Posts Tagged plateau

[WEB SITE] Strategic Training May Expand the Recovery for Traumatic Brain Injuries.

June 1, 2017

Dr. Kihwan Han

Dr. Kihwan Han

A recent study from the Center for BrainHealth at The University of Texas at Dallas shows that a certain type of instructor-led, brain training protocol can stimulate structural changes in the brain and neural connections several years after a traumatic brain injury (TBI).

The findings, published in Brain and Behavior, further suggest that changes in cortical thickness and neural network connectivity may prove an effective way to quantitatively measure treatment efficacy, an ability that has not existed until now. Building upon previous research, the study challenges the widely held belief that recovery from a TBI is limited to two years after an injury.

“A TBI disrupts brain structure. These brain changes can interfere with brain network communication and the cognitive functions those networks support,” said Dr. Kihwan Han, research scientist at the Center for BrainHealth and lead author of the study.

“For people with chronic TBI, they may have trouble with daily tasks such as creating shopping lists and resolving conflicts with others for many years after the injury. These findings provide hope for people who thought, ‘This is as good as my recovery is going to get’ and for the medical community who have yet to find a way to objectively measure a patient’s recovery,” he said.

The study included 60 adults with TBI symptoms lasting an average of eight years. Participants were randomly placed into one of two cognitive training groups: strategy-based training or knowledge-based training. Over an eight-week period, the strategy-based training group learned strategies to improve attention and reasoning. The knowledge-based training group learned information about the structure and function of the brain as well as the effects of sleep and exercise on brain performance.


These findings provide hope for people who thought, ‘This is as good as my recovery is going to get’ and for the medical community who have yet to find a way to objectively measure a patient’s recovery.

Dr. Kihwan Han,
research scientist
at the Center for BrainHealth


 

Magnetic resonance imaging measured cortical thickness and resting-state functional connectivity (rsFC) before training, after training and three months post-training. Previous studies have shown that cortical thickness and rsFC can be potential markers for training-induced brain changes.

Individuals in the strategy-based reasoning training showed a greater change in cortical thickness and connectivity compared to individuals who received the knowledge-based training. Changes in cortical thickness and functional connectivity also correlated to an individual’s ability to switch between tasks quickly and consistently to achieve a specific goal.

“People who showed the greatest change in cortical thickness and connectivity, showed the greatest performance increases in our cognitive tasks,” Han said. “Perhaps future studies could investigate the added benefit of brain stimulation treatments in combination with cognitive training for individuals with chronic TBI who experience problems with attention, memory or executive functions.”

The work was supported by the Department of Defense, the Meadows Foundation and the Friends of BrainHealth Distinguished New Scientist Award.

via Strategic Training May Expand the Recovery for Traumatic Brain Injuries – News Center – The University of Texas at Dallas

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[VIDEO] SaeboStim Micro Combined with Mirror Therapy – YouTube

 

Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence. In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products. At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued. Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began. Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence. Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.

via SaeboStim Micro Combined with Mirror Therapy – YouTube

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[WEB SITE] 17 Ways To Help Stroke Survivors Recover Faster – Saebo

If you or a loved one has suffered from a stroke, there are many difficulties that can develop as a result. Primarily, these effects are physical, emotional, and cognitive.

Below, we provide tips on how to overcome these common post-stroke conditions. Keep in mind that dealing with the aftermath of a stroke can be frustrating, but with patience and consistent effort, considerable progress can be made.

 

 

Tip 1. Recognize Symptoms of Stroke

One of the most important ways to successfully recover from stroke, is by taking preventative measures such as knowing and recognizing the symptoms of a stroke because immediate treatment can be life saving and greatly affects the chances for a full recovery. Unfortunately the chances of a second stroke occurring increases in stroke survivors. According to The National Stroke Association, about 25% of stroke survivors will experience a second stroke. Within the first 5 years after the first stroke, risk of a second stroke is about 40% higher. Fortunately it is estimated that of all secondary strokes, about 80% of them are preventable with lifestyle changes and medical intervention. Read more about recognizing the symptoms of stroke in men and in women to better prepare you to act FAST.

 

Tip 2. Walking Again and Foot Drop

Foot drop is the difficulty or inability to lift the front part of the foot because of fatigue or damage affecting the muscles and nerves that aid in its movement. To combat this, using a brace or Ankle-foot Orthoses (AFO) has proven to be a major aid in rehabilitation. These devices prevent the front of the foot from dipping down and disrupting walking movements.

Leg exercises described in this supplementary post after experiencing a stroke are crucial for recovery. While each patient should have a custom exercise routine, personalized for you, there are several exercises that should be included in most every stroke survivor’s regimen. These low-impact strength and stretching leg exercises for stroke recovery are a good complement to use in conjunction with the Saebo MyoTrac Infiniti biofeedback system.

Richard Sealy, director of The Rehab Practice, a private neuro-therapy rehabilitation program in the United Kingdom, regularly works with individuals, families, and caregivers to establish custom exercise routines to aid in recovery from long-term neurological problems, like the damage caused by stroke. While he acknowledges that each patient should have a custom exercise routine specific and personal to their struggles, he recommends a series of exercises for anyone working to strengthen their legs and improve range of motion during stroke recovery.

Rehabilitation of the legs and feet can occur at a faster rate with a combination of the aforementioned exercises and orthopedic aids such as the SaeboStep.The SaeboStep is a unique foot drop brace worn on the outside of the shoe that assists with lifting the toes when walking. It is made to eliminate cumbersome, unreliable splints and braces placed within the shoe.

 

Tip 3. Dealing with Curled Toes

Often referred to as “curled toes” or “claw toe,” this symptom is caused by a miscommunication between the brain and muscles within the foot. This misfiring of signals causes an issue with controlling muscular movements, leading to over-contracting of the toes and spasticity, a condition where there is a miscommunication between the brain and the muscles in the toes, causing them to over contract.

The best way to regain strength and movement while dealing with this condition is to create a routine with a variety of exercises—toe taps, floor grips, finger squeezes, and toe-extensor strengthening. With effort and repetition, these workouts can make a huge difference in recovery.

 

Tip 4. Lack of Arm Function

One of the most common deficiencies following a stroke is the impairment of the arm and hand. This typically results in decreased strength, coordination, and range of motion. Those affected are often unable to support their own arms in order to perform rehabilitation exercises. When this occurs it is crucial that you include additional arm support during rehabilitation to avoid the arms becoming weaker due to learned non-use.

Learned non-use occurs when a stroke survivor prefers to use their strong arm because it is easier to move. This tendency makes it even more difficult for a stroke survivor to recover, because challenging the weakened arm with these exercises plays a crucial role in regaining arm function. Often physical therapists and occupational therapists use a technique known as Constraint-Induced Movement Therapy (or CIMT) to challenge a weakened shoulder and make further exercises and drills possible. Mobile arm supports such as the SaeboMAS and SaeboMAS mini help support the weight of the arm, allowing the user to do a much wider range of exercises. For more information about the SaeboMAS and how it can aid in stroke recovery click here.

As with rehabilitating any part of the body with reduced function after a stroke, it is important to consistently repeat the exercises and stretches to strengthen the brain-muscle connections. It is also important to stay positive and try to have fun with your rehab. Here are 35 fun rehab activities for stroke patients to help keep you motivated.

 

Tip 5. Hand Paralysis

Paralysis is the inability of a muscle to move voluntarily. The National Stroke Association sites as many as 9 out of 10 stroke survivors have some degree of paralysis following a stroke. Rehabilitation and therapy can help to regain voluntary movement, even several years after the stroke takes place.

The primary symptoms of hand paralysis are spasticity (stiff muscles), weakness, and lack of coordination. Fortunately, there are several methods of treatment in addition to therapy to help manage and recover from spasticity. Additional treatments include medications to relax muscles, botox injections (relaxes muscles temporarily), stretching exercises, anti-spasticity orthotics, and functional orthoses. Surgery is another option in the most severe cases.

The least invasive and most permanent treatment for hand paralysis is therapy to rehabilitate the connection between your brain and muscles using neuroplasticity. To make these exercises even more effective and to increase your rate of recovery, it is important to repeat your hand exercises often. By performing exercises repeatedly, you are strengthening that brain-muscle connection.

 

Tip 6. Difficulty Speaking and Communicating

Another common side effect of stroke is aphasia, which is the inability to speak or understand speech. This is one of the most frustrating side effects for survivors to deal with. It’s estimated that 25 to 40 percent of people who suffer from a stroke develop aphasia, though this condition is not limited to stroke survivors. Aphasia occurs when there is damage to the brain, specifically the left side that deals with language. There are two primary forms of aphasia: receptive aphasia and expressive aphasia. Receptive aphasia is when the individual has trouble understanding what is being said to them. Expressive aphasia is when the individual is having difficulty expressing what they want to say.

When communicating with someone with receptive aphasia, try not to use long complex sentences. When communicating with someone with expressive aphasia, it is important to be patient and remember that the person’s intelligence has not been affected by the stroke, just their ability to speak.

For those with aphasia, the most important thing you can do to improve your communication is to take a deep breath and try to relax. If you can remain relaxed and focus on what you are trying to say you will have much greater success. It is easy to get flustered or feel self conscious, but you shouldn’t. Create tools that you can use to make communication easier such as a book of words, pictures, phrases, or symbols that can help you get your message across. If you are going out and know you will not be around friends or family, it may also be helpful to carry a card or piece of paper that indicates that you have aphasia and explains what it is, just in case you find yourself needing to explain your condition.

Once these tools are set in place, seeking the help of a speech-language pathologist (SLP) can greatly increase one’s ability to regain normal speech behavior. SLPs can assist in rehabilitating all types of physical speech behavior and offer support and proper guidance for you or a loved one. Read more about aphasia and recovery here.

 

Tip 7: Coping with PTSD After Stroke

Following a stroke, it is fairly common for a survivor to experience PTSD, or Post-Traumatic Stress Disorder. This condition is usually associated with combat veterans and sexual-assault survivors; however, according to a study published in the journal PLoS One, almost a quarter of stroke survivors experience some form of PTSD.

Common symptoms of PTSD include the victim experiencing the traumatic event over and over in their head or in the form of nightmares. This replaying of the event is typically accompanied by the individual’s unyielding anxiety and feelings of self doubt or misplaced guilt over their condition. Some experience a state of hyperarousal or feelings of being overly alert.

The two main treatments for PTSD include medications such as antidepressants, anti-anxiety medications or psychotherapy. If you are experiencing PTSD, it is important that you communicate how you feel with your doctor, family, and friends, as a strong support system can help you find the relief from psychological pain that you deserve.

 

Tip 8: Understanding Fatigue

Feeling tired is a normal part of life for everyone, but for stroke survivor, fatigue is a very common symptom that can be frustrating to deal with. About 40 to 70 percent of stroke survivors experience fatigue, which can make recovering feel even more difficult. Post-stroke fatigue is draining both physically and emotionally/mentally, and rest may not be the only solution.

It is important to discuss the fatigue with a doctor so they can rule out potential medical causes or determine if fatigue might stem from current medications. By speaking with the proper medical professionals and taking time to squeeze in a nap or rest as often as possible—and by maintaining a positive mindset—you can help yourself or a loved one combat the constant drowsiness of fatigue and work on returning to pre-stroke energy levels. The key thing to realize is that some level of post-stroke fatigue is normal and that survivors need to be proactive about treating and working around it.

 

Tip 9: Counteract Learned Non-Use

If the limbs weakened after stroke are not consistently exercised over time, muscles have the potential to atrophy—waste away due to cell degeneration. This often occurs when the person tries to compensate for their weak limb by using their stronger limb more often. Daily attempts to move the affected limbs are necessary to maintain and improve functionality.One method is the use of Constraint-Induced Movement Therapy (CIMT). CIMT is a form of therapy that prevents the unaffected limbs from moving while trying to exercise the affected ones.

 

Tip 10: Reduce Inflammation and Stress

Inflammation in the body can cause other issues to arise, which is why it’s important to stay stress free whenever possible. When stress does begin to take hold, a hormone called cortisol floods the body, causing pH levels to become imbalanced with acidity. High acidity levels—after an extended period of time—can kill good bacteria in the body while giving rise to bad bacteria, ultimately weakening the immune system.

With that in mind, a natural probiotic like yogurt is a great way to boost good bacteria in the body. Supplemental drinks can also improve the immune system significantly. In addition to pH balance, adopting stress management exercises such as yoga, deep breathing, tai chi, qi gong, and meditation, can limit one’s cortisol levels, promoting overall health.

 

Tip 11: Coping with Emotional Effects

Experiencing a stroke is not only a major hardship to overcome physically; it can also take a huge toll on a survivor’s emotions in many ways.

If the area of your brain that controls personality or emotion is affected, you may be susceptible to changes in your emotional response or everyday behavior. Strokes may also cause emotional distress due to the suddenness of their occurrence. As with any traumatic life experience, it may take time for you or your loved one to accept and adapt to the emotional trauma of having experienced a stroke.

Some common emotional changes strokes may cause are PseudoBulbar Affect, depression, and anxiety. Thankfully, there are several methods for treating the emotional changes associated with a stroke, with the first step being to discuss how you or your loved one is feeling with a doctor. Treatment may consist of one, or a combination, of the following: one-on-one counseling, group counseling, medication, diet, and exercise. The most effective treatment is different for everyone, so it is important to discuss and explore which combination works best for your or your loved one.

 

PseudoBulbar Affect

Sometimes referred to as “reflex crying,” “emotional lability,” or “labile mood,” PseudoBulbar Affect (PBA) is a symptom of damage to the area of the brain that controls expression of emotions, and it is one of the most frequently reported post-stroke behaviors. Characteristics of the disorder include rapid changes in mood, such as suddenly bursting into tears and stopping just as suddenly or even beginning to laugh at inappropriate times.

 

Depression

Survivors have a one in four chance of developing serious depression as a side effect of stroke. If you are feeling sad, hopeless, or helpless after having suffered a stroke, you may be experiencing this. Other symptoms of depression may include irritability or changes to your eating and sleeping habits. Talk to your doctor if you are experiencing any of these symptoms, as it may be necessary to treat with prescription antidepressants or therapy to avoid it becoming a road block to your recovery.

Along with medication and therapy, a lot of research shows that a few simple lifestyle changes help relieve the symptoms of depression. If you or a loved one is having a difficult time coping with the emotional repercussions of a stroke, here are tips on how to implement positivity and resilience:

  • Attend a support group. Talking about your struggles with people in the same situation makes you feel less lonely and can offer helpful insight or different approaches to dealing with difficulties.
  • Eat healthy food. A good diet is important for your general health and your recovery from stroke and can also improve your mental health.
  • Remain socially active. Although you may not be able to do as much as you used to, it’s crucial to stay in touch with family and friends and take part in social activities.
  • Be as independent as possible. Humans need to feel independent and competent. Stroke recovery may require the help of caregivers, but if there are things that you can safely do by yourself, insist on it.
  • Exercise regularly. Physical activity, especially a low-impact one like walking, is proven to boost mental health and will also contribute to your recovery.

 

 

Tip 12: Set Recovery Goals with Your Therapist

Setting specific and meaningful goals can help keep one focused and motivated once they are achieved, and these goals can range from simple tasks to long-term accomplishments. By establishing a list consisting of difficulties and goals, overcoming obstacles can be put within reach.

When setting these goals, working with a therapist, doctor, or close friend can be a good way to find encouragement, as well as assistance in creating a list that places goals into an appropriate timeframe. Overall, a therapist will be familiar with your case, understanding the issues and complications, and will be able to offer sound advice in all aspects of recovery.

 

Tip 13: Stay Motivated

Since apathy is common during stroke recovery, staying motivated can be a challenge. Combining one’s interests with a solid rehabilitation regimen can effectively eradicate feelings of lethargy and depression. The best thing to do is to focus on a reason for recovery and to associate it with your plan of action. This can be done by implementing sentimental items into daily routines, thus giving you personal and motivational support at all times. For example, if one of your routines is to write a list of things to do for the day, try writing it on the back of a special photo. That way, as you’re checking things off, you’ll have a little reminder to keep you motivated.

 

Tip 14: Watch Out For The Recovery Plateau Stage

The recovery plateau stage refers to the point at which a stroke survivor begins to see a slow down or stop in the progression in their recovery. Some of the most significant improvements often occur in the subacute phase, which is usually the first three to six months after the stroke  (though there is anecdotal evidence of people making significant stroke recovery progress outside of that zone.)

Seeing improvement in the early days of a survivor’s recovery can make it a lot easier for them to stay motivated and continue working hard in therapy. Research shows that further recovery is still very possible after the plateau stage though, which is why it is so important to have a strong support system to encourage you to continue with therapy and working on recovery.

 

Tip 15: Working After Stroke

Since the brain is a major organ affected when it comes to strokes, chances are that some of its functions may have trouble performing like they did before. After a stroke, learning new things, or even just recalling information can be a challenge, and working through thoughts may suddenly be difficult.

After rehabilitation, many stroke survivors do find themselves able to return to work, but preparing for this transition can come with a lot of questions. Are you physically going to be able to perform your job? Will your disability benefits lapse? What do you need to communicate with your employer? These can be tough questions, but they do have answers. Some may not ever be able to go back to the same work, but for others, just a little assistance is needed.

When you are ready to return to work, it is important to know your rights and what your employer is, and is not, legally required to provide to employees with disabilities. Keep in mind that if you are unable to perform the essential functions of your job even with reasonable accommodation, your employer is not obligated to offer you a different position or create a new role for you. They might be willing to anyway, but it is not a requirement.

 

Tip 16: Understand and Combat Memory Loss

Not only is it common for stroke survivors to experience, but memory loss can affect a wide range of people through multiple factors. Age, physical trauma, and emotional stress have the potential to cause memory decline, but rebuilding memory’s strength is highly possible and can be fun.

Specifically, incorporating technology into daily rehabilitation exercises is a great way to show quick improvements. There are numerous apps for smartphones and tablets that use different techniques to significantly improve memory, and they have the ability to set reminders, schedule appointments, and oversee other illnesses.

 

Tip 17: Be Aware of Vascular Dementia

A common problem among stroke survivors, this symptom disrupts cognitive functions, which can make it challenging for one to sort out information.

Due to the damage of blood vessels from a stroke, blood pressure, cholesterol, and blood sugar must be maintained at healthy levels to ensure good blood flow throughout the body. If you are diabetic, it is crucial that you are paying careful attention to your blood sugar and insulin levels. Studies have shown that by managing these three components, vascular dementia can be decreased or prevented.

Helping Stroke Survivors Help Themselves

The process of stroke recovery is long and full of ups, downs, twists, and turns. It takes hard work and dedication to regain mental and physical function after a stroke. The information and tips above will help you to identify and overcome the many challenges that come with recovery.

To read our answers to the most common stroke recovery questions, click here. And remember, at the end of the day, there are dozens of approaches you can take to improve the speed of stroke recovery.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via 17 Ways To Help Stroke Survivors Recover Faster | Saebo

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[VIDEO] Henry Hoffman Q&A Video Series: Can Patients Years Following Stroke Actually Make Progress? – YouTube

Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence. In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products. At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued. Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began. Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence. Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.

via Henry Hoffman Q&A Video Series: Can Patients Years Following Stroke Actually Make Progress? – YouTube

 

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[BLOG POST] SaeboFlex Helps Client Regain Hand Function 23 Years After Stroke

SaeboFlexStroke survivor exhibits remarkable improvement in hand function more than two decades after stroke, disproving theories that recovery window is limited to 6 months. 

Charlotte, N.C. – Tuesday, July 25, 2017 – Until recently, researchers believed that if a stroke survivor exhibited no improvement within the first 6 months, then he or she would have little to no chance of regaining motor function in the future. This assumed end of recovery is called a plateau. However, a groundbreaking new article published in the Journal of Neurophysiology discusses a stroke patient’s remarkable improvement decades after suffering a stroke at the age of 15. Doctors Peter Sörös, Robert Teasell, Daniel F. Hanley, and J. David Spence formally dismiss previous theories that stroke recovery occurs within 6 months, reporting that the patient experienced “recovery of hand function that began 23 years after the stroke.”

The patient’s stroke resulted in paralysis on the left side of his body, rendering his left hand completely nonfunctional, despite regular physical therapy. More than twenty years after his stroke, the patient took up swimming when his doctor recommended he lose weight. A year later, he began to show signs of movement on his affected side and returned to physical therapy. Therapists fitted the patient with the SaeboFlex, a mechanical device shown to improve hand function and speed up recoveryand, after only a few months of therapy, he began picking up coins with his previously nonfunctional hand. He also saw notable improvement in hand strength and control with the SaeboGlove, a low-profile hand device recently patented by Saebo.

Functional MRI studies showed the reorganization of sensorimotor neurons in both sides of the patient’s brain more than two decades after his stroke, resulting in a noticeable recovery in both hemispheres and improved motor function. “The marked delayed recovery in our patient and the widespread recruitment of bilateral areas of the brain indicate the potential for much greater stroke recovery than is generally assumed,” the doctors reported. “Physiotherapy and new modalities in development might be indicated long after a stroke.”

“This article highlights what we have seen for the last 15 years with many of our clients,” states Saebo co-founder, Henry Hoffman. “Oftentimes, stroke survivors are told that they have plateaued and no further progress is possible. We believe it is not the client that has plateaued but failed treatment options have plateaued them. In other words, traditional therapy interventions that lack scientific evidence can be ineffective and can actually facilitate the plateau.”

“The SaeboFlex device is a life-changing treatment designed for clients that lack motor recovery and function,” Hoffman continues. “Whether the client recently suffered a stroke or decades later, they can immediately begin using their hand with this device and potentially make significant progress over time. I agree with the authors that the neurorehabilitation community needs to take a hard look at traditional beliefs with respect to the window of recovery following stroke. It is my hope that this article will spark more interest by researchers to investigate upper limb function with clients at the chronic stage using Saebo’s hand technology.”

The abstract and article in its entirety can be viewed at the Journal of Neurophysiology’s website, jn.physiology.org.

If you are suffering from limited hand function or have been told you have plateaued, then schedule a call with a Saebo Specialist or click here to get started on the road to recovery.

via SaeboFlex Helps Client Regain Hand Function 23 Years After Stroke | Saebo

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[BLOG POST] How to Prevent or Minimize the Plateau Phase After a Stroke – Saebo

The rehabilitation process throughout the first several months of stroke recovery can be confusing and often daunting, with peaks and valleys that either encourage or slow the healing process. Varying levels of paralysis are common, and adjusting to ongoing therapy requires a shift in mindset and a complete lifestyle overhaul.

Yet, some of the most significant improvements often occur during these early days, reflecting the initial plasticity of the brain. Therefore, gaining momentum during this neurologically progressive time is key to facing the often-frustrating period ahead—a stage known as a plateau. During this stage, it may feel as if the initial spike in progress was the end of successful rehabilitation and that no further improvement is possible. But for some, the plateauing phase is quite common and even to be expected, and understanding this will help both the patient and caregivers to avoid losing hope, motivation, and persistence during this difficult time.

Are plateaus real?

Over the past two decades, research has reaffirmed the frequency and common intricacies of plateauing in newer stroke patients. In the past, it was more likely for doctors to assume that patients only regained motor function in the first few months after a stroke, and that once the plateau occurred, ongoing exercises and therapy were ineffective.

However, recently published reports now show that patients can regain motor recovery and function up to 23 years after a stroke. Medical professionals are now finding that this complex recovery period often continues to occur for months and even years after a patient has left rehab—and primarily resumes only if patients and caretakers build a recovery planand have access to evidence-based technology to prevent the plateau phase after leaving traditional rehabilitation. Designing a home-exercise program, often by upgrading the previous inpatient therapeutic regimen, is the key to maintaining progress or restarting growth if the plateau phase has begun.

What causes a plateau?

When a stroke occurs, a specific area of the brain suffers an infarction, obstructing the blood supply and killing the functionality of a section of the brain. Though this specific area is not recoverable, the area directly surrounding the infarction-impacted region still holds potential for rehabilitation. In the moments directly after the stroke, however, the area simply does not work.

During the initial healing phase known as the subacute phase, which is usually the first three to six months after the stroke, the most consistent and encouraging signs of progress occur in these regions. This natural healing stage often takes place when patients are being coached along in rehab; but if the plateau stage occurs towards the end of  the natural healing phase, it’s common for patients to be sent home for a shift in care.

For this group of patients, this is a difficult transition for several reasons: familiar exercises must be altered and adjusted, the home routine requires greater adaptability, and patients face the discouragement of no longer seeing an uptick in progress, often deterring patients and caretakers from pushing on. Progressing through the discouragement is more easily accomplished when patients and caretakers understand the plateau stage. A solid plan of ongoing, managed care is necessary for continuing to bolster the still-developing parts of the mind.

It’s not the patients that have plateaued, rather treatment options have plateaued them.

It is important to keep in mind that traditional therapy that isn’t evidence-based can be ineffective and can actually causea plateau. Sometimes a patient’s recovery is only as good as the therapist, and if the therapist isn’t modifying the treatment to the patient’s specific needs and incorporating the latest proven interventions because they haven’t been trained or educated, the patient will most likely plateau. If the therapist is well educated on the latest advances and interventions in stroke recovery the patient has a much better chance of avoiding the plateau phase. So, a plateau phase may not be an absolute, it’s a possibility.

How can you overcome a plateau?

After reassuring research, the medical community confirms that working with a managed care professional with a series of ongoing exercises does promote improvement in a stroke patient’s long-term recovery. When signs of recovery seem to stall altogether, here are a few common practices for jumpstarting at-home care.

Saebo Rehabilitation Devices

The brain’s cortical plasticity is a key component in this stage of recovery, and Saebo offers several tools for employing this factor. Motor function and utilization of the hands can be continuously developed with the assistance of the SaeboGlove or SaeboFlex, easing therapy at home with minimal assistance and instruction. The SaeboFlex and SaeboGlove include a proprietary tension system that encourages the extension and grasping strength of the hands of healing stroke patients. This action simultaneously supports brain growth and reprogramming, encouraging the plasticity of the mind through task-oriented exercises.

If patients are unable to functionally use their affected hand, they will develop learned non-use and will eventually reach the plateau phase due to avoidance. The SaeboFlex and and SaeboGlove are two tools that may prevent or minimize the plateau phase and allow patients to engage their affected hand in functional tasks that would otherwise be impossible.

Constraint-Induced Movement Therapy

Similar to the SaeboGlove and SaeboFlex’s use of cortical plasticity, Constraint-Induced Movement Therapy (CIMT) encourages the regrowth of neurological pathways damaged during a stroke. This promotes more meticulous use of the affected hand. By keeping the functional hand from taking full responsibility for daily tasks—usually with a mitt—this method involves preference of the developing side of the brain. Though CIMT is an intensive process, which must be guided and supervised for several-hour stretches at a time, positive results may be seen for years to come.

At-Home Exercises

Maintaining a regimen of exercises that both meets the needs of ongoing recovery and the patient’s comfort is essential to progressing past the plateau stage after traditional rehab. The factor of neuroplasticity allows the brain to constantly adapt, but persistence and regularity is key. When followed correctly, an increase in motor function and strength is probable in many patients. Continuing physical exercise assists with many aspects of the healing process, supporting flexibility, coordination, and balance. Though physical activity does not prevent the occurrence of a second stroke, it will keep the body in key health for recovery.

Staying Motivated

During the difficult transition to home care, supportive family and medical professionals are the vital factor in helping patients maintain motivation and feel guided toward success. As a patient is just beginning the rehabilitation process, it is almost solely in the hands of the assistant to set the tone of the session, and this mutual understanding will drive the exercises forward, making it easier to set and meet small goals along the way. Roadblocks and frustrations are common, but with a structured and steady plan, these stages will pass and times of progress will return.

Handling Emotional Changes

When difficult emotions arise, it is crucial to realize that this is completely normal. Stroke recovery is a long, often slow process, and frustration, anger, and depression are understandable obstacles to encounter. Know that these feelings and physical plateaus will pass with time when both patients and caretakers allow themselves self-care and patience. It is also helpful for families to keep this in mind, as maintaining a genuinely flexible and positive atmosphere during rehabilitation will help all parties see these changes and efforts as a long-term process.

Keep Moving Forward

When heading into long-term stroke treatment, awareness of evidence-based treatment interventions may prevent or decrease the plateauing stage. But with consistent at-home tools and exercises, progress will return, even if it feels slower than in previous phases. The recently damaged brain is taking the necessary time to heal and regrow, and this requires setting short-term goals and celebrating small victories. Reaching the plateau stage is an opportunity to reconsider the next best way forward with your therapist—progress is still ahead, even if the methods and system require a new outlook.

Source: How to Prevent or Minimize the Plateau Phase After a Stroke | Saebo

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[BLOG POST] Recovery from stroke after more than 20 years – Motor Impairment

 

Much can be learned from case studies of individual patients. This has been shown more than once in the field of stroke research.  The observations by the illustrious neuroanatomist Dr. Brodal of his own stroke are an example (Brodal 1973).

A paper recently published in the Journal of Neurophysiology provides another example. It features a case of delayed partial recovery from weakness and paralysis produced by a devastating stroke, with improvements in hand function more than two decades after the initial event (Sörös et al. 2017).

 

WHAT DID THEY FIND?

In 1979, when the patient was 15 years old, his cervical rib compressed his subclavian artery, such that thrombosis formed back to the innominate artery. Emboli subsequently entered the carotid and vertebrobasilar circulations. A dense left hemiplegia developed with a large right frontoparietal infarction.

No detail of any initial rehabilitation is given but partial use of the left shoulder and elbow, along with the left leg had been regained about 4 months after the stroke. However, minimal recovery occurred in the left hand: it was spastic and useless for 23 years.

When the patient began regular swimming in 2001, he noted finger movements of his left hand. In 2009, he began extra physiotherapy using a spring-loaded orthosis for his left hand. Currently, the patient can use his left hand to pick up small objects like coins.

Functional MR imaging was performed when the second period of recovery had occurred. When the patient repeatedly opened and closed his left hand there was extensive activation in both hemispheres and bilaterally in the cerebellum. In contrast, movements of comparable size and rate made by the unaffected hand (i.e., the right hand) produced only focal activity in the contralateral sensorimotor cortex, supplementary motor area and cerebellum.

 

SIGNIFICANCE AND IMPLICATIONS

While the case features a rare complication of the thoracic outlet syndrome produced by a cervical rib, it highlights spectacularly the capacity of cortical and cerebellar circuits to be reformed or reactivated in such a way that new functional movements can occur at the distal extremity, i.e. the hand. It is not possible to determine whether the swimming and later rehabilitation caused or even contributed to the surprising improvement. It may have occurred spontaneously.  Nonetheless, the case has important messages for rehabilitation of stroke, especially in young people.  The traditional view in rehabilitation following stroke is that most of the functional improvement occurs within the first 12-18 months.  One widely promoted view is that the initial motor recovery occurs to a fixed proportion of the initial severity of the deficit (70% of recovery occurs in the first three months) (Prabhakaran et al. 2008; Smith et al. 2017).  This case of prolonged paralysis with delayed recovery after a severe ischaemic stroke means that the therapeutic window for improvement can be much longer than traditionally thought.  By implication, many new therapies (potentially cellular, pharmacological or physical ones) could be tested long after stroke.

 

PUBLICATION

Sörös P, Teasell R, Hanley DF, Spence JD. Motor recovery beginning 23 years after ischemic stroke. J Neurophysiol 118: 778-781, 2017.

 

KEY REFERENCES

Brodal A. Self-observations and neuro-anatomical considerations after a stroke. Brain 96: 675-694, 1973.

Prabhakaran S, Zarahn E, Riley C, Speizer A, Chong JY, Lazar RM, Marshall RS, and Krakauer JW. Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair 22: 64-71, 2008.

Smith MC, Byblow WD, Barber PA, and Stinear CM. Proportional recovery from lower limb motor impairment after stroke. Stroke 48: 1400-1403, 2017.

 

AUTHOR BIO

Simon Gandevia is an NHMRC Senior Principal Research Fellow and Deputy Director of Neuroscience Research Australia (NeuRA). His research investigates the sensorimotor control of human movements. He has special interests in proprioception, muscle, breathing control, and fatigue.  He is Chief investigator of the NHMRC Program grant at NeuRA on Motor Impairment. You can learn more about Simon and his research here. You can also follow him on Twitter @SimonGandevia and @MotorImpairment.

Source: Recovery from stroke after more than 20 years – Motor Impairment

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[BLOG POST] How to Make New Brain Cells and Improve Brain Function

Scientists used to believe that the brain stopped making new brain cells past a certain age. But that believe changed in the late 1990’s as a result of several studies which were performed on mice at the Salk Institute.

After conducting maze tests, neuroscientist Fred H. Gage and his colleagues examined brain samples collected from mice. What they found challenged long standing believes held about neurogenesis, or the creation of new neurons.

To their astonishment, they discovered that the mice were creating new neurons. Their brains were regenerating themselves.

All of the mice showed evidence of neurogenesis but the brains of the athletic mice showed even more.

 These mice, the ones that scampered on running wheels, were producing two to three times as many new neurons as the mice that didn’t exercise.

The difference between the mice who performed well on the maze tests and those that floundered was exercise.

That’s great for the mice, but what about humans?

To find out if neurogensis occurred in adult humans, Gage and his colleagues obtained brain tissue from deceased cancer patients who had donated their bodies to research. While still living, these people were injected with the same type of compound used on Gage’s mice to detect new neuron growth. When Gage dyed their brain samples, he saw new neurons. Like in the mice study, they found evidence of neurogenesis – the growth of new brain cells.

From the mice study, it appears that those who exercise produce even more new brain cells than those who don’t. Several studies on humans seem to suggest the same thing.

Studies performed at both the University of Illinois at Urbana- Champaign and Columbia University in New York City have shown that exercise benefits brain function. The test subjects were given aerobic exercises such as walking for at least one hour three times a week. After 6 months they showed significant improvements in memory as measured by a word-recall test. Using fMRI scans they also showed increases in blood flow to the hippocampus (part of the brain associated with memory and learning). Scientists suspect that the blood pumping into that part of the brain was helping to produce fresh neurons.

Dr. Patricia A. Boyle and her colleagues of Rush Alzheimer’s Disease Center in Chicago found that the greater a person’s muscle strength, the lower their likelihood of being diagnosed with Alzheimer’s. The same was true for the loss of mental function that often precedes full-blown Alzheimer’s.

Neuroscientist Gage, by the way, exercises just about every day, as do most colleagues in his field. As Scott Small a neurologist at Columbia explains,

 I constantly get asked at cocktail parties what someone can do to protect their mental functioning. I tell them, ‘Put down that glass and go for a run.

So if you want to grow some new brain cells and improve your brain function, go get some exercise!

Source: How to Make New Brain Cells and Improve Brain Function | Online Brain Games Blog

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[Abstract] Chronic Stroke Survivors Improve Reaching Accuracy by Reducing Movement Variability at the Trained Movement Speed

Background. Recovery from stroke is often said to have “plateaued” after 6 to 12 months. Yet training can still improve performance even in the chronic phase. Here we investigate the biomechanics of accuracy improvements during a reaching task and test whether they are affected by the speed at which movements are practiced.

Method. We trained 36 chronic stroke survivors (57.5 years, SD ± 11.5; 10 females) over 4 consecutive days to improve endpoint accuracy in an arm-reaching task (420 repetitions/day). Half of the group trained using fast movements and the other half slow movements. The trunk was constrained allowing only shoulder and elbow movement for task performance.

Results. Before training, movements were variable, tended to undershoot the target, and terminated in contralateral workspace (flexion bias). Both groups improved movement accuracy by reducing trial-to-trial variability; however, change in endpoint bias (systematic error) was not significant. Improvements were greatest at the trained movement speed and generalized to other speeds in the fast training group. Small but significant improvements were observed in clinical measures in the fast training group.

Conclusions. The reduction in trial-to-trial variability without an alteration to endpoint bias suggests that improvements are achieved by better control over motor commands within the existing repertoire. Thus, 4 days’ training allows stroke survivors to improve movements that they can already make. Whether new movement patterns can be acquired in the chronic phase will need to be tested in longer term studies. We recommend that training needs to be performed at slow and fast movement speeds to enhance generalization.

Source: Chronic Stroke Survivors Improve Reaching Accuracy by Reducing Movement Variability at the Trained Movement Speed – Feb 01, 2017

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[WEB SITE] 28 Stroke Recovery Tips for Healing & Habits – Flint Rehab

These stroke recovery tips start with the brain and and end with your lifestyle… Why? Because stroke recovery is about more than just the ‘brain thing.’ It’s about the ‘life thing,’ too.

So we’ll start with some basic tips on healing the brain after stroke, and then we’ll cover 3 other important topics:

You can pick and choose which stroke recovery tips you like, but we encourage you to stick around for the full show.

1. Master the Rewiring Process

To rewire your brain after stroke, you need to utilize repetitive practice (repeating an exercise over and over) to trigger neuroplasticity, the mechanism that your brain uses to heal itself after injury.

Neuroplasticity is the #1 thing to focus on during stroke recovery. Become an expert on it and you won’t regret it.

A great book that goes into depth on the subject is called The Brain that Changes Itself by Norman Doidge. It’s one of our top recommended stroke recovery books.

2. Keep Your Nutrition Game Up

We’ll keep this part extremely simple: Eat mostly whole foods, avoid packaged/processed food as much as possible, and supplement where necessary.

If you do these things, then you’ll be consuming a diet that supports your body’s healing.

3. Don’t Fall for the Plateau

The plateau is real – but the word itself is so deceiving! When results slow down after the first few months of recovery, don’t mistake it for a dead end.

Recovery will only stop when you stop.

You can bust through the plateau by keeping your regimen consistent but varied with different exercises.

4. Avoid Permanent Lopsidedness

During stroke recovery, the phrase “use it or lose it” is commonly used by therapists to describe the clinical condition of learned nonuse.

Learned nonuse occurs when you completely stop using your affected limb, and after a while your brain literally forgets how to use it.

The best way to avoid learned nonuse is to move your affected limbs at least a little bit every day.

5. Permanently Treat Pain and Spasticity

Localized pain can be treated with heat packs and medication, which can provide the relief you need to carry out necessary tasks. These treatments, however, are short-term and temporary.

To get long-term relief from painful spastic muscles, you need to relieve the spasticity. How do you get rid of spasticity?

By dutifully performing your rehab exercises so that your brain regains control over your spastic muscles – and they relax. Again, it’s all about neuroplasticity.

6. You Don’t Know What Works…

…Until you’ve tried them all.

Something that worked for a friend might not work for you, or it could be the best thing ever! But you won’t know until you try.

7. Get Tons of Sleep

Sleep helps improve movement recovery after stroke by giving your brain a chance to process and retain all the information it learned from the day’s exercises.

Sleep also helps reduce fatigue, irritability, and toxic buildup in your brain.

It what stroke survivor Jill Bolte Taylor, a neuroscientist who survived a massive stroke, rates sleep as her #1 recommendation for recovery after stroke.

8. Prevent It from Happening Again

Stroke survivors are at higher risk of experiencing another stroke, so prevention is key.

This isn’t the perfect formula, but they’re great guidelines for a generally healthy lifestyle that promotes good health and vitality.

9. Deal with Misbehaving Feet

If you’re suffering from foot drop or curled toes, then AFOs (ankle foot orthosis) can help align your feet and make walking easier and safer.

If you want to regain normal use of your feet without AFOs, then rehab exercises combined with TENS therapy can help get you there.

It’s strongly suggested that you continue to do rehab exercises for your feet and legs because the use of AFOs will make the conditions worse since you won’t be exercising those muscles at all.

Up next is Part 2: Mindset Tips

Source: 28 Stroke Recovery Tips for Healing & Habits – Flint Rehab

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