Tuesday, November 13, 2012

Function: You get what you want but not what you need.

Function. Function. Function. Function.
That's all you ever hear. "We're trying to get the patient functional." 
Why? 2 reasons: 

1. You want survivors to be functional. You want them to be able do every day, real-world tasks. When therapy ends, the therapist wants the patient to be able to do as much for themselves as they possibly can. Function is a good thing, no doubt. 

2. Generally, function is paid for. Lets say the goal is walking. If the patient is not walking, at some point, you have to end therapy. And with the ending of therapy comes the ending of payment.

But there's a problem with this "focus on function." I can be functional and walking, but require a cane an orthotic on my ankle. The cane is used to overcome the weakness of the affected leg. The orthotic on the ankle is used to overcome the inability to lift the foot. Focusing on function means overcoming a deficit. Sounds good, right? But if you are using a cane an orthotic have you really overcome the deficit? Maybe we shouldn't chew. We can put everything in a blender.

I've long been an advocate of a focus on recovery, not function. Think of recovery as a game of soccer. Function is a score of 1 to 0. You win. But there are two ways to win. One way to win is to pick up the ball with your hands and throw it in the goal. The other is training hard, practicing with your team, getting in good shape, practicing skills, getting in the game, and putting all the practice into, well, practice. Using the "good" extremity to accomplish goals (known as compensatory movement), orthotics, assist devices, etc. etc. does not lead to recovery. 

Very often function flies in the face of recovery area. For instance, a person may very well have some dorsiflexion (the ability to lift the foot at the ankle). But the movement is often weak and incomplete. Therefore it is "nonfunctional." And so it is ignored. And if a movement is ignored the portion of the brain representing that movement will get smaller. 

And so the ability to lift the foot will decrease. And so the movement is ignored even more. And so there is less brain involved, and so on and so on and so on. This process is known as learned nonuse.
 By: "stroke recovery blog" "stroke blog"


oc1dean said...

My example of this was when I had a replacement OT who asked me what my next goal was. 'To read a paper'. She found some Dycem put in on the table and placed the newspaper on it, showing me how it stayed in place as pages were turned. I'm sure she marked it off as a completed functional task. If she had any brains at all she would have asked me why. My whole goal in that exercise was to be able to hold my left arm up in the air, hold the paper with my fingers, open my fingers to get to the next page, etc. I still can't do any of that.

Peter G Levine said...


Amy said...

What are Dycem?

Bert R said...

Dycem helps a lot with a lot of functions. As a stroke survivor, it's best to have something assist you with the difficult task so you can focus on a less intense, higher repetition level that can be achieved without as much over-ride-this helps train the brain closer to "normal" function which in the long run, will bring you closer to optimal function. Dycem is good tool-but not the full answer.

Blog Archive