Rehabilitation Matters

Buddist Biker Beats Cognitive Decline

The Dalai Lama, watched a brain operation during a visit to an American medical school in the early 1990s and asked the surgeons a startling question: Can the mind give shape to brain matter?

When you think about it, why is it that older people drive so slowly in the outside lane of the motorway?  You can picture how it is – cloth cap, sitting close to the wheel, a white-knuckle grip and oblivious to what is happening around them.  

Wouldn’t you think that being older they would be in more of a hurry to get somewhere – less time to live and all that?  Now whenever I have offended someone with ranting about this they usually say,  “This decline you see - Its natural – its about cognitive decline – reflexes, balance, eyes etc getting poor with age.” 

I have for a long time wondered how much ageing is a natural event and how much of it is based on a belief – albeit a deeply held unconsicous one -  that we have been conditioned to turn into reality.  It seems that science is starting to agree with me.

A few years I was presenting at a conference on the topic of "orthotic management of stroke". The presentation had a few controversial elements to it.  Leaving aside the orthotic element, I mentioned the emerging science of neuroplasticity and how potentially this could be an area to watch in terms of stroke rehab.   Whatever happens, this topic will be a “Hot” one in years to come. 

My thought was – would it be possible to increase the plasticity of our cognitive processes with some form of exercise to allow much faster recovery in the event of a stroke? Or would it be possible to create some form of after-the-event exercise that would enhance stroke recovery?

 Until recently my master plan for prevention of cognitive decline was to give everyone over 50 a high powered motorcycle.  There are some other techniques being developed that might be more palatable for the majority.

 In response to the Dalai Lama's question,  neuroscientists had explained to him that since the 1980's we know that mental experiences reflect chemical and electrical changes in the brain. When electrical impulses zip through our visual cortex, for instance, we see; when neurochemicals course through the limbic system we feel.

But something had always bothered him about this explanation.

The Dalai Lama asked “Could it work the other way around?”

That is, in addition to the brain giving rise to thoughts and hopes and beliefs and emotions that add up to this thing we call the mind, maybe the mind also acts back on the brain to cause physical changes in the very matter that created it.  If so, then pure thought would change the brain's activity, its circuits or even its structure.

 One brain surgeon hardly paused. Physical states give rise to mental states, he asserted; "downward" causation from the mental to the physical is not possible.  Despite this slap down ten years ago, the Dalai Lama had put his finger on an emerging revolution in brain research.

Neuroscientists have since overthrown the dogma that the adult brain can't change.

We now know, its structure and activity can morph in response to experience, an ability called neuroplasticity.  The discovery has led to promising new treatments for children with dyslexia and for stroke patients, among others.

But the brain changes that were discovered in the first rounds of the neuroplasticity revolution reflected input from the outside world. For instance, certain synthesized speech can alter the auditory cortex of dyslexic kids in a way that lets their brains hear previously garbled syllables; intensely practiced movements can alter the motor cortex of stroke patients and allow them to move once paralyzed arms or legs.

The kind of change the Dalai Lama asked about was different. It would come from inside.

Something as intangible and insubstantial as a thought would actually rewire the brain. To the mandarins of neuroscience, the very idea seemed as likely as the wings of a butterfly leaving a dent on an armored tank.

What I know for sure - and science is reinforcing - Is that visualisation of tasks helps an athlete reach higher levels of performance.  So why should it be a surprise that stroke survivors who can visualise correct movement of their arms using Tailwind will make faster progress.  Our spinal cord injured clients should visualise their legs pedalling their FES bike if they want to make faster progress. Thoughts are things.

 

The Quest for Improved Footwear for Diabetics

You may not be aware that around the world, every 30 seconds, someone loses a limb due to the late complications of diabetes.  Foot complications have a massive impact on the person and the cost of care provision to society.  This is not just a problem for the so called developed world - it's a global problem that clinicians have been struggling with for years. I share some thoughts about this issue.

Clinic teams try to personalise care by providing management that matches the persons individual level of risk of foot ulceration.  Friction and shear within shoes or from something in contact with the feet can cause massive damage.  You see diabetes can lead to neuropathy which can mean that the affected person is unaware of the damaging effects of pressure and shear.  In addition, the body tissues shape, elasticity and response to stress becomes altered by the disease process.

The key of course is prevention - but this has proved quite difficult in practice for a number of reasons.  Clinic teams that have worked for over 20 years in this area had hoped to see a reduction in patients coming to their clinics, but actually the growth in patient numbers still continues.

In Scotland, a Foot Action Group has created some clinical guidelines based on concensus of the best management strategies - again based on risk.  The aim always being to prevent the patient from having any ulceration. Once ulceration has occured, there is a much greater risk of further breakdown because of the altered tissue mechanics of the healed ulcer - assuming that healing can take place.

The "traffic light system" developed in Scotland is shown here.  (CLICK image to Magnify) It's meant to be clear and easy to understand.

It's long been recognised that footwear - properly designed to prevent the mechanical stresses that lead to ulceration is the key.  

Prescription footwear is widely used - but poorly understood. It's sometimes blamed for foot problems but, when properly designed should be a primary tool for the prevention of diabetic foot problems.

One the one had clinicians often have a poor appreciation of tissue mechanics and how shoes are designed and manufactured.  On the other hand persons knowledgeable about the requirements for prescription foot wear are not exactly numerous.  To top it all, prescription footwear has a reputation for being ugly and unattractive - especially with custom made shoes that might have to accomodate a deformed and high risk foot.

The challenge for clinicians and footwear manufacturers is to provide footwear that protects the users feet as required by the prescription and yet are attractive. Can we provide attractive footwear that our patients will wear? Increasingly the answer is "Yes"

This video introduces the challenge of creating prescription footwear. 

I'm a Director of Klaveness Skofabrikk, a Norwegian shoe manufacturer well-known for their "High St" shoes in Scandinavia.  We are on a quest to raise the quality of shoes for medical applications and apart from simply meeting a prescription, we want to use our technology to delight wearers.

 

There is a sting in the tail.  As in many areas of health care, consumers may have to recognise that they have to invest more of their own funds in their own health care. The NHS would be hard pressed to supply all that is required.