Stroke & Traumatic Brain Injury (TBI)

The immediate emergency medical concerns of Stroke and TBI are well documented and should be accessed other places. My experience and advice lies with those who have healed physically  from the initial trauma or incident.  Active, ongoing cranial bleeds are serious stuff and not for amateurs to deal with.  This being said…

There is good news and bad news for anyone who has incurred brian damage whether by trauma, vascular event, reactions to chemicals or tumor.  I was taught over 30 years ago that whatever recovery someone had after two years was probably all they were ever going to get. “Sucks to be you” Generally that platitude holds true.  Insurance reimbursement for treatment usually runs out long before that, folks learn how to make do with their disability, connective tissue that supports posture remolds to accommodate what a person does, people give up and get used to what they have.   If they tried their hardest at the beginning of their recovery, they remember where they hit the wall then and rarely visit it.  They and their support team, if they have one, find ways to make things work, how they are not realizing that although

Given good news/bad news situations, I always take the bad news first. The bad news…what is lost is lost. If brain cells have been obliterated, they are gone.  My clients have heard me say the good news is there is so much of their brain they never used before they can train old lazy cells to make up for the absent ones.   Although that is not exactly true, the concept of neuroplasticity or the body’s ability to adapt to demand and create new links in areas thought to be dormant is increasing in popularity and acceptance.  The brain can be re-trained.  Intention, patterned motions, vision therapy, nutrition, craniosacral therapy, meditation and several other different types of therapies have shown that there is plasticity within the brain that allows for changes that even 20 years ago were thought to be impossible.

Ideas

If you found this spot exploring options for holistic ways of recovering from either stroke or TBI, know that most insurance coverage for services related to rehabilitation is limited in scope of numbers of treatments, kinds of treatments and are usually limited to a certain period of time after the original occurrence.  This is sad. When I was working in the physical therapy field I had to tell more than one person, “I wish I could do more, but you have run out of coverage…and money…we cannot do any more for you”  Good practitioners  feel almost as frustrated by the system as you do.

Practice the things you learned in therapy, build on them. I will be sharing many things a person can do, always be sure to modify  practice, with safety in mind, eg, if sitting balance is a problem…don’t work on skipping!

When a person has a brain injury there is a certain amount of time that is required for healing, Bone takes an average of 8 weeks to mend, ligaments up to a year and a half, inflammation from trauma can continue as long as there are irregularities that irritate sensitive structures. Sometimes there are alignment issues with the cranial sutures (joints that look like squiggly lines in the skull) Sometimes  the autonomic nervous system is compromised and doesn’t work right, The change in blood flow patterns after this type of injury can change how a person thinks, reacts, moves and processes information.  It is frustrating to remember how easy it was to do things and many people just give up. They also give up hope.  Don’t.

Time is one element insurance companies forget about. What a person is capable of 3 months after initial insult is nothing like what a person is capable of 4 years later.  But by the time 4 years have gone by, most people are no longer receiving therapy because progress has slowed down or financial restrictions have set in.    Problems with recovery arise when connective tissue patterns have changed,  because of muscular  ineptitude when wounds are fresh become fixed because of inability to move through.   Tightness becomes rigidity, and inability to access the damaged part of the brain makes it difficult to even locate poorly functioning body parts using awareness, the offending limb is dragged along, ignored as the person just tries to live a life.

Baby Development Book

When you were born and your brain didn’t have quite so much information in it, you were fairly helpless:  Arms and legs would move alright but you could not hold your head up, roll over, sit, crawl, or walk you interacted with your environment and each of these task took time and one skill built on another.  After an adult has a stroke usually priorities for the family is to get life back to as close to normal as quickly as possible. Walking, talking, eating…and job skills.  Most people, and many therapists never go back to the building blocks that make these things possible in the first place. A good baby development book is actually a good guide for a home stroke    rehab program.

Try going through developmental sequences and see what is easily accomplished and what is ‘missing’. The parts you don’t do well are the things to practice, Don’t forget that before purposeful movement, came purposeful eye movements. Many people with TBI do not realize that there are pieces of sequences missing. For example, when it is time to stand up, they will try to push themselves straight up, where a normal pattern is to bend forward to put weight over both legs and the bending forward process makes it easier for the hip muscles to   do their job of elevating the body. When we try to walk by ‘putting one leg in front of the other’ the mind ignores the normal pattern of hip flexors which usually advances the thigh after the pelvis has already moved forward and the weight has shifted onto the supportive leg.  When there is noticeable weakness on one side people often try to pick up the leg they are standing on and don’t know why it doesn’t move.  This is why doing rolling and quadruped activities are  important to restoring weight shifting in vertical.  Vision therapy type exercises help to activate other types of brain function as well. Babies use their eyes much more deliberately because they need to make sense of their universe.   Many people with TBI have multiple blind spots and do not know it because the brain actually will fill in ‘spots’ with what it guesses belongs in the middle of the scene.

Neglect

If because of hemiplegia there is neglect of the side that doesn’t work well, doing things to increase awareness of the less functional side is important to regaining function. there are two basic camps of thought one is to forcibly restrict the better side so that there is no alternative but to use the weaker side. The other is to acknowledge life needs to be functional as quickly as possible and to work the best side in such a way that life can work and independence can be achieved as soon as possible.

Fortunately, there is no law that says you cannot alternate or combine techniques. Increasing awareness of a neglected side can be accomplished by wearing compression garments or sensory stimulation.  Wearing bells, bangles that make sounds with movement act as biofeedback devices.  Glow in the dark shoelaces on the feet help increase awareness of foot position. These shoelaces don’t have to be restricted to shoes, however, they can be used to wrap legs or arms candy-cane style so they can be observed in darkness. When nothing is visible but the wrapped limb, any movement observed becomes bio-feedback and invites exploration. there are even bracelets with feathers and led lights so stroking the wrist and hand can have pleasant feelings associated for the functional hand when the affected hand is without sensation.   Non function after a brain insult is not because of a problem in the hand or foot, but because the electric signals that used to make them operate have been turned off at the breaker box.  It is like a car ran over the transformer box that goes to it’s house. Glow in the dark toys become like candles in a power outage, not enough to do the full job but illuminating important points of interest.

Neglect is not unusual.  When there has been an insult to the brain that results in damage and lack of signal to the body or an interruption of the brains ability to receive input about limb position, torso orientation, the person is not being stubborn or obstinate or lazy. Instructions seemingly fall on deaf ears but it as if you want them to know what is going on in a favorite television show when the TV is turned off.  Exaggerating signals, or finding new ways of getting the information.  New pathways can be formed in the brain, in order for this to happen a deliberate attempt must be made.  It’s like fighting gravity, difficult but it can be done.

I know people who use scented soaps or perfume on one side to increase input to the brain to increase awareness.  I have used the pointy end of a golf tee to find and trace areas of sensory depression. I have had people use body paint because that is far more interesting than just touching what feels absent.  Then washing it off there is visual  feedback of what parts are missed.  Colors are more fun that using ice for stimulation.  A hand held vibrator to both stimulate circulation of blood and lymph is also a good sensory integration tool. It can be directed from areas with excellent sensation and watched as it is pushed or pulled into less aware areas. as well as a relaxation prompt for muscles that may be in constant spasm due to incorrect signal from the brain or poor postural abilities. Pillows and bolsters to hold a body in a closer to neutral position make life easier for the muscles working overtime on the ‘unaffected’ side.

The good news is that with this type of injury, if the body does regain it’s connection with the brain, it generally keeps it. Refinement processes continue as long as mindful attention is paid.  Revisiting success reinforces success and broadens the path. Don’t forget, it takes an infant almost a year to walk in the first place but once they learn…they have it.   (of course learning to skip or ride a bike require new attention and time) The brain uses what it has, and discards what it doesn’t think it needs) Remember cramming for a test results in temporary learning true learning requires repetition and co-ordination takes practice.

Quadruped

Even if the person can walk and communicate, going through the basic steps of looking, performing visual tracking activities, lying on their stomachs (if this is a safe position for them) turning head side to side, coming up on elbows, getting into quadruped (hands and knees position) etc help to retrace. or replace building blocks that may have been erased by cells damaged by trauma, bleed, inflammation or neglect.

A 180 lb adult may need help doing these things.  I always found my more severely disabled  clients walked better after a half hour of mat work than by an hour of standing activities in the parallel bars.  The first time you walked it was a progression from crawling, where you explored many aspects of weight bearing before you dared to put yourself in a position where you might fall down.  Six feet is a lot higher and a lot more dangerous to fall from…it makes sense to me that you should be even more sure of your balance than the 9 month old exploring standing.  The way your balance is off is different than the way a normal toddler looses their balance. Quadruped rocking is a heck of a lot safer than an unbalanced walk, and crawling across the room if a person can get up and down off the floor may be safer than walking.

When considering going quadruped,  those with hemiplegia (one sided weakness) may not be able to get up on hands and knees because of the one sided weakness, instability or deformity.   If your wrist is un-usable, balance on elbows, if shoulder is unstable, support it from beneath with pillow or the right sized stuffed animal.  Bear weight through forearms, if both shoulders have good range of motion gold arms and rest your head on forearms.

What if a person cannot lay on their belly?  Sometimes peoples abdominal muscles and hip flexors shorten so that lying face down is painful. Always being mindful of the difference between uncomfortable and painful, what happens if lying prone (belly side down) is uncomfortable…perhaps they need to assume that uncomfortable position with help let the position stretch what needs stretching and if struggle is needed to get out of the position, it will be reminiscent  to long forgotten pathways from infancy,  Work on rolling  front to back, and back to front. (just be sure to be in a safe environment…there is a reason babies are  put to bed in cribs and not on flat beds…protection from falls is of utmost importance.  Side-lying stretches where the persons weight shifts from right to left. Belly down position can be supported by bolsters or pillows., turn head, move eyes side to side, stick your tongue out. Shift weight side to side, front to back, on the diagonal. The possible varieties of movements are endless. Alternate weight bearing from Right arm to Left hip to weight shift with toes. Lie down and move into quadruped several times in a row, Experiment to see what the best way is today…

Lying in a three quarter prone position may be enough of a stretch and is an excellent postilion to work hip and shoulder movements and stability.  Sheets or pillowcases can be put under heavy limbs so if a person has help, the helper can help slide the limb in the direction the person doing exploration is moving. Again helper is acting as a biofeedback mechanism as well as helping to jump start a ‘stuck battery’

Exercise with the awareness of an  explorer or archaeologist. Look for small changes.  Use mirrors and landmarks to note improvement. Do not do the same exercises everyday. People recovering from strokes may seem to have stopped improving then have a leap in function only to plateau again. It’s like having a sink hole that has taken out a road. It is not until the road is open that the work done on building up the foundation, and closing in from the side is complete.  If you call off ‘the workmen’ when the job is almost complete the path may not open. Revisit places and movements that have been unsuccessful in the past. Do not be discouraged by slow progress. progress is progress. Our brains are marvelous creations and have far more recuperative possibilities than most could ever imagine.

Quadruped progression

Lie prone

Lift head, hold head up, focus on objects, turn head from side to side

bend and straighten knees

come up on elbows

bring hips into position

come into quadruped position independently or with help, Bolsters to maintain positions that the brain cannot hold  is perfectly acceptable while trying to ‘find’ it.

shift weight

attempt crawling

use a wall and come into high kneeling, shift weight with elbows on a chair or couch in front of you

Practice getting up and down off the floor safely, with assistance as needed.  If being on the floor is familiar if a fall occurs without injury (babies do that all the time) being on the floor won’t freak someone out. panic and despair go away or don’t appear if a person finds themselves in a familiar position