Advances In Regaining Function Post-Stroke

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By: Dr. John Conde, DC, DACNB Special to the Boca and Delray newspapers

Through groundbreaking medical research over the last decade, there is hope for stroke patients to regain functionality through a process termed adaptive plasticity. Adaptive plasticity is the process by which the brain and nervous system can change and be “re-wired” according to the environmental stimulus it is exposed to. With this information, there is new hope for individuals that have recently suffered a stroke but also for those patients that have had significant functional deficits for years without proper rehabilitation. In conjunction with all this exciting new research, novel therapeutic approaches are available now to fully take advantage of adaptive plasticity.

Traditional rehabilitation encompasses speech therapy, physical therapy, and occupational therapy which are essential in the acute and sub-acute phases post stroke. However, advanced therapeutic interventions exist which not only work on the physical deficits of the injury but also on the neurological compromise. These therapies work on the “re-wiring” and o setting new brain maps. Three cutting-edge rehabilitative procedures will be reviewed and include Interactive Metronome, Dynavision D2, and Computerized Assessment of Postural Mechanisms (CAPS).  They have been extensively studied and allow the examiner and therapist to objectify the findings allowing for proper progression.

In referencing Interactive Metronome, this is primarily a motor-timing therapy. It works on a neurological process called efferent copy which integrates the cerebellum and the frontal lobe, two very important parts of the brain that allow us to have executive functions and independent thought processes. The exercise requires the user to keep up with a computer generated beat that is delivered in both an auditory and visual manner.

In regards to the Dynavision D2, this is a revolutionary diagnostic and rehabilitative tool. It works on visuo-motor-spatial skills as well as the efferent copy mechanisms referred to earlier.  This therapy also has a positive effect on the cerebellum and the frontal lobe. The user is required to manually compress targets made up of LED lights that are blinking in a strategically established manner according to the neurological presentation of the person. The information is recorded and attention is focused on speed and sequence.

Lastly, CAPS or computerized assessment of postural systems is a diagnostic and rehabilitative modality. One of the first signs of neurological injury is disequilibrium which sometimes cannot be visually perceived or even elicited on a bed side exam. The CAPS unit is able to measure the smallest amounts of sway on a very sensitive accelerometer and provides an abundance of information for the practitioner to more effectively diagnose the deficiency and create an appropriate treatment plan. It is also used for therapeutic interventions by working on expanding what is termed the center of mass (COM) from the center of pressure (COP).

Nutritional and dietary considerations must be taken into account when rehabilitating a stroke patient. Emphasis must be placed on reducing inflammation through anti-inflammatory based diets that remove foods like red meat, fried foods, dairy, peanuts, and partially hydrogenated oils.  Importance must also be placed on consuming a low glycemic diet to reduce excessive insulin production from the pancreas and subsequently reduce the neurodegenerative effects of insulin on the brain. In conjunction with eating more complex carbohydrates it is important to eat many meals throughout the day. I usually recommend eating every two hours with the largest meals coming before 2:00PM. Anti-oxidants such as CO-Q10, reduced glutathione, acetyl-L-carnitine, and alpha-lipoic acid are effective free radical scavengers. Following a stroke, free radical production is significantly elevated due to altered physiology therefore reducing there harmful effects on cells is conducive to healing.

Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, drconde@thecondecenter.com, and at www.thecondecenter.com