Function: You get what you want but not what you need.

Function. Function. Function. Function.
 
That's all you ever hear. "We're trying to get the patient functional." 

Why? 2 reasons: 

1. You want survivors to be functional. You want them to be able do every day, real-world tasks. When therapy ends, the therapist wants the patient to be able to do as much for themselves as they possibly can. Function is a good thing, no doubt. 

2. Generally, function is paid for. Lets say the goal is walking. If the patient is not walking, at some point, you have to end therapy. And with the ending of therapy comes the ending of payment.

But there's a problem with this "focus on function." I can be functional and walking, but require a cane an orthotic on my ankle. The cane is used to overcome the weakness of the affected leg. The orthotic on the ankle is used to overcome the inability to lift the foot. Focusing on function means overcoming a deficit. Sounds good, right? But if you are using a cane an orthotic have you really overcome the deficit? Maybe we shouldn't chew. We can put everything in a blender.

I've long been an advocate of a focus on recovery, not function. Think of recovery as a game of soccer. Function is a score of 1 to 0. You win. But there are two ways to win. One way to win is to pick up the ball with your hands and throw it in the goal. The other is training hard, practicing with your team, getting in good shape, practicing skills, getting in the game, and putting all the practice into, well, practice. Using the "good" extremity to accomplish goals (known as compensatory movement), orthotics, assist devices, etc. etc. does not lead to recovery. 

Very often function flies in the face of recovery area. For instance, a person may very well have some dorsiflexion (the ability to lift the foot at the ankle). But the movement is often weak and incomplete. Therefore it is "nonfunctional." And so it is ignored. And if a movement is ignored the portion of the brain representing that movement will get smaller. 

And so the ability to lift the foot will decrease. And so the movement is ignored even more. And so there is less brain involved, and so on and so on and so on. This process is known as learned nonuse.

 By: "stroke recovery blog" "stroke blog"

The Wrong Question

"What is the single most important thing you should know about stroke rehab treatments?"

That's easy: Your asking the wrong question.

If you are talking about rehabilitation treatments you are talking clinical stuff. You are talking about a clinician-- usually a therapist-- in a clinical setting. And both clinician and clinic are great but they are not enough during two time periods:

1. Every day

2. Once your discharged from therapy.

Let's consider why clinical stuff "every day" is not enough. How much therapy might you get? An hour-- two-- three? Recovery is a full time job during the first few months after stroke and it is the first few months after stroke that you're still seeing therapists. So even when therapists are there, there almost always not there enough.

OK, now lets take "Once your discharged from therapy." Discharged from therapy is in and of itself the very definition of not enough therapy, because you've been discharged. Discharged like a bullet from a gun, off you go! So once you are discharged you are definitely not getting enough clinical stuff.

So maybe the question ("What is the single most important thing you should know about stroke rehab treatments?") is wrong. What if instead the question was "What is the single most important thing you should know about stroke recovery options?"

Isn't that freeing? You are no longer under the rules of managed care because managed care does not care if you try, on your own, to take on your recovery using whatever options you can find. You can spend as much time as you want. And even if recovery options are an adjunct to rehabilitation treatments, they expand the opportunities for recovery.

So, "What is the single most important thing you should know about stroke recovery options?"

Sweat equity. That's it. The more you put in, the more you make your brain uncomfortable and force it to change. the more repetitions, the more challenge, the more focus— the more recovery.

Pot Decreases Spasticity.

If you want to reduce spastcicity, move to Colorado. Pot (or the active ingredients in pot) can potentially reduce spasticity. This includes every pathology in which spasticity is a sequelae, like...

stroke

multiple sclerosis

spinal cord injury 

dystonia (see reference section)

But wait there's more! It turns out that pot make have a benefit for much of what ails survivors from arterial disease to seizures (10% of survivors experience a seizures). So why has your MD not talked to you about Mary Jane as a possible treatment for, well, anything? Simple. It is  the burning weed with its roots in hell duh!

And its dangerous. Very Very Dangerous.

Stronger After Stroke for 2.99!

This is a special promo for the 1st ed. Remember, the 2nd edition is available for pre-order (See link on the right hand column).

You Done Yet?

I'm always pretty confused about when recovery ends. I haven't had a stroke, so I only know what I've heard. For some people recovery ends when therapy ends. In fact it's pretty common that once therapy ends survivors actually decline to various degrees. But some people seem to trudge onward. I hear this a lot; "I've been at it for three years, and I'm still making progress. It's a long road – but it's worth it."

Some survivors believe that recovery ends when they're able to do so much with their life that you're too busy living to continue working on recovery.

But just like an athlete trying to get better, a little means a lot. This is the thing that clinicians often don't know. Clinicians think that the world is binary – that you're either functional or nonfunctional. That is you're either able to do the task (i.e. walking, dressing, etc.), or you're not. I've always thought it should be more nuanced than that; little bits of movement are important irrespective of the function. It probably comes from my involvement in research. In research you measure little bits of "better" movement.

What good is "better" movement? What does it get you?
Better movement means …
•less spasticity
•better blood flow (when muscles contract there is "venous return" of blood back towards the heart)
•better cardiovascular health (the more you move, the stronger your heart gets) 

You get the idea. More movement generally means more health. And health is measurable. It's measurable in terms of... 

•a reduced heart rate
•less chance of falling
•the ability to fight infection better etc. etc.

So call it what you will. Recovery. 

Exercise. 

VisionQuest. 

Safety. 

Antiaging.