Tuesday, November 18, 2008

Wine and Movement.

Motor. Motor. Motor. That's all you ever hear about when it comes to stroke recovery. In rehabilitation research we tend to obsess over movement. Movement quality, movement speed, and how movement effects function. Of course movement is only half the equation. The other half is the feeling of movement. Now-- I know, you're thinking, "Oooh, he's going to get all squishy with the feelings..." Nope. The feeling of a movement is an essential to learning how to move. If you cannot feel the movement, every time you do the movement, it's like the first time. Lack of feeling the eliminates an essential part of the motor learning feedback loop. I did a talk recently to therapists and between spiels a therapist came up and told me that, like me, she thought that the feeling of movement (called proprioception) could be re-taught after stroke. And she put it in a very interesting way. She said it's like learning to appreciate fine wine; at first you can't tell table wine from a 1939 Ch√Ęteau-whatever. But over time, as your palate develops, you learn to taste subtle differences. Bottom line: proprioception can be re-taught.

2 comments:

Dean said...

What did the therapist do to bring back proprioception? I have fairly good balance, I just can't tell where my limbs are in space.

Peter G Levine said...

Dean, Great question and surprisingly little has been written about it. Why the lack o' info? Because it's easy to see and therefor measure movement. How do you measure the feeling of movement?

Of course, I do have some suggestions:

1. Use mirrors. If you don't know where your limbs are,the mirror will tell you.
2. With your eyes closed, move your good side in to a position. With your eyes still closed, try to match the position with you "bad" side limb. Do this over and over to retrain the brain how things feel.
3. Consider mirror therapy (put this in google as it appears: "mirror therapy" stroke.
4. Look at, focus on and attend to the the affected side. Most survivors I know treat the "bad" limbs like strangers. But they are friends. As a caregiver once told me, "He's had the arm all his life, and he intends to keep it."-p

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