Tag Archives: mental imagery

Break it down

Recovering from a stroke is a daunting task.  Where do you start?  What do you do first? What movements need to be trained first? Second? Third? And if that wasn’t enough – what about the very low level stroke survivors?  The ones with lots and lots of impairments.  They have so much to overcome and the day is only so long…What do you prioritize?

Start with one task. Any task.  It almost doesn’t matter what it is – it just has to be important to you, to the survivor.  Walking, getting up from a chair, reaching to grab an object on the table, opening a door, holding a cell phone.  Any task that is meaningful is recoverable. I’ll say it again –

Any task that is meaningful to the survivor is recoverable.

Wait – what? I know some of you are thinking, “but that goes against what the doctors have told me” or “I’ve seen survivors with permanent disability so you must be wrong.”  I’m not wrong and I’m not an unrealistic optimist. Here’s why:

Those doctors aren’t thinking long-term.  They can’t possibly fathom the amount of time recovery takes or the amount of hours that go into it.  They’re taught that the brain, once damaged, stays damaged.  They’re taught to think negatively because in our litigious society, hope can lead to liability. They aren’t dreamers – they can’t be.  Let them handle your blood pressure and cholesterol but don’t let them dictate your prognosis.

And yes, there are stroke survivors who years later have disability. That doesn’t mean that they’re done recovering – it just means that they have “plateaued.” Their efforts and their training are no longer sufficient to challenge the system and promote rewiring.  They are living in the “status quo” because they’ve got a routine that they’re doing and they aren’t changing it.  Maybe they are comfortable with their day-to-day.  It’s safe and they’re not afraid all the time.  That’s absolutely okay – if they’re happy and they have a meaningful life that they enjoy!

But if they’re not happy or fulfilled (or you are the survivor and in that situation) – read on!

What to do:

To change the system you must challenge it to rewire and perform meaningful tasks – and you must do so REPEATEDLY. When I say repeatedly, I mean A LOT of repetitions and quite OFTEN. How many repetitions? While there is no “magic number” studies show that 1200 repetitions begins to activate new areas of the brain.  So there’s a starting point – more than 1200 repetitions before anything even begins to improve….

Well crap (excuse my language) – that’s a lot of repetitions just to get started. (sad face).  And when most of those repetitions are UNSUCCESSFUL there is another issue to deal with – frustration. Frustration is a rehab killer.  The hardest part of rehabbing Dad has been finding a way to eliminate or “push through” the frustration that comes with a lot of unsuccessful efforts.  In order for him to regain movement he has to try to move, but when he makes an attempt and nothing happens, his world comes crashing down again and again.  I’ve tried lots of things to help him through, but ultimately the ONLY WAY that has worked is to break the task down into small and achievable parts.

This is where my background as a physical therapist and a gymnastics coach have come in handy.  If you think of a task as a sequence of parts or a series of movements you can rehab your way back to doing anything. Remember – the brain is plastic (meaning it wants to rewire and learn new things), you just have to stimulate it.

Here’s an example:

The Task: Reaching and grabbing an object on the table with your affected side while sitting.

The steps of that task:

  1. Sitting in a chair with good posture
  2. Bending the elbow and lifting the hand off your lap
  3. Lifting the arm up off your lap
  4. Lifting the arm up onto the front edge of the table
  5. Extending (straightening) the elbow
  6. Sliding/reaching across the table with the arm
  7. Moving your hand close to the object – so that you can grab it (positioning it)
  8. Opening your fingers to place the object in your hand
  9. Closing your fingers around the object
  10. Squeezing the object with enough force to hold it

Now I’m guessing some of those parts you can do right now with success and some you can’t.  That’s okay – you have to start somewhere!  Take any of those parts (in any order you want) and try to do 30-50 attempts of one part several times a day. If you can’t physically move the arm or hand, that’s fine – you’re still trying to connect the brain and the arm so it counts.  If you’re tired of watching nothing happen, take a break from the physical and VISUALIZE IT (see the post titled “Day dreaming can be beneficial”).  That also counts toward those 1200 repetitions. After several days (maybe weeks depending on how many you do per day) and lots and  lots of repetitions – you’ll be able to do that part of the task!  You’ll see success and as Dad reminds me constantly:

“One small improvement leads to more improvements.  It just takes a little success each day to make you want to try again tomorrow.”

With one part down, it’s time to move on to another part and repeat the process.  Keep practicing the first part, but also add in repetitions of the second part.  Ta-da! You have an exercise routine that YOU created and YOU progress! And it’s got the big 3 “must-haves” for rehab and progress – It’s challenging in that it’s different daily and forces remodeling, it’s meaningful to you and it’s repetitive.

The best part of this method is that the possible tasks are endless and you pick what you want to regain most.  If you’re struggling to break something down and can’t think of the component parts – message me or leaving a request in the comments.  I’ll give you a break down of the task you’re working toward and help you learn the process so that you can do the next one.

And remember –

“Through perseverance, many people won successes out of what seemed destined to be certain failures.” 

 

 

 

 

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Day dreaming can be beneficial…

In athletics, mental imagery has been proven to improve performance and to allow athletes better focus (whether it be during practice or during competition).  It allows athletes to review the motor program and the sequence of their movements prior to participation.  It makes them better. Period.

Stroke survivors ARE athletes, so why not visualize the goals that you’ve set for yourself? Mental imagery can relax you, it can focus your attention and it allows you to see success immediately (something stroke doesn’t allow in the “real world”). Just thinking about a task or imagining that you are using the affected arm has been shown to activate areas of the brain and increase overall brain activity.  It helps relax you and can improve your mood.  It is effective as practice for movement even though you are not moving!  It can be done by any stroke survivor, no matter your level of current disability. And most importantly, it is SAFE!  Since you are not moving, you can use visualization anywhere and at any time without worrying about what could happen.

Oh yeah.  One more thing….IT WORKS! Visualization can improve motor function after a stroke!

So how and what do you visualize? How much and how often?

Well, the “how” is easy. Set yourself up in a comfortable chair and minimize all distractions (radio, TV, family, pets, etc).  Close your eyes and force yourself to relax.  Maybe take a few deep breaths to calm yourself before your start.

Now, the “what” is completely up to you.  It needs to be meaningful to you – so be creative and think about things that you are passionate about. (I have Dad imagine walking around Citizen’s Bank Park at a Phillies game – see above).  It needs to be challenging – so imagine yourself rehabbed and recovered, doing things that are beyond your reach now.  And finally, it has to be repetitive – so visualize the same task often during the day/week.  Try to start with 3-5 minutes at a time and work up to 10 minutes as you are able.

Make the images in your brain detailed.  Think about smell, sight, taste.  Focus on sensation (through your affected hand/foot) and allow yourself to imagine everything from temperature, to texture, to pressure.  Recall memories to fill in the gaps – what is the weather like? What does your shoulder feel like?  How heavy is your foot as you lift it?  BE SPECIFIC and don’t let any detail go unappreciated. Most importantly – be dedicated to the idea that this IS going to help you and that you ARE going to recover.  This visualization is a predictor of future events – not just a day dream.