Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Wednesday, September 22, 2010

stroke rehabilitation and drop foot

This is an extremely common result of a stroke. The patient can't lift their foot
during walking to clear the ground. The problem is that dorsiflexion is not occurring. The standard response seems to be get them a AFO to lock the foot at 90 degrees. I didn't see any attempt to determine why the dorsiflexion was not occurring.
I can see numerous different reasons and I am not medically trained.
1. The motor cortex area that controlled the Tibialis anterior muscle was damaged and in the penumbra.
2. The motor cortex area that controlled the Tibialis anterior muscle is dead.
3. The pre-motor cortex was in the penumbra.
4. The pre-motor cortex is dead.
5. The executive control was in the penumbra.
6. The executive control area is dead.
I don't know my math very well but I think this leads to 6! 6 factoral or 6* 5* 4 * 3 * 2 * 1 = 720 possible variations as to the cause of dropfoot.
Correction: I asked a PhD friend about this and his reply was;

On your combinatorics question - the 6! = 720 combinations would refer to a situation in which all six items are distinct from each other and for which the order matters. I don't believe that is the case here. It seems to me that you are describing three possible areas for controlling dorsiflexion (motor cortex, pre-motor cortex and executive control) that are always there, and the failure of dorsiflexion happens if at least one of these areas is damaged/dead. So if I call those areas M, P and E and if they are either alright (Y) or damaged (N), then normal control happens for one configuration only:



In the second row, there are seven other combinations:




In other words, three areas with are either Y/N leads to 2^3 = 8 total combinations, of which only one is all Y, and the other 7 refer to a dysfunction. Then I would say there are 7 different variations as to the cause of dropfoot.

And we have a one-size-fits-all AFO for this.
The standard seems to be a rigid plastic AFO, sometimes with a built-in hinge.
I received one of these for two reasons, allowing my toes to clear the floor and stop the eversion of my foot.
Currently have quit using the AFO from 1 year ago. The use of it was preventing me from getting a decent heel strike and was not allowing me to build up any muscle strength in my ankle muscles.
I think that there should be a protocol for each underlying diagnosis. In my case I can dosiflex in any position but doing it while walking does not work very well. My diagnosis is that since my pre-motor cortex is dead it was not coordinating the firing of all the muscles of walking. Do not take any of this as medical advice.
Peter Levine has a good description of what you are missing by using an AFO to compensate.

1 comment:

  1. Ever since you and Pete schooled me on the use or rather, the disuse, on my AFO, I put it to rest. My bedroom door has an expensive door stop now. While it is advantageous to use immediately after one has a stroke, I believe continued use of one has detrimental effects. The AFO hinders the return to walking. Since I bailed on my AFO, I'm walking better and strenghtening the muscles in my leg and ankle. At first I was just able to take a few short steps, but now, I'm able to walk without it and I have transitioned to a soft ankle brace exclusively. Thank you Dean and Peter for showing me I can walk without my AFO.