2020-11-10

Ep 115 — Stronger After Stroke with Peter G. Levine


“Stronger After Stroke” is one of the most recommended books for stroke survivors by stroke survivors. It is a roadmap for recovery after leaving the hospital. Peter G. Levine talks about the importance of repetition to neuroplasticity. He dives deeply into Dr. Edward Taub’s Constraint Induced Therapy, and what stroke survivors can learn from musicians and athletes.

And Levine joins us in this episode of the Strokecast.

Bio

(From Pete’s Amazon author page)

Peter G Levine Stands in front of a tile wall wearing a black shirt and facing the camera.

Peter G. Levine is a researcher, author, clinician, adjunct professor, and science communicator. His career in clinical research has been dedicated to finding and reporting on the best systems for driving post-stroke brain plasticity.

For two decades Levine has tested emergent stroke neurorehabilitation options including EMG-based gaming, wearable robotics, mental practice, functional electrical stimulation, transcranial magnetic stimulation, and modified constraint-induced therapy (mCIT). He was the lab co-director at the University of Cincinnati Academic Medical Center, and a Research Associate at Kessler Institute for Rehabilitation. He continued his clinical research with The Ohio State University B.R.A.I.N. lab.

Levine communicates what he’s learned in research through his blog, dozens of magazine and journal articles, hundreds of professional talks on stroke recovery and brain injury, as well as his book, Stronger After Stroke.

Constraint Induced Therapy

Constraint Induced Therapy (CIT) at the most basic level, is about encouraging the survivor to use an affected limb by forcing its use. At one level, we all know we’re supposed to use our affected limbs as much as possible. Of course it’s not always easy.

In my case, I try to do something like flip a switch or open a door three times with my left hand. After three tries, I let myself use my unaffected limb. That way I get the practice and I don’t get too frustrated when I can’t do something yet.

CIT takes that to the next level. It involves restricting the unaffected limb with a sling or other mechanism to force the use of the affected limb for hours a day of therapy. It should be done under the supervision of a therapist because there is certainly a risk of falling or other injury when the unaffected limbs we rely on more than ever are suddenly restricted.

But forcing deliberate use of an affected limb is the best way to bring it back on line.

Practice

One of the key themes we talked about was the importance of practice and repetition. Musicians and athletes (like Peter G. Levine and Stephen Page)  know the importance of repetitive, deliberate practice.

Professionals and amateurs who want to be the best they can, practice. And the enjoy it. Spending hour after hour working on a segment of a song or to shave half a second off a run is how they build the skills they need and want to acquire.

Malcom Gladwell in his book “Outliers” popularized the idea that to develop expertise in something takes 10,000 hours of practice. And deliberate practice at that. It’s a theory based on the work described in The Cambridge Handbook of Expertise and Expert Performance.

Developing skills and particular motions after stroke is similar. It requires more and more repetitions. As Pete shares, it takes 1200 repetitions to develop a single motion in a single joint. Of course walking requires dozens of joints, muscles, and motions. So multiply all those 1200s against one another, and get to work!

Homunculus

The homunculus is a representation of the brain and various parts of the body. The more you use a part of the body, the more neurons it takes up in the brain. For example, the hands and tongue take up more space in the than the elbow and pinkie toe.

The more time and energy you dedicate to something, the more space in your brain is dedicated to that task. For example, a homunculus of my brain would likely show a much larger segment dedicated to speaking than to throwing a baseball.

One way I think about how this applies to survivors (and I may be stretching the homunculus analogy) is that a skill from the prestroke days that a survivor was an expert at may come back before a skill one had limited experience with simply because despite the damage there were simply more nerves dedicated to it.

As you continue to work on a skill post stroke, a larger portion of the brain will be dedicated to it. More nerves, dendrites, and synapses will become involved. This is neuroplasticity at work.

Four Lessons for Recovery

Pete summed up his approach and book in 4 lessons.

  1. Recovery takes a lot of repetitive practice.
  2. Recovery takes a lot of visualization.
  3. Don’t expect miracles.
  4. Don’t let the perfect be the enemy of the good.

Hack of the Week

Pete uses a strap with Velcro as a simple, low-cost AFO. It’s a tool that helps lift the toe to make walking smoother and combat foot-drop.

The nice thing about a solution like this is that it also gives you access to a wider assortment of shoes while reducing the risk of tripping.

Links

Stronger After Stroke Blog

https://recoverfromstroke.blogspot.com/

Stronger After Stroke on Amazon

https://amzn.to/2U6MBsD

Pete on Research Gate

https://www.researchgate.net/profile/Peter_Levine2

Stephen Page

https://www.medbridgeeducation.com/instructors/stephen-page-ot/

Kessler Institute

https://www.kessler-rehab.com/

Taub Therapy Clinic

https://www.uabmedicine.org/patient-care/treatments/ci-therapy

Dr. Edward Taub

https://www.uab.edu/cas/psychology/people/faculty/edward-taub

Dr. Jill Whitall

https://www.umaryland.edu/commencement/archived-events/commencement-2018/speakers-and-honorees/jill-whitall-phd.php

Signe Brunnström on Wikipedia

 

https://en.wikipedia.org/wiki/Signe_Brunnstr%C3%B6m

Brunnstrom Stages of Stroke Recovery

https://www.neofect.com/us/blog/understanding-the-brunnstrom-stages-of-stroke-recovery

Modified Ashworth Scale

https://www.sralab.org/sites/default/files/2017-06/Modified%20Ashworth%20Scale%20Instructions.pdf

Homunculus

https://en.wikipedia.org/wiki/Cortical_homunculus

Brian Harris on Strokecast

http://Strokecast.com/MedRythms

Where do we go from here?

  • So check out Pete’s book  here and blog here.
  • To get better, continue practicing and doing those exercises your PT and OT recommended.
  • If you think you reached a plateau, try some different exercises, and keep going.
  • Share this episode with someone you know by giving them the link http://Strokecast.com/StrongerAferStroke
  • Don’t get best…get better

Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

*Amazon links are affiliate links. I may receive compensation for purchases made through them.


Here is the latest episode of The Strokecast

2020-11-02

Ep 114 -- Naps, Gratitude, and Yoga with Kristen Aguirre


Kristen Aguirre was working as a TV reporter and anchor in Denver, CO,  when she had her stroke. What followed, of course, changed her life. She spent months in rehab, eventually returned to the air. She has since left that role and now focuses on her recovery, her workouts, and working with other survivors. We cover all that and more in this episode.

Bio

Kristen Aguirre is an emmy nominated latina journalist turned young stroke survivor. At the age of 31 Kristen suffered an ischemic stroke. It left the entire left side of her body paralyzed. Her doctors told her she would probably need a wheelchair the rest of her life.

Despite the prognosis Kristen kept pushing and never lost hope. After months in the hospital and therapy, Kristen is now back to running, lifting weights and rebuilding her career.

She uses her story to motivate others to never stop pushing and how to hold onto hope in daunting times.

Gratitude

One of the topics Kristen talks about is gratitude. As part of her daily prayer and meditation ritual she makes certain to find something to be thankful for each day. At the very least, we’re here. We woke up today. And that’s the start of any new amazing journey.

Neurofatigue

After a stroke, naps take on new importance. Our brains, working with fewer optimized resources, burn a lot more energy.  Plus, a lot of the work of recovery and neuroplasticity can only happen as we sleep. I talked about it in the episodes on this page.

It can be a big thing in a person’s life. While I don’t deal with it as much these days, it still pops up from time-to-time (usually when I’ve been getting less sleep for other reasons…go figure). If I have another injury it will come roaring back with a vengeance.

When it does, it’s not like being tired. There’s no reserve bank of energy to dig into. There’s not an option to push through, Sleep suddenly becomes essential.

Part of living with stroke is not having a reserve pool of resources or bunch of spare spoons. Naps are the natural result of looking into that pool and finding it empty.

Like Minded

Kristen teaches a women’s empowerment workshop in Jane Connely’s Like Minded program. Several Strokecast guest teach in that program. You can find those interviews with Jane, Joe, Ella, Vince, and now Kristen at Http://Strokecast.com/LikeMinded

To learn more about this program for brain injury survivors that comes from the mind of Heal the Brain with Jane, visit the program here:

https://healingthebrainwithjane.com/membership-purchase

Beauty and Her Brain

 Kristen is starting her own podcast focused on issues women face in stroke world. Kristen herself talked about navigating post stroke life and balancing her deficits with her appearance and with getting comfortable in her new skin.

While she’s working on the show, she’s already profiling some of these amazing women on the Instagram page for the show here: https://www.instagram.com/beautyand_herbrain/

Once the show is live I look forward to listening to it and adding it to this list of stroke-related podcasts.

Links

Kristen Aguirre on Instagram

https://www.instagram.com/kristenaguirre

Beauty and Her Brain on Instagram

https://www.instagram.com/beautyand_herbrain/

Kristen Aguirre website

http://kristenaguirre.org

Kristen on LinkedIn

https://www.linkedin.com/in/kristenaguirre/

Kristen on Muck Rack

https://muckrack.com/kristenaguirre

Kristen on Twitter

https://twitter.com/kristenaguirre

Craig Hospital

https://craighospital.org/

Talking Yoga

https://www.talkingyoga.com/

Like Minded with Heal the Brain with Jane

https://healingthebrainwithjane.com/membership-purchase

Like Minded Instructors on Strokecast

http://Strokecast.com/LikeMinded

Neurofatigue on Strokecast

http://strokecast.com/tag/neurofatigue/

Other Stroke Podcasts

http://Strokecast.com/StrokeRelatedPodcasts

Where do we go from here?

Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.


Here is the latest episode of The Strokecast