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POST-STROKE REHABILITATION
It is devastating when an individual suffers a stroke. But rehabilitation is often possible and provides
hope for patients, their spouses and caregivers.
There are two types of strokes. An obstructive stroke is where something (typically a blood clot)
obstructs the flow of blood in an artery of the brain causing damage to the
area of the brain normally
supplied by the blocked artery. A hemorrhagic stroke is when an artery actually tears apart leading to
bleeding in the brain causing damage to the surrounding area. The symptoms that a patient experiences
after a stroke depend on the location and the severity of the circulation/blood flow
obstruction. If the part of the brain responsible for moving the legs is damaged, the patient will have difficulty walking, but will
still have feeling in their leg. Or, if the pathways that carry the signals to and from the brain are damaged,
then an entire side (leg, arm, face and speech) may be affected. The obstruction might be thought of as
a block in the road.
The patient’s symptoms will tell the astute clinician the location of the stroke and a close examination
will expose what areas are working, which are not and if there is viability in those areas to justify
additional rehabilitation and physical intervention. The medical approach to treating patients who have
suffered mild to severe stroke includes a course of physical therapy and occupational therapy. Physical
therapy works to decrease pain and increase strength and joint range of motion. Occupational therapy
works to teach patients how to perform and accomplish daily living tasks (i.e.: walking, cooking, bathing, etc.). If speech has also been affected, speech therapy
will probably be prescribed to speed recovery of language. All of the positive outcomes of these
therapies are attributable to brain plasticity.
The plasticity of the brain is truly a wonder and should not go
underestimated. Plasticity is the brain’s natural ability to learn and grow new connections between neurons (nerve cells.) We now know that
neurons are able to survive for years even though they may not be working optimally. This opens the
door to positive therapeutic intervention years after the stroke has occurred. Exhausting all possibility of
retraining the portions of the brain and body that have not been damaged irreparably by the stroke
seems logical.
Chiropractic neurology and the hemispheric model of care is an excellent option for those that have
exhausted the benefits of physical and occupational therapy. The hemispheric model of care is based on
the fact that your brain has a right and left hemisphere (half) and that certain functions take place largely
in one side or the other. Language, for example, is primarily a left hemisphere event. Thus, strokes that
occur affecting the left hemisphere have a greater probability of affecting speech and language centers.
The hemispheric model focuses on treating the half of the brain with poor function and the area of the
body with pain/dysfunction. This model also utilizes sensory stimulus to excite areas near the stroke
location to excite/rehabilitate the affected hemisphere even more. For example, eye exercises that use
the left hemisphere coupled with chiropractic adjustments of the right side of the body will have a greater
probability of increasing the integration of a damaged left hemisphere than adjusting, stretching and
strengthening alone. It is important to remember that all areas of the brain excite one another and
consequently we are able to use many pathways to stimulate and encourage plasticity in the damaged
area.
For more information on the post graduate clinical neurology program, please visit the Carrick
Institute online at www.carrickinstitute.org and click on the “About” link.
Putting the pieces of the puzzle together for patients is a tremendously specific and individualized
process. It is no different from rehabilitating the brain and body for any other symptomatic difficulty or
disorder. Individual attention and commitment on the part of the patient, his/her caregivers and their
doctor is the essential element that ties together intelligent clinical assessment, therapeutic application
and subsequent results. Without that attention every step of the way, the chances of making major
improvements is diminished significantly. Unfortunately, hospitals are not set up to provide that type of individualized care. Often times, full-time
care facilities do not have the staff trained in specific neurologic rehabilitation and in some cases are
providing contradictory treatment. However, this does not mean that stroke victims should give up hope
or “just learn to live with it.” Almost always, there is something that can be done to either increase
function, decrease pain or both. Equally important, the thought process has changed in regards to the
brain’s plasticity. We now know that old cells can grow new connections and that new cells are actually
made in the brain. The chiropractic neurologist’s job is to put together physical symptoms with central
nervous system/brain function and determine how to help both in concert with one another.
If you or someone you know is struggling with stroke induced symptoms, I would strongly encourage a
visit to a chiropractic neurologist for the latest approaches to brain based rehabilitation.
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IN THE NEXT ISSUE
Counting sheep? Problems sleeping? What a better article to read while trying to get to sleep? Dr. Theirl
discusses neurologic health and its impact on a good night’s sleep.
ADHD Article Now Available On-Line
The role of chiropractic and the treatment of Attention Deficit Disorder is the topic of a two-part article originally printed in the Journal of the American
Chiropractic Association in July 2002. While it is written for the doctor, it features valuable insights that are likely to be of interest to anyone whose life is affected by attention and learning difficulties.
It is now available in html or pdf format on the ACA’s website. Visit
http://www.acatoday.com/media/releases/adhd_part1.shtml and
http://www.acatoday.com/media/releases/adhd_part2.shtml
ASK THE DOCTOR
How to find a chiropractic
neurologist
I have a friend outside of NYC who I think could benefit from seeing a chiropractic
neurologist. How can I find a really good one?
Like with any other practitioner, personal recommendation is always the best place to start.
Because there are so few board certified chiropractic neurologists (roughly 600 in the world)
personal recommendation is rarely available. The places to start are the
directories of board certified doctors. They can be found at www.acnb.org and
www.dendrites.com. These websites provide listings of doctors holding a few different neurology post-graduate degrees. The one
that I hold, and that which is most current in my opinion is Diplomate of the American Chiropractic
Neurology Board (DACNB). I would suggest you look for those letters after the doctor’s name. Confirm (again through the directory on
acnb.org) that the doctor’s status is current regardless of which neurology degree is held. After that comes the more time consuming part: interviewing the doctor. I would suggest posing the following questions to the doctor directly (sometimes staff will be able to answer basic questions, but it is better to speak to the doctor personally).
My friend has [this particular] disorder. Do you commonly treat patients with this disorder?
Do you perform a full exam prior to determining if chiropractic neurology is an appropriate approach to treating this disorder?
When did you become board certified?
Are you willing to work closely with my friend’s other doctors to coordinate treatment?
Are you accepting new patients?
I am happy to refer people to colleagues of mine when I know someone in the area. Please email me
with the nearest metro area and we’ll do our best to find someone for your friends/family.
SPRING VACATION
The office will be closed from April 25th through May 12th,
2003 for the doctor's continuing education and spring vacation.
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