The neurology of stroke and the changes in ability to control physical movements or expressions that occur in stroke patients devastate thousands of people worldwide. Stroke is a major contributor to numerous disabilities from muscle atrophy and musculoskeletal deterioration to depression. This paper discusses the potential role of specific progressive muscle re-education (PMR), such as that used in the basic Touch for Health 14 muscle test and balance (hereafter “TFH14”), in reversing the impact of the stroke sequel, especially on the musculoskeletal system. The possible implications for caretakers, nursing and rehabilitation therapies are discussed in light of a single case study with the hopes of opening a dialogue for a more formal research investigation.
Stroke is the most common serious neurologic disorder in the United States and world-wide, comprising 50% of all hospitalizations for a neurologic disease. In most European countries, stroke is of great importance because of the tremendous expenditures arising from cost-intensive treatment and the large demand for continued nursing care. In Japan and other Asian countries, stroke is the second most frequent cause of death in patients aged 65 years or more. For Chinese stroke patients, disability at admission is the most important predictor of disability at discharge because of a lack of rehabilitation facilities and effective rehab methodology.
Stroke often presents as a disabling illness that not only involves many aspects of a patient’s life but also places a substantial burden on family members and others. The aims of rehabilitation are to minimize the impact of the disability resulting from the stroke and to optimize the quality of life for both the patient and his/her personal caregiver. Progressive muscle re-education, as in the TFH 14, may enhance rehabilitation and recovery by arming caregivers with a simple repetitive exercise to apply helping the stroke victim to regain independence without increasing the financial burden.
Progressive muscle re-education, as in the TFH14, increases muscular coordination and endurance and enhances brain plasticity and the neurologic ability of the patient to recover more fully after a stroke, allowing them to regain their independence and resume Activities of Daily Living. The increase in motor coordination and ability may prevent falls and other injuries associated with musculoskeletal weakness and poor coordination. In the TFH 14, the non-paretic and the paretic limb are used together to retrain balance between the hemispheres. Thus the TFH 14 (PMR) benefits the muscles by soliciting specific responses that impact proprioception and the expression of movement as controlled by the individual. This results in a progressive effect on other neurons encouraging the return of some of the lost function. Research, ingenuity and technology have already developed a “robotic brace” intended to help people exploit their neural plasticity. While this device may affect physical function it will surely have a financial effect. Many of the medical devices aimed at treating patients afflicted with neurological disorders have not fundamentally changed in decades, or require costly, high-risk brain implants. Progressive muscle re-education as in the TFH 14, may exploit neural plasticity but without increasing any of the financial burden. The TFH 14 may give the brain a more dynamic way of forming neural connections to compensate for neurons whose links were injured or severed to grow new nerve endings.