I almost could not believe it, but it is my obligation to write an article about it, since I think it is appropriate to clear up this topic, because the disinformation is the worst enemy of the recovery post CVA (also called ECV or ICTUS), it is harmful to the patient, the family, and the sanitary system. In all these years of close contact with patients and relatives who had to cope with problems linked to a cerebral stroke, I have been able to make up a list of atrocities that distinguished specialists were able to tell a relative when they were asked about a neurocognitive rehabilitation treatment which as we all know, is better known as the Perfetti Method.
Note to the inadvertent reader:
The intention here is not to speak about the efficiency or the validity of the method compared to other rehabilitative proposals, but rather to dissipate some myths which loom over the neurocognitive rehabilitation, i.e. the Perfetti Method.
Necessary preamble, in order to avoid rivalries like the football fanatics whom we all love very much.
The state of mind that the relative is in at the time of asking for help, in selecting an appropriate rehabilitation, is very fragile, which it is often the mood found the first weeks after suffering the accident, and probably never felt because he had never talked about a stroke or its effects, but he is clear that the rehabilitation the patient is receiving is partial and massively applied and usually of little attention to the real needs of his relative, the patient who has suffered a cerebral injury.
That is the reason, why they try to get information, make questions, study, and face others, and not even having a good knowledge of what the neurocognitive rehabilitation is about; they intuit that it makes sense, that it has certain logic, moreover, if the injury affected the brain, it is reasonable that the therapeutical proposals are aimed to the body, but also to the cerebral functions that make us move.
Therefore, they take courage and humbly face these unreachable professors who are 100kms, away from the patient and the reality of the people who make up the family, always busy explaining what happened, what is needed now, and what the future will be. Then they mention that they have heard about a particular way of doing rehabilitation, which it is called the Perfetti Method or Neurocognitive Rehabilitation and they ask if their relative can get it.
At this precise moment, the therapist put his hand over his heart and sheds all his ¨human¨ and ¨scientific¨ frankness to the person facing him, regardless of common places, inexact and unfortunately in most cases atrocities referred not only to the rehabilitation but sometimes even to Mother Neurophysiology.
Before I begin to enumerate the extravagances which I have heard throughout all these years, I want to precise that to the best of my knowledge, things are changing, and that even the most fanatic physiatrists and neurologists are shyly admitting the possibility and necessity of applying the patients who have suffered a CVA, a neurocognitive rehabilitation.
With great satisfaction, I have also received several requests, for consulting and training courses in public and private establishments, where they explicitly have told me that the requests from members of the family of affected patients, for the neurocognitive rehabilitation has become too frequent and insistent.
I have spent many years of education in this field, only with the certainty that the power resides in the individual, the family, and the community, because it is around us, and we are the ones who have the power, let us not forget that we are the QUESTION, and when the question is insistent, then it is able to move capitals, and when there is capital among us, even the OFFER pledges to the will of the contributor.
Therefore, even if you think that you cannot solve anything, ask something because that is your right, and if you keep reading the following lines, to each dogmatic answer of the leader about the neurocognitive rehabilitation, I will give you an additional answer in order for you not be unarmed before the arrogance, thus making your pressure more effective time after time.
Let us begin with the first common stand, since I think it is the strangest and the most creative, that is to say:
- THE PERFETTI METHOD IS A SURPASSED METHOD.
This rumor made me laugh so hard, that I could not resist and I had to dedicate a complete article to it.
It seems odd to me, for the simple reason that the rehabilitation is an application of the science, that is to say, where knowledge extracted from the basic sciences is applied and complements the recovery after a cerebrovascular accident, like the neuroscience, the neurophysiology, the biology, and many others.
The Neurocognitive Rehabilitation (Perfetti Method) does nothing more than translate the new neuroscience discoveries in therapeutic actions, it is not a standard technique of maneuvering, but rather a way of thinking about the therapeutic needs of the patient, through the creation of exercises more oriented to solve the problems caused by the cerebral injury and always under the constant glimpse of the latest scientific research and the approach of a good therapist, which is similar to the researcher, where the patient’s case is not only studied but it is constantly looked after based on the latest researches.
Therefore, when I hear that the Perfetti Method has been surpassed, stated by people who in their therapeutic plan consider passive mobilizations, and not knowing that Professor Perfetti, even from a temporary point of view, is the unique name for rehabilitation in this contemporary millennium and in life, aside from indignation I also feel deep concern and worry.
At any rate, faced with this question, the answer is a question:
“I understand Professor, if I may ask you, by what thing was it surpassed?”
At this point, the ignorance should go along with a certain degree of courage in order to say that what his relative is currently receiving, is part of those therapeutic procedures which have surpassed the neurocognitive rehabilitation.
Nowadays, with the appearance of very costly machines, like the CAMMINOMAT, or the GUANTOREHA or ROBOTIC ARM or VIRTUAL REALITY, we will surely doubt before such array of innovation. But, keep always present that, paraphrasing one of my favorite authors, who is also contemporary and still alive, ALAIN BERTHOZ,
“…..to recover a complex system like the human being, you need the same complex system, just another human being….”
Perhaps, in the future I will write about this topic, because it intrigues me very much, but I would like to show you just some small examples of how the technology hides only one innovation necessity, which is not supported by solid scientific bases. Just see what simple members of a family do at home with their relative, after hitting himself against rubber walls and if you know the machines mentioned above, with an obvious changed name, you can see that there is no need of extraterrestrial technology in order to offer significant experiences to the patient.
These are not real neurocognitive rehabilitation exercises, but rather times of hitting the road and guided gripping moments, where the patient can do daily action experiences just the same with the above mentioned machines, but certainly less mechanic and closer to the patient´s reality.
2. THE PERFETTI METHOD IS VERY LONG.
I am sorry, but thinking about it, I must admit that this one is my favorite cliché, simply because it is more imaginative. We have a clear objective in our head after a stroke, which is to recompose the pieces of our family, our body, and continue onwards to get the best recovery that nature can offer us, nothing more nothing less; we want the best rehabilitation period! There are no other recoveries or temporal patches, just the best.
“Excuse me Professor, I do not do part of the task because it is too long, does that mean that what my relative is getting here with you guys, is going to guarantee the same quality recovery, but in a shorter time?”
Unfortunately there are sub variables of the clichés that go from the tragic comic ones to the dementia ones, in fact, I could tell you:
“Who does the neurocognitive rehabilitation wants to have the patient on a wheel chair and does not want him to stand up”, while whoever is in front of them has to give them the autonomy as a gift…
There is not a more immense happiness, than watching my patients walking again or resume the quality of walking, and I do not think that it is legal or humane to voluntarily keep a patient in a wheel chair without a therapeutic need, among other things, I recently wrote an article about how to ¨take off¨ a patient from the wheel chair.
However, an answer that without hesitation, I would give our interlocutor could be:
“I perfectly understand, thanks Professor, and one last thing, I know you are very busy, but I have heard about spasticity and that it is a problem very difficult to handle once it appears; do you think if we skip some of the recovery steps, could it lead us to this problem?
(if you want to be prepared with respect to spasticity, I suggest this article HERE )
If our interlocutor has not called security yet, and another more significant answer comes, it means that the challenge has been assumed, and at this point I could tell you that the spasticity is not a great disease, even if the leg produces a substantial hypertonia, it can be used as a support place where the weight can rest and fix itself, and in this case try to read the article about the hemiplegic gait.
Personally, I feel sorry for making you study all these things, but knowledge is now the only efficient card that is convenient to play. The most frequent cliches have been discussed, though there are more popular and overwhelming ones, although more difficult to hear, I suggest that you give it a quick reading too, you never know.
- THE PATIENT SHOULD HAVE GOOD SENSIBILITY IN ORDER TO DO THE PERFETTI METHOD.
This about the sensibility as a requisite to have access to the neurocognitive rehabilitation is another link to another cliché: ¨the sensibility is not recoverable¨ and it is part of a trilogy of fantasies which also include:
“The patient should have some movements in order to do the Perfetti Method” and “The patient should not have cognitive problems”.
Very often this third act of the saga, where it is believed that the patient should not have cognitive problems is opposed to a diametrically opposed one, where it is said that the patient who has had a cerebrovascular accident does not need neurocognitive rehabilitation if he “is well in the head and is intelligent”. (Yes, I know, you think that you have read it wrong, but in fact the word is intelligent …).
If there is something that everybody knows about the Perfetti Method, is that each exercise considers the perception as one of the fundamental elements, thus saying that in order to do the neurocognitive exercises, it is necessary not to have sensibility problems, is like telling the parents who send their kid to school alone, because he knows how to read, write and do mathematic calculations. If we go to school is to learn how to do them, and if we go to the physiotherapist is because we have to recover what we have lost due to the ischemia or the cerebral hemorrhage.
The sensibility is never completely absent; it is the therapist´s talent what will allow to locate the most adequate starting point.
A practical example: if the patient is not able to perceive which finger in his hand moves, he might perceive it if instead of requiring him to recognize the 5 fingers, we ask him for two; the thumb and the pinky.
And if he is still unable to recognize if we are moving his thumb or his pinky, he could probably be able to perceive the presence or absence of a movement of the fingers. Going onwards, there is always a “zero point” from where we start our recovery work. Among other things, it is amazing to hear that some specialists can say just the opposite, “If the patient has sensibility, it is useless to do the Perfetti Method”.
As to the severity of the assertion that the sensibility is not recoverable, we are faced with a very serious conflict of interpreting the problem and of the profession in general. If a professional is responsible of handling a patient who has suffered a cerebral injury, he must consider all the aspects which will allow a maximum recovery, including the plasticity of our brain.
To say that the sensibility is not recoverable, in other words that the brain has no plasticity means to negate one of the cardinal principles of neurology and neurophysiology, hence I consider this aspect very worrisome, because if the plasticity is not and neither all other residual abilities of the patient to reorganize after the injury, the central nuclei over which we base all therapeutic activities, then I ask myself, over which rotation revolves all the decisions. The most common alibi of all the chosen ones, is the autonomy, but this autonomy, which among other things is one of my favorite words and the wish of my patients, would not be more efficient if it were for a better real quality of the recovery?
Summarizing, the answer that could be given faced with the assertion:
“There should not be any sensibility problems in order to do the Perfetti Method”
Could be:
“I understand Professor, my mother/father/relative has sensibility problems, do you not think that these sensibility problems can influence the movement abilities? Could it be a good idea to spend time to help my mother/father/relative recovering part of that sensibility in order to have a greater autonomy and abetter quality of life?
If at this point, our esteemed interlocutor plays the card, “the sensibility is not recoverable”, I suggest reading these two articles that completely treat the neuroplasticity and the stem cells but the question that would totally unmask him:
“I understand Professor, but do you think that the brain, the bones, and the cartilages in our body have plastic abilities which could allow improvements? ”.
Already on the corner and conscious of facing a different family, the ones used to be quiet and where a few phrases were enough to destroy it, will say:
“Yes sure, but only in the first months (The brightest ones will speak about a year and a half)”.
Since this cliché is the most damaging of all for the ones who suffer, unjust, mean, and deceitful, I have dedicated a specific line in order to supply you with comparative tools, and not to cut your legs when you listen to this sentence. Read this article about the expiration dates here:
To this dogma of the expiration date, there is an associated moderate cliché:
- THE PERFETTI METHOD IS GOOD, BUT ONLY ON THE FIRST SIX MONTHS.
Of course, due to the recovery window of 6 months that it is not the time when the patient shows the most quantity of spontaneous recovery expressions, because the true recovery is a process that takes a longer period of time.
The fifth cliché is opposed to the first whereby says:
- THE NEUROCOGNITIVE WORKS BUT AFTER THE FIRST 2 MONTHS.
Here you would have understood that the reasoning over which this assertion is based, is that it easier in the first two months to have sensorial, motor, and cognitive problems, but it is preferable to wait for an spontaneous recovery from a more favorable injury, than the one you really get from the recovery.
This cliché is rather curious and makes me think on the type of interpretation made of the functioning of our body.
- THE PERFETTI METHOD WORKS, BUT ONLY FOR THE HAND
I do not know, sometimes I think about my feet, and the great job they have done handling my equilibrium, adapting to different types of surfaces, I like to look at some athletes like skaters, gymnasts, dancers and the football pros. If I had to answer, I would ask:
“If Maldini would have suffered a stroke, the Perfetti method could have helped his feet?”, but for you, I have a more diplomatic answer:
“I understand Professor; his hand is more complex and requires a more refined work, but then, if the feet are less complex, he could have enjoyed a more and faster more refined work! “Professor, could we try the botilinum toxin instead and close the foot on that tutor? ”.
Unfortunately, the list is long, and this article has been quite difficult, so I compromise myself to write another article with other cliches in the near future.
I hope that this has been useful even if there is not a direct confrontation or a direct consciousness, just be aware that beginning to ignore all that it is passively said, is the first act which precedes the change. I also hope that reading these lines, have enthuse the sense of oppression and of vulnerability that have been tested when some things were said, in certain non human ways. If you would like to enrich your list about the cliches normally said about the Neurocognitive rehabilitation and the Perfetti Method, please feel free to sit down and write down your comments.
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