Saturday, December 17, 2011

The Tao Stroke Recovery

I would like to respond to Dean, someone who has supported my book from the very beginning, and has supported this blog. It's impossible to even calculate how much Dean has help me get my message out. 

He has even come to one of my talks!

Dean posted a comment which you can find here.

In his comment he disagreed with the premise of a blog entry I wrote. I basically said that stroke survivors should focus on specific tasks while they're trying to recover. It's called "task specific training". It's benefit has to do with motivation; the more important the task is to the survivor, the more motivation available to the survivor on their quest towards recovery. The tediousness of working towards recovery is mitigated by the survivor's inherent interest in the task that they're trying to accomplish.

And Dean brought up an excellent point. It's the same point that is often made by clinicians when the issue of task specific training comes up. As Dean put it "Task-specific training is just taking the easy way out because if you can't walk properly you're not going to get better by practicing bad walking." Dean goes on to point out that unless there is a precise evaluation of movement deficits, there's no way to tell what should be practiced.

And I totally agree. While I'm a big proponent of focusing on a valued task to provide motivation, bad practice leads to bad movement. When it comes to movement, quality matters. And quality matters for many reasons.
  • bad movement takes more energy than good movement
  • bad movement takes more time than good movement
  • bad movement can lead to injuries
  • bad movement can lead to a lack of enjoyment of a wide range of activities
  • bad movement looks bad which has social implications
  • etc., etc.

So how does a stroke survivor reverse "bad practice leads to that movement"? That is, how do you do "good practice that leads to good movement"? 

My lab work has focused on stroke specific outcome measures testing poststroke movement. I used a laundry list of these outcome measures. They are often complicated and require special equipment. We also use movement analysis laboratories that collect thousands of bits of data to determine if movement is increasing or decreasing in quality. Finally, we use technologies like functional magnetic resonance imaging and transcranial magnetic stimulation to determine if the part of the brain dedicated to movement is expanding.

But for the stroke survivor trying to improve quality of movement, some of the simplest "data collection" works quite well. 
  • Using mirrors to provide real-time feedback can be helpful. 
  • Using a mirror at the end of a treadmill can provide insight into the quality of gait.  
  • In the upper extremity is often helpful to use the "good" side to remind yourself what "normal" looks like.  
  • Videotaping specific movements throughout the arc of recovery can be helpful as well. Video provides a chronological log of where you were, where you are, and can be suggestive of what to work on next.

"Practice does not make perfect. Only perfect practice makes perfect."
Vince Lombardi


oc1dean said...

Come on Peter, the t-shirt was a little over the top.

Peter G Levine said...


3 things:

-1: If you don't want the t-shirt thing on there I'll remove it (can't tell if you're joking!)
-2. Of course, its Deam Martin, but you need that shirt.
-3. I think you have important things to say about recovery; have you considered writing a book? You could take the "other" position of "It's not all rainbows and unicorns...what you REALLY need to know is..."

In any case, thanks for the blog entry idea. Best,-pete

oc1dean said...

Leave it, I was joking

Mike said...

I felt that I improved better than before the moment I switched to activities I enjoy or activities I used to enjoy, like playground games.
I continue to try to do " fancy walks" that kids do on the playground.Nutrients( antioxidant & vitamin B-rich greens) makes a huge difference.

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