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The majority of stroke survivors whom I’ve met, when describing their prior physiotherapy and any other rehabilitative efforts, will report that the focus of therapy was usually on seated stabilisation, seat to stand, weightbearing and walking practice. All vital stuff. But only a small minority remembered being introduced to/practising upper limb exercises.

This happens for a number of reasons, but as time and resources are most usually limited, therapists often do not have time to devote to extensive hand-function efforts. Many receive no upper limb therapy at all. And by the time further treatment is sought, the task is all the more harder. At the height of the pandemic, many patients were told that it was safer to go home and receive no therapy or no further therapy.

This is why it’s critical that the leading edge Upper Limb Clinic developed at the Institute of Neurology at UCL by Professor Nick Ward builds up more and more a body of evidence of efficacy so that it becomes clear that a ‘3 week intensive blast’ of multi-therapies that such a Clinic can offer, with the learning for survivors and families that can accompany it, can become an effective bolt-on or plug-in funded for each hospital in the UK with a stroke unit in order to push/promote/kick-start recoveries. Maybe this will happen in due course. I hope so!sive

In the meantime, it’s vital that stroke survivors are shown what to do as far as upper limb is concerned in the community, as soon as possible after discharge, in order to continue the work of the therapists or initiate it if none has yet been done.

The reason is that all evidence points to the fact that high dosages of repetitions, over time, stand best chance of assisting upper limb recovery. This has to be done by the survivor, at their own residence. Survivors need to know what to try to do themselves and what they need to seek help with/for.

The evidence (see yearly-updated in-depth reviews of well over 4,500 studies including over 2,170 randomized controlled trials at www.ebrsr.com) reveals that:

• Task-specific training, alone or in combination with other therapy approaches, may be beneficial for upper limb function.
• Higher and lower intensity task-specific training may have similar effects on upper limb function.
• Trunk restraint with reaching training may improve upper limb function.

Let’s discuss how you as a stroke survivor can use this evidence. Remember, high dosages of repetitions (of reach, grasp and release) are needed. Remember that all attempts at repetitions (including mental practice) drive neuroplasticity. You NEED to get it done, over and over again, even if nothing is happening: there are ‘tricks of the trade’ as it were’ that you can use.

I’m going to show you all of this in a series of Youtube clips.

You can go ahead and get access to the full series of videos on physical DVD or anytime online streaming access, if you like, by going clicking to here The Successful Stroke Survivor Full Video Series 300 minutes.

Have a look at this small video I put together: this is clip 1 of 20 or so about upper limb training. Then take part with me by subscribing to the new ARNI Stroke Rehab Tips on Youtube. Upper limb rehab will come first and Video 1 is already up on there: watch and subscribe for further Youtube videos! Many other stroke rehab topics will be loaded up on there as time moves on.

If you do want to take part, you need only a minimum amount of kit. A short stick (cut a broomstick and chamfer the edges), a tray or book, some items with blue tack stuck to the bottom (or MUCH better a laptop board with heavy duty Velcro strips attached and some specific items with Velcro squares attached to them – click the link to get, or make your own board).

Being in a seated position is fine when doing upper limb task-specific training. But completing the reaching task by moving your trunk forward to complete a reaching activity is ‘cheating’. This is where trunk constraint works well. This is often done via a chest seatbelt/harness.

How to start retraining your upper limb after stroke? Your starter programme consists both of stretches and tasks. You may or may not have been taught how to safely self-stretch but the idea is that more is better and safety is paramount. You have to stretch your upper limb (gently), knowing at the same time simply stretching won’t bring recovery. You have to be task-focused. So, when you do a stretch, you then do something challenging and specific functionally with the stretch.

For example, stretch, then try to pick a hairbrush up and put it into a cupboard. In your retraining sessions, stretches must be considered as promoting the chances of the successful performance of the task.

Remember my upper limb catch-phrase: stretching enables the task and extends ‘time on task’.

These are very important for improving your potential ability to reach for, grasp and release items with your hand: activities that are denied to so many stroke survivors. You can use stretches daily in order keep muscles long and prevent further complications. The best results are often seen in people who have consistently stretched their wrist, fingers and thumb on their more-affected side from a very early period in the hospital.

Upper limb task-specific practice concerns reaching (which you perform mainly with your shoulder, elbow and wrist joints) and grasping/releasing (which you do mainly with your fingers and thumb joints). Stroke survivors often find it very hard to make purposeful movements requiring precise control of either; rendering movement slow, inaccurate, and usually not well directed or coordinated. Isolated recovery efforts for the upper limb, often in terms of grasping and releasing an item during a task, correspondingly demand effort and accuracy.

Unlike (to an extent), lower body, training coping strategies for and during rehabilitation of the upper limb should be largely avoided.

If you have spasticity and find it hard to reach away from your torso,  you may tend to ‘throw’ your more-affected arm at a task mainly by activating your shoulder joint. This stands in contrast to a more controlled movement sequence, where your arm can move away from your torso using your shoulder, elbow and wrist joints to help position your hand to complete a task. The latter situation is better than the former.

Success at reaching therefore needs to be trained for. Building up strength and working for incremental spasticity decline can be worked on at the same time. So, trunk constraint whilst performing task-practice has strong evidence for improving outcomes, because it makes ‘cheating’ nearly impossible to do.

Also, limb de-weighting via wrist holding or using de-weighting technology is a therefore a good way of facilitating this from the start. See picture, below and left. This is because ‘heavy arm’ can render tasks very difficult to perform.

I’ll show you all this in one of the videos, and how a therapist, trainer or any family member can do this precisely to help the survivor ‘get the ‘gap’  between thumb, first finger and middle finger, in order to pick up an object.

So, arm de-weighting, often in terms of assisting in reaching for an item during a task can be used to initiate and/or extend your time practising a task.

One thing you need to know is that although there is evidence that functional control of your hand will only improve once you gain more control over joints which are closer in towards the body (proximal) rather than further away (distal), recent evidence suggests that you should be also be trying to work with your fingers and thumb right from the start rather than waiting for your arm to get stronger in order to position your hand accurately.

This might sound strange if you can’t even ‘get a gap’ between your first finger and your thumb, or that your fingers and thumb are ‘floppy’. Both states would seem to make ‘useful’ hand function non-existent.

However, it’s suggested that, via specific retraining, distal control can and should be trained for immediately after stroke, This is also because if you waited for control to return from proximal to distal, you might achieve some strength in the shoulder, elbow and wrist over time but may not have done any task-specific grasp and release attempts at all, let alone put in the very large amount of intensive retraining time that might stand a chance of helping you regain control of the main reason why you have an arm in the first place.

The UCL World Stroke Day Forum is back!

Being physically active is a great way to improve and maintain health and wellbeing… and reduce the chance of a stroke. And of course, rehab is required if you’ve had one.

If you have had a stroke, you will hopefully have been shown how to implement your own programme of consistent repetitive movement at home during your recovery.

To help you with this and many other features of tackling limitations from stroke, you are invited to take part in a week-long programme of online sessions.

Each has been designed to encourage open dialogue and activity between researchers, clinicians, charities and stroke survivors.

We’ll also be joined by the team behind the campaign We Are Undefeatable, which aims to inspire and support people with long-term conditions to build physical activity into their lives in a way that works for them. They will talk about their campaign, the kind of movements that can be done from the comfort of your own home, and give some tips about how to make being more active fun.

The programme is available by clicking: Register Here.

Looking forward to seeing you: do book to enter the various workshops taking place during this amazing week-long event NOW!

On Tuesday, September 28, from 6pm to 7pm, on the NR Times website, a webinar will be held to discuss what the Rehabilitation Prescription is achieving for patients, and what more could/should be done.

The impact so far of the Prescription, and its potential, will be assessed by four leading names from across neurorehab. The webinar, held by NR Times working alongside NRC Medical Experts, is the first in a series to analyse key issues in neurorehabilitation. The panel taking part in the webinar are:

• Professor Mike Barnes, one of the UK’s most experienced neurorehabilitation experts
• Dr Tom Balchin, founder of The ARNI Institute.
• Sara Grimshaw, clinical specialist occupational therapist at Rehabilitate Therapy.
• Hokman Wong, senior solicitor and brain injury specialist at Bolt Burdon Kemp.

The Rehabilitation Prescription is designed to give patients, GPs, case managers and everyone involved in an individual’s care a comprehensive overview of their immediate and longer-term neurorehabilitation requirements in one summary document, which acts as a guide to navigate the complexity of neurological disability.

The event will look at whether the Rehabilitation Prescription really is improving patients’ lives or whether, when the patient reaches the community, outside of the realm of NHS help, a rehabilitation prescription that can be used to guide ongoing rehabilitation, is part of standard current practice or not.

Certainly, rehabilitation prescriptions for stroke survivors which are updated as a patient advances in their don’t seem to happen at all. But it it would be invaluable for a patient to know that any therapist they work with can access a ‘passport’ containing up to date information on their rehabilitation needs, which can perhaps also be updated over time…

* The webinar is free to attend but registration is needed. There is also the opportunity to submit questions in advance. To register, visit here.

LOOKING FORWARD TO SEEING YOU THERE!!

Your exclusive invitation for professionals who help those with brain injury, and for survivors and their families, only by application RIGHT NOW!

For 2.5 hours, this Thursday (23rd September 2021, 10.30am to 1pm), listen to and talk directly with the UK’s Leading Experts in Stroke Recovery.

Listen to and ask Professor Val Pomeroy (University of East Anglia) about getting to grips with/analysing action control and Professor Avril Drummond (University of Nottingham) about managing fatigue.

Co-chairs: Hokman Wong (Bolt Burdon Kemp) and Tom Balchin (ARNI).

This is a rare chance for you to ask these two engaging experts about their fields and any other query you have. They will present for 45 mins each and the rest of the time will be concerned with taking your questions. So do come prepared with a few questions to ask: go for it!

There is NO CHARGE and we can also also apply on your behalf for a Certificate for 2.5 hours National CPD Service CPD points for attending.

These people are experts who I myself try and engage with when I need help in order to help a patient with a certain issue. So whoever you are, be it professional, survivor, family member or carer, do book up for this event (see flyer below). 

Reservations for Thursday’s awesome event are going quickly, so please do read the flyer below and reserve yours NOW by emailing tom@arni.uk.com 

Please note: if you already registered (for example, you attended last Thursday’s Conference with Professors Cathy Price and Heidi Johansen-Berg), then there’s nothing more to do except login at 10.15 or so, ready for 10.30 start!

Professor Valerie Pomeroy is Professor of Neurorehabilitation and Director of Research at the School of Health Sciences, University of East Anglia with expertise in translational research into neuroscience-based rehabilitation interventions (proof-of-concept and early phase trials). Emphasis is placed on care closer to home and development of sensitive physiological measures for timely identification of response to therapy, prediction of response and the neural correlates of response. A particular expertise is in MedTech development especially after securing team mentorship on the Design Council Leadership Programme in 2014.

Professor Avril Drummond is Professor of Healthcare Research in the School of Health Sciences in the University of Nottingham. She is Non-Executive Director at University Hospitals of Derby and Burton NHS Foundation Trust. She is particularly interested in patient care and NHS research. She is an expert in rehabilitation research and evaluation of service delivery. An occupational therapist by background, her research includes rehabilitation research in stroke, traumatic brain injury, low back pain, total hip replacement, Multiple Sclerosis, specific studies of GP fit notes, hemianopia, early supported discharge, fatigue, falls prevention and home visit assessments, the work of the stroke units and community re-enablement.

Open this Email for Your Invitation to listen to, and talk directly with via Zoom, the UK’s Leading Experts in Stroke Recovery!

Listen to and question Professor Cathy Price (UCL) about language recovery, Professor Heidi Johansen-Berg (Oxford University) about neuroplasticity & imaging, Professor Val Pomeroy (University of East Anglia) about movement analysis and Professor Avril Drummond (University of Nottingham) about the management of fatigue.

On 16th and 23rd September, ARNI and BBK are holding two COMPLETELY FREE 2.5 hour stroke rehabilitation event/discussions for survivors and their families, and for professionals who help those with brain injury.

The reason for holding these events is that these topics have ranked as the top four that survivors and professionals we’ve asked would like to ‘get the latest information about’ as they recover (or help others recover).

This is a rare chance for you to ask the experts about their presentation and any other query within their field of expertise. They will present for 45 mins each and the rest of the time will be concerned with taking your questions, so do come prepared with a few questions to ask: go for it!

These four people are experts who I myself try and engage with when I need help in order to help a patient with a certain issue. So whoever you are, be it professional, survivor, family member or carer, I urge you to book up for these events as soon as you can.

Reservations for these events are going quickly, so please do read the 2 flyers below and reserve yours NOW by emailing the email address on the flyer (webinar@boltburdonkemp.co.uk) or by just emailing me back. Do attend one or both days.

Professor Cathy Price is Professor of Cognitive Neuroscience and Director of the Wellcome Centre for Human Neuroimaging at Queen Square, whose early work in human neuroimaging helped to produce new approaches for investigating the brain bases of cognitive functions. She also provided theoretical frameworks for understanding cognitive impairments in neurological patients. Her research has helped to transform our understanding of how the brain supports language processing – including speech perception, speech production, semantic memory and reading. Cathy has shown how specialisation for all types of language processing emerges through cross-talk among unique combinations of areas that are each involved in many other non-linguistic functions. Her current work is in the development of neuroimaging tools that predict and explain how stroke survivors recover from speech and language impairments (aphasia).

Professor Heidi Johansen-Berg is Professor of Cognitive Neuroscience and Director of the Wellcome Centre for Integrative Neuroimaging (WIN) in the Nuffield Department of Clinical Neurosciences. WIN is a multi-disciplinary neuroimaging research facility. WIN aims to bridge the gap between laboratory neuroscience and human health, by performing multi-scale studies spanning from animal models through to human populations. Within WIN, Heidi heads the Plasticity research group. Her group is interested in how the brain changes with learning and recovery from damage, such as stroke. Her group use cutting edge brain scanning techniques to monitor brain change and develop new technologies to enhance rehabilitation effects following stroke.

Professor Valerie Pomeroy is Professor of Neurorehabilitation and Director of Research at the School of Health Sciences, University of East Anglia with expertise in translational research into neuroscience-based rehabilitation interventions (proof-of-concept and early phase trials). Emphasis is placed on care closer to home and development of sensitive physiological measures for timely identification of response to therapy, prediction of response and the neural correlates of response. A particular expertise is in MedTech development especially after securing team mentorship on the Design Council Leadership Programme in 2014.

Professor Avril Drummond is Professor of Healthcare Research in the School of Health Sciences in the University of Nottingham. She is Non-Executive Director at University Hospitals of Derby and Burton NHS Foundation Trust. She is particularly interested in patient care and NHS research. She is an expert in rehabilitation research and evaluation of service delivery. An occupational therapist by background, her research includes rehabilitation research in stroke, traumatic brain injury, low back pain, total hip replacement, Multiple Sclerosis, specific studies of GP fit notes, hemianopia, early supported discharge, fatigue, falls prevention and home visit assessments, the work of the stroke units and community re-enablement.

With the emergence of the COVID-19 pandemic and the subsequent mandatory lockdowns that followed, performing rehab exercises prescribed by physiotherapists, at home without help (save some telerehab options) was and still continues to be the most usual mode of rehab available for some stroke survivors.

Evidence suggests, however, that non-adherence represents a significant challenge for many when it comes to exercising at home. Even when exercises are delivered by a physiotherapist in a face to face setting, research shows that approximately 50% of patients are not adherent.

Unsurprisingly, non-adherence becomes significantly more prevalent when rehabilitation is administered at home without any physiotherapist supervision.

There are many factors that contribute to non-adherence such as self-image, attitude towards health and exercise, depression, anxiety and most importantly self-efficacy.

In simple terms, self-efficacy can be described as the beliefs an individual has towards their ability to successfully perform a task or achieve a certain outcome, in this case completing home exercise.

In theory, if a person has low levels of self-efficacy relating to a particular task, they would not only have an aversion to that task but the effort applied would be of a less intense and less persistent quality when they are forced to engage.

Although there are many ways in which a physiotherapist can help improve self-efficacy in patients that are not confident in themselves to perform exercise at home, self-efficacy for home exercise is not routinely appraised in stroke survivors.

This is because no tool has been developed thus far to reliably and accurately measure self-efficacy towards home exercise in the stroke population.

Brunel University London is aiming to determine if an adapted version of the Self-Efficacy Home Exercise Program Scale (SEHEPS) can reliably and accurately measure self-efficacy for home exercise in the outpatient stroke population.

This is a pilot study to test the validity of the SEHEPS on the outpatient stroke population.

I’ve personally been helping with this, as I think it’s a facet that’s rather missing from ‘what’s available’ after stroke to help people at home.

What’s your view? Let’s see what we can do to help the Brunel Team get this right for us stroke survivors – thanks everyone for your support, in advance!

If you think you fit the (current) participant criteria below – ie, you:

1. are aged 18 or above
2. have been diagnosed with a stroke
3. can provide consent
4. understand written/spoken English sufficiently enough to complete the study 
5. are community-dwelling (not currently in hospital or residing in a care home)

and would be able to give a few minutes of your time to improving after-stroke rehab considerations by helping to test the validity of the scale, to ensure it reflects your own needs/considerations/ideas, do please email the Team today…

Dr. Cherry Kilbride, Dr. Elmar Kal, and Gary Sahota on 1909128@brunel.ac.uk

Thank you

Lots of people know that recording what they do in retraining helps them to improve their retraining after stroke.

You can do the ‘Basics Is Best’ approach: concentrate on doing during your self-retraining time, what you can do, with reference to a customised plan. And then record it. And then refer to your recording when you need to.

BUT THIS ALL VARIES ACORDING TO WHO YOU ARE.

Do you need a planner? Yes and no. Many people prefer to go freestyle (loose-plan), and since I had a stroke in 1997, I’ve done just that. This is because you can ‘group around’ just 4 or 5 of the most essential exercises to do and progress at them.

Do you need to record training? Yes. And I’ll explain why, below.

Do you need to evaluate your training records? Yes and no. I’ll explain more below, don’t worry!

I hope the above doesn’t make you run a mile! Because as with all things, retraining can be much more complex than this if you wanted it to be. But believe me, it doesn’t have to be. It can be ultra-simple.

Let me prove it to you. But bear in mind that my ‘big own secret’ to my success has always been the recording of training.

I’ve returned from total paresis on one side of my body to near full function. But I still need to retrain, 24 years on, in a way that mirrors those wanting to get stronger and fitter. The big key that has emerged from the research, as far as I’ve concerned, is that increasing one’s performance in both aspects plays a direct part in increasing functional control. Plus smart use of the adjuncts (the myriad of interventions available to you).

First, confusion must not be allowed into your retraining. A (loose) plan is needed

A simple way to view improvement is to think about the word ‘progression‘ as it applies to you. Progress is fulfilling and exciting…and it personalises your training. It creates interest in your own improvement. So how can you measure progress? I put it to you that measuring progress yourself is hard! Even neurophysios ‘measuring’ your status and improvement can be wrong, although they can certainly help you to narrow down a picture for you of your own presentation at a point in time.

A few of the people who I’ve trained become upset because they don’t feel they are getting much more progress, even though they feel they are working as ‘smartly’ as possible, and think it’s because they’re doing something wrong. When one analyses their self-training, it’s almost always because they have missed out being guided onto training on the basics, given no progressive training plan that stands a chance of working for them and they also don’t actually record progress even though it is always strongly advised by neurophysios.

At ARNI, for instance, when these people are reminded how they really were physically and mentally a few months before, they can see that actually, progress is still coming in steadily and well. Often, once the ‘big fixes’ have worked, there is a period where progress cannot visibly be seen week to week, and may often appear to be going backwards. It is at these points that the steady recording of training details pays dividends to put progression in perspective.

Remember, your recovering brain may play tricks on you. Even after, say 6 sessions of working with ARNI, you have moved from nearly being able to shuffle along with two helpers holding you up, to being able to get off the floor unaided and walking independently without a stick for twenty yards, you may still think you’ve not made progress. You might laugh, but I’ve seen it happen too many times for it to be amusing anymore.

It’s fair to say that even though I have told so many people about how well training diaries which accompany retraining work, only a few people have ever shown me that they use them.

The people who do have all excelled in their retraining and progressively got back new movement evidenced by ability to do new tasks and activities. This is why I really want you to record your progress.

Recording of ‘work done’ is something that can be done really easily. ‘Many a mickle makes a muckle’, and all that. All you need to do is make notes in a box or just tick pre-made boxes. And days go by into months, into years, very quickly.

You’ll create your very own ‘record of success’. Why wouldn’t you do it, really?

Some people can get away without using a training diary, but it is not a good idea. It creates interest and a bond to training. It means that training is not just an abstract thing you do a couple of times a week: it means that you are ‘tied’ to it.

If the stroke has not affected your writing, reading or vision, buy (or ask a friend or relative to buy for you) a diary. or use an Excel spreadsheet or something similar if you are computer literate. It’s the cheapest and best thing you can do for your own rehab.

If you get a diary, make sure it’s A4 size. Through experience I’ve found that the A6 or A5 diaries don’t give me the feedback I need. Buy one with a week spread out over 2 pages. Basically, you want to be able to see your whole week.

Get the leather bound variety: why not? You’re worth it. Get one with gold-blocking on the front. Why not? This needs to be something visible and ‘of worth’, not something that can get lost. A coffee-table thing. You are not only going to record the exercises you did in this diary, but you will record briefly how you felt and other details which I’ll note further down in this info-blog.

In the end YOU need to make sure that YOU invest the time in YOU. And, this time should be recorded. Otherwise you can simply go into a ‘holding pattern’ of neither doing badly, but not doing particularly well either.

Remember the ‘toy duck in a bath syndrome’ analogy from by book/manual: The Successful Stroke Survivor?

At its most simple (and it should be simple), a glance to last week’s note should be all that’s required to set a planner of ‘what to shoot for’ this time. In terms of the other aspect (what are you finding it easier to do?), this can also be a place to record that information and information on progression can be gleaned from tiny but progressive gains made in a tiny core group exercises (no more than 4, trained weekly), with 3 minor ones trained daily, plus fitness work. This does of course require you to be cognitively ok also, in order to this. Further external measures are also vital indicators but often not fully necessary (or consistently necessary).

My ARNI trainers all keep records of their sessions with survivors (we send this to the survivor and instructor to work with together). This has been ARNI protocol for at least the last 10 years, and it works well.

Instructors set ‘homework’: one to five key movements, that if worked upon, might open up scope for new function. And there is usually a very clear correlation between those who indicate that they are not doing any rehabilitation work outside of class, and non-progress.

We have even had some stroke survivors who, in class are extremely dedicated. But when they turn up each week and are questioned and their training records (of whatever sort) noted, it’s clear they have done nothing. In the end, you don’t ask. And in the end, they sometimes leave because their progress is not as it should/could be.

I’ve also found that the oldest stroke survivors usually accept that a high level of inability to perform activities will be with them through the rest of their lives, and do not believe that it is worth the effort and time trying to change things a little. I do understand this belief and it’s ok. But I wish to offer my own belief that whoever you are, whatever your age, you should do your best to help yourself consistently. If not for yourself and for your own life-state from now on, then for those who love you and care for you.

You can’t rely on your best friend, your partner or your parent telling you that you ‘seem to be doing much better.’  This isn’t good enough, and it’s hardly objective enough. These loved ones may not tell you the truth or they may not know it. Progression is notoriously hard to ‘measure’. So, you don’t need to. All you do is record what you do. You need to start to record your training then gently create your own feedback (whatever you like)… not just by recording what you manage to do, but how you feel about it too. This feedback should be encouraging but critical: reflecting the truth as far as you can see it. You’re not a neurologist or neurophysio (or unlikely to be), and it doesn’t matter at all.

All you’re doing is recording what you’re doing, and recording how you feel about it. Plus additions like weight, supplementation, sleep patterns, medication – if you want to/need to.

I did, and again it was a big key to my recovery. Did any physio show me how to do this stuff? Absolutely not. I needed to do it because I WANTED my recovery to be excellent. And I took my cues from what I could find out at the time, particularly in hand-exercise books (piano-exercises) and formative weight training books.

So, why record?? The reason is that the value is largely in the process of recording, itself. Hardly anyone gets this.

Writing, if one can do it (or typing, I’m sure), also may well contribute to ‘hardwiring’ what one has written or typed into the brain in comparison to just doing something and trying to remember what one has done into the brain.

Furthermore, to be filling in your diary week on week means that you are planning your week around your retraining, even loosely. And you will find that it is a source of enormous self-pride.

The other big key to recording, which I’ve noted no-where else in my texts for survivors, is advice to:

1. Have a plan from the last time you recorded
2. Make rough notes on a Post-it, or jotter.
3. Take that Post-it into training and annotate it by noting sets and reps with marks and/or numbers and scribbles. 
4. Then ‘transfer this info into best’ by writing it up in your proper A4 diary.

In this way, you have clear, legible detail that you can add to as you write it all down. Your diary will constantly reinforce the fact that, even if things are ‘going wrong in your progress’, that you are actively doing something about your own physical condition. Week on week, year on year.

At points along the way, you will begin to see patterns of development (or things you can work on) based on the data tracked in your diary. This is useful information for assessing goals. Compared to the amount of hours you will spend with progressively more movement in your lifetime, the few minutes a day (or every couple of days) it takes to make your diary entry is a tiny investment that will reap huge dividends.

Some people never give up their training diaries, and consequently have an amazing record of their rehabilitation. A memoir of lessons learned and goals achieved. What begins as a simple tool to improve training turns into a personal history, an archive, of your life as a stroke survivor rehabilitating.

I personally started to record my own training roughly a year after I had my stroke, and although they morphed into mainly records of my weight training progression (probably a natural requirement for very many other survivors too), it is incredible to look back on now and see what has been achieved. I still have all seven, in a pile. I only stopped because I was doing such freeform training, that I felt that I was at a stage where training (and experimental training) was so much part of my life and routine anyway that recording was unnecessary.

The best advice for stroke survivors reading this, is that at whatever point you are, to start recording your retraining, it will immediately add a sense of purpose, a seriousness and dedication to incremental development. You can easily that a training diary is one of the keys to real body transformation, and it’s so easy to do. I challenge you to do the same.

I buy a training diary for myself and my training partner every year – to just list a few key lifts (the big four) and this has again led directly to solid progression all over again. It’s great.

I’ve also got a much smaller notebook next to my bed where I chock in the date and number of sets and reps of lying on bed hamstring curls and pull-ups. Performance on both of these, for me at any rate, can diminish quickly. So I need to keep track – and not stop.

Some stuff like treadmill 45 degrees fast-walking/weighted-walking doesn’t need to be done, but a marker per day such as half a mile or a mile is a good one. My treadmill is in my office, so it’s hardly a hardship.

Depending on how much you want to use your training diary, besides recording training sessions, you may also decide to use it to record the times when you felt happy because you recognised that progress had been made as you did a specific thing. If you recall something like this, when filling in your training diary, record it too. The more information you gather the better job you (and your therapist or trainer if you have one) can do at managing your training. I remember that for years, we gave stroke survivors who came to see us a ‘Critical Incident Book’. This was not to record how many times they fell over!

We asked them to record any incidences when they found themselves doing something new. The result was a surge of confidence because when they were actively looking for the beginnings of new movements, typically they found themselves doing something unconsciously that they could not do before. One of my clients found that she was reaching for a fridge handle with her paretic hand and trying to open it, so I made sure that she tried to do it again like this each time she encountered her fridge. This became a ‘no-brainer’ ADL task for her, and she trained her brain to do it better and better over time.

In the same way, another lady recorded that she had just walked over a small bridge at her workplace without having to hold on. Even though she moves slowly due to her foot falling to the outside, it is a source of pride to her that she does not hold on, and never allows herself to do it again. Conquering this also means she has also become much better at not clutching onto walls when walking in big rooms. Many stroke survivors will go all the way round the whole wall of a room, however big it is, to avoid walking across it.

Such incidences are exciting because they show that the training is ‘working’, Certainly function is unlikely to be as efficient as before. But switched-on stroke survivors will then use these indicators of movement and work on them as triggers for their everyday rehabilitation.

So, doing it (safely) is important. Recording it is equally as important. You are training for you. You must be 100% honest when entering data. Record the quality of your repetitions: the form you use for each exercise must be as consistent as possible every time you train. If you did five good repetitions of a technique, but the sixth needed a tad of help from a family member or trainer, don’t just go ahead and record all six as if they were done under your own steam.

Sounds strict? Yes… but it can become a habit very quickly, and you’ll be very glad you did so. Record the ones you did alone, but note the assisted repetition as only a half repetition.

The order in which you note your exercises is also important for comparison purposes, and this is especially important for strength sessions. If one week the ‘getting up from the floor technique’ is your first exercise and the following week you train this movement at the end of the session, for obvious reasons, you cannot fairly compare your performance over those two sessions. You must, please, be forgiving to yourself regarding your own performance. Training progress is most definitely not linear!

This point goes way back to previous blogs of mine about the nature of success in stroke rehab and also to the points made about creativity in retraining.

Your mission now is to take as much control over your life as you can. Learn from your mistakes. Capitalise on the good things you have done. Do more of the positive things you are already doing and fewer of the negative things. It’s not a daunting task. Just set up a spreadsheet on the computer or use an A4 diary if you can. There are also A5  dedicated training diaries available from ARNI Charity site (shown below), but really, it’s much better to get your own A4 one.

It can make you obsessive about self-rehabilitation. But I’ve not met very many people of the thousands of survivors I’ve met who really are. In fact, there’s no need to be this way.

Short, progressive 45 minute max sessions daily or once every two days, with additional high dosage daily upper limb work and moderate daily fitness work as required, works much better.

Remember, the more information you gather over time, the better job you (and your physiotherapist or trainer if you have one) can do at managing your training. So the better records you keep, the better you are going to get. This is exactly the zone in which you need to be operating in as a successful stroke survivor, where each mini-success build on mini success. Iterative success. And you’ll see these successes translating into more functionality in daily life.

Many factors like fatigue or pain may mean that you simply won’t be able to do so much rehabilitation for yourself at first – but these require observation, evaluation and management. You will soon understand that retraining can help you with each of these two – and so it will merge with your lifestyle… and that lifestyle is certainly not all about retraining. It just becomes something you ‘do’, alongside everything else in your life. And that’s the free key to stroke rehab success I offer to you today!

And as a reward for reading this far (!), do feel free to email me personally on tom@arni.uk.com to ask for my whole 7 DVD set for just £30 including postage and packing. This is down from the original £100 including postage and packing.

See video below (which has sound switched off: it’s not your pc!).

Is your rehab on pause or are you just needing more? Or do you know someone in this situation? Is physio just too expensive or unavailable? Are you currently still in a wheelchair or just not doing enough to progress? Do you know how to? Or, do you have just a few limitations from stroke?

Whatever your status, whoever you are, to mark 20 years of ARNI, we would like to offer you today the Successful Stroke Survivor DVDs (Full set) (all 45-60 mins) with a massive £50 off!  

7 DVDs for just £39.60! Please hurry while stocks last at ARNI, to avoid disappointment. Read the many testimonials below.

With this offer, 4 of the 7 DVDs can be gained for free!

If you are a stroke survivor, by following the advice in these 7 DVDs you will totally transform yourself. You will be able to consider careful reduction of the use of a wheelchair, stick and rigid plastic orthotic, as appropriate. Amongst many other things, Dr Balchin will show you a totally innovative method to get down and up from the floor, how to do it in a totally safe way and run you through all eventualities.

He will show you how to recover balance, how to walk and turn without problem, how to cope with drop foot, how to reach, grasp and release well again, how to become stronger and robust.. and how to tackle all sorts of activities of daily life that you hadn’t dreamed possible after stroke.

Importantly, he will show you how to become more self-reliant rather than dependent on others.

Research has suggested a lack of physical activity as a significant risk factor for stroke, suggesting increasing exercise and physical activity levels may aid stroke prevention by providing significant health benefits. Strong evidence exists to support this, suggesting aerobic exercise improves an individual’s heart health and vascular profile, through reducing total and low-density lipoprotein cholesterol, reducing blood pressure and enhancing glucose regulation. These health improvements can prevent many stroke-inducing conditions, including obesity and type-2 diabetes, suggesting the positive role of exercise in preventing recurring stroke.

Additionally, research has also indicated exercise following a stroke helps to improve balance and mobility, reducing the severity of any remaining disability, minimising the long-term physical impacts. The evidence also indicates that aerobic activity following stroke may increase the individual’s independence and quality of life.

Aerobic physical activity can also provide psychological benefits. Mental health benefits have been observed in a number of research studies, with concomitant reduction of depression rates being noted.

Do cardiac rehabilitation exercise classes generally gain uptake with stroke survivors?

Cardiac rehabilitation exercise classes can be incorporated into post-stroke rehabilitation protocols in the UK, to help stroke survivors achieve these benefits. Such programmes often feature 10-12 weeks of group exercise classes and health education sessions. But, despite the benefits noted, uptake in these exercise classes is significantly poor amongst strong survivors, with less than 50% of UK stroke survivors participating in cardiac rehabilitation post-stroke.

Nottingham University researchers note that little has been proven about why participation in these exercise classes is so low. Perhaps, for some survivors, a lack of understanding of the benefits. For others, a lack of motivation. For others perhaps issues with accessing and participating in the classes. Many other factors (and combinations of) can cause non-attendance. Maybe many can’t find them, or if they do try them, find that they don’t help their situation and prefer to reduce their cardiovascular risk without being in a group.

The national situation has, of course, lately been an over-riding issue as classes have been unavailable for well over a year, although some have found reasonably efficient ways to run group exercise classes online. ARNI however, has found that ‘bringing the training to the survivor’ to be the most powerful way to continue throughout lockdown: by training people in one to one situations, outside, on well-matted areas when the weather permitted. And if the person was able at least to sit (or/and stand outside).

A question for you….

Have you ever taken part in a cardiac rehabilitation class or ANY other form of structured exercise class?

If so, would you help ARNI friends at Nottingham University understand your experiences with cardiac rehabilitation?

This research will be investigating factors influencing participation and access to cardiac rehabilitation or similar exercise classes amongst stroke survivors. It will simply involve you taking part in a one-off online interview (approximately 45 minutes), where they will ask you about your experiences. This interview will be conducted remotely over Microsoft Teams or over the telephone… so you won’t need to leave the comfort of your own home. As a thank you for your participation, all participants will be entered into a prize draw following completion of the interview.

Nottingham University hopes this research will help them to add to the evidence of how we can improve UK cardiac rehabilitation opportunities amongst stroke survivors…

Please contact the co-investigator right now: Emma Martin at mzyerma@nottingham.ac.uk

See flyer.

Emma will be very happy to answer any and all questions, and thanks you very much for considering helping her and the team at Nottingham University!

Strong evidence exists that physiotherapy improves the ability of people to move and be independent after suffering a stroke. But at six months after stroke, we know that many people remain unable to produce the movement needed for every-day activities such as answering a telephone. So, what can be done?

1. First, it’s important to be able to recognise if a physiotherapy intervention is really aiding a survivors’ abilities to undertake everyday activities or whether the intervention is doing less than it than it purports to/would ideally do.

This requires a deeper knowledge of the biological underpinnings of neuromuscular function. Neuromuscular function includes the ability to use weak muscles in the right order and at the right time during movement and performing everyday tasks in the same way as you did before the stroke.

2. Second, to optimise a physiotherapist’s chances to advise/work on an optimal combination of rehab interventions for each individual after stroke, it would be ideal to find out what kinds of sleep patterns are most beneficial for them.

Physiotherapists need to be able to have the same opportunity to diagnose how to help each stroke survivor gain the kind of very accurate movement measures at any point in their rehabilitations that currently, only specialist University facilities can routinely produce. This equipment is obviously expensive and can only be used in large specialised laboratories.

Ideally, more portable equipment should also be able to be accessed by therapists, which would cost less and is designed for use in small spaces. But such equipment would have to also be sensitive enough to provide meaningful feedback for therapists in a similar way to those used by the specialist labs. Such feedback could then be very useful for therapists and survivors to create optimal rehab plans together which would really enable the survivor to work on his/her edges of current ability.

A School of Health Sciences research team at the University of East Anglia (UEA) headed up by Professor Valerie Pomeroy are attempting to find out if this can be done, and will also examine how sleep patterns affect rehabilitations.

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The UEA would like to invite YOU to come TWICE to their Movement and Exercise Laboratory (MoveExLab) to get involved with this Project if you can/if it’s appropriate for your circumstances.

Dr Balchin says: you never know how such involvement can directly or indirectly push your own rehab forward, at whatever time away from stroke you are. Knowledge is power, Anything that can give you clues and cues about the state of your rehab and current/future interventions can be useful.

Go for it if you can/if it’s appropriate for you!

Inclusion criteria: you need to be 18 or above, have had a stroke at any point in the past, be discharged from NHS stroke services and be without an allergy to latex.

What you’ll be doing:

Upon application, if no contra-indications are revealed, you’ll be invited to undertake 2 assessments at the MoveExLab.

These assessments (around 90 mins to complete each) will be between 2 and 4 months apart. In each, you’ll have EMG electrodes placed on your skin using hypoallergenic sticky tape. These will measure your muscle activity as you move and don’t hurt at all, but just record your natural muscle activity during movement.

They’ll then place reflective markers on your skin. These markers are tracked by infra-red cameras placed at the top of the walls of the MoveExLab.

You’ll then be asked to pick up a telephone several times, which is placed a number of different positions, whilst your performance on the tasks is recorded (and reconstructed on the computer).

Then you’ll complete some questionnaires about how you sleep.

Then you’ll wear a motion watch on each wrist for 7 days to measure your everyday activity, which you’ll then send back in an SAE.

The Team will be in contact with you throughout the period of your involvement.

Travel expenses can be reimbursed for return journeys of up to 50 miles (ie, 25 miles each way).

If you are travelling in from further away, you can claim travel expenses for your journey up to 50 miles in total as well. 

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Apply now by speaking with the principal investigator: Professor Valerie Pomeroy..

Email: v.pomeroy@uea.ac.uk  Phone: 01603 59 1923

Or get in touch with her personal assistant: Pel Fordham.

Email: p.fordham@uea.ac.uk   Phone: 01603 59 1923

Both will be very happy to answer any questions you might have.

Location: School of Health Sciences, Queen’s Building, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ