I noticed a lot of hits on my blog for this. Rajul Vasa has a 66 page paper on this if you want to wade thru it. She totally lost me in the clinically drawn conclusion section. I don't know whom this is written for but I'd be willing to bet not a single stroke survivor is going to be able to understand this and apply it to their recovery. And probably few therapists.
Great word salad though. Maybe the whole point is to increase your cognitive abilities of reading comprehension.
My earlier post on it here including pros and cons.
I'm kinda smart and I have absolutely no clue what the following gibberish is supposed to mean.
Clinically Drawn Conclusion:
1.
Increased degrees of freedom of paretic flail MSS (Musculoskeletal system) of
one side of the body
from a small lesion in CNS make self-organizing dynamic system unstable from
within. (And what the hell does this mean?)
2.
For safety reasons brain switches off the control on Centre of Mass [COM] from
affected hemisphere
and solves the problem of safety of COM by steering the control on COM
exclusively to
good side of MSS that is to non-lesioned hemisphere. This is positive instant
plasticity that facilitates
good side to control COM but is functionally negative plasticity on a long run
with adaptation
of good side of the body to control COM exclusively making it hard for the
stroke subject
to use affected side despite natural recovery of brain tissue. (Wow, just Wow?)
3.
Action plans of self-organizing stroke CNS and MSS to re-stabilize the system
and to combat external
invariant forces like gravity to control and defend COM [a priority of all living
organisms] becomes
the added constraint to restoration of lost control besides the presence of
lesion.
a.
Self-organizing stroke CNS exploits anticipatory postural activity and
Spino-Spinal interlimb sensory
motor neuronal connectivity [left
side of the spine to right side of the spine and from cranial to caudal and caudal to cranial connections] to induce muscle contraction in a chain of paretic muscles
during functional acts with slightest movement of COM to restrict increased degrees
of freedom from paresis that poses threat to safety of COM.
b.
Synergic activity in chain of paretic muscles in paretic limbs is considered as
pathological abnormal
movement and associated reaction, when in fact it is uninterrupted extended anticipatory
activity in chain of paretic muscles with slightest movement of COM. This extended
anticipatory activity is the result of uninterrupted control on COM by good side
of body that renders paretic side as an automatic follower of good side with
interlimb Spino-Spinal
connectivity.
(Wow, just Wow?)
c.
Self-organizing brain exploits anticipatory postural control to induce
uninterrupted continuous
contraction in Paretic weak muscles to turn them stiff and spastic in order to reduce
degrees of freedom in paretic limbs to reduce threat to the safety of global
COM by
inducing so called abnormal pathological synergic movement that remain constant
in one
direction only towards the central axis to remain within narrow base of support [BOS]
and do not allow any variability in direction for safety reasons.
d.
Spasticity, synergic grouping and contracture act optimally not only to reduce
increased degrees
of freedom from flaccidity but act as a “BRAKE” on the fluid movement of COM for
safety a priority.
e.
In my view, Spasticity in stroke patients is in fact the resultant effect of
uninterrupted muscle
activity from anticipatory postural control with slightest movement of COM whereas
muscle’s velocity dependent spastic behavior well described by neurophysiologists
in laboratory set up in unloaded condition when the limb segment is moved
passively by examiner is a reflex action.
f.
Self organizing stroke CNS promotes automatic central postural control of
global COM with
synergic grouping of chain of muscles in priority over the development of
voluntary selective
control on segmental COM.
g.
Automatic postural gravicentric muscle activities allow segmental COM to move
only in the
direction towards the central axis and do not yield in any other direction for
safety of
COM and for COM to remain within the narrow Base of Support [BOS].
4.
Microscopic morphological changes like contracture, loss of viscosity,
stiffness in paretic muscles,
in connective tissue and in basic fabric (the fascia) that binds the entire
skeleton together
at the central axis, ‘the spine’ enable the paretic side MSS anatomically
connected to non
paretic MSS to get mechanically bound together for a macroscopic change in
behavior of paretic
MSS for, “The whole is bigger than sum total of its individual parts”. Meaning
that the system
as a whole determines in an important way how the parts behave. (Wow, just Wow?)
o Macroscopic
change in behavior of paretic MSS can be compared with passive ‘Towing’ by
non-paretic MSS when muscle motors of paretic MSS fail.
(what the hell is this?)
o Towing
the huge mass of paretic MSS by non-paretic MSS becomes easy with contracture
in widely spread Thoraco-lumbar fascia that spans both sides of the central axis
and houses large trunk muscles bilaterally with bilateral innervation helping
to bind both
paretic and non-paretic MSS together at the central axis with contracture and contraction. (Wow, just Wow?)
5.
Contracture in muscles of limbs that has an origin on the central axis the
trunk [Lattissimus, Pectoral
and Iliopsoas] enable the limbs to get bound to the trunk with microscopic morphological
changes like stiffness, loss of viscosity, loss of sarcomere, thus binding
entire paretic
MSS with non paretic MSS.
o Lattissimus
muscle is anatomically well placed in terms of connecting scapula and the pelvic
girdle together and is attached on to Humerus bone and is in continuity with
the gluteus
maximus on the opposite side (Vleming & Wingerden, 1996). It is interesting
to see
that self organizing brain exploits anatomical advantage of Lattissimus to bind
two girdles
together like a log by turning it spastic to restrict dissociation between two girdles
for safety of COM, a priority for all living organism.
2.
To make the lattissimus muscle spastic or to induce extended continuous
contraction with anticipatory
activity in lattissimus muscle, brain exploits anatomical continuity of left
paretic lattissimus
with the right normal gluteus maximus on the opposite side. With every step of walking
and standing up using good leg hip extensor muscles, paretic lattissimus gets
stretched with
its own inertial mass and anticipatory extended continuous contraction becomes
inevitable in
paretic Lattissimus turning it spastic.
3.
Self-organizing stroke brain exploits un-opposing pull of normal trunk muscles
pulling the torso away
from paretic leg to sustain the head, arm and trunk mass (HAT) onto the normal
hip thereby
off-loading / reducing weight bearing on paretic limb for safety of COM. This
steering of good
torso away from paretic hip by selforganizing brain fails therapeutic efforts
to permanently shift
weight on paretic LL.
4.
Reduced weight bearing on paretic leg is a huge problem in therapeutics. Forced
feedback / verbal
commands / visual feedback / weight training / treadmill training / force plate
sensory training
etc. does not get permanent shift of weight on paretic leg unless paretic LL
relearns to gain
control on COM in all 3 Cartesian coordinates with paretic muscles in many
different basic postures
and selforganizing brain feels secure and trusts paretic leg’s ability to
control and restore
COM.
5.
In my experience, Restoration of sensory motor control of the paretic UL is
dependent on the restoration
of control on COM by paretic Lower Limb. With poor loading of paretic limb,
stroke subject
is almost hopping on single good leg making spino-spinal neuronal connections
to make paretic
upper limb to go in flexion posture as is seen when you and me hop on single
leg.
Anatomical
Coupling of paretic Lattissimus muscle with opposite normal gluteus and
inertial mass
of paretic lattissimus helps it get stretched with each step of walking
standing up and in sitting
down.
6.
New functional behavior; “Towing” of paretic MSS by non-paretic MSS makes
exchange of dominance
between two MSS impossible. This makes “Normally Abnormal, to be Normal”.
7.
“Towing” wherein one side MSS leads and the other side MSS follows
automatically, it disturbs spatiotemporal
efficiency, coplanar economy of hip knee actions important for energy savings.
8.
Towing of paretic MSS makes it dependent on non-paretic MSS for geocentric
reference. This allows
non paretic MSS to lead uninterruptedly with paretic MSS turning supportive by
trailing behind
and acting optimally as a “brake” on COM movement to ensure further safety.
9.
New functional integration between two MSS, one leading and controlling the COM
all the time and
the other trailing behind and following all the time ensure safety of COM,
always a priority during
postural and supra postural tasks.
10.
Added safety to COM is provided by passive inertia of paretic mass.
11.
Impedance to movement from spasticity, rigidity and stiffness in muscle and
contracture in passive
tissue and muscle is a defensive strategy of the self-organizing CNS in
prioritizing safety of
COM when it cannot control and restore COM to safety.
12.
Associated reactions apparently seem to be helping to tow paretic MSS.
13. Paretic
UL can be abused (with
sub-cortical postural reorganization, spino-spinal reorganization and
physiological constraint inter limb coupling) at every step taken by paretic LL ( that moves like a prop without coplanar movement
economy at hip and knee, with poor loading and without its ability to control
COM in all
3 Cartesian coordinates.
14.
Poor loading on paretic leg reduces sensory input from under the paretic foot
and ankle foot geography
gets influenced by adjoining segments like knee joint, femur and trunk posture
etc. making
self-organizing brain to depend on vision with sensory reweighting.
15.
Depending on vision for balance is, an automatic solution by self-organizing
brain at a heavy cost of
making “Normally Abnormal, to be Normal” wherein cortical vision is used for
balance instead of
sub-cortical proprioceptive sensation.
16.
This makes the availability of vision to gauge the threat and obstacle in space
only if, balance is taken
care of by stopping to walk to look or by holding the wall or holding onto
people around.
This
makes multi-tasking a problem for stroke subject that could cause frustration /
depression /
and
self-image problems.
17.
Power of self-organizing brain is mightier compared to any therapeutic efforts
made by rehabilitation
team unless therapeutics are designed to Reorganize the self-organized brain by exploiting
the priority of self-organizing brain, to control and restore COM using paretic
MSS.(Holy cow!)
18.
Human body is the direct window to the brain. Paretic MSS itself can be
therapeutically exploited
to channelize the dialogue between brain, body and the external environment; ‘the gravity’ to re-organize
self-organized brain to restore lost sensory-motor control on paretic side.
Amy, help please!