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| Peter G. Levine Stronger After Stroke Blog |
I'm about sick of what I'm starting to call "movement elitism." The idea is that, unless you move perfectly, you shouldn't move. Because… you'll ingrain "pathological movement patterns." I've railed against this before. And here it goes again...
Curious Person (CP)
Clinical Movement Elitist (CME)
CP: Why should a stroke survivor not move when they're alone?
CME: Because they move wrong.
CP: What will moving wrong do?
CME: Make it so they'll never move right.
CP: So what should the survivor do to practice movement?
CME: Wait until there's a clinician around to tell them how to move.
CP: Won't the survivor run out of money eventually?
CME: It’s worth every penny because bad movement is bad. It will make moving right harder.
CP: Don't we all learn to move by correcting mistakes?
CME: Yes but survivors need guidance.
CP: Couldn't they sit in front of a mirror and model the movement of the "good" side?
CME: Yes, but they'd fail in the execution.
CP: So they need to be perfect right out the box?
CME: Yup.
CP: What if they can't move right?
CME: I move them.
CP: Doesn't that defeat the purpose any "productive struggle"?
CME: Survivors shouldn't struggle too much.
CP: Why should they not struggle?
CME: They'll move even worse.
CP: Survivors need lots and lots of repetitions to recover moment, right?
CME: Yup.
CP: And that has to do with forging new pathways in the brain?
CME: Yup. It takes thousands of repetitions to get the brain to regain control over muscles.
CP: How long do you typically see a patient?
CME: About an hour a day.
CP: How many repetitions do you have survivors do in a typical session?
CME: A lot...as many as we can.
CP: Did you know that the number of repetitions done in a typical stroke rehab session has been counted?
CME: I did not. Know.
CP: The average number of repetitions in a typical session for the arm is 18 and for the leg its 38
CME: It will take a while.
CP: How do you reckon the survivor will get to the thousands of repetitions they need? The movement elitist may seem cornered, but they have an ace…
CME: Even if they could practice on their own, and even if that practice is beneficial, the bad movement will cause orthopedic problems like bad joint movement and pain. It may be good for their brain but it’s gonna be bad for their body.
CP: Couldn’t the improved movement and the better brain control lead to less ortho problems?
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