Sunday, July 28, 2013

Two Roads Diverged...

There are two ways to go after stroke: 
1. Compensation (technically: The compensatory approach)
2. Recovery (technically: The restorative approach)

Compensation involves getting on with your life by any means necessary. If your right hand doesn't work, you do everything with your left hand. If you can't walk because your foot drops, you put on an AFO. If you have trouble speaking, there's an app  for that.

Recovery involves using the intact part of the brain to take over for the "stroked" part of the brain.

It would be nice to say that the focus of clinical rehabilitation is on recovery. But for the most part, managed care only pays for compensation. Insurance companies want to get the survivor safe, functional, and out the door. Why do they want the survivor safe? Because an unsafe survivor will cost them more money down the road (think falls). Why do they want the survivor out the door? Because every day in any clinical setting costs a ton of money. But while survivors also want to be safe, and out the door, is it in their best interest to be "functional"?

On the face of it, sure, survivors want to be able to function. "Function" is a catchall word that means "getting on with your life." And it's seductive. Everyone wants to be functional. Everyone wants to be independent, and able to

But there is a problem with function. And it's not just a generalized idea that if you "focus on function" you'll ignore recovery. It's a very specific concept based in neuroscience.

It would make sense that if you focus on learning compensation, you would spend less time on recovery. And this would mean that you would become better at compensation, but less recovered. But it's more than just a time issue. It's a brain issue.

It turns out that something special happens to the brain after stroke. The brain is in an almost "infantile state" after stroke (in fact, after any brain injury). And "infantile state" is a good thing. The brain, through a release of special proteins is "primed" for learning
— like an infant's brain. But what will it learn?

Well, it could learn to compensate. If you are right-handed and you have limited use of your right hand after stroke, the brain could learn to compensate. Your left hand would be doing a whole bunch of things never did before. The left hand is now handwriting, attempting to tie shoes, brushing the hair and teeth, and dressing. And it's doing it all alone
no right hand to help. So during this period in which the brain is "primed" for learning, the left hand does all the learning.

But if the focus is not compensation, but recovery, there will be more recovery. The brain is "primed" for learning, and it learns to recover.

Tuesday, July 16, 2013

NSAIDs Increase Risk of Stroke

Do over the counter pain relievers cause stroke? Some do, some don't. Might some pain relievers also cause heart problems and other cardiovascular problems? Same deal: Some do, some don't.

Note: As a group these meds are called Nonsteroidal anti-inflammatory drugs or "NSAIDs" (pronounced: NAY-sads). (List of all NSAIDs here)

In 2011 rather large study of this issue was completed. This study was a meta-analysis. A meta-analysis is a study of all the available studies. Although this is not news (it did come out in 2011) it is important for folks with chronic pain. If for instance you have frequent headaches and you take certain painkillers for that headache pain it could increase your risk of stroke and heart problems. Ibuprofen, for instance, tripled the incidence of stroke. 

Keep in mind, this study was not done with people who have had stroke. The statistics may be different if you've already had a stroke.

And "dying from heart trouble was four times greater" when using some NSAIDs. 
As Consumer Reports puts it: "...all (NSAIDs) except naproxen were associated with similar increased risks..."

Here's my suggestion: Ask your medical doctor about this research.

Monday, July 1, 2013

PT/OT invented rehab - not.

A scene from 
Walking with Cavemen.
Rehab is not new. It goes back -- not hundreds of years but back to the earliest humans. We’ve been "rehabbing" for hundreds of thousands of years. And what we did to recover, all those thousands of years ago, may have been more effective than most of what's been developed since. 

Consider the stroke-rehab ideas coming from recent neuroscience (and to a lesser degree, OT, PT and Speech therapy). This recent work has more in common with "rehab" tens of thousands of years ago, than it does with the decades between 1920 and 2000. What has this recent research and our deep ancestral rehabbing have in common? Researchers now call it "intensity." But back then they called it something else: Survival 
There's a lot of folks, therapists mostly, who think that rehab started in 1918 or so. They'll tell you that PT was developed in response to polio and WW I. They'll tell you that, in the US anyway, its champion was Mary McMillian, the first PT, credited with starting the first legitimate PT training school in the US. Some of them may even know that Pehr Henrik Ling developed and codified the concept that exercise=health in the 1800s. Ling went further, developing a standardized way of promoting rehabilitation and recovery. 
But what of “Rehab=Survival=The Latest Research"?

Imagine a survivor trying to rehab 150,000 years ago. Let's call our stroke survivor “Magch” and his mate-pair “Youngh.” It seems as if we probably had language even then. This is the way the conversation probably went…

Youngh: “How many times do I have to tell you to stop leaning to your good side?”

Magch: (leaning towards his "bad" side): “Yes honey.”

Is that rehab? Yes! If Magch did that movement tens of thousands of times until it felt natural, today's neuroscientists would call him a genius.

Our ancestors knew a thing or two about rehab. Read about it here.

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