Fact or Fiction: Understanding recovery of movement after stroke

Last week, I presented a talk for stroke survivors affiliated with The Pacific Stroke Association.  Several attendees asked me to post my slides.  I am doing so, but some of the slides may not be entirely self explanatory.

Feel free to contact me with questions.

PSA 3-17

Get rid of the rigid AFO

The rigid AFO serves a purpose early in rehabilitation following stroke.  It provides stability to the weak leg, allowing people to safely stand and transfer.  This rigid AFO, however, is NOT the ankle brace that should be used when one is learning how to walk again.  It is time to start demanding that ankle orthosis be made so that a hinged ankle and some form of dorsiflexion assistance can be added once the survivor is ready to learn to walk.  Using a rigid ankle brace almost demands that the person learn to walk with a stiff leg, that is thrown forward with hip hike and circumduction.  One cannot bend the knee for walking if the ankle is fixed!  Simple biomechanics.   So, how do we change the way Therapists, Physicians, and Orthotists approach the ankle??

“Discharged from Therapy” does not mean you are done.

Today, I received 3 phone calls.  All from individuals who had their stroke less than 6 months ago.  They were worried because they had been discharged from Physical and Occupational Therapy.  The therapists told them that “they had reached her goals”.  Problem is, they had not yet reached their own goals!!  So, three different calls, three different people, all asking if their was any chance that they could continue to improve from their stroke.  The answer: YES.

I talk a lot about this in my book.

“Highs, Lows, and Plateaus: a path to recovery from stroke.”



There are many options and resources for the stroke survivor and their family.  Recovery takes time, effort, and direction.

I would love to hear from stroke survivors who have improved months, even years after their stroke.

The dismissive health care professional

I often think about why some health care professionals are so negative.  They say things like, “he will never walk again”, “that patient is non-compliant and never does their home exercises”, “the family is just wasting money on rehab”.

I believe in offering hope through education.  Maybe that patient can’t walk today, but we do not know what kind of technological advances the future holds.  It is important to continue to exercise to maintain bone density, muscle mass, muscle and joint range of motion.  I have a client who spent 11 years in his wheelchair.  But, he continued to exercise at the Adaptive Physical Education program at the local college and he continued to go to pool therapy every week.  Last spring, he walked across the Golden Gate Bridge!  At last, technology had provided a tool for him.

I think that people want to be compliant with their home exercise program.  But sometimes, they do not have the thought processes that enable them to be independent in initiating and completing exercises.  Sometimes the home environment is so full of other stresses and worries that exercises is the last thing on their list.  Once, I had a client who NEVER did his home program.  He did go to the gym, but did not do the exercises correctly.  After much frustration, we decided to have him get a Neuro-psych eval.  His stroke had affected his ability to initiate and follow-through on tasks.  Physical rehab was put on hold while he worked on his cognitive rehab!!  Everything in the proper order.

Money, somehow it always seems to get spent.  How it is spent is a personal decision. A rehabilitation professional has an obligation to present their patient/client with options.  It is the survivors decision how to use their money toward those options.  Many years ago, I worked with a family who insisted on a particular piece of equipment for the mom in the family.  I thought it was too expensive and her prognosis was not good.  She had a tumor.  Insurance denied payment, so the family decided to pay out of pocket.  They never regretted that decision, because it provided freedom and independence and allowed her to be engaged with her family for several months.

I have started telling people to find a doctor /therapist/ trainer who believes in them!  It is OK to change doctors, change therapists… Also, we know that individuals and their families need to stay proactive and continue to look for new devices, new therapies and changes in rehab.  Neurological rehab is VERY dynamic right now.  Things are changing quickly.

My video talks a little bit about this.  Would love to hear what you think or tools that you have used.