Saturday, October 20, 2012

Here Come the Vendors

I do a lot of talks about stroke recovery. About 80 per year. I learn so much from the therapists I talk to. Many of them are committed, caring, bright and motivated. I like the fact that I'm doing my talk to good people.

But there is one segment of therapists that can be tough to love. 

Attending my seminars have been lots people from a variety of companies. These companies usually represent products. Sometimes they represent services, clinical trials, organizations, etc. But usually it’s products. And for me, these people can be very dangerous. They either want to know what I'm saying about their product or want me to promote their product. Those who want to know what I'm saying about their product never voluntarily tell me where they work. Those that want to promote their product are just the opposite. At some point in the seminar they'll approach me and talk up their product. And it's always uncomfortable. 

Many of the products have little or no scientific evidence behind them. Doing the research to provide evidence for a product is expensive and laborious. It's quicker, cheaper and less fraught with risk to just put your product to market, and promote it. And I become a part of their promotion. So when I'm approached, it usually feels like hucksterism. It feels like I'm being sold on a product so that my seminar might become a platform for promotion.

People will hand me their card, and talk about the product. That card will become a reminder to look at product up. So how do I look it up? I try to strip away the product name in order to get to the core of the product, and then research that core. For example, let's say somebody is selling Stroke-A-Way. If I look up Stroke-A-Way all I'll find is what Stroke-A-Way wants me to find. So instead, I look up the "active ingredient" (concept, or exercise, or whatever). I try to see if the active ingredient is scientifically based.

But what if it doesn't work? A lot of times I can go straight to clinical research sites during the seminar and look the "active ingredient" up. I can also send out a quick e-mail to experts in the field (I've been in research for a long time; lots of contacts) and ask their opinion.

So: What if the product sucks?

If the product has no evidence, I don't advocate it. And if you're a vendor, and I say your product
has no evidence, you'll be pissed. But you shouldn't be. You're at the course, you read the course description, and you know I'm in research. So... I'm going to do the research.

I wish these folks would read their diploma. On there- someplace- is the word "science." It'll be an Associate of Science, a Bachelor of Science, a Masters of Science, or Doctorate of Science. When you got your license you dedicated yourself to providing treatment options based in... science.

So bringing it up in the seminar is not just dangerous for me, it's dangerous for the vendor. What if, because the vendor made me aware of the product, I research the product. And what if I find no evidence it works? The next time somebody asks me about the product I'll say there's no evidence behind it. I have to. It's my job. It probably would have been better had they not talked to me about it at all.

You know what the most widely read entry in this entire blog is? The entry on neuroaid. I only became aware of the product because they copped the name of this blog; The Stroke Recovery Blog. The theft got my attention, and made me do the research to find out that it...
  • had a very low level of evidence behind it
  • was available in a less expensive form
  • used researchers who had a clear conflict of interest to promote it.
So if you get my attention, be prepared for the inevitable question: Is it evidence-based? This is my job. And I talked to  a lot of stroke survivors who want it to be the job of every clinician. Figure out what works, and then do it. And the stuff the doesn't work. Don't do it.

BTW: Frankly, I don't necessarily advocate the products advertised on this blog. However, I will not accept advertisement for products A)
that clearly don't work or B) competing products exists which better provide the "active ingredient."
By: "stroke recovery blog" "stroke blog"

Wednesday, October 10, 2012

Sex After Stroke

A recent article showed that sex was at least "least somewhat important" in approximately half of men 75 years and older. Odds were reduced in interest and participation in sexual activity the higher the age, if the partner had physical limitations and the use of antidepressants and beta blockers.

So what is the effect of stroke on sexual activity? 
Almost 75% of strokes occur in folks over 65. Added to the advanced age of most stroke survivors there is also usually add increase in medications as a result of a stroke. There are also the mental and physical impacts of stroke that take a toll on sexuality. Included reasons are to believe that the stroke may affect the relationship, financial issues and low self-esteem.

Stroke is not usually cause sexual dysfunction. 
But there are a variety of us psychological issues that do impact sex after stroke. The new challenges that stroke survivors and caregivers have to go through when they get home block out everything else. Scheduling health care workers, dealing with managed care and paperwork, as well challenges of getting to and from all the appointments are just some of the problems that get in the way of other, more fun, things. There is a period after stroke in which sex usually doesn't take place. But this little is usually temporary. For instance, 80% of men with erectile dysfunction after stroke regained the ability to have sex a few months later. And that change was spontaneous.

There is a general belief that after stroke sex can cause another stroke. This hardly ever happens (although it may be true in people with parallel heart disease -- consult your physician). Despite the fact that sex is safe after stroke as many as half of all survivors fear that sex may cause harm. Many partners of survivors also have fear that sex will cause another stroke in their partner.

By: "stroke recovery blog" "stroke blog"

Wednesday, October 3, 2012

Walking in Rhythm

During stroke recovery "the good trains the bad." This is known as "bilateral training." In anyone, stroke or not, it is true "the good trains the bad." Here's an example: I'm a drummer. I'm right-hand dominant. If I try to tap my left hand as fast as I can it is not as fast as if I tap it alternately with the right dominant hand. Research has found that my left hand will not only be quicker, but it will be more accurate when I do the movement with my right hand. So I will be both faster and hit the drum where it should be hit.

In stroke survivors bilateral training can be used to begin the recovery process. And it can be used to help stroke survivors with very little movement. Survivors with very little movement are sometimes called "lower-level." (This designation says nothing about the ability to think, only the ability to move.) The reason bilateral training works for lower-level stroke survivors is because the way bilateral training may work. And I say may, because nobody's really sure. Bilateral training may work because the two limbs communicate with each other even when that communication does not go through the brain. It's the reason infants step even before they can walk.
Click here: See a baby walk before it can walk

It's why, in animal experiments, you can sever the spinal cord but the back legs will automatically go into walking pattern when they're put on a treadmill. It has to do with neural networks that are in the spinal cord. These networks are collectively called the central pattern generator (CPG). The CPG allows for limbs to communicate from the fingertips of one hand to the fingertips of the opposite hand (or "toe to toe"), right through the spinal cord.

In the arms and legs, bilateral training is relatively straightforward. In the arms you would have each arm trying to hit a target. You could have both hands attempting to alternate to hit a target. You could also have it set up so the "good "hand has to hit a target that much further away than the "bad" hand. You can also do this with a rhythm. The idea would be to use a metronome (click, click, click, rhythmically) or music where the drumbeat would dictate when each hand would have to meet the target.

In the lower extremity it similar: there is a rhythmic component. You would try to take exactly the same step length with the "good" and "bad" legs. A rhythmic component is added the same way as the arms: music, or a metronome is used to establish be in each footfall happens on each beat. It is thought that reestablishing the rhythmicity of gait will help reestablish the symmetry of gait.

As I said in a PT trade mag...

"A simple metronome either heard through headphones or carried by the therapist next to the stroke survivor can be used to promote the re-establishment of rhythmicity of gait. Plugging the ears using standard noise-reducing plugs can boost the volume of footfall to make that obvious to the survivor. The trick is then to match the footfall to the beat."

By: "stroke recovery blog" "stroke blog"

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