Key principles of rehabilitation

Dear all,

I have been reviewing variouse information on the internet (videos, posts etc.). I feel that most of them does not address the key points of Stroke rehab. Here I am just summarising the key principles of stroke rehab.

  1. Purpose of therapy is to create symmetry
  2. Focus on weight bearing on the affected side, hands and legs
  3. Effects of brain damage are 3 folds, weakness, sensory loss and cognitive changes- all reahb must take into accoint all these 3 aspects.
    4 Core strengthening is absolute key to recovery.
    5 Use sensory exercises.
    6 Understand what is cognition and how it can effect ability to carry out exercise.
  4. Take steps to prevent body parts going into flexion.
    8 Sleeping and sitting position decides how the body is going to feel when moving, so alingnment is essential.
  5. Use whatever activity is there, ‘use it or lose it’
    10 Minimise compensation, think how the unaffected side is moving and try to copy it
    11 Recovery is never ending, hence, continue
    12 Manage fatigue, too many repetitiions would not work - 2-3 repetitions are enough, but needs many times during day, take regular rest
    13 Use stretch and massage
    14 Proper professional guidance is essential
    15 If there is neglect, this needs to be addressed early on
    16 Understand your condition
    17 Involve loved ones in your rehab
    18 Use technology eg FES
    19 Monitor mood, if if you are not feeling happy talk to a professional

It is a checklist, there is more but thiese are the basics of a good rehab programme.

I hope that this helps.

Wishing you all the best.

Kusal - Specialist Stroke OT

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Thanks @kusal that’s really helpful.

I’m having difficulty getting any therapy as the stroke unit can’t refer patients for physco therapy where I am.

I don’t really know what I need and I’m sure there will be a long queue of private professionals willing to help. Physio therapists, occupational therapists, psychologists how do I find who I need and what they can do?

Any advise please​:+1::+1:

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Good starting point @Kusal that could be built into a great resource :slight_smile:

Would you like some commentary on the above?

Caio
Simon

Don’t overlook charities as well, brain injuries charities might be able to offer discounted fees.
Is there a stroke charity near you ?

Ideally you will get some free as part of your rehab.

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Hi Gav,

Sorry to hear that your local stroke unit cannot refer you to physio! I am bit surprised, may I ask where do you live? There must be a local NHS service. I would look for you.

Sadly with NHS unable to deliver, private is the route for many people. I work both privately and for NHS- I deliver the exactly the same care. Lots of therpists do not cover the points that I have highlihgted.

You can search CSP and RCOT website for private therapists.

Please let me know your thoughts.

Kind regards

Kusal

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Definitely Simon , I want to hear from all of you!

Hi @Kusal and thanks again.

I’m in Devon. I’m not really sure I need physio, it’s more brain therapy for cognition, emotions and problem solving it was this that I could not be referred.

I know I’ve been very lucky to not need physio needs but apart from balance and dizziness I’m pretty good in that area.

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Your OP did not format correctly.
It runs 1,2,3,4,5,6,4,8,5,10,11 etc.
This is probably because you don’t fully understand how markdown interprets what you write.

Make all your numbered bullet points start ”1. Your text… " In the edit window that you interact with

Then markdown will post them with format into a numbered list when it displays them - there is a preview window available which is accessed from an icon who’s appearance depends on the interface you’re using but should probably be bottom right corner of the edit window
Ie

1. First
1. Second
1. Third

Will format as

  1. First
  2. Second
  3. Third

You might also clear the grammatical and typing glitches. With the distractions removed it will be easier to focus on improving the meaning, completeness, accuracy, and applicability/ relevance of the listed points.

I’ll comment about semantics of the points when it is easier to unambiguously refer to them and their intention or content

Caio

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@Kusal Thanks for the list. My PT and OT therapists said bi-lateral exercise is very good such as holding a bar to do overhead movements and such, curls, two hands on lat machine pull-down etc. but also important is unilateral moves on the affected side to give more strength and focus to that side.
Such as a single arm row. Or single arm curl. One legged leg extensions.
Would you agree?

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I am sorry Simon, I cannot control software- I hope that what I have written makes sense - if you have any questions about any points please feel free to post it here and I would clarify. I hope that you would appreciate that other than me, there will be only few therapist who would be able to summarise in this manner.

Take care

Kusal - Stroke OT

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Hi Gav,

Thanks for your reply.

You are referring to cognitive rehab, which many OT’s are unable to deliver. OT’s can complete cog screen/assessment but how it relates to practice that were they struggle. Neuropsychologists carry out assessments and provide strategies - but they are very rare. Some OT’s do cognitive rehab- I have developed my own model which I explain to me my NHS and privage pt’s. Devon is a big area- some areas OT’s are not able to provide cog rehab and if there are no neuro psychologists available then clients cannot be referred - as there are no services. Which is the likely reason.

Cognitive rehabilitation can be delivered remotely, so there are options.

If you provide me with a bit more information i.e. what are your difficulties, then I would be able to provide further guidance.

Please let me know if I can be of help.

Kind regards

Kusal

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Hi Outlander,

Your therapists are correct- when we carry out tasks using one side the other side of the brain also copies the same, so using both sides works fairly well. I was referring to weight bearing - when people put more weight on good side- that is slightly different - the way to deal with it is to force brain to put more weight on affected side. So depending on aim of the task it would vary- your exercises would depend on this, hence, clarifying this from your therapists is the best option.

I am only providing a list of factors to consider if you are undergoing stroke rehab.

I hope that this makes sense.

Kind regards

Kusal- Stroke OT

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You wrote the post so you are in control of its formatting. So your really mean you can be bothered?

Words are tokens for concepts, objects, relationships & states. To communicate we need to share understanding of what the token means.

You say symmetry in pt 1. Symmetry relative to what? Left and right sides of my body? Why aim for symmetry? Don’t you really mean mirror image? When I was not broken I did not have equivalence or symmetry between left and right. You now say that’s key? Is that really believable?

I’ve got just as many concerns to make about the other 17 bullets. To make your list valuable will be quite a lot of work but if you can’t be bothered to sort the formatting out to start with why would anybody bother to spend the effort to assist you?

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This is what we could all have done with. Unfortunately, it does not happen in many cases. After I had my stroke 9 and a half years ago I received some help from the NHS for 3 months and was then left to fend for myself. There was no information on what to do or where to go for help. It has cost me many thousands of pounds (and some sheer bloody mindedness) to get to where I am now and I still have a long way to go.

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Hi
Simon - trust me I did try to format it but it would not rectify the issue. Regarding your question, what is symmetry? Plsease refer to this Inserts improve symmetry, velocity in stroke patients | Lower Extremity Review Magazine. It would provide you the answer.

Minnie - I am sorry to hear your experience, but I am glad to hear that you are improving although it has been a very expensive journey.

The purpose of the checklist is not provide treatment, but to provide stroke survivors a tool that they can take to their therapists and clarify if all aspects of stroke rehab has been covered. I would request anyone to chllenge their therapists to explain the clinical reasoning behind the treatment, for me educating my clients is the first thing that I do. Under new initiative clients would be able to self-refer to NHS therapy services, if you need therapy please self-refer and when you meet therapists please discuss the cheklist - this would only help you to get the most out of treatment that you receive.

I hope that this helps.

Kind regards

Kusal

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Hi @Kusal

Hmmm, you mean “I tried but I could not find the way to make it format correctly (and I didn’t really try because if I’d followed your instructions carefully I would find that it all worked)”.

You’re making my points about pt/ot communications for me

You have externalized the cause of the misformatting to something implacable when it is in fact your failure at this stage, and if you don’t move on to fix it it will be our failure. Almost immaterial when it’s words on a forum, life changing debilitation when it’s capability development in a stroke warrior

So far you’re thread is a perfect parallel for what goes on between a stroke warrior and a therapist in both directions when discussion rationalizes away lack of progress rather than use words to establish true communication, which is a prerequisite gateway to progress.

I’m not going to read the reference. Your role as a professional is to be able to render the detailed clinical information in terms that are meaningful to a service consumer. Your first bullet point is not meaningful, does not convey understanding & cannot be reapplied in a personal circumstance by people who have not read the research. It is therefore inadequate. you’re not communicating. You have an aid memoir for yourself perhaps but not something that is suitable to adequately equip a service consumer frame the service that they need (and in the case of the NHS have already paid for)

All your other bullet points contain similar or equivalent weaknesses that could be resolved to be a great resource. Currently it’s the first tentative step that shows that there is a pathway.

What one communicates is not what one writes or says but what is read or heard and understood - It’s hard to do well.

In respect to your “I have a professional responsibility to issue caveats etc” that does mark you out you as different to forum members. we come here for community - It’s not my opinion singly that matters but it might be a conversation for the community as a whole to ask itself about.

I think you need to consider if you’re a member of the community how you present stuff. Further while I don’t know the specifics my suspicion would be the admin told you not to advertise your services for sale like you maybe got close to with that YouTube? rather than prohibited the provision of advice- I expect is a subtle distinction- if every piece of advice comes with “consult a professional” then I’d rather than not have the advice because there’s plenty of other people here who provide their own experiences without the addition

My two cents worth. I won’t reply again unless invited to
Ciao
Simon

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I think Kusal is trying to be helpful. The responses are making me feel somewhat uncomfortable, I would completely understand if he didn’t bother to contribute further.

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Thanks @clibbers1 i too have found Kusals information to me helpful

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Hi Clibbers and GavT,

Thanks for your support.

I felt that stroke survivors are not explained what would help them to get better, in particular what treatments can help them and why . That is why I joined the forum, however, I understand because survivors are not familiar with the reasons for treatment, me explaining the reasons are creating a degree of mistrust and anxiety. My intention was never to cause this, but to provide advice and support to explain what can be achieved. In view of this, I feel that many surivors may not be in a place to use me as a resource at present. Hence, I feel that me leaving the forum would be best step. If anyone wishes to clarify anything, I would be more than happy to support - please email me on kusal_das@hotmail.com. In addition, I post videos on my TikTok channel - if anyone is interested, you can always check it out.

Wishing you all the best.

Kind regards

Kusal

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You have been nothing but helpful to me. I would not have seen this post if I had not actually looked for your profile to see what you have said recently. You have been so helpful to me, in fact, that I would bother to especially look for you. You have not once tried to sell your services here, but given advice freely and appropriately. Former computer builder, repair person, programmer and website design and administration. I can barely figure out how to use my phone post stroke, nor have time to learn new methods in technology when my time needs to be spent on learning how to use my phone, pay my bills, walk without falling, figure out how to groceries and medicines, not to mention how to budget half the income I had when I worked paycheck to paycheck. I hope you stick around, for my sake and for the others you have been helpful to as well. I am saving your email address. I almost wish I tik tokked or that you were on YouTube.

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