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Clinicians should STOP doing these things ASAP! Using inversion as a mental model is a fantastic way to improve as a clinician. Instead of asking ourselves “how can we be the best clinicians for our patients?”, maybe we should look at it differently. How about “what should we STOP doing or AVOID doing” when it comes to neurorehabilitation? Using the concept of “Inversion” as you focus on being a better clinician. When you invert something you turn it upside down. As an example, instead of asking “how can I succeed?”,  you would ask “what would cause me to fail?” What things do I want to avoid during my treatments? What are the UNFORCED ERRORS that I want to avoid? Sometimes to be a better worker, performer, husband, wife, human,   it might be best to think not what you need to do, but rather what you should avoid doing. When we focus on improving, we sometimes miss the very obvious unforced errors. Here are some unforced errors to think about when treating patients following a stroke. (No particular order... these are just a few of many) 🛑 Spending too much time on ADL training in the early days and not immediately emphasizing intensive task practice and stimulation. 🛑 Not providing families with in-room programs like mental practice, mirror box therapy and electrical stimulation. 🛑 Telling your patients that “no further progress is possible” or they have “plateaued”. 🛑 Not recommending appropriate products for home use (estim, splints/gloves, MAS). 🛑 Not staying up-to-date with the latest neuro research. 🛑 Strengthening the unaffected side and avoiding sufficient stimulation to the involved side. 🛑 Doing too few reps with their patients. No more 3 sets of 10! 🛑 Too prideful or afraid to ask for help. Lives depend on you. 🛑 Not emphasizing the importance of cardiovascular training. 🛑 Not doing enough education regarding the stages of stroke recovery and the power of neuroplasticity. Using inversion is a good mental model for any facet of your life whether it is weight loss, lifestyle change or rehabilitation. Instead of what you should do better, try inverting it and consider what should you stop doing today! #noplateauinsight 

You need to deweight the limb to max out those reps…. When the neuro arm is stronger, you will see less spasticity in the hand during exertive functional movements. Strengthening the proximal muscles is a must. We also see if you deweight the arm using a mobile arm support, the grip aperature will be larger, meaning the hand will have less tone during exertion. Using a mobile arm support is a MUST for every #CIMT clinic or clinicians practicing task training.   Lan Y, Yao J, and Dewald JPA examined paretic hand opening and closing by 26 patients with chronic stroke under three conditions:    1) upper limb supported by table,  2) upper limb loaded to 25% of maximum voluntary shoulder elevation torque,  3) upper limb loaded to 50% of maximum voluntary shoulder elevation torque.    What did they find?   The degree to which the hand could be opened decreased with shoulder loading in patients with moderate deficits.     Conversely, grasping forces increased with shoulder loading - particularly in patients with severe deficits.    Based on the authors’ findings, it seems possible that patients whose ability to open the hand is present but limited, may benefit from upper limb support when performing tasks requiring hand opening.   This study emphasizes the effectiveness of de-weighting the limb so adequate hand opening can occur during repetitive task-training.    With the arm supported, the user will require less exertion resulting in decreased hypertonicity distally during the task.    #noplateauinsight  #saebomas

Don’t be stuck with the wrong therapist! Many of us perform due diligence when making big decisions such as purchasing a car, deciding on the best computer to buy, or finding a home.    Why do we not provide this level of scrutiny when searching for the very best therapist (or clinic) to make or break our own recovery?   Here are 5 must-ask questions a patient should keep in mind when interviewing an outpatient therapist:   1️⃣ Do you embrace evidence-based treatment?    This is a must! If the answer is yes, be sure to ask for examples of what type of interventions he or she considers to be evidence-based. Go to www.ebrsr.com to see what stroke treatments are considered beneficial. You can also search on Pubmed.   2️⃣ Do you subscribe to more than one specific treatment approach when treating stroke clients?   Get your keys and run for the door if the therapist only practices one approach. Research shows that no single approach is superior and that it will take numerous strategies and techniques to foster recovery.   3️⃣ How many neuro patients do you treat per month?   Ideally, more than half of their caseload should be neuro patients.   4️⃣ Are you comfortable with utilizing stroke technology?   If the therapist states “My hands are my special tool”, then this will be your first red flag. If the clinician only uses his or her hands for treatment, then I am assuming he/she will need to move into your home to offer daily “special” hands on treatment. This is clearly not effective, nor realistic.   5️⃣ What technology does your clinic currently have that may be beneficial?   Have the therapist specifically list what equipment they use to address impairments similar to your concerns. Again, look at www.ebrsr.com for all of the research.   Although the above is not a comprehensive list of questions to ask (personality, energy level, compassion, communication style, etc.) when choosing a therapist, it does touch on the key topics regarding neurorehabilitation treatment.    Remember, you are the customer and they are providing you a service. #noplateauinsight

Nice to see Yung Gravy warming up using his #saeboglove with Alec Burleson from the St. Louis Cardinals before throwing out the first pitch. https://lnkd.in/dtbj97yb

Why are therapists not using biofeedback more often? 💭 It appears to be significantly underutilized in the therapy world. HOWEVER, It provides many benefits including the immediate ability to show the “real time” state of muscle contraction and relaxation.   For example, when a patient exceeds (contracts a muscles) or falls below (relaxes a muscle) a preset threshold, an auditory or visual response will be provided. This feedback alerts the patient so they can monitor their muscle response real time. There are so many reasons to use biofeedback with patients. Improve postural control and balance  Improve strength and ROM Reduce spasticity/spasms Minimize compensation Activate force couples Improve motor control Break-up synergies Many more Biofeedback research is solid going back many decades. If you need one more reason to use it, check out the level 1 systematic review and meta-analysis published earlier this year.   The study was looking at whether biofeedback can improve upper/lower extremity dysfunction in stroke patients. -10 articles were chosen -303 stroke patients were enrolled in the ten studies -5 studies included patients with lower limb involvement while five included upper limb -Biofeedback was provided for approximately 10-30 days -The frequency of the treatment was 5 x / week for 20-60 min Results showed that biofeedback therapy was associated with significantly improved post stroke upper and lower limb function. Think about consistently adding biofeedback to your tool box and give it a shot. It is a great motivator for your patients. https://lnkd.in/dSAqu-_S #thoughtechnology #mtrigger #mindmedia #noraxon

Rapper, singer-songwriter and actor making progress with the #saeboglove. Go Yung Gravy!

Don’t Ignore these 11 treatments when managing post-stroke spasticity... According to a recently published scoping review in the Toxins Scientific Journal, eleven key treatments were found to be effective for improving functional recovery and quality of life in post-stroke spasticity.  The focus was placed on high-quality (GRADE A) medical, rehabilitation, and surgical interventions. The study involved an intensive search on Medline and PubMed from January 1, 2000 to August 31, 2023. The authors looked at a total of 32 treatments for post-stroke spasticity. Only interventions with GRADE A evidence were considered. The results revealed eleven treatments supported by GRADE A evidence, comprising 14 studies. Thirteen were systematic reviews and meta-analyses, and one was a randomized control trial. The GRADE A treatments included: Transcutaneous electrical nerve stimulation  Peripheral magnetic stimulation  Non-invasive brain stimulation Localized muscle vibration  Botulinum toxin A injection Whole body vibration Intrathecal baclofen  Shock wave therapy Stretching exercises Dry needling  Splinting I encourage you to read the full article and consider widening the net of possible interventions when it comes to managing spasticity for your clients. As a reminder, spasticity is a brain problem, not a muscle problem. Driving cortical changes (i.e., functional task practice, etc.) WILL be the way to reduce spasticity BUT we need the above methods to prep the arm and hand for therapy. https://lnkd.in/eW69WY8f https://lnkd.in/e7cQxC8N