Game Changer for Stroke Rehabilitation

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By Dr. John Conde Special to The Pineapple Stroke, or cerebral vascular accident, occurs when a blood vessel in the brain ruptures or is blocked by a blood clot. Typically a stroke produced by a ruptured blood vessel is termed a hemorrhagic stroke where as one caused by a clot is termed an ischemic stroke. Either way the effects can be devastating rendering the individual with paralysis, spasticity, dizziness, disequilibrium, speech difficulties, fatigue, anger, aggression, anxiety, and even death. The American Stroke Association has launched a campaign termed FAST which stands for face, arm, speech, and time. This campaign focuses on prevention and increased vigilance from the individual and surrounding friends and family. The main warning signs that are highlighted here are a drooping face, arm weakness, speech difficulty, and the last one being time to call. The understanding in the medical literature is that the faster an individual receives treatment the greater the chance for survival. In the event a stroke is identified the major treatment options are aimed at dissolving the clot in an ischemic stroke which includes a procedure known as IV rtPA, tissue plasminogen activator. This treatment must be administered within 3 hours of onset making stroke identification paramount. Stroke rehabilitation is essential for restoring a person’s functional capabilities to at or near pre-stroke status. As in acute care, timing is of the essence. Beginning rehabilitation as soon as possible is important to limit neurons in the brain termed astrocytes from producing excessive scar tissue and thus limiting neuronal activity. Traditional rehabilitation encompasses speech therapy, physical therapy, and occupational therapy. However, technology and knowledge in the field of neurological rehabilitation has advanced significantly in the last ten years. Three cutting-edge rehabilitative procedures will be reviewed and include Interactive Metronome, Dynavision D2, and mirror therapy. These therapies are all based on a concept called neuroplasticity which states that the brain can change or mold according to the environmental stimuli it is exposed to. In referencing Interactive Metronome, this is primarily a motor- timing therapy. It works on a neurological process called efferent copy which integrates the cerebellum and the frontal lobe, two very important parts of the brain that allow us to have executive functions and independent thought processes. The exercise requires the user to keep up with a computer generated beat that is delivered in both an auditory and visual manner. In regards to the Dynavision D2, this is a revolutionary diagnostic and rehabilitative tool. It works on visuo-motor-spatial skills as well as the efferent copy mechanisms referred to earlier. This therapy also has a positive effect on the cerebellum and the frontal lobe. The user is required to manually compress targets made up of LED lights that are blinking in a strategically established manner according to the neurological presentation of the person. The information is recorded and attention is focused on speed and sequence. Lastly, mirror therapy works on the mirror neurons in the frontal lobe. This is an excellent therapy for limb dysfunction as in spasticity when a person’s arm is curled up and usage is difficult and in foot drop when the person loses the ability to elevate the foot of the floor when walking. The goal of this therapy is to “trick” the brain into thinking the affected limb is fully functional. This therapy can actually activate the neurons in the pathway producing the limb movement without actually moving the affected limb. Nutritional and dietary considerations must be taken into account when rehabilitating a stroke patient. Emphasis must be placed on reducing inflammation through anti-inflammatory based diets that remove foods like red meat, fried foods, dairy, peanuts, and partially hydrogenated oils. Importance must also be placed on consuming a low glycemic diet to reduce excessive insulin production from the pancreas and subsequently reduce the neurodegenerative effects of insulin on the brain. In conjunction with eating more complex carbohydrates it is important to eat many meals throughout the day. Anti-oxidants such as CO-Q10, reduced glutathione, acetyl-L-carnitine, and alphalipoic acid are effective free radical scavengers. Following a stroke, free radical production is significantly elevated due to altered physiology therefore reducing there harmful effects on cells is conducive to healing. Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back-neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at (561)330-6096, drconde@thecondecenter.com, and at www.thecondecenter.com