Updated on 8th Dec 2011
Hello Dr. Vasa,
Carole has been making steady progress with her stepping not using an AFO on her affected leg.Â This progress has been at home and not in some "conventional" rehab center.Â She was told by the "conventional" rehab center staff that they could do no more for her.
She has been using the techniques you suggested and show in your video and using the incline board to step without the AFO.Â She has started trying to walk without the AFO by sliding her foot along as you suggested and is making progress doing so.Â Her balance and confidence have improved and she is now regaining some ability to extend her arm at the elbow.Â What people and probably most therapists fail to realize is the interdependence of a stroke survivor's balance and the spasticity of the upper limbs.Â Many stroke survivors struggle along using canes, walkers or an AFO but want to regain ability to use the hand and arm.Â As you have pointed out in the VASA Concept these abilities are related and as you regain confidence and balance and are able to integrate both legs into the "whole" body again the function of the arm and leg will start to return as the body does not sense the need to protect the "center of mass" by drawing up the arm and hand close to the body in a spastic situation.
Far too many stroke survivors are told the conventional wisdom of "This is as good as it will get".Â Never stop trying to regain what has been lost.Â Â My suggestion to anyone who reads this is to start by regaining your ability to walk unaided (without braces or canes or walkers) before trying to "fix" the arm and hand problem.
Dr. Vasa you have my permission to use the above to supplement our other comments regarding the effectiveness of your Concept and techniques.
Again many thanks
Updated on 9th Aug 2011
Dr. Vasa you asked about our reported recent tightness in Carole's arm and wrist.Â We really can't explain the tightness other than the following.Â One of her Medical Doctors recommended a course of Botox for her arm and wrist during a follow-up.Â We let them treat her left biceps and the muscles that control the wrist flexion.Â The treatment was supposed reduce her spasticityÂ and reach maximum effectiveness 10-14 days after the treatment.Â Carole's left arm loosened up some but her wrist never loosened much at all.Â The tightness may be a reaction of the botox wearing off and resulting in additional reactional spasticity.Â I have become concernedÂ about the toxicity of the Botox to her body.
In my estimation this was a colossal waste of time andÂ taxpayer money as this was paid for through our Medicare system.Â Its amazing that the system will pay for multiple treatments of botox but not spend an additional cent on further physical therapy or occupational therapy rehab other than short sessions of outpatient treatment.
When Carole went through rehab after her stroke she had the additional burden of the craniectomy so she really never got to participate fully in even the mediocre inpatient rehab offered here.Â Dr. VasaÂ your techniques are the only onesÂ that have helped Carole at all in our quest for her further recovery.Â We appreciate you personal attention to all of this even though you are half a world away and a very busy person.
Its a pity that techniques like yours are not implemented throughout the world.Â Money would be well spent to implement the Vasa Concept here in the US, I think the return on investment would be much greater and the outcomes of stroke survivors would be greatly improved.Â But, alas, the siren's call of money from the drug industry is way too tempting.Â In addition Â the complacency of the rehab industry causes millions to suffer needlesslyÂ by being told there is no hope.Â Well I for one believe there is always hope and with the proper methods recovery can occur
My name is Larry McWhorter, I live in the United States and found Dr Rajul Vasaâs web site while searching for therapies for my wife. She had a massive ischemic right brain stroke on 9th May 2008 and in this emergency time she was airlifted by helicopter to bring her to a big hospital. She had a decompressive crainectomy done (May 11th 2008 ) within 2 days post stroke, This was done to save her life as her brain was swelling and she had become unresponsive.
A 17x17 cm portion of her right skull was removed.Â She is paralyzed in her left arm and left leg, with spasticity especially of the arm and hand and foot, ankle.Â She also lacks muscular control of the left side of her face. I could not bear to watch Carole, the love of my life, as she struggled with her disabilities and was desperate to find a solution to her problems.
She went through two rehab centers and showed painfully slow improvement.Â She walked with the aid of a "hemiwalker" and assistance from me.Â Her fingers were very stiff and spastic but she was able to muster a small amount of flicker movement in them.
I would at this point like to make certain observations regarding the help and treatment that was available to Carole, here in the US.
Firstly we were limited by the insurance, so that Carole had 20 working days inpatient and 20 day outpatient. When Carole recovered enough from her stroke to move to a rehabilitation facility, she was not sent to the stroke Ward but sent to the Brain Injury Ward due to her craniectomy.Â While in the Brain Injury Ward she received 20 days of rehab which included "Physical Therapy" (lower body), "Occupational Therapy" (upper body), "Speech Therapy" and "Respiratory Therapy".Â The therapy she received was targeted to get her up and moving and transferring from bed to wheel chair- not on improving her condition.Â The therapy sessions were not long enough (30 minutes) and many times were interrupted.Â At best she received 20 minutes of "quality" rehab.Â The two therapies that did her the most good were the Speech Therapy, which helped her swallowing and tongue movement and the Physical Therapy which got her able to stand and "drag' her full KAFO brace. The therapy on her arm was totally lacking and consisted of therapist aided range of motion stretches, splinting and nothing else.Â It is my opinion that she was "written off" by her therapists and her therapy doctor because of the severity of her stroke.Â We were told that she may never be able to walk, much less recover any use of her left arm.Â Upon Carole's discharge, I insisted that the therapist order for and AFO rather than a KAFO so that is what she left the hospital with.
The insurance dried up and soon I decided to pay out of pocket for an additional 20 therapy sessions. Mind you, we had lost fully half of our income when she had her stroke as Carole was a legal secretary before her stroke.
My daughter found a clinic where she received more similar therapy but grouped her in discussions with similar afflicted stroke survivors.Â She completed her therapy there and was able to navigate a bit better with her AFO. But not a lot was gained for her arm and hand.
Here in US the focus, I've found is on the patient accepting their fate and staying within the confines of convention rather than pushingÂ boundariesÂ Things like ADL (activities for daily living) are propagated, which makes the patient think and believe that his or her recovery has plateaued and that no further recovery is possible. Stroke survivors are taught to accept their fate and that nothing else but small pieces of recovery are possible.
On researching on the net extensively, what I have discovered, is that there is very limited information out there relating to recovery techniques.Â Almost everything is clinic or facility concentrated and nothing is out there for people who want to help their loved ones to truly recover the paralyzed body. What we actually encounter is the spasticity, stiffness, contracture on the paralyzed side and mind you all these problems despite all possible treatment done by so many therapists and doctors in most modern rehab facility!
All the while, I was doing online research trying to find something that would give us hope for a better outcome than she had so far encountered.Â I found two physiotherapy discussion boards with some discussion of the VASA Concept and they intrigued me. The Vasa website is the only one that I've found that offers some information and techniques for home bound therapy.Â Soon I reached out for help from Dr Vasa.
Neuroplasticity is talked about all over the internet but very little practical application information is found. The Vasa site is the only one I've found that discussed the "How To" of so called Neuroplasticity. Most of what I've found on the net on spasticity is of very little practical use.Â Most focuses on passive stretching or splinting and not on how to actually overcome the spasticity.
There is too much reliance upon machines in contemporary therapy.Â Machines may have their small place but the human interface should be stressed, as in the Vasa recommendations, rather than machines. As emphasized in the Vasa Concept, the brain most definitely is the most powerful tool in stroke recovery.Â Technology is secondary.
Many a times I think of stroke victims in under developed countries and wonder what must be happening to them? We in US with facility of flying by helicopter to save life, BUT remain lifeless once life is saved. Life thereafter is of dependence at home or indoor rehabilitation facility by spending all our wealth behind multidisciplinary rehabilitation! I wonder how they must be coping with such complex condition. How do they become self reliant and independent without any rehabilitation facilities? I suppose they might be accepting the loss of paralyzed body and self learning how to get on with life And we here in US spend on doctors and therapists to tell us to accept loss, and to hear that recovery is plateaued. I feel stroke victims in poor countries and we in developed country might beÂ t sailing in the same boat in terms of Stroke survivors here in US are taught to accept their fate of uselessly hanging spastic stiff upper limb, and slow painful walking with constant fear with foot turning and toes curling and leg acting as a prop rather than the leg, as it was earlier to stroke happened after spending all our savings! When stroke survivor in under developed country and developing country does it without rehab facility!!!!!
Hope stroke victim in the future does not have to face this sad reality of today and have to go through emotional trauma to the family, of course endless suffering on the part of the victim and economic drain on the family and social and other restrictions on travelling enjoying and living full life. I feel, the change will have to be at the foundation level if there is to be any effect. Until teaching facilities and the professors have a change in opinion, it will stay the way it is.Â Convention rather than revolution is easier to cope with in these instances.Â For a teacher or professor to push the boundaries takes a lot of courage.
Lastly, Carole's rehab doctors took very little time to sit and discuss anything with us about strokes. Some of the Neurologists where Carole received her initial trauma treatment were willing to discuss what possibly "might" happen but were very reserved in their opinions of a possibility of recovery past a certain point.Â The physiotherapists and occupational therapists have very little time to sit and discuss recovery methods and techniques questioning what they do seems to annoy them.Â My overall assessment of the Doctors and Therapists we have encountered here in our area of the U.S. is that they are stuck in the "Conventional" rut and no one is pushed or dedicated to upgrading their knowlege beyond their comfort zone.Â Mind you this is based upon the Doctors and Therapists we have encountered here in our region of the U.S.
The very first thing I was told by Dr Vasa, was to get Carole out of the hospital style bed hospital bed helps nursing and therefore helps caretaker but for patient, it limits the movement of the body and gives fear to turn by self making one dependent on someone to help to turn) and put her back in "our" bed.Â We implemented Dr Vasaâs recommendations regarding the bed and the hemiwalker - that one thing made a big difference to the both of us. Dr Vasa offered the best possibility of recovery - the concept of integration of the whole body into exercises and not just the affected side of the body. Here, there is a lack of understanding of the âwhole body conceptâ, as it relates to recovery.Â Much too much time and energy is wasted upon things like passive stretching and machines in recovery.
Carole started first with sitting on the bed and lifting her butt and shifting sideways.Â Her first tries were very exhausting and she struggled when doing them.Â The second day she did better and the third day she was able to complete 4 trips down and back on a king sized bed in 15 minutes. Unfortunately on the fourth day negligence on the part of special care taker she slipped off the bed and landed on the floor with her weak leg crossed under her and her weak arm in an awkward position. We had to postpone Dr Vasaâs recommendations until the surgeon gave us the green signal. But I must mention that while she was doing her butt shifts I could see the daily improvement in her strength and her ability to control herself more easily.
So Carole got much better. She still has quite a way to travel but the Vasa concept works where other therapy has fallen very short. The testimonial to this is the fact that I saw more recovery since the use of Dr Vasaâs recommendations, than virtually all of the other recommended professional therapy. It works.Â Seeing is proof. The treatment would have yielded even quicker, better results I am sure, if I could have stayed home and helped her with the excersises more often, rather than having to earn a salary. Â
I'm sure there are Doctors and therapists who desire to push for a better understanding of new therapies like the Vasa Concept, but finding them here in US is next to impossible.
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