Monday, February 24, 2014

the most important gizmo for recovery is you

I do stroke recovery talks to PTs and OTs (and a mix of other clinicians, survivors and caregivers) all over the US. Today I'm in Cheyenne, WY. 
Between Casper and Cheyenne
I've had many conversations with therapists over the years. One of the things that's remarkable is how little consistency  there is in the tools therapists have. Some therapists have every gizmo known to man, others have little other than their creativity and a few standard tools. Imagine the difference between working in a leading-edge rehab hospital vs. an on-the-road home care therapist.
That's me. The king of PowerPoint.

Do "stroke recovery machines" make a difference? Within reason, no. There are a few tools that may be essential. For instance, electrical stimulation, parallel bars and a mirror may be essential at some points in some survivor's recovery. Really, much more important is the training of the therapist. This is not just true in stroke rehab but in many areas of medicine; outcomes are directly tied to the training of the clinician. For most survivors, the knowledge of the therapist is the most important gizmo. 

But remember, they'll "discharge" you at some point and then the most important gizmo for recovery is you (and caregivers!).

Tuesday, February 11, 2014

Don't stop. Don't stagnate. Don't let a lull convince you recovery has ended.

What about "Long-Term Rehab Management of Stroke"? What do we know about stroke recovery as we get into months and years and decades? 
What does this post have
to do with this girl?

The first thing we know is that its nonsense to believe that recovery has some sort of expiration date. I like the idea of someone coasting for a month or longer and then recommitting themselves to recovery. Its never too late.
What does tend to happen is "adaptation." The word refers to the notion that if you do the same techniques you get the same results. Survivors and therapists can both cause adaptation. Therapists can get used to what they use and go automatic and unimaginative with treatments. Survivors can get lazy and not push against their present abilities. 

Bottom line: There is good  evidence in the research that so-called "chronic" survivors can continue to make progress.

Don't stop. Don't stagnate. Don't let a lull convince you recovery has ended.

Thursday, February 6, 2014

Wanna write a book?

From the publisher of my book...You can email her directly (contact info, below) if you're interested. Best, -pete

"I’ve been thinking about two possible new books on stroke for our list and I wondered if you might know of anyone who might be interested in writing them:
A Caregiver’s Guide to Stroke: a handbook to help the caregiver, addressing all of the issues and best practices they should know about: creating and managing a health care team, dealing with the various physical, emotional and cognitive issues, etc. The right author would most likely be a social worker, therapist, or professional caregiver.
Myths vs. Facts on stroke: a book aimed at dispelling the myths/misinformation about the causes, treatment, physical and cognitive impact of stroke." 

Julia Pastore
Executive Editor, Demos Health Publishing

Tuesday, February 4, 2014

Yes! Stretch!

The small units that make up muscles are called sarcomeres.
Help! Stretch me!
Sarcomeres shorten when we contract our muscles. When we stretch for a long time, there is an increase in the number of sarcomeres. Literally, muscles get longer.

For example, increased flexibility is directly related to an increased number of sarcomeres. One of the ways that the number of sarcomeres can increase happens to all of us: Growth from birth to out 21st year. Growth in the length of bones during childhood provides a prolonged stretch of muscles. As muscles are stretched to their physiological limit they react by developing an increase number of sarcomeres. Stretch has to be of sufficient duration for this remodeling of muscle to occur.

The opposite is true as well. When muscles are left in shortened position, the number of sarcomeres decreases. Nothing provides a prolonged shortening of muscles like spasticity after stroke and brain injury.

So all the rules of stretching are thrown out the window when the muscle is spastic.

How is spastic muscle different than normal muscle? Let me count the ways...

Spastic muscles... 
have lost some (if not all) communication with the brain.
are often kept in a shortened position on the "bad" side for long periods of time.
are not subject to the same rules of stretch. (That rule: The more you stretch the longer the muscle will become.)

Spasticity after brain injury keeps muscles (on the "bad" side) in a shortened position long enough to lose sarcomeres.

It comes as some surprise to most therapists, but there is very little scientific evidence that stretching muscle reduces spasticity. In the very short term there is a small reduction in spasticity. But spasticity is not reduced in any lasting way by stretching because spasticity is not caused by muscles. Spasticity is caused by brain injury. Brain injury causes the brain to cede muscular control to spinal reflexes. Increasing the number of sarcomeres will not reduce spasticity. If it did, every case of spasticity would be eliminated by a regimented stretching program. And wouldn't that be nice?

Soooooo... Should you not stretch? No! I mean yes! I'm confused! Yes, you should stretch!

Why should you stretch? Because even if stretch has no lasting effect on spastic muscle, there are several reasons to do it anyway. Stretch... 
feels good 
reduces spasticity for a sort amount of time 
is good for joints 
may be good for other tissue besides muscle (ligaments, veins/arteries, nerves, skin, etc.)

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