What happens during a session?

Treatment for rehabilitation of stroke, traumatic brain injury, cerebral palsy

So, what exactly happens during a session?

During the first session, electrodes that resemble band-aids are placed on the skin directly above the targeted muscles. Let’s say you have lost right arm movement after a stroke.  One muscle that may be targeted in the biceps.  That’s the muscle that brings your arm up to your head (or the big one on Popeye from eating spinach).  Even the slightest effort of muscle activity will be displayed on the monitor in front of you in the form of a line moving across the screen.  Put more effort into the movement and the line rises; relax your arm and it decreases.   That’s right…the computer is listening to your muscle through the electrodes that are attached to the EMG (electromyography) device.  The big difference between this program and other programs using EMG are the number of muscles that are targeted.  This program targets up to ten; most others use one or two.  Why so many?  Let’s say you have a beach house on stilts.  If you found one that had a crack in it, you most likely would also check the others.  All of the supports work together to support the house.  Same with your arm.  If you had a stroke, you most likely have problems with one side of your body, not just your arm.  So, to get your arm moving correctly, the other muscles involved (like the back and shoulder) need to be included in the work.  The fancy name for this constellation of muscles is the “myotatic unit”.

Fear of the unknown makes a lot of sense. The worst “routine” medical appointment I have had was when, during an eye exam, retinal tears were found.  Getting them repaired was pretty painful.  The worst part was I was not expecting it.  Nothing done during motor control restoration causes pain.  In fact, I occasionally ask the patient if they are experiencing any pain.  There’s “good pain” and “bad pain”.  An example of “good pain” is the discomfort that sometimes is felt during a gentle stretch of a tight muscle.  As the muscle slowly stretches the discomfort subsides.  Notice I called it “discomfort” and not pain.  “Bad pain” is tissue tear or destruction, like when you step the wrong way off a curb and twist your ankle.  One of the things that happens during a session is a greater awareness of muscle activity.  After an injury or stroke a person often needs to re-find motor pathways that have been dormant.  Think of them as someone who lounges around all day sitting on the couch.  All of the sudden they are told by their doc to start exercising (and lose weight).  The muscles are not used to this kind of activity and need to be gently “woken up”.  During a session, the patient is typically asked to do gentle stretching of the muscles that are being targeted.  The important point here is YOU are doing the stretching, not someone else.  You can control the level of the stretch and by doing so the level of discomfort.  The goal is to keep it within the discomfort level, never to the point of pain.  The origin of the muscle difficulty is different for traumatic brain injury and cerebral palsy, but the overall treatment method is the same.

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