Friday, February 20, 2009

The body after stroke. Working in mysterious ways.

Stroke is weird; unlike most neurological diseases, stroke is nonprogressive... A stroke survivor doesn't get more brain damage as time goes on. Unlike multiple sclerosis, Parkinson's, Lou Gehrig's disease, etc. stroke and other forms of brain injury do not get worse over time.

And through the process of neuroplastically rewiring the brain recovery happens. So there is an argument that can be made that says people can actually get "better" after stroke. This is going to sound twisted but... the stroke tells you what needs to be worked on. In other words, the very deficits that stroke presents are the exact things that need to be worked on to recover from stroke. It's hard to do, but stroke survivors should embrace those deficits as acceptable challenges.

There are other “deficits” after stroke that may also have a sort of internal logic. (Note: Deficits related to stroke--and other primary diseases are called sequelae).

Can sense be made of all the sequelae we fight so hard to get rid of after stroke? Is there a reason for them?
  • Movement close to the body (proximal, i.e. the hip and the shoulder) returns before movement that is far away from the body (distal, i.e. hand and foot). Why might this be? It may be because you can't do anything with the distal unless you can get the distal where it needs to be by using the proximal.
  • Spasticity is a reality for many stroke survivors. Spasticity may be considered internal protection mechanism, generated by muscles, to protect muscles.
  • Stroke survivors with one sided weakness can rarely move one joint without moving a whole bunch of other joints. This is called synergistic movement. In the hand and arm there are two such movements: the flexor synergy, which looks very much like a hand to mouth. There is also an extensor synergy. This movement looks very much like picking something up. If there are any movements that you don't want to lose they are feeding movements. These synergies look very much like feeding movements.
  • Heminopsia (a one sided visual deficit -- difficulty seeing towards the affected side) and unilateral neglect (ignoring the affected side) may provide a lack of focus on what does not work and focusing on what does work.

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