Posts Tagged intensity

[WEB PAGE] The Ultimate Guide to Stroke Exercises

Functional recovery is possible, even years after a stroke. Learn how to harness neuroplasticity through repetitive exercise, and the all-around health benefits of staying active after stroke or brain injury.

By JUNE LEE, 21 SEP 2020 

The Ultimate Guide to Stroke Exercises

Having a stroke is a mentally and physically taxing experience. According to the World Health Organization (WHO), 15 million people suffer from stroke worldwide each year. Of these, 5 million people die, and many survivors are left permanently disabled.

Stroke survivors may lose physical abilities and cognitive skills or undergo behavioral changes because strokes cause temporary or permanent damage to the brain areas that control those functions.

But here is the good news: the brain is able to recover after stroke, whether initially or months to years later. While short-term recovery after stroke (called spontaneous recovery) is limited to the first six months, long-term functional recovery can occur at any point thereafter. Stroke survivors who continue to engage their affected side in daily activity and exercise can capitalize on functional recovery potential throughout their stroke journey.

The Importance of Stroke Exercise for Rehabilitation and Recovery

The brain is capable of rewiring and repairing itself even if its cells are damaged. The undamaged parts step in to perform the tasks that the damaged parts were performing. This phenomenon (called neuroplasticity) allows stroke survivors to regain lost movement and function. The key to neuroplasticity is the consistent performance of repetitive tasks so that the brain can relearn how to perform these tasks through different neural pathways.

In simpler words, stroke exercise is one of the most effective means by which stroke patients can heal themselves, get stronger, improve the quality of their lives, and maximize their recovery from stroke. Because lifestyle factors like being overweight and having high blood pressure are a common cause of stroke, daily exercise becomes even more important in reducing the risk for recurrent stroke and other complications.

No matter the severity of the stroke, survivors can improve their quality of life through healthy lifestyle changes and engagement in restorative activities. Whether implementing big changes or small ones, the key to meaningful functional recovery is engaging in your post-stroke routine changes consistently.

The Physical and Mental Health Benefits of Stroke Recovery Exercises

Let’s look at some of the important physical and mental health benefits of engaging in stroke rehabilitation exercises. Post-stroke exercise is shown to produce many positive outcomes, which may include:

Physical benefits

  1. Speeds up all-round stroke recovery
  2. Recovers strength
  3. Improves endurance
  4. Increases walking speed
  5. Improves balance
  6. Boosts the ability to perform daily routine activities
  7. Prevents the recurrence of strokes.

Mental benefits

  1. Reduces depression and enhances mood
  2. Boosts brain health
  3. Relieves stress
  4. Helps in increasing a sense of self-worth and self-reliance that can decrease after a stroke
  5. Gives patients a sense of purpose and a goal to work towards.

Exercises to help Patients in Stroke Recovery at Home

The positive effects of post-stroke exercise are undeniable. However, when setting up an exercise routine as a stroke survivor, it is important to incorporate both cardiovascular fitness and muscle strengthening to ensure the most effective outcomes.

Stroke exercises are always safer to do with a loved one or caregiver around. However, if that is not possible, patients can modify an exercise program to ensure safe performance. For instance, completing exercises from sitting as opposed to standing to avoid loss of balance. It is also wise to consult a doctor or a therapist should any uncertainties about any of the stroke exercises arise or if you have any other underlying health condition.

Cardiovascular Fitness

Aerobic exercise is fundamental to building a healthy heart, improving endurance, and maintaining healthy lungs. Cardiovascular exercise can also improve the sensory perception and motor skills of stroke survivors. Walking outside or on a treadmill, stationary cycling, recumbent cross training and many other forms of exercise that get your heart pumping are extremely beneficial for stroke recovery.

Stroke survivors must get at least 20-60 minutes of light to moderate aerobic exercise (50 to 80% of your maximum heart rate) 3 to 7 days a week to improve the chances of stroke recovery. Patients can choose to do aerobic exercise at one go or in smaller sessions during the day.

Resistance Exercises for Strengthening Muscles

Resistance training or muscle strength training plays a crucial role in post-stroke recovery, as it helps to recover physical strength, stamina, stability, and improve range of motion.

Here are some commonly prescribed exercises for stroke recovery at home:

1. Wrist Curls

Equipment: A stable chair with armrests (preferably padded), light weights, or any household object which can provide some resistance and is easy to grip.

How To Do It: Sit up straight on the chair. Place your arms on the rests with your palms facing upward. Let your wrists dangle over the edge of the armrests. Grasp the weights firmly and comfortably, and with slow controlled movements, bend your wrist up towards your forearm and back down again (only your wrists should be moving).

Benefits: Wrist curls are isolated movements that build forearm strength, improve range of motion, and enhance gripping ability.

2. Wrist and Hand Stretch

Equipment: Stable chair with armrests.

How To Do It: With your arms facing downward and your wrists dangling over the edge of the armrest, drop your hand down and use your other hand to gently lift your wrist up and down and side to side.

Benefits: This simple movement stretches the ligaments in the wrist and forearms to maintain range of motion.

Modification: If you add a weight while completing this exercise, you are completing a reverse wrist curl, strengthening the muscles on the opposite side of your forearm.

3. Shoulder Openers

Equipment: Light weights or any light object that can be gripped easily and will provide some resistance.

How To Do It: Grasping your weights (make fists with your fingers facing inwards), hold your arms at your sides, and bend your elbows 90 degrees. With slow controlled movements, move your fists outwards while keeping your arms in position at your sides (like you are opening a door). Bring your arms back to your starting stance. (Can be performed both sitting or standing).

Benefits: This exercise improves range of motion and strength in the shoulders.

4. Table Towel Slide

Equipment: Folded Towel and table.

How To Do It: Place the towel in front of you. With your weaker hand on the towel and your stronger hand on top of it, slide the towel away and towards you (using your stronger hand to guide and push). Apart from going back and forth, you could also go clock and counter-clockwise, forming circles on the table.

Benefits: Stretches and strengthens shoulder and arm muscles and promotes neuroplasticity through improved arm coordination.

5. Trunk Bends

Equipment: A stable chair.

How To Do It: Sit on the edge of your chair with your feet planted slightly apart but firmly on the ground. Bend forward as far as you can, and try to reach your ankles or the floor between your legs. Then use your core muscles for sitting back up as straight as you can.

Benefits: Improves core strength and helps with weight shifting.

6. Knee Rotations

Equipment: Firm, flat surfaces such as a bed or a mat.

How To Do It: Lie on your back and rest your hands by your sides. Bend your knees with your feet flat on the floor. Keeping your knees together, drop them, slowly, to the left then, bring them back to the center. Then drop them to the right and back to the center.

Benefits: Improves core, back strength, coordination, and balance.

7. Hip Abduction

Equipment: Stable chair.

How To Do It: Sit up straight on the edge of your chair. Gently tighten your abs and straighten one knee. With your toes pointed to the ceiling, slowly move your foot out to the side. Return to the starting stance, then repeat on the other side. You can decrease the intensity by lying down and performing this exercise or make it more difficult by attempting this from standing, if you are capable.

Benefits: Strengthens hips, core, leg, back, and improves coordination and stability.

8. Standing Knee Raises

Equipment: A firm surface to hold on to.

How To Do it: Stand with your back straight and hold on to a firm surface. Shifting your weight to one leg, bring the other leg up in front of you while bending your knee to a 90-degree angle. Hold for a few seconds and resume the starting position. Then switch legs.

Benefits: Strengthens upper and lower abs, hips, and back. It also helps with posture, balance, and coordination.

9. Sit to Stands

Equipment: Stable chair.

How To Do it: Sit up tall in your chair with your knees bent (90 degrees). Place your feet firmly on the floor shoulder-width apart. Slowly rise to a standing position while ensuring that your knees never cross the tips of your toes. Sit back down slowly and in a controlled manner. To make it less intense, use your arms for support, and to make it more difficult, cross your arms on your chest.

Benefits: Strengthens core and upper thigh muscles, improves weight shifting and balance.

10. Hip Thrusts

Equipment: A flat, firm surface like a bed or a mat.

How To Do it: Lie on your back with your feet flat on the ground and knees bent. Place your arms by your sides, palms down. Gently contract your abs and squeeze your glutes (backside muscles) to lift your hips and make a bridge. Hold on this position for a few seconds and lower to the starting stance. You can make it easier by straightening your legs and placing a rolled-up towel under your knees, then squeezing and lifting your hips. You could also make it more intense by lifting one foot at a time while holding the bridge.

Benefits: It boosts the strength of the core, glutes, lower back muscles, and muscles that support the spine.

Frequency and Intensity of Stroke Exercises

Stroke exercise is most beneficial if done consistently and repetitively. It is always best to consult your medical team about the type and frequency of exercises that are optimal for your unique situation. Do not risk your safety by attempting things that you are unsure about.

As a guideline, resistance exercises should be done 3-5 times a week. 2-3 sets of 12-15 repetitions (of each exercise) should be completed to achieve noticeable results. A survivor who is new to exercise post-stroke exercises may have to work up to the ideal frequency of exercise over time.

Stroke exercise should never cause pain. Pain may indicate that you are causing new or lasting damage to your muscles and joints. If your exercises produce a burning, shooting, or otherwise uncomfortable sensation, stop immediately and modify the activity (ex. reduce weight, perform the exercise within a smaller range of motion). If it is not possible to perform the activity without pain, remove it from your program and ask your doctor.

Conclusions

A stroke results in drastic and sudden changes in life that can leave survivors struggling physically, socially, and emotionally. However, proper stroke exercise is the path to reclaiming the body, mind, and quality of life. With determination and hard work, there is light at the end of the tunnel and a more promising future ahead.

For more information, support, or to know more about the latest developments in stroke recovery, give us a call at (888) 623-8984 or email at info@neofect.com.

Source: https://us.blog.neofect.com/the-ultimate-guide-to-stroke-exercises/

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[Abstract] Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system.

Purpose: Motor recovery of the upper limb (UL) is related to exercise intensity, defined as movement repetitions divided by minutes in active therapy, and task difficulty. However, the degree to which UL training in virtual reality (VR) applications deliver intense and challenging exercise and whether these factors are considered in different centres for people with different sensorimotor impairment levels is not evidenced. We determined if (1) a VR programme can deliver high UL exercise intensity in people with sub-acute stroke across different environments and (2) exercise intensity and difficulty differed among patients with different levels of UL sensorimotor impairment.

Methods: Participants with sub-acute stroke (<6 months) with Fugl-Meyer scores ranging from 14 to 57, completed 10 ∼ 50-min UL training sessions using three unilateral and one bilateral VR activity over 2 weeks in centres located in three countries. Training time, number of movement repetitions, and success rates were extracted from game activity logs. Exercise intensity was calculated for each participant, related to UL impairment, and compared between centres.

Results: Exercise intensity was high and was progressed similarly in all centres. Participants had most difficulty with bilateral and lateral reaching activities. Exercise intensity was not, while success rate of only one unilateral activity was related to UL severity.

Conclusion: The level of intensity attained with this VR exercise programme was higher than that reported in current stroke therapy practice. Although progression through different activity levels was similar between centres, clearer guidelines for exercise progression should be provided by the VR application.

  • Implications for rehabilitation
  • VR rehabilitation systems can be used to deliver intensive exercise programmes.

  • VR rehabilitation systems need to be designed with measurable progressions through difficulty levels.

via Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system: Disability and Rehabilitation: Assistive Technology: Vol 0, No 0

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[Abstract] High Intensity Exercise for Walking Competency in Individuals with Stroke: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE:

To assess the effects of high intensity exercise on walking competency in individuals with stroke.

DATA SOURCES:

A systematic electronic searching of the PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCOhost), and SPORTSDiscus (EBSCOhost) was initially performed up to June 25, 2019.

STUDY SELECTION:

Randomized controlled trials or clinical controlled trials comparing any walking or gait parameters of the high intensity exercise to lower intensity exercise or usual physical activities were included. The risk of bias of included studies was assessed by the Cochrane risk of bias tool. The quality of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.

DATA EXTRACTION:

Data were extracted by 2 independent coders. The mean and standard deviation of the baseline and endpoint scores after training for walking distance, comfortable gait speed, gait analysis (cadence, stride length, and the gait symmetry), cost of walking, Berg Balance Scale , Time Up&Go (TUG) Test and adverse events were extracted.

DATA SYNTHESIS:

A total of 22 (n = 952) studies were included. Standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute effect size and subgroup analysis was conducted to test the consistency of results with different characteristics of exercise and time since stroke. Sensitivity analysis was used to assess the robustness of the results, which revealed significant differences on walking distance (SMD = .32, 95% CI, .17-.46, P < .01, I2 = 39%; WMD = 21.76 m), comfortable gait speed (SMD = .28, 95% CI, .06-.49, P = .01, I2 = 47%; WMD = .04 m/s), stride length (SMD = .51, 95% CI, .13-.88, P < .01, I2 = 0%; WMD = .12 m) and TUG (SMD = -.36, 95% CI, -.72 to .01, P = .05, I2 = 9%; WMD = -1.89 s) in favor of high intensity exercise versus control group. No significant differences were found between the high intensity exercise and control group in adverse events, including falls (OR = 1.40, 95% CI, .69-2.85, P = .35, I2 = 11%), pain (OR = 3.34, 95% CI, .82-13.51, P = .09, I2 = 0%), and skin injuries (OR = 1.08, 95% CI, .30-3.90, P = .90, I2 = 0%).

CONCLUSIONS:

This systematic review suggests that high intensity exercise could be safe and more potent stimulus in enhancing walking competency in stroke survivors, with a capacity to improve walking distance, comfortable gait speed, stride length, and TUG compared with low to moderate intensity exercise or usual physical activities.

 

via High Intensity Exercise for Walking Competency in Individuals with Stroke: A Systematic Review and Meta-Analysis. – PubMed – NCBI

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[Abstract] The Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome after Traumatic Brain Injury: a Systematic Review & Meta-Analysis

Abstract

Objective

To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods.

Data sources

Pubmed, Embase, PsycINFO and Cochrane Database.

Data selection

Electronic databases were searched for prospective controlled clinical trials assessing the effect of timing or intensity of multidisciplinary neurorehabilitation programs on functional outcome of patients with moderate or severe TBI. A total of 5,961 unique records were screened for relevance, of which 58 full-text articles were assessed for eligibility by two independent authors. Eleven articles were included for systematic review and meta-analysis.

Data extraction

Two independent authors performed data extraction and risk of bias analysis using the Cochrane Collaboration Tool. Discrepancies between authors were resolved by consensus.

Data synthesis

Systematic review of a total of six randomized controlled trials, one quasi-randomized trails and four controlled trials revealed consistent evidence for a beneficial effect of early onset neurorehabilitation in the trauma center and intensive neurorehabilitation in the rehabilitation facility on functional outcome, as compared to usual care. Meta-analytic quantification revealed a large-sized positive effect for early onset rehabilitation programs (d = 1.02, p < .001, 95%-confidence interval [CI]: 0.56-1.47) and a medium-sized positive effect for intensive neurorehabilitation programs (d = 0.67, p < .001. 95%-CI: 0.38-0.97) as compared to usual care. These effects were replicated based on solely studies with a low overall risk of bias.

Conclusions

The available evidence indicates that early onset neurorehabilitation in the trauma center and more intensive neurorehabilitation in the rehabilitation facility promote functional recovery of patients with moderate to severe TBI as compared to usual care. These findings support the integration of early onset and more intensive neurorehabilitation in the chain of care for patients with TBI.

via The Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome after Traumatic Brain Injury: a Systematic Review & Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Walking: What say the scientist and what is best practice – Full Text PDF

Abstract

In this part we try to listen to the science, that has and still do over the whole world investigation by stroke patients over the walking aspect and the best way to get the best recovery or compensation. Recovery is only for an group possible, that had an “minor” stroke and there we see that the old system is not too much damaged and recovery is possible. But with greater damage of the brain individual after an stroke must go another way to get his independently and that is compensation. That compensation start with the first movement in bed and will also affect the diagonal. The science has reported that the walking pattern on the EMG don’t change very much after an short period and they said that this pattern are fixed within in certain period. We have our doubt and have search to other forms of training and learning and see that changes is well possible but to be sure the science must investigated that. Here is an problem because science gives another interpretation of the word intensity. For the scientist this is “more time” to do the exercises and in our view, it is the heaviness of the exercises and that can be done by an individual with an stroke an certain time before he is fatigue.

In the treatment we start with the individual with an severe stroke that need all assistance to get him on his feet and will have need of an splint on his knee because the power in the knee muscle is to limited, to hold the knee. Regrettable an individual after an stroke that the scientist never investigate because this is too difficult. From this starting point we walk through all the steps, we must make to get independent walking individual when possible and what the problem were when that goal cannot fully reached.

And we discuss other forms, approach or new development to get walking possible with the use of the diagonals. Part 8 will discuss other casus with an severe stroke. (Jan van de Rakt, Steve McCarthy-Grunwald -Diagonals Part 7 Stroke 5 Walking: What say the scientist and what is best practice. Ita. J. Sports Reh. Po. 2018; 5; 2 ; 1013 – 1062 ; ISSN 2385-1988 [online] IBSN 007-111-19-55 ; CGI J OAJI :0,101 )

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[Abstract] Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?

Provisional Abstract
Background and Purpose
Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on healthcare resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is founded in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible due to patients’ environmental factors. This paper addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy.

Summary of Key Points
We provide an overview of TH and present evidence that a web-supported program used in conjunction with Constraint Induced Therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, ‘LifeCIT’ is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial measurement units and mechanomyography sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained.

Recommendations for Clinical Practice
We propose that wearable sensor technologies and TH programs have the potential to provide cost-effective, intensive, home-based stroke rehabilitation.

Source: JUST ACCEPTED: “Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?” |

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Chapter 9

Mobility and the Lower Extremity

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995).In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

For evidence tables, please click here.

Source: Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation

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[WEB SITE] Neuroplasticity: 10 Things Stroke Survivors Need to Know

Neuroplasticity is a big word getting a lot of buzz. It means the brain (“neuro”) can change (“plastic”). We hear a lot about it in stroke and brain injury rehab because it gives hope to survivors that their brains can heal, adapt, and rewire after they have been damaged. We also hear the word in advertisements for new treatments or programs. What exactly is neuroplasticity, and how does it work?

Intuitively, we know that we get better at the things we practice, and we are shaped by our experiences. Therapy for a damaged brain is essentially no different. The best therapies exploit how neuroplasticity works by using repetitive positive experiences to forge and strengthen pathways in the brain. To better understand how this works, we look to the research published by Kleim & Jones that outlines the 10 principles of experience-dependent neuroplasticity.

Neuroplasticity - What it Means for Stroke Survivors

1) Use it or lose it

The skills we don’t practice often get weaker.

2) Use it and improve it

The skills we practice get better.

3) Specificity

We must skillfully practice the exact tasks we want to improve.

4) Repetition matters

We must do a task over and over again once we’ve got it right to actually change the brain.

5) Intensity matters

More repetitions in a shorter time are necessary for creating new connections.

6) Time matters

Neuroplasticity is a process rather than a single event, with windows of opportunity opening for different skills at different times. In rehabilitation, starting earlier is usually better than starting later.

Recent research shows that even 5+ years post-stroke, people with aphasia made significant progress in language skills using Language Therapy daily.

7) Salience matters

To change the brain, the skill we’re practicing must have some meaning, relevance, or importance to us.

8) Age matters

Younger brains tend to change faster than older brains, but improvement is possible at any age.

9) Transference

Practicing one skill can result in improvement of a related skill.

10) Interference

Learning an “easier way” of doing something (i.e. a bad habit or compensation) may make it harder to learn the proper way.

 

Whether you’re learning a new skill or re-learning a lost one, it’s clear we must practice the thing we want to get better at. Unfortunately, many stroke survivors, recovering but not yet ready to return to work, sit at home alone between therapy sessions. They turn to TV to pass the time, despite being willing to do the exercises they need to improve their skills. Fortunately, there are new technologies (such as an app that helps you practice talking or a video game that guides you through meaningful movements) that can help provide intense, meaningful, and skilled stimulation that will change their brains for the better. Understanding how neuroplasticity works can help you evaluate which methods can truly help you reach your goal.

Regrettably, there are some people who are exploiting the term neuroplasticity to give brain injury survivors false hope that they can get better with unproven treatments that require little to no effort. If the therapy does not have you directly practicing the skill it claims to improve, please be cautious. There are no quick-fixes (remember: intensity and repetition matter), and there is no one-size-fits-all solution (remember: specificity and relevance matter). Anyone who tells you otherwise, using brain-brandingneuro-marketing, or brain-training terminology while charging you for a service or product, is banking on you not knowing the difference. But now you do.

 

Further Reading on Neuroplasticity:

 


Tactus Therapy apps are an affordable and accessible way to get some of the mental stimulation needed for recovery. You can personalize Language Therapy, Answering Therapy, and Conversation Therapy with your own questions or photos, helping you use repetition & personal relevance to your advantage.

Source: Neuroplasticity: 10 Things Stroke Survivors Need to Know

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[WEB SITE] Neuroplasticity: 10 Things Stroke Survivors Need to Know

Neuroplasticity is a big word getting a lot of buzz. It means the brain (“neuro”) can change (“plastic”). We hear a lot about it in stroke and brain injury rehab because it gives hope to survivors that their brains can heal, adapt, and rewire after they have been damaged. We also hear the word in advertisements for new treatments or programs. What exactly is neuroplasticity, and how does it work?Intuitively, we know that we get better at the things we practice, and we are shaped by our experiences. Therapy for a damaged brain is essentially no different. The best therapies exploit how neuroplasticity works by using repetitive positive experiences to forge and strengthen pathways in the brain. To better understand how this works, we look to the research published by Kleim & Jones that outlines the 10 principles of experience-dependent neuroplasticity.

1) Use it or lose it: The skills we don’t practice often get weaker.

2) Use it and improve it: The skills we practice get better.

3) Specificity: We must skillfully practice the exact tasks we want to improve.

4) Repetition matters: We must do a task over and over again once we’ve got it right to actually change the brain.

5) Intensity matters: More repetitions in a shorter time are necessary for creating new connections.

6) Time matters: Neuroplasticity is a process rather than a single event, with windows of opportunity opening for different skills at different times. In rehabilitation, starting earlier is usually better than starting later.Recent research shows that even 5+ years post-stroke, people with aphasia made significant progress in language skills using Language Therapy daily.

7) Salience matters: To change the brain, the skill we’re practicing must have some meaning, relevance, or importance to us.

8) Age matters: Younger brains tend to change faster than older brains, but improvement is possible at any age.

9) Transference: Practicing one skill can result in improvement of a related skill.

10) Interference: Learning an “easier way” of doing something (i.e. a bad habit or compensation) may make it harder to learn the proper way.

Whether you’re learning a new skill or re-learning a lost one, it’s clear we must practice the thing we want to get better at. Unfortunately, many stroke survivors, recovering but not yet ready to return to work, sit at home alone between therapy sessions. They turn to TV to pass the time, despite being willing to do the exercises they need to improve their skills. Fortunately, there are new technologies (such as an app that helps you practice talking or a video game that guides you through meaningful movements) that can help provide intense, meaningful, and skilled stimulation that will change their brains for the better. Understanding how neuroplasticity works can help you evaluate which methods can truly help you reach your goal.

Regrettably, there are some people who are exploiting the term neuroplasticity to give brain injury survivors false hope that they can get better with unproven treatments that require little to no effort. If the therapy does not have you directly practicing the skill it claims to improve, please be cautious. There are no quick-fixes (remember: intensity and repetition matter), and there is no one-size-fits-all solution (remember: specificity and relevance matter). Anyone who tells you otherwise, using brain-branding, neuro-marketing, or brain-training terminology while charging you for a service or product, is banking on you not knowing the difference. But now you do.

Source: Neuroplasticity: 10 Things Stroke Survivors Need to Know

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Abstract

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995). In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

Get Full Text PDF

via Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation.

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