Thursday, November 3, 2011

Safe, functional, g'bye!

Some clinicians think that neuroplasticity means little in the every day life of someone who suffers from brain damage. These neuroplastic naysayers believe that change in the brain is not worth a hill of beans if there’s no “functional change”. I rather disagree. I think that “function” is a manifestation of what insurance companies think will get patients out the door as quickly and inexpensively as possible. Consider ambulation. Insurers believe that someone walking, no matter how ugly the gait, no matter the orthopedic risk, no matter the bracing or assistive device, is better than not walking. 

So what happens? Therapists slap on AFO’s and call it toast. Everybody’s happy, right? The only problem is that a more natural, recovery of dorsiflexion is now made impossible by a rigid orthosis that disallows the very movement that stroke survivors are trying to recover! Penny wise and pound foolish, insurance companies impede the very process of recovery. And that's prior to the plateau, as the brain is coming back online. Once the survivor is chronic, there is no further gain at the ankle, despite potential neuroplastic change that may be available during the chronic phase. change is the only true substrate of recovery from brain damage. Everything else from bracing to stretching are local Band-Aids ameliorating symptom rather than cause.


Jen said...

My thoughts exactly. . . .except that I have very few sane thoughts left after going through the past 10 months of stroke recovery with my husband. He's the one who had the stroke, and I'm the one who's sick of talking and thinking about it (ha! I'm sure he is, too). The thought of doing any research into new technology is exhausting, but my in-laws brought my husband to a Bioness seminar, so now we're waiting to see if our insurance will cover the therapy and equipment. The "foot drop system" *seems* to have potential for not only helping his foot move and flex to take steps correctly, but also to send the messages to the brain about how to re-wire so that this becomes natural for him. Wish us luck - with any progress, I will be singing Bioness's praises on my own blog!

garydotgray said...

Thank you Peter: Your post brings to light a major challenge in the stroke community.

It is sad to say that the very people who we rely on to protect and support us with our recovery have laid down rules for our recovery from the dark ages.

It is even sadder that the dollar trees grow so large that they totally obscure the reality forest.

Then our health care professionals are forced to walk blindly through the reality forest with dark glasses and white cane in hand.

Thanks again Peter for briefly pulling back the political/commercial clouds to allow a shaft of sunlight to illuminate the darkness. : )

A classic case of "He who pays the piper gets to call the tune"

Mike said...

Isn't it stretching is also important, especially to the ligaments

Peter G Levine said...

Hi Mike,

I would say stretching is important. The effects of stretching on spastic muscle are equivocal, however.

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