Saebo: Faster than ever!

"My son" loves the show "The Flash" and lo and behold, he (Mr. Flash) was wearing a Saeboflex in tonight's episode! 

The 2 minute survivor exam that tells you a ton

I've been involved in a lot of trials that have involved brain scanning. (example)

But I've never been a big fan of using brain scans to try to predict the deficit. In school we were taught to look at the artery that was blocked. The artery that was blocked leading to the brain or in the brain was supposed to give you some indication about what deficits were.

I would suggest this is where neurology and physiatry on one hand-- and neuroscience on the other-- kind of disagree. The neurologist and phsyiatrist say that this info (brain scan and/or artery blocked) helps determine the deficit, and even the chance of recovery.

But neuroscientists would suggest that, because the brain wiring is "random access" (that any part of the brain may be wired to any other part of the brain), looking at a brain scan maybe grossly predictive, but really tells you not much at all.

In all my seminars I suggest that the thing to do is to examine the patient in a very limited way.

Here's suggestions that will give you global insight into the potential for recovery:

1. Can they move their hand? First, let's define "hand movement." I would suggest that hand movement is any movement from the wrist to fingers, in any direction. The easiest movement for most survivors is closing (fist) the hand. The problem is that many strokes survivors think that they can't close their hand. If they think they can't, do this: 

• Bend (technically: Flex) the wrist. This will allow you to open the fingers. 
• Put the elbow in more than 90° of extension (more straight than a "shake hands" position) 
• With your fingers inside the palm ask the survivor to try to touch their chin. 
• This will force the flexor synergy into play, and if they are able, the fingers will flex and you'll feel the pressure on your fingers. Voilà: they have hand movement! From that you can determine potential for recovery of the hand. (Hint: there is potential).

2. Brush both forearms lightly with your fingertips. Ask the survivor if they feel the same, and if not, how they feel different. If they do feel different, this suggests that sensation has been hit. Try to get them to give you a percentage ("My bad arm feels about 25% of my my good arm feels"). There is a general association between tactile (brushing your fingertips) and proprioception (feeling where that limb is in space). And proprioception has huge implications for recovery.

3. Vision: Can they follow the tip of a pen with their head held straight in front of them all the way towards their affected side? If they tend not to follow things on the affected side, this suggests a hemi field cut and possibly "unilateral neglect" – an inability to attend to the affected side.

4. Speech: can they speak; do they understand what's being said?

5. Are they walking, how well, how fast are they walking?

There-- now you have global insight into that stroke survivor. Isn't that more important than knowing that an occlusion of the inferolateral arterial group infarcted the posterolateral thalamus?

The Wrong Question

"What is the single most important thing you should know about stroke rehab treatments?"

That's easy: You're asking the wrong question.

If you are talking about rehabilitation treatments you are talking clinical stuff. You are talking about a clinician-- usually a therapist-- in a clinical setting. And both clinician and clinic are great but they are not enough during two time periods:

1.  Every day

2. Once you're discharged from therapy.

Let's consider why clinical stuff "every day" is not enough. How much therapy might you get? An hour-- two-- three? Recovery is a full time job during the first few months after stroke and it is the first few months after stroke that you're still seeing therapists. So even when therapists are there, there almost always not there enough.

OK, now lets take "Once your discharged from therapy." Discharged from therapy is in and of itself the very definition of not enough therapy, because you've been discharged. Discharged like a bullet from a gun, off you go! So once you are discharged you are definitely not getting enough clinical stuff.

So maybe the question ("What is the single most important thing you should know about stroke rehab treatments?") is wrong. What if instead the question was "What is the single most important thing you should know about stroke recovery options?"

Isn't that freeing? You are no longer under the rules of managed care because managed care does not care if you try, on your own, to take on your recovery using whatever options you can find. You can spend as much time as you want. And even if recovery options are an adjunct to rehabilitation treatments, they expand the opportunities for recovery.

So, "What is the single most important thing you should know about stroke recovery options?"

Sweat equity. That's it. The more you put in, the more you make your brain uncomfortable and force it to change. The more repetitions, the more challenge, the more focus— the more recovery.

Oh dear blog, how I have neglected thee!

Oh dear blog, how I have neglected thee!

But I have a good excuse. In fact I have many. But let me just give you the two big hits:

1. As usual, I'm on the road a lot, doing talks on stroke recovery. If you a are a survivor, please note that my talks are available at a discounted rate. Jus' sayin'. Love to see you there. We'd probably use you as a guinea pig, so be forewarned.

2. At the beginning of last summer I was offered work as a consultant for a lab at Ohio State. It's a long story, but this lab is the latest iteration of the lab that I've worked for— or with— for the last 15 years.

And in all those 15 years, I've been involved in all kinds of cool stroke recovery studies. I've been involved in studies of constraint induced therapy. I've been involved in studies of mental practice (imagery), electrical stimulation machines, as well of the song whole host of other gizmos. I was lucky enough to also be involved in a transcranial magnetic stimulation (TMS) study. Boy! That was a cool study! Basically we were able to touch stroke survivor's brains, without having to go through the messy business of opening up part of the skull.

I could write much more than this blog entry can hold about TMS. But I'd like to tell you a little bit about the latest study I've been involved in. It's the coolest!

A pharmaceutical company run by neuroscientists, called Dart Neuroscience, thinks it may have come up with a pill to help stroke survivors recover.

This pill is thought to help the brain produce BDNF (brain derived neurotrophic factor). BDNF is called by some

neuroscientists "miracle grow for the brain." It is produced by the brain for the brain during times in which the brain needs to learn.
For instance, BDNF comes out right after birth. And you can imagine why – the infants brain is trying to figure out what that smell is, who that face belongs to, how to use their hand, and on and on. So the brain needs help, so it produces BDNF to make all that stuff easier to learn.BDNF is also produced by the brain after brain injury – including stroke.

This is one of the reasons that the stroke survivor's brains are said to be in in "infantile state" — because, like an infant's brain, the stroke survivors brain is awash in BDNF.

But if there was a pill that produced BDNF in survivors it would help in two ways:

1. Typically BDNF is only available in the brain for about a three month period after the stroke. If a pill would produce even more BDNF it would open a larger window of opportunity for recovery.

2. Some stroke survivors just don't produce BDNF— at all— after their stroke. This medication would help those people. A lot.

To get a study like this off the ground involves a pretty monumental effort by dozens of people. I am one of those people.

So, dear blog, I apologize! 

But I'm back!