I happen to think your definition of learned non-use is completely wrong. It is vastly more likely that the neuronal cascade of death in the first week is the problem. You may be able to initially move a muscle but after the neuronal cascade of death has occurred, you no longer have live brain cells that can do that task. You are assigning learned non-use to an impossibility and blaming the patient rather than BLAMING THE DOCTOR for not stopping the neuronal cascade of death.
My take is that your doctor has the learned nonuse problem, they have learned to do nothing for stroke survivors and have been getting away with it for decades.
Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life
2012, Archives of Physical Medicine and Rehabilitation
ORIGINAL ARTICLE
Quantifying Nonuse in Chronic Stroke Patients: A StudyInto Paretic, Nonparetic, and Bimanual Upper-LimbUse in Daily Life
Marian E. Michielsen, MSc
†
, Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD
ABSTRACT.
Michielsen ME, Selles RW, Stam HJ, RibbersGM, Bussmann JB. Quantifying nonuse in chronic stroke pa-tients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life. Arch Phys Med Rehabil 2012;xx:xxx.
Objective:
To quantify uni- and bimanual upper-limb use inpatients with chronic stroke in daily life compared with healthy controls.
Design:
Cross-sectional observational study.
Setting:
Outpatient rehabilitation center.
Participants:
Patients with chronic stroke (n=38) and healthycontrols (n=18).
Intervention:
Not applicable.
Main Outcome Measures:
Upper-limb use in daily life was measured with an accelerometry based upper-limb activity monitor, an accelerometer based measurement device. Uni-manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Out-comes were expressed in terms of both duration and intensity.
Results:
Patients used their unaffected limb much more thantheir affected limb (5.3h vs 2.4h), while controls used bothlimbs a more equal amount of time (5.4h vs 5.1h). Patients usedtheir paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominantside. The intensity with which patients used their paretic side was lower than that with which controls used their nondomi-nant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used theiraffected side was much lower than that of the nonaffected side.
Conclusion:
Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.
Key Words:
Ambulatory monitoring; Motor activity; Reha-bilitation; Stroke; Upper extremity.©
2012 by the American Congress of Rehabilitation Medicine
Objective:
To quantify uni- and bimanual upper-limb use inpatients with chronic stroke in daily life compared with healthy controls.
Design:
Cross-sectional observational study.
Setting:
Outpatient rehabilitation center.
Participants:
Patients with chronic stroke (n=38) and healthycontrols (n=18).
Intervention:
Not applicable.
Main Outcome Measures:
Upper-limb use in daily life was measured with an accelerometry based upper-limb activity monitor, an accelerometer based measurement device. Uni-manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Out-comes were expressed in terms of both duration and intensity.
Results:
Patients used their unaffected limb much more thantheir affected limb (5.3h vs 2.4h), while controls used bothlimbs a more equal amount of time (5.4h vs 5.1h). Patients usedtheir paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominantside. The intensity with which patients used their paretic side was lower than that with which controls used their nondomi-nant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used theiraffected side was much lower than that of the nonaffected side.
Conclusion:
Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.
Key Words:
Ambulatory monitoring; Motor activity; Reha-bilitation; Stroke; Upper extremity.©
2012 by the American Congress of Rehabilitation Medicine
No comments:
Post a Comment