The NOGGINS AND NEURONS Podcast
Stroke and TBI Recovery with Dr. Robert Teasell MD: Part I

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part I

September 14, 2021

Stroke and TBI Recovery with Dr. Robert Teasell MD: Part I

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PETE:  When I first got involved in clinical research, I remember there was this statistic that the lag time between bench and bedside and rehabilitation was 15-20 years and the idea was you know that in oncology you couldn’t have that much lag time because people die of cancer whereas typically nobody dies of bad therapy. Do you think that the translation is still that long? What would you estimate is the, or is it impossible to estimate, it depends on the therapist kind of deal?

 

TEASELL: It depends on the treatment and it depends on the kind of support that the treatments got. A lot of it’s cultural as well but I would say that 15-20 years...you know from moving into the research into regular clinical practice would be considered to be a very early adoption. That would be considered to be rapid. It’s more than 15-20 years. In some cases, I think it’s a couple generations. You know, when we sit down with our therapists and ask them, you know, ‘do you use the adjunct therapies?’ the answer is usually not a lot and why? Well there’s a number of reasons-timing, but it’s just like it’s not part of the culture. Like it’s just not part of the culture. You know...And you ask them, ‘would you like to do it?’ ‘Of course, we would, I mean, why wouldn’t we? Right. I wouldn’t mind trying something new or trying this new technology or this new treatment but I don’t know where to start; it’s not what we’ve traditionally done; it’s not what we tend to do; I’m busy enough as it is’ and so these treatments don’t get incorporated or added. So, you know, the reasons are legit, they’re fine, but I mean, if we’re looking at ways that we might be able to further improve recovery and the next big step...cuz you know, one of the things that you get a feeling in stroke rehab is people just not sure where we’re gonna go next. It strikes me that this is a lost opportunity that we could take advantage of.

 

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified is Part 1 of a captivating interview with Dr. Robert Teasell and Marcus Saikaley of the Evidence-Based Review of Stroke Rehabilitation (EBRSR). Join us as we learn about:

  • The history of EBRSR, including Teasell’s original work:

    • To demonstrate that chronic pain can be debilitating, the evidence supporting facts around chronic pain, patient advocacy and policy change.
    • With the Ontario government to create and implement best practice guidelines for stroke recovery, therapists inability to agree on recommendations and Dr. Teasell’s idea to duplicate his work in chronic pain research.
    • With the Ontario government funded project of stroke evidence as the birth of the EBRSR.
    • The growth of research and importance of using the research in practice.
    • Evolution of additional research reviews for Traumatic Brain Injury and Spinal Cord Injury.
  • Stroke rehab has more evidence than any other area of neuro rehabilitation.
  • Behind the scenes look at how systematic reviews are completed, including PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines.
  • Knowledge Translation and clinical practice change.
  • Reasons why research tends to focus on the Upper Extremity
  • Changes in stroke rehab over the years, Canadian and American processes and standardization of care and outcomes. Best practice includes:
    • The right amount of intensity
    • Task-Specific interventions
    • Early intervention
  • Adjunct therapies, brain primers and missed opportunities. Examples include mirror therapy, Repetitive Transcranial Magnetic Stimulation (rTMS), Robotics, Action Observation and Functional Electrical Stimulation (e-stim). NOTE: Despite the fact that adjunct therapies account for 85% of the research they are rarely used.
  • Home programs, early supported discharge and best “patient handoff” to promote continued recovery and optimal results.

We hope you find value in part 1 of our conversation to the extent you feel empowered to look at your current practice and discover possibilities to improve client and clinic outcomes.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Evidence-Based Review of Stroke Rehabilitation

Evidence-Based Review of Moderate-to-Severe Acquired Brain Injury

Spinal Cord Injury Research Evidence

Collaboration of Rehabilitation Research Evidence

Collaboration of Rehabilitation Research Evidence twitter

Dr. Teasell’s Google Scholar Page 

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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

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Debra's Website:

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More Listener Q‘s & More StrokEngine

More Listener Q‘s & More StrokEngine

September 10, 2021

More Listener Q's & More StrokEngine

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PETE: And having other kinds of problems like diabetes flares up or whatever it is...and so they cycle back through to the therapist and what the therapist sees is not the people getting better because they’re gone. They’re Kathy Spencer...they’re people that are living their life and going to work and doing stuff that’s important to them. The therapists keep seeing the sick people, who are often sick because they don’t exercise, and the therapists don’t interface with the successful survivors. And that’s the other thing, like, some of the people that I’ve met through some of the survivor Facebook groups, they’ve come to my talks. And you know, I’ve got to meet them, and they’re still working and they’re pressing and they’re exercising and those people I think it would be good if you knew who those people were. And that you kept in touch with them. We trashed Facebook in the last episode so now let’s say something nice. There’s some groups on Facebook that you can get engaged in that are really good to help you know the full rainbow of the kinds of survivors that exist.

DEB: Yeah...

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb got into more N & N FB group member questions and another Stroke Engine intervention. We discussed:

  • Goal setting strategies to instill motivation for recovery:

    • Benefits of involving athletic trainers for stroke recovery success
    • Hard (honest) conversations about interventions that work and what’s required
    • Habits, routines and home programs during inpatient rehab
    • Thinking about the dreaded plateau before it happens
    • Patient and practitioner viewpoints about pushing harder on the recovery journey
    • Improving service delivery with tele rehab, consultations, part B and the “low-level athlete” mindset
    • Survivor Facebook groups are opportunities to interact with successful survivors
    • Moving away from practice are territorialism and into professional collaboration to optimize survivor recovery
    • Using therapy opportunities wisely to educate and empower clients to be involved in their recovery journey
    • Tiny changes lead to big improvements
  • The dance of cognitive rehab: no pencil & paper tasks! Only the “doing” works
    • Understanding the fatigue factor and the just right challenge
  • Stroke Engine A-Z:
    • Aerobic exercise following stroke to improve cardiovascular health, quality of life, leg and body function, spasticity, cognition, dexterity and more!
    • Task specificity, brain re-wiring, task focus (bring in meaning), repetition and follow through
    • Mental imagery, wandering thoughts and guided mental practice to reduce boredom
    • Use brain primers first: mental imagery & mirror therapy prepare for task specific training
    • High and low intensity related to task specific training and efficacy for the upper and lower extremities

 As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast with Venmo or PayPal:

  • Venmo @neurons
  • Use the PayPal app  (appears as Creative Concepts OT - add the note NEURONS under donation amount)

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

Debra's Website:

Music by scottholmesmusic.com

Deb‘s Trip & Listener Questions

Deb‘s Trip & Listener Questions

September 6, 2021

EPISODE TITLE: Deb's Trip & Listener Questions

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DEB: I think too, that if we do a case study and we talk about it and we kinda say what our process is and the way that we think about things and link it to the research, maybe it will help clinicians to know that they’re probably thinking about things the right way. I think sometimes there’s just insecurities around trying something new. Or, even doing what you think you should do. Especially if you don’t have a mentor available to you...which I always recommend anybody have a mentor of some type or even work in a clinic where there are seasoned therapists there or at least people who have some more experience than you do because it’s hard. Especially when you’re a new grad. It’s hard to put all those pieces together in a meaningful way. And then...yeah!

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talked about Florida travels and listener questions. We talked about:

  • Deb’s Florida travels-rural towns and ALF visiting leniency, catching up with cousins, dolphins and beauty.
  • Florida driving challenges were worth it to see Doro, Lynette and the Neuro Hub in person.
  • While at the Neuro Hub, Deb got to see the RecoveriX in action and experience the Neofect Smart Glove.
  • Upcoming podcast guests, including Dr. Teasell and Marcus Saikaly from the EBRSR, Mary Warren, PhD, OTR/L, vision, tennis and learned non-use; Jennica Colvin and Suzanne McCrum from Trio Rehab in Texas, and Drs. Dawn Neumann and Barbra Zupan who will talk about their work in recovery of emotional behavior in folks with brain injury.
  • Diaschisis, neural pruning, what happens in the brain when a person no longer does an activity and brain area interdependence.
  • Pete’s next book and publishing decisions, his mom and New Jersey weather
  • The Noggins And Neurons Facebook group is growing
  • A listener question about the difference between ischemic and hemorrhagic strokes, survivor stories and recovery stats.

We hope you enjoy this fun conversation as much as we did!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Improvement of functional was greater in hemorrhagic than ischemic stroke

Cognitive Rehabilitation Training Course (ACRM)

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Debra's Website:

Music by scottholmesmusic.com

Brain ‘Splain Pete Style

Brain ‘Splain Pete Style

August 25, 2021

Brain 'Splain Pete Style

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EPISODE TITLE: Brain ‘Splain Pete Style

DEB: What?

PETE: So, I’ve got a funny story for you...So, my college had a career development day. And they wanted people to do an hour, hour and a half on whatever they wanted to do and people were doing it on how to run a good zoom meeting and how to grab a great power point and a lot of other interesting things and of course I pitched my crazy, ‘how does the brain really learn? and ‘how can we engage students if we look at it from a neuroscience perspective?’ And they said ok, we’ll give you an hour and a half to do that, so I show up at the college today and I go to the room that I’m supposed....it’s in this big convention center....and I go to the room I supposed to be in and, ah, the door’s locked. So I called the lady that runs the whole thing and she says, “well, um” I said ‘when will the door be unlocked?’ And she said, “well, um, at 9:00 they’ll be coming in,” this is by the way at 1:00 in the afternoon or 12:00 in the afternoon. “At 9:00 they’ll be coming in and they’ll set up everything so you have it ready” And I’m getting this weird vibe from her and I realize I’m there a day early.

DEB: Awesome!

PETE: And then I said to her, ‘I got a funny story, I’m out in front of the door waiting for somebody to unlock it like an idiot. So, ah, that was fun. But here’s the favor I have to ask you...So what I would like to do is, I know we had an agenda tonight but I would like to do my entire talk for tomorrow for an audience of one and that way I get to practice it.

DEB: That’s a great idea!

PETE: You like that idea?

DEB: I do...

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete presents valuable information on “The Brain and How it Learns Simplified: Driving Cortical Plasticity.” We talked about:

  • Deb’s upcoming road trip and her fast car.
  • The number of CEU talks Pete has done from 2010 to 2020 (700 of them) and this teacher presentation being the first live presentation since March of 2020.
  • Review of Pete’s work in research-do you love hearing this stuff as much as I do?
  • Learning defined, the circulatory system defined, the difference between the two and
  • Motor learning, college and motor cognition. It’s the original template for all learning.
  • Brain Derived Neurotrophic Factor, exercise, sleep and protein synthesis are essential for learning.
  • The homunculus man, the motor cortex and why hands-on learning is key for learning.
  • Using eating, mating and patterns to keep an audience engaged.
  • The Davinci man, arm span and murmurations of starlings to understand how the brain works
  • Repetition, challenge and meaning are necessary for learning. Celebrate small wins to stay motivated and feel life satisfaction.
  • Hemispherectomy and the ability to be independent-no excuses, action observation, tossing balls in class, repetitive practice and measuring change.

Pete practices his presentation and Deb enjoyed being the audience. We hope you find the information valuable too.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Spark: The Revolutionary New Science of Exercise and the Brain by John Ratey, MD with Eric Hagerman

'I only have half a brain'

The homunculus in 3D

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Debra's Website:

Music by scottholmesmusic.com

StrokEngine: A-Z Treatment Options

StrokEngine: A-Z Treatment Options

August 19, 2021

StrokEngine: A-Z Treatment Options 

 

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DEB: Acupuncture has to do with stimulating certain trigger points along the body’s meridian lines to help regulate the flow of energy or chi. They looked at this in the different phases of stroke and they found that it’s not more helpful in general. So they looked at in terms of balance, cognitive function, depression, dexterity, independence a lot of other things, that it’s not really effective for. But you know what it’s effective for? Swallowing problems. It’s effective for dysphagia.

PETE: What? Get out!

DEB: I’m not kidding you....

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk start a conversation on stroke treatments listed on the Stroke Engine website. We started the episode with a listener question about the number of repetitions needed for the brain to change and motor recovery to occur. Pete shared more research and we talked about what it means for real life recovery. We also discussed:

  • Growth mindset, learning and recovery
  • Hints about our upcoming conversation with Robert Teasell and Marcus Saikaley of the Evidence Based Review of Stroke Rehabilitation (EBRSR)
  • Virtual Reality for the upper extremity, the View Master and the Ramachandran Rule
  • Acupuncture and dysphagia, cognitive function and insomnia
  • Virtual Reality for the lower extremity, measuring real-time data, gait rhythmicity, the Nu Step and the Kinetron

Pete and Deb took a deep dive into these topics, looking at pros and cons of each along with next steps for clients and clinicians, including measuring change.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

How many repetitions does it take to drive brain changes and movement changes in folks with brain injury/ stroke?

This study showed that there were similar outcomes under three dosages of repetitive practice...

There were four groups:

  • Group A (the control) received 3 hours of traditional therapy consisting of passive movement, therapeutic positioning, and weight bearing on the affected limb. Throughout study the score increased ~3 points for the Fugl-Meyer.
  • Group B: Modified constraint induced therapy consisting of 3 hours of shaping practice per day, and a constraint on 90% of all waking hours. Throughout study the score increased ~17 points for the Fugl-Meyer.
  • Group C: 300: repetitions per day, 5 days per week, increases across all outcomes (FM, MAL, WMFT, etc.) started at 2 weeks and the trajectory continued throughout the study. Throughout study the score increased ~17 points for the Fugl-Meyer.
  • Group D: Same as Group C, but double the number of repetitions. Throughout study the score increased ~19 points for the Fugl-Meyer.

The Brain Boosting Power of the Mighty N -Back

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Debra's Website:

Music by scottholmesmusic.com

What Makes a Great Therapist?

What Makes a Great Therapist?

August 13, 2021

What Makes a Great Therapist?

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“I want to do what I did with the smaller group earlier this week and read you my favorite letter. Because, I think the thing that pushes me and everything...My why...My purpose...are embedded in the idea of service in care to others. Meaning all of those to self, to family, to community, the society. And, if you’re not clearly in touch with just how unbelievable it feels to care for others, my favorite letter of several hundred thousand will hint.”

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk about qualities that make someone a good clinician. Here’s what we came up with:

  • Understanding qualities of excellence can aid in selecting the right therapist
  • Striving for excellence is a lifelong quest
  • Proper training may lay a foundation for clinicians developing necessary skills for clinical success
  • Asking significant questions is as important as knowing what to do with the answers
  • Be a good listener to provide excellent patient care
  • Advocacy and listening often go hand in hand
  • Lifelong learning includes topics beyond diagnoses and deficits
  • “The Diving Bell and the Butterfly” book or movie can help with understanding brain injury
  • Develop observational skills and don’t be afraid to speak up about what you learn so you can help your patients
  • Traumatic brain injury survivors can re-learn empathy

Pete and Deb talk about these topics and more. We share stories and thoughts from personal experiences and hope this helps you in your clinical practice or recovery.

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Debra's Website:

Music by scottholmesmusic.com

Sleep: Vital for Everyone, Essential for Survivors

Sleep: Vital for Everyone, Essential for Survivors

August 8, 2021

Sleep: Vital for Everyone, Essential for Survivors

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DEB: Did you know that rest and sleep are considered occupations? The Occupational Therapy Practice Framework is a document that we use is occupational therapy to guide the process of what we do in OT and it also explains what occupations are and what they mean. And sleep preparation is a thing in the OTPF and it talks about routines. Bedtime routines to prepare yourself, to prepare the body, to prepare the mind that it’s time to wind it down and get ready to fall asleep. They talk about how routines that prepare the self for comfortable rest are important and then they have some examples; grooming, get your clothes out for the next day, reading and listening to music, saying goodnight to others and engaging in meditation or prayers before bed, determining the time of day and length of time that somebody desires to sleep. And then how much time somebody needs to be awake...so being mindful of that and planning for that. And establishing healthy sleep patterns. When you start with these habits you can build them into a routine and then your body just kind of gets used to looking for that.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk about all things sleep. In this conversation we cover:

  • Sleep disorder statistics in stroke survivors
  • The effects of insomnia on behavior and emotions
  • How lack of sleep can lead to Alzheimer’s Disease
  • Sleep stages and what occurs in the body, including dendrite formation and learning consolidation
  • The effects of sedatives and prescription medications on sleep
  • Sleep hygiene strategies for people who have difficulty sleeping

Pete and Deb also talk about avoiding caffeine and sugar before bed time to improve sleep quality; the value of routine for sleep preparation and establishing healthy sleep patterns and natural ways to set the internal clock for improved sleep quality.

We hope you enjoy our thoughts and find them mentally stimulating and thought provoking!

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Neurobiology of Sleep and Circadian Rhythms

Sleep and Stroke

Male seahorse "birthing" baby seahorses!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Debra's Website:

Music by scottholmesmusic.com

Dr. Jones, TexMex, and Synaptic Connections

Dr. Jones, TexMex, and Synaptic Connections

August 5, 2021

Dr. Jones, TexMex, and Synaptic Connections

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PETE: Hey everybody, this is Pete. I just wanted to jump in real quick and tell you about a mistake I made. I forgot to put the bio for our interview with Dr. Theresa Jones ahead of the actual interview. So, I’m gonna put the bio at the beginning of this episode, which kinda works because it is a review of the episode and what we learned, when we did interview Dr. Jones. Thanks!

DEB: New clinicians working in the world of stroke recovery need to understand what is too much too soon. And I think she made some good points about it. That early mobility doesn’t mean early intensity. So, you know, early mobility really is to get the person up so that other systems in the body don’t start to fail them. And...which would impact negatively, negatively impact their recovery. So we keep them healthy while they’re still in that acute stage so that when they enter that more subacute phase they can participate.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb have a stimulating conversation about our interview with the Great, Dr. Theresa A. Jones, a behavioral neuroscientist from University of Texas at Austin. Some things we reflect on include:

  • How repetition rules in learning. In fact, intensity and learned non-use came up again. It’s nice to hear Dr. Jones’ perspective and how to think and talk about these topics in practice and recovery.
  • Getting beyond feelings of intimidation and putting people on different levels based on education and ego for improved communication and care.
  • Real time look into the brain through windows in rat skulls.
  • Being a woman in a male dominated field, making it work and resilience.
  • Humility, communication and translating animal research to humans.
  • Sorting through compensation and recovery and Dr. Jones’ research perspectives
  • Moving into gray areas, thinking and clinical reasoning. Ask questions from the understanding that even science doesn’t have all the answers. Don’t be afraid to hear that you’re thinking is off track and be open to where it will take you in future thinking.
  • Neuroplasticity in action and what it looks like in real time.
  • Monkeys in research, COVID, travel and more questions to ask Dr. Jones.

We hope you enjoy our thoughts and find them mentally stimulating and thought provoking!

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:1

Repost of articles posted on the Dr. Jones interview:

Theresa A. Jones, PhD Articles:

Jones TA (2017) Motor compensation and its effects on neural reorganization after stroke. Nature Reviews Neuroscience. 18:267-280.

Clark TA, Sullender C, Jacob D, Zuo Y, Dunn AK & Jones TA (2019) Rehabilitative training interacts with ischemia instigated spine dynamics to promote a lasting population of new synapses in peri-infarct motor cortex.  Journal of Neuroscience, 39: 8471-848

Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E & Jones TA (2021) Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behavioural Brain Research, 396:

Dorothy A. Kozlowski, PhD and Theresa A. Jones, PhD Articles:

Use-Dependent Structural Events in Recovery of Function

Use Dependent Exaggeration of Neuronal Injury After Unilateral Sensorimotor Cortex Lesions

Use Dependent Exacerbation of Brain Damage Occurs During an Early Post-Lesion Vulnerable Period

Neural Plasticity and Neural Rehabilitation Following Traumatic Brain Injury

Combinatorial Motor Training Results in Functional Reorganization of Remaining Motor Cortex After Controlled Cortical Impact in Rats

Combining Multiple Types of Motor Rehabilitation Enhances Skilled Forelimb Use Following Experimental Traumatic Brain Injury in Rats

Learned Non-Use Article:

Barth, J., Geed, S., Mitchell, A., Lum, P. S., Edwards, D. F., & Dromerick, A. W. (2020). Characterizing upper extremity motor behavior in the first week after stroke. PloS one15(8), e0221668. 

VECTORS trial

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Debra's Website:

Music by scottholmesmusic.com

Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

August 2, 2021

Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

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Rodents and Recovery with Behavioral Neuroscientist Dr. Theresa A. Jones

PETE: So one of the things I find interesting about fMRI’s...it doesn’t directly measure neuroplastic change and I always thought you would have to get really lucky drilling a hole through the skull, through the meninges and somehow get a very big microscope and see actual synaptogenesis and you’d have to get very lucky that those neurons just happen to get connected at that point. But you’re saying in this model they glow green and you can see that process happening in individual neurons?

 

DR. JONES: I feel so lucky to have lived long enough for these techniques in neuroscience that I had nothing to do with to be dropped into my lap. Yeah these, they’re transgenic mice that seem to be normal except they have been manipulated to have fluorescent proteins expressed in a subset of their cortical neurons, so that you can see the dendritic barbers of the cortical neurons either through thin skull or through implanted windows. And so you can watch the same parts of a neuron over time and see how they change and because you have the windows are big, you look at a whole big dendritic field and at least with cortical changes in response to learning new ways of moving, those changes seem not just to be in one neuron. I mean there’s crazy activity that gets instigated and, after a stroke, there’s crazy activity...by activity I don’t mean activity...I mean structural changes in neurons. A structural neural plasticity um is just explosive in response to strokes because that’s the remodeling process.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb engage in stimulating conversation with Dr. Theresa A. Jones, a behavioral neuroscientist from University of Texas at Austin. We talk about:

  • Translating research from bench side to bedside and what that means in terms of informing clinical practice and brain injury recovery
  • The importance of communication when translating research from animals to humans and questions are key, especially in terms of parameters and boundaries. Conditions matter!
  • Background details in Dr. Jones’ research such as age and health status of animals as it relates and applies to humans.
  • Some advantages of studying animal models include studying topic area one at a time, generalizing information, aging animals
  • The behavioral changes that follow stroke are major players in stroke outcome!
  • Intensity, timing and potential for harm; the VECTORS trial and mobilizing clients following stroke.
  • Repair and remodeling processes depend on neural activity patterns which are determined by behavioral experiences
  • Behavioral compensation is one of the most obvious ways behavioral adaptation (change) occurs following stroke and can be a major driver in brain remodeling after stroke
  • Compensation coupled with disuse impedes recovery of more normal movement
  • Bimanual training in animal models to learn about influence on unimanual function
  • Patterns of synaptic changes across both hemispheres that occur with learning new ways of using the good limb on its own vs. together with the affected limb
  • Dr. Jones’ thoughts on:
    • writing, which is a skill
    • rabbit holes and tangents-they’re fun
    • ways to improve communication, which might include putting the ego aside

We hope you enjoy our conversation with Dr. Jones. She is a true delight and makes information about brain research and stroke recovery understandable.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Theresa A. Jones, PhD Articles:

Jones TA (2017) Motor compensation and its effects on neural reorganization after stroke. Nature Reviews Neuroscience. 18:267-280.

Clark TA, Sullender C, Jacob D, Zuo Y, Dunn AK & Jones TA (2019) Rehabilitative training interacts with ischemia instigated spine dynamics to promote a lasting population of new synapses in peri-infarct motor cortex.  Journal of Neuroscience, 39: 8471-848

Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E & Jones TA (2021) Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behavioural Brain Research, 396:

Dorothy A. Kozlowski, PhD and Theresa A. Jones, PhD Articles:

Use-Dependent Structural Events in Recovery of Function

Use Dependent Exaggeration of Neuronal Injury After Unilateral Sensorimotor Cortex Lesions

Use Dependent Exacerbation of Brain Damage Occurs During an Early Post-Lesion Vulnerable Period

Neural Plasticity and Neural Rehabilitation Following Traumatic Brain Injury

Combinatorial Motor Training Results in Functional Reorganization of Remaining Motor Cortex After Controlled Cortical Impact in Rats

Combining Multiple Types of Motor Rehabilitation Enhances Skilled Forelimb Use Following Experimental Traumatic Brain Injury in Rats

Learned Non-Use Article

Barth, J., Geed, S., Mitchell, A., Lum, P. S., Edwards, D. F., & Dromerick, A. W. (2020). Characterizing upper extremity motor behavior in the first week after stroke. PloS one15(8), e0221668. 

VECTORS trial

 

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Music by scottholmesmusic.com

The N&N Review: What We’ve Learned and Where We’re Going

The N&N Review: What We’ve Learned and Where We’re Going

July 29, 2021

The N&N Review:

What We’ve Learned and Where We’re Going

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Pete and Deb started off with a little silliness before moving on to talk about Noggins And Neurons podcast stats...

DEB: ...So I did look up downloads before we reconvened here tonight and we’re over 5,500...so, it’s saying something, I’m just not sure exactly what it’s saying and some day I hope to know

PETE: It’s like reading tea leaves. So, what is today’s episode about?

DEB: Today’s episode is...I love the name that you called it....it’s sort of a State of the Union episode because we have over 5,000 downloads, we’ve...how many episodes did we make so far? We’ve got 22 or 23 out there?

PETE: I think it’s 22. I could be wrong...

DEB: You’re probably right...We’re gonna talk about whatever the state of this union is.

PETE: I think you’re right, it’s 23....

DEB: And we have 122 followers. I think those are the people that have taken the time to follow us through Podbean.

PETE: So maybe that’s a good place to start. We have no idea what any of these numbers mean. We don’t even know if the download is only through Podbean’s site or through all sites. Isn’t that correct? We don’t know that, right?

DEB: Yeah, I don’t understand the back end of this thing.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about the podcast data and speculate on what it means. We highlight information from previous episodes and:

  • Try to determine what the topic download numbers mean. We speculate that therapists want to learn more about specific interventions, are curious about what other OT’s are doing and likely aren’t interested in common clinical concerns such as fall prevention.
  • Wonder why there were fewer listens to the episode with Super Survivor Kathy Spencer. Pete suggests that we can all learn from Kathy and other survivors who are doing well.
  • Share our viewpoints about reasons for intervention episodes having high interest.
  • Talked about our favorite episodes and why.
  • Enjoyed re-visiting important points already made while adding new thoughts.

We hope you enjoy this review and would love to hear from you! You can share information about who you are, your interest in stroke and brain injury and whatever else you think is relevant!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Music by scottholmesmusic.com

Measuring Spasticity

Measuring Spasticity

July 25, 2021

Measuring Spasticity

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PETE: So, are we sorta kinda ready?

DEB: Yeah, ready or not...here I come

PETE: We’re never gonna outgrow this, are we?

DEB: No

PETE: It’s just gonna be like this forever...OK...so, hey, Deb Battistella, how you doin’?

DEB: Pete Levine, I’m great, how are you?

PETE: Oh, by the way, American College of Rehabilitation Medicine...I’m doing a talk for them in September. So, if you’re a member of ACRM or you’re planning to go, you should go to my talk! Thanks! That was a public service announcement from one of the co-hosts who was self-promoting his own stupid talk even though he doesn’t make any money off it. So, don’t worry about that, just come to his talk. Thank you very much.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about measuring spasticity. We start with a rabbit hole of sorts where we discuss the problem of home care OT’s not addressing client and caregiver needs when cognition is involved and overall therapist abuse by rehab companies. Here’s more detail about our conversation:

  • We talked about a problematic, current, real-life scenario where OT discharged a patient who would still benefit from skilled OT
  • Pete mentioned professional association advocacy that doesn’t seem to be working
  • We learned there is a time of day when spasticity isn’t present
  • Pete mentioned reasons why it’s important to use spasticity measurement scales rather than observation
  • Deb sought further clarification on spasticity, ROM and contractures - and yes, I’ve been an OT for over 20 years
  • We talked about spasticity measurement scales and how to perform them

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Music by scottholmesmusic.com

 

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part II

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part II

July 21, 2021

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part II

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EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk with Doro & Lynette from The Neuro Hub, Orlando, Florida, about leading edge OT services they provide. In part 2 we:

  • Learned about the Neuro Hub locations, staff and more
  • Talked about the roles sleep, gut health and heart rate variability for recovery and health
  • Discussed how nature, exercise and community are important for achieving optimal health
  • Learned how Doro and Lynette educate on and incorporate mindfulness strategies to promote the mind-body connection and facilitate improvement in their clients
  • Talked about non-OT books that inform OT practice
  • Found out how the Neuro Hub uses brain computer interface technology in stroke and brain injury recovery.

You will hear fun facts and behind the scenes details and thoughts about these topics, including how the brain computer interface program incorporates evidence into practice on many levels. Doro & Lynette bring their dynamic personalities and passion for OT to this conversation. We’re certain that everyone who listens will find meaning and inspiration... Clinicians perhaps you’ll break out of tradition and create new opportunities in practice...Survivors and caregivers maybe you’ll seek high quality care for the recovery journey – it’s out there!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Music by scottholmesmusic.com

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part I

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part I

July 18, 2021

Leading-Edge OT with Doro & Lynette of NEUROHUB: Part I

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EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk with Doro & Lynette from The Neuro Hub, Orlando, Florida, about leading edge OT services they provide . In part 1 we covered:

  • The Neuro Hub business model and their client-centered practice
  • Following your heart for career satisfaction
  • The Neuro Hub OT Process – evaluation, treatment, goals and motivation
  • The many players and concerns associated with driving following neurological injury (and other diagnoses)
  • The importance of cognition and vision and the relationship among the two
  • Neuroscientists and other medical professionals who inform and inspire us
  • How Doro & Lynette treat subluxation – from therex (it’s not always a bad word in OT practice), to mindfulness, K-T Taping, e-stim and more

Doro & Lynette bring their dynamic personalities and passion for OT to this conversation. We’re certain that everyone who listens will find meaning and inspiration... Clinicians perhaps you’ll break out of tradition and create new opportunities in practice...Survivors and caregivers maybe you’ll seek high quality care for the recovery journey – it’s out there!

Questions and Comments about the podcast?

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Music by scottholmesmusic.com

What Works II

What Works II

July 13, 2021

What Works II

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DEB: I wanted to talk about Marijuana
PETE: Well. Who doesn’t?
DEB: Exactly!
PETE: You live in New York man, you can do anything you want! Ohio they’ll string you up but yeah...so what about pot?
DEB: Well first of all I learned that it doesn’t cause stroke the way cigarettes do....cigarette smoking...it’s really good for treating other effects beyond the spasticity and things like that. It’s more like anxiety, anger, sadness, frustration, hopelessness, fear, depression types of feelings which I think is really important because if people are feeling those negative types of emotions then it’s harder to participate in your rehabilitation.
PETE: I’ve done some talks in Colorado recently and you know there's often therapists from every different kind of facility and I'm like, hey does anybody here um work in skilled nursing....and yeah, yeah they do... so um, are they allowed to smoke pot, I mean like you know, these are people they’re adults... can they smoke pot? They go, yeah, yeah, they can smoke pot. I go, how does that affect rehab? Well they don’t want to go. They just say no...
DEB: They’re too chill?
PETE: They say no I’m not going anywhere. That's the downside.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about interventions that do work. In part II we covered:

  • Subconscious mind and stroke recovery
  • Dysarthria
  • Resistance to new ideas, working through it and moving into acceptance
  • The role of research to help us leave our comfort zones
  • Combining interventions to drive neuroplasticity, create home programs and the importance of the therapist/client relationship
  • Letting go of the old you as a means of evolving and progressing through recovery
  • E-stim, functional e-stim and functional improvements along with how to uncomplicate it so therapists use it more
  • Small group of interventions that work and often work better when combined together
  • Acupuncture, acupressure and dry needling along with muscle vibration in stroke recovery
  • Task specific training, the LEAPS Trial, Modified Constraint Induced Therapy, gait and ambulation
  • Mind-Body interventions and Hippo Therapy can improve balance
  • Brain-Computer Interface to improve UE function following stroke
  • Sensory brain areas are neuroplastic and re-training improves joint position sense, light touch, 2-point discrimination, and better Berg Balance scores
  • Physical activity as a cognitive intervention for stroke recovery
  • Marijuana to reduce neurotoxicity and pain as well as decrease depressive and anxiety symptoms

You’ll hear more clinical reasoning in action in this second episode of what works as Pete and Deb talk about some commonly used interventions and a few that are less common and what the research says. We talked more about interventions that work well together, creating home programs and novelty in the rehab process.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

What Does Work I

What Does Work I

July 10, 2021

WHAT DOES WORK I

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PETE: But there may be a mental block there, a sort of phobia, a fear that they’d never be able to get it back and you do see that in survivors. You go, Mr. Smith, you know we can fool around with balance training and we can fool around with grasp and release training, you have trouble opening and closing your hand so that would be good we can work on that, we can work on balance, but you were a scratch golfer back in the day. So if we put a putter in your hand and we get you to start to golf, you’ll be working on balance and you’ll be working on grasp and release and we won’t even have to worry about it cuz the whole system will drive itself. And then Mr. Smith says, I never want to go back to playing golf because I was such a good golfer. And now you’re going to come in with this what, you’re gonna have what, like a putter return thing or something and stick an old putter in my hand? I don’t want to do that. But if you can get him to turn that corner all of a sudden, the system starts to run itself.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about interventions that do work. We covered a lot of ground and made two episodes. In part I we covered:

  • Action observation – how and why it works
  • When it’s good to use Constraint Induced Therapy
  • Mirror therapy – yes, it came up again!
  • How mental practice got its start and how and why it works
  • When and when NOT to use stretching
  • We talked about interventions that go well together
  • Mindset and thinking about boredom with recovery

Like everything in life, stroke and brain injury recovery is multifaceted and so intervention selection must be too. Pete and Deb talk about the topics listed above as individual interventions and how they might look if combined with others. You’ll hear clinical reasoning in action! It is part of the rehab process, is ever evolving and must always include the head of the team – the survivor.

Questions and Comments about the podcast:

Donate to The Noggins And Neurons Podcast: Venmo @neurons

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

Music by scottholmesmusic.com

Sensation Recovery

Sensation Recovery

July 5, 2021

Sensation Recovery

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PETE: If you can’t feel it, it’s harder to integrate it into anything that you do and so you don’t do it as much and so you add to learned non-use.

DEB: Yeah. And think about that with the person who also has neglect. They don’t know that they have that side and they don’t feel that side, there’s no reminder that the side is there so it impacts body awareness.

PETE: Absolutely. Let me ask you this, as a clinician, and I’ll try to get my head around this as well, if you think that sensation is recoverable, do you think it’s worth putting some of your valuable clinical time, your limited amount of time with that patient focused specifically on sensation recovery?

DEB: I think it would be worth it. Because if sensation and movement are linked together, it’s important, and for all the reasons that we just talked about, the things that can go wrong, improving sensation can increase safety, it can increase independence, quality of life...yes, I think we should be working on that.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about recovering sensation. We talk about:

  • The role of sensation in movement, body awareness and safety
  • The impact of sensation on quality of life
  • Repetitive practice and sensation recovery
  • Assessing and treating sensation along with best practice info on documentation
  • Active and Passive interventions
  • A sensation recovery home program

Pete and Deb talk about the points listed above and a few others in detail with the hope that you can do more around improving sensation after stroke or brain injury.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Music by scottholmesmusic.com

tPA: The Clot Buster

tPA: The Clot Buster

July 3, 2021

tPA: The Clot Buster

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PETE: And you still hear in doctors voicing this reluctance to use tPA because they’re afraid people are going to bleed out.

DEB: There’s so much that doesn’t make sense to me around those types of decisions and the way that our society is right now with suing people because if you don’t have tPA, it’s not going to end well. So if you’re already in a situation where it’s not going to end well, what is the risk? And I do think that some of it has to do with the way that we view the life cycle and our beliefs around living and dying.

PETE: Really....how so Deb? This is gonna get deep quick, I can tell...

DEB: Here we go...

PETE: What do ya got?

DEB: Well, we don’t get out of here alive. I mean we do die and I have seen a lot working in the critical care units...I have seen people come in with those MOLST forms

PETE & DEB: Medical Orders for Life Sustaining Treatment -MOLST

DEB: So those are pretty specific, and you can put exactly what you want on there and I have seen family members and doctors walk all over those forms and keep people alive who don’t want to be kept alive. And it’s extending...often times it’s extending an unhealthy situation to begin with and people don’t want to live that way because it’s not living and, you know, just sometimes it’s really hard to let people go, it’s hard to watch people suffer, it’s hard on caregivers...and I don’t...there’s so much, ummm, (sigh), what’s the right way to say this...people don’t know...if you’ve never been around people who are very debilitated and who need a lot of care to total care, then it’s hard to imagine the challenge on a person, on a caregiver for that...until you start doing it and everything changes that way...so, you know, because we don’t know how things are going to turn out, but if a person is having a stroke and they’re already presenting poorly, and tPA might make it better, then to me it makes sense...give the tPA.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about tPA – Tissue Plasminogen Activator. We cover:

  • tPA, when administered safely and appropriately can mean the difference between a life of disability and one of ability.
  • Signs and symptoms of stroke
  • How tPA works (physiologically) in the body
  • When tPA isn’t or can’t be used
  • Possible adverse effects of tPA
  • Therapy and early mobility following tPA administration
  • Lifesaving benefits of mobile stroke units and all they’re capable of doing

Pete and Deb talk about tPA from our research, therapy and personal backgrounds. Hopefully we sparked enough interest that you want to learn more and do additional research. Knowledge is power and helps inform decisions wherever you find yourself in life.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Music by scottholmesmusic.com

What Doesn’t Work II

What Doesn’t Work II

June 29, 2021

What Doesn't Work II

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PETE: Here’s one for you...acupuncture may not be helpful for improving  functional ambulation, spasticity and activities of daily living for the lower extremity. Again we’re still talking about the lower extremity. Here’s one that may not surprise you...Neuro Aid may not be beneficial for improving stroke severity

DEB: Huh! That’s interesting. It made it in here, into the EBRSR

PETE: Yeah. How about this one? Stimulants may not be beneficial for improving motor function. Do you remember when stimulants were all the rage for people with brain injury because it was thought that they would somehow get better if they had...what’s the big one again?

DEB: Ritalin...

PETE: Adderall

DEB: oh Adderall yeah... Ritalin’s the one that I seem to remember somebody talking about a lot at the hospital

PETE: For brain injury recovery?

DEB: I think so because it was a stroke center

PETE: How about this one...have you ever heard of wholebody vibration?

DEB: Yeah!

PETE: Yeah? Wholebody vibration may not be beneficial for improving balance, functional ambulation, and muscle strength. How ‘bout them apples?

DEB: How ‘bout them apples?

PETE: Yeah...

DEB: Is that going to come up again in what does work?

PETE: That’s a good question because I know for acupuncture there are some things where it does work

DEB: Yeah...I do too.

PETE: You can have that. You can have stuff that doesn’t work for one thing but where it works for another. Yeah, absolutely

DEB: Maybe we should’ve done a comparison what does this intervention work for, what doesn’t it work for?

PETE: That is the third one...so we have what doesn’t work, what does work and what’s the comparison for things that do work and don’t work and when do they work and not work? This is a lot of work!

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about more of What Doesn’t Work. We discovered:

  • There’s mixed evidence around bilateral training
  • How clinical reasoning works and why it’s important in the rehab process
  • The literature is mixed about music therapy, telerehabilitation, arm/shoulder robotics for arm recovery
  • Neuro Aid engages in shady practices and it may not improve spasticity
  • Research supports that recovery does NOT occur from proximal to distal – it is indeed a myth!
  • Yet again the importance of bringing meaning into recovery
  • Acupuncture, Botox, exoskeleton systems, whole body vibration and stimulants may not be effective for lower extremity recovery
  • It’s important to look closely at evidence available for treating spatial neglect
  • That hyperbaric oxygen therapy isn’t effective for stroke recovery

Pete and Deb infuse clinical reasoning and stories into this interesting conversation about stroke and brain injury interventions that don’t work. People who have experienced stroke or brain injury are smart. They are also in a vulnerable space and may be susceptible to being taken advantage of. This why all of us, survivors, caregivers and healthcare providers must do our research to ensure they receive high quality interventions that work.

As always, we want to hear your top takeaways! 

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Music by scottholmesmusic.com

What Doesn’t Work I

What Doesn’t Work I

June 27, 2021

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PETE: “Stem cells are gonna shine in the future. There’s no FDA approval. You can’t get it anywhere in the United States. You can’t get it anywhere in Europe. There are places that you can get it and I’m gonna put a link in the show notes to two places that do it. Both of them are in China. I had a survivor, that when I wrote about this in my blog, report that he went to China to get this done and it cost him about 16,000 U. S. dollars to do it and this....it makes it difficult. You know, the Chinese are doing it but we’re not doing it. You know...it’s tough to standardize things unless nations across the world agree to the standardization. I have to say, and the reporting back that I got from the blog, it didn’t seem to work that well. But, you know, you never know. So I think there’s great hope for stem cells for people with brain injury, and a lot of other neurological diseases...You know, Amyotrophic Lateral Sclerosis, MS, there’s a bunch of stuff out there that could probably benefit from this stuff. It’s just not there yet.”

DEB: “Yeah...Well, from the information I read it seems to play a role in decreasing inflammation which is a big problem following brain injury.”

PETE: “I think stem cells are gonna shine in the future...People are freaked out. Look, my dear loved one went down. And then you go online and you go, ‘stem cells...boom, we gotta get ‘em. Let’s go to China. I’ll do anything for my spouse. You know, whatever it takes.’ And this is part of the problem here...This is a very vulnerable population and it’s a very vulnerable time in their life. If you’ve ever been a caregiver, you know. You’re just like desperate for answers. And then somebody’s coming by saying ‘yeah we got this thing. Oh, but by the way, it’s not FDA approved but they do it in China,’ you know it’s just a dangerous situation.”

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified, Pete and Deb talk about What Doesn’t Work. This turned out to be a big topic, so we turned it into two episodes. In part I we talk about:

  • Conventional therapy – what it looks like since it’s referred to in the research but not clearly defined
  • An eclectic intervention approach appears to be the best way to promote recovery
  • Challenges in reading the research and deciding whether or not certain interventions or certain aspects of interventions actually work
  • Interventions that don’t work and are harmful or dangerous, those that don’t work and don’t seem to be harmful and the ones that work but better options might be available
  • Stem cells, how it works and researcher reports that stretch the truth about outcomes and more
  • How the research shows there are some effective aspects of NDT but in general doesn’t stand up well compared to other approaches

Pete and Deb share exciting news about upcoming guest interviews at the beginning of the episode before they talk about stem cells and brain injury recovery; Pete’s curiosity around word choices used in the EBRSR – it may, it may not, it can, etc. that leaves us clinicians confused, and his plan to ask Dr. Teasell to clear that up for us; and the lack of research on Neurodevelopmental Treatment (NDT), a highly thought of and used intervention.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Music by scottholmesmusic.com

Subluxation and Shoulder Pain

Subluxation and Shoulder Pain

June 20, 2021

Subluxation and Shoulder Pain

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“And my problem with taping generally is, it’s kind of band-aidy because as soon as you take it off the arm could fall right back out. However, if you could get that to reduce pain and then have them do stuff, which then activates the SITS muscles and the deltoid and it brings that humerus back into where it needs to go, in the meantime because they are doing stuff...they’re driving cortical change, which reduces spasticity, which may indicate more movement and now we get this upward spiral of recovery that could be quite helpful. So taping may be a temporary thing but it might be a good temporary thing.”

EPISODE SUMMARY: This episode of NOGGINS & NEURONS: Stroke and TBI Recovery Simplified covers subluxation and pain. In this episode we learn:

  • That moving the hand engages the shoulder and the muscles that reduce subluxation
  • The proximal to distal arm recovery notion is a myth
  • That approximately 80% of stroke survivors experience shoulder subluxation
  • The importance of proper arm positioning to prevent shoulder subluxation and soft tissue damage
  • Pete’s and Deb’s opinions of overhead pulley use by stroke survivors - again
  • Ways to measure subluxation
  • About treatment strategies for supporting the shoulder, improving subluxation and reducing pain

Join Pete and Deb as we talk about subluxation statistics, how to prevent shoulder subluxation and/or soft tissue damage and the importance of safely moving a hemi-paretic shoulder. We discuss several braces that are commonly used to support the shoulder as well as common challenges experienced when donning and doffing them.  We also cover e-stim, NMES, functional e-stim, TENS, stretching, and taping as effective methods for addressing subluxation. We learned that brain controlled interfacing (BCI) with e-stim (which incorporates action observation and motor imagery) results in greater improvements in reducing subluxation and pain, than when functional e-stim is used alone.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Comley-White, N., Mudzi, W., & Musenge, E. (2018). Effects of shoulder strapping in patients with stroke: A randomized control trial. South African Journal of Physiotherapy, 1-11. ISSN. (Online) 2410-8219, (Print) 0379-6175.

Hartwig, M., Gelbrich, G., & Griewing, B. (2012). Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post hemiplegic shoulder-hand syndrome: a randomized clinical trial. Clinical Rehabilitation 26 (9) 807-816. DOI: 10.1177/0269215511432355 cre.sagepub.com

Jang, Y., Kim, T., Lee, B. (2016). Effects of brain–computer interface-controlled functional electrical stimulation training on shoulder subluxation for patients with stroke: A randomized controlled trial. Occupational Therapy International, 23(2), 175–185. https://doi.org/10.1002/oti.1422

Chatterjee, S., Hayner, K., Arumugam, N., Goyal, M., Midha, D., Arora, A. (2016). The California tri-pull taping method in the treatment of shoulder subluxation after stroke: A randomized clinical trial. North American Journal of Medical Sciences (8)4

Kate Hayner's Calif Tri Pull Taping Method video

Where electrodes should be placed for NMES and subluxation

Products to help subluxation and shoulder pain:

OmoTrain

GivMohr Sling 

StimRouter

Research:

A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients

Effect of arm sling application on gait and balance in patients with post-stroke hemiplegia: a systematic review and meta-analysis

Music by scottholmesmusic.com

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