The NOGGINS AND NEURONS Podcast

Listener Q‘s & Decoding Teasell

September 22, 2021

Listener Q's & Decoding Teasell

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DEB: An easy question for you to answer from JE. She is wondering, ‘Is there ever a time when spasticity turns itself off?’

 

PETE: Yes, there is a time when it turns off and that’s when they’re sleeping. Then that had implications for things like a splint that you can’t get on when they’re awake, you might be able to get it on when they’re asleep. So, my wife...this was another joke I used to tell in my talks. So my wife would say ‘yeah, I know about the splinting (Pete whispering) and sometimes I would sneak into their room and I’d be very quiet and I wouldn’t want to wake ‘em and then I would put the splint...’ and she’s a PT so it was probably something on the lower extremity...um...a boot or something. ‘And then I would sneak out.’ (Normal voice) But that’s not ethical right? So I’m like maybe I should report you to the state board, Ila! But no, I think as long as you ask permission first and every clinician that I told that joke to they’d go just ask first and you’re good. So you can do it if they’re sleeping, and truly, if you want to get a real perspective on the amount of spasticity that  they have, then it’s good to do something like the Modified Ashworth, which is a test of spasticity, while they’re sleeping because that’ll give you a true baseline. The other thing is if you’re confused about whether something is contracture or spasticity then, if it’s contracture, when they’re sleeping, it’ll still be evident as much as it ever was, whereas if you let them fall asleep and you can move it, then you know it’s just a whole lot of spasticity. Because sometimes it’s hard to tell the difference between a 4 on the Ashworth, which is, you know, can’t move it, and true contracture but that is a way of sort of the differential diagnosis of that.

 

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete & Deb share more thoughts about our conversation with Dr. Robert Teasell and Marcus Saikaley as well as listener questions. In this episode we talk about:

  • Rehab light for stroke survivors in the US
  • Client transitions throughout the rehab process, continuity of care through and a warm hand off
  • Best assessment tools to objectively measure upper extremity coordination
    • Box and Blocks test - grasp/release
    • Fugl-Meyer - finger to nose/dysmetria – liked by Dr. Teasell and done the most by Pete
    • Nine Hole Peg Test - manual dexterity
    • Action Research Arm Test – assesses specific changes in limb function
    • Jebsen Hand Function Test (JHFT) – functional hand motor skills
    • Wolf Motor Function Test (WMFT) -
    • Arm Motor Ability Test – Pete dislikes but Doro seems to know about it
  • Repetitive Transcranial Magnetic Stimulation is a primer. It’s nonpainful and very expensive. Direct Electrical Stimulation to the brain is a primer and requires surgery.
  • Less expensive brain primers cost little and are easy to use.
  • Times when spasticity turns itself off, the Modified Ashworth Scale and telling the difference between spasticity (Modified Ashworth score of 4) and contracture.
  • Brain Primers and focus on function – challenges for OT practitioners related to occupation-based interventions and making a plan for using primers to facilitate success.
  • Primer interventions appropriate for survivor home use. They might be boring but they work!
    • Bilateral Arm & Leg Training – intact limb helps improve affected limb movement
    • Mental Practice – use ready-made recordings and create client-centered recordings. Good to do just prior to engaging in mirror therapy.
    • Action Observation – at home upper extremity examples include watching another person obtain items for setting the table. Make videos of the person and watch repeatedly
    • Electromyography/biofeedback – using surface electrodes an EMG machine will show a muscle moving when it can’t be felt – even when it’s thought about. Can do repetitive practice before you’re able to move. Moves into a more expensive direction. Mental practice/mental imagery can be used instead – more trust is required but the same effect occurs.
  • Teasell suggests using 1 primer and 1 facilitator – for example, follow a primer with something such as strength training, trunk training or constraint-induced therapy.
  • Adding cognition may increase fatigue and rest is necessary.
  • Terms used in the EBRSR and what they mean. If an intervention beats standard of care:
    • 66% of the time or more they use the word may or can
    • 50-66% of the time they consider the evidence to be conflicting or mixed
    • Less than 50% of the time the term may not is used

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Pete’s blog, book, Stronger After Stroke, and talks.

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