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| Peter G Levine The Stroke Recovery Blog |
There is a common suggestion among many in the "alternative medicine" industry expressed in the question: "If it means less business, why would your doctor want you to be healthy?" A strict emphasis on healthy lifestyle including diet and exercise would be like the proverbial "apple a day" - keeping the doctor away.
Doctors who do this - who keep themselves away as much as they can - are the best doctors. And therapists who "keep themselves away" are the best therapists.
Many pathologies allow for a definitive discharge point. The patient who has had a knee replacement gets therapy, and then goes home to live the rest of his life. But neurological disorders are different. Many, from Parkinson's disease to multiple sclerosis, are progressive. But what of non-progressive neurological disorders like stroke and traumatic brain injury? Does this "apple a day" philosophy work? Is there a point at which these populations no longer need therapists?
Many patients with brain injury (including stroke) believe that they will always need therapists. Most see therapists as essential to the recovery process, no matter how long (months, years, decades) it takes for them to achieve their highest level of potential recovery. But this view is incorrect.There is a point at which therapists are no longer the fulcrum for recovery. Nor should they be, for reasons that range from financial to practical. At discharge stroke survivors are, and should be, in complete control of their own recovery. During the chronic phase of recovery from stroke, the speed of recovery slows. The physiological action of recovery is based on a lot of self-directed hard work. Much of what is required is relatively simple, and revolves around the broad concept of repetitive practice. In order to take charge, stroke survivors need to be given the tools to initiate and follow an "upward spiral of recovery." This term is used to describe the path to the highest level of potential recovery. The "upward spiral of recovery" is driven by real-life demands for everything from coordination to cardiovascular strength.
3 comments:
I am 16 months post-stroke. I had a month of inpatient rehab and a month of out-patient, and that's all I needed. I walk well, drive, and have returned to work. In fact, if it wasn't for this cursed spasticity, I would say I'm in better physical condition than pre-stroke, since my blood pressure is now under control, I eat better and exercise regularly. I attribute most of my recovery to the fact that I never suffered from the debillitating fatigue that most stroke survivors complain of. I truly wish that there was a serious research effort undertaken to understand why some survivors are spared.
February 10, 2013 at 9:32 AM
5711 frdiatI don't think there is any science backing your claim. i think the rich do better than the poor having more and longer therapy. I'm not sure what your 'discharge point is:' acute rehab? when the outpatient therapist says you've plateaued? Do you think speech therapy should end also? What if you can't find resources, are unable to do math? New therapy tools like the Tibion? I think Medicare must be following your philosophy in their recent reduction of outpatient therapy.
February 11, 2013 at 3:35 PM
Hi Pete, I respect you a lot, but I had to comment about this.
- “Discharge” often comes way too early, in my experience. Especially people who have serious cognitive and language deficits.
- If people know that they can come back when they get “stuck”—for instance, an especially spastic muscle group, or a particular task they want to do but can’t figure out a way to start working on it—more people might feel OK with stopping therapy for a while. But usually, once you’re discharged, that’s it: you can’t come back.
- My best experiences in therapy have been group therapy (language and OT), at about a year or two post-stroke. The rules about reimbursement were even more complicated than one-on-one therapy. I didn’t participate in another group because I would have to be discharged, and I wouldn’t surrender the choice to keep going with therapy if I needed it. Instead I opted to have therapy about once a month (after I won an appeals process).
- Many survivors in the chronic phase are still very isolated—there are so many, many obstacles to have a social life. Therapists are often the only people who have any idea what survivors are going through. My answer? Insurers need to make group therapy (PT, OT, and Speech) much more accessible and affordable, and that way, the survivors have a built-in support network.
- Grace www.myhappystroke.com
February 13, 2013 at 9:09 AM
See the original article DIY Stroke Recovery
in The Stroke Recovery Blog
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