Stroke Research Ideas

[Fyzzio]

Hi,
I have not replied to any of your other posts (which, by the way, all are similar; penumbra etc.), but feel obliged to do so now.

I appreciate how frustrating the lack of recovery can be.

Your first comment is rather insulting to our profession - we relate our therapy interventions to patient goals, so please don't play down any comments that patients make .

Could you please consider the following:

a) In more than 20 years of Neurophysio, I have not seen 2 patients with the same MRI/ CT scan result (even the common "superficial" ones), who present with the same symptoms
b) I have also not seen that the same intervention always has got the same effect on different people
c) I can also not promise, that I will provide the same intervention in exactly the same way on two consecutive days, using the same words, touching in the same way, even giving the same resitance
d) Dead brain is exactly that - dead. No matter, how well neuroplasticity works, no by-pass it will be able to create will ever replace exactly the function, the brain was coordinating before.

As much as Physio is a science, it is an art, and as that not to be underestimated. The human being consists of more than physical building stones - there is also a mental component, a spiritual one and a family one, if not more. I believe they are all equally important.
Even if we are ever able to link penumbra damage to functional presentation and therapies to hard core neuroplasticity, to purely rely on that will not mean anything - in the sense of guaranteed function recovery.

Good luck with trying to prove me wrong.

Regards,
Fyzzio

[oc1dean]

I don't have to prove you wrong, The medical establishment has to be able to prove its hypothesis without using clinical experience - See Toni Patts' blog on Advance. I look at this from a cause and effect analysis. Effect - lack of dorsiflexion, What is the cause? motor cortex is damaged but alive; motor cortex is dead; pre-motor cortex is damaged but alive; pre-motor is dead; executive control is damaged but alive; executive control is dead. Each of those causes should have different possible therapy interventions. Dead brain is dead but the functions can be relocated or maybe neurogenesis works. The only problem there is whether parts of the brain can do two functions at once or functions are kicked out and replaced by the formerly dead functions. I refuse to believe that dead brain functions can not be recreated, they may not be the same but the girl with epilepsy that had half her brain removed and still functions quite well proves that relocation is possible. All I am asking for is the scientific method be applied to stroke rehabilitation. I don't believe in the comment ' All strokes are different, all stroke recoveries are different'. The first part is definitely true, the second part has yet to be proven.
This could all be easily resolved if we get a longitudinal research study like the Framingham heart study.
Anyway,I am a 'bad' patient.
If you're lucky you will never meet a 'bad patient'asking, Why, Why, Why?
I have been reading a new book, Deep Survival : Who Lives, Who Dies and Why by Laurence Gonzales.This paragraph on page 82 I think should be applied to us stroke survivors.

Psychologists who study survival say that people who are rule followers don't do as well as those who are of independent mind and spirit. When a patient is told he has 6 months to live, he has two choices: accept the news and die, or rebel and live. People who survive cancer in the face of such a diagnosis are notorious. The medical staff observes that they are 'bad patients',unruly, troublesome. They don't follow directions. They question everything. They're annoying. They're survivors.

[Fyzzio]

Hi,
thanks for this interesting discussion. And we do agree in so many points. You still, however are only looking at the brain. What about muscle physiology and the loss of motor units and neurons?

Another question:

All I am asking for is the scientific method be applied to stroke rehabilitation

So, you want a 'one problem - one treatment' rule

Psychologists who study survival say that people who are rule followers don't do as well as those who are of independent mind and spirit.

Should they ever be able to prove a scientic, 100% guaranteed treatment which links directly to the 'damaged area', will you follow it? Or will you be unruly and annoying - as this is part of surviving? Do you believe any research is ever going to be good enough for you?


Please also look at the logistics of a study. About 10 years ago I went to the Annual Scientific Meeting of the Stroke Society of Australasia. The last topic of the day was 'Research: when is enough enough'. The two gentleman on the podium (the Director of the Society and the Head of the Cochrane Stroke group) were unable to agree on the sample size of any Stroke related trial and compared Stroke trials to heart trials. Apparently, the trial to officially accept Aspirin as prescrition medicine included 25.000 patients and was considered a not large enough study.
We know these days that after a stroke, the harder you physically work and the more often you work, the better the results are. However, the sample sizes for these trials have been fairly small. Not because that's what they wanted to do, but because of the nature of the disease. After all, in most cases, Stroke is a consequent problem on top of an already established deficit. In the past, I had a young stroke client with a CO of 11%. All those people you have to exclude from studies.

There are so many more things we could go on about now. Aren't there? This is fun.
Have to go now,
cheers,
Fyzzio

[oc1dean]

Yes we do agree a lot. I heard similar arguments from my wife,'What the hell makes you think you know more than your medical staff?'
I would love to see case studies, but you're right I would continue to be a bad patient, my last neurologist lied to me rather than say he didn't know the answer.
Cheers again,
Dean