Therapists ask me what therapies have worked in my rehab. I can understand why because they want to add that therapy to their roster of abilities.
Survivors ask me what exercises worked in my rehab. They are hoping that if they can just find the right exercise to do they will recover.
Both of these questions are invalid because the first thing to understand is how recovery occurs and where you are in the process. Until you know that can you select a therapy or exercise to work on. If you are working on penumbra recovery in the first 6-12 months then you take the little pieces of movement you do have and keep extending them longer and farther. If you are trying to get back functions that were in the dead brain area then you need to work on neuroplastic therapies that move those functions; try passive movement, mental imagery, thermal stimulation, action observation. All of these are discussed in other posts on my blog.
Until we get the whole concept of what needs to be done to recover changed from this specific therapy or exercise will we finally come up with a therapy model for stroke rehab. So don't enable the doctors and therapists by accepting a therapy or exercise without them specifying how it meets the protocol of recovery. See my blog on restructure stroke rehab model and theoretical basis of stroke rehab for my ideas. I actually think they are pretty good.
I think the effectiveness of one therapy exercise for example would differ for every stroke rehab patient. Each would have different needs,different reactions, and different coping mechanisms so each therapy exercise should really be designed depending on these.
ReplyDeleteThis really points out the fact that until we get a specific damage diagnosis we can't correlate any therapy properly to recovery.
DeleteYes Dean, but if you follow that idea, then a stroke victim will just be left lying in their bed for weeks past the window for any sort of meaningful recovery.
DeleteI dont exactly get the dead brain functions. according to my PT whats died are not the motor cortex but the corticospinal connections to the spine. since I didnt recover hand or foot, he expected them not anymore to recover but the brain functions should still be there just the spine is inaccessible to them. and My damage was at the back with part of brainstem and motor cortex in the front so then the brain area is not dead? yet still I cannot extend movement because I only improved my shoulder by moving it lots of times it was 90degrees lift now its like 145 degrees lift.but couldnt move my fingers anyway so no way to improve them.
ReplyDeleteso in summary, my brain is not dead but the little pieces of movement don't exist.
Well then, you really need to challenge what your therapists know. How exactly do they know what has died? Have they never heard of axon pathfinding or dendritic braching? What is their protocol of sending neurons around that dead area? Your questions and non-answers are exactly what causes my swearing on this blog. We as patients shouldn't have to figure out how to recover ourselves. We are paying trained persons that should know the answers.
DeleteI don't have your level of knowledge, but I believe in keeping pushing any thing which won't work, and it seems to work. I never take the professionals assumptions at face value. I now drive short journeys, up to 45 minutes each way), walk as much as I can every day, read lots (whilst wiggling some part of my body-never still), and I am re-learning to touch type. I will not accept that I can't ever be normally functional again!
DeleteThey dont worry too much abut correlating specific brain areas to paretic limbs. I told them based on my research the part of the motor cortex that controls my foot and hand is not dead so I have better chance for recovery. and they said.. well your recovery pattern doesnt differ that much from other people and I have seen alot of patients and based on that I dont expect your hand or foot to recover much as Im past 5 months. I said I knew somebody who used electrical stimulation and after 4 years and months of stimulation the foot was no longer paretic but then the doctor said, electrical stmulation is no miracle worker we used to think it could cure paresis but it wasnt that easy. she said all strokes are different you cant just expect to recover in the same way, you have to be realistic in your goals. well I read stronger after stroke and I believe if I try hard enough I can fully recover. I even recommended the book to another survivor who was losing hope about getting her life back. am I being realistic? I just need a doable training that guarantees my full recovery.
ReplyDeletethat said I still dont understand what you said above, my motor cortex is not dead according to you I can extend movement but in my case I cant my fingers dont move at all, it seems the connection to my spine is dead so i just need to reroute that part? but that means your article doesn't apply fully to my case.
Well if your motor cortex is not dead then your doctors and therapists should have something to help you. The comment about being realistic is just shorthand for them not knowing what the hell to do. There is nothing that guarantees full recovery. You are going to have to figure out for yourself how to recover, there seems to be no database anywhere that documents stroke recoveries. I've got dozens of posts of axonal pathfinding and sprouting which is what you probably need.
ReplyDeletewhat therapies can I do? I do mental practice already.
Deletehow was your recovery pattern? did you get stuff back on your own or through hard work?
And why would specific knowledge about neuroplasticity help me? I already believe in it, I just need a protocol to do which has high chances and high time efficiency.
DeleteI still have zero use of my hand and left arm, my left leg has spasticity that prevents a normal walk. But I still consider myself fully recovered because there is nothing I won't do. You might want to look at my dead brain rehab posts even though they don't directly apply to you. You along with the 10 million survivors a year are all in the same boat. You have to figure out your recovery yourself because there is no one in the world to help you. I can't even get myself further recovered because I don't know how to stop spasticity.
DeleteWe know neuroplasticity works, We don't know how/why a neuron that is doing its job drops what it is doing to help out a neighboring neuron. If we knew how to repeat that we could have genuine stroke rehab that works. That is a question for your highly paid doctor, not me
DeleteIn the book stronger after stroke spasticity is explained as the brain not having enough control so I assumed if one has no more paresis in that limb then spasticity disappears? unless it didnt in your case?Thanks I will try do those stuff but it seems so vague like watching youtube videos will cure me? its weird...
ReplyDeleteNo one in the world knows that answer, every stroke survivor is completely on their own to solve their own problems. Which was the whole point of this post. I have some control over my bicep but it still has quite a bit of spasticity, enough that I can't easily extend my arm using my triceps.
DeleteI see, well my curiosity is more in the following question: what are YOU doing to get your arm/hand back and try remove spasticity? you seem very wise.
ReplyDeleteWell I have pretty much given up on doing any rehab specific exercises. Living my full social life takes precedence and my deficits do not stop me from doing anything. If someone comes up with a defined stroke protocol that has a high chance of success I might do that
DeleteHi, I probably am comparing apples to oranges, and my hand was not tightly clenched, but I found that using vibration helped to unlock my hand. I had a Niagra therapy hand held massager and was holding that with my good hand and steadying it with my affected hand, and just that minimal use helped to relax the fingers. After that, when it seemed that my hand was improving, I would bend the fingers back with my good hand, regularly, and, eventually I could manipulate them pretty well. they still do not respond quickly and automatically, but they are functional. i certainly would not bother to try touch typing.
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