's very little that works with athletes that doesn't work with stroke survivors. Every fundamental concept in athletic training can be superimposed on stroke recovery. Again, lower-level, but the same basic concepts hold true. Training concepts that athletes use can be used to recover from stroke. Basic concepts such as multiple hours (massed) practice, weight training, cardiovascular training, pushing the limits of ability and cross training, etc. all work superimposed on stroke recovery. The bottom line is that stroke survivors should see athletes as inspirational figures.
The photo is of Steve Prefontaine who exemplified the pursuit of the infinite.

Thursday, September 11, 2008

Stroke recovery: A Leap Of Faith

I wrote this article recently. I describe Stroke recovery as a leap of faith, not unlike other leaps of faith we constantly take. Here are some highlights...
  • I talked to a stroke group the other day. They were about 30 strong, and they were feisty. I do talks all over the country on the state of stroke recovery research. I have spoken to audiences that have included therapists, doctors and researchers. But nothing is quite like staring down the barrel of a group of stroke survivors. They've lived through stroke and have, to whatever degree, experienced the loss of control that defines brain damage. Each person who survives stroke is dealt a unique "hand of loss" causing the dispossession of everything from language to limbs, from emotions to personal independence. Stroke survivors have literally been there and back. They can be a bit prickly when someone suggests that they need to work harder. And that's just what I was suggesting.
  • Much of what I believe helps a stroke survivor recover involves a leap of faith. I believe that massed practice works. Massed practice involves literally massing hours of practice together. I believe repetitive practice works. Repetitive practice involves doing the same movement, repeatedly, until long after sanity screams to stop.
  • I believe that there is no way to recover unless the stroke survivor stays aware of new developments for stroke recovery as they emerge. I think stroke survivors need to have a strong cardiovascular and muscular foundation in order to have the energy to do all the other things necessary to recover to the highest level of potential. In short, I believe that stroke recovery is best served if efforts toward recovery are treated like a full-time job
Convincing the Experts
  • When I speak to therapists about this emerging research-based paradigm shift, there is some push back. Therapists give me a sideways look and let me know that I'm whistling a bit of Dixie if I think that most stroke survivors are going to be willing to carry out a complicated and labor-intensive plan.
  • Stroke survivors are more blunt. "Six hours a day of practice! I have better things to do, thanks!" They also ask questions that require absolute answers. "If I do put in the time and effort, what return can I expect?" they demand. "What about the repetitive practice? How many times do I have to repeat a movement before my brain rewires enough to do the movement right?"
  • I've learned to be direct when answering. I tell them, "There are no guarantees. You could work very hard and get very little return. No one knows how many repetitions are needed. Some people think the magic number is 10,000. Others think it's closer to 150,000. Some researchers suggest a million or two. But even if we knew the 'optimal' number, the fact is that the number of repetitions needed is different for every survivor because of any number of variables." Well, to stroke survivors, this is the cherry on top of a mud pie, let me tell you. But I have an ace up my sleeve—and that ace is a mirror.
  • I asked the members of the group what they did before their stroke. One gent had been a lawyer. Another was a farmer. And I have just spent three years writing a book. The three of us were a collective of experts in leaps of faith.
  • I suggested to them that the monumental challenge of law school followed by the bar review then the bar exam (a three-day, six-hours-per-day exam) were several leaps of faith. Betting the farm on the mysterious and unpredictable miracle of life, year-in and year-out, through flood and draught, is the farmer's perpetual leap of faith. And what of the three years spent writing a book distilling the very message I was now telling them? This may have been the ultimate folly. I am guaranteed of selling only five copies—all of them to my mom."

Monday, September 8, 2008

Falls. Only funny in the movies.

There are few luminaries in the stroke recovery game that I really respect. Few bring anything new and most just add to an expanding din of quasi-misinformation. Two that I do respect are Carr and Shepard. These two Aussie therapists are vanguards of the paradigm shift that stroke recovery theory is now in. They have a book called Stroke Rehabilitation (go figure) that has some gems in it. One of those gems is about what causes falls after stroke. I hate falls. Heck, I’ve broken bones falling. For stroke survivors, falls can be the beginning of the end. There is a statistic that has always resonated with me: If someone is 65+ and they have a fall that lands them in hospital for at least one night they have a 50% chance of dying in the next year! And up to that 70 % of patients have a fall in the six months after their stroke.

So what do Carr and Shepard say about falling? Falls very often happen in four situations:

• Starting walking
• Stopping walking
• Turning
• Uneven surfaces

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