SEMINAR STUFF

Share 

$39. Shipping included... 
Because recovery should not cost an arm and a leg.
. . .

Note: Info in links may be subject to copyright laws. 

TREATING

Electrical Stimulation (E-Stim)

• E-Stim to Reduce Spasticity in the Leg
• Upper limb electrical stimulation exercises
• All The Things E-Stim Can Do For Stroke Recovery 
• General considerations for E-Stim

Bilateral Arm Training

• BATRAC (Bilateral Arm Training with a Rhythm) (see "TRAINING" for clinical dose) 

Mirror Therapy

• Mirror Therapy
• Mirror Therapy II
• Mirror Therapy for Intention Tremor

Increasing walking speed 

• Speed-Dependent Treadmill Training 
• Double walking speed with verbal encouragement (QUICK READ)
• Double walking speed with verbal encouragement (FULL STUDY)

Lower extremity Constraint Induced Therapy

• L.E. Modified Constraint Induced Therapy

Sensation Recovery

• Lower extremity
• Upper extremity 

Repetitive and demanding practice decreases spasticity and “pathological” synergies

• Constraint induced therapy reduces spasticity
• Intensive training in patients with increased muscle tone improves function without exacerbating spasticity
• Constraint induced therapy reduces spasticity and increases functional use
• Constraint induced therapy increases strength and decreases spasticity

VIDEO

• Taping for genu recurvatum
• How a Baclofen Pump Works
• GRAPHIC: Selective Dorsal Rhizotomy (starts @ 2 min in)
• GRAPHIC: What your brain really looks like
• GRAPHIC: Surgery for Acute Subdural Hematoma
• Great ideas for survivors to self-recover by "super-survivor" Kathy Spencer 
• Brilliant vid on the great work MDs do to lessen the effects of stroke-- fantastic graphics!
• Kahn Academy: types of ischemic stroke

RESEARCHING

Researching Stroke Recovery

• Evidence-based review of stroke rehabilitation
• StrokEngine: Tons of info for therapists and survivors
• PubMed Central: PubMed Central: Free Journal Articles
• Cochrane Database of Systematic Reviews

Clinical Guidelines from around the World

• New Zealand
• UK
• Australia
• USA/VA/DoD
• Scotland 

Information About Other Forms of Brain Injury

• Evidence-Based Review of Brain Injury

Find Stroke-Recovery Research in Your Area

• National Institute of Health
• Internet Stroke Center
• CenterWatch

Two Free Stroke-Specific Magazines

• StrokeSmart Magazine
• Stroke Connection Magazine

MEASURING

Measuring Recovery

• The best Rehab Outcome Measure search engine EVER!
• Calculator to score patients accurately for G-Code Med. B (Claims-Based Outcomes Reporting [CBOR])
• TONS MORE stroke recovery tests
• Nottingham Sensory Assessment
• Walking Speed: the Sixth Vital Sign
• 10m Walk Test: What Does the Data Mean?
• FUGL- MEYER: Rules for UE and LE
• FUGL- MEYER: Score sheet for UE and LE
• Motor Activity Log (MAL) Manual
• The Modified Ashworth: U.E and L.E (clean) 

Cognitive (mental) Tests

• Mini-Mental Exam (copyrighted)
• VA SLUMS Exam

READING

Articles by Pete

←See list of selected articles on the lower left column of this blog

REFERENCING

• References for information used in the seminar

RESOURCES

Amazing CIT dissertation by STACY L. FRITZ that includes:

• WOLF MOTOR FUNCTION TEST
• Motor Activity Log (MAL) Manual
• Fugl-Meyer Upper Extremity Motor score sheet
• CIT Home Diary
• CIT Daily Activity Log 
• BEHAVIORAL CONTRACT FORM

Does walking early (sometimes within 24 hours) help or hurt?

·  An article where they interviewed therapists, docs and nurses: Conclusion: Our study shows that most clinicians had concerns in relation to early mobilisation of stroke patients and more clinicians had concerns for haemorrhagic than for ischaemic stroke.

· An article looking at very early mobilization and depression: Conclusion: Very early mobilization may reduce depressive symptoms in stroke patients at 7 days post-stroke.

· Early mobilization out of bed after stroke may be all good: Conclusion: It seems to reduce severe complications but not cerebral blood flow:

· Early mobilization out of bed after stroke, maybe: Conclusions: Insufficient data are available to prove the beneficial effects of early mobilisation after stroke.

· A Very Early Rehabilitation Trial for Stroke (AVERT): Conclusions: Very early mobilzation of patients within 24 hours of acute stroke appears safe and feasible.  

· The LEAPS trial (the largest study ever done on post-stroke rehab): "patients who received early locomotor training experienced more multiple falls."

A GREAT OT BLOG!

• The Anonymous OT 

Why Dynasplint is half dead (and all dead for survivors)

Do you have muscles tightened by spasticity? 

Sarcomeres are the small units in muscle that contract when your muscles contract. (Great image here. Look at the bottom right corner.)  Sarcomeres will increase in numbers when muscle is put through a prolonged stretch. Increasing sarcomeres is how muscles are lengthened. Lengthening of muscle and increasing sarcomeres increases flexibility. Which is a good thing because we can talk about neuroplasticity until the cows come home but if your arm (or whatever) "won't go that way," all bets are off.

 
OK. So how might you increase the number of sarcomeres? One way that many clinicians think works is called "dynamic splinting." The idea is that you'd wear something that would hold you in a position that would stretch you. If you could wear it at that posture for 2-3 hours, the clinician would "dial in" a more "aggressive" range of motion. Over time you'd gain sarcomeres which would allow you to have more range of motion. 

Sounds groovy, right?

It works for, say, marital artists who want flexibility so they can KICK ASS.

Stretching ROCKS! Sometimes!

You stretch, you get a longer muscle, everybody's happy!

But yeah. That whole science thing gets in the way. Don't you just hate science?

It turns out that the way to elongate (add sarcomeres)  "normal" muscle is nothing like the way you'd do it in spastic muscle. To stretch spastic muscles so they gain length, the stretch must be held at least 48 hours. And dynamic splints are not kept on for anywhere near that long; a few hours, max. 

And here's another little interesting tidbit. The 600 pound gorilla of dynamic splints is a company call DynaSplint (get it?) and they've had a little bit of trouble lately. The kind of trouble where they may have defrauded the Federal Govmint. And they laid off 500 workers in one day. Which makes sense since it was a DynaSplint salesperson that was the whistle-blower that brought the whole company down. Which then triggered their bank to stop their operating budget.

And while I have no idea of any of those problems are warranted, one thing I do know is that they are fraudulent in another way. Again and again they claim that their splinting systems help folks with spasticity. They also claim they increase muscle length. Don't buy it!

The neuroplastic model of hypersensativity reduction after stroke for fun!!

Hypersensativity after stroke can come in two basic flavors:

1. A touch (or some other stimulus that normally does not hurt) hurts. A lot. This is called allodynia.

2. Something that usually does hurt hurts a lot more that it should. In other words, it hurts a lot more than it might on the unaffetced side. This is called hyperalgesia.

So how might you treat this. Lets go to the never-ending neuoplastic well, shall we? We know that stroke damages the brain which may cause the altering and amplifiying of sensation. So what if we used the same process to reverse it? These are hypothetical (although some have been tested) so keep that in mind. So what are the neuroplastic model to treat? Possibilities include...

1. TENS (mild electrical stimulation). Dosage here.
2. A placebo. An example would be suggesting a manual therapy (like message or manipulation of the extremity) will help reduce it. Discussion here.
3. Comparison. Put the gel on the unaffected side and say, "See, its just a bit cold. We'll take exactly the same gel (it can even be done at the same time)and put it on the 'bad' side and they'll-hopefully-feel the same.
4. Mirror therapy. Set it up like this: Have him look only at the unaffected side as either the survivor or someone else gives the "good" limb the stimulus which is painful to the "bad" limb. It will look like its getting put on the affected side, but with no pain.

Further reading here.  Duscussion of the difference between hyperalgesia and allodynia here.

Falls. Bad.

Here is your challenge: 

In the comments section, write everything that this survivor could do better in order to get up the stairs more safely. 

We all know that falls are bad. 

Falls can kill you. For survivors, falls are especially bad. Stroke affects balance, coordination, strength, and any number of other things that can lead to an increased risk of falls. On top of that, survivors tend to fall towards their affected side. In the affected side tends to be more osteoporotic. So have at it. This is good place to start as anywhere. What is this gentleman doing wrong? How do you do differently? What can you suggest?

Young Survivors: You may look great AND struggle.

A couple of bits of bad news for younger stroke survivors. First, a look at this video (on the right side of the site).

My interpretation: Young people who have insomnia are at a much higher risk of stroke. And by much higher I mean more than 8 times the risk. 

That's valuable information. But. There's a not-so-subtle intimation in this video that a lot of young stroke survivors complain about. Namely, that young people are out doing drugs (and other bad things) which keep them awake. 

The second bit of bad news

There's a new article out with a not-so-subtle name "Poor Long-Term Functional Outcome After Stroke Among Adults Aged 18 to 50 Years." Its bottom lines may come as some surprise to clinicians: many young survivors stroke survivors struggle with everyday tasks. 

After 10 years, 1 in 8 patients (12.9%) was not able to function independently. 

When interviewed the author's seem to suggest that, young survivors often don't show severe outward signs of problems related to stroke. For instance, they would struggle much less with walking than older survivor. But that does not mean that these everyday tasks are not problems. One author Frank-Erik de Leeuw, Ph.D., put it this way "Even if patients seem relatively well recovered with respect to motor function, there may still be immense 'invisible' damage that leads to loss of independence." 

I've heard this before from young survivors. People will come up to then say "You look great!" And they think to themselves, "I don't feel great." 

 One interesting note: Almost all the popular press has reported that this article suggests that "one-third" of young stroke survivors are having problems. I've read the article. It's one in eight. I'm not great at math. I'm pretty sure that's not one third.