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When we hear this phrase said by the operators of a rehabilitation clinic or hospital: ¨the patient does not cooperate¨ our world falls apart. We have just passed the most critical stage where we did not even know if our relative would survive the stroke and now we find ourselves in a moment where we are doing everything in our might to reorganize the whole family’s life. We have decided and want to get to the top of the hill, even though some inconveniences that have not really mattered. But when the physiotherapist tells us that our relative unfortunately does not cooperate and does not actively participate in the physiotherapy, we feel that is going to be more difficult to reach the objective. In other words as if now we have to fight another enemy. Let me advice you that it is not another enemy, it is the same enemy that we have had since the stroke, but that now requires specific therapeutic attention. WHAT PATIENTS ARE USUALLY TOLD THAT ARE UNCOOPERATIVE? Typically there are two types of patients who are tagged like that. ● Patients with right hemiplegia, aphasia, and apraxia. ● Left hemiplegic patient with consciousness and attention disorders. These two types of patients represent a great amount of the total who have suffered a stroke, therefore the phrase ¨the patient does not cooperate” affects dozens of...

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T: “What happened?” P: “I feel a pull” T: “What do you mean by a pull?” P: “Something that is pulling” T: “And that pulling, feels like what” P: “It is like an elastic band that when I try to make a movement, it pulls me” Let us stop right here for a moment, and try to reason over the lines between patient and therapist, during a simple movement of the body. Let it be you, the patient directly interested in the results of the stroke, or a relative just looking for information, or a colleague who everyday faces in his patient’s’ recovery, the phrase: “I feel a pull” which I am sure is familiar to you. At this internal moment of the therapy, where the physiotherapist asks his patient, what he feels in his body, is of fundamental importance. Yes, because the exercise, is not something that the patient takes as if it were a drug, it is an experience that has the value of making the patient more conscious of his body, his way of organizing his movement, and the effects of the pathology. Because of this, the language represents one of the most important tools of the neuro cognitive rehabilitation according to Perfetti, since it offers the opportunity, either to the patient or to the therapist, to have a window over all that happens in that...

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Neglect is one of the most characteristic consequences of stroke in left hemiplegic patients, or rather those who have suffered damage to the right side of the brain following a stroke. The synonyms for neglect can provide us with a better understanding this particular phenomenon. In fact, neglect is often also referred to as: Unilateral spatial agnosia Hemi-inattention Hemispatial neglect Regardless of what we call it, this problem consists of an spatial attention disorder in which the patient fails to perceive that which occurs on their left hand side. Neglect is commonly dealt with as an exclusively visual problem. In fact, left hemiplegic patients have evident difficulties orienting their eyes towards their left field of vision, especially during the initial weeks after the stroke. In certain cases, those who are affected by neglect might leave the entire left hand side of their meals untouched, or might completely omit to shave the left hand side of their face. Neglect, or hemi-inattention, is often an aspect that is not given the necessary amount of attention in the field of rehabilitation, and is typically considered a phenomenon that will spontaneously resolve itself within a few months after the stroke. The reality, however, is quite different. In fact, that which gradually decreases during the first few months following the stroke is the visual component of neglect. While many patients report having been aware...

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When a cerebral ischemia or hemorrhage also involves the anterior part of our brain, the frontal and prefrontal zone, we can detect in some patients more or less some marked disturbs of the behavior. These are alterations in behavior that sometimes induce relatives to believe that there has been a sudden change of personality. Just as we will see below; the frontal lobes regulate many aspects of our reasoning and social behavior. I often find myself repeating this phrase, because if we think about behavior is not like movement: the movement we can see, touch and measure, but the behavior that is something less tangible and concrete. So, while facing the changes in movement of our family member, we can easily do 1 + 1 (that is to say, brain injury is the cause of paralysis), with behavior, this simple addiction becomes more complex and difficult to see movement and behavior as the tip of the iceberg of a complex cognitive organization, which originates in our brain. Therefore, facing the behavior of our loved one that seems so different and changed, that simple 1 + 1 becomes so difficult and we run the risk of blaming it for the change it had as if it had been intentional or psychological. The Case of Phineas Gage  To describe the possible alterations of the behavior after an injury of the...

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Stem cells after a cerebrovascular accident (CVA)

The brain already has them thanks to the neurogenesis Lately there is a great cultural discussion around the stem cells issue, in the recovery after a stroke or a cerebrovascular accident; therefore we must clear up some important aspects. The disability caused by an ischemia or a cerebral hemorrhage is very grave in the majority of the cases, since it carries a muscular paralysis and aphasia. Thus, I clearly understand those who are looking for shortcuts or quick ways to get a better recovery. that search also led to the proliferation of a great variety of therapeutical proposals often...

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