Motion Capture for Stroke Survivors

As a stroke survivor and an OT who specialized in stroke rehab, I am not impressed with most motion capture systems for stroke survivors.  First, these systems create the impression that you need a computer to see and analyze movement.  But analysts who watch ice skaking and diving demonstrate how accurate the human eye is when you know where to look.  Slow motion replays have proven that experts can detect if a skater's foot did not land correctly after a quadruple jump or divers bent their hips slightly just before they entered the water.  Second, most of these systems focus only on shoulder and elbow movements while the hand maintains a static grasp on a handle.  Hello - all the arm does is deliver the hand to the target.

The one system that impresses me is Amadeo.  It monitors each individual finger plus the thumb as the hand opens and closes.  It provides biofeedback to help clients learn what their muscles are doing before they see visible motion.  It can provide EMG stimulation if a client's muscles need assistance.  The forearm can be placed in different positions to help the hand adjust to different positions that objects assume in the real world.  It can be used in exercise mode or with video games.  You can see a demonstration of Amadeo at youtube.com/watch?v=GM9HjI2OIrA.            Of course, roll-out of this system is constrained by how many rehab centers can afford it.  homeafterstroke.blogspot.com

ADLs Are Where the Repetitions Are

Brain plasticity is amazing, but rewiring the brain requires thousands of repetitions.   Activities of Daily Living (ADLs) are a great way to get those reps. The examples below show why three sets of ten each day cannot compete with ADLs.

1) Twice a day I open my affected hand to grasp a tube of toothpaste so my sound hand can remove the cap.  My affected hand opens again to hold the tube while my sound hand puts the cap back on.  In nine years I have opened my hand over 5000 times before brushing my teeth.

2)  Shopping is therapy for my hand.  I open my affected hand to let go of the cart to reach for items with my sound hand.  My affected  hand opens a 2nd time when I grab the cart to move on. My affected hand opens a 3rd time so I can empty the cart in the check-out lane and again to load food into my car.  Pick uping 30 items + empty cart + load car means I open my hand 60 + 2 + 2 = 64 times.  64 x 2 visits a week x 9 years means I have opened my hemiplegic hand 59,904 times in the grocery store.

3)  The distance I have walked at the grocery store is huge.  I step away from the shopping cart and bend down or reach up to get items I want.  The curves I make to detour around people and other carts require more steps than walking in a straight line.  According to my pedometer I walk 2,000+ steps each time I visit the grocery store.  2,000 x 2 visits a week x nine years = 1,872,000 steps!
homeafterstroke.blogspot.com

Electrical Stimulation with NeuroMove

My hand was completely flaccid for three month after my stroke.  I did not get motion back until I started using an electrical stimulation device called NeuroMove.  Electrical stimulation strengthens muscles, but NeuroMove also has a biofeedback component.  I was able to watch a line on a monitor creep higher and higher as I thought about moving my hand.  That immediate feedback kept me focused and working hard even when I did not see movement.  When my muscle activity finally increased above the threshold line, I got a few seconds of stimulation and was rewarded with a visible hand motion.  NeuroMove would not help me until I made a sincere attempt to recruit the muscles that open my hand.  Equally important, NeuroMove would not repeat the stimulation until I completely relaxed the muscles I just used.  This added feature is important because stroke survivors have trouble both recruiting and relaxing muscles.

I tried other electrical stimulation devices that stimulated my muscles at pre-set intervals or when I pushed a button.  I could not coordinate my efforts with those devices.  In the beginning it took me 20 seconds to figure out how to recruit a muscle and up to 60 seconds to make that muscle relax.  Devices without a biofeedback component zapped me whether I was ready or not.  It was like dancing with a really bad partner who kept jerking me around the dance floor.  NeuroMove patiently waited for me.

Neuroplasticity helps stroke survivors grow new connections in the brain, but that does not mean we can find them. The biofeedback component of NeuroMove helped me find connections
I did not know I had.  NeuroMove stimulated my muscles AND helped me retrain my brain.
homeafterstroke.blogspot.com

Two Sets of Ten Do Not Undo 12 Hours of Disuse

I had back spasms after my stroke.  It was terrifying to be frozen in standing hoping I would not drop my cane or fall down.  So I was motivated when a PT gave me exercises to strengthen the weak abdominals that allow my back to arch every time I lift my hemiplegic leg.  I do these exercises every morning before I get out of bed.  However, I learned the hard way that a few repetitions do not undo the effects of 12 hours of disuse.  Exercise strengthens muscles but does not retrain the brain to use muscles when we are distracted.  Here is an example.

About 2/3rds of the time I arch my back when I lean my stomach against a counter for support as I reach.  To remind myself to lean on my right hemiplegic hand when reaching, I put a beige piece of non-slip shelf liner on the front edge of the kitchen sink.  I kept forgetting to do this so I added a 2nd memory aid.  A blue piece of non-slip shelf liner reminds me to 1st rest my sound hand on the counter before my hemiplegic hand reaches for the beige shelf liner.  I am improving so I know I can learn this new habit.  homeafterstroke.blogspot.com