Thursday, September 1, 2016

Overchallenge for Stroke Recovery

Overchallenge. I'm not sure its a word, but it is essential to stroke recovery.

Overchallenge forces something to change. The word forces is important. Some of the best strategies for recovery involve forcing the survivor into something that challenges them towards recovery.

That last sentence has a lot to unpack. So lets unpack...

First, "forcing the survivor" is not really correct. The survivor forces themself. No one likes to be "forced" to do anything. Plus, it won't work that way. When it comes to relearning movement after stroke, no one can force you. I can't force you to learn movement. But you can, and do, force yourself to learn. That's the way it works: The brain changes according to the owner's wishes. So, survivors self-force their own overchallenge.

Second, the word forced is accurate because that's exactly what is done. Take forced use. Forced use is when the survivor uses their "bad" side for a certain amount of time. 

(Note to nerds: Forced use therapy (FUT) and constraint induced therapy (CIT) often get confused. 

FUT: The survivor uses only their "bad" side for minutes to hours per day, at home.

CIT: The survivor has their behavior "shaped" by a clinician with repetitive practice of component parts of a skill. It is usually done with 3-6 hours of practice in the clinic with a therapist, as well as FUT done at home)
Third, overchallenge requires a forcing into an area that the brain is uncomfortable. Usually, the concept of overchallenge is associated with muscle building. But with regard to stroke recovery, overchallenge has to do with brain building. And the brain does not want to build. It does not want challenge. Because here's how the brain looks at it "Why should I challenge myself? If I do, I will change. And what if I change into something I don't like?" 

But overchallenge is exactly what the brain needs to recover. Here are a few of recovery strategies that use the overchallenge concept:
1. Constraint induced therapy
2. Forced use therapy

But overchallenge could be walking longer distances, challenging your balance on uneven surfaces (safely, of course) not relying on aids of various kinds, etc. Even something like reaching...even ...further, across a table for something has the ability to overchallenge. 

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