What would be the effect of a swift kick in the butt on stroke recovery?
I'm pretty sure that study would never pass the ethics board. But(t) it is a joke that got to a fundamental truth: Clinicians make the process of recovery too complicated.
There is this notion among many clinicians that there should be a constant striving towards "function." That is, that the survivor should work towards some particular goal (i.e.: walking, dressing, eating, toileting, etc.)
I disagree. Movement, irrespective of function, is important. Here's an example…
Constraint induced therapy (CIT) for the upper extremity (arm and hand) involves working the arm and hand – a lot.
At the end of CIT, the survivor may, or may not be any more "functional." But maybe the wrong things are tested. If you're working with the upper extremity, then you'll test the upper extremity. But here's a weird side effect of CIT: better walking. Why? Because arm swing is made better. We may not think about the arms with regard to walking, but they are important in balance and timing.
And other things that are often not measured very often get better. Things like a reduction spasticity, less shoulder pain, more active range of motion. Movement, irrespective of function, is good.
3 comments:
Interesting view of CIT! My left has been and still is bugging me when I walk. I had already been thinking that less tone in my arm would probably make me walk better and now I know how I can achieve this! Thanks!
As an OT, my experience is that the issue about function is "industry driven" eg medicare and other insurers want to see outcomes in terms of more independent ADL, gait, or other task. I am very happy to help someone work on isolated arm and joint motion, knowing that it is one small piece of the constellation of movements that life requires. Thanks for a very nice blog!
Wendy; well put!
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