Having a stroke can damage the parts of the brain that help keep balance, leaving some people having a hard time learning to walk again. Problems with balance can mean people are more likely to fall and injure themselves – this being more than just an annoyance and uncomfortable feeling that interferes with their quality of life. It also raises the risk of debilitation and the possibility of fatal falls.
Tai Chi Chuan may help you with these problems. Tai chi Chuan is an inner and highly spiritual ancient Chinese martial art, practiced for integrating body, mind and spirit. According to the philosophy behind the practice, the slow, fluid postures and sequential movements of tai chi focus our concentration while gently working muscles; therefore promoting mind and body calmness and health.
Not surprisingly, modern-day scientists are backing up these ancient claims. Earlier research performed in 2006 by the University of Michigan has previously shown that Tai Chi can improve balance and reduce falls among healthy elders. More recently, researchers at the University of Illinois in Chicago (UIC) have endorsed Tai Chi is a drug-free way to treat these stroke-caused balance problems.
It was in Hong Kong where the study was held, that Mrs. Hui-Chan, professor and head of physical therapy of UIC, and her colleagues decided to try proving that Tai Chi would help stroke survivors. 136 persons who had suffered a stroke more than six months earlier participated in the study. They were put into 2 groups: One practiced breathing, stretching and other exercises that included sitting and walking; the other one, which was the Tai Chi group, practiced a simplified form of this ancient martial art consisting of coordinated movements of the head, trunk and limbs that required concentration and attention to balance. At the end of the 12 weeks study, all the participants were given several balance tests. Both groups performed about the same on a test which involved the ability to stand, walk and sit back down. However, when it came to testing the ability of maintaining balance, like shifting weight, leaning in different directions and standing on moving surfaces… the Tai Chi practicing group clearly showed a significant better performance than the control group did. This study also showed that, in addition to improving balance, Tai Chi improves strength and cardiovascular fitness too.
These results of the research have been published in the January issues of Neurorehabilitation and Neural Repair magazines.
Generally speaking, Tai Chi is a quite beneficial exercise activity for stroke survivors, which is considered low-cost because no equipment and few facilities are needed. What’s more, Tai Chi classes can give seniors opportunities for healthy group interactions that help prevent social isolation, too. We invite you to find out whether there are any Tai Chi classes in your area, and you can also speak to an instructor to ask whether the type of Tai Chi they teach is suitable for people who’ve had a stroke in order to practice movements that will be the most suitable for you.
No doubt, Tai Chi is getting more and more interest from health authorities. The NIH’s National Centre for Complementary and Alternative Medicine (NCCAM) is currently sponsoring studies to find out more about Tai Chi’s benefits, how it works, and diseases and conditions for which it may be most helpful.
Sources:
ScienceDaily.com
Stroke Rehabilitation Journal
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It is important to have a high-personalized program. If after a stroke, you have complex medical conditions which prevent your participation in a regular stream rehabilitation program, a LTLD program may help you. What does LTLD stand for? The Low Tolerance, Long Duration (LTLD) Unit is a hospital-based program that provides multiple assessments of different disciplines and rehabilitation.
Usually, two types of stroke rehabilitation are usually practiced. It basically depends on the severity of stroke and your age. The disabilities and impairments are evaluated by several kinds of scores, from which doctors can judge the severity of the stroke and therefore put patients into 3 categories: mild, moderate and severe.
The regular stream stroke rehabilitation is geared towards patients with moderate strokes; and are generally 19-75 in age. Typically, they are able to tolerate a minimum of 60 minutes of therapy per session and their overall expected length of stay is approximately 30-60 days. However, stroke rehab patients who are older than 75 years of age may also be suitable for regular stream stroke rehab if they are able to meet these tolerance benchmarks. Regular stream stroke rehab is also able to accommodate stroke rehab patients with severe strokes if they are younger than 55 years of age, able to sit supported for more than 30 minutes at one time and can tolerate a minimum of 30 minutes of therapy per session.
Apart from the two factors like age and severity of stroke, if you have cognitive impairments and additional disorders or diseases that affect your ability to tolerate the intensity of a regular stroke rehab program, LTLD is a good alternative option. In summary, patients in need of LTLD stroke rehab may:
- Often have suffered from previous strokes
- Have multiple unfavourable disease conditions
- Lack relatively sufficient family support
- Have a sitting tolerance of not more than 5-10 minutes
- Present with aphasia
- Be disoriented with reduced judgment and insight
- Be incontinent
After all, you must be medically stable and demonstrate the potential to learn and improve function.
We are only aware of LTLD stroke therapy being available in Canada where it originated as of today. If you are available of other centres who practice LTLD, do let us know and we will make this information available to our newsletter subscribers.
Take the example of Toronto rehab center. LTLD rehab is provided by an inter professional team including physicians, nurses, physiotherapists, occupational therapists, speech language pathologists, pharmacists, an advanced practice clinician, service coordinator, social worker and other health professionals.
Doctors in Toronto rehab insists on a very goal-oriented rehab program. When a patient arrives, the team works with them to establish some mutual goals and care givers track the success rate of these goals as one of the outcome measures. Patients will not see the drama of high-intensity rehab where significant changes occur in a shorter time. Progress is slow by nature of the type of patients.
It seems that the participants of this program appreciate this innovation. Sylvia, one of the patients under LTLD rehab program, said that LTLD rehab allowed her to regain her strength and confidence so she could once again live independently. “You need to accomplish things within your boundaries. That’s probably the most important thing to realize in this type of program—that people need to work at their own pace and participate as a member of the rehab team.”
Talk to your rehab experts f you are interested in the LTLD rehab program.
Sources:
Greater Toronto Area (GTA) Rehabiliation Network
Toronto Rehab Magazine
As a consequence of a brain injury, the hemiparesis may occur and bring you spasticity, muscle weakness, and a persistent deficit in movement coordination. Such incoordination occurs at least in part because the brain part responsible for mediating an action intention and the part in charge of action execution are no longer intact.
Nearly 80% of people who have had a stroke have more or less trouble moving one side. People with hemiparesis may have trouble moving their arms and legs, difficulty walking and may also experience a loss of balance. As a result, doing simple everyday activities could be difficult. Depending on the damaged area of the brain, the most common type is pure motor hemiparesis: Patients with pure motor hemiparesis have face, arm and leg weakness.
Classic treatment consists of physical the occupational therapy as we mentioned several times in our previous editions. Electrical stimulation to the area of the brain as we presented recently also becomes an interesting treating approach. On the other hand, certain treatments can be helpful in relaxing the muscles in people who have spasticity referring to our last year June’s edition.
A quite common and systematic method is called Modified constraint-induced therapy (mCIT) and it has been presented in our last year January’s edition. It is a focused treatment to stroke patients with hemiparetic arms. Three times a week at their therapist for half an hour each time, patients are asked to practice focused exercises using their weak arm. This therapy could last for 10 weeks. Preliminary studies indicate that mCIT substantially improves affected upper limb use and function in stroke patients.
Certainly, repeated exercises could improve motor activity and allow for smooth controlled movement, as the brain will re-establish the neuronal circuit that mediates voluntary movement. However one disadvantage of this approach is that the recovery is dependent on performance of an impaired limb.
Is there any method independent of the behavioural output of a paretic limb? Yes. Today, we will introduce you another new therapy: Mental Practice, sometimes called Motor Imagery. This therapy is based on when people imagine themselves using a certain body part, areas of the brain and muscles can be activated as if the person is actually doing the activity.
Here is the small model to illustrate one way to do it. The model demonstrates that mirror box for simulation of a left limb moving successfully. The right (unaffected) limb moves around in the “workspace”, giving a reflection of the left (paretic) limb moving successfully in space. You will be instructed to “imaging the reflected limb actually is your limb moving”.
Therefore, your observation of the reflected limb provided a direct perceptual cue of the paretic limb is completing a controlled movement. During the first weeks, you might just have to go through with very simple movements, later in subsequent weeks, you may be asked to do some simple object manipulation like holding a pen drawing some geometric shapes, all this while observing your paretic limb in the mirror.
There are no specific risks involved in participating in motor imagery and it is inexpensive. Motor imagery is actually quite easy to do at home, and many people find it a fun and relaxing way of having additional therapy. Ask your rehabilitation therapist to see if he/she can guide you as to
- how many times a week you should do motor imagery exercises,
- what specific activities and movements you should do,
- what activities you should not do,
- how long each motor imagery session should be,
- how to change activities as you improve.
Have a great imagination journey!
Sources:
American Stroke association
Heart and Stroke Foundation of Canada
Archives of Physical Medicine and Rehabilitation
Reuters
As a stroke survivor, you may be very familiar with aspirin. Many patients after an ischemic stroke are prescribed aspirin to. Aspirin normally prevents the blocking of blood vessels. Aspirin shows a reduction of risk of recurrent strokes and transient ischemic attacks (TIAs) by 18%. Because of its established efficacy and low cost, aspirin is considered by many as first-line therapy in the majority of stroke patients.
Inevitably, you are at the same time more than familiar with ibuprofen (Non-steroidal anti-inflammatory drug – NSAID), a very common pain relief medicine. However, a group of researchers at the University of Buffalo in USA has shown that there’s a far less than ignorable interaction between the two drugs aspirin and ibuprofen. The study suggests that ibuprofen may block aspirin form its initial effect, and undermine its ability of prevention of a secondary stroke.
Conducted in 2008, this research has included a cohort of 28 patients in Dent Neurologic Institute were identified as taking both aspirin and ibuprofen daily and all were found to have no aspirin’s effect from their daily dosage. On the other hand, the effect is temporary because when afterwards, the researchers found in 18 of the 28 patients back for a second neurological visit after discontinuing NSAID, the sensitivity to aspirin is coming back. These patients also regained aspirin ability to prevent blocking blood vessels.
It is the first one to demonstrate the clinical consequences of the aspirin-NSAID interaction in patients which delivered us an extremely important message: No Aspirin right after Ibuprofen.
This study also showed us that it is critical to notice unexpected interaction among drugs which are administrated in the same period of time. NeuroAid has been approved to be safe to stroke patients and lack of interaction with aspirin, this safety research of the therapy combining NeuroAid and aspirin has been published in Cerebral Vascular Diseases last May.
Sources:
Stroke ( Journal )
Sciencedaily.com
Hands are the chief organs for physically manipulating the environment, and each hand is dominantly controlled by the opposing brain hemisphere. After a stroke with partially damaged brain, grasping a block, gripping a glass, pinching to pick up a small ball or simply opening hands … These tasks may suddenly seem to be too difficult to reach. Indeed, impaired hand function is one of the most frequently persisting consequences of stroke.
The essential of the hand movements is controlled by specific part in our brain (within the motor cortex), and accomplished by two sets of muscles and tendons.
After a stroke, if the controlling brain area is damaged, it will also result in the shortening of soft tissue, skin, tendons and muscles. These will further become one of the most limiting factors to regaining hand function later. If the tissues are not stretched, it will result in spasticity which will further limit use of hand and arm and diminish the recovery potential.
The loss of hand functions results from the combination of two factors : a loss of brain activity due to the stroke and the physical changes in muscle and tendons that occur as a consequence. The less active the motor cortex and the more severe the spasticity , the less one can use his/her hand muscles.
Both problems need to be addressed as part of rehabilitation: stimulating the building of new circuits of information in the brain and releasing the spasticity in the hands, to allow these circuits of information to activate the hands.
Usual interventions include muscle vibration and electrical nerve stimulation in the limbs enhance the motor cortical output to target muscles; mental practice (patient’s concentrating on moving the muscle). NeuroAid, which supports neurological functions, can also help patients to regain hand function more rapidly. With time, the cells in that part of the brain affected by the stroke progressively become more easily activated. The changes in the strength of the connections between the brain and muscles lead to improvements in the ability to use the muscles.
Further intervention are under exploratory development, for example a team of Canadian doctors has developed a test to evaluate hand muscle control: tapping a single keyboard key with the index finger; picking up pegs, one at a time and placing them into holes on a pegboard; and pushing with index finger against a metal bar that measures force. Performance on this test was linked to the ease with which brain cells that control muscle functions can be activated; how active the brain cells are at the time of testing; and the strength of the neural connections between the brain and the muscle. Such test supports then the development of new clinical treatment strategies which will better match each patient situation at the different stages of the recovery process. This may open in the future a route way for more effective individualized optimized treatment protocol for stroke survivors based by adjusting the treatment to the individual’s exact situation and recovery dynamics.
There are specific books or tools such, which may help you find out the exercise which are most suited to your situation – by researching on the internet we came across several books written by stroke survivors who are more than happy to share their experiences. To benefit from these ex stroke patients’ genius creations, you can visit Amazon.
I thought we could use this newsletter to share which books you found to be most useful for your recovery, do write us a short email on which was your favourite book during your recovery journey and why it helped you . We will publish the list of the best ranking books in the upcoming newsletter.
Sources:
Medical News Today
Blue Bridge Healthcare, USA
The disabilities caused by stroke are due to the damaged parts of the brain. Traditional occupational therapy helps physically the patients to regain lost functions. However, what if we try to directly train the brain?
Here is the story of Mr. D in a rehabilitation institute in Chicago. Last year, an innovative trial wascarried on to help patients to regain their motor function. This trial actually investigated the cortical stimulation, which used a small electrode to provide low-level stimulation to the brain when activated during intensive occupational therapy.
The novel combination may help the brain develop new circuit of information (pathways) that bypass stroke-damaged brain tissue. These newly established pathways then permanently can take over some of the functions previously performed by the damaged part of the brain.
In practice, cortical stimulation involves surgically implanting a small electrode under the patient participant’s skull, and above the part of the brain where is responsible for motor function. A small battery-powered stimulator is inserted under the skin, just below the collar bone; it triggers the electrode, which is connected through a lead to the electrical stimulator. It is activated only during therapy when the therapist waves a hand-held device over the stimulator.
The surgical implantation takes about 90minutes, during which time patient participants are under general anaesthesia. Mr. D said he had no major complaints of pain after surgery and he went home the next day.
Doctors said that compared to stroke patients who received only traditional therapy, those who also receive cortical stimulation had more improvement both immediately and long-term. Mr. D said that since completing the research, he had been able to do almost everything he could before his stroke – However, not everyone who participates in the research has such a positive outcome, and this therapy is only suitable for those who have moderate movement disorder after a stroke.
On the other hand, the theory in this trial appears to be promising. It shows that an adult’s brain can continue to develop in response of a stimulus and try to fix the problems. That is called “neuroplasticity”, and will be focus of one of our upcoming issue.
Source:
Northwestern Memorial Hospital, USA
The essential players in this rescue mission, stem cells, are characterized by the ability to renew themselves through mitotic cell division and differentiate into a diverse range of specialized cell types. Stem cells can now be grown and transformed into specialized cells with characteristics consistent with cells of various tissues such as muscles or nerves through cell culture.
Though the results are preliminary, it offers a glimmer of hope to millions of people left brain-damaged or crippled by strokes. However, before that can happen, scientists need to refine their methods of encouraging stem cells — either embryonic, as in this study, or adult — to reliably form neurons that don’t turn cancerous. This will still take many years.
Sources:
Stem Cells Journal
PLoS One
* Promote flexibility and relaxation of muscles on the affected side
* Help return to more normal movement
* Improve balance and coordination
* Decrease pain and stiffness
* Maintain range of motion in the affected arm and leg
Before beginning with these exercises, please be ensured that your clothing will not restrict movements. It is not necessary to wear shorts such as shown in the illustrations, leisure clothing such as sweat suits or jogging suits is appropriate.
Exercise 1: To enhance shoulder motion and possibly prevent shoulder pain
To enhance shoulder motion and possibly prevent shoulder pain: Lie on your back on a firm bed, and interlace your fingers with your hands resting on your stomach. Slowly raise your arms to shoulder level, keeping your elbows straight. At last, return your hands to resting position on your stomach.
Another similar exercise will help you to maintain shoulder motion, especially for someone who has difficulty rolling over in bed. While raising your hand and straightening your elbows, slowly move your hands to one side and then the other.
Exercise 2: To promote motion in the pelvis, hip and knee
Lie on your back on a firm bed and keep your interlaced fingers resting on your stomach. Bend your knees and put your feet flat on the bed. Holding your knees tightly together and slowly move them as far to the right as possible, return to the centre and repeat it by moving them to the left.
Exercise 3: In this exercise, movements needed to rise from a sitting position
Sit on a firm chair that has been placed against the wall to prevent slipping. Interlace your fingers; reach forward with your hands. With your feet slightly apart and your hips at the edge of the seat, lean forward, lifting your hips up slightly from the seat, then slowly return to sitting.
An important thing is to take your time when you exercise. Don’t rush the movements or strain to complete them. If the pain occurs, move only to the point where it begins to hurt. If the pain continues, don’t do this exercise.
Sources:
Circulation Journal of the American heart Association
National stroke association
Already in 1987, two Canadian Scientists, Friedland and McColl studied patients during the first two years after a stroke and identified four aspects of social support which could provide positive and useful help. These were:
- satisfaction with social support
- satisfaction with social support
- the single most significant relationship in the individual’s life
- close friends and family
- the community
Used in therapy, it is helpful to view adapting to a stroke as a process of transition, a change of patient’s initial role (spouse, parents etc). That is, the individual comes to understand and make sense of the situation by moving through phases of researching and understanding.
Personal Construct Theory was devised primarily for people with intact language systems – even there was no such mention in Kelly’s original work about this application. However, in case of acquired brain damage, a “grid technique” is widely used today, which is originally from Kelly’s sub-theory: the Role Construct Repertory Test. It aims to elicit constructs from a person by asking them to consider groups of role titles which have been selected from their social context. The role titles are written along the top, and the bipolar constructs are written down the side. Each role title is considered in relation to each pair of constructs.
An example of the procedure would be that three elements are considered:
- Self before illness
- Self now
- Self I would like to be
And put the following words below in the grid:
- very good – very bad
- can move – can’t move
- happy – sad
- angry – not angry
- Calm – more excitable
The grid allows to understand one’s behavior in relation to the aphasic (patient or impatient) and to acknowledge one’s pain because of the loss of abilities. Past-self and present-self may be shown to be significantly far apart which would then form a basis for therapeutic intervention. It helps to set a therapy focus around achievement and being fulfilled. It is possible to distinguish a theme about communication and the ability to socialize.
In a case, Mr. X talks about his distress at his changed ability in talking: “I know I talk slower than what I could do before the stroke, but, it was a shock, because round here people talk quick and I talked quicker than them and I miss the words out, the little words and that. I think it was a shock.”
Note the use of the contrast between before his stroke and afterwards, the pain caused by the loss of his abilities of speech is clear.
Along with PCT, while talking to a stroke survivor with communication disabilities, try to grab adjectives with which he/she describes him/herself, and compare those to the language he/she used before the stroke. Help them with the right and appropriate strategy and give them a positive strength. Personal characterization can also offer a basic starting point.
The application of PCT to our understanding of the reactions to stroke and acquired communication problems can offer theoretical insights which make it easier to understand the meaning of the problem to the individual. It offers a structure to the recovery process.
In the end, here are several communication tips for daily life:
- Personalize the conversation, including using the person’s name to get attention, making eye contact or a gentle touch
- Use short, simple sentences and speak clearly and slowly.
- Repeat sentences exactly, if the person does not seem to understand a word, try substituting it with another one.
- Be specific
Offer simple choices such as “Yes” or “No”.
Sources:
Stroke rehabilitation Journal
Several important factors underscore the potential value of exercise training and physical activity in stroke survivors. Studies have demonstrated the trainability of stroke survivors and documented beneficial physiological, psychological, sensorimotor, strength, endurance and functional effects of various types of exercises. Unfortunately, stroke remains a leading cause of long-term disability. Consequently, stroke survivors are often deconditioned and predisposed to a sedentary lifestyle that limits performance of activities of daily living.
Walking, bending and stretching are forms of exercise that can help strengthen your body and keep it flexible. A simple activity like sweeping the floor can be undertaken every day. In these two editions of newsletter, we will give you some tips to get you started. We will introduce you to two exercise programs in the following paragraphs. Firstly what we will present is for the person whose physical abilities have been mildly affected by the stroke. In the next issue we are going to talk about exercises for those with greater limitations. The exercises may be performed alone if you are able to do so safely. However, for many stroke survivors, it is advisable to have someone standing beside while an exercise session is in progress.
Exercise 1: To strengthen the muscles which stabilize the shoulder
Lie on your back with your arms resting at your sides. Keeping your elbow straight, lift your affected arm to shoulder level with your hand pointing to the ceiling, then raise your hand toward the ceiling, lifting your shoulder blade from the floor.There is a variation to strengthen the muscles which straighten the elbow: stay in the same position and put a rolled towel under the affected elbow.
Bend the elbow and move your hand up toward your shoulder while always keeping your elbow resting on the towel. Hold for a few seconds, and then straighten your elbow and hold. Slowly repeat the reaching motion several times, remember to lower your arm to rest by your side.
Exercise 2: To improve hip control in preparation for walking activities:
Lie on your back, start with your unaffected leg flat on the floor and your affected leg bent. Lift your affected foot and cross your affected leg over the other leg, lift the affected foot and uncross, then resume the cross motion. Please repeat the crossing and un-crossing motion several times.
Exercise 3: To enhance hip and knee control
Start with your knees bent, feet resting on the floor. Slowly slide the heel of your affected leg down so that the leg straightens. Slowly bring the heel of your affected leg along the floor, returning to the starting position. Keep your heel in contact with the floor throughout the exercise. Taking off the shoes during this exercise is recommended as your foot will slide more smoothly.
Fatigue while exercising is to be expected. You will have good and bad days like everyone else. Certainly these programs can be modified to accommodate for fatigue or other conditions. However, it may be necessary to tolerate some discomfort to make progress.
Sources:
Circulation Journal of the American heart Association
National stroke association