Wednesday, January 28, 2009

Young Stroke Survivors: Unique Ambitions Drive recovery.

Young stroke survivors are interesting to those of us in stroke-specific rehabilitation research because there is so much raw material and raw potential. Many younger stroke survivors have the effects of the stroke as the only problem they have. They are often not on meds, they have tons of energy, and they are not willing to give up the balance of their life.

Here is the gist:
Stroke in adulthood: A normal architecture, altered. Imagine building a new house. You build a good foundation, a solid frame, a strong roof, etc. You put in the plumbing, electrical, and walls. Your new house is done. Then one day you have an accident! You back your car into the corner of the house. That part of the house needs to be fixed. The foundation is still there, the solid frame still exist in most of the house, the roof is still good; plumbing, wiring, everything is still good. You only need to fix that one room.
•    A stroke in adulthood affects a normally developed brain. The size and location of the stroke determines what skills are lost.
•    Stroke in childhood: An altered architecture. Now imagine you neighbor builds a house, but he’s not a very good builder. The foundation is uneven and the frame is crooked. Everything that is built around the foundation and frame is affected by the poor basic architecture of the building. To “fix” the house would require starting from scratch.
•    A stroke in childhood affects how the brain develops. The brain in childhood is a blank slate. Neurons (nerve cells in the brain) haven’t “decided what they want to be when they grow up,” and whatever is imprinted on that blank slate affects the way the brain develops. Children have an immense amount of brain plasticity available to them. After stroke, children often do amazing things, given the amount of brain injury they have. There are classic examples of children who have a complete hemisphere (half of their brain) destroyed by stroke. In an adult, such a stroke would institutionalize the person for the rest of his or her life, but some children survive and thrive with half a brain. They are able to learn to read, write, have a sense of humor, be productive, and enjoy life. So it is unfair to describe the brain after a childhood stroke as having “poor architecture.” In fact, it could be considered “excellent architecture” given the amount of brain damage they have.

The impact of stroke before the brain is fully developed is much different than the impact of stroke after the brain is fully developed. The process of recovery in the two is very different, as well. In fact, it is only in the adult brain that is truly “recovery.” In childhood stroke becomes a part of development.

Friday, January 23, 2009

A Lot To Live Up To: "The Magic Cure for Spasticity Reduction"

More than any other aspect of stroke recovery, stroke survivors and therapists ask me about spasticity. Are there effective treatments? Can spasticity be eliminated? What do I do?

There are many treatments for spasticity, but all of them are Band-Aids. That is, they don't eliminate spasticity; they mask it or temper it. Treatments range from injections that temporarily "quiet" the offending muscles (i.e. Botox, phenol blocks) to drugs that usually work systemically (which means they hit all your muscles and usually have a global sedative effect). There are surgeries that snip a nerve rootlet here or a tendon there (these are permanent and nor reversible; they eliminate spastcicty, but also eliminate the potential for the muscle ever to come back.)

There is one answer, however. It is outlined in this article I wrote recently.

Trust me, I did not make up the headline.

Monday, January 12, 2009

Bilateral Training

Assume you never had a stroke. If you are right-hand dominant and you are trying to do something equal and opposite (like drumming) your right hand will slow so the left hand can keep up.

But it works in the opposite as well...your left hand will be able to drum faster, will have better trajectory and make fewer mistakes if you do the drumming with both hands at the same time... together. The right hand essentially trains the left hand.

After a stroke the unaffected "good" arm/hand will train the "bad" arm/hand. It's called 'bilateral transfer'. This transfer of info from one limb to the other, some scientists think, happens below the brain; right through the spinal cord, as if the two limbs are communicating directly. this may be one of the (many, many) reasons the legs usually come back sooner; bilateral transfer is used constantly during the one activity the legs are most involved in...walking. Want it to sound more scientific-y? Here's my slide for it...

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