Functional Intervention for Neuroplasticity After a Stroke Mary Gessler, BS, COTA/L
ME BS degree from Northeastern University, Boston, MA Corporate employment 19 yrs. OTA graduation in 2011 Professional employment and specialization in CVA treatment 6 yrs.
ME Stroke team co-champion Responsible for monthly community stroke support group Began stroke community outings March 2017 Specialty Stroke Education American Stroke Association, Stroke Rehab Specialist training NDT training Hemi-Move 1 & 2 And many many more..
Stroke Facts Stroke is the fifth leading cause of death in the USA Stroke kills more than 130,000 Americans each year Someone in the USA has a stroke every 40 seconds Every four minutes a person dies from a stroke
Stroke Facts cont. Yearly 795,000 strokes occur in the USA 610,000 are first strokes 185,000 are recurrent strokes 20-64 yr. olds make up 31% of all strokes
Stroke Facts cont. Stroke is the leading cause of long-term disability. Mobility is reduced more than half in stroke survivors 65 and over. 75% of stroke survivors experience UE impairments persisting into the chronic stage.
Symptoms of Stroke for All Confusion Depression Difficulty speaking Balance issues Numbness or weakness Severe headache Vision disturbance
Stroke in Multi-Cultures The following cultures have a higher risk of strokes: African American Hispanics Asian Pacific Islanders
Women Are Different Than Men According to University TX Southwestern Med Center Symptoms include: Difficulty breathing Feeling weak all over Hallucinations Seizures Sudden behavior changes Nausea / vomiting
Women Stroke Facts cont. Yearly in the USA approximately 55,000 more women than men experience stroke More women die from stroke than breast cancer yearly After stroke, women have greater disability than men Increased risk is due to hormone status, pregnancy, & childbirth
Risk Factors More Common in Women High blood pressure Diabetes High cholesterol Migraine headaches Atrial fibrillation Emotional stress Depression
Neuroplasticity Neuro = nervous system (brain & spinal cord) Plasticity = plastos or moldable Definition: Neuroplasticity is involved in motor learning rehabilitation after stroke
So What is Neuroplasticity? Our brain continues to change throughout our life time The brain has the ability to rewire itself after trauma Research shows that the brain can generate new neurons (known as neurogenesis)
Neuroplasticity cont. Key to changes in Neuroplasticity: Chemical Signals Altering it s Structure Altering it s Functional Change
Chemical Transferring chemical signals between neurons and triggers actions and reactions. This represents our Short Term Memory Change happens very rapidly
Structure Altering the structure Brain changes the connections between neurons which takes more time. Physical changes takes time which represents our Long Term Memory.
Functional Changes Altering function as you use a brain region it becomes more and more excitable easy to use again. With learning different networks of brain activity is happening. The brain shifts how and when they are activated
What Does Pavlov Have to do With This? Pavlov used a type of neuroplasticity Rang a bell = Salivation For Motor Learning to Occur: Challenging NEW/novel task Repetitive Practice Functional task Novel environment
Motor Learning Definition: a relatively permanent change in behavior due to practice. Motor learning: a set of processes associated with practice leading to a permanent change in the capacity for skilled action Acquiring the capacity for skilled action Learning takes practice and practice Learning must be performed Learning produces a change in behavior
Motor Learning The brain should be focused on task in order for motor activity and motor learning to occur The activity must be: Meaningful to the patient Challenging Changed frequently
Motor Learning cont. Motor Performance is the temporary change in movement behavior seen during a practice session Motor Learning is a permanent change in movement behavior measured after a retention period Motor Learning is only due to practice
Types of Learning Declarative Learning Facts or Knowledge that can be expressed in declarative sentences Remembering a phone number Controlled by the cortex Practice can transform declarative learning to procedural learning
Procedural Learning Procedural Learning Occurs without attention or conscious thought Walking, swimming, riding a bike, dancing Develops slowly through very high repetition Expressed through improved performance on a task Controlled by the cerebellum Therefore performance is still possible in the absence of cortex (brain injury, dementia)
Characteristics of MCA Middle Cerebral Artery Syndrome (MCA) Weakness on affected side of body in the arm more than the leg Sensory and weakness on affected side in face Gaze impairment Homonymous Hemianopsia Aphasia Ataxia on the affected side Perception difficulties
Characteristics of ACA Anterior Cerebral Artery Syndrome (ACA) Weakness and sensory loss Urinary incontinence Frontal Lobe damage Akinetic Mutism Definition: A medical term describing patients tending to neither move(akinesia) nor speak (mutism). First described in 1941 as a mental state where patients could not move or speak.
Characteristics of PCA Posterior Cerebral Artery Syndrome (PCA) Memory deficits Involuntary movements Homonymous Hemianopsia Difficulty recognizing people Dyslexia with reading only, writing in tact
Characteristics of Pontine Stroke Double vision Dizziness Vertigo Slurred speech Imbalance
Video of Carl Video
Cerebellum Stroke Decreased Balance Decreased Movement Vertigo Headache Vomiting Ataxia
Video Video of H.B. dancing with wife.
Right Hemisphere Damage Highly distractible; with short attention span Poor judgment and safety May be disoriented Poor insight into their condition Confusion, time, space concepts Motor problems Eye hand coordination
Right Hemisphere cont. Balance issues Visual field loss Left Neglect Spatial perceptual Impulsive Difficulty with visual cues
Left Hemisphere Damage Aphasic Visual deficits Difficulty with following directions, repeating words, or actions Slow and cautious Perseverates Uses yes/no inappropriately Anomic unable to name objects
Other Interventions Bioness Mirror Therapy Modified Constraint-Induced Movement Therapy (MCIMT) Dynavision Mental Practice (MP) Functional Activities cooking, grocery shopping, laundry
Pushers Patients who use non-affected side to push toward affected side. Takes approximately 3-4 weeks to resolve Some cases can last up to 6 months Associated more with Left hemisphere strokes
Pusher cont. Use a wall and mat for patient to sit on so they can t move unaffected side Have a mirror with tape down the middle in front of patient so they can see what midline looks like Have the patient reach for an article of clothing using the unaffected hand Have patient look in mirror sitting up in midline position
Interventions What s is a routine task that s important to the person? Example: Putting on a bra (Theraband, in front on table, W/C, chair /c arms, EOB, sitting on toilet, Standing, sports bra, back close, front close (types: hook & eye, snap, velcro, shoe string one hand, etc)
Intervention Activity Audience participation pass out information
Sex is an ADL Sexuality is a core characteristic for human beings Important part of development and growth The ability to be intimate with one another Some sexual expressions include: holding hands, kissing, flirting, and sexual intercourse
Sex is an ADL cont. Patients may feel more comfortable talking to their OT The necessary aspects of therapeutic relationship include: empathy, openness, and sensitivity Suggest the patient and spouse, or significant other sit down and talk with you Ask the couple what is important to them right now in wanting to be intimate Tell story about H.T.
Community Resources Avenues Rehab driving program Ability Rehab driving program Next Step Stroke Foundation Ability Rehab Program (formally known as Rehab Institute) Stroke Support Groups
Community Outing
Important Websites www.stroke.org (National Stroke Association) www.strokeassociation.org (American Stroke Association) www.aota.org www.americanstroke.org (Next Step website) www.nopw.org
References Stroke Facts. (n.d.). Retrieved July 19, 2017, from https://www.cdc.gov/stroke/facts.htm 2017 Stroke Fact Sheet. (n.d.). Retrieved July 19, 2017, from www.stroke.org Thomas, A., & Doherty, M. (2017, June 05). Thinking it through: Using Mental Practice to improve motor recovery and activity performance in clients with a stroke. OT Practice, 22(10), 1-4.
References Bajwa, R. (n.d.). Brain Plasticity; Rewiring the brain. Retrieved September 13, 2017, from http://blog.cognifit.com/brain-plasticity-rewiring-brain/ Neuroplasticity. (n.d.). Retrieved July 16, 2017, from http://www.stroke-rehab.com/neuroplasticity
References Mac Rae, N. (n.d.). Sexuality and the Role of Occupational Therapy. Retrieved August 14, 2017, from https://www.aota.org/about-occupationaltherapy/proffessionals/rdp/sexuality.aapx Mc grath, M., & Sakellariou, D. (2016). Why has so little progress been made in the practice of Occupational therapy in relation to sexuality. The American journal of occupational therapy,70(1), 1-5.
References Walker, L. (2017, June 5). Group Discipline Incorporating Evidence -Based Modified Constraintinduced movement therapy in an inpatient rehabilitation facility. OT Practice, 18-20. Why are women at higher risk for stroke than men. (2016). Retrieved July 19, 2017, from http://www.utsmedicine.org/stories/articles/year- 2016/stroke-symptoms-women-risk
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