Dear Readers,

Welcome to NeuroAiD's February 2009 Newsletter. The idea of this monthly release is to share vital information for stroke patients and their families, and help them deal successfully with the common challenges life presents after a stroke.

This month, we focus on two common disabilities and their recovery strategies after a stroke. 1.) Hands are the chief organs for physically manipulating the environment, their recovery is extremely important. We here present you the latest intervention and a three-step test to examine hand muscle control.     2.) Swallowing difficulty, called ‘dysphagia’. For some stroke survivors, having trouble swallowing can be an invisible - but extremely disabling. We let you discover how the therapist can help you and give you some useful tips. We also take a glance at cortical stimulation, one developing technology on stroke recovery.

We want this to be more than a one-way communication, and would be most happy to hear back from you. What you have experienced and learned will be very valuable to others and we will make sure it reaches as many people in our community as possible. Do also let us know what topics you wish to read in future issues of your NeuroAiD's newsletter.

We would like to assist you in your return to daily life while recovering from stroke. As you are probably already aware, making the best use of time is of vital importance in your stroke recovery. Therefore, please allow us to call you at a number, day and time of your convenience, to hear your questions and explain our answers. If you agree, kindly email us the table below at info@neuroaid.com :

• Number :
• Date :
• Location / time zone :
• Person to ask for :

If you choose to contact us yourself instead, call us on our US toll free number: 1-800-882-4046 / +65-6478-9430 or email us at info@neuroaid.com

The NeuroAiD™ Team at Moleac

Hands are the chief organs for physically manipulating the environment, and each hand is dominantly controlled by the opposing brain hemisphere. After a stroke with partially damaged brain, grasping a block, gripping a glass, pinching to pick up a small ball or simply opening hands … These tasks may suddenly seem to be too difficult to reach. Indeed, impaired hand function is one of the most frequently persisting consequences of stroke.

The essential of the hand movements is controlled by specific part in our brain (within the motor cortex), and accomplished by two sets of muscles and tendons.

After a stroke, if the controlling brain area is damaged, it will also result in the shortening of soft tissue, skin, tendons and muscles. These will further become one of the most limiting factors to regaining hand function later. If the tissues are not stretched, it will result in spasticity which will further limit use of hand and arm and diminish the recovery potential.

The loss of hand functions results from the combination of two factors : a loss of brain activity due to the stroke and the physical changes in muscle and tendons that occur as a consequence. The less active the motor cortex and the more severe the spasticity , the less one can  use his/her hand muscles.
Both problems need to be addressed as part of rehabilitation: stimulating the building of new circuits of information in the brain and releasing the spasticity in the hands, to allow these circuits of information to activate the hands.

Therefore the rehabilitation can indeed be adapted in each patient to the extent to which he suffers from each cause.

Usual interventions include muscle vibration and electrical nerve stimulation in the limbs enhance the motor cortical output to target muscles; mental practice (patient’s concentrating on moving the muscle). NeuroAid, which supports neurological functions, can also help patients to regain hand function more rapidly. With time, the cells in that part of the brain affected by the stroke progressively become more easily activated. The changes in the strength of the connections between the brain and muscles lead to improvements in the ability to use the muscles.

Further intervention are under exploratory development, for example a team of Canadian doctors has developed a test to evaluate hand muscle control: tapping a single keyboard key with the index finger; picking up pegs, one at a time and placing them into holes on a pegboard; and pushing with index finger against a metal bar that measures force. Performance on this test was linked to the ease with which brain cells that control muscle functions can be activated; how active the brain cells are at the time of testing; and the strength of the neural connections between the brain and the muscle. Such test supports then the development of new clinical treatment strategies which will better match each patient situation at the different stages of the recovery process. This may open in the future a route way for more effective individualized optimized treatment protocol for stroke survivors based by adjusting the treatment to the individual’s exact situation and recovery dynamics.

There are specific books or tools such, which may help you find out the exercise which are most suited to your situation – by researching on the internet we came across several books written by stroke survivors who are more than happy to share their experiences. To benefit from these ex stroke patients’ genius creations, you can visit Amazon.

I thought we could use this newsletter to share which books you found to be most useful for your recovery, do write us a short email on which was your favourite book during your recovery journey and why it helped you . We will publish the list of the best ranking books in the upcoming newsletter.

 

Sources:

Medical News Today

Blue Bridge Healthcare, USA

After talking about dysphasia in many of our topics before, we become quite familiar with this subject; however, how much do we know about its twin brother: dysphagia? After a stroke, the damage to speech and movement is usually obvious. But for some stroke survivors, having trouble swallowing can be an invisible -- but extremely disabling. A swallowing disorder called dysphagia often occurs as a result of stroke. Dysphagia may occur in up to 65 percent of stroke patients. If not identified and managed, it can lead to poor nutrition, pneumonia and increased disability.

Following a stroke, weakened muscles in the mouth or throat, a loss of sensation in the tongue, poor muscle coordination, or the inability to cough can impair swallowing. For example, the tongue is a key participant in the mechanism of swallowing. It moves food around the mouth and helps to form an adequate food bolus which can be handled by the rest of the swallowing apparatus. The tongue is also needed for transporting this food bolus back toward the pharynx. If half of the tongue is damaged, it may be difficult for a person to initiate the swallowing reflex effectively by moving food to the back of the throat. Beyond the tongue, if certain muscles are affected, they may not close off the airway enough to prevent food or liquid from leaking into the lungs. Weakened muscles may also delay swallowing or result in an incomplete swallow.

What are the typical signs of Dysphagia? You may want to refer to an expert or a speech-language therapist if you experience these:

• Excessive drooling
• Food falling out of the mouth
• Clumsiness in getting food to the back of the mouth
• Difficulty starting or completing a swallow
• Food remaining in the mouth after swallowing
• Frequent throat clearing, coughing or choking after eating or drinking
• Voice that sounds wet or gurgling
• Complaints of food or drink sticking in throat

The condition is diagnosed by a series of exam. A speech-language therapist will evaluate how well the muscles in the mouth move; he/she will listen to the patient’s voice for an idea of how the voice-box is working. The patient may be given food and liquid to swallow, while the therapist will observe the internal swallowing skills, to see if there’s a problem or delay. For instance, if all the muscles on one side are weak or paralyzed, it’s going to be difficult to chew. They will have something sticking on the right side of the mouth; if swallowing is delayed, it may indicate a problem, normally it takes about a second to swallow, even a small disruption places that person at risk for aspiration into the lungs.

The speech-language therapist will then suggest ways of managing a patient’s swallowing problems. To avoid aspirating liquid, for example, making a simple change in head position may work, like turning it more to one side, or tucking in the chin. The therapist can also teach the patient ways to strengthen the muscles involved in swallowing. A therapist also recommends tips for caregivers or family members to protect the patient from aspiration, such as:

• Make sure that the person with dysphagia sits up in a chair at a 90-degree angle while eating, and continues to sit upright for at least 30 minutes after a meal.
• Don’t use straws which make it too easy for liquid to leak into the airway from the back of the throat
• Allow plenty of time for meals
• Encourage smaller bites and sips
• Reduce distractions like television, music and number of people in the room
• Make sure the person has good oral hygiene

Eating is one of life’s simple pleasures. With proper treatment, most stroke survivors who struggle with swallowing problems will be able to enjoy eating again. "Even stroke survivors who may have to stay on feeding tubes for an extended time don't have to be completely deprived of their favorite foods", says a speech and language therapist at St. Mary's Medical Center Acute Rehabilitation unit in San Francisco, "We can work with them so they can tolerate a small amount of the food they love"...

Sources:

Strokeassociation.org

Stroke.about.com

Jacqueline Gunther (France) - I am a victim of a stroke in 1986 which left me himplegic. I got to know Neuroaid in July 2008 and I ordered immediately. By the end of the first three months treatment, my face is less droopy and my voice went back to normal. I decided to extend Neuroaid beyond the three month… I had an interruption of one month between two treatments and felt I was losing sensation again. After resuming treatment, I regained flexibility in the legs and felt more responsiveness on my face. My speech therapist confirmed these impressions. I would definitely recommend Neuroaid to other stroke patients and to those who have already started to continue, because it really helps.

The disabilities caused by stroke are due to the damaged parts of the brain. Traditional occupational therapy helps physically the patients to regain lost functions. However, what if we try to directly train the brain?

Here is the story of Mr. D in a rehabilitation institute in Chicago. Last year, an innovative trial wascarried on to help patients to regain their motor function. This trial actually investigated the cortical stimulation, which used a small electrode to provide low-level stimulation to the brain when activated during intensive occupational therapy. The novel combination may help the brain develop new circuit of information (pathways) that bypass stroke-damaged brain tissue. These newly established pathways then permanently can take over some of the functions previously performed by the damaged part of the brain.

In practice, cortical stimulation involves surgically implanting a small electrode under the patient participant’s skull, and above the part of the brain where is responsible for motor function. A small battery-powered stimulator is inserted under the skin, just below the collar bone; it triggers the electrode, which is connected through a lead to the electrical stimulator. It is activated only during therapy when the therapist waves a hand-held device over the stimulator.
The surgical implantation takes about 90minutes, during which time patient participants are under general anaesthesia. Mr. D said he had no major complaints of pain after surgery and he went home the next day.

After the occupational therapy is completed, the implanted electrode and stimulator are surgically removed while the patient is under general anaesthesia, but progress made during the treatment remains.

Doctors said that compared to stroke patients who received only traditional therapy, those who also receive cortical stimulation had more improvement both immediately and long-term. Mr. D said that since completing the research, he had been able to do almost everything he could before his stroke – However, not everyone who participates in the research has such a positive outcome, and this therapy is only suitable for those who have moderate movement disorder after a stroke.

On the other hand, the theory in this trial appears to be promising. It shows that an adult’s brain can continue to develop in response of a stimulus and try to fix the problems. That is called  “neuroplasticity”, and will be focus of one of our upcoming issue.

Sources:

Northwestern Memorial Hospital, USA

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