How to Increase Functional Stroke Recovery Levels and Prevent Noncompliance in Stroke Rehabilitation

First...lets take a step back: What is a stroke?

If you don’t know what a stroke is, we recommend this video from TED-ed, which beautifully animates and explains what occurs during a stroke.

Lesson by Vaibhav Goswami

Now that we all know what a stroke is, lets discuss what’s necessary for a successful stroke recovery? (For the purposes of this article, we are focusing on the paralysis and motor deficit recovery from a stroke)

The most simplistic way to understand stroke recovery is with the phrase “What you train is what you get better at” (i.e. if one trains flexion of the wrist over and over again, they will slowly get better at this muscle movement). What our team takes from this phrase is that stroke recovery is incredibly individualized. Each stroke survivor faces a different level of disability and each stroke survivor has different desires when it comes what levels of functional ability they want to achieve. For this reason, neuro-physio therapists are vital for a patients recovery. A therapist is able to determine abnormal kinematics in a stroke survivor and hypothesize underlying impairments, and then also incorporate strategies for intervention which are specifically designed for the requirements of said stroke survivor.

Given how individualized stroke recovery is, it’s difficult to pinpoint how to create successful recovery paths, but we’ve decided on these 5 key factors:

  1. Dosage — High repetitions and high frequency: The more repetitions a patient completes, the better they get.
  2. Specificity — Activity specific training: tasks should be contextualized to something important in the daily life of the patient.
  3. Motivation — Goal driven and meaningful activities: a program can be made motivating by being challenging, progressive, and meaningful to the patient.
  4. Complexity — Training should be novel, progressive, and involve problem solving
  5. Forced use — Training should involved force use of impaired limbs, so that the patient does not strengthen incorrect synergy patterns.

All of these factors add up to create a commonly used rehabilitation strategy: Task-Specific Training (TST). Task Specific Training describes a rehabilitation regime in which exercises are targeted at specific functions that sufferers of stroke struggle with every day. To best serve the patient, tasks should be: 1) repetitive and involve mass practice, 2) randomly ordered, and 3) relevant to the client and context of their daily lives.

So whats the problem? Task-Specific Training tends to be tedious and boring. And yes, no one has ever said that stroke recovery is going to be fun, but it could be so much better. Specifically, low-budget neurological physical therapy centers have very little opportunity to incorporate motivation with the other factors required of a successful recovery. A therapist, who has the onus of creating individualized recovery strategies for each patient, must currently use makeshift strategies.

For example, a patient who has trouble picking things up may be taken through a series of progressive exercises. First they might be asking to play with a Hanoi tower, and are told to pick up and move the rings about 50 times. This process might repeat itself for at least a few therapy sessions.

Hanoi Tower Graphic: https://www.scientificamerican.com/article/the-tower-of-hanoi/

Once the patient finally gets good enough at this, the therapist may ask them to begin the same activity, but with coins, hence increasing the complexity of the task to one that requires finer and more detailed motor skills. The therapist will tell patients something along the lines of “Please pick up and put down the penny on the table 50 times”. Finally, when the patient is good enough at this task, they might be asked to begin stacking the coins, over and over again.

Stacked Coins: https://openclipart.org/tags/Gold%20coin

Once people realize that this is the therapy process for many stroke survivors, it’s easy to see why noncompliance is such a large issue. Stroke survivors simply don’t feel engaged with these tasks, and don’t want to do seemingly menial work to recover. While motivation may seem like only one of the five factors, it is probably the most important. How is a patient ever going to get better if they aren’t even motivated to do so? Put bluntly, many current TST based rehabilitation strategies are demeaning and boring, and discourage patients from really getting better.

We know what’s needed for a successful stroke recovery, and we know whats missing: How does our device, the Track Trainer, fit in?

Initially, we wanted to advertise the Track Trainer as an end-all solution for stroke survivors. After thorough research and interviews, we understand that this is simply not possible, as the therapist will always be a vital factor in stroke recovery. Still, the Track Trainer will help therapists craft a successful rehabilitation process for their clients. The Track Trainer does so by using Task-Specific Training, but by incorporating it in a way that patients are doing activities which feel exciting and enjoyable. Patients level up in our device by improving their own motor function, and will feel intrinsically motivated to achieve functional recovery of their upper limbs. To learn more about the Track Trainer, check out our website http://thetracktrainer.com/

Not trying to cause a storm, but I’ll be happy if I make some waves.