Perturbation training is pushing the patient’s limb or body in order to cause instability that the patient is asked to resist. An example of this that I used to do is at the shoulder. I would have the patient lay on their back and hold their arm straight up in the air. Then I would push the arm in all different directions and say to the patient “don’t let me move you.” So the patient would try to resist my pushes. Perturbation training is rarely done in neuro physical therapy. Or maybe it’s done more often than I think, but it’s not done soon enough. My last post talked about falling and how falls are a necessary evil for our recovery. Dean commented that therapists need to push and shove patients when they are learning to walk and I agree. Most PTs would be horrified to try this. PTs are all about safety, safety, safety. Well when you have a stroke, absolutely everything is incredibly unsafe no matter what we’re taught. I think all that safety stuff should still be taught but therapy sessions should be focused on not safe stuff instead of safe stuff.
I said something in a comment once about falls and our friend Dean replied that I would make an excellent neuro PT and that I might actually know what I’m talking about. Now, I had to do a post about this because Dean has a strong, strong dislike of physical therapists, understandably so. So him saying that is a HUGE HUGE compliment! What I said that made him say that was this…..All neuro PTs listen up! Falls are a necessary evil for stroke survivors. It’s gonna happen. It just is going to happen. So instead of therapy focusing so much on preventing a fall, therapy should focus on what to do in certain scenarios. If someone is falling, teach them to throw out a protective extension, if possible. Teach them and practice ways to control the fall as best as possible. Dean said, and I LOVE this, that learning to walk again after a stroke is just a series of controlled falls. Good God that’s beautiful. Therapy needs to teach people how to get up after a fall. I know for a fact this skill is not taught. Maybe it’s taught to some people, but it’s sure as hell not taught to the majority of patients. A series of controlled falls, therapy needs to focus on controlling those falls, not preventing them.
Cool people call them ‘plyos.’ Plyometrics are jumps. I can’t jump, so no plyos for me right now. A plyometric exercise is when an eccentric contraction is immediately followed by a quick and powerful concentric contraction. What that means is that you’re stretching out a muscle by making it longer, then using that energy to shorten the muscle really fast and powerfully. So, think of a squat jump. Jillian Michaels loves to have people do these on The Biggest Loser. Ok, first you squat down. This is using the quadriceps muscle eccentrically and stretching it out as you squat. Then you straighten your legs and jump in the air. This motion is concentrically contracting the quadriceps muscle by shortening it. And you jump in the air, that’s the plyometric part. You’re doing a high intensity burst by using all the energy you created when squatting to jump up. It’s a way to create power in a muscle. You stretch the muscle, then you powerfully concentrically contract it. Be careful with plyos, they can be hard on the joints. Sprinkle them throughout your workout. Like I said, I couldn’t do a plyo if I wanted because I can’t jump off the ground. If you can jump, try some plyos maybe.
I’m in therapy and I don’t care who knows it. When your entire life and world is interrupted by a stroke at the age of 30, a little therapy is quite, quite necessary to figure some things out. Frankly, I think everyone should do some therapy and do a little internal work, but saying that would fall on deaf ears to most people. My therapist, who is absolutely unbelievably amazing, does psychotherapy developed by Carl Jung with me. One component of this therapy is getting to know your inner self, your personal truth. Apparently, I have a rather strong inner self. This is because a year and a half after my stroke, when I could barely walk and barely talk, and despite being told differently by some friends and relatives who didn’t know the truth and who were fooled by outward appearances and who were supposed to have my back no matter what but did not, I left my relationship because there was a constant inner voice saying “this ain’t right.” I had a very good reason to stay put. I was financially secure, now not so much. My life would have been “easy” had I sold my soul and played the appropriate role in front of others. But I couldn’t do it. Even in the state I was in, it made me sick. And that is SO SO SO SO SO not something that I should have had to decide at that time. But I did, so I left. I look back on that now and am kind of amazed that I did that. Listen to your inner voice, people, don’t ignore it.
It takes a while after something like this to realize that the existing medical community knows nothing about recovering from a brain injury and you are completely on your own if you want to get better. Me, Dean, Barb, etc… We all know that we have to do our own research on recovering because we’ve all been at this for 3+ years. Well, in a few weeks I’ll be at 3 years post stroke. But the majority of you I think wound up on this blog because you or a loved one recently had a stroke and you’re within that first year or two. Now if you had a little itty bitty baby stroke or a TIA this is not directed at you. If you had a major event like I did and like most people here did and your entire life is completely turned upside down, this is for you. That first year – there’s going to be loads of support. Then it goes away because people go on with their own lives. That’s why a few years later you’re really gonna know who your friends are. That first year – you’re going to be scouring the internet for something that will make it all better. It doesn’t exist. That first year – you’re going to have a ton of doctor appointments and you’re going to think they’ll tell you something helpful and useful. Most likely, they will not. Basically, that first year is absolute hell. Do whatever you can to get through that first year, it gets better.
I told a couple of people that I would research trunk ataxia and see if I could make any specific suggestions other than just strengthening the trunk. I never had trunk ataxia. I had ataxia BAD, still do but it’s not so bad anymore, and it did not affect my trunk. It affected my right arm and leg. I have a friend who has significant ataxia in the trunk and told me that for a while, she felt her trunk shaking even when she was just sitting down.
Here’s what I think………………balance exercises would be extremely important because balancing engages the postural muscles. But balance exercises require standing….and balancing….and that’s too much to ask of some people. Soooo here’s an exercise that I used to give to people right after back surgery to help engage, be aware of, and strengthen those muscles. It’s fun and it’s a mental game too. Ok maybe I’m stretching the truth by calling it fun. Lie on your back and put a blood pressure cuff under your low back. Then inflate the cuff to about 80 mmHg. Then you contract both the muscles in your belly and in your low back. They work together. Once these muscles are contracted, you do leg lifts and different things with your limbs while trying to keep the blood pressure cuff at 80. Ataxia is a problem with control and this exercise is all about controlling those muscles.
Here’s Grumpy Cat’s take on Valentine’s Day……..
And I just think these are hilarious……………
Did you ever have pain in your toes or fingers but nothing actually seems to be wrong with your toes or fingers? Or numbness? Or weakness? Or tingling? I’m going to explain why this can happen in the orthopedic realm but in the neurologic realm I don’t think that I, nor anyone else, knows a damn thing. You know how people will say “I have a pinched nerve in my neck?” Or back? This is what that means. The spinal column is made up of (usually) 24 bones that look like this
Sometimes the discs rupture a little bit or rupture a lot – or there doesn’t have to be a rupture, sometimes the disc just bulges – and then all kinds of crap from the inside of the disc comes out and puts pressure on a nerve. The spinal cord is encased within this vertebral column and at every level of the bones down your spine, the spinal cord shoots off some nerves. Nerves control everything – pain, numbness, tingling, weakness. And, nerves are all connected so what happens at the neck or back can cause weird shit to happen in the fingers or feet or anywhere all the way down the length of the nerve. So these symptoms that can be caused by a messed up disc in the neck can cause weird feelings or decreased strength all the way down at your fingertips. Same thing in the low back but a messed up disc there can cause weird symptoms down to your toes. These symptoms are called cervical/ lumbar radiculopathy. If you’re having pain for this reason, it’s called radicular pain. This can be treated by doing various things. You have to figure out what’s causing the symptoms first before you decide on a treatment plan.
I miss this stuff. 😦
One of my favorite people just had a baby and she was telling me about some back pain that she had when she was pregnant, and continues to have. Let me tell you a little bit about the anatomy of the spine. The spine is curvy. That curve that goes in a little bit at your low back, that’s called lordosis. Move up the spine to the upper back, that curve is the opposite. This curve, the one that curves out a little bit, is called kyphosis.
Then at your neck the spine curves in a little bit again and you have some more lordosis. When all is said and done(I guess that saying doesn’t really apply here but whatever) the spine when looked at from the side should look like a backwards ‘S.’ The main thing you want to do when trying to have super duper good posture is maintain these curves.
Pregnancy causes one to have a rather large belly. When looking at a pregnant woman from the side, it appears that she has increased lordosis in her lumbar spine(increased inward curvature of the low back). However, this is an optical illusion and is not the case. Actually, in most cases pregnancy will cause the lumbar spine to be kyphotic(increased outward curvature) because the fetus is actually pushing out on the lumbar spine so instead of creating more lordosis(inward curve), kyphosis(outward curve) is created despite looking very much like the low back is much more lordotic. For each condition, increased kyphosis or increased lordosis, there are certain things that you can do to help the back pain but the first step is figuring out why you are having pain and what your spine is doing which you cannot do by just looking at the spine or saying “well you’re pregnant, this is why you have pain…”
Does that make sense? Most PTs and doctors would not say this to you. That pregnancy causes your spine to do this but I’m very much used to saying things that people disagree with so believe what you will.
A member of the Pittsburgh Penguins, our hockey team, recently had a stroke. This news just came out yesterday and a few people felt the need to tell me about it. I debated doing a blog post about it because I’m already annoyed. From everything I’ve read, it sounds like he had a little itty bitty baby stroke. He is going to be glorified as some kind of hero if he ever returns to the NHL after suffering a stroke. Anyone that can return to a professional sport, like Teddy Bruschi, after having a stroke, did NOT have a major stroke. If his recovery is anything even remotely close to the norm after having a stroke, he will never play hockey again. If this is the case, Kris Letang, come join us won’t you? We’d love to have you.
When I had my stroke, it was physically taxing to speak. Just talking took an incredible amount of effort and I didn’t want to do it. I used to just grunt. Especially when I was really tired. I would reach a point in the day where I was just done talking and I would just grunt. A friend of mine used to say “are you in grunt mode?” I remember talking to Brooke a while ago and she said “it’s very hard to understand that just speaking could be hard.” It was, it was hard as hell. I forget what it’s like to speak normally and not worry about what I sound like.
For the first time since beginning this blog, I just made myself cry. If you never lost the ability to speak and express yourself, be very grateful.
I sound ok now. Everyone tells me that I sound perfectly fine but to me, in my head, it’s still pretty bad. But it’s ok and it’s not super hard anymore.
My back hurts right now and I know a little bit about back pain so I thought I’d share what I’m doing to make it feel better. A long, long time ago in a galaxy far, far away when I was a physical therapist, I became what’s called McKenzie certified. This, in my opinion, is the best way to treat back pain and here’s why. This method is all about figuring out what movements cause your back to hurt and based on that, decide how to treat it. It’s actually getting to the root of the problem and not just giving you generic exercises for back pain. For example, and this is really simplified, it’s common for pain to come on/worsen when you bend forward so bending backward should lessen the pain. Did you ever bend over to lift something up and all of a sudden you got this horrible pain in your back and couldn’t straighten back up? It’s bending over forward that caused the pain so bending backward might help. Flexion and extension of the spine. A lot of people are in shock that I would have patients extend the spine. With this treatment, you won’t just go in, get your “alignment” checked, have something popped and told you have to come back 3 times a week for 12 weeks. Who knows who tells you something like that? Anyone?
It’s my upper back that’s hurting. My thoracic spine. I’m doing some thoracic extensions to make it feel better. Often, bending forward is the problem because we do it all day, we live in a world of flexion. You are probably flexing the spine when you’re sitting, because most people slouch when they sit. And after a stroke, well you’re going to sit quite a lot. But sometimes I would treat back pain with some kind of forward bending. Not often, but sometimes.
But this pain I’m having I’m treating with extension. And the number one thing you should do, above all else, the most important thing for your spine, the single piece of advice I would give if I could only give one piece of advice, is to have good posture AT ALL TIMES.
Addendum: I just read through the entire posture website again and I disagree where it says not to sleep on your stomach. Sleeping on your stomach can be good for your back. It all depends.