Mom’s update, June 30th 2011,
Ava started her day with mom. When she arrived she was told that mom was in the shower, but she actually was back getting dressed and placed in her chair. Ava walked into the room and mom had her eyes closed. Ava said, “Hey Nonny!.” Mom said, “Who is it?” with her eyes closed. Ava said, “It’s me Ava.” Mom said, “Oh” and opened her eyes! Ava said so if it were someone else you would keep your eyes closed? Ava couldn’t believe it! Ava did her PT and range of motion exercises. Then she talked with mom. She told her all about a workshop she went to yesterday at BOCES (I presented). Mom said, “I am so proud of her” (meaning me – go figure). Ava said she was nervous to start her new job at BOCES and mom said, “Don’t worry, you’ll do great.” Ava took out several activities and mom said no. She then took out the magnadoodle and mom said yes and drew on the magnadoodle. At one point mom picked up the stylus upside down but it wouldn’t write. Ava told her to turn it the other way and mom said, “I’m stupid.” Ava told her, “No you’re old and can’t see! It’s a small magnet.”” and then laughed. Mom laughed too! (They have a good relationship where they tease each other!) Ava told mom about Jean and the fact that he is signing with an agency in the city and mom said, “I knew he could do it!”
Our cousin Donna came with Aunt Peggy. Donna said mom recognized them. Mom used their names. Donna brought a book with optical allusions. There was a black and white picture with a vase in white and two profiles in black. Donna asked mom what she saw and she said I don’t know. Donna said it is a vase (long A) and mom corrected her and said “vase” (vaz). Leave it to mom! Donna then asked mom what she saw in black and then told mom it was two profiles and mom turned her head to show her profile. Donna held the book and turned the pages but mom wanted to turn the pages. Donna said she would do it and mom said, “Pain in the neck!” Donna sang songs and mom filled in the words. Donna also said nursery rhymes and mom filled in the words. Mom had conversations with them and Donna said mom was amazing!
Dad said she was “capped” all day today (they put a cap over the trach hole) and that her numbers (respiratory) were good. Dad said mom played with a few items on her table but that they mostly watched TV and talked.
Kathy and I went to an all day conference on stroke recovery! It was given by Peter Levine who wrote the best selling stroke recovery book in the US – Stronger After Stroke. He discussed evidence based practice. We learned so much – it was a little overwhelming because we learned sooooo much. His philosophy is:
Repetitive Practice – repeat the same task over and over
Task specific – functional – try to incorporate tasks the person liked to do before their stroke (place knitting needle with yarn next to peg board to make a visual connection that the pegs will eventually get you closer to the knitting) If the person liked dominos then have then turn over dominoes to get the person to practice using their wrist to turn from palm down to palm up.
Mass Practice – repeat the tasks over time (days, weeks, years)
Challenging – must be challenging – push the person slightly beyond comfort level and then aim for successive approximations over time
Three out of four of the suggestions we have been doing based on special education best practices and common sense! (as well as a review of literature)
STROKE SURVIVORS ARE ATHLETES – both want and need to move better.
Both benefit from weight training
Both benefit from cardio training
Stroke survivors - Half as much muscle strength and it takes twice as much energy to do a task
Both use nueroplasticity to “get better” – motor learning (athletes – look at their form (takes place in the brain)
Both benefit from task specificity
Both benefit from massed practice
Both have to express movement
Both need metrics to advance (stop watch, lbs, heart rate, blood pressure)
Both benefit from mental practice (go back to your room and remember how you moved before your stroke) Mental with physical both
Both need coaching (get into the persons brain and coach them)
He mentioned : CONSTRAINT USE THERAPY
Taking existing neurons and having them rewire – this happens in the gray matter of the brain –
White matter is the ascending and descending parts of the neurons
It’s the number of connections that is important –
How do you reduce the number of synaptic connections? (retire - lol) (If you don’t use it, you loose it! – My 93 year old aunt still does word searches every day! She is growing dendrites – connections in the brain)
If the brain is not growing it is shrinking – keep doing cognitive tasks to prevent shrinking.
You build new dendrites (connections) by using the brain more and more –
1% of all the neurons are lost during a stroke – rewiring means you use the other neurons to take over what was lost.
I won’t bore you with all of the notes, but it was amazing. Kathy and I learned some new vocabulary! Everyone there was OT’s, PT’s or Speech. Kathy and I were the only educators! At one point there was an acronym on the board and I turned to Kathy and asked her what it was and a woman next to Kathy chuckled. Kathy turned to her and said we were teachers and not clinicians and she was surprised. The conference started at 8am and ended at 3:30 and when it was over my brain hurt! It was so much information to absorb in one day but it was so exciting!
OK, let me explain “Constraint Therapy” in a nutshell. Restraint is when you place something on someone to limit their movement and they have no control to remove it. Constraint is when you place something on a person and they are in control of removing it. So with that stated, constraint therapy is the placing of a constraint (a mitt or a sling or both) on the side that was not damaged by the stroke (the “good side”) and forcing the person to use the side that was damaged to complete tasks. You are growing new dendrites by forced use. You are rewiring the brain.
We learned so much I need to reread my notes and the handouts so I can better understand the neuro-plasticity of the brain.
Neuroplasticity (also referred to as brain plasticity, cortical plasticity or cortical re-mapping) is the changing of neurons, the organization of their networks, and their function via new experiences. It is our job as family members, friends, and substitute therapists to make new experiences that will (over time) rewire mom’s brain!
We are what we repeatedly do. Excellence then, is not an act, but a habit – Aristotle
Peace and Love…
And remember! Don’t quit 5 minutes before the miracle happens!
She is truly a miracle!
~Claud
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