I spent 4 days in mid-February going through the intensive Certified Stroke Rehabilitation Specialist course. This is the only stroke-specific certification for Occupational and Physical Therapists in the U.S. My brain was filled to the brim with new information and I wanted to share some of it with you!

A notebook lies open on a desk with the word "Notes" written in it.

Executive Function

Executive function is made up of the higher-level thinking processes we use to live our daily lives. It includes the ability to problem-solve, plan, set goals, make decisions, and multi-task.

The instructors shared a study that found up to 75% of survivors will deal with cognitive changes.

That’s a lot!

Specifically, executive function changes sometimes look like “laziness,” difficulty finishing tasks, being agitated or restless, or saying inappropriate things. It’s important to have conversations about these cognitive changes in order to normalize survivors’ experiences and help care partners understand.

That’s not to say there aren’t things you can do to improve and work on these changes. I made a video on ways to improve short-term memory but the concepts apply to executive function, too.

Spasticity

We have pathways that carry information from the body, via the spinal cord, to the brain on what movements we want to do. We also have pathways that carry information from the brain back to the body to initiate the muscle contraction to do those movements.

In a typically functioning nervous system, we see something called reciprocal inhibition. This is when one muscle or muscle group turns on and the opposing muscle group turns off.

Let me give you an example to break this down. When you brush your teeth and bend your elbow to bring the toothbrush to your mouth, your biceps fire to allow your elbow to bend. At the same time, your triceps “turn off” so that you can achieve this movement.

When someone has a stroke, the signal from the brain back to the body is interrupted. In addition, the sensors in our muscles (muscle spindles and Golgi tendon organs) are still working and able to send signals to the brain, but the muscle spindles can become abnormally triggered.

This can result in a variety of abnormal muscle tone including

  • Hypertonia: increased muscle tone that makes it difficult to lengthen muscles (stretch).
  • Spasticity: velocity-dependent, high muscle tone that may catch and release with quick movements.
  • Co-contraction: causes the primary and opposing muscle groups to fire at the same time.
  • Spastic dystonia: the muscles stay in a contracted position and are unable to relax.
  • Clonus: causes the stretch reflex to be triggered and will cause shaking and spasms.

The muscles that bend are stronger than the ones that extend, which is why it can be hard or painful to extend or straighten the fingers, wrist, and elbow after a stroke or brain injury.
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Many effective treatments for spasticity like e-stim, Botox injections, and oral medications require consulting your doctor. However, a free option that high-level research supports is prolonged stretch of the affected muscles. It can help to decrease spasticity, improve range of motion, and increase independence in daily activities.

The Core Issue

I’ve previously talked about the importance of proximal stability for distal mobility with a specific focus on scapular (shoulder blade) and shoulder strengthening. Just to quickly refresh, proximal stability just means that the muscles closer to our body have to be strong and stable before we can move the smaller muscles away from the body.

The course reiterated the need to focus on that proximal stability first. This includes making sure that our core is strong and that we have good postural alignment. We have to build a strong foundation to enable movement.

I hear a lot of frustration from survivors who, understandably, just want their arms and hands to work. What if we took a step back?

Before jumping straight to the arm and hand, let’s prioritize the core and scapula. Lay the foundation for improved movement.

Here are some simple ways to start improving core strength:

  1. Desk push: Sit up tall in a solid chair without wheels in front of a table or desk with your feet on the floor. Gently grab the edge of the table and press your hand or hands forward into it. You should feel some activation in your lower abs.
  2. Thigh push: Again sitting tall in a solid chair, place your hands on top of your thighs. At the same time, push your hands down into your thighs and push your thighs up against your hands.
  3. Single-leg lift: Sit in a solid chair with your feet on the ground. Place your hands on the seat of the chair by your hips or on armrests, if the chair has them. Keep your knees bent and lift one at a time just above hip level.

Adaptive Shoes & Clothing

The course not only taught me more about stroke treatment, but I also learned about brands that are making stylish adaptive clothing and shoes!

  • Nike: They offer the FlyEase adaptive shoe line with different models that are easy to get into and more hands-free. The FlyEase line also offers wider models to accommodate AFOs!
  • UGG boots: The Universal line has oversized, double zippers, stretch laces, and rear pull tabs. They can also accommodate AFOs.
  • Zappos AFO Friendly Shoes: They have an entire section that offers AFO friendly shoes for everyone.
  • Zappos Adaptive Clothing: They partnered up with Tommy Hilfiger to create shirts, shorts, and dresses with magnetic and velcro closures, as well as shorts and pants with elastic tighteners.

These options are a bit pricey, but it’s nice to know that brands are starting to realize that everyone likes to look and feel nice in what they’re wearing.

I learned a bundle from this course. If you learned something from this article, please feel free to share it!