Posts Tagged injury

[BLOG POST] Talking About Your Injury

First, let’s review some general ideas. Many survivors initially think that few people know about their injury. After all, if the survivors did not tell others, how would they know? The reality is usually different. Sometimes, the injury event was on the news. For instance, if a survivor was in a major car accident or shooting, it generally made the news. Also, following an injury, family members may make prayer requests through social media or religious institutions. In this case, everyone who is connected via social media or anyone is part of the religions institution is aware of the injury event. Moreover, a brain injury is a big piece of news. Once one person hears about it, they are likely to “share the news” with friends from work, school or other social environments. Overall, information often makes the rounds to people you know quite quickly. However, the information is often piecemeal and occasionally, inaccurate.

With this in mind, the guiding principle when talking to others about your injury should that you give honest information in a manner that will engender others to have appropriate confidence in you. In some cases, people may be truly confused or concerned how you are doing and are using questions as a sort of gauge of health. The better you handle the situation, the more likely the other person will walk away with confidence in you.

Here are a few pieces of advice regarding talking about your injury:

  1. Always keep in mind who the person is that you are speaking with. For instance, is this a friend or an acquaintance? Is this person trustworthy to keep information private or likely to share it with everyone? Do I have a personal relationship or a professional relationship with this person? These factors will influence what you will share (or not share) with the other person.
  2. Whenever possible, keep information short and with limited detail. Remember, once you have said something, you cannot take back the information and the person you are speaking with may share that information with many others. Also, the less details you give, the less opportunity you are giving the other person to ask probing, sometimes uncomfortable, questions.
  3. Be sure to have a good exit/”no thank you” line. Not everyone has a right to your information and there are times you will not want to talk about your injury. A good exit line usually involves saying something nice, making your request and ending with something nice. For example: “Thank you for your concern but I really don’t enjoy talking about my recent health issues. However, I really appreciate that you cared so much to check on me.”
  4. Always tell the truth. If you tell a lie, there are two possible unpleasant outcomes. One, if the other person finds out that you deliberately lied, this can ruin the relationship. Second, if you tell a lie and the other person realizes the information is wrong but falsely thinks that you actually believe the lie, the other person will assume that you are quite confused.
  5. Be aware that you know a lot of medical/health terms that other people will not know, will not understand or even misunderstand. The average person on the street does not know terms such as “hemiplegia” or ” homonymous hemianopsia .” Using terms that other people do not understand may overwhelm the other person. Also, there are some terms that others may misunderstand. For instance, if you say that you are in “rehabilitation”, other people may falsely assume that you have a substance abuse problem. It may be better to say, “I have been working on my recovery from my injury” or “I have been in injury rehabilitation” rather than saying “I have been in rehabilitation.”
  6. Do not exaggerate or embellish your injury experience. Your story is already powerful and does not need any help. Also, exaggerating or embellishing may make the experience seem worse and cause other people to lose confidence in you.
  7. Be careful about using humor. Many people will not find much humor in your injury experience and may take too much humor to mean that you do not appreciate the seriousness of your injury. Again this could lead to a loss in confidence in your skills.
  8. Always ask questions of the other person. If the other person gets to ask all of the questions and you have to give all of the answers, eventually the friendly conversation may feel like an interrogation. The best way to balance the power is to ask questions of the other person, such as how are things going for their spouse, children or job.
  9. Practice your responses. When you are asked questions, the way to engender confidence is to have great responses. The best method to ensure you have great responses is to practice, out loud, your responses. This way, you can hear how your answers actually sound when coming from your mouth (which often sound different than how you imagine them in your mind) and practice different potential responses. It is often helpful to practice with a trusted loved one and/or to record and review your responses. This will help you find the best and most natural responses to questions.

These were just a few ideas and suggestions when talking to other about your injury. Always remember the key principle of giving honest responses that engender confidence!

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at:


via Talking About Your Injury

, , , ,

Leave a comment

[Abstract] Neural Correlates of Passive Position Finger Sense After Stroke

Background. Proprioception of fingers is essential for motor control. Reduced proprioception is common after stroke and is associated with longer hospitalization and reduced quality of life. Neural correlates of proprioception deficits after stroke remain incompletely understood, partly because of weaknesses of clinical proprioception assessments.

Objective. To examine the neural basis of finger proprioception deficits after stroke. We hypothesized that a model incorporating both neural injury and neural function of the somatosensory system is necessary for delineating proprioception deficits poststroke.

Methods. Finger proprioception was measured using a robot in 27 individuals with chronic unilateral stroke; measures of neural injury (damage to gray and white matter, including corticospinal and thalamocortical sensory tracts), neural function (activation of and connectivity of cortical sensorimotor areas), and clinical status (demographics and behavioral measures) were also assessed.

Results. Impairment in finger proprioception was present contralesionally in 67% and bilaterally in 56%. Robotic measures of proprioception deficits were more sensitive than standard scales and were specific to proprioception. Multivariable modeling found that contralesional proprioception deficits were best explained (r2 = 0.63; P = .0006) by a combination of neural function (connectivity between ipsilesional secondary somatosensory cortex and ipsilesional primary motor cortex) and neural injury (total sensory system injury).

Conclusions. Impairment of finger proprioception occurs frequently after stroke and is best measured using a quantitative device such as a robot. A model containing a measure of neural function plus a measure of neural injury best explained proprioception performance. These measurements might be useful in the development of novel neurorehabilitation therapies.

via Neural Correlates of Passive Position Finger Sense After Stroke – Morgan L. Ingemanson, Justin R. Rowe, Vicky Chan, Jeff Riley, Eric T. Wolbrecht, David J. Reinkensmeyer, Steven C. Cramer, 2019

, , , , , , , , ,

Leave a comment

[BLOG POST] Motor Control • What Does it Do – Clinical Education

Motor Control / Muscle Activation / Motor Re-education, whatever you might want to call it — is one of the crucial keys to a successful rehabilitation program especially in sports medicine rehabilitation but is often times overlooked by many clinicians.

What Happens After Injury and How it relates to Motor Control?

Injury causes chemical pain and swelling, both of which have inhibitory effect on muscle’s ability to contract.

“Persistent pain alone will cause muscle weakness due to decrease in neural output” — P. Brukner & K. Khan

Motor ControlTherefore, muscle conditioning or motor control must commence after initial injury along with pain and inflammation management. This process or treatment aims to teach the patient how to activate those muscles that are inhibited following an injury. For example, following a shoulder impingement injury, local stabilizers of the shoulder like the supraspinatus are inflamed and inhibited. Athletes or clients should be taught how to activate and control that damaged muscle before proceeding to other forms of muscle conditioning and/or strengthening.

I have been blessed to grew up in a university and clinics which taughts and applies the practice of activating first the local stabilizers of the body is the first priority rather than taking theshortcut of activating global muscles thinking that if global muscles are activated so do the local stabilizers. But sadly, it is not always the case. I am devastated to see so many clinics trying to fire up global muscles without knowing if local stabilizers are right on point before firing their guns.

“It’s like pulling the trigger of a gun without positioning the gun first to hit it’s target.”

It is important to differentiate what a global muscles and local muscles are. Global muscles are the large, torque-producing muscles, whereas local muscles are responsible for local stability. For example, in the shoulder region, global muscles are your deltoids & upper trapezius, while local muscles are your rotator cuff like supraspinatus and infraspinatus. In the recent years of study, there has been an increasing understanding of the important role of activating first the local stabilizers of the joint before the torque producing global muscles.

When There is No Motor Control..

When there is no motor control, there is a incorrect motor patterning syndrome, especially after injury.

Clinical Sports Medicine BookAccording to the book, Brukner & Khan’s Clinical Sports Medicine (Mcgraw Medical)..“Rehabilitation of these incorrect motor patterning syndrome relies on careful assessment of the pattern of movement, theindividual strength, function of the involved muscles and the flexibility of the muscles and joints. As this abnormal movement pattern has been developed over a lengthy period, it is necessary for the patient to learn a new movement pattern. This takes time and patience.The movement should be broken down into components and the patient must initially learn to execute each component individually.Eventually, the complete correct movement pattern will be learned.”


How To Do Motor Control? Tips and Tricks.

As I practice in clinics, I always use cuing and tactile / verbal feedback to facilitate control of desired movements. For me to feel if the right muscle is being activated I always palpate 2 groups of muscles. One is the muscle in which I want to control or facilitateand another are the groups of muscles which I do not want to be substituting during motor learning. I find this effective in facilitating motor control. Other techniques I use are visualization of the correct muscle action. Also, I often times demonstrate and describe the muscle action to the patient. One technique which I haven’t used yet because it is so time consuming, but I think will be more effective is to have anatomical illustrations of the muscles involved around what you want to monopolize. Use of instructions that cue the correct action also helps. For example, phrases like “pull your navel towards towards your spine” to facilitate control of transversus abdominis. One of the best advise that I would give is to focus on precision. The patient has to concentrate and focus on the precise muscle action to be achieved. It should be stressed that activation of the muscles should be a gentle action. Other muscles should remain relaxed during this localize exercise.

Once again..

“Do not pull the trigger of gun without positioning the gun first to hit it’s target.”


  • Clinical Sports Medicine Revised 3rd Edition by Peter Brukner and Karim Khan

I like to hear it from you. What are your thoughts on these? Do you agree or disagree?

via Clinical Education • Motor Control – What Does it Do

, , , , , , , , ,

Leave a comment

[WEB SITE] Epilepsy: 15 Ways to Avoid Accidents and Injury


Spread the Word

You never know when or where a seizure will strike. That’s why it’s a smart idea to tell the people around you the most often that you have epilepsy, what that means, and what they can do to help you if you need it. That includes family members, co-workers, people at the gym — anyone you run into on a daily basis.


Install Wall-to-Wall Carpeting

A plush carpet with plenty of padding is a safer choice than hardwood or tile floors. Soft flooring can cushion you if you take a tumble during a seizure. A cushy landing means fewer, less serious injuries. Put nonslip carpeting at the bottom of any stairs and in your bathroom, too. Don’t use throw rugs. They’re easy to trip over.


Remove Glass Furniture

Landing on it can leave you bruised and bloody. Look for shatterproof mirrors, too. Clear your home and workspace of any other items that could hurt you if you fall.


Clear the Clutter

Less is more when it comes to home decor. A crowded house or work area can be a danger zone. Keep furniture to a minimum. Clear walking areas of extension cords, file folders, pet bowls, children’s toys, and other loose items.


Pad and Secure the Furniture

Use padded child-proofing products to soften desk or table corners and sharp counter edges. You can also wrap hard objects like faucets in soft material. Secure your TV, computer, and other heavy items to a wall or heavy desk so they can’t fall on you.


Fall-Proof the Bathroom

Hard and wet bathroom surfaces pose a big risk. Put nonskid strips on the tub bottom and shower floor. Rails or grab bars are a good idea, too. Take showers instead of baths if you can — you can drown in just a bit of bathwater. Keep drains clear so water doesn’t back up and make things more slippery. You may also want to use a shower chair and hand-held water nozzle.


Don’t Lock Your Inside Doors

That makes it easier to get help from someone else in the house. Use an occupied sign for the bathroom instead. Also, be sure your doors open toward the hall and not into the room. If they don’t, and you fall against one, helpers may not be able to push it open. You can change out the hinges so they open the other way.


Avoid Open Flames

Be extra careful in the kitchen. Gas or open flame cooking surfaces, like a grill, could cause a fire if you or your clothing touches them during a seizure. Microwaves are the safest choice, or you can try an electric stove. Use the back burner on a stove top. If you have a cookout, ask someone else to work the grill.


Take the Elevator

Headed to the upper level of your work complex, doctor’s office, or shopping mall? Nix the escalator and take the elevator. A seizure on a moving stairway could be dangerous, even life-threatening, if your hair or clothing gets caught. The way some escalators move also can trigger seizures.


Get There Safely

Check your state’s laws: If you have uncontrolled seizures, you may not be able to drive. Opt for a taxi, bus, or the subway. Always stand far back from the tracks or road, so you won’t be hit if you fall. If you bike to work, always wear a helmet. Knee and elbow pads are also a good idea. Stick to side roads when you can.


Use the Right Tools

You can still enjoy gardening, yard work, and other hands-on hobbies, as long as you follow a few simple safety tips. Get a lawnmower that stops when you let go of the handle. Look for power tools that shut off when you put them down.


Find a Friend

Skip scuba diving, hang gliding, and any free-climbing sports where help can’t get to you quickly. You can still enjoy fun stuff like swimming, gymnastics, and even harnessed rock climbing. Use the buddy system so someone is always there with you. Contact sports, like football, baseball, basketball, and soccer, should be OK, but check with your doctor.


Blow Out the Candles

Sure they look and smell great. But they could start a fire if you knock them over. Battery-operated options are safer. Never carry a candle with a burning flame, even if you think your seizures are well-controlled. Get someone else to carry hot items that could burn you if you fall, like fireplace ashes or even an iron. Or wait until they cool down to move them.


Prepare for Trips

Ready for a vacation? Look for short flights or those that allow you to take a nap. A lack of sleep raises your chance of a seizure. Take someone with you who knows about your condition and how to help if you need it. Pack all your meds in your carry-on luggage. Bring extra in case your travel gets delayed.


Be Proactive

There are basic steps to take every day. The most important is to wear a medical bracelet that says you have epilepsy. If you have a seizure away from home or work, someone will know what’s wrong and how to help. Also:

  • Get plenty of sleep.
  • Take your medicine.
  • Don’t drink alcohol — it can cause seizures.

via Epilepsy: 15 Ways to Avoid Accidents and Injury | US Med Line

, ,

Leave a comment

[Abstract+References] Brain Plasticity and Modern Neurorehabilitation Technologies


In recent decades, interest in studies on basic and applied aspects of how the nervous system functions has been growing rapidly around the world. The recovery of lost functions rests on processes of neuroplasticity, which is determined by the ability of the brain to transform its structures in response to injury. The effects of both routine and state-of-the-art neurorehabilitation technologies are ensured by synaptic plasticity— long-term potentiation and long-term depression, which influence learning and the preservation of new knowledge and skills obtained during rehabilitation. The introduction of new methods of neuroimaging, neurophysiology, and mathematical statistics have powerfully stimulated the development of the neuroplasticity doctrine. It has become clear that the main role in the recovery of injured functions is played by the reorganization of cortical nets and not by tissue reparation as such. The Research Center of Neurology has accumulated significant experience in the use of innovative treatment methods based on modern neurorehabilitation principles. Some of them are used for acute stroke; among other things, their effectiveness and safety have been shown with regard to patients in intensive care units (cyclic robotic mechanotherapy) and patients with severe motor deficit and an associated somatic pathology (stimulation of plantar support zones). Opportunities to assess neuroplasticity under various rehabilitation methods using fMRI and navigated transcranial magnetic stimulation (TMS) are revealed. The center also studies the fundamentals of consciousness using original neuroimaging and neurophysiological protocols for the sake of its recovery. The center is actively introducing its data into the practice of domestic clinics specializing in recovery medicine and neurorehabilitation.


  1. 1.
    C. H. Rankin, T. Abrams, R. J. Barry, et al., “Habituation revisited: An updated and revised description of the behavioral characteristics of habituation,” Neurobiol. Learn. Mem. 92 (2), 135–138 (2009).CrossRefGoogle Scholar
  2. 2.
    I. Jin, E. R. Kandel, and R. D. Hawkins, “Whereas short-term facilitation is presynaptic, intermediateterm facilitation involves both presynaptic and postsynaptic protein kinases and protein synthesis,” Learn. Mem. Cold Spring Harb. 18, 96–102 (2011).CrossRefGoogle Scholar
  3. 3.
    C. Lüscher, R. A. Nicoll, R. C. Malenka, and D. Muller, “Synaptic plasticity and dynamic modulation of the postsynaptic membrane,” Nat. Neurosci., No. 3, 545–550 (2000).CrossRefGoogle Scholar
  4. 4.
    M. Lenz, A. Vlachos, and N. Maggio, “Ischemic longterm-potentiation (iLTP): Perspectives to set the threshold of neural plasticity toward therapy,” Neural Regen. Res., No. 10, 1537–1539 (2015).CrossRefGoogle Scholar
  5. 5.
    N. Hardingham, J. Dachtler, and K. Fox, “The role of nitric oxide in pre-synaptic plasticity and homeostasis,” Front Cell Neurosci., No. 7, 1–19 (2013).CrossRefGoogle Scholar
  6. 6.
    S. D. Bury and T. A. Jones, “Unilateral sensorimotor cortex lesions in adult rats facilitate motor skill learning with the ‘unaffected’ forelimb and training-induced dendritic structural plasticity in the motor cortex,” J. Neurosci. Off. J. Soc. Neurosci. 22, 8597–8606 (2002).CrossRefGoogle Scholar
  7. 7.
    R. J. Nudo, “Postinfarct cortical plasticity and behavioral recovery,” Stroke 38, 840–845 (2007).CrossRefGoogle Scholar
  8. 8.
    A. Arvidsson, T. Collin, D. Kirik, et al., “Neuronal replacement from endogenous precursors in the adult brain after stroke,” Nat. Med. 8, 963–970 (2002).CrossRefGoogle Scholar
  9. 9.
    Y. Bach and P. Rita, “Central nervous system lesions: Sprouting and unmasking in rehabilitation,” Arch. Phys. Med. Rehabil. 62, 413–417 (1981).Google Scholar
  10. 10.
    W. T. Greenough, H. M. Hwang, and C. Gorman, “Evidence for active synapse formation or altered postsynaptic metabolism in visual cortex of rats reared in complex environments,” Proc. Natl. Acad. Sci. U. S. A. 82, 4549–4552 (1985).CrossRefGoogle Scholar
  11. 11.
    J. Liepert, H. Bauder, H. R. Wolfgang, et al., “Treatment-induced cortical reorganization after stroke in humans,” Stroke J. Cereb. Circ. 31, 1210–1216 (2000).CrossRefGoogle Scholar
  12. 12.
    Y. Sagi, I. Tavor, S. Hofstetter, et al., “Learning in the fast lane: New insights into neuroplasticity,” Neuron 73, 1195–1203 (2012).CrossRefGoogle Scholar
  13. 13.
    E. Auriel, B. L. Edlow, Y. D. Reijmer, et al., “Microinfarct disruption of white matter structure: A longitudinal diffusion tensor analysis,” Neurology 83, 182–188 (2014).CrossRefGoogle Scholar
  14. 14.
    L. A. Chernikova, M. A. Piradov, N. A. Suponeva, et al., “High-tech methods of neurorehabilitation in nervous system diseases,” in Neurology of the 21st Century: Diagnostic, Treatment, and Research Technologies: Manual for Doctors, Ed. by M. A. Piradov, S. N. Illarioshkin, and M. M. Tanashyan (ATMO, Moscow, 2015) [in Russian].Google Scholar
  15. 15.
    L. G. Tarasova, L. A. Chernikova, and A. S. Chubukov, “Hand motion recovery in poststroke hemiparesis patients by the method of intensive training of the paretic upper limb,” Lech. Fizkul’t. Sport. Med., No. 8, 34–39 (2008).Google Scholar
  16. 16.
    P. R. Prokazova, M. A. Piradov, Yu. V. Ryabinkina, et al., “Robotic mechanotherapy using the Motomed Letto 2 simulator in complex early stroke rehabilitation in the resuscitation and intensive care unit,” Annaly Klinich. Eksp. Nevrolog., No. 2, 11–15 (2013).Google Scholar
  17. 17.
    A. A. Belkin, I. A. Avdyunina, N. A. Varako, et al., “Intensive care rehabilitation: Clinical recommendations,” Vestn. Vosstanov. Med., No. 2, 139–143 (2017).Google Scholar
  18. 18.
    K. Ustinova, N. Epstein, L. Chernikova, et al., “Effect of robotic locomotor training in an individual with Parkinson’s disease: A case report,” Disab. Rehab.: Assist. Technol. 6 (1), 77–85 (2011).Google Scholar
  19. 19.
    S. N. Morozova, E. A. Zmeykina, R. N. Konovalov, et al., “Changes in functional connectivity of motor zones in the course of treatment with a Regent multimodal complex exoskeleton in neurorehabilitation of poststroke patients.” Hum. Physiol., No. 1, 54–60 (2016).Google Scholar
  20. 20.
    E. I. Kremneva, L. A. Chernikova, R. N. Konovalov, et al., “Assessing supraspinal control of locomotion in norm and in pathology using a passive motor fMRT paradigm,” Annaly Klinich. Eksp. Nevrol., No. 1, 31–37 (2012).Google Scholar
  21. 21.
    L. A. Chernikova, E. I. Kremneva, A. V. Chervyakov, et al., “New approaches in the study of the neuroplasticity process in patients with central nervous system lesions,” Hum. Physiol., No. 3, 272–277 (2013).CrossRefGoogle Scholar
  22. 22.
    O. V. Glebova, M. Yu. Maksimova, and L. A. Chernikova, “Mechanical stimulation of plantar support zones during acute moderate and severe stroke,” Vestn. Vosstanov. Med., No. 1, 71–75 (2014).Google Scholar
  23. 23.
    I. V. Saenko, S. N. Morozova, E. A. Zmeikina, et al., “Change in functional connectivity of motor zones using the Regent multimodal exoskeleton complex in stroke patients,” Fiziol. Chel., No. 1, 64–72 (2016).Google Scholar
  24. 24.
    M. A. Piradov, S. N. Illarioshkin, A. O. Gushcha, et al., “State-of-the-art neuromodulation technologies,” in Neurology of the 21st Century: Diagnostic, Treatment, and Research Technologies: Manual for Doctors, Ed. by M. A. Piradov, S. N. Illarioshkin, and M. M. Tanashyan (ATMO, Moscow, 2015), pp. 46–98 [in Russian].Google Scholar
  25. 25.
    N. A. Suponeva, I. S. Bakulin, A. G. Poidasheva, and M. A. Piradov, “Safety of transcranial magnetic stimulation: A review of international recommendations and new data,” Nervno-Myshech. Bol., No. 2, 21–36 (2017).Google Scholar
  26. 26.
    M. A. Piradov, M. V. Krotenkova, R. N. Konovalov, et al., “Neuroimaging technologies,” in Neurology of the 21st Century: Diagnostoc, Treatment, and Research Technologies: Manual for Doctors, Ed. by M. A. Piradov, S. N. Illarioshkin, and M. M. Tanashyan (ATMO, Moscow, 2015), pp. 11–82 [in Russian].Google Scholar
  27. 27.
    L. A. Legostaeva, E. A. Zmeikina, A. G. Poidasheva, et al., “Navigated transcranial magnetic stimulation under fMRT resting control during rehabilitation of patients with chronic consciousness disorders: Blind intervention study,” in VI Baltic Congress on Child Neurology: A Collection of Abstracts, (St. Petersburg, 2016), pp. 221–222 [in Russian].Google Scholar
  28. 28.
    O. A. Mokienko, R. K. Lyukmanov, L. A. Chernikova, et al., “Brain–computer interface: The first experience of clinical use in Russia,” Hum. Physiol., No. 1, 24–31 (2016).CrossRefGoogle Scholar
  29. 29.
    O. A. Mokienko, A. V. Chervyakov, S. Kulikova, et al., “Increased motor cortex excitability during motor imagery in brain–computer interface trained subjects,” Front. Comput. Neurosci. 7, 168 (2013).CrossRefGoogle Scholar
  30. 30.
    A. G. Poidasheva, G. A. Aziatskaya, A. Yu. Chernyavskii, et al., “Dynamics of cortical motor representation of the common digital extensor when teaching motor imaging using the brain–computer interface: A controlled study,” Zh. Vyssh. Nerv. Deyat. im. I.P. Pavlova, No. 4, 473–484 (2017).Google Scholar

via Braind Modern Neurorehabilitation Technologies | SpringerLink

, , , , , , , , ,

Leave a comment

[BLOG] What is Left Neglect?

The Transitional Learning Center's Blog

Left neglect, also known as unilateral neglect or hemispatial neglect, is one of the oddest symptoms of a brain injury.  It can also be one of the most troublesome symptoms.  Left neglect is a deficit that occurs following an injury to the right side of the brain.  Due to the injury, the brain has difficulty paying attention to items on the left side.  This is generally most apparent in difficulties noticing items visually on the left side.  For instance, a survivor with left neglect may bump into frames of doors on the his or her left or miss eating food on the left side of his or her plate.  It appears as if he or she is blind to items on the left but this is not a true vision issue.  It is an attention issue.  The brain is not attending to information on the left.  The survivor can have…

View original post 1,249 more words

, , , , , , , , , , , , , , , , , , , , , , , , , , ,

Leave a comment

%d bloggers like this: