For more details on this study click on link below :-

http://uk.reuters.com/article/scienceNews/idUKTRE4988E620081009

Ginkgo has been used as a medicine for centuries and remains a very popular herbal medicine. Some findings suggest it can improve cognitive function and decrease development of Alzheimer’s disease symptoms. It is generally considered safe.

It was quite natural to treat your spouse after a stroke and had been discharged from the hospital just like before! She looked physically fine except for the spasticity on the affected limbs. However slowly it dawned on me that a stroke survivor is different from a physically impaired person in the sense that a stroke survivor suffers from brain damage!

Any damage to the brain however small still causes a lot of dysfunction in terms of the thinking process, processing words and understanding. Initially my wife told me things that she didn’t mean to say! For example she wanted bread but what came out from her mouth was noodles! When I brought her noodles she said she told me to get bread! I was flabbergasted by such things and initially get rather stressed out because of the frequent out-burst of anger from her apart from doing double work.

I did not understand this aspect of brain damaged and we had quite a few tiffs in the initial stage. As I read more and understood what was happening, I began to have compassion and understand her frustrations too! She could not help it either! The caregiver, as the person with a good brain intact is expected to empathize with the stroke survivor and with understanding comes the ability to handle and brush-off ‘unfair accusations’ and not allowing yourself to get angry, thus making caregiving less stressful and more meaningful.

I hope that sharing our experience in this area of ‘Behavioral Change’ can help other family members and caregivers to sail through the recovery process with less stress and better understanding, hence compassion for the stroke survivor. As you see the slow improvements, that is the reward for all caregivers and make all the aches and pains worthwhile.

In the days ahead, I will put up posts on this issue with personal experience and less of a technical treatise on the subject and hope that others who are going through similar experience can benefit from the sharing. Please leave your comments, positive or otherwise, so that we can learn together and enjoy mutual benefits. Thank-you!

Motor imagery (MI) is the mental representation of movement without any body movement. Abundant evidence on the positive effects of motor imagery practice on motor performance and learning in athletes, people who are healthy, and people with neurological conditions (eg, stroke, spinal cord injury, Parkinson disease) has been published.

An advantage of MI is that patients can practice it independently during the regeneration phase between two physical therapy sessions. MI can also be practiced in all stages of stroke recovery. In an early stage of recovery, MI allows patients to mentally practice a task which they cannot yet carry out physically due to motor impairment. However, it has not been determined yet, when it is best to start with MI.

The Video Links given below are the routine MI and BIT exercises that Rock goes through daily! The use of the mirror is to create the artificial impression to her brain that her affected hand is moving in tandem with her good hand! In a way this is also considered Bilateral Isokinematic in a sense. There are in total 8 Videos of different exercises involved and you may watch each specific exercise to get a better understanding of how it is done. These Videos were recorded at the University Hospital Stroke Rehab Clinic with the kind permission of Puan Noorieni the Chief Physiotherapist there. Hope these Videos are helpful to other caregivers who want to use them at home but you need to purchase or make those accessories yourself. Thank-you.

Exercises that Rock did since 2005 … 3 times a day with each exercise lasting an hour or more.

1. Motor Imagery – Wrist Rotation Exercise.
2. Motor Imagery – Wrist Up-down Exercise.
3. Motor Imagery – Wrist Open-close Exercise.
4. Weight Bearing Exercise.
5. Bilateral Isokinematic – Elbow Exercise.
6. Bilateral Isokinematic – Fingers Exercise.
7. Bilateral Isokinematic – Wrist Up-down Exercise.
8. Bilateral Isokinematic Relaxation Procedures.

]]> http://www.nurtureyourown.com/Sprouts/208/motor-imagery-therapy/feed/ 1 http://www.nurtureyourown.com/Sprouts/194/bit-in-action/ http://www.nurtureyourown.com/Sprouts/194/bit-in-action/#comments Wed, 18 Jun 2008 09:17:12 +0000 bokjae http://www.nurtureyourown.com/?p=194 Hello everyone! It has been quite sometime since my last post on Bilateral Isokinematic Training (BIT) and today, I would like to share a Video Clip on the Initial Relaxation Exercises before commencement of the actual BIT Exercises. Just a bit of background introduction to the main Actresses shown here. They are my wife rock, the stroke survivor and Puan Norani the Senior Occupational Therapist at the University Hospital in Petaling Jaya, Selangor. The video was shot in her Clinic and I have to say Puan Norani is a very experienced, well-trained OT with many years of experience in this field and she is gentle and patient

Like all Physiotherapy and OT Exercises, bringing the person into a state of relaxation is very important for effective therapy. Proper movement of the other parts of the hand in this case are related to the state of relaxation. Never, never start the exercises when the person is not relaxed because then it will be the Spasticity that is causing the movements and not the proper linkages, muscles of the hand.

As her caregiver, I am learning the whole exercise process and the various routines so that at home I can repeat the exercises properly and for at least three times a day. Each exercise routine lasts about 30 minutes and allow time for the person to rest. The Relaxation Exercises are repeated for each and every routine. Patience, gentle coaxing, verbal affirmations are the right approach for caregivers who assist stroke survivors going through the exercises.

I had shared quite a bit of information on stroke, you can view my articles at the
stroke archive by click on the link.

Many studies and research are being done now to study the effects of this form of treatment and honestly, it is so technical that it is difficult for me to explain this in layman terms! I am sure you have noticed how babies when they kick, they often use both legs! This is what the doctors call our human inherent natural body Symmetrical Motion with respect to the mid-sagittal plane! Such studies comes under Neuro-Physiology.

In simple terms, BIT is being introduced into Stroke Recovery Programmes for upper body limbs training and there are contradicting research results from the medical practitioners. Some said BIT do not contribute significant improvements as compared to Unilateral training and others strongly recorded significant improvements! I went through the research papers and the test results are dependent on selected patient samples, extent of damaged, age factor etc. All I can say is that there are more proponents who observed positive improvements than negative ones.

In my wife’s case, she is on this program for about 2 months now and we noticed a marked improvement in the sense that her muscles are stronger thus her upper limb movements improved! I am doing a video on her typical routine which I hope that I can post it here for the benefit our readers.

One popular technique is the use of ‘Mirror Imaging’. What happens is that the affected hand is placed inside a box where on the out-side of the box is a mirror! When the patient is told to move her good hand, she sees the reflection of the good hand on the mirror giving the impression that the affected hand is moving! However I noticed that although my wife raised her right wrist, the good side, her affected left hand moves accordingly! What she sees is just the mirror reflection and she cannot see her own left hand because it is in the box!

Well that much for BIT and there are many other techniques used in her session but always using both hands (Bilateral) rather than just exercising the affected hand (Unilateral) to move which is the normal Psyhio Training. Guess that’s all for BIT and do be look out for the videos in my coming posts. The filming is schedule on the 27th May.

Eat low-fat diet with a variety of grains, vegetables and fruits along with some high-protein foods like meat or dairy products and balance how many calories of intake with exercises.

Deciding to change is the first step and remind yourself that changes don’t have to take place over-night. Start with easy ones then one by one add more kinds of vegetables, reduce portion sizes.

Bladder problems are another issue. Quite often, fear of having to go to the bathroom frequently or loss of bladder control causes a person to limit fluids. This can cause other problems such as dehydration, dry mouth, difficulty swallowing, loss of appetite and constipation.

Depression can affect people’s appetite in different ways. Many people turn to certain foods for comfort when they are depressed. These may be old favourites from childhood – scoop of ice-cream, mashed potatoes etc. The danger is overdosing it and increase intake of sugars, fats and other unhealthy elements. There are some who lose their appetite when they are depressed. Eating with others can help you and the person in your care stay connected. Remember that staying physically active can help decrease the symptoms of depression.

Bowel management often involves preventing constipation. Fiber counts…add up! Fibers are found in cereals, grains, nuts, seeds, vegetables and fruits. A diet rich in fiber (about 25 to 30 grams each day) along with adequate fluid intake and physical activity can help promote good bowel function. Fiber also provides a sense of fullness, which helps in managing how much one eats.

This will be the concluding Part of Stroke & Diet and hope that you find these Four Parts useful or helpful, especially if you have a family member or friend who is a stroke survivor. What was written under Stroke & Diet in these four Part mini-Series are collections from various sources and it is difficult to give any references to them. I suppose with the Internet checking for further reading to these is not such a difficult task anymore. Thank-you for your patience!

Stroke & Diet Part 1 ~ Stroke & Diet – Part 2  ~ Stroke & Diet – Part 3

What is a Stroke? ~ Facts of Stroke & The Warning Signs. ~ Stroke Risk Factors. ~ Understanding Spasticity Eating & The Stroke Survivor ~
The Job No One Asks For Caregivers Month ~ Botox & Spasticity ~ The ABC’s of Caregiving Behavioural Changes ~ There is Hope ~ Improving Awareness ~ Fall Prevention for Stroke Survivors ~ Sleep Disorders.

Personally I feel that it is equally important to address the issue of Antioxidants in relation to a healthy diet be it for stroke survivors or ordinary folks. Sufficient quantity of fiber and antioxidants in our diet are the building blocks for good health.
Antioxidants are disease-fighting compounds that prevent and repair damage caused by oxidation from environment pollutants, chemical toxins, tobacco smoke, lifestyle abuse and poor diet choices. Unchecked oxidation can lead to cancer, heart disease, Alzheimer’s diseases and Parkinson’s diseases.

From the Book “The Antioxidant Miracle” by Lester Packer Ph.D., Lipoic Acid, Pycnogenol, Vitamins E and C will help you to prevent oxidation. One source for these antioxidant content can be found in fruits. A five to ten servings of fruits daily should supply you with sufficient antioxidants. One serving is about the size of your fist. Locally in South-East Asia we have the following fruits that are rich in antioxidants.

Guava.
Red-fleshed Guava contain high quantity of the antioxidant Lycopene, more than strawberries, spinach and broccoli. Lycopene may lower the risk of cancer such as prostate, ovarian, cervical, oral, pharyngeal, esophagus, stomach, colorectal, lung and pancreatic cancer. One pink-flesh Guava contains 37 calories and is a good source of fiber and Beta-Carotene another antioxidant. Helps to lower cholesterol as well as blood pressure too.

Lemon.
Lemons contain high levels of the antioxidant Flavonoid, Hesperetin and Eriodictyol which may lower heart disease by lowering cholesterol and prevent “bad” cholesterol oxidation. A medium size lemon contains 17 calories and is an excellent source of Vitamin C. Limonoids, Phytonutrients in lemons can fight colon cancer.

Papaya.
Papayas are top source of Beta-Cryptoxantin, an antioxidant that may reduce the risk of lung cancer. Also rich in Vitamins A and C, fiber, Folate and Potassium. Papayas also contain Papan an enzyme that aids in protein digestion.

Mango.
Half a mango contains 68 calories but twice your daily requirement of Beta-Carotene and Vitamin C. The antioxidants neutralizes free radicals and regulate cell division.

Lychee.
Ten Lychees contain 63 calories and rich in Vitamin C. Japanese researches discovered that Lychees help protect against liver damage.

Pineapple.
Fresh Pineapples are the only known source of Bromelain, an enzyme that inhibits inflammation, a usual source of oxidation triggers leading to lung and breast cancer. It also hastens wound healing and prevent asthma flare-ups. It thins mucus too which makes it helpful for bronchitis and sinus problems. Finally it prevents sluggish blood which is good for heart problems.

Pomelo.
Full of the antioxidant Naringenin and Eriodictyol which reduce the risk of heart diseases by lowering cholesterol and preventing “bad” cholesterol oxidation.

Strawberry.
Strawberries are loaded with brain-healthy antioxidants anthocyanins and quercetin. It also contains Ellagic Acid, another antioxidant which could reduce the risk of prostrate cancer. Eight pieces of medium-size strawberries have 45 calories and provide more than 150 percent of the daily requirement of Vitamin C. They are also packed with fiber and manganese.

Watermelon.
One serving provides lots of Lycopene and Vitamins A and C. It also enhances male fertility, the amino acid Citruline (found mostly in the rind) may function as a natural alternative to Viagra.

Pear.
Pears are leading source of the antioxidant Epicatechin, which helps combat free radicals linked to aging. They are also one of the best source of cholesterol lowering fiber which are found in the peel. A pear contains about 4gms of this fiber and only 100 calories.

RELATED POSTS ON STROKE

Stroke & Diet Part 1 ~ Stroke & Diet – Part 2

What is a Stroke? ~ Facts of Stroke & The Warning Signs. ~ Stroke Risk Factors. ~ Understanding Spasticity Eating & The Stroke Survivor ~
The Job No One Asks For Caregivers Month ~ Botox & Spasticity ~ The ABC’s of Caregiving Behavioural Changes ~ There is Hope ~ Improving Awareness ~ Fall Prevention for Stroke Survivors ~ Sleep Disorders.

Recommended Food:

• Choose lean meats, fish and poultry and bake, broil or grill whenever possible. Add beans, peas, lentils, nuts and seeds to it.

• For Calcium supply, include 3 cups of low-fat or fat-free milk, yogurt or low-fat cheeses for good bone health. For those who cannot consume milk use calcium fortified foods and beverages to fill the gap.

• Limit your fat, sugar and salt for these extras can add-up. Check food labels and look for low in saturated and trans fats. Sugars often only provide added calories with little added nutritional value so reduce your intake and if possible avoid it. Choose and prepare food with little salt or sodium.

• Eat any type of fish with edible bones, such as canned salmon or sardines. Fish contains Omega 3 Fatty Acids which helps to reduce risks for Arrythmia or sudden death, blood clots and Atherosclerosis, reduce Triglycerides levels and lower Blood Pressure.

• Choose dark-green vegetables like kale, broccoli, turnip greens and mustard greens. The calcium in these veggies is better absorbed than the calcium found in spinach, rhubarb, beet greens and almonds.

• Calcium-fortified tofu, soymilk, orange juice, breads and cereals are excellent staples. Tofu, soy, walnuts and flaxseed oil are the plant sources of Omega 3 Fatty Acids.

• Vitamin D also plays an important role by helping in with calcium absorption. Exposure to the sun is another way where our bodies produces Vitamin D say 15 – 20 minutes exposure. Be careful with supplementation because Vitamin D is stored in the body and can be toxic in relatively low amounts (>2,000 i.u./day).

Watch out for my next post on Stroke & Diet Part 3, which will cover Recommended Fruits which are beneficial for stroke survivors!

RELATED POSTS ON STROKE

Stroke & Diet Part 1 ~ Stroke & Diet Part 3

What is a Stroke? ~ Facts of Stroke & The Warning Signs. ~ Stroke Risk Factors. ~ Understanding Spasticity Eating & The Stroke Survivor ~
The Job No One Asks For Caregivers Month ~ Botox & Spasticity ~ The ABC’s of Caregiving Behavioural Changes ~ There is Hope ~ Improving Awareness
Fall Prevention for Stroke Survivors ~ Sleep Disorders.

Poor diet and lack of exercise contribute to stroke and other cardiovascular diseases in the following ways:

• Diet affects Dietary Cholesterol, which has a major impact on Atherosclerosis. High Cholesterol dramatically increases the risk of all cardiovascular diseases, including Ischemic Stroke.

• Diet affects blood pressure.

• Diet impacts diabetes which dramatically increases the risk of stroke and cardiovascular disease.

• Diet contributes to overweight and obesity which in turn increases the risk of diabetes and cardiovascular disease.

The diet of a stroke survivor necessarily take into consideration the following:-

Control Cholesterol:

Cholesterol is present in the cell wall of every cell in animal and human bodies. The amount of cholesterol determines how permeable (leaky) the cell is. Cholesterol is so important to our basic biology that our bodies manufacture all the cholesterol they need from saturated fat. Dietary Cholesterol is extra.

Cholesterol manufacture is under genetic control and it is possible that diet and exercise won’t be enough to lower the level. The use of cholesterol lowering medication may be called for. Older cholesterol drugs work to block absorption of dietary cholesterol. A new type of drug addresses the manufacture of cholesterol in the liver.

Tropical oils (palm and coconut) and partially hydrogenated oils contribute to cholesterol levels. Hydrogenated oil is vegetable oil with hydrogen whipped into it, generally to increased shelf life. Nutritionists now label these oils as “trans-fat.” It is suspected that trans-fats also contribute to atherosclerosis a disease in which cholesterol deposits form on the walls of arteries, narrowing them.

Control Blood Pressure :-

Diet affects blood pressure because it affects weight, sodium and atherosclerosis. Atherosclerosis increases blood pressure by narrowing arteries from the inside. Sodium causes water retention because our kidneys need water to maintain a proper electrolyte balance. This retained water puts pressure on the blood vessels and keeps them from relaxing, thereby increasing blood pressure.

One good diet formulated by nutritionists is the DASH Diet (Dietary Approach To Stop Hypertension) which is low in saturated fat, cholesterol, and total fat. It emphasizes fruits, vegetables and low-fat dairy foods and includes whole-grain products, fish, poultry and nuts. It is reduced in red meat, sweets and sugar-containing beverages, as well as rich in magnesium, potassium and calcium, protein and fiber. Research has reported reductions in blood pressure in as little as two weeks after beginning the DASH diet.

I did a search on this and confirmed that this is true. A Research Team at Yale University did a project called Haemorragic Stroke Project and the findings were given in a Report on May 10^th 2000. For those who want to know more please go to the following site :-

http://www.fda.gov/cder/drug/infopage/ppa/

The implications are serious in this findings. Many people buy OTC medicine for common cough and cold and for some weight-loss prescriptions without realizing the danger if such prescriptions or drugs contain PPA. Even for first time users taking drugs that contain PPA stand the risk of a Haemorragic Stroke. Perhaps this explains why young and healthy people died suddenly of a Stroke although they never possessed any symptoms or tell-tale signs like High Blood Pressure, Diabetes etc.

The next time you run to your local drug store for some cold medicine please check that it does not contain PPA! In the US, the FDA has stopped drug companies from using PPA in their prescriptions.

RELATED POSTS ON STROKE
What is a Stroke?
Facts of Stroke & The Warning Signs.
Stroke Risk Factors.
Understanding Spasticity
Eating & The Stroke Survivor
The Job No One Asks For
Caregivers Month
Botox & Spasticity
The ABC’s of Caregiving
Behavioural Changes
There is Hope
Improving Awareness
Fall Prevention for Stroke Survivors
Sleep Disorders.