Proprioception after Stroke

November 2019: Semrau et al (In Press) Differential loss of position sense and kinesthesia in sub-acute stroke. Cortex, https://doi.org/10.1016/j.cortex.2019.09.013 https://www.sciencedirect.com/science/article/pii/S0010945219303351

Humble opinion: Its relatively rare to see evidence published relating to position sense and kinesthesia, so this is an article worth reviewing, especially, because these investigators found that more than half of all those recovering from stroke had deficits in both! This places these at far higher clinical significance, than perhaps has been previously appreciated. All 285 participants in this study had recent, first-ever strokes. The methods, measures, tasks and data analyses all point towards a study that has high scientific integrity. Therefore, these findings can be trusted, giving us true, valid and reliable findings. Interestingly, the study recruited many more participants who were male, but the average age of 61 is reflective of a relatively “normal” stroke cohort.

As I inferred before, to find that more than half of people diagnosed with a recent, first-ever stroke experience deficits in position sense and kinesthesia, means that we should certainly be screening for this in all acute stroke patients, because, this is not an easily-observable deficit. What the investigators also found was that most patients with both deficits were diagnosed with right hemispheric lesions in both cortical and sub-cortical regions; so, at the very least, this sub-cohort of patient should be screened. It’s also worth keeping in mind that 22% of participants experienced only one of these deficits; and this was more likely to occur in those with smaller lesions. Unsurprisingly, the findings indicate the two deficits share common neural pathways. The other significant finding is that yes, these deficits do adversely impact a person’s ability to undertake everyday tasks. I suggest this is a very important article to read, but as always, this is just my humble opinion.

To read the abstract, select Journal Club 2019 and Proprioception after Stroke.

Neuroplasticity, Stroke Recovery & Learning

August 2019: Carey et al (2019) Finding the intersection of neuroplasticity, stroke recovery, and learning: Scope and contributions to stroke rehabilitation. Neural Plasticity, Article ID 5232374, https://doi.org/10.1155/2019/5232374

My congratulations to Leeanne and her colleagues on this incredible piece of research. The fact that an initial search identified just over 400,000 publications gives you some idea of just how much work was involved in this investigation. The temptation to stop right there must have been very strong indeed. Not only is this research innovative in its research question and methods, it is intriguing in its findings. As the title indicates, the investigators set out to find the intersection between neuroplasticity, stroke recovery and learning, and what they found is portrayed in Figure 3. Interestingly, the findings don’t quite intersect, which may say more about where research is up to, in the evolution of this evidence; because, the connectivity between these three issues is in no doubt at all. That “cognition was the major theme identified”, does not come as any surprise. Other identified themes like “task-based….and activity-based learning” and “experience-dependent learning” provides the therapeutic perspective. This watershed evidence is a “must read” for all those involved in recovery after stroke, I’d suggest. This article is freely available. As always, this is just my “humble opinion”.

PS: To make my blog less complicated, as of this month, I’m only going to post. I’ll leave it to others to comments if they want to.

Neuroplasticity After Stroke

July 2017: Livingston-Thomas et al. (2016) Exercise and environmental enrichment of task-specific neuroplasticity and stroke recovery. Neurotherapeutics, 13, 395-402. DOI 10.1007/s13311-016-0423-9

Earlier this week I was in Melbourne running a 2-Day Neuroplasticity workshop. My thanks to all those who attended – such an enervating and inspiring group of therapists. Two of the issues we discussed were firstly, the fact that neuroplasticity is an “umbrella term” that includes both brain reorganization and neurogenesis; and secondly, the fact that some of the neuroplasticity literature can be really difficult to read and comprehend. Its important that we don’t allow this difficulty to prevent us from understanding neuroplasticity because, after the first few hours post-stroke, it is foundational to all recovery in all people diagnosed with all strokes.

This article explores neuroplasticity from more of a neurogenesis perspective. Sure, it is hard to read, but not impossible to understand. What I reckon these authors give us, is an intriguing review of the literature relating to two of the most contemporary issues in stroke recovery; physical activity and an enriched environment. This is well worth reading, and yes, it may take some extra concentration! You’ll find “Humble Opinion” in its usual place under this topic on the 2017 Journal Club page.

Just to give you the “heads-up”, I reckon my book will be released in August. It’s titled (surprise, surprise!!) Changing Stroke: Radical Rethink of Recovery.