The Challenger Newspaper - March 2014 - Page 15

PostStroke Upper Extremity Recovery Through Rehabilitation

by Michelle Ashley

Stroke is considered one of the leading causes of long-term disability in the United States (Latham et al., 2006). A common impairment experienced by individuals post-stroke is hemiparesis. Hemiparesis refers to one-sided weakness, which affects 80 percent of stroke survivors. Hemiparesis causes weakness or an inability to move one side of the body, impacting an individuals upper extremity, lower extremity or facial muscles (National Stroke Association, 2012). The severity of upper extremity hemiparesis in the first month after injury remains the strongest predictor of outcome, as well as reflecting the degree of damage done to the cortical motor areas and the corticospinal tract (Krakauer, 2005). Research involving neuroplasticity, which refers to the brains ability to reorganize itself by creating new neuronal connections, suggests that upper extremity retraining may be more beneficial when encouraged early in an individuals rehabilitation process (Johansson, 2000; MackenzieKnapp, 1999). The impact of initial severity can be lessened with rehabilitation techniques utilized within the first six months post-injury (Krakauer, 2005). Rehabilitation techniques and modalities include but are not limited to: upper extremity passive range of motion, weightbearing, and electrical stimulation. These techniques and modalities can be utilized early on in the rehabilitation process to facilitate muscle movements that have been weakened or lost due to hemiparesis. Passive range of motion (PROM) aids in preventing joint contractures and maintaining joint flexibility for the arm affected by hemiparesis (Stroke Rehab, 2010). PROM is performed by passively moving the individuals

arm through its available range of motion. Additionally, weightbearing is utilized to aid in the recovery process. Weightbearing inhibits muscle spasticity, reduces tone, increases muscle length, and facilitates underactive muscle groups. Weightbearing also provides multi-sensory feedback to the various muscle groups in the hemiparetic arm by encouraging essential signals to travel to the brain, and promotes the necessary cross talk between the two hemispheres (Martin, 2013). Electrical stimulation (E-Stim) can be utilized as an adjuvant to the above techniques or used alone. E-Stim is used when treating a hemiparetic arm to enhance sensory awareness, provide strengthening of the weakened arm muscles, and aid in improving range of motion (National Stroke Association, 2012). The device sends an electrical charge to the impaired muscle groups, which enable muscle contraction as the individual works to make a movement. These are just a few of the techniques that can be utilized during the rehabilitation process to increase upper extremity after suffering from hemiparesis post-stroke. As noted earlier, it is important to seek rehabilitation early in the recovery process for the best prognosis. The clinicians and staff at the Nevada Community Enrichment Program (NCEP) are equipped with the knowledge, tools, and resources to ensure the proper rehabilitation plan is provided to assist an individual throughout their recovery process. Enabling them to live their life to the fullest and return to the activities they find meaningful. Michelle After earning her B.S. in psychology and human development with an emphasis in neurological science from Washington State University, Michelle worked for

seven years as a research assistant on a neuroscience project studying stoke and traumatic brain injuries at Legacy Emanuel Hospital in Portland, Oregon. The passion for neurological rehabilitation she developed during her assistantship took her to Henderson and Touro University, where she is completing her M.S. in Occupational Therapy, and then to the Nevada Community Enrichment Program (NCEP) where she completed a internship working with the survivors of stroke and traumatic brain injury. Originally from Beaufort, NC, Michelle, 30 now calls the Pacific Northwest home. References Johansson, B. B. (2000). Brain plasticity and stroke rehabilitation: The willis lecture. Stroke, 31, 223-230. doi: 1 0 . 11 6 1 / 0 1 . S T R . 3 1 . 1 . 2 2 3 Krakauer, J. W. (2005). Arm function after stroke: From physiology to recovery. Seminars in Neurology, 25 (4), 384395. Latham, N. K., Jette, D. U., Coster, W., Richards, L., Smout, R. J., James, R. A., Gassaway, J., & Horn, S. D. (2006).Occupational therapy activities and intervention techniques for clients with stroke in six rehabilitation hospitals. American Journal of Occupational Therapy, 60, 369378. Mackenzie-Knapp, M. (1999). Case report: Electrical stimulation in early stroke rehabilitation of the upper limb with inattention. Australian Journal of Physiotherapy, 45, 223-227. Martin, S. (2013). Stroke intervention strategies: Bobath/ NDT [PowerPoint slides]. Retrieved from OCCT 640 Touro University Nevada. National Stroke Association. (2012). Paralysis [Website]. Retrieved from http://www.stroke. org/site/PageServer?pagenam e=hemiparesis Stroke Rehab. (2010). Passive range of motion [Website]. Retrieved from http://www.stroke-rehab.com

Obesitys Link to Type 2 Diabetes (from page 12)

Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City.

Zonszein said that there are genetic factors involved in the development of type 2 diabetes, and the type of fat someone has matters, too. People who have less brown fat (considered a good type of fat) and carry more weight around the middle are generally more likely to get type 2 diabetes, according to Zonszein.

But, he added that the exact trigger for the development of type 2 is still the six-million-dollar question. We cant point to exactly what causes type 2, but we do know that its not good to become obese, he said.

Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City, also pointed out that a combination of factors lead to the development of the condition. But we do know that excess weight is related to an increased risk of type 2 diabetes, he said.

Mezitis said the new findings need to be confirmed in other studies, and that additional studies need to look at a more diverse population.

In the meantime, he added, We can tell the population to start making small changes in their diet. That may be easier to maintain. And, even a small amount of weight loss helps reduce your risk of type 2 diabetes. A weight loss of 10 percent of your body weight significantly reduces your risk of diabetes, high cholesterol and heart disease.

Valley Health (from page 14)

and delivery, post-partum, nursery and neonatal intensive care. We are currently enhancing maternity services at Centennial Hills Hospital with the addition of a Level III neonatal intensive care unit and two mobile water birth units. We are also researching the services that will be available at our sixth facility, which will be located at US 95 and Galleria Drive in Henderson. Valley Hospital will continue to perform womens health procedures including, but not limited to, breast, gynecology, and gynecology oncology surgeries.