STROKE RECOVERY

“The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills.”
-Mayo Clinic

From Sea Dragon patient Robbie Edwards (70 years old):
“I first encountered acupuncture in acute rehabilitation, following an ischemic stroke in 2013. I continued treatment with Cinda at Sea Dragon following my release and do so to this day. Her knowledge of the effect of a stroke is extensive and reassuring after a scary and life-changing event. I deal with a muscle control disorder (spasticity) caused by nerve damage in the brain. In my case, the left hand is continually contracted, and to a lesser degree also my leg. Acupuncture on the top of my head, and in the offending limbs, greatly reduces the contraction and enables me to exercise. Low voltage stimulation through the needles also greatly helps.
“Cinda is so much more than an acupuncturist; I would consider her a confidant, an advocate, and a friend. To my fellow survivors, I would highly recommend Cinda’s gentle and effective care.”
“To my fellow survivors, I would highly recommend Cinda’s gentle and effective care. Her knowledge of the effect of a stroke is extensive and reassuring after a scary and life-changing event.”

What is a stroke?
A stroke is death to brain cells from either oxygen starvation (as in an embolism) or pressure and position shift (as in intracranial hemorrhage).
What is the difference between a “bleed” and a “clot”?

• A hemorrhagic stroke is caused by a ruptured blood vessel and is commonly referred to as a “bleed”. Brain injury can occur due to increased pressure and possibly displacement of the brain.
• An ischemic stroke is caused by a blockage of blood flow within a vessel, commonly called a “clot”. This is most often caused by atherosclerosis, which is a narrowing of blood vessels by plaque deposition that can led to clotting. These blood clots can block the blood vessel where they are formed (thrombosis), or can dislodge and become trapped in vessels closer to the brain (embolism).

Symptoms and diagnosis of stroke:

• One-sided facial drooping, arm and/or leg weakness, difficulty speaking clearly, and possibly a severe headache or visual changes. These are all indicators of a stroke and emergency treatment should be sought immediately, since injury to the brain increases as time elapses.
• An important acronym to remember is: FAST
  • Face: Ask the person to smile. Does one side of the face droop?
  • Arms: Ask the person to raise both arms. Does one arm drift downward?
  • Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • Time: If you observe any of these signs, call 9-1-1 immediately. Note the time of the first symptom. This information is important and can affect treatment decisions.
• An MRI can quickly diagnose a stroke caused by a clot
• A CT scan is a faster means (within a few hours) of diagnosing a stroke caused by a bleed.

How will doctors treat the stroke at the hospital?

• Any type of stroke is best medically treated as soon as possible so as to minimize damage to the brain by restoring proper blood flow to the brain, and/or alleviating pressure.
• Treatment for a stroke caused by a clot is best within 3 hours from symptom onset; the clot must be surgically removed or dissolved with medication to avoid permanent damage.
• Treatment for a stroke caused by a bleed is alleviation of the increased pressure within the brain. This can be done using medications in a hospital setting, and/or surgical repair of the damaged vessel.

What can my family and I do in the days and weeks following a stroke?

• Depending upon the location and severity of the stroke, there may an initial period of “brain shock”, where it is best to allow the brain to be quiet and allow the inflammation to diminish. Brain shock can last up to 6 weeks following a stroke or other brain trauma. During this period, symptoms can worsen as a result of edema or swelling. Some or all symptoms may improve after this time with hard work and diligent rehabilitation.
• Intensive and daily rehabilitation to regain normal body movement and/or speech includes acupuncture, physical, occupational, and speech therapy.
• Other helpful therapies may include: osteopathy, massage therapy, jin shin jyutsu, qi gong, and tai qi.

How can Traditional Chinese Medicine and Acupuncture help aid recovery after a stroke?

• Acupuncture and Chinese Medicine can help calm the nervous system, which is comprised of the brain, spinal cord, and nerves. This calming effect helps to shorten the brain shock period and allows the brain to begin its recovery more quickly.
• Reduction of brain swelling/edema can be achieved with gentle acupuncture treatments that support the brain and body to detoxify and self-heal with improved circulation to damaged brain tissue.
• Using shallow acupuncture points on the scalp and other parts of the body, an energetic and physical connection between the brain and body can be re-established and relearned. This is called brain plasticity and is the key to effective rehabilitation.

What are optimal conditions for recovery?

• A motivated patient and supportive caregivers. Recovery from a stroke can be a lengthy process and requires a lot of hard work. The process must be approached with patience and a long-term vision. Sometimes interim results are so small that they are best visualized with eyes closed.
  • For example, wiggling the affected (“paralyzed”) toes may not be perceivable shortly after stroke. Therefore closing one’s eyes and visualizing the toes moving, while giving the brain and body the instructions to move may be a helpful interim solution before the toes actually begin to move. A family member or assistant can help by gently placing their fingers lightly on the area being engaged and giving feedback as to whether they can feel the initiation of movement before it’s visible.
  • In the case of spasticity, where a limb is constantly in contraction, breathing and seeing the hand relax is helpful. Also a mirror-box may be used to show the brain the reflection of the functioning hand so it perceives normal movement and control of the affected side.
  • A knowledgeable team of acupuncture, physical, occupational, and speech therapists working together to guide you in your rehabilitation.
  • Treatment of rehabilitation therapies such as physical, occupational, and speech therapy, in combination with acupuncture create optimal results.
  • Scalp acupuncture allows the entire body freedom of movement to exercise and position the body as needed during other therapies.

What can I expect from rehabilitation?

• It’s important set a firm foundation and slowly work towards additional tasks, rather than rushing a final goal such as unassisted walking. The natural order of treatment evolution is to first ensure that you are able to maintain your proper posture, whether you are sitting or standing. Once proper posture is realized, the focus shifts to sitting up with as little external assistance as possible, engaging core muscles for stability. Once stable sitting is possible, standing and eventually walking are added to the routine.
• The “affected” or paralyzed side of the body must never be ignored and should be engaged to participate in as many activities of daily life as possible.
  • For example, it may be tempting to neglect the left (affected) arm and just learn to do everything with the right arm and hand. However, the connection between the brain and left arm will not have the opportunity to reestablish itself if the arm is never called on to do work. Instead try using your left arm to feed yourself, or assist with dressing; even if the affected limb is clumsy, it should be called upon as much as possible to participate in the activities of daily life.
  • You should regularly touch, massage, and safely/gently move your affected limbs and joints. An example of this is to touch and massage the affected fingers with the healthy fingers, and use the healthy foot to touch the affected leg. Close the eyes and ask the brain if it can identify which fingers or toes are being touched, how much pressure is being applied, or whether the object touching the affected side smooth or rough, warm or cold. Your body can re-learn these skills, but only if you are a diligent teacher.

What is the ideal window for treatment?

According to the Mayo Clinic, once you are medically stabilized, “The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills.”

From both the medical and integrative medicine perspective, the strategy immediately following stroke is to calm the nervous system, reduce swelling and inflammation in the brain, and restore cognitive and body function as soon as possible.

Prognosis (possible outcome) for recovery of function after stroke depends on numerous variables including: size and location of the brain area affected, time elapsed from stroke to treatment, age, and physical condition prior to stroke. A person’s motivation and commitment to recover function are of paramount importance to outcome.

Much improvement can be made in the first few months to a year following stroke since the muscles and nerve pathways have not yet become accustomed to lack of use in the affected limbs. Following this early period, improvements are still possible though decreasingly likely with the passage of time. With acupuncture treatment and rehabilitative exercise, maintenance of function and range of motion lead to optimized use of affected limbs and prevention of pain.

Resources

The American Stroke Association. http://www.strokeassociation.org

Project Walk: Paralysis Recovery Center. http://projectwalk.com/

American Heart Association / American Stroke Association Guidelines for Adult Stroke Rehabilitation and Recovery
http://stroke.ahajournals.org/content/early/2016/05/04/STR.0000000000000098

The Mayo Clinic. http://www.mayoclinic.org/stroke-rehabilitation

UCSF Stroke Center. http://stroke.ucsf.edu/educational_and_support_resources/faqs