In order to obtain the Best Possible Post-Stroke Recovery.
My name is Valerio Sarmati, and as you may have guessed I’m an expert on Post-Stroke Rehabilitation.
During the course of my experience in this field, many of my patients and their family members have often told me about certain problems that are commonly encountered among those who have suffered a stroke:
- Not many people were able to provide them with useful and practical information
- They didn’t know what was right and what was wrong
- They didn’t know the extent to which one can recover
Happy reading
1 Understanding Stroke:
Stroke damages the brain and its functions, not the muscles!
The difficulty of movement, perception and reasoning following a stroke are caused by the alteration of the brain’s functions.
It is therefore follows that treatment should focus upon the recovery of these brain functions, and not the muscles!
If fact, you’ll see later on how the treatment of the muscles is counterproductive to the recovery process.
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2 The Brain is Adaptable:
The 12 months following the stroke are the most crucial for the purposes of recovery!
During the first year following the stroke, the brain has an excellent degree of adaptability, and this is therefore the perfect time to accelerate the recovery process.
But we must use caution, as the opposite is also true! If the patient is subjected to incorrect treatment during this period, is will be very easy for incorrect (pathological) movements to be learned, and for muscular rigidity (spasticity) to take hold. This adaptability must be exploited with proper rehabilitation. There is no specific deadline, however, and the brain will nevertheless remain adaptable and ready to learn.
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3 Understanding Spasticity:
Spasticity is not a muscular problem either!
Spasticity is one of the major problems associated with stroke. It is represented by muscle stiffness (hypertonia), reflexive and uncontrolled muscle contraction, and difficulty contracting the muscles voluntarily.
But the problem does not lie in the muscles themselves! Once again, the problem is caused by difficulty in using the cerebral functions required to organize the movement.
The following points will explain how spasticity can worsen or improve based on the rehabilitation technique utilized.
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4 Avoid using Orthotics!
The use of orthotics, like splints for the hands and Codeville orthotics for the feet, is counterproductive!
Following a treatment program that does not focus upon the control of spasticity, the hand often tends to close into a fist, and the foot tends to extend to the ground toe-first and sideways, both as a result of intense rigidity.
For this reason, orthotics like a splint for the hand and a brace for the foot are often prescribed.
The splint is nothing more than a platform to which the open hand is secured, and this will not help to improve the situation. Instead, it will increase the rigidity of both the muscles and the joints, and the same holds true in the case of the foot brace.
The problem must be addressed upstream, by trying to prevent spasticity from taking hold, and by developing greater control on the part of the patient.
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5 Avoid rehabilitation techniques that will cause the Spasticity to worsen.
The neuromotor and muscular techniques are those which will increase spasticity.
These techniques arose prior to the modern scientific discoveries that revealed the brain’s ability to organize movement through the cognitive processes.
The neuromotor techniques are those that act upon the reflexes, and therefore at a lower level of the movement, such as the Bobath, Kabat and Vojta method, while the muscular techniques act directly upon the muscle, without taking the actual problem of the cerebral functions into account.
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6 Avoid the use of botulinum toxin.
Botulinum toxin only has a temporary effect on spasticity.
In my opinion, treatment with botulinum toxin is even counterproductive to stroke rehabilitation. In fact, it represents an attempt to reduce spasticity following inadequate rehabilitation that has led to the development of spasticity in an abnormal manner.
Botulinum toxin destroys the junctions between the nerve and the muscle, thus resulting in a temporary relaxation of the muscle fibres for a few months. But the problem often returns after a few months, sometimes even worse. What’s more, by destroying the neuromuscular junctions, certain parts are damaged that are fundamental for the recovery of the movement in the future.
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7 It is necessary to prevent spasticity from taking hold, and to develop greater control on the part of the patient.
The movement is organized through the use of the cognitive processes, the reflexes and the muscles.
Stroke decreases the brain’s ability to best exploit the uppermost level of the movement’s organization by the cognitive processes, and the body therefore finds itself having to deal with the situation using only the lower levels, or rather the reflexes, the spinal cord, and the muscles.
But these lower levels of movement control are naturally less refined than those that can be obtained using the cognitive processes as well.
The role of rehabilitation is to teach the patient to make the most of their remaining cognitive functions, and to recover those that have been altered by the stroke, and this is done using exercises that primarily involve the cognitive processes.
If the rehabilitation focuses upon the lower levels of the movement (the reflexes and the muscles), this will result in an increase in the pathological or spastic movement.
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8 Damage to the brain results in alterations to the information flows.
Spasticity and muscular movement difficulties only represent the tip of the iceberg in terms of stroke-related problems. In fact, the alteration of the cognitive processes, such as the ability to pay attention, to learn, to remember and to perceive, results in difficulty interacting with the surrounding environment.
Interaction with the external environment takes place through the continuous exchange of information with the environment itself.
I’ll give you a practical example: difficulty in walking is not caused by spasticity alone or by difficulty in contracting the muscles, but rather by difficulty in perceiving the ground with the feet, in perceiving how one’s leg is positioned in space, or in paying attention to the body while performing this activity.
It therefore seems obvious that the treatment should focus upon improving this interaction with the environment, and above all the ability to obtain information from the body and the environment itself.
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9 The Perfetti method focuses upon the recovery of the individual’s ability to retrieve information.
The individual’s information capacity is one of the fundamental aspects of the exercises foreseen by the Perfetti Method.
In fact, the exercises are nothing more than a set of guided experiences whereby the patient is given the opportunity to obtain adequate information from their body and from the object (the environment). These exercises are then incorporated within a pedagogical pathway, whereby the patient is given the opportunity to re-learn the rules of the movement in such a way as to allow them to be used in everyday life.
These therapeutic situations are aimed at reorganizing the cognitive processes.
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10 The importance of working at home.
The Post-Stroke Rehabilitation process also requires the assistance of the patient’s family members!
Stroke recovery requires patience and consistency, and it is therefore extremely important for the family members to learn simple and effective exercises that will give continuity to the recovery of the main functions.
The Perfetti Method contains exercises that can be easily learned by all members of the family.
Just as they have been for many others before you, I hope that these suggestions will help you better orientate yourselves in the post-stroke future that you or your family member are facing.
See you soon
Valerio Sarmati
Here you’ll find our newsletter, to which a total of about 20 patients, family members, and professionals subscribe every day in order to receive free additional information about stroke and stroke recovery. The first report will be titled “10 Things You Need to Know About Stroke”