Functional Intervention

for

Neuroplasticity

After a

Stroke

Mary Gessler, BS, COTA/L

ME

BS degree from Northeastern University,

Boston, MA

Corporate employment 19 yrs.

OTA graduation in 2011

Professional employment and specialization

in CVA treatment – 6 yrs.

ME

Stroke team co-champion

Responsible for monthly community stroke support group

Began stroke community outings March 2017

Specialty Stroke Education

American Stroke Association, Stroke Rehab Specialist training

NDT training

Hemi-Move 1 & 2

And many many more …..

Stroke Facts

Stroke is the fifth leading cause of death in the

USA

Stroke kills more than 130,000 Americans each

year

Someone in the USA has a stroke every 40

seconds

Every four minutes a person dies from a stroke

Stroke Facts cont.

Yearly 795,000 strokes occur in the USA

610,000 are first strokes

185,000 are recurrent strokes

20 - 64 yr. olds make up 31% of all strokes

Stroke Facts cont.

Stroke is the leading cause of long-term disability.

Mobility is reduced more than half in stroke survivors 65

and over.

75% of stroke survivors experience UE impairments

persisting into the chronic stage.

Symptoms of Stroke for All

Confusion

Depression

Difficulty speaking

Balance issues

Numbness or weakness

Severe headache

Vision disturbance

Stroke in Multi-Cultures

The following cultures have a higher risk of strokes:

African American

Hispanics

Asian

Pacific Islanders

Women Are Different Than

Men

According to University TX Southwestern Med Center

Symptoms include:

Difficulty breathing

Feeling weak all over

Hallucinations

Seizures

Sudden behavior changes

Nausea / vomiting

Women Stroke Facts cont.

Yearly in the USA approximately 55,000 more women than men experience stroke

More women die from stroke than breast cancer yearly

After stroke, women have greater disability than men

Increased risk is due to hormone status, pregnancy, & childbirth

Risk Factors

More Common in Women High blood pressure

Diabetes

High cholesterol

Migraine headaches

Atrial fibrillation

Emotional stress

Depression

Neuroplasticity

Neuro = nervous system (brain & spinal cord)

Plasticity = plastos or moldable

Definition:

Neuroplasticity is involved in motor learning

rehabilitation after stroke

So What is

Neuroplasticity? Our brain continues to change throughout our life time

The brain has the ability to rewire itself after trauma

Research shows that the brain can generate new neurons

(known as neurogenesis)

Neuroplasticity cont.

Key to changes in Neuroplasticity:

Chemical Signals

Altering it’s Structure

Altering it’s Functional Change

Chemical

Transferring chemical signals between

neurons and triggers actions and reactions.

This represents our Short Term Memory

Change happens very rapidly

Structure

Altering the structure

Brain changes the connections between neurons which takes more time.

Physical changes takes time which represents our Long Term Memory.

Functional Changes

Altering function as you use a brain region it becomes more and more excitable easy to use again.

With learning different networks of brain activity is happening.

The brain shifts how and when they are activated

What Does Pavlov Have to do

With This? Pavlov used a type of neuroplasticity

Rang a bell = Salivation

For Motor Learning to Occur:

Challenging NEW/novel task

Repetitive Practice

Functional task

Novel environment

Motor Learning

Definition: a relatively permanent change in behavior

due to practice.

Motor learning: a set of processes associated with practice leading to a permanent change in the capacity for skilled action

Acquiring the capacity for skilled action

Learning takes practice and practice

Learning must be performed

Learning produces a change in behavior

Motor Learning

The brain should be focused on task in order for motor

activity and motor learning to occur

The activity must be:

Meaningful to the patient

Challenging

Changed frequently

Motor Learning cont.

Motor Performance is the temporary change in

movement behavior seen during a practice session

Motor Learning is a permanent change in movement

behavior measured after a retention period

Motor Learning is only due to practice

Types of Learning

Declarative Learning

Facts or Knowledge that can be expressed in declarative sentences

Remembering a phone number

Controlled by the cortex

Practice can transform declarative learning to procedural learning

Procedural Learning

Procedural Learning

Occurs without attention or conscious thought

Walking, swimming, riding a bike, dancing

Develops slowly through very high repetition

Expressed through improved performance on a task

Controlled by the cerebellum

Therefore performance is still possible in the absence of

cortex (brain injury, dementia)

Characteristics of MCA

Middle Cerebral Artery Syndrome (MCA)

Weakness on affected side of body in the arm more than the leg

Sensory and weakness on affected side in face

Gaze impairment

Homonymous Hemianopsia

Aphasia

Ataxia on the affected side

Perception difficulties

Characteristics of ACA

Anterior Cerebral Artery Syndrome (ACA)

Weakness and sensory loss

Urinary incontinence

Frontal Lobe damage

“Akinetic Mutism”

Definition: A medical term describing patients tending to neither move(akinesia) nor speak (mutism). First described in 1941 as a mental state where patients could not move or speak.

Characteristics of PCA

Posterior Cerebral Artery Syndrome (PCA)

Memory deficits

Involuntary movements

Homonymous Hemianopsia

Difficulty recognizing people

Dyslexia with reading only, writing in tact

Characteristics of Pontine

Stroke

Double vision

Dizziness

Vertigo

Slurred speech

Imbalance

Video

Video of Carl

Cerebellum Stroke

Decreased Balance

Decreased Movement

Vertigo

Headache

Vomiting

Ataxia

Video

Video of H.B. dancing with wife.

Right Hemisphere

Damage Highly distractible; with short attention span

Poor judgment and safety

May be disoriented

Poor insight into their condition

Confusion, time, space concepts

Motor problems

Eye hand coordination

Right Hemisphere cont.

Balance issues

Visual field loss

Left Neglect

Spatial perceptual

Impulsive

Difficulty with visual cues

Left Hemisphere Damage

Aphasic

Visual deficits

Difficulty with following directions, repeating words, or actions

Slow and cautious

Perseverates

Uses yes/no inappropriately

Anomic – unable to name objects

Other Interventions

Bioness

Mirror Therapy

Modified Constraint-Induced Movement Therapy (MCIMT)

Dynavision

Mental Practice (MP)

Functional Activities – cooking, grocery shopping, laundry

Pushers

Patients who use non-affected side to push toward

affected side.

Takes approximately 3-4 weeks to resolve

Some cases can last up to 6 months

Associated more with Left hemisphere strokes

Pusher cont.…

Use a wall and mat for patient to sit on so they can’t

move unaffected side

Have a mirror with tape down the middle in front of

patient so they can see what midline looks like

Have the patient reach for an article of clothing using the

unaffected hand

Have patient look in mirror sitting up in midline position

Interventions

What’s is a routine task that’s important to the person?

Example:

Putting on a bra (Theraband, in front on table, W/C,

chair /c arms, EOB, sitting on toilet, Standing, sports bra,

back close, front close (types: hook & eye, snap, velcro,

shoe string one hand, etc)

Intervention Activity

Audience participation – pass out information

Sex is an ADL

Sexuality is a core characteristic for human beings

Important part of development and growth

The ability to be intimate with one another

Some sexual expressions include: holding hands, kissing,

flirting, and sexual intercourse

Sex is an ADL cont.…

Patients may feel more comfortable talking to their OT

The necessary aspects of therapeutic relationship

include: empathy, openness, and sensitivity

Suggest the patient and spouse, or significant other sit

down and talk with you

Ask the couple what is important to them right now in

wanting to be intimate

Tell story about H.T.

Community Resources

Avenues Rehab driving program

Ability Rehab driving program

Next Step – Stroke Foundation

Ability Rehab Program (formally known as Rehab

Institute)

Stroke Support Groups

Community Outing

Important Websites

www.stroke.org (National Stroke Association)

www.strokeassociation.org (American Stroke

Association)

www.aota.org

www.americanstroke.org (Next Step website)

www.nopw.org

References

Stroke Facts. (n.d.). Retrieved July 19, 2017, from

https://www.cdc.gov/stroke/facts.htm

2017 Stroke Fact Sheet. (n.d.). Retrieved July 19, 2017,

from www.Stroke.org

Thomas, A., & Doherty, M. (2017, June 05). Thinking it

through: Using Mental Practice to improve motor

recovery and activity performance in clients with a

stroke. OT Practice, 22(10), 1-4.

References

Bajwa, R. (n.d.). Brain Plasticity; Rewiring the brain.

Retrieved September 13, 2017, from

http://blog.cognifit.com/brain-plasticity-rewiring-brain/

Neuroplasticity. (n.d.). Retrieved July 16, 2017, from

http://www.stroke-rehab.com/neuroplasticity

References

Mac Rae, N. (n.d.). Sexuality and the Role of Occupational Therapy. Retrieved August 14, 2017, from https://www.aota.org/about-occupational-therapy/proffessionals/RDP/Sexuality.aapx

Mc grath, M., & Sakellariou, D. (2016). Why has so little progress been made in the practice of Occupational therapy in relation to sexuality. The American journal of occupational therapy,70(1), 1-5.

References

Walker, L. (2017, June 5). Group Discipline

Incorporating Evidence -Based Modified Constraint-

induced movement therapy in an inpatient rehabilitation

facility. OT Practice, 18-20.

Why are women at higher risk for stroke than men.

(2016). Retrieved July 19, 2017, from

http://www.utsmedicine.org/stories/articles/year-

2016/stroke-symptoms-women-risk

Questions

Notes