Reading to Recover

Ever want trip up a therapist? Ask this question: What's the latest stroke recovery research say? The answers will be, politely, inconsistent. Some therapists actually know a lot. Others haven't read their professional journals, ever. Look for facilities and therapists that are "evidence-based" (basing treatment on the best available scientific evidence). Being evidence-based is sort of like having a GPS.

Imagine you have two people; one person has an absolutely stellar sense of direction. They never seem to get lost. The other person has no sense direction at all. They get lost in their own neighborhood. Let's say the “neighborhood looser” buys a GPS. Now who has a better sense of direction?

Imagine you have two therapists; one therapist is very smart, intuitive, conscientious, and caring. Everyone says they are a great therapist. The other therapist is sloppy, snotty and disorganized. Let's say snotty therapist reads a lot of stroke recovery research and implements what he reads. Now who is the better therapist?


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Simple. Brain. Recovery. Game.

Stroke recovery involves neuroplasticity. You can slice it and you can dice it but the bottom line always comes back to stroke as brain injury -- and how to overcome it. If you can't get the brain to reorganize around the injury, recovery is toast.

• Spasticity: caused by brain damage.

• Inability to feel the movement: caused by brain damage.

• Unilateral neglect (decreased attention to the “bad” side): caused by brain damage.

• Lack of control over the affected arm and leg: caused by brain damage.

• Aphasia: caused by brain damage

• Vision problems: caused by brain damage

• And much more!: caused by brain damage

So the answer to the question “… how might movement problems be overcome?” is simple: Rewire your brain.

And it is good that it is simple because only the stroke survivor can do it. A therapist could have a double major physical and occupational therapist PhD from Harvard school of Super Duper Rehab summa cum laude with postdoctoral training as a Rhodes Scholar and they still can't do it for you. You know the old Smokey the Bear poster: "Only you can prevent forest fires"? For stroke survivors the poster should say: "Only you can drive neuroplastic change". Fortunately, the rules for rewiring your brain are very, very simple. Unfortunately, rewiring takes a tremendous amount of hard work.

And what does it take? Repetitive practice.

Repetitive practice is boring.
So try spicing up with a video game yay!

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When all you have is a hammer everything looks like a nail

I got an email from an author the other day. He’s written a book about stroke recovery. He said that he’d heard that I did “...not like presenting other peoples' work as helpful for stroke survivors." I explained to him my position this way:

I work in rehab research; have since the 90's. All of that research has been stroke-specific. One of the things I've learned is that clinicians had made the mistake over and over and over (for decades) of buying into completely ineffective treatment options. They did this for 2 reasons:

1. The treatment had/has a charismatic leader
2. Clinicians in rehab don't typically read research.

So even if large studies came out and say "Those things don't work" clinicians just kept/keep on doing (and promoting, and selling books about, and teaching) them. And then there are categories of "treatments" that have no research (standardized, controlled trials) at all supporting them. So in my talks (I do many) I start by saying "Most of what has been used for stroke recovery is ineffective or untested. Here's what we think we know…” And most clinitians get it. They're pros. They want better tools.

I actually promote (when appropriate) a bunch of people and ideas. But anything endorsed is evidenced based and what that means is very specific: Has the treatment option reached meta-analysis and did that meta-analysis show efficacy? If it has and it does I'm all in.

If not, I let people know.

What I find from survivors is that they want us to hash this stuff out. They want us to have these discussions and not just stick with the same old because it’s what we feel comfortable.

E-Stim. If dude can do it, so can you.

Electrical stimulation after stroke is the single most important modality there is for recovery. A modality is...application of something therapeutic like a hot pack or cold gel or...e-stim. Part of the reason e-stim is so important is that it does so many different things. 

Drunk smoking guys use e-stim for fun!

But here's some funny: Some OTs (occupational therapists) cannot do e-stim clinically. Why? It turns out that in some States OTs have to get a special post-secondary education certification to do it. Which was always weird to me. You know that ad where you can use the stim "ab-exerciser" that’s supposed to give you ripped abs while you lounge around because the e-stim builds muscle? And who’s ordering that? Some drunk guy at 2 in the morning. HE can do it, but OTs can't? Weird. 

E-stim does so much that its lack of use clinically for survivors has flummoxed me for years. The reasons given for not doing it clinically tend to be of the "Its too complex to set up" variety. "It’s too expensive." is another thing. Some e-stim machine are expensive. But even the cheap gizmos can do the job. Most of the reason it’s  not done is because no one wants to figure out the machine.

Jesse says: 
E-stim is not just for 
drunk folks and kids!

Enter my 10 year old son, Jesse. I have a lot of e-stim machines stored in my basement. I've accumulated them over time in various ways. And boys will be boys and boys (and their friends) will go into the basement and put electrodes all over themselves and turn up the stim and see what pops. And they figure the machine out. Because e-stim works like this: Put on the electrodes (they stick to your skin) and turn up the stim. And see what happens. And that’s it.

And yet many clinicians shy away from e-stim. They shy away from something that can do everything from help recovery of sensation, to stretching to building muscle to starting the neuroplastic process. So talk to 'em. And if they have any questions, tell 'em to email me.

Note: There are some serious contraindications to doing estim in some folks. i.e., they can mess up pacemakers and other electronic devices. So always ask your doc first!

The perfect time to have a stroke?

I'd argue that the "best" age to have a stroke is 27. The entire brain is fully wired (the frontal lobe wires in the 26th year). You're young enough to undertake the rigors of recovery (recovery is statistically better the younger you are). But you're old enough to have your brain wired "normally" (recovery in children is often a mixed bag because the brain is not yet fully developed).

But what is the best day to have a stroke? Any day but the weekend. Turns out the having a stroke on the w/e means lower quality care than during the week.