Blog writing
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Researched current medical literature and wrote articles at an 8th-grade reading level.
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Hand Rehab After Stroke: The Top 5 Evidence-Based Methods
Original post available at Neofect blog ↗
After a stroke, it’s challenging enough to navigate the medical system to find what services you need, let alone the right treatment approach for you.
You've probably heard a lot of recommendations on how to recover hand function after stroke, and everyone seems to give different advice. That's why we sifted through the research for you. We'll explain the top 5 evidence-based methods for hand rehabilitation, why they work, and who they work for.
The top 5 evidence-based treatments for improving hand function after stroke:
Constraint‐induced movement therapy (CIMT)
Mental practice
Mirror therapy
Virtual reality
High-dose repetitive task practice
Constraint-Induced Movement Therapy (CIMT)
What it is:
Constraint-Induced Movement Therapy (CIMT) is a neuro-rehabilitation method where the non-affected hand is constrained or restricted in order to force the brain to use the affected hand, thereby increasing neuroplasticity.
There are two key components: constraint and shaping.
Constraint refers to the way in which the hand is restricted. Therapists have used casts, splints, and mitts to restrict the use of the non-affected hand. None of them have been shown to be more effective than the other.
Shaping involves repetitive movements or activities at the patient’s ability level which become progressively harder. Therapists use shaping techniques to avoid overwhelming the motor system.
Why it works:
Our brain automatically completes a task in the easiest way possible. Our brain is more interested in completing a task than in how it is accomplished.
After a stroke, it’s easier for our brain to do tasks one-handed. This leads to “learned non-use”.
When we constrain our non-affected hand, suddenly our stronger hand becomes the weaker, less functional hand and we’re forced to use our affected hand. Our affected hand might not have much movement, but to our brain, any movement is better than no movement, and the brain is highly motivated to figure out how to accomplish a task.
This is where the "shaping" piece is so important. If you are presented with rehab tasks that overwhelm the motor system or are higher level than your affected hand can functionally do, you'll be more likely to knock the table over than to participate in picking up pennies from the table.
If you knock the table over with your affected hand, your occupational therapist might actually be excited about it; but in practical life finding that balance of not being too easy and not being so hard that you give up is an important lesson for every human being, not just those after stroke.
Who it’s for:
This approach is used for people who have at least 10 degrees of active wrist and finger extension, as well as 10 degrees of thumb abduction (the ability of the thumb to move out of the palm).
It’s been shown to be effective even years after stroke. Lower intensity CIMT is better than higher intensity in the very early stages after stroke.
Mental practice
What it is:
Mental practice, sometimes called motor imagery or mental imagery, is a training method for improving your hand and arm function without moving a muscle!
Mental practice is typically done by listening to pre-recorded audio that describes in detail the motor movement of a specific task. The listener imagines their hand and arm moving in a “typical” way, and the instructor provides cues to extend their arm or open their fingers, as well as the entire sensory experience of the task.
While it’s true that you can do mental practice on its own, it's best combined with physical practice immediately following.
Why it works:
Brain scans show that similar parts of the brain are activated whether the movement is actual, observed, or imagined.
It’s a separate area of the brain that’s responsible for actually triggering muscle movement, but it goes to show that there’s a lot more required of the brain to complete a task than just sending a signal to the muscle.
Who it’s for:
Mental practice has been shown to improve arm movement and functional use in patients after stroke of all levels of abilities and as a treatment approach for people months or years after stroke!
Mirror therapy
What it is:
Mirror therapy is another voodoo-seeming approach that has a lot of scientific evidence to back it up. It essentially tricks your brain into thinking your affected hand is moving.
You position a mirror to reflect your non-affected hand while hiding your affected hand. Any movement of your non-affected hand will be reflected in the mirror and make it seem as though you are actually moving your affected hand.
Why it works:
The approach is centered around mirror neurons, which fire in your brain when you see your arm move. Typically, we think about motor neurons being sent from the brain to the muscle, but we don’t realize that mirror neurons are connected to the motor neurons.
After a stroke you lose the ability to access your motor neurons, but not your mirror neurons. By accessing your mirror neurons through seeing your movement (even if the movement is fake), you are tapping into the network between the neurons.
It’s like trying to reconnect with an old friend on Facebook by finding the friends they’re connected with. It might not be the most direct approach in a real life situation, but in stroke rehab that friend of a friend might be your strongest connection.
Who it’s for:
Mirror therapy can be used for people with no movement of the hand or smaller movements of the hand and shoulder, but not functional movement of the hand.
If you have functional movement of your hand, meaning individual finger movement and wrist movement, you have surpassed the benefit that mirror therapy can provide.
It can be used early after stroke, as well as in the chronic stages of stroke.
Virtual reality
What it is:
Virtual reality uses a computer interface to simulate real-life objects and events. It's become an increasingly prevalent rehabilitation technique to provide motivation and engagement in therapy.
There are two types:
Immersive: goggles are placed over the eyes and the patient is visually in a different environment than their actual physical one
Non-immersive: sensors are placed on the body and track the movement of the body and the movements are shown on a screen
Why it works:
Virtual reality works best when paired with traditional therapy. It's theorized to provide more motivation and engagement for the intensity of therapeutic exercise needed for neuroplasticity. It's been shown to be beneficial in high doses, meaning more than 20 hours.
Another possible factor of why virtual reality works are the same mechanisms that make mirror therapy effective (tapping into the mirror neurons) could be similar.
Virtual reality also creates a biofeedback loop: your brain sends a signal to the muscle, and the brain receives a signal back in the form of visual or auditory input. Basically, you get rewarded for your effort.
Who it’s for:
Virtual reality can be used with people who have mild to severe impairments, and from early after stroke to years out.
When deciding what's right for you, it's important to look at the adjustability of the device to meet you where you're at and also to increase in difficulty as you improve.
If you have minimal movements, you'll want a virtual reality tool specifically for stroke rehabilitation. If you have more movement, it's possible to use gaming systems not specifically designed for rehab, but make sure you have the support to optimize it for rehab.
High-dose repetitive task practice
What it is:
Repetitive Task Practice is when you practice a task or a part of a task over and over. Task-specific training is a type of repetitive task practice, and refers to the task we complete that is relevant to our daily life.
"Reach to grasp, transport and release" is a type of task-specific training because it is one of the common motor requirements for many functional daily tasks.
The keys for repetitive task practice:
The task must be meaningful
The participant must be an active problem-solver
Real-life objects are used
The difficulty level is not too high and not too low
Repetition is key
Why it works:
Repetitive Task Practice is based on motor learning theory. Our brains are driven by function. We're able to achieve neuroplasticity with the development of skills, as our brain processes the demands of the task, which have motor and cognitive components.
It's often used with other treatments, such as virtual reality, to increase the 15-hour dosage that has been shown to be beneficial.
Who it’s for:
Task-specific practice is generally used and is studied in people who have some functional ability of their hand. It's been shown to be beneficial throughout the rehabilitation process.
Even though the research has been focused on the "functional ability" of the hand by practicing reach, grasp, transport, and release; there's potential for recovery by using the same principles of task-specific practice (real-life objects, functional tasks, and problem-solving) even without the ability to grasp.
Functionally, we can use our affected upper extremity as a stabilizer, an assist, or for manipulation. There are lots of ways to get that side involved to prevent "learned non-use" and to improve your problem-solving skills.
Now what?
There are two key factors to any hand recovery method: support and meaning.
Neofect aims to support and inspire you to live your best life with virtual reality tools that can be used as part of a constraint-induced movement therapy program or with repetitive task practice.
Our companion app to create healthy habits for stroke recovery: Rehabit and our YouTube Channel: Find What Works are based on the principles of repetitive task practice and aim to give you the tools to live your best life.
The only question is, what are you waiting for?
Why Is Energy Conservation Important For Multiple Sclerosis?
Original post available on Neofect blog ↗
Multiple sclerosis and fatigue
Multiple sclerosis, or MS, is an autoimmune disease that causes the body’s immune system to interfere with the way our brain sends messages to our body. The brain sends messages that travel along axons, which are protected by a myelin sheath. In multiple sclerosis, the immune system causes inflammation to this protective layer, which can cause scar tissue to build up along the pathway, causing difficulties in sending the correct messages to the body.
Multiple sclerosis can cause many symptoms. The symptoms may change over time as the disease progresses. One of the most common symptoms of multiple sclerosis is fatigue.
There is a high level of evidence for non-pharmacological interventions when managing fatigue including energy conservation and exercise-based interventions.
How does energy conservation help?
Getting dressed in the morning can be exhausting! It can be extremely frustrating if you don’t have the energy to do anything else during the day, or if you can’t even make it through your morning routine. But there are little life hacks that can make your life just a little easier. These strategies are called energy conservation. Energy conservation refers to completing tasks in the most energy-efficient way. It involves planning out your day and prioritizing the activities that are important to you.
As an OT, I’ve devoted my life to preaching about the importance of doing activities that are meaningful to an individual. This is going to look different for everyone, so it’s going to take some soul-searching to look at what activities you love and why you love them. For some people, having the ability to complete their morning routine is everything. Some people are motivated by creative endeavors or exercise. As we go through life and our abilities and priorities change, we all need to re-evaluate the best ways to implement the things we find meaningful and life-giving.
If you love gardening but aren’t able to do it in the same way, think about what it is that gives you life. How can you meet that need in a different way? Can you simplify your morning routine or skip it so that you have more energy? Can you plant and care for a potted plant or raised flower bed? Are there adaptive gardening tools that would make holding onto things easier? Sometimes, looking at what is meaningful brings up a lot more questions before it gives any answers, but having a specific long-term goal to focus on is beneficial to improve quality of life.
Energy conservation tips and tricks
MAKE A PLAN: Make a list of the activities you need to do throughout the week. Include dressing, bathing, meals, laundry, cleaning, leisure activities (watching tv is okay, but try to think of one other activity that brings a smile to your face), and anything else that is important to you.
ASK QUESTIONS: Do you need to bathe every day? Are there services available and within my budget to help with meals, laundry, and cleaning? Do I have more energy in the morning or night? Do I get enough sleep? Is it possible to spread out responsibilities?
TAKE IT EASY: Sit when you can (use a shower chair and sit while bathing, get all your clothes together and sit down to get dressed, put your underwear and pants on your feet before standing up, sit when doing food prep or folding laundry).
PACE YOURSELF: You don’t have to do it all at once. Take breaks. If showering is exhausting, rest before putting your clothes on.
Exercise to manage fatigue
You might think that exercise would be the opposite of conserving energy, but it can also be effective at managing the impact of fatigue. It’s all about balance. The most important thing is to not overdo it.
Find an activity that you might enjoy: walking, aquatic exercises, chair yoga, resistive training with theraband. Finding something you like will help keep you motivated.
Take things slow. Warm up with stretches.
Make sure you’re safe. Use proper body mechanics when exercising. Take precautions if you’re prone to falls.
Make sure to check in with your physician or therapist prior to starting an exercise routine.
Creating a Post-Stroke Recovery Routine
Original post available on Neofect blog↗
Having a daily routine helps us create habits to meet our goals. After a stroke, there is a lot of information and recommendations that may feel overwhelming. Organizing your day in a way that works for you will help you stay focused on your post-stroke rehabilitation and get back to the things that matter most.
We'll discuss 6 things to work into your day that have been shown to assist in your stroke recovery and show you how to begin to make them a habit. Download our rehab calendar below.
Aerobic exercise
Strength training
Sleep
Meditation
Intensive repetitions
Functional goal training
1. Aerobic exercise
It is common for people who have had a stroke to become deconditioned. They may have limited movement and may struggle with depression. Aerobic exercise is important for stroke because it improves the function of the heart and lungs, which can reduce the risk of heart disease and future strokes.
Aerobic exercise has also been shown to boost mood and improve cognition in people post-stroke, specifically information processing and motor learning tasks.
The American Heart Association recommends people with stroke participate in aerobic exercise for 20-60 minutes, 3-5 days a week. The recommended method is treadmill training, if able.
If you’re unable to safely use a treadmill or walk outside, there are several other ways to get the heart pumping and increase the rate of breathing, which are the key ingredients in aerobic exercise. A recumbent bicycle, hand bicycle, or rowing machine are a few options. You might also try a punching bag or chair aerobics.
2. Strength training
Strength training is also an important piece of exercise to incorporate into your daily post-stroke routine. Strength training focused on high repetitions prevents muscle atrophy and actually improves the quality of muscle fibers and overall functional capacity.
Guidelines for strength training are 2-3 times a week. Strength training should take about 30 minutes. Recommendations for which muscles to train should be done in collaboration with your physician and/or your physical or occupational therapist. Typically, you want to address major muscle groups and complete 2-3 sets of 10-20 repetitions. You want to exercise your muscles to the point of fatigue.
3. Sleep
The brain requires sleep to detoxify proteins that are built up during waking hours. It also helps solidify working memory. For people recovering from stroke and in the process of building new neural connections, sleep is essential for recovery.
Sleep disorders are common after stroke and should be addressed with your physician to ensure maximum recovery, but making sleep a priority by putting it into your schedule is one step in the right direction.
4. Meditation
You might be tired of hearing about the benefits of meditation, but it has been specifically studied in people with stroke and has been shown to improve balance, fatigue, depression, and disability. 20 minutes of daily meditation is the recommended dosage, but if you’re new to meditation, aim for 5 minutes a day using a meditation app and increase as you feel the benefits.
5. Intensive repetitions
Intensive repetitions (moving your muscles and joints over, and over, and over again) is the best way to create neuroplasticity and create new neural pathways to the muscles that were affected by the stroke.
The Neofect suite of rehabilitation tools helps make intensive repetitions motivating and fun. It gives you both visual and auditory feedback.
6. Functional goal training
Intensive repetition of movement is only one piece of the picture. You also need to practice a functional goal over and over to retrain your brain on how to complete a task.
Choose one long-term goal. Write it on a sticky note and place it on the mirror. Add it to your daily schedule and commit to practicing it every day. Studies have shown that quality of life increases with improvements in function over improved motor control. One of the best ways to work on your skills is to incorporate practice into the things you already have to do during the day.
Creating a routine
Does it all sound overwhelming? Take a deep breath and think about it one step at a time. Create a digital or physical calendar and schedule time to complete the above activities. You can print out our sample calendar and place it in a plastic sheet protector. Check off your accomplishments for the week with a dry-erase marker, and wipe it clean the next week. Prioritize what’s important to you to start with. You’ve got this!
Parkinson's and Exercise
Original post available on Neofect blog ↗
Parkinson’s is a neurodegenerative disease that affects an area of the brain that produces dopamine. Dopamine has both motor and non-motor effects on the body. Common motor symptoms of Parkinson’s include resting tremors, slow movement, rigid muscles, and balance/coordination difficulties. Non-motor symptoms include constipation, apathy, depression, and sleep disorders.
Pharmacological options only address the symptoms but do not stop the progression of the disease. Exercise is beneficial for everyone, but when it comes to Parkinson’s, exercise can not only help improve both motor and non-motor symptoms, it can also create a neuroprotective effect: protecting the nervous system from damage and slowing down the course of the disease.
Research is still being explored when it comes to the most effective exercise for people with Parkinson’s, but let’s take a look at the evidence to help guide you in developing an exercise program, which could help you find relief from some of your symptoms and help slow the progression of your symptoms. Any exercise program should be created in collaboration with your physician or healthcare professional based on your abilities and goals.
Aerobic exercise
Cycling has shown benefits in decreasing tremors, improving walking, and improving organization and planning. Depending on a person’s ability, using a stationary bike might be a better option for safety and positioning. Bikes that have a built-in motor assist actually show greater benefits than static bikes.
Walking is a great aerobic exercise and has many cardiovascular and mood-enhancing benefits. People with mild to moderate Parkinson’s have seen improvements in walking and balance after 6 weeks of treadmill training 40 minutes a day 3 times a week. Aerobic training on a treadmill has also been shown to decrease the fear of falling.
Forced aerobic exercise is done with a partner who pushes you to a certain intensity of the workout (90-100% of maximal heart rate). This has been researched in cycling and has shown improvements in stiffness, slow movement, and tremors. Functional MRIs have shown increased activity in the cortical and subcortical areas of the brain with forced aerobic exercise.
Strength training
Studies in strength training have been shown to increase muscle mass and bone density, which are favorable outcomes for people with Parkinson’s and can lead to improved function and independence. Lower limb strength training has been associated with an improvement in walking in people with moderate Parkinson’s.
Tai Chi and yoga
People with Parkinson’s who practiced Tai Chi for 6 months were found to improve balance and decrease falls, as well as demonstrated improvements in movement. Yoga has been found to have a similar effect with the added benefits of decreasing depression and improving quality of life. There are many options for yoga for all abilities, and many poses can be done in sitting.
Bottom line
Looking at research and trying to find “the right exercise” can be overwhelming. One of the most important things when starting an exercise program is making it sustainable. You’re more likely to be consistent with activities that are meaningful and life-giving. Sometimes reframing the “why” of exercise can make all the difference.
Some people might feel motivated to do exercise just by thinking exercise is something they “have to do” to slow the progression of the disease, but it might not be the most effective motivator. When we do things because “we should” or “we have to” it doesn’t feel like a choice, and our brain responds by feeling stressed. It might be more helpful to connect more to your body. “I move because it makes my body feel better”. This also helps guide you from overdoing it.
When it comes to Parkinson’s, people can often feel disconnected from their bodies, as it is behaving in such a way that feels out of their control. Making a decision about what kind of exercise is best for you as an individual actually helps change the way you feel about an activity and it becomes more sustainable.
People with Parkinson’s are especially prone to depression and isolation. It’s easy to spiral further into depression, but neurologically, it works the same way to spiral upward out of depression. One step at a time may seem small, but it helps us take the next step.