Relearning the Activities of Daily Living

 For patients who are recovering from a recent stroke, or similar brain injury, one of the struggles they face is the loss of independence in everyday life. The basics of self-care – eating, bathing, dressing, toileting, transferring (walking), and continence – which we usually take for granted, become activities that cannot be done without assistance. These activities of daily living (ADL) are tasks that must be relearned.

Regaining the ability to care for oneself is synonymous with returning to living an independent life. This is achieved through a process of occupational therapy which involves both relearning the muscular movements necessary to carry out tasks as well as increasing confidence levels in one's abilities in order to achieve a full recovery.

Task-specific Training

In order to relearn the processes needed to carry out the ADLs patients must undergo a regimen of exercises to regain coordination and strength, and to improve motor skills. These exercises are task-specific and tailored to the patient depending on which components they are missing. They focus around using repetition to build up muscle strength and memory.

A variety of techniques are used to retrain the muscles. For example, mirror therapy in which a mirror is placed on a table so that it covers the affected arm and reflects the unaffected one. This triggers mirror neurons, which are in the same area of the brain as motor neurons, making the patient think both arms are carrying out the same action. Recovery can also be aided through brain stimulation. Wires are placed on the scalp through which current stimulation is sent to the brain. This excites damaged areas of the brain, helping to increase the chances of them recovering.

The tasks do produce improvements in function and also cortical reorganization, however, these improvements do not generalize and transfer beyond the targeted activity or area. As such a range of exercises is required to improve motor activity in several areas.

Cognitive Strategy Training

While task-specific training is the only way to help patients recover their previous coordination and muscle power, this can be supplemented by cognitive strategy training. This involves utilizing the brain's ability to reorganize and create new pathways to improve cognitive skills such as attention, working memory, logical thinking, reading, and occasionally psychosocial functioning. This can be used in tandem with the physical exercises to increase self-esteem, and problem-solving strategies, as well as regulating training frustration.

Recovery can be a long and discouraging process. In order for the combination of these training techniques to have any lasting effect on motor improvement consistency is crucial. However, with time these exercises can enable stroke rehabilitation patients to live independently again.  

The Long-Term Effects of Sports-Related Head Trauma

 At least 300,000 sports-related head injuries occur in the United States every year. The short-term effects of sports head injuries have long been known. Concussions, as the result of a blow to the head can cause headaches, dizziness, and nausea in the short term. More recently it has been discovered that head injuries can cause problems long after the initial incident.

Post-Concussion Syndrome (PCS)

Around 15% of people who have suffered a single concussion develop persistent, injury-related symptoms. These can last anywhere from a couple of weeks, to a few months, up to a year. While the immediate symptoms of concussion are fairly mild, PCS can manifest itself in the form of noise sensitivity, concentration and memory problems, depression, and anxiety. It is thought that this condition can be exacerbated by pre-existing psychological conditions, being female, and being an older individual. While PCS cannot be treated as a whole, medications can be administered to alleviate certain symptoms, while psychotherapy and neurotherapy can be carried out to improve mental health and brainwave activity.

Chronic Traumatic Encephalopathy (CTE)

Another, more extreme consequence of repeat head injuries is CTE. This syndrome only manifests itself around 8 to 10 years after injury, and is most prevalent in professional athletes in sports such as football, boxing, wrestling, and ice hockey.

Symptoms develop in four stages- the first stage is characterized by a deterioration in attention, increased disorientation, headaches and dizziness. Later this condition develops to cause memory loss, social instability, erratic behaviour, and poor judgement. In the final two stages, patients may suffer from progressive dementia, reduction in muscle activity and control, vertigo, deafness, and, in extreme cases, suicidal tendencies.

The reasons behind why this happens are largely unknown and currently the only method of diagnosis is through post-mortem direct tissue examination. Treatments may include the use of speech and language therapists, and occupational therapists, however, as there is currently no cure, most treatment revolves around supporting the patient, and making him or her comfortable.

There is presently little conclusive research on the prevention of CTE, however, it is thought that immobilizing the head during a blow may prevent the future memory loss and learning difficulties associated with CTE. Of course, the best preventative action is to reduce the risk of head injuries, and to allow time to fully recover following any concussion which, for 85% of cases is up to three weeks.

Everything You Need to Know About Strokes

This week we tell you everything you need to know about strokes: how they are caused, how you can recognise one, and how they are treated.

Causes

Strokes are caused when the brain does not receive enough oxygen. There are two ways in which this can occur. An ishemic stroke, the more common form, is caused by clots in the blood vessels which supply the brain which stop the blood flow. The second, rarer form is the hemorrhagic stroke, which is caused by ruptured blood vessels bleeding into, or around, the brain.

Symptoms

There are various physiological indicators that a stroke has occurred. It is often signalled by a sudden numbness in the face, arm, or leg, and especially on a single side of the body. This may be accompanied by sudden confusion, and the inability to speak or understand others' speech.

Trouble seeing in one, or both, eyes can result from a stroke, as can having difficulty walking, and losing balance and coordination. The final symptom of a stroke is a sudden, and severe headache.

The sooner a stroke is identified and treated, the less permanent damage it is likely to do. This is because, the sooner treatment is administered, the more of the brain can be saved.

Cures and Therapies

Accute stroke therapies are administered to try and stop the stroke while it is happening, either to stop the bleeding or to dissolve the clot. If the cause of the stroke is ischemic aspirin is given, as this has the effect of thinning the blood, preventing further clots. With hemorrhagic strokes it it a little less straight forward as the patient must be monitored to ascertain what the cause of the bleeding is. It may be as a result of blood thinning medicines, high blood pressure, head trauma, or blood vessel malformation. Once the cause is identified tre

atment can then be tailored to the patient's need. Immediate emergency care for hemorrhagic strokes is concerned with controlling the bleeding, and medications may be given to reduce blood pressure or to slow the blood flow.

In the case of quickly identified and treated strokes there may be very little lasting damage, however, for some, there may be a need for a range of therapies to relearn certain skills. Strokes can cause paralysis or movement control problems, pain, difficulties using or understanding language, memory and thinking problems, and emotional disturbances, depending on which area of the brain is affected. Rehabilitation therapy involves the input of a range of specialists including physiotherapists, psychologists, occupational therapists, speech and language therapists, dietitians, specialist nurses and doctors, all of whom work to help patients relearn skills to make them as independent as possible.

Strokes can be damaging but the key to full recovery is knowing and recognising the signs and taking early action to get medical help.  

Introducing Dr. Spinner

Last month we met Dr. Joseph Herrera. This month we introduce you to Director of Pain Medicine and Minimally Invasive Spine Surgery for the Department of Rehabilitation Medicine, Dr. David Spinner.

Dr. Spinner has always had a keen interest in sports, specifically baseball, basketball and the winter Olympics. Besides being a fan of various teams, he has also participated in many sports over the years, including volleyball, skiing, tennis, and most preferred of all, baseball. This interest in sports directly links to his current particular interest in sports injuries and the related field of musculoskeletal medicine. Musculoskeletal medicine is left largely unexplored in most medical sectors and it was his interest in this niche topic which led him to eventually specialize in Rehabilitation Medicine.

The medical education leading towards Dr. Spinner's eventual specialization began at Emory University, before being continued at the New York College of Osteopathic Medicine. Following this he completed an internship at Maimonides Medical Center, Brooklyn and subsequently embarked on a residency at the Icahn School of Medicine. In 2015 he won an award for pain medicine fellowship excellence for his work during a fellowship in Interventional Pain at the Beth Israel Deaconess Medical Center and the Harvard Spine Center. He has made contributions to furthering the field of Rehabilitation Medicine through investigating new ways to advance procedures and improve patient care. Dr. Spinner is one of the first physicians in the country to be certified in diagnostic musculoskeletal ultrasonography, and performs many musculoskeletal pathologies. His focus lies in ultrasound guided interventions, advanced spine interventions, and minimally invasive spine surgery, and he has written several publications concerning these techniques. The list of other interventions that Dr. Spinner performs also includes spinal cord and peripheral nerve stimulation, kyphoplasties, endoscopic rhizotomies, and disectomies.

As a specialist within his field, Dr. Spinner lectures on musculoskeletal ultrasonography across the country and was the lead editor for the Atlas of Ultrasound Guided Musculoskeletal Injections, the first textbook on this subject. He has developed his own unique strategies towards the treatment of both acute and chronic pain.

The interest that Dr. Spinner has in this field continues beyond his professional practice. He is a supporter of various pain and musculoskeletal charities, including the Facial Pain Association, a resource for information and guidance for those suffering from neuropathic facial pain. Dr. Spinner is also an active and involved supporter the Wounded Warriors Project, whose mission it is to honour and empower war veterans who suffer from physical and mental ailments in relation to their military service.

Tips to keep your brain young and healthy

Changes in our brain functions are a very common consequence of ageing and mental decline may be one of the most feared results of getting old. According to research more than 16 million people in the United States suffer from cognitive impairment, which means they have trouble remembering, focusing or even learning new things.

If you are noticing some of the early symptoms of cognitive impairment such as forgetting appointments and recent events or having trouble making sound decisions here are a few tips to keep your brain healthy and young.

Exercise

Physical exercise can help the brain become more efficient and adaptive to change.  According to Harvard Medical School “research shows that using your muscles may also help your mind. (…) Exercise lowers blood pressure, improves cholesterol levels, fights diabetes, and reduces mental stress, all of which can help your brain as well as your heart.” Exercising 3 times per week is a great way to start.

Eat healthy

A healthy diet can help both your body and mind. Eating foods that are low in saturated fat and keeping your calorie intake balanced will keep your brain younger. Also, vitamins B6, B12 and folic acid, which can be found in cereals and grains have proved to reduce homocysteine levels that are linked to cognitive impairment.

Mental Exercise

Engage in activities that challenge and stimulate your brain. Try solving math problems or crosswords, painting, or learning a new craft or language.

Socialize 

By having friends and going out, you are open to new experiences and challenges. They are also a great motivation when it comes to getting involved in several activities.

Avoid tobacco, alcohol and other drugs

Excessive abuse of tobacco, alcohol and other drugs can reduce your ability to remember, focus or execute tasks.

Keep your emotions balanced

Even though extreme anxiety and depression are not linked to cognitive impairment, it is always beneficial for your metal health to keep your emotions balanced.

Maintain social connections

 Constant communication and interaction with others is very important in maintaining social connections. The ability to bond with others over a period of time is associated with lower blood pressure and better mental health.  

Avoid injuries

Head injuries such as concussions can affect your brain’s activity while getting older. Reduce the risk by protecting your head.

These are just some simple tips and tricks to help your brain stay young and healthy. They are easy to incorporate in your everyday life, and will also improve your physical and mental health.