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:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Wednesday, January 26, 2011

deep brain neurons and stroke rehab research

Visualizing neurons in the deep brain. This technology
sounds like a fascinating way for stroke researchers to
watch neuroplasticity take hold. Between deep brain neurons, connectomics,
and array tomography, one of these should be required for
researchers to prove that therapies work.
Stanford scientists have devised a new method that not only
lets them peer deep inside the brain to examine its neurons
but also allows them to continue monitoring for months.
Because light microscopy can only penetrate the outermost
layer of tissues, any region of the brain deeper than 700
microns or so (about 1/32 of an inch) cannot be reached by
traditional microscopy techniques. Recent advances in micro
-optics had allowed scientists to briefly peer deeper into
living tissues, but it was nearly impossible to return to
the same location of the brain and it was very likely that
the tissue of interest would become damaged or infected.
With the new method, "Imaging is possible over a very long
time without damaging the region of interest," said Juergen
Jung, operations manager of the Schnitzer lab. Tiny glass
tubes, about half the width of a grain of rice, are
carefully placed in the deep brain of an anaesthetized
mouse. Once the tubes are in place, the brain is not exposed
to the outside environment, thus preventing infection. When
researchers want to examine the cells and their interactions
at this site, they insert a tiny optical instrument called a
microendoscope inside the glass guide tube. The guide tubes
have glass windows at the ends through which scientists can
examine the interior of the brain.
"It's a bit like looking through a porthole in a submarine,"
said Schnitzer.

Tuesday, January 25, 2011

Succeeding at getting up again after failure

Succeeding at failure(the original title) not quite correct
In order for me to recover I will have to neuroplastically modify my brain and in order to do that I will probably have to get up after failing millions of times for each muscle control. As long as I can get up again and fail all over again. Albert Einstein has a quote 'Insanity: doing the same thing over and over again and expecting different results.' Does this imply that all stroke survivors that believe in using neuroplasticity are insane for that belief? Or should we just ignore Einstein because we are smarter than him?
I will succeed at failing and trying again.

Monday, January 24, 2011

What do you feel like on your stroke rehab journey/caregiving?

Billk from strokenet referred to it as 'one big biology experiment, with me in the bottom of the Petri dish'
Ethyl17 from strokenet  'In space, no one can hear you scream'.
A friend from Australia put in a presentation to a stroke conference. 'It seemed like I was the first person on this journey.'
My take is something my dad sometimes used to say 'Up sh*t creek without a paddle'. I finally did manage to buy a t-shirt from the Sh*t Creek Paddle Company. This is kind of what I as a stroke survivor feel like. No directions and no propulsion aids. And no towing service available.
Notice the backstroke--->:roflmao:
Whats your take? I'm sure there are other equally subversive and pungent ones. Please add some more, I'm collecting them for letters I want to write. :ranting:
Dean

Tuesday, January 18, 2011

Gait and stroke rehab

I know that this is stepping on PT responsibilities but I think that all PTs and OTs should have to produce something like this for their patients. Take this with a grain of salt, I do not intend this as medical advice, but education for yourself so you can be a better patient.
When I first got out of the hospital, still in a wheelchair I would sit staring at people walking to see what they were doing right that I couldn't do. My PTs did not have any videos of human gait that would have helped me understand where I was going wrong, all I got was do it this way with no breakdown into smaller pieces. I finally fired that PT and went to one that could at least see what was going wrong. here are some videos I found on the internet if you want to try and look at them and improve on your own.
Also read a complete textbook on human gait, way over my head but at least it gave me a few muscle groups to strengthen at the gym. I still waddle but the leg swing out is significantly reduced.
Gait Analysis: Normal and Pathological Function
by Jacquelin Perry, Bill Schoneberger
Besides a human walking there is a model you can slow down, speed up and turn
http://www.frontiernet.net/~Imaging/gait_model.html
coordination normal gait
Movies from the NeuroLogic Exam and PediNeuroLogic Exam websites are used by permission of Paul D. ****, M.D., University of Nebraska Medical Center and Suzanne S. Stensaas, Ph.D., University of Utah School of Medicine. Additional materials were drawn from resources provided by Alejandro Stern, Stern Foundation, Buenos Aires, Argentina; Kathleen Digre, M.D., University of Utah; and Daniel Jacobson, M.D., Marshfield Clinic, Wisconsin. The movies are licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 2.5 License.
  • Biomechanics of gait walking
http://www.utoledo.edu/hshs/kinesiology/pdfs/Biomech_of_Walking_and_Running.ppt#257,2,Biomechanics of Gait Walking
http://www.cse.ohio-state.edu/research/ ... index.html
A comparison of normal and stiff-legged gaits.This one even includes some stair walking
http://www.youtube.com/watch?v=wkYMLidUO-A
Contains the skeleton walking
http://www.youtube.com/watch?v=8s0FY4D_ ... re=related
  • Muscle Activation During Gait

http://www.youtube.com/watch?v=GV6CAZiv5Zo&feature=endscreen&NR=1

  • Primal Pictures human anatomy demo
sitting to standing, toe flexing, head turning
http://www.youtube.com/watch?v=1Ohpyc2K ... re=related
  • Some free demos available here
http://www.anatomy.tv/
  • Running robot
http://www.youtube.com/watch?v=sv35ItWLBBk
  • animated gait in slow motion
http://www.nsf.gov/news/mmg/media/media/gait_final1.swf
movement analysis here go to site map/gallery
http://www.musculographics.com/index.html
demo video looks good I wish all therapy depts. could have this in order to break down exactly what stroke survivors are doing wrong so the indivdual pieces could be corrected.
http://kine.is/modules.php?op=modload&n ... load&cid=2
  • This gives the various phases of gait
http://moon.ouhsc.edu/dthompso/gait/intro.htm
A lot of this is very pertinent to me because my pre-motor cortex is dead, which means planning of complicated movements is not being automatically done so I have to manually think about and fire the individual muscles. Of course this is my own self diagnosis, which the patient should never do.
http://www.lowerextremityreview.com/news/in-the-moment-stroke
Now if we could get the 3d movements and stroke rehab mapped to standard walking then we might get to where a damage diagnosis could be correlated with the therapy prescriptions.

Saturday, January 15, 2011

Who's in charge of Stroke rehab research?

A great philosophical question that hundreds of thousands of Americans each year need answers to. According to the national Stroke Association there are over 6 million US survivors.
I can't talk about other country stroke associations but in my limited view they seem to be for medical staff only with a bone thrown to survivors with stroke support groups.
The ASA has no place to find out what research it supports and no survivor office.
The NSA has no place to find out what research it supports and no survivor office. It does have an Advovacy office http://www.stroke.org/site/PageServer?pagename=advocacy
This seems to be more tuned to what the NSA wants rather than what survivors may want. I contacted Jill Thiare because her name was listed in one of the emails.
advocacy@stroke.org was also listed as a contact email address but that one doesn't work. My question to them was: How do I advocate what the NSA does?
Your mission statement is as follows:
"We provide education, services and community-based activities in prevention, treatment, rehabilitation and recovery. National Stroke Association serves the public and professional communities —people at risk, patients and their health care providers, stroke survivors, and their families and caregivers."
You are failing in the part about rehabilitation and survivors. All you want survivors for is to advocate for your goals. Your goals are not the same as a survivors goals.
No answer on how survivors get involved in the NSA except as volunteer gofers.
The World Stroke Organization has no survivor office.
The APTA seems to have no way for users of PT services to interact with the organization.
The AOTA seems to have no way for users of OT services to interact with the organization.
What we really need is a truly survivor based and run organization. Numerous individuals have set up their own forums and web pages but there is no cohesive understanding of where stroke rehab should go. If we don't do something now the baby boomers coming down the line will have nowhere to go to to get decent information. Similar to what we have now where everyone assumes that your spontaneous recovery is good enough for you.
No one is taking responsibility.
Who will step up to the plate? ANYONE?

Friday, January 14, 2011

The Canoe Race as Stroke rehab


Ok this really has nothing to do with rehab but Barb, another stroke blogger, does row and I do want to get back to canoeing.
The Canoe Race:
Toyota vs. Ford
Anonymous Author
Pages of "The Paper"


Toyota and Ford decided to have a canoe race on the Missouri River. Both teams practiced long and hard to reach their peak performance before the race.
When the race was over, the Japanese team won by a mile.
The American team was very discouraged and depressed. They decided to investigate and find a reason for the crushing defeat. A team made up of senior management was formed to find the problem and recommend appropriate action.
The team’s conclusion was: The Japanese team had eight people rowing and one person steering while the American team had eight people steering one person rowing.
Feeling a deeper study was needed, the American management team hired a consulting company for a second opinion, paying them a lot of money.
The consulting company advised the Americans that, of course, there were too many people steering and not enough people rowing.
Wanting to prevent another loss to the Japanese, the rowing teams management structure was totally reorganized to:
-Four steering supervisors
-Three steering area superintendents
-One assistant superintendent steering manager
Also, the management team implemented a new performance system that would give the one person rowing the boat greater incentive to work harder. They called this incentive, “The Rowing Team Quality First Program,” with meetings, dinners, and free pens for the rower. They got new paddles, canoes, more equipment, and extra vacation days and bonuses.
The Japanese won the next race by two miles.
Humiliated, the American management team laid off the rower for poor performance, halted the development of a new canoe, sold the paddles, and canceled all capital investments for new equipment. The money saved was distributed to the Senior Executives as bonuses. Also, the next racing team was outsourced to India.

There is a definite problem with this joke, they talk about rowing which is this case would mean an eight person shell. So the term canoe is wrong and they would be getting new oars rather than paddles.

Monday, January 10, 2011

anatomy and stroke rehab

Your OT and PT probably rattle off muscle names assuming that you know exactly what they are talking about. Of course you know that your calf muscle is triceps surae and is a pair of muscles located at the calf. The gastrocnemius and the soleus. The muscle you can't control that causes dropfoot is your Tibialis anterior muscle , otherwise known as lack of dorsiflexion. I could keep going but the point here is that having an understanding of what muscles are problematic is needed in order to mentally imagine and neuroplastically move control to a new area. The best book I found for this is Anatomy of Movement by Blandine Calais-Germain This one came recommended from my OT. It helps me visualize what muscles are being used for what movements and has some excellent diagrams. Bodybuilding books would be a good second choice and available at all libraries.
If we ever get to a damage diagnosis where our doctors specify exactly what sections of the brain are damaged then our therapists could use that diagnosis along with anatomy diagrams to show you exactly what you need to work on. Either easy neuroplasticity, from the penumbra or the draining bleed area, or hard neuroplasticity, moving dead brain function control to another location. And if you are lucky and smart enough you won't canabalize your executive control to get back motor movement.

Sunday, January 9, 2011

rowing and stroke rehab

We have a rowing machine in our basement, sometimes called an ergometer. This past week I started using it again. The various therapies involved are turning on two light switches with my affected hand, it looks ugly but what the hell. Walking down the steps does still require that I put my good hand against the wall as I come down. My form on the rower is pretty much straight-armed, this is on purpose, to lessen and counteract the spasticity of my left arm. I do still use the spasticity of my curled left fingers to keep a grasp on the handle. The back and forth on the slide strengthens my quads and the slide up works my hamstrings. Currently only doing 750 meters. I'll work my way up to the race length of 2500 meters in the next couple of weeks. After I am done with my workout I just use my left leg to go back and  forth on the slide, mainly to get the hamstring working better.
I tried this at the gym, but most of the other persons on the rowers are trying too hard and grunting while doing it.

I am trying to get 'ripped'. You know those balloon-headed aliens on science-fiction shows. I figure I will be able to start looking like them if I work at this enough. That would really appeal to those working out at the gym. Especially those pulsing veins on the forehead, that would look good with my baldness. :roflmao:

Tuesday, January 4, 2011

3d movements and stroke rehab

A new research center at Stanford will address mobility disorders with powerful 3-D simulations of a patient's movements
http://news.stanford.edu/news/2010/december/delp-movement-research-123010.html
I did have this done as part of a research study I was in on ankle movement but was not able to see those results. I could see an extremely important use for this for all PTs working with stroke gaits. And maybe then someone will be able to identify very specific small movements to work on. My first PTs could only demonstrate the correct way to walk and since my walking was pretty screwed up their admonitions didn't work.

Or if your therapist does not have quite such a high-tech item maybe this would work
Could Your Clinic Benefit From Slow Motion Video Analysis?

This does mean your therapist will have to get outside off their comfort zone because this would mean working on individual muscles rather than their training of complete functional movements.

In one of Uncle John's Readers my daughter told me that it took 200 muscles in order to walk. I just thought, 'Oh great, I have to relearn 100 of them'. But if these technologies could be used for hemiplegic gaits then they could tell me specifically which muscles are spastic and which ones are weak or missing. Well I can dream about the future of rehab. If only I was in charge.