What does stroke rehab look like in the future?
This is only my vision, please add your comments. I'm sure a medical person doing
this would come up with something different.
A scan(CT or MRI or something even newer) is done showing the damaged areas of the
brain, the dead area and the penumbra. This is then mapped to a 3d representation
with the medical staff enumerating the damaged area functions. The penumbra
representation is probabbly the most important since this is the area that normally
spomtaneously recovers in 6-12 months. Penumbra recovery is what most therapies like
CIMT depend on. This is where the 'Use it or lose it' statement comes from. Dead area
recovery is much more difficult and requires neuroplastically moving control to
another location in the brain. For extreme recovery there is this girl with an early
stroke with only half a brain.
http://www.pbs.org/saf/1101/segments/1101-6.htm
I know that currently the penumbra is not scanable but until it is any therapy
protocol is just a shot in the dark.
So the therapies for penumbra recovery should be completely different than the
therapies for dead brain recovery.
Preventing another stroke is not an area I have any expertise in, so I won't comment.
Penumbra recovery would have a list of therapies mapped to recovery of impaired
functions, including the efficacy of those therapies.
Dead brain recovery would also list therapies mapped to recovery of dead areas.
Most of the research I have seen makes the assumption that their protocol is what
causes recovery and there is never any discussion of spontaneous recovery being the
cause.
Based on this we should be able to ask our therapists for proven therapy protocols
that map to the damage specifically seen.
With this information we will be able to tell what is relatively easy to recover and
what may never recover, so rather than our doctors not telling us anything about our
recovery they may be able to say with a lot of hard work you can recover these
functions.
With two lists we could see what researchers have proven and add our personal
experiences to them.
The 3d scanning ability is available now. Penumbra scanning is something to ask research colleagues on. The lists of therapies for penumbra recovery vs. dead brain recovery is something that survivors could do. Somehow we have to get this in front of all the stroke asssociations across the world, and ones like Society for neuroscience. Maybe an article in World Stroke Organization magazine, International Journal of Stroke.
Ok, It is submitted as a viewpoint article to International Journal of Stroke. I doubt it will get printed but at least the editors can discuss. I would highly recommend others to submit viewpoint/opinion articles to them. I know it mainly is expecting submissions from doctors/researchers but sometimes we have to shout to be heard.
Dean
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