Rules for a Good Life After a Stroke

If I have a stroke, I’d like my family to hang this wish list up on the wall where I live and where you live. And, pass it on to your friends and relatives:

Rules for a Good Life After a Stroke

If I have a stroke, I want my friends and family to embrace my reality. I am still the same person on the inside. I just have difficulty getting it on the outside. Please be patient with me and let me finish. Remember, I'm rebuilding my brain pathways.

If I have a stroke, I don’t want to be treated like a child. Talk to me like the adult that I am.

If I have a stroke, I still want to enjoy the things that I’ve always enjoyed. Help me find a way to exercise, read and visit with friends. Don’t isolate me. I still need my friends, and my friends can help me improve just by being there.

If I have a stroke, don’t be afraid to reminisce with me. I still like to hear about the fun things we did. Remember, I'm rebuilding my brain pathways.

If I have a stroke, and I become agitated, take the time to figure out what is bothering me. Sometimes I have no control over my emotions but don’t worry, I won’t hurt you. Remember, I'm rebuilding my brain pathways.

If I have a stroke, treat me the way that you would want to be treated.

If I have a stroke, make sure that there are plenty of snacks for me in the house. Even now, if I don’t eat I get angry, and if I have a stroke, I may have trouble explaining what I need. Remember, I'm rebuilding my brain pathways.

If I have a stroke, don’t talk about me as if I’m not in the room. Remember, I'm rebuilding my brain pathways.

If I have a stroke and you are my caregiver, don’t feel guilty if you can’t care for me 24 hours a day, 7 days a week. It’s not your fault, and you’ve done your best. It would help if you can find someone who can help you.

If I have a stroke and you are a friend, the best thing you can do for me is ask my caregiver if there is something you can help with. It doesn’t have to be much they’ll appreciate any help they can get, big or small.

If I have a stroke, and I have to live in a stroke care facility like a nursing home, or some such, please visit me often.

If I have a stroke, don’t act frustrated if I mix up names, events or places. Take a deep breath. It’s not my fault and it's not your fault. Remember, I'm rebuilding my brain pathways.

If I have a stroke, don’t exclude me from parties and family gatherings. Social interaction helps me improve. Remember, I'm rebuilding my brain pathways.

If I have a stroke, know that I still like receiving hugs or handshakes.

If I have a stroke, remember that I am still the person you know and love, I'm just rebuilding my brain pathways.

***********************************************************************************************************

Ken is now singing with the angels

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

Upon hearing of the recent unexpected passing of one of our stroke survivors, Ken West, I was immediately sad … yet was just as quickly glad that I had been hanging around with my video camera during our Dignity Health-sponsored camp in Prescott, AZ, last May.

I know I've said it before, but I'll say it again that I witness so many miracles at every Stroke Camp. One of those revealed itself as Ken was encouraged to play the keyboard with music therapist Amy Baumert during free time Saturday morning. Ken had severe aphasia — difficulty with receptive or expressive communication — and yet, with the magic of music, he could sing many of those well-learned songs of life. He is just one of many, many examples of why music therapy is such an important part of the Stroke Camp experience.

He practiced with Amy, and then performed in front of the entire camp on Sunday morning. I was captivated by his deep voice and how much he had achieved. Most of all, I loved his laugh, especially when he was laughing at himself. And the applause after his presentation was so genuine and rich, filling each of us with deep joy and even a few tears.

Please take two minutes of your precious time to listen to Ken, an extraordinary man beloved by so many. Our deepest sympathy to his wife Carla and family. He was a gift to all of us …

Strokes Perplexing Wave of Emotions

For those of you who are getting these posts via email, I have replaced the previous SOS article, due to its poor print quality, with this one.

This article was taken from a Strike Out Stroke Facebook posting I got last January. Strike Out Stroke is a registered trademark and is a division of Retreat & Refresh Stroke Camp. I don't know who the author is but I do appreciate their information. If anyone knows please let me know so that I can give proper credit.When someone survives a stroke, a family feels relief, happiness, and joy. But no one can be prepared for the perplexing wave of emotions that a stroke survivor experiences.

Although emotional changes after stroke are typical, the impact on a survivor’s personality may be the most difficult to deal with. For caregivers and families, it’s important to remember that stroke causes trauma to the brain and that the behaviors and responses displayed are a reflection of that injury.

Recognizing and coping with the behavioral changes that accompany stroke are just as important as addressing physical issues during the rehabilitation process. Emotional reactions are complicated by the array of sensory and motor disabilities that follow brain damage from stroke. Survivors struggle with deficits in language, reading, writing, speech, memory, judgment, planning and so much more. These cognitive problems can weigh heavy on stroke survivors and their families. Conflict may arise when the survivor feels misunderstood or utter despair over the loss of physical capabilities.

While some emotions are “normal” responses to biological and lifestyle changes after stroke, other feelings may signal a more serious problem.

To help you understand what your loved one is going through, here are the most common emotional reactions that accompany stroke:

Emotional lability – Following a stroke, the person may seem like a stranger: survivors may respond one way immediately after the event, only to respond differently a week or two later. Soon after stroke, the person may struggle to control his or her emotions. Survivors are said to be “emotionally labile”, meaning they are prone to strong feelings and rapid mood swings. The person may embark on fits of laughing or tears that do not fit’s their mood or seem inappropriate for the situation. They may be happy and sad in only a few minutes.

Impulsivity – Stroke survivors can be impatient and impulsive. Because areas of the brain are disinhibited, stroke survivors may be more impulsive. They fail to think ahead, or move too quickly – possibly causing themselves or those around them harm in the process. Caregivers should be especially watchful for this reaction when makingdecisions about a stroke survivor’s ability to drive a car.
Anxiety – Anxiety is considered a “normal” reaction to lifestyle adjustment following stroke. As a person begins to cope with their new disabilities, they may feel a sense of loss that triggers anxious feelings. Anxiety is frequently associated with periods when a person is left along for a period of time. Fears can arise of another medical emergency, their growing dependence on caretakers, and helpless for their condition.

• Self-centered behavior – Insensitivity to others is commonly seen in post-stroke patients. Many survivors become largely concerned with their own interests and exhibit inflexible, rigid thinking. This lack of empathy can contribute to demanding behavior. Caregivers can feel as if the person is impossible to reason with, which could result in the breakdown of family ties and important social bonds.

• Apathy – Stroke survivors may be content with sitting around for hours without doing nothing at all. While this lack of motivation may be alarming to caregivers, apathy is a consequence of damaged brain areas. Stroke survivors may lack initiative and show little feeling or interest in activities. It’s important to note, however that apathy is different than being tired or depressed: An apathetic person feels content with their state of being, whereas a depressed person feels despair.

• Depression – Depression is a common reaction following any life-altering event, including stroke. Survivors may feel a sense of sorrow for activities they were previously able to do. Many question their self-worth; people value themselves through their activities. A loss of identity can result in depression, anger and frustration. Both patients and family members may cycle through the stages of the grieving process (denial, anger, bargaining, depression, and acceptance).

Post-stroke depression is characterized by:

• Feelings of sadness
• A sense of hopelessness or helplessness
• Increased irritability
• Changes in eating, sleeping and thought patterns

Treatment for post-stroke depression may be necessary. If the person’s depressive symptoms worsen over time, interfere with daily functioning, or include suicidal thoughts and ideation – consult a medical professional immediately. A range of therapies and treatment options are available to help.

Are post-stroke personality changes permanent?

Personality changes that occur after a stroke are often the hardest to deal with. Luckily, not all changes are permanent. As the recovery process advances, some reactions may disappear. The person may “mellow out” over time as he or she builds coping skills and adjusts to life as a stroke survivor.

How to cope with changing behaviors after stroke:

• Be patient. Have understanding that your loved one is facing many challenges and in most cases, cannot help behaving in undesirable ways.
• Remind yourself that these behaviors are a part of the brain injury. Stay strong for your loved one – your support is important.
• If your loved one is having angry outbursts, try to find what triggers him or her. It could help prevent future incidents.
• Stay calm. Avoid raising your voice when you talk to the person and take a time out if you need to deal with the problem alone.
• Talk with other family members about the changes your loved one is going through. Educate them on what to look for and how they can help if your loved one is having an especially bad day.
• Seek counseling or join a support group. Working through your frustrations with others who are in similar situations can be helpful and healing.
• Discuss personality changes with your healthcare provider. You doctor can help you assess your loved one’s health condition and provide recommendations on post-stroke recovery.

Would You Like To Be A Stroke Camp Volunteer

Will you take some time right now to listen to that little inner voice that may be directing you in a very meaningful and rewarding direction. If you do, my hope is that it is speaking to you about us.

If any of our needs listed below interest you, please feel free to contact us using the phone number or addresses at the bottom of this post for further information or to answer any questions you might have . 
-----------------------------------------     

*********************************************************************************

Personal Testimony of Laura T. Barnett

I would like to take this opportunity to introduce myself. My name is Laura T. Barnett and I live in McHenry, Illinois. I had my stroke in 1980 when I was 23. I belonged to Stroke Survivors Support Group in Elgin for many years. Through that club, I found out about Stroke Camp. Since about 2008, I have been going to Stroke Camp once a year. I love it!

This is an excerpt from some of Chapter 1 of my book, Blink Twice If You Mean Yes. I had been in a coma for two weeks. Many of you stroke survivors have memories of being totally mixed up. I can tell you for sure that I didn’t know if I was having a bad dream or not. At this time, I wasn’t able to talk or move.

Am I Having a Nightmare?

A voice broke the silence when a woman called, 

“Laura, it’s time to wake up.”

Okay, Mom. Is that you?

“Laura, wake up.”

No, it isn’t Mom. I know she’s talking to me because she’s calling my name. But who can it be? I can’t seem to open my eyes.

“Laura Barnett, wake up.”

Now, who’s she talking to?

“Come on, Laura Barnett. Wake up.”

Oh, she must be talking to me. That’s right, I’m married now. I used to be Laura Klehr. Now I’m Laura Barnett.

She bent over me cheerfully saying slowly, “Laura, it’s June 15, 1980.”

Drifting in and out, I suddenly heard the date. 

WHAT? Is she nuts? Come on. The last day I remember was May 31. 

I formed words to say, 

No, it can’t be June 15. 

 I finally was able to open my eyes, but everything was a blur. The figure scurried about as if not one word had come out of me. Agitated because I thought I had clearly answered her the first time, I restated, 

No, it can’t be June 15! 

 Once again she didn’t even acknowledge me but went right on moving about the room. 

I can’t believe this! What’s wrong with her? Is she deaf? 

I tried again, thinking I was screaming, 

NO! IT CANNOT BE JUNE 15!

There was no response. The woman-shaped form said, 

“You’re in Northwest Community Hospital.”

A HOSPITAL? What for? Hey, lady! What am I in here for?

Because I had not responded, she said it again. This time she said it so slowly that she was irritating me, 

“You—are—in—Northwest—Community—Hospital.”

She must think I’m a real dummy. I heard her the first time. Oh brother! She won’t tell me what’s going on. What is she? A nurse? Most nurses have the decency to answer when spoken to.

The next day came, and a different female figure said, 

“It’s June 16, and you’re in Northwest Community Hospital.”

I don’t understand how it can be the middle of June already. 

But, because of the different nurses insistent repetition of the dates, it slowly sank in that they had to be right. 

These people must really be nurses, but I don’t know why I’m in the hospital. I wish someone would tell me!

---------

            PERSONAL TESTIMONY OF LAURA T. BARNETT

In Blink Twice If You Mean Yes, it is 1980, and I wake up from a two week coma. Unable to talk or move, I discover that the nightmare that I thought I was having is real. Only later do I find out that at age 23, I have suffered a rare brain stem stroke. Through the blinking of my eyes, I have a tiny peephole into communicating with my family, friends, and the hospital staff.

God forged a strength and determination in my soul that allowed me to walk out of that hospital four months later. However, I wasn’t aware that it was God. Because I was headstrong in the ways of the world, I thought this inner resolution was of my own making. 

God will allow us to go through something that seems ridiculously unfair because He needs someone to go through difficulty and come out victorious for His glory. When people have been through a great hardship, and they come out whole, sane, happy, and joyful, it makes others think, maybe I can do it. 

I could have given up! That would have been the easy way out.

Threaded uniquely in my journey is the progress from the isolation and alienation from God of a secular person to moving gradually to spiritual discovery. Searching for the purpose of my stroke, I miraculously come to faith in Jesus fourteen years later, March 1, 1994. When I committed my life to Christ, I found the answer. 

Because of my disability, my life since Christ has not been trouble-free. There have been broken bones, surgeries, the challenges of daily living, and then a divorce. My left arm continues to be disabled, and both of my legs are relatively useless. 

Yet through all of this, God sustains me and gives me joy. He is so awesome! I give God all the glory!
---
Copyright notice: Please do not copy or forward any part of this blog article without written permission from Laura T. Barnett. If you wish to do so, please leave a comment on this article with your contact information. 

**********************************************************************************

Emotions of stroke can be hard to tame

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

A survivor’s emotional response to anything and everything may change a little or drastically in the post-stroke world. Some report spells of endless tears and then laughter or vice versa. A kind deed or moderately sad tale may turn them into a waterfall. A childhood joke may send them into convulsing laughter.

Depending on the stroke’s location, the brain injury may jumble or exaggerate emotions. The doctor may diagnose certain conditions that explain these behaviors. As the caregiver, you have the challenge of paying attention to these changes and discovering their triggers where possible. Also make sure you don’t ridicule what may seem like a childish response.

It’s exhausting and frustrating to control out-of-control emotions, even if they’re as harmless as laughter or tears. Reassure them it’s okay and it’s not them; it’s the stroke. Help them feel more comfortable around others and to create signals or words that indicate they want or need to leave when they experience these difficult emotional moments in public.

Remember, a caregiver's arms are the strongest safety net in the world. 

Smile, challenge and repeat

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

During a visit, a family member saw the stroke survivor successfully raise her affected leg three or four inches off the ground and lower it. That was quite an accomplishment, but the visitor decided to have some fun.

“Oh, I didn’t see that,” she said, in a totally innocent voice.

The survivor played along. With a smile, she repeated the motion.

Isn’t that just a little more enticing than, “Lift that leg”?

Different fuels motivate us when we don’t want to do something or struggle with the task awaiting us. That’s just being human. Survivors battle even greater challenges, and we can lift that emotional load significantly by adopting some new game plans along the way.

• Challenge the survivor by saying, “Nah, you can’t do that.”
• Say “Don’t you do that!” in a playful tone. That often has the desired effect in encouraging them to do just the opposite.
• Use bribery whenever and wherever possible. Make it fun!

And just like the shampoo bottle says: shampoo, rinse and repeat. Only this time: smile, challenge and repeat.

Listen to a survivor

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

Stroke can often open up a whole new world when it comes to vocabulary.

A caregiver saw a sign, “tree trimming ahead,” and asked her survivor husband if he could read it. He said, “Cut ‘em up pretty soon.” He couldn’t say the specific words but he knew what they meant. Most of the time he’s correct, but surprisingly, it’s often hardest with little words like “a,” “the,” “and” or short proper nouns and names. He wrote “Bob,” but it didn’t look right. He couldn’t come up with the word “buffet” but said it was a place where “all ready and pay for it.”

Well, you know what, that’s okay because he “gets it.” It’s exercising a part of his brain that the rest of the world often lets go dormant. It’s actually creative. And by golly, a buffet is a place that’s all ready and you pay for it! 

Remember the following:
• Words may literally take on a whole new meaning after stroke.
• Clichés may be lost in translation in a post-stroke brain.
• Look for signs of puzzlement or confusion and take time to explain. 

Listen to your survivor. You may learn a new vocabulary word or a description that you have always taken for granted.

'Tis the planning season!

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

Our staff and volunteers take fun seriously! Planning for the 2016 Stroke Camp season started last year as our crew got together to work on the theme, discussion group topics, entertainment, crafts and much more.

Now, I'm not going to reveal right now what we're doing for 2016, but I thought you'd enjoy this glimpse into what went into our planning for last year's theme of our around the world with Stroke Camp. We are a close-knit group that thrives on fun and working together to create the best experience for our stroke survivors, caregivers and volunteers.

We tried out costumes for skits and group activities and had many laughs in the process. We also experimented "on" some of our local stroke survivors who are members of the Chime Strokers to try the "me books" concept last year, which was very successful. It was an opportunity for us to gauge the interest, comfort level and how much time it took to complete the project. 

As you can tell, we love what we do because we love our survivors and caregivers. We love even more what we get in return: the smiles, the laughter, the friendship and THE love!

Can't wait for the new season to start!!

 

It's the moments that matter … part 3

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

One of the best parts of being involved in Retreat & Refresh Stroke Camp is witnessing everyone being themselves. Camp is the place where you can "let go" and "let your guard down" and laugh and be silly and simply be HUMAN.

Oh what a relief it is!

At our August 2015 camp in Colorado sponsored by Cheyenne Regional Medical Center, I was enjoying the beauty of the mountains and suddenly had a front row seat to watch the comic antics of stroke survivor Stacy Gupton, left, and music therapist Catie Alpeter. Those two are the queens of clowning around at Stroke Camp, and they outdid themselves this year.

My finger went trigger happy on my camera as I captured their poses and how they egged each other on. They're both creative souls — Stacy an amazing artist and Catie an incredible music therapist — and I certainly can understand the need to just act crazy once in a while … well, as often as I can … :-)

What was most beautiful to witness was how these two young friends played and laughed. And nothing was stopping Stacy, who has limited use of her left side from the stroke, from accepting any challenge Catie issued.

This is just one of many, many examples of why Stroke Camp is so important in the lives of our campers AND volunteers. The short video includes several photos from one of many moments that matter. It's all about laughter, love and friendship … at every camp, in every life …

And I know Catie and Stacy will understand why their moment needs to be shared … because it's so darn beautiful, just like both of them …

It's the moments that matter … part 2

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

One of the many joys of Retreat & Refresh Stroke Camp is the rediscovery of the simplest pleasures in life … which we often take for granted. Just waiting for those moments to happen is what makes me love everything about the Stroke Camp experience.

I'm extremely blessed to have the opportunity to photograph so many of these special memories, and here are just a few of these occasions from the 2015 camp season.

I loved watching Lauren Kramer, our director of operations, inviting one of our survivors to get up and dance at our Montana camp during the Saturday night entertainment. As many of the couples started to hit the floor, some of our staff and volunteers were looking for "singles" who might like the chance to dance. Lauren asked Irene, who is always up for some fun.

And it was so inspiring to witness Irene forget all about any physical challenges and simply move to the music. One of the greatest lessons I've learned about being involved with Stroke Camp is how important it is to just "ask" … ask a survivor or caregiver if they want to dance or sing or play or be part of the group.

If we'd all ask someone if they'd like to participate, so many walls and fears would be erased in this world. Don't just wonder if someone wants to do something, ask them. Sometimes that's all they need to hear to join the fun, to be invited, to be included. Just ask.
 

Stroke Camp is also all about encouraging our survivors and caregivers to express themselves creatively, and they don't have to be artists to create something truly amazing.

One of our crafts last year was a form of Japanese painting, a unique technique of applying small drops of paint to a special water base and watching them spread into beautiful images. I watched a lot of campers try this art form for the first time, but I was particularly drawn to Wayne at our Chicago-area camp and watching his priceless expression as he discovered that he could create art all by himself.

His face tells the story of the wonder of what the human mind and body can create when given an opportunity and canvas to dabble and design. Yes, you have a creative bone in your body, whether you think so or not, and that "talent" is different in everyone. We just need the right forum to express it, and Stroke Camp is one of the most creative environments in the world because our campers are encouraged to be themselves.

A little nudge, a little encouragement, a little patience, a lot of love … it all goes a long way at Stroke Camp …

It's the moments that matter … part 1

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Staff Volunteer

One of the most precious elements of Retreat & Refresh Stroke Camp is witnessing moments that are memorable and that matter. I have been so blessed to be in just the right place at the right time to see priceless human connections unfold before my camera lens. This week and for the next couple of weeks, I want to share the stories behind some of my favorite photos that in some small way tell the story of Stroke Camp and why this organization is so vital to so many folks.

During evening activities at our Living Springs camp in 2014, I was mesmerized by watching music therapist Kyle Wilhelm, right, interact with stroke survivor Mel. Mel has severe aphasia, which has hindered his ability to speak, but it has not dampened his enthusiasm for life and the odd ability to say two words, "hot dog!"

I love Mel and his devoted wife and caregiver Dora, and I stood off to the side for about 10 minutes watching Kyle work with Mel to bring some rhythm to his speaking efforts. We've seen some amazing miracles with music therapy at camp, which is a whole other subject. What I loved about this moment was the human bond these two men are sharing to learn new ways of communicating.

The roots of Stroke Camp are based on pure and simple human connections. It's truly what camp is all about, whether it's a survivor or caregiver getting personalized attention on ways to improve their daily life, or reminding them that there IS life after stroke.

Yes, there IS much more to be discovered about life after a stroke … much more laughter to be shared … much more love and friendship to be revealed. And that's the ultimate beauty of Stroke Camp …

The Whole Brain Nothing But The Brain.

This post is about the brain. Strokes and brains are closely related (thank you Mister Obvious). The brain is more than a glob of tissue in your skull. It is so much more complicated, and consisting of so many parts that it defies comprehension. Cutting the blood supply (aka; stroke) to any of these parts will have dire consequences. 

I'm going to tell you about a mobile app that will show you every part of the brain plus explanations giving you a better understanding of the complexity of this organ. 

This is a free app called 3D Brain (by DNA Learning Center) that I found on the Google Play Store. I would be willing to say that it is free on the iTunes - Apple Store, too. Just bring up the store app of your choice and do a search on 3D Brain.

3D Brain was produced by the Dolan DNA Learning Center at Cold Spring Harbor Labratory, 1 Bungtown Road, Cold Spring Harbor, NY 11724: www.dnalc.org

The following is taken from the info tab of the 3D Brain app itself as it appeared on my Android tablet. If you don't want to read all this then scroll down to where I show you the graphics and how to use the app.

-------------
Overview
The brain is a remarkable structure that defines who we are as individuals and how we experience the world. Recent advances in neuroimaging have allowed researchers to look inside the brain, providing vivid pictures of its subcomponents and their associated functions. The gross structure of the brain is familiar to most. The outer layer of the forebrain constitutes the familiar wrinkled tissue that is the cerebral cortex, or cortex for short. The large folds in the cortex are called gyri (from the Greek, ‘circle’). The small creases within these folds are fissures (from the Greek, ‘trench’). Each hemisphere of the cortex consists of four lobes— frontal, parietal, temporal, and occipital. Other important structures are the brainstem, cerebellum the limbic system (which includes the amygdala and hippocampus).

The G2C Brain consists of 29 interactive structures that can be rotated in 3-D space. Each structure contains information on associated functions, disorders, brain damage, case studies, and links to contemporary modern research.

Case studies
Perhaps the most well known-case study in neuroscience is Phineas Gage, who suffered severe damage to the prefrontal cortex following a railroad-related accident in 1848. An explosion drove a large iron rod through Gage’s skull, and he was later reported to have severe social impairments. Although the extent of these impairments remains controversial, his case study was a landmark in that it correlated specific cognitive functions with a specific brain area. Since then, tens of thousands of case studies have sought to associate specific brain regions with specific functions, and many of these are documented in G2C Brain structures. However, it is important not to overstate the point. All cognitive functions result from the integration of many simple processing mechanisms, distributed throughout the brain.

Associated functions
arousal
emotion
language
learning
memory
movement
perception
sensation
thinking
many others

Associated cognitive disorders
Almost without exception, cognitive disorders correlate to multiple regions in the brain. Just as the genes and biochemicals associated with cognition are expressed throughout the brain, gross structures that correlate with cognitive disorders are widespread. This is certainly true of the six disorders covered in G2C Online: ADHD, Alzheimer's autism, bipolar disorder, depression, and schizophrenia.

Associated with damage
It is possible for the brain to repair damaged neural networks or to compensate for the loss of function in particular structures. Common impairments resultants from brain damage include deficits in attention, emotion, language, learning, memory, movement, perception and sensation.

Substructures
amygdala
basal ganglia
brainstem
Broca's area
cerebellum
cingulate cortex
corpus callosum
dentate gyrus
entorhinal cortex
frontal lobe
hippocampus
hypothalamus
inferior temporal gyrus
limbic system
medulla
middle temporal gyrus
occipital lobe
parietal lobe
perirhinal cortex
pons
prefrontal cortex
premotor cortex
primary motor cortex
somatosensory cortex
subiculum
superior temporal gyrus
temporal lobe
thalamus
ventricles
Wernicke's area
and many others
----------------------------------------------

Here I will show you the steps to use the app.

1. When you start the app you are presented with the following screen. You can tell your in 3D View mode because you can see the blue line under the words 3D VIEW near the top left of the screen. You can touch the brain and rotate it left and right by sliding your finger.



2. From this first screen you can bring up the list of parts as shown below by touching the word Brain that appears just under that blue line. The list will look like this:


3. Touching any of the items in the list as shown above will show you a 3D image like this one below. I selected Amygdala. Again, touching the image and sliding your finger left or right will rotate the image:



4. Now, if you touch the word LABELS near the top of the screen that is just to the right of the words 3D VIEW, you'll see the following with the blue bar now under the word LABELS, and lines pointing to each area for that part. This image does not rotate:



5. Next, if you want to see more information about this part, then touch the word INFO that is to the right of the word LABELS near the top of the screen.

This is what you'll see. A detailed description of the item:



6. To position to another brain item, touch 3D VIEW again and start over. That's all there is to it.

Research reviews

Harrison and Weinberger (2008) review schizophrenia by integrating research on genes, gene expression, and neuropathology (Pubmed ID number: 15263907).

Malenka and Bear (2004) review the processes underlying long-term potentiation and long-term depression (Pubmed ID number: 15450156).

Selkoe (2002) reviews evidence that Alzheimer's disease begins with subtle alterations of synapses in the hippocampus, caused by assemblies of the amyloid beta protein (Pubmed ID number: 12399581).

Sudhof (2004) reviews the synaptic vesicle cycle (Pubmed ID number: 15217342).

*******************************************************************************

How I Got an Extra 100 Hours of Rehab

The following article is part two of two parts written by Clay Nichols. Part one is in last week's post titled "Busting Recovery Myths". Clay, as you learned last week, is co-founder of MoreSpeech and Bungalow Software. Both provide Speech & Language Software.

I encourage you to visit his site by clicking on this link: Speech & Language Therapy Software for stroke and brain-injury survivors . 

----------------

by Clay Nichols

Specific steps I took to get extra, personalized rehab treatment (free) after an injury and made a full recovery.

Previously, I explained how your brain recovers from an injury such as stroke or TBI, and why insurance sometimes doesn't provide enough therapy to make that recovery, then denies additional therapy... because you didn't make progress (what I call the Insurance Catch-22). So, if recovery is possible, but you need more than what insurance typically provides, what can you do?

Here’s what I did.

My Rehab

A year or so ago I had a shoulder problem from too much computer use. (I’ve been creating speech therapy software for over 20 years. All that time on the computer caught up to me.) So off I went to the PT.

She had me do a bunch of exercises to strengthen my shoulder but it was tough to remember the exercises. How high should I rotate my arm, here? I know, you're saying hey, you're overthinking this. If it doesn't hurt you're OK. Well, some of the movements I made caused my tendons to pop. It didn't hurt but when she cringed I knew it was a Bad Thing. And as I did the exercises, she corrected my form quite a bit. If I did those exercises wrong they wouldn’t have the desired effect, or worse, they’d cause further damage.

So, I couldn't remember the exercises and wasn't even following her directions perfectly in therapy. And I'd need over 100 hours of treatment for full recovery. I didn't have an extra $10,000 to spend on having the PT guide me through each of those 100 hours. Also, I'd rather not spend an extra 100 hours driving to and from the PT and sitting in the waiting room.

I'm not complaining. Stroke & TBI survivors have it much worse.

Why Deliberate Practice is the key to improvement

Just Do It is not as effective as Do It Right

Before I explain my nifty solution, I want to point out why I didn't follow Nike's advice and Just Do It. If I wanted the exercise time to have maximum effect I needed to do the exercises the right way, and not just going through the motions (quite literally in this case). Doing 100 hours of exercises improperly wasn't going to help me much.

In his book So Good They Can’t Ignore You, Dr. Cal Newport studied how people improve significantly at a skill. He demonstrated that exceptional skill is rarely due solely to luck and natural gifts, but due to what’s termed deliberate practice.

Put another way, if you just show up and work hard, you’ll soon hit a performance plateau beyond which you fail to get any better. We all hit plateaus. Cal Newport, PhD

Plateaus? Sound familiar? It’s what survivors in speech therapy run up against all the time, as I described previously.

What Dr. Newport calls Deliberate Practice, would translate, in Rehab, to Treatment. If you have apraxia following a stroke, and can't speak, you don't simply try harder to speak, you consult a speech therapist. They would then provide you with specific exercises for the Apraxia. An excellent example of treatment in speech therapy is the the Rosenbek Hierarchy, which is a very specific treatment protocol which research has shown is effective for Apraxia treatment. The idea behind it is that the patient starts with success (getting as much assistance as needed) then that assistance is gradually reduced as the patient improves.

Don't sacrifice socializing!
Practice is preparation, not replacement, for socializing.

Speech & language treatment should not displace social interaction: don’t give up enjoyable time with the family to sit in a room doing drill practice. But don’t expect social interaction, alone, to improve your speech and language as effectively as treatment. Treatment can also provide confidence, which makes socializing more relaxing.

How I Multiplied PT by 2000%

So….can you guess of how turned my few hours with the PT into 2000% more treatment?

I had her video record me with my phone while she told me how to do the exercises, with feedback just for me, like "how high do I raise my arm? This high."

Viola! I had a personalized training video. So, I had clearer instructions, with feedback included as voice-overs during therapy, and I could just watch it while doing the exercises.

I went in a few more times, for a total of about 4 or 5 hours of PT. And those videos let me turn that into over 100 hours of practice.

*******************************************************************************

Busting Recovery Myths

The following article is part one of two parts written by Clay Nichols, Co-founder of MoreSpeech and Bungalow Software which both provide Speech & Language Software. It was originally published in their free newsletter in August 2015. Clay has given me permission to re-post his article on our blog. 

Clay has spent the last 20 years helping patients, caregivers and speech pathologists with speech & language software. He's picked up a lot of tips and tricks along the way and he shares them in his free newsletter.

I encourage you to visit his site by clicking on this link: Speech & Language Therapy Software for stroke and brain-injury survivors . 

----------------

What you need for speech & language recovery. And why you might not get it.
---

Stroke and TBI survivors talking to Clay:

"They told me the window for my recovery had closed." - Stroke Survivor

“She said I had plateaued, and that I was as good as I was ever going to be," recalls Ms. Hervey, in a Wall Street Journal article (11/28/2006)

----

I’ve had lots of stroke and brain-injury survivors recount similar stories. And then their therapy ended. 

But, it’s a myth.

The origin of this myth is complicated. I don't think any speech therapist is saying "No patient can improve beyond X months". But that's what patients hear. Some survivors truly can't make progress, either because their deficit it too severe, or they are not motivated to do the work to improve. But that's on a case by case basis, not because there is some arbitrary "recovery window". 

Here’s what Dr. Jim Lynskey, PT, Ph.D has to say in Stroke Smart magazine:

"In truth, study after study shows that the so-called 'window of recovery' does not exist. Although the time shortly after a stroke occurs is important, most stroke survivors see the effects of recovery for the rest of their lives. Continuing physical, speech, and occupational therapy for years after a stroke can still yield positive results." (emphasis added)

The National Institutes of Neurological Disorders and Stroke (part of the NIH) agrees:

“For some stroke survivors, rehabilitation will be an ongoing process to maintain and refine skills and could involve working with specialists for months or years after the stroke."

Brain-rewiring, called Brain Plasticity, continues into Adulthood.

Scientists have discovered that the ability of the Brain to “rewire” itself doesn’t end in childhood, as was once believed.

“Today we recognize that the brain continues to reorganize itself by forming new neural connections throughout life. This phenomenon, called neuroplasticity, allows the neurons in the brain to compensate for injury and adjust their activity in response to new situations or changes in their environment.” writes Stephanie Liou at Stanford University.

Insurance Catch-22

Many get less therapy than insurance will provide. What you can do to get more.

We know the brain can continue to recover, even years later. So why do I hear from caregivers that they are being told the patient plateaued and (most importantly) insurance has not pre-authorized a follow-up visit to assess that expected readiness for more therapy? 

If the expectation from the insurance company is: You need to go home and practice until you’re ready for more therapy. Shouldn’t the insurance company pre-authorize the follow-up to confirm their assumption?

Yet, no caregiver I’ve ever spoken to has had that follow-up prescheduled. I don't think this is anything nefarious. It's just a flaw in the system. This may explain why therapy more often ends due to lack or progress rather than exhausting benefits. The data from speech therapists confirms that therapy ends 400% more often due to lack of progress than lack of benefits. Insurance is prepared to provide more benefits if you can make more progress.

The root cause of this seems to be the policy of many insurance companies that they will pay for additional therapy only when the current therapy produces results. That seems like quite a reasonable policy aimed at putting resources where they will do the most good. That’s certainly not the effect it has.

Patients need 2 to 8.8 hours of therapy per week

A review of research studies indicates that treatment of 8.8 hours 
of week is effective. Conversely, 2 hours per week is not effective.

Click this link to see: Code, C, Petheram, B 2011.

Most caregivers and patients I speak with tell me insurance is providing 3 or fewer sessions and most sessions are 45 minutes. Do the math. That's maybe 2.25 hours a week.

In a peer-reviewed medical journal article: Code & Petheram report:

“Average hours of treatment for aphasic people in the developed world ranges between 1–5 hours per week, with a great deal of variability, although recent research suggests that intense
treatment of 9 hours per week over a relatively short period is needed in order to be effective. It is concluded that there is a significant gap between what the research suggests is the appropriate amount of treatment and actual provision throughout the English-speaking world. (Code and Petheram, 2011)." (emphasis added)

The same article reported a study that showed two hours was not enough weekly treatment to be effective. These are statistical averages and every patient is different. Some may need less or more than the average. Ask your therapist how many hours of practice you need.

Speech Therapy May Not Be Appropriate

Just as there is not rule that says recovery stops after X months or years, there is no guarantee that a patient will make progress. Some patients don't have a good "starting point" for therapy. Perhaps
they have no language whatsoever and have not made progress after 20 or 30 hours of speech therapy. Or patients may prefer to spend their time on something other than speech therapy. I tell
caregivers that stroke recovery like the old TV Detective Shoes: You have to show Motive and Opportunity. If the patient is motivated then the caregiver can provdide the opportunity. Some
patients seem unmotivated but are actually just blocked by some obstacle (fear of failure, difficulty in getting to therapy, etc.). We can remove obstacles, but we cannot provide motivation.
I'll be discussion that in an upcoming article of these Rehab Resources.

Your speech therapist's hands are tied

Your therapist has no control over the insurance company's policies. They became therapists to help you, but their hands are tied. The insurance company decides what they will pay for. If they'll pay for only 10 sessions, your treatment ends in 10 sessions. You could pay out-of-pocket but therapists understand that most people can't afford that. If you pulled out your checkbook it would cost $100 to $400 per extra hour of therapy. FYI, I'll be covering some suggestions for much more affordable therapy in a future Rehab Resource. Also, if they suggest that you need more therapy than insurance will provide then patients are likely to expect the therapist to appeal to the insurance company, a faceless bureaucracy. And your therapist would have to do that on their own time. The insurance company certainly won't pay the therapist to advocate for more money from the insurance company.

Avoid the Plateau & get more therapy

If the patient gets the additional 6 or 7 hours of weekly practice the research shows is needed, then they could make enough progress to avoid the problematic plateau and avoid therapy ending prematurely. It's a double-win: you make more progress and get more therapy, increasing the odds of even more progress.


So, now we know:

Recovery is possible even years later (From Resource #1) If...

1. The patient can get enough therapy, but...

2. The Insurance Catch-22 means that patients often do not get enough therapy....

3. You just need to find a way to get more treatment.

So, if insurance won’t pay for additional therapy unless you make progress, but doesn’t provide enough therapy to make that progress, how can you get the extra 6 or 7 hours of weekly treatment to make the progress insurance is looking for? I'll cover that in the next issue.

My Solution... in an upcoming issue

I’ll tell you how I overcame the Insurance Catch-22.

I'll also tell you how you can use that same approach to improve your odds of getting all the insurance-provided therapy you deserve and likely increase the speed of your recovery, and your odds of getting all the insurance-provided therapy you deserve (and need!).

Blog editer note: I will post the "Solution" next week but, if you don't want to wait, go to Rehab Resources site and look for "How I got 100 extra hours of rehab" :

http://www.bungalowsoftware.com/blog/index.htm#patients
Clay Nichols

Co-founder of MoreSpeech and Bungalow Software which both provide Speech & Language Software




For over 20 years, Clay has helped patients, caregivers and speech pathologists with speech & language software. He shares the tips & tricks he's picked up along the way.

He is not a speech pathologist.

But he consults with the speech pathologists he works with. You should consult your speech therapist regarding any tips you read anywhere, including the Rehab Resources.

*****************************************************************************

Stroke caregivers are survivors, too

By Monica Vest Wheeler
Retreat & Refresh Stroke Camp Volunteer Staff

A while back, I wrote a post entitled, "We're Survivors, NOT Victims," in hopes of ridding the word "victims" from the stroke world vocabulary. I haven't met a stroke "victim" yet in the 75 Stroke Camps I've attended as a volunteer. Every one of them has been a survivor in every sense.

I've also learned much about stroke caregivers. They are survivors, as well, as they've spent countless hours in worry and care over a loved one who has had a stroke. They heard every bad scenario and prognosis in the book, and yet, they never gave up the most unique of human emotions: hope. 

Stroke caregivers run on some invisible adrenaline that can't be mass produced or even replicated by the finest chemistry labs in the world. You can't manufacture love. 

I've met caregivers of all ages, from young children whose parents have endured a stroke … to adult children caring for parents … to spouses withstanding a dramatic evolution in their relationship … to retired parents suddenly taking on a caregiving role for their adult children … to siblings, nieces, nephews, cousins and dear friends stepping into the position of caregiving with little warning or preparation.

Just when you think you've heard or seen every imaginable situation, I meet new people and witness new memories in the making at every camp I have the privilege to attend. Even those folks I've known for several years continue to evolve in their caregiving role through time. I wanted to share just a small sampling of the beauty and perseverance of caregiving I observed through my camera lens in 2015.

And I can only imagine what I will see this year … what images will inspire and stay with me forever …