Saebo, Inc.

Are you a neuro therapist or a therapist that treats neuro? There is a distinct difference…   A neuro therapist embraces the latest advances in evidence-based treatment so their bench to bedside time will be nominal.   They will subscribe to more than 1 specific treatment approach when treating stroke clients.    A neuro therapist’s caseload will mostly comprise of, you guess it, neuro patients. He or she will be comfortable with utilizing stroke technology and has some of the latest tech in their clinic.   Finally, a neuro therapist will never give up on their patients because they don’t believe in permanent plateaus. Yes, there will be mini-setbacks and they will need to pivot at times, but progress will still be made. The key to seeing this progress might be at a micro level, and trust me they will see it, when others do not. https://lnkd.in/eeRETAs3 #proudneurotherapist #EBP #noplateauinsight 

Are your treatment sessions supported by research? How about your colleagues? Periodically, it is always a great idea to check National Library of Medicine (NLM) or Cochrane to confirm the latest best practices. Encourage your clinical team to have monthly article reviews during lunch to educate, debate, and inspire. The neurorehab field has come a long way over the last 20 years. Still not where we need to be, but happy with the progress.

Should NDT/Bobath still have its own chapter in therapy text books? Most, if not all, major stroke guidelines worldwide do not recommend NDT as a key intervention for stroke recovery. The evidence is super clear regarding this inferior treatment approach. Should educators still be dedicating “meaningful” time on theoretical concepts when repeated Level 1 evidence suggests more beneficial interventions? Check out a clip from an upcoming episode of the #NoPlateauPodcast. Jessica Schmidt MS, OTD, assistant professor of occupational therapy at Concordia University of Wisconsin, and I dive deep on the Educators Role in Translating Evidence to Practice. #EBP #noplateauinsight https://lnkd.in/eQYfexCc

Plateaus suck. Just like athletes and musicians, many stroke survivors will have periodic and temporary plateaus or setbacks as they continue to improve.   It is a back-and-forth process.    Improve a little, then a plateau occurs.    Modify the training and improve some more.    Then, here comes another plateau. Modify again.    You get the idea.    This “climbing up the recovery ladder” process is like improving your golf swing or learning how to play an instrument.    SIDE NOTE: Remember when Tiger completely redid his golf swing…3 TIMES?   Plateaus are real and will occur. Many will change up their practice routine to push through to climb another rung in the ladder.    So where am I going with this?   Recent advances in clinical research have shown that repetitive task training improves arm and hand function in stroke survivors suffering from MILD to MODERATE impairment. Unfortunately, Individuals with more SEVERE weakness are unable to benefit from similar powerful treatment principles due to lack of movement.    This inevitably leads to a term called “learned-nonuse” which means failure to use the affected limb. Without movement, there is no chance for recovery. Basically, here comes a plateau.    So, how can we help stroke survivors take advantage of what the research wants us to do?   Occupational therapists received orthotic training in school and should understand the rationale behind selecting appropriate dynamic orthoses based on the client's condition. Most clinicians also have been introduced to electrical stimulation and other movement-assistive devices.   ⚡ A dynamic hand orthosis (or glove) will allow severely impaired hemiparetic patients to take part in purposeful task training. Simply put, it’s taking a non-functioning hand and allowing it to grasp and release again. ⚡ FES allows the client to generate purposeful movements during appropriately timed tasks. ⚡ Unweighting devices like, mobile arm supports, can properly position the severely impaired arm in preparation for occupational performance.   With solutions commercially available (and taught in OT/PT schools), there is no excuse for patients to leave “empty-handed”.     Patients:    If spasticity is preventing you from using your arm or hand, get with a therapist who is knowledgeable with the above solutions. Your recovery depends on it.   You will be engaging your hand and your brain will thank you for it.  Therapists:    If you are currently not providing neuro-based solutions in your tool bag, ask yourself why?    Treating clients with mild to moderate hemiparesis is hard. Treating severely impaired hemiparetic clients is even harder.    Now is NOT the time to say, “Sorry Mrs. Jones, there is nothing more I can do for you as no further progress can be made”.    There is no expiration date on neuroplasticity, so let's keep driving changes and help your clients climb one more rung! #noplateauinsight

Are You Concerned About Strengthening a Spastic Muscle?   I hope not! For some clinicians, strengthening a hyperactive or spastic muscle is a very controversial topic.    The thought of having stroke survivors squeeze their spastic finger flexors or flex their overactive biceps causes some clinicians to have acid reflux.    Early in my career, I was frequently reminded to not evoke abnormal movement patterns while treating patients suffering from hemiparesis.    According to many of my senior colleagues at the time, strengthening hyperactive muscles was considered harmful and detrimental even leading to increased spasticity, exaggerated abnormal movement patterns and possibly pain.    Of course, this was purely theoretical, based on “we’ve always done it this way”, carried on year-after-year, with no science to back it up.    Nevertheless, I never questioned why and how this would happen, and as a novice clinician, I was not ready to challenge conventional principles. MY BAD!   When I co-Founded Saebo, I started to search for evidence-based treatment for clients suffering from spastic hemiparesis.    To my amazement, there were many studies indicating positive functional outcomes for strength training - without increasing spasticity or pain. In addition, none of the articles concluded that this form of treatment was ineffective or harmful.   In fact, according to ebrsr.com (Evidence-Based Review of Stroke Rehabilitation) 33 RCTs were found evaluating strength training for upper extremity motor rehabilitation. The findings showed that strength training was considered beneficial for clients suffering from hemiparesis.   Over the last 2 decades, the neurorehabilitation field has observed a clinical shift when it comes to recommended treatment interventions, as popular theoretical concepts from decades past have faded into the shadows of new scientific evidence.    From the days of avoiding contact on the palmer surface of spastic hands, or heavy emphasis on tone reduction techniques, to now appreciating the efficacy of hand and arm strength training (Patten et al., Butefisch et al., Teixeira-Salmela et al., Sharp et al., Fowler et al.).    From shunning abnormal movement patterns, or excessive exertion in fear of increasing spasticity, to now endorsing highly repetitive task-oriented training and Constraint Induced Movement Therapy (Wolf et. al, Winstein et al., Arya et al.)    From suggesting that the client’s inability to move one’s limb was the result of spasticity, to now recognizing that muscle weakness is the main contributing factor to lack of motion and impaired function (Harris et al., Patten et al., Ada et al.).    The evolution of neurorehabilitation treatment has been palpable to say the least.   As neurorehabilitation technology continues to flourish, and conventional treatment interventions are replaced or transformed based on current science, I cannot help but remain optimistic about the future. #noplateauinsight #spasticity #EBR

Top 3 Approaches Commonly Used To Manage Visual Field Loss Visual field loss is a common consequence of stroke, affecting a significant number of individuals. These defects can greatly impact a person's daily functioning and quality of life. It is estimated that visual field loss occurs in 20% to 57% of stroke survivors. The most common type of visual field defect is hemianopia, where half of the visual field is lost on either the right or left side. This loss of vision can significantly impact a person's ability to perform daily activities such as reading, driving, and navigating their surroundings. Top 3 Interventions 1️⃣ Restitutive Interventions Restitutive interventions aim to restore or regain lost visual field areas. These interventions typically involve visual restitution therapy, which employs techniques to stimulate the damaged visual areas and promote recovery. What does the research say? Studies investigating the effectiveness of restitutive interventions have shown mixed results, with limited evidence supporting their efficacy. 2️⃣ Compensatory Interventions Compensatory interventions focus on helping individuals adapt to their visual field defects by changing their behavior and activities. Eye scanning training, reading training, and exploration of the visual field are common compensatory strategies. What does the research say? Research suggests that these interventions may improve visual search strategies, reading skills, and the ability to perform activities of daily living (ADL). 3️⃣ Substitutive Interventions Substitutive interventions involve the use of aids or modifications to compensate for the visual field defect. One example of a substitutive intervention is the use of prisms, which can expand the visual field and enhance the person's ability to see on the affected side. What does the research say? The evidence for the effectiveness of substitutive interventions is limited and of low quality. While the evidence for interventions targeting visual field loss after stroke is limited, some interventions show promise in improving functional abilities and quality of life. Compensatory interventions, such as eye scanning training and reading training, may be beneficial in enhancing visual search strategies and reading skills. Further research is needed to establish the effectiveness of restitutive and substitutive interventions and to explore the role of assessments in guiding interventions for stroke survivors with visual field defects. Check out the below article for additional information. https://lnkd.in/emFFtfHs #noplateauinsight #visiontherapy #visualfieldloss