"Functional" ≠ Stroke Recovery

The focus, nay obsession, clinicians have with "function" has the potential to hinder recovery. Basically the word function and the word recovery are used interchangeably. But they mean different things. "Function" is a buzzword that makes everybody in rehab feel good. But it has its downside. Focusing on function gets in the way of the neuroplastic rewiring necessary for the fullest recovery endpoint. How can this be? Let me ask this rhetorical... Does using a boat make you a better swimmer? 

Puts Things In Perspective, Don't It?

Who is the person who has had the most neuroplastic change in their brain? Michael Jordan? Eddie Van Halen? Yo-Yo Ma? Einstein?

I've always claimed that it is Michelle Mack. 

Click here to see what she does with half a brain.: 

Stroke Recovery. Wired.

File this under "I couldn't have said it better myself...waitaminute...I did!" I sent an email recently to Ben Philipson, the developer of one of the three EMG-based electrical stimulation machines. These machines are an important part of stroke recovery and rehabilitation.

Since I can't say it any better (again) I leave with this link to his blog.


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Jim Thorpe. The World's Smartest Man?

I never understood the argument that athletes get paid too much. A kid grows up, shows up at practice, usually for multiple sports in the rain and snow and heat. Sweats, works, develops skills. And then at the end of 15-20 years or so of hard work it pays off with a 10,000 to one shot and a pro contract. I always imagine the people who complain the most are people who’ve never worked really hard for anything in their life.

"I worked really hard. I just chose to develop my brain,” they would counter. But they'd be comparatively lazy. They only developed their brain. Athletes develop their brains too, but the development is done through structured and dedicated bodily movement. It is a different part of the brain, but it is still the cortex. It's still neurons and synapses blending and communicating. It's still neuroplasticity.

Research into stroke recovery has revealed a simple truth: If someone was an athlete, at any point in their life (not necessarily right before their stroke), they have a better chance of a more full recovery. Why might former athletes do better? Is it because the movement portion of the brain, the part that is typically injured after stroke, is bigger in athletes? Or is it because athletes are used to training insanely hard for results?

I asked this of a neurologist and neurosurgeon, Prithika Chariwhen when we met at a shared talk in Munich 3 years ago. Her answer was simple (considering she was a brain surgeon); “Probably both."

Stroke survivors need to be athletes. By extension stroke survivors also need to be dancers and yogis and musicians. Work as hard as athletes.

And for all those nincompoops who think using your motor cortex is just plain dumb, click on this.

The Forgotten Leg

Constraint induced therapy (CIT) and modified constraint induced therapy (mCIT). We know them and we love them. These recovery options are richly researched and intuitive. I mean really, how much thought does it take? "If I tie up my 'good’ arm, and work really hard with my 'bad' arm and hand it will move better.” Duh, hello.

The concept of CIT has been extrapolated to everything. For instance there is CIAT (constraint induced aphasia therapy). CIAT is based on the same old idea: If the stroke survivor forces themselves to talk a lot, talking gets better. In many ways a constraint induced therapy is the trunk from which all the theoretical branches spring. And that trunk is as solid as it can be. "Practice makes perfect.” “We are what we repeatedly do.” “Use it or lose it.” Cliché, cliché, cliché but true, true, true.

All good news to be sure. But one bit of the body that has been left to drag behind: The leg. How would you do the CIT for the lower extremity (LECIT)? You could tie up your good leg, but falls, decubitus ulcers, hospitalization, throwing a clot, having another stroke, so let's say… no.

But still the idea is compelling enough for researchers and device makers across the rehabilitation spectrum to want to claim LECIT as their own. I wrote an article about the competing perspectives.

The bottom line is that to adhere to the spirit of constraint induced therapy, you have to overstress the affected leg. And this requires caution. And a therapist. And a lot of work.

Two Great Tastes

Figuring out what helps a stroke survivor recovery may involve finding that one magic bullet. But it probably won't. It will probably be a few magic bullets, a smattering of magic hand grenades and a ton of magic TNT. Enough of this explosive rhetoric!

The point is, recovery requires multiple recovery strategies. As time goes on, the combination of strategies will change.

There is a tendency among many researchers to focus on their little piece of the pie. They'll pioneer treatment "X". They'll develop treatment "X". They'll advocate "X" and they'll cling to "X" forevermore.

Our lab takes a bit of a different tact. If different things work for different survivors at different times you damn sure better have a feel for the whole ball o' wax.

Here is a recent study our team did fusing "Two great tastes that taste great together".

Bon appetit!