Therapy and Motor Learning
There are advances in stroke rehabilitation which significantly assist stroke patients in gaining mobility and independence.
According to the American Heart Association, a stroke occurs when a blood vessel that carries oxygen and nutrients to the brain cannot get the blood and oxygen it needs, so it starts to die.
When a person suffers a stroke, it usually means altered facial expressions and loss of function on one side of the body and sometimes speech impairement, depending on the area of the brain that is affected.
Until recently, it was believed that once the brain was injured, as in the case of a stroke, the damage was permanent. However, recent studies have demonstrated the plasticity of the brain and its ability to "re wire" itself after injury.
Most of the studies have determined that this "re wiring" of the brain comes as a result of re learning the lost functions through increased and repetitive use.
The involved extremities in a stroke are "flaccid" or very weak, or show "spasticity", an abnormally increased muscle tone or a mixture of both. In any case, the patient will have a difficult time using the involved side's arm and leg to peform any of their daily activities.
Undergoing Physical, Occupational and Speech therapy helps restore these lost functions. However, rehabilitation focuses on making the patient functional, this means, teaching the patient to walk, get in and out of bed, feed, and dress themselves, even if it requires having to compensate with the uninvolved side to do most of the work.
Depending on the severity of the stroke, patients can fully recover their ability to perform their daily activities independently as in the case of a mild stroke, or they may become disabled in varying degrees as in the case of a more severe stroke.
Initially after the stroke, therapy is usually given for a few hours daily for 4-8 weeks, as an inpatient either at the hospital or rehabilitation facility. Once the patient goes home therapy is given for one to two hours two to three days a week for a few months to a year. The current treatment methodologies do not emphasize the constant engagement of the affected side in the therapy, mainly because time restrictions and insurance reimbursement issues which focus on functional gains.
Motor Learning involves the repetition of the right patterns of movement on the affected side of a person who has had a stroke. We facilitate the correct movements until the patient is able to achieve these movements on their own. The idea is not to allow the "re wiring" or re learning of abnormal movement patterns but to facilitate normal patterns.
In both Motor learning and Constraint induced movement therapy studies where stroke patients that showed decreased brain representation of affected extremities, and were engaged in repetition of activities using these extremities showed that if for example the patient was engaged in repetition of a movement involving his right index finger, the area of the brain controlling that index finger would increase, and so did the ability of the patient to move that finger.
Anyone who has had a stroke knows that the most difficult joints to move are the wrist and fingers and the ankle. This lack of movement results in the patient being unable to use their hand or clear the floor while walking.
Currently, there is advanced technology such as electrical stimulation units which help in the incorporation of the hand and ankle in the rehabilitation of the total patient, increasing movement and decreasing spasticity. Studies show that repetition using these electrical stimulation devices, as little as 30-45 minutes 3 times per week can produce better rehabilitation results than conventional therapy.
The guided and repetitive use of the involved extremity in the performance of a purposeful activity re-enforces the ability to perform this activity.
Spasticity, or increased muscle tone, which cannot be controlled by the patient, hinders in many cases the patient’s ability to use the extremity. Botox is currently being used successfully in some cases, to help reduce this spasticity and allow for the re training of the extremity. Neural tension release techniques, or the release of spasticity through patient positioning also helps decrease the spasticity thus allowing for increased use of the extremity.
We at South Florida Rehabilitation Consultants, have learned, it takes a great deal of work and repetition, over time, to re learn the lost movements.
It is important that stroke patients and families are knowledgeable about the rehabilitation methodologies and how they are implemented in different facilities in order to obtain the best outcomes.
Author: Fulvia Barrera, MBA, PT, graduate of Virginia Commonwealth University, Medical College of Virginia, BS in Physical Therapy, and Florida International University, Masters in Business Administration.
Ms. Barrera has more than 30 years of experience treating stroke patients.
She is the owner of South Florida Rehabilitation Consultants, Inc. Private physical, occupational and speech therapy office, dedicated to the treatment of stroke patients. We provide one to one individualized treatment sessions.
Contact us today at: www.floridarehab.net or by phone at 305-412-9099.
J. Liepert, W.H.R. Miltner, H. Bauder, M. Sommer, C. Dettmers, E. Taub and C. Weiller. Motor Cortex plasticity during constraint induced movement therapy in stroke patients. Neuroscience letters, Volume 250, issue 1, June 26, 1998, pages 5-8.
S.J. Page, S.A. Sisto, P. Levine, Mc. Grath RE. Efficacy of modified constraint induced movement therapy in chronic stroke: a single blinded randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 2004, Vol. 85, issue 1, pages 14-18.