Hi everyone. 🙂 Long time no talk. My plan was to take a break from blogging for a month or 2 as I build back up a semi-normal life but Dean f’ed up my plan by e-mailing me and asking me a question that I kinda thought was brilliant so I had to write a post about it. I asked Dean for his permission to share this so HIPPA police stay away from me. He asked about a foot issue that he is having, that it’s landing wrong during the gait cycle. Then he asked for exercises that would further increase the offending motion and in my orthopedic PT brain I thought “uhh why would he want to do that?” He told me that “I want to work on both inward and outward motion because I think doing both will cause neuroplasticity to take place faster.”
Yes, I totally agree. Oh man. So Dean’s issue is that when he walks his foots lands wrong and turns outward. For an orthopedic issue – well let’s just get the opposite muscle really strong and fix the motion. For a neuro issue, can’t think like that. It makes so much sense what Dean proposed – to work on the motion that’s bad and causing the issue and gain more control over it. Gain more control, and then….well you’ll be able to control it better and in turn hopefully decrease the problem. So, the motion that’s causing him the issue is that due to his spasticity, his left foot hits the ground in a position of eversion. It doesn’t land straight forward like a good foot should.
So he asked me for exercises that would further force it to turn outward, and I was thinking, “whaaaaa?” And then a few seconds later I thought it was genius of him to come up with that.
WordPress just sent me a notification that today is my 2-year anniversary of starting the blog. I remember reading somewhere that the majority of personal blogs are discontinued within 2 years because of lack of interest. So good for me I guess! This blog has changed DRASTICALLY from when I started it. I started it because I was an arrogant brat who thought I knew something. Little did I know that I knew nothing and had a hell of a lot to learn. Now this blog has kind of turned into a movement of sorts.
A stroke is not just an injury. If you break a bone, tear a ligament, or mess up a joint somehow you will probably be all better in a few months and have very minimal, if any, lifelong deficits. That’s provided you have a good orthopedic surgeon and physical therapist. If not, you’re screwed. I did not just get injured. This event nearly ended my life and RADICALLY, DRASTICALLY, MONUMENTALLY changed both me and my life forever. The neurologists didn’t offer me anything in terms of advising me on how to get better. I was told by multiple top-rated neurologists and “stroke experts” in the entire WORLD that I was not going to recover anymore at a year and a half. I was not going to recover anymore my ASS. Don’t say that to anyone else neurologists that “treated” me. If I learn of you saying that to anyone else I will drive to downtown Pittsburgh, walk into your office and we will have words. I promise you that. You’d think, you’d imagine that an “expert” on strokes would have mentioned meditation and the MOUNTAINLOAD OF EVIDENCE that exists to support how meditation can fix the brain. You’d think a brilliant neurologist would have mentioned that. You’d think. But no. No one said that to me. Now I’m saying it and will not stop saying it until it is taken seriously by the medical community. Actually, even then I will not stop saying it.
There is a theme in stroke recovery and that theme is ‘repetition.’ I say it all the time. But I think I say it too much. I think I’m giving the wrong impression. It’s easy for me to say that now, 3-years post-stroke, because that’s what I need to do. I need to do a crapload of repetitions. But that first year this was NOT the case. I don’t know when the right time is after a stroke to start exercising intensely and for long periods of time. I don’t know.
What I do know is this…..The importance of sleep and rest is EXTREMELY downplayed. Healing takes place in the brain when you are asleep. That’s when the brain recharges. The first year after my stroke, I was afraid to move – so I barely did. The first year, why I did this I have no idea because I very much wished I was dead, but that first year I would walk on my treadmill for an hour and a half to two hours every single day. This meant holding onto the handrails with a death grip but I did it. Don’t ask me what motivated me to do that because I have no clue. I’m serious, I was suicidal, I wished the stroke killed me. But it didn’t, it left me disabled. Walking on the treadmill would wipe me out for the rest of the day. That was it for me. Other than my treadmilling, I rested. I slept. A LOT. Max of 3 hours of activity a day. Then at 9 months post-stroke I started a practice of meditation and chanting. For nearly a year, everything I did in my yoga practice was sitting in a chair. There was very little physical movement. I sat in a chair, did meditations and breath work using very specific brain protocols. A little at a time, a very little at a time, I was able to do more and was less afraid of physical movement. The meditations and breath work rewired my brain without actually performing a specific movement. And also, I still slept and rested a lot. I got back into exercise very SLOWLY and with A LOT of rest.
Look, I’ve been through absolute hell so I have a WILDLY different perspective on things than other medical people. What I’m about to say I would not have said 3+ years ago. When you spend years and years in school to become a doctor or therapist it makes you have a certain air, an ego, an arrogance. I get it. I had it. I had it big-time. Every single doctor or therapist I’ve ever met has it to some degree. Some a little, some a lot. I had it, then I had something else. I had a stroke and those arrogant doctors not only didn’t help me, they made it worse. I did my own research and found my own ways to get “better.” That involved a hell of a lot of sleep and yoga. the real kind. It’s expensive and not covered by insurance(which is utterly ridiculous) so you have to pay out-of-pocket for it but the price is irrelevant to me, it gave me my life back. I now know things, a lot of things, about recovering from a brain injury. Again, I wouldn’t have said this 3 years ago but today I’ll say it – Why on earth would you take the advice of someone who hasn’t walked this path? The “experts” I saw gave me NO helpful advice. If I offended anyone with this post, then you’re gonna be offended.
Someone gave Peter’s book a bad review because it didn’t specifically mention cerebellar strokes. I think I know who it was and let me just say – that’s annoying as all hell. I will defend Peter G. Levine to the death. There is NO difference where in the brain your stroke occurred. It’s all brain damage. Saying this lobe, that lobe – NO. Neuroplasticity doesn’t discriminate based on what lobe was damaged. As Peter says in the post I have linked, the same rules apply to strokes in the cerebellum.
I got a question about a shoulder brace. Here it is….
“I have subluxation on my left side. Not always. The KY helps. I would rather do shoulder shrugs with chanting & music than just counting .I also thought a brace -the criss cross cloth kind might help me hold my shoulders back. the left slumps forward.”
Does everyone know what subluxation is? It’s the step before dislocation. The joint is out of whack but not completely dislocated yet. Now my initial reaction would be to say “no don’t get a shoulder sling.” The reason is this…..We all know that nothing to us is more important than repetition…..which leads to neuroplasticity. When you use a brace, neuroplasticity doesn’t happen because you’re not using the muscles. I was at a course taught by Peter G. Levine and he was talking about using canes and said “we teach people to neuroplastically strengthen the wrong leg.” He’s absolutely right. The stuff about walking and transfers that a physical therapist teaches you is for SAFETY. Getting a limb back to normal function is an entirely different story. Entirely. You pretty much have to do the opposite of all that safe stuff that your PT taught you in order to get stronger. Disclaimer: do all the safe stuff.
Shoulders are a little different. It’s not like walking or climbing steps where just doing the action will promote neuroplasticity. The position of your shoulder has to be addressed before you use it. Sooooo, I don’t know. I never had a patient get a shoulder sling but I worked in orthopedics. I never worked in neuro. I also didn’t have this problem myself. My shoulder never subluxed. It hurt, but never subluxed. So I don’t know. Peter if you read this, what are your thoughts on this? Like I said, I have no experience with shoulder slings for subluxation and can’t recommend one but this looks very good.
Last night I received an email from a woman whose doctor advised her to take Neuroaid. That makes me nauseous. As if I haven’t vomited enough in the last 2.5 years. Neuroaid is a scam. Peter hates it. But I’m used to doctors giving absolutely terrible awful advice so the nauseousness subsided and didn’t actually make me puke. Look, I am a HUGE advocate of Eastern Medicine and do a lot of it. But I know how to figure out what will help and what won’t. Meditation – works. Neuroaid – won’t work. There’s a buttload of research supporting the effectiveness of meditation. There is zero research to support the use of Neuroaid. The first year after my stroke I read up on every pill and supplement that exists hoping to find some miracle drug that would recover me. It doesn’t exist. Believe me, I would know. Dean has some research that says that the SSRI antidepressants will HELP neuroplasticity but they sure as hell won’t do it for you. The only way to recover from a stroke is time and hard work.
I had never heard of this and didn’t know what the hell it was until I took a course taught by Peter G. Levine. BDNF stands for brain-derived neurotrophic factor. That’s a really long name for a protein. BDNF is a protein that is produced by the brain. It helps neurogenesis – it makes new brain cells. New brain cells = neuroplasticity. Neuroplasticity is the rewiring of the brain. BDNF has been referred to as Miracle-Gro for the brain. So we want it. Stroke survivors want a lot of it. Exercise stimulates its secretion. So the moral of the story is…..workout……a lot. Here, read this.
Everyone has heard of an MRI. Maybe you don’t know exactly what it is – well this is what it is. In simple terms, an MRI takes a picture of the soft tissues of the body. An x-ray takes a picture of bones. So if you break a bone, you get an x-ray. If you tear your ACL or have a stroke (like me!!!) you get an MRI. Well hopefully you get an MRI if you have a stroke, I almost didn’t. Anyway, an x-ray takes pictures of bones and an MRI takes a picture of pretty much everything else. So ever hear of a functional MRI(fMRI)? This is an MRI that scans your brain while you are performing a task. They can look at what part of the brain/how much of the brain is being used to perform that motion. The EXCITE trial kind of kicked off the excitement(no pun intended) about neuroplasticity (rewiring of the brain). This study showed that when a stroke patient is thought to have no more recovery in the brain, a whole lot of recovery can take place. Keep at it, the brain changes for the rest of your life. Site about different imaging techniques.
- FMRI Brain Scanner Reads Thoughts Letter By Letter (medicalnewstoday.com)
A stroke is a brain injury, not a muscular injury. It may seem like your muscles don’t work anymore but they do, they’re still there and just as good as they once were, well at first that is. Soon atrophy starts and that’s when your muscles will look less developed. But the actual stroke doesn’t affect the muscles. You just have to work a hell of a lot harder to use them and learn to use them again because the signal to them from the brain is messed up. That’s why the physical therapists make you do all those weird exercises. They want to make those signals work again, or make new signals. They’re trying to neuroplastically change the brain. You know the phrase “use it or lose it?” It’s true. Before the stroke, I could just move every direction, every way, upside down and forward without thinking about it. It was second nature to me. After the stroke, I had to ‘learn’ how to move again. This is called motor learning. I wasn’t learning how to move in the traditional sense, I knew HOW to move cognitively, my muscles just didn’t cooperate. I had to ‘learn’ to use them again. So now I don’t really weight train, well sometimes I do, but I try to do everything I can by myself. Every time I do a ‘new’ movement, or ‘old’ movement, I’m helping to rewire the brain. Neuroplasticity takes a lot of repetition. You know how athletes get better? Lots of repetition, they’re ‘rewiring’ the brain. Use it or lose it. Love this.