Stroke Recovery and Solutions from Complementary & Alternative Medicine, A Literature Review
A Natural Health and Wellness Essay.
Muscle Synchronizers for Help with Stroke Symptoms from Sharon W. Giammatteo for article Stroke Recovery and Solutions from Complementary & Alternative Medicine, A Literature Review from Kimberly Burnham, PhD, Nerve Whisperer
Visualization and Acupressure as Tools in Cardiovascular Disease and Stroke Recovery
Americans suffer 1.5 million heart attacks and strokes each year. Put another way one in every three deaths are related to the cardiovascular system (heart, blood flow to the brain, blood vessels).That means in 40 seconds or about the amount of time it takes to read this paragraph, someone in the United States has a stroke.
Digesting Color and Light
This paper adopts the perspective that light and color can be “digested” by our eyes, skin, and intestinal system. Color and light therapy can be nourishing to bones and organs in a way that is similar to food. There are several systems of complementary and alternative medicine which associates various colors with organ health, including Khwaja Azeemi’s Color Therapy, Traditional Chinese Medicine and Five Element Acupuncture, Art Therapy in people post stroke, Chakra Healing approaches, and the study of sunlight and its effect on sleep-wake cycles.
Perception of Self
Writing poetry can also change your perception of yourself, your environment and the people around you making you more aware and connected to your surroundings. An article by L. Pinhasi-Vittorio (2008). “Poetry and prose in the self-perception of one man who lives with brain injury and aphasia.” Top Stroke Rehabil 15(3): 288–294, describes the case of a man who has expressive and receptive aphasia as a result of brain injury (stroke). “As the 2 year study progressed, the participant discovered his ability to write poetry as a way of expression. In writing and reading his poems, his perception of himself changed over time; he felt empowered by his ability. This study suggests that the usage of expressive writing, namely prose and poetry, can have a positive impact on self-perception and ultimately can enhance the rehabilitation process.”
Maybe you haven’t had a stroke but what if reading and writing poetry could improve your ability to think more clearly and communicate more effectively with the people around you?
Stroke Rehabilitation
The Ottawa Panel, using the Cochrane Collaboration literature review methods developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation.
“The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture in the management of post stroke.”
— Khadilkar, A., K. Phillips, et al. (2006). “Ottawa panel evidence-based clinical practice guidelines for post-stroke rehabilitation.” Top Stroke Rehabil 13(2): 1–269.
Massage Benefits Stroke Patients
“Seven days of bedtime back massage, for 10 minutes each evening, significantly reduced the anxiety, pain, blood pressure and heart rate of elderly stroke patients, according to a recent study.”
Participants were 102 stroke patients 65+ years old, experiencing shoulder pain and not already receiving pain-relief measures.
Those in the massage group received 10 minutes of slow-stroke rhythmical back massage before bedtime while the subject was either seated, leaning on a pillow, or lying prone in bed.
Three days after the 7 days of massage had ended, these improvements were maintained among the massage
“The results of this study support the view that [slow-stroke back massage], as an alternative adjunct to pharmacological treatment, is a clinically effective nursing intervention for reducing anxiety and shoulder pain in elderly stroke patients.”
— Mok, E. and C. P. Woo (2004). “The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients” Complementary Therapies in Nursing & Midwifery, Vol. 10, pp. 209–216. Hong Kong Polytechnic University Department of Nursing and Wong Chuk Hang Hospital, in Hung Hom, Kowloon, Hong Kong.
Effect of Therapies on Blood Chemistry
A study looking at blood chemistry in yoga practitioners found, “the ventilatory response to hypercapnia and arterial blood gases during ujjai respiration [type of yoga] of once per minute for an hour were determined in a professional hatha yogi. The results suggest that lower chemosensitivity to hypercapnia in yoga practitioners may be due to an adaptation to low arterial pH and high PaCO2 for long periods.
— Miyamura, M., K. Nishimura, et al. (2002). “Is man able to breathe once a minute for an hour?: the effect of yoga respiration on blood gases.” Jpn J Physiol 52(3): 313–6.
Another study looked at the effect of acupuncture on calcium levels, researchers, concluded, “electro-acupuncture could regulate the content of Ca2+ in the ischemic area of brain, inhibit Ca2+ overload, so as to protect neurons from ischemic injury.”
— Xu, N. G., W. Yi, et al. (2002). “[Effect of electro-acupuncture on calcium content in neurocytes of focal cerebral ischemia].” Zhongguo Zhong Xi Yi Jie He Za Zhi 22(4): 295–7.
Manual Therapies and Cerebral Vascular Accident / Stroke
Stroke is the third leading cause of death in Western society; in China it is the second most common cause of death in cities and the third in rural areas. It is also a main cause of adult disability and dependency.
In a search of a variety of studies on the use of acupuncture with people with strokes, researchers found fewer people died or needed to be institutionalized as a result of the stroke and the odds of improvement in global neurological deficit was higher in the acupuncture group compared with the control group.
Researchers said, “when acupuncture was compared with sham acupuncture or open control, there was a borderline significant trend towards fewer patients being dead or dependent, and significantly fewer being dead or needing institutional care in the acupuncture group after three months or more.”
— Zhang, S. H., M. Liu, et al. (2005). “Acupuncture for acute stroke.” Cochrane Database Syst Rev(2): CD003317. [Full Text] http://stroke.ahajournals.org/content/36/10/2327.full and Wu, H. M., J. L. Tang, et al. (2006). “Acupuncture for stroke rehabilitation.” Cochrane Database Syst Rev 3: CD004131.
In another study researchers concluded, “acupuncture appeared to be safe.” — Zhang, S. H., M. Liu, et al. (2005). “Acupuncture for acute stroke.” Cochrane Database Syst Rev(2): CD003317. http://stroke.ahajournals.org/content/36/10/2327.full.
An acupuncture study in 2000 found “pain caused by a lack of blood flow to an area can be helped by acupuncture.”
Researchers noted, “clinical experience and controlled studies confirmed the efficacy of acupuncture in various pain syndromes (tension headache, migraine, trigeminal neuralgia, posttraumatic pain, lumbar syndrome, ischialgia, etc.) and suggest favorable effects in the rehabilitation of peripheral facial nerve palsy and after stroke.
There is sufficient evidence of acupuncture to expand its use into conventional medicine and to encourage further studies of its pathophysiology and clinical value.”
— Jellinger, K. A. (2000). “[Principles and application of acupuncture in neurology].” Wien Med Wochenschr 150(13–14): 278–85.
Reiki in Stroke Rehabilitation
In a study looking at the use of Reiki as an adjunct to standard stroke rehabilitation programs, researchers found, Reiki had “a positive effect on mood and energy.”
— Shiflett, S. C., S. Nayak, et al. (2002). “Effect of Reiki treatments on functional recovery in patients in poststroke rehabilitation: a pilot study.” J Altern Complement Med 8(6): 755–63.
Manual Therapy Improves Vertebral Artery Circulation
In a study looking at manual therapy, researchers found, “treating the patients with drugs in combination with manual therapy resulted in improved circulation in the vertebral artery bed, lower clinical signs of vertebrobasilar insufficiency.”
— Fedin, A. I., KakorinSv, et al. (1991). “[Effect of manual therapy on blood pressure in hypertensives with cervical osteochondrosis].” Kardiologiia 31(10): 56–9.
A study looking at Manual Lymph Drainage found, “manual lymphatic drainage therapy causes vessel narrowing followed by increased blood flow in the arterioles, capillaries and venulae of the skin as well as in peripheral arteries and an increased lymph flow in lymphatic collectors”
— Hutzschenreuter, P., H. Brummer, et al. (1989). “[Experimental and clinical studies of the mechanism of effect of manual lymph drainage therapy].” Z Lymphol 13(1): 62–4.
CAM and Cardiovascular Disease
Cost can be a significant factor in the use of complementary and alternative medicine approaches.
One 1996 study found, “the combined treatment with acupuncture, Shiatsu and lifestyle adjustment may be highly cost effective for patients with advanced angina pectoris.”
— Ballegaard, S., S. Norrelund, et al. (1996). “Cost-benefit of combined use of acupuncture, Shiatsu and lifestyle adjustment for treatment of patients with severe angina pectoris.” Acupunct Electrother Res 21(3–4): 187–97.
While a second study noted, “the addition of manual therapy to the complex of early rehabilitation measures in coronary patients early after coronary artery bypass surgery (CABS) eliminates postoperative anginal attacks in 70% cases, reestablishes balance of cellular and plasma components of hemostasis, enhances fibrinolytic activity.
— Arutiunian, R. (2000). “[Effects of manual therapy on pain reflex syndromes and various hemocoagulation parameters in patients with ischemic heart disease after surgical treatment].” Ter Arkh 72(12): 24–6.
Yoga and Circulation
Stress, muscle spasm in the vascular wall and peripheral blood pressure all affect the risk for strokes, heart attacks and other cardiovascular problems. A number of complementary and alternative medicine (CAM) approaches have been shown to be beneficial to decrease the risk of cardiovascular incidence and improve outcomes.
In a 2004 study, Berg Balance Scale (BBS) and Timed Movement Battery (TMB) test improvements with yoga, lead researchers to conclude, “The results suggest that yoga may be beneficial to people who have had a stroke.”
— Bastille, J. V. and K. M. Gill-Body (2004). “A yoga-based exercise program for people with chronic poststroke hemiparesis.” Phys Ther 84(1): 33–48.
One study hypothesized that yoga and meditation will improve parameters of endothelial function. A course in yoga and meditation was given to the 33 subjects with and without coronary artery disease (CAD) for 1.5 h three times weekly for 6 weeks and subjects were instructed to continue their efforts at home. Researchers found, “a significant reductions in blood pressure, heart rate, and BMI in the total cohort with yoga.” In concluding they found, “in the group with CAD, endothelial-dependent vasodilatation improved 69% with yoga training” and said, “yoga and meditation appear to improve endothelial function in subjects with CAD.”
— Sivasankaran, S., S. Pollard-Quintner, et al. (2006). “The effect of a six-week program of yoga and meditation on brachial artery reactivity: do psychosocial interventions affect vascular tone?” Clin Cardiol 29(9): 393–8.
Another yoga related study looked at “the short-term impact of a comprehensive but brief lifestyle intervention, based on yoga, on anxiety levels in normal and diseased subjects. The subjects had history of hypertension, coronary artery disease, diabetes mellitus, obesity, psychiatric disorders (depression, anxiety, ‘stress’), gastrointestinal problems (non ulcer dyspepsia, duodenal ulcers, irritable bowel disease, Crohn’s disease, chronic constipation) and thyroid disorders (hyperthyroidism and hypothyroidism). The intervention consisted of asanas, pranayama, relaxation techniques, group support, individualized advice, and lectures and films on philosophy of yoga, the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness.
Among the diseased subjects significant improvement was seen in the anxiety levels of patients of hypertension, coronary artery disease, obesity, cervical spondylitis and those with psychiatric disorders.”
— Gupta, N., S. Khera, et al. (2006). “Effect of yoga based lifestyle intervention on state and trait anxiety.” Indian J Physiol Pharmacol 50(1): 41–7.
Another study found that “Yoga lifestyle intervention retards progression and increases regression of coronary atherosclerosis in patients with severe coronary artery disease. It also improves symptomatic status, functional class and risk factor profile.”
— Manchanda, S. C., R. Narang, et al. (2000). “Retardation of coronary atherosclerosis with yoga lifestyle intervention.” J Assoc Physicians India 48(7): 687–94.
Qigong Increases Blood Flow
In results shown on a transcranial Doppler sonography, EEG, stimulus-induced 40 Hz oscillations, and near-infrared spectroscopy, Qigong researchers found, when the Qigong master concentrated on intense imagined stimuli, blood flow increased (e.g. 22.2% increase in mean blood flow velocity (vm) in the posterior cerebral artery, and a simultaneous 23.1% decrease of vm in the middle cerebral artery).
Neuromonitoring during QiGong appears able to objectify accompanied cerebral modulations surrounding this old Chinese meditation exercise.”
— Litscher, G., G. Wenzel, et al. (2001). “Effects of QiGong on brain function.” Neurol Res 23(5): 501–5.
Another study suggested, “Qigong exercise could significantly decrease the positive rate of abnormal electrocardiographic autopower spectrum function and improve perfusion of coronary artery or cardiac dysfunction produced by myocardial ischemia.”
— Jin, K. Q. (1992). “[Effect of qigong on electrocardiographic autopower spectrum function].” Zhongguo Zhong Xi Yi Jie He Za Zhi 12(7): 412–3, 389.
Qigong and Medications
In a study on the use of Qigong in combination with medications, researchers found the hands-on and energetic techniques of qigong to be beneficial in reducing cardiovascular problems and strokes. They noted, “the therapeutic role of qigong exercises combined with drugs is reported for three medical conditions that require drug therapy for health maintenance: hypertension, respiratory disease, and cancer.
In these studies, drugs were administered to all patients who were divided into two groups, a group that practiced qigong exercises and a control group that did not.
For hypertensive patients, combining qigong practice with drug therapy for hypertensive patients resulted in reduced incidence of stroke and mortality and reduced dosage of drugs required for blood pressure maintenance.”
— Sancier, K. M. (1999). “Therapeutic benefits of qigong exercises in combination with drugs.” J Altern Complement Med 5(4): 383–9.
Reflex Point Use for Vascular Function
In 1973, Kamenetskii did a study on the value of therapies using reflex points to improve vascular tone after a stroke.
— Kamenetskii, V. K. (1973). “Effect of reflex restorative therapy (“point” massage and acupuncture) on vascular tonus following a stroke].” Vopr Kurortol Fizioter Lech Fiz Kult 38(3): 274–5.
At The Center for Integrative Manual Therapy and Diagnostics, the use of reflex point for clinical treatment and for homework programs has benefitted many clients. These reflex points have names like “synchronizers”, “hypothalmus regulation mechanisms”, and “reference points”. They are used to improve cranial circulation and decrease muscle spasm during the treatment.
— Giammatteo, T., & Weiselfish-Giammatteo, S. (1997). Integrative manual therapy for the autonomic nervous system and related disorders: utilizing advanced strain and counterstrain technique. Berkeley, Calif.: North Atlantic Books.
Reflex Therapy
From The Chartered Society of Physiotherapy in England comes this overview, “Reflex therapy is an umbrella term describing the variations of treatment approaches developed in Egypt, India and China whereby the body is topographically represented in the body’s extremities. From a practical point of view, reflex therapy is a gentle, holistic, hands-on localized pressure applied to the feet, hands or head of a patient by a therapist in a systematic fashion relating to the needs of the individual.
The holistic and in-depth nature of reflex therapy may also be attributed to the fact that the area which is stimulated during treatment is in direct relationship to those parts of the brain which control our emotional and physical responses.
Reflex therapy is seen to enhance the health physically, mentally and emotionally both during and following a treatment with often lasting benefit.
Conditions which can be relieved by reflex therapy include, arthritic conditions, immune deficiency disorders, mental health, migraine and headaches, muscle and joint disorders, neurological conditions — eg cerebral palsy, Parkinson’s disease and stroke, pediatrics, sports injuries, stress-related conditions, and many more.
— Evans, H & Jones, C (2000). ‘Prenatal therapy, Metamorphosis and the Metamorphic Technique’ in: Charman, R A (ed) Complementary Therapy for Physical Therapists, Butterworth & Heinemann, London, pages 162–170
— Jones, C (1995). ‘Reflex Therapy’ in: Dennis, M, Everett, T & Ricketts, E (ed) Physiotherapy in Mental Health, Butterworth & Heinemann, London, pages 264–274.
— Oschman, J L (2000). ‘Energy Medicine — the new paradigm’ in: Charman, R A (ed) Complementary Therapy for Physical Therapists, Butterworth & Heinemann, London, pages 3–36
— Skellam, L & Smith Oliver, J (2000).’Reflex Therapy’ in: Charman, R A (ed) Complementary Therapy for Physical Therapists, Butterworth & Heinemann, London, pages 186–195.
— Jones, C. and C. Herbert (2007). Reflex Therapy, The Chartered Society of Physiotherap.
Integrative Manual Therapy and Strokes
There are two courses through the Connecticut School of Integrative Manual Therapy, specifically focus on working with people who have had strokes: IMT Stroke and Cranial A4 Stroke. — CenterIMT (2005)
One focuses on improving function of the muscles and systems of the body in someone with a stroke. The other course focuses on normalizing blood flow in the head and addresses the neurological dysfunction caused by the stroke.
In a case report on the use of Integrative Manual Therapy with a 78 year old man with high blood pressure and a recent stroke, the therapist noted, “prior to therapy, the patient presented with slurred speech, decreased comprehension, and loss of balance in walking. The patient’s main goal was to be discharged from the hospital. The man was treated with several Cranial Therapy techniques. After the treatment was completed, the patient presented with significant improvements in speech and comprehension and an improvement in balance during gait. The patient was discharged from the hospital the very next morning.” — Dillon, D. A. (2000). “The Benefits of Integrative Manual Therapy on Speech Impairment and Balance Secondary to Stroke.” Center for Integrative Manual Therapy and Diagnostics e-Journal.
The therapist continued, “to be released from the hospital, he had to be able to answer questions clearly without slurring his speech as well as be able to show he is no longer confused in his thinking, and be able to walk without balance problems.”
In another case of a baby who had a stroke in utero, the parents reported, “Allen [not his real name] had a stroke in-utero just prior to birth. We were told he might never sit up unassisted, walk, run, or speak. We sought out therapists to help Allen. When he was 9 months old, we visited CenterIMT for 2 days, about 8 hours of therapy. The following day Allen began to crawl for the first time. Subsequent trips have given Allen the abilities to walk, jump, run and speak. He was originally diagnosed as a hemiplegic (limited use of his entire left side). Throughout CenterIMT and follow-ups with his incredible OT / PT team at home, Allen has shown significant abilities with his left hand and fingers. He has increased mobility overall, and cognitively has begun to read and write at the age of 4!”
Frank Fantazzi, a physical therapist and orthopedic certified specialist at a clinic in Milwaukee describes another client’s recover from facial paralysis. “We use Integrative Manual Therapy to decrease the tension on the nerves and surface tissues, improve circulation and improve soft tissue and facial mobility.” — Griffin, K. L. (2000). “Facing the pain.” The Milwaukee Journal Sentinel.
Evidence Based Medicine
“There is no consensus about indicators for measuring quality of acute stroke care in Germany.
Overall a set of 24 indicators was developed to measure performance of acute care hospitals in the 3 health care dimensions structure, process and outcome as well as in 3 treatment phases prehospital, in-hospital/acute & postacute.”
— Heuschmann, P. U., M. K. Biegler, et al. (2006). “Development and implementation of evidence-based indicators for measuring quality of acute stroke care: the Quality Indicator Board of the German Stroke Registers Study Group (ADSR).” Stroke 37(10): 2573–8.
Mental Practice and Strokes
“Mental practice (MP) of a particular motor skill has repeatedly been shown to activate the same musculature and neural areas as physical practice of the skill. Pilot study results suggest that a rehabilitation program incorporating MP of valued motor skills in chronic stroke patients provides sufficient repetitive practice to increase affected arm use and function.” — Page, S. J., P. Levine, et al. (2007). “Mental practice in chronic stroke: results of a randomized, placebo-controlled trial.” Stroke 38(4): 1293–7.
Biophysiography, Nutrition, and Stroke
This article in Top Stroke Rehabil presents an overview of nutritional, herbal, and homeopathic treatment options from complementary and alternative medicine (CAM) as adjuncts in stroke prevention, treatment, and rehabilitation.
Simple preventive interventions such as use of a high-quality multivitamin/multimineral supplement in patients with undernutrition may improve outcomes with minimal long-term risk. Natural agents such as the antioxidant alphalipoic acid, certain traditional Asian herbal mixtures, and some homeopathically prepared remedies show promise for reducing infarct size and associated impairments. A number of nutrients and herbs may assist in treatment of stroke-related complications such as pressure sores, urinary tract infections, and pneumonia.
Individualized homeopathy may even play a helpful adjunctive role in treatment of sepsis.”
— Bell, I. R. (2007). “Adjunctive care with nutritional, herbal, and homeopathic complementary and alternative medicine modalities in stroke treatment and rehabilitation.” Top Stroke Rehabil 14(4): 30–9.
Cerebral Aneurysm Anatomy & Statistics
“In a series of 1314 consecutive patients with cerebral aneurysms from a defined catchment area in eastern Finland (870,000 inhabitants), 561 patients (43%) had middle cerebral artery aneurysms (MCAAs). One or more associated aneurysms were common; 221 patients with MCAAs (39%) had multiple intracranial aneurysms (MIA). In other words, three-fourths (73%) of all patients with MIA had at least one MCAA. Multiple MCAAs, found in 111 patients (20%), were common in this Finnish population. One hundred of these patients had bilateral MCAAs, of whom 63 had mirror aneurysms, that is, aneurysms at the same site but on different sides. Thirty-five patients had “pure” mirror aneurysms, that is, they did not have any other aneurysms.” — Rinne, J., J. Hernesniemi, et al. (1996). “Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome.” Neurosurgery 38(1): 2–11.
“Most MCAAs (81%) were located at the bifurcation. Three-fourths (72%) of the proximal MCAAs were associated with MIA.
The frequency of intracerebral hematomas (42%) was by far higher in patients with MCAAs than in patients with ruptured aneurysms at other sites. Most of the intracerebral hematomas occurred in patients with bifurcation MCAAs that pointed laterally.
Epilepsy, severe hemiparesis, and visual field deficits were the most common disabilities in long-term survivors, associated far more frequently with MCAAs than with aneurysm at other sites.” — Rinne, J., J. Hernesniemi, et al. (1996). “Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome.” Neurosurgery 38(1): 2–11.
Other researcher report on “a case of a giant aneurysm of the middle cerebral artery (M.C.A.), presenting with history of visual hallucinations, is described. The aneurysm was successfully excised, with disappearance of previous symptoms. The interest of the case is constituted by the very unfrequent location for an aneurysm over 3 cm in diameter, by the occurrence of epilepsy as the first symptom and by the excellent response to surgical therapy.” — Pasqualin, A., R. Da Pian, et al. (1979). “Giant unruptured aneurysm of the middle cerebral artery manifesting with epilepsy: successful surgical treatment.” J Neurosurg Sci 23(4): 303–10.
Another case had two main characteristic features: seizures had a quite late onset and were the only symptom the patient experienced.” — Zambrelli, E., A. Cavallini, et al. (2003). “A possible case of unruptured middle cerebral artery aneurysm presenting as epileptic seizures.” Neurol Sci 24(3): 141–4.
— Heros, R. C., R. G. Ojemann, et al. (1982). “Superior temporal gyrus approach to middle cerebral artery aneurysms: technique and results.” Neurosurgery 10(3): 308–13.
— Guzzetta, F., D. Battaglia, et al. (2006). “Symptomatic epilepsy in children with poroencephalic cysts secondary to perinatal middle cerebral artery occlusion.” Childs Nerv Syst 22(8): 922–30.
Cardiac Arrhythmias
Abnormalities of cardiac arrhythmias and conduction can be lethal (sudden cardiac death and stroke) or symptomatic (dizziness or palpitations).
There is evidence from smaller studies that mind/body techniques involving relaxation influence the autonomic nervous system and could play a role in the prevention and treatment or arrhythmia. — Shiga T, Wajima Z, Inoue T, Ogawa R. Magnesium prophylaxis for arrhythmias after cardiac surgery: a meta-analysis of randomised controlled trials. Am J Med 2004;117:325–33
Nutritional supplements such as co-enzyme Q10, L-carnitine and selenium, plus a number of herbal medicines, may also be useful. — Shiga T, Wajima Z, Inoue T, Ogawa R. Magnesium prophylaxis for arrhythmias after cardiac surgery: a meta-analysis of randomised controlled trials. Am J Med 2004;117:325–33
Researchers concluded, “millions of deaths are attributed to arrhythmias. Given that several trials in humans have strengthened the evidence that omega-3 fatty acids may prevent arrhythmias, these supplements could have the potential of influencing heart death due to arrhythmia and could have a considerable role to play in benefitting public health. The role of potassium and magnesium in the treatment of arrhythmia is very promising based on current data.” — Sali, A. and L. Vitetta (2007). “Integrative medicine and arrhythmias.” Aust Fam Physician 36(7): 527–8. [Full Text] http://www.racgp.org.au/afp/200707/17418
“The insular cortex has been shown experimentally to contain an arrhythmogenic center that may play an important role in the genesis of cardiac arrhythmias and electrocardiographic changes in patients with intracranial (eg, cerebrovascular) lesions.
The observed association of a neurosurgical intervention in the region of the left insular cortex with a cardiac arrhythmia supports but does not prove the suggested role of the insula in the causation of heart rhythm disturbances after stroke.” —
Svigelj, V., A. Grad, et al. (1994). “Cardiac arrhythmia associated with reversible damage to insula in a patients with subarachnoid hemorrhage.” Stroke 25(5): 1053–5.
Stroke and the Mitral Valve
“Embolic strokes of the middle cerebral artery can be associated with problems of the mitral valve. In one case the embolism was a fragment of the papillary muscle after mitral valve (Geroulanos, l969). In another, there was a stoke during percutaneous mitral commissurotomy.” (Vijayakumar,2004).
— Geroulanos, S. (1969). “[Embolism of a papillary muscle fragment in the right middle cerebral artery after mitral valve prosthesis with a Beal disc valve].” Thoraxchir Vask Chir 17(4): 320–5.
— Vijayakumar, M., T. Rajesh, et al. (2004). “Intra-arterial thrombolysis for left middle cerebral artery embolic stroke during percutaneous mitral commissurotomy.” Catheter Cardiovasc Interv 62(2): 249–51.
Stroke Rehab in an Enriched Environment
An enriched environment (EE) “includes a steady source of positive emotional support; Provides a nutritious diet with enough protein, vitamins, minerals, and calories; Stimulates all the senses (but not necessarily all at once!); Has an atmosphere free of undue pressure and stress but suffused with a degree of pleasurable intensity; Presents a series of novel challenges that are neither too easy nor too difficult for the child/adult at his or her stage of development; Allows for social interaction for a significant percentage of activities; Promotes the development of a broad range of skills and interests that are mental, physical, aesthetic, social and emotional; Gives the individual an opportunity to choose many of his or her own activities; Gives the person a chance to assess the results of his or her efforts and to modify them; Offers an enjoyable atmosphere that promotes exploration and the fun of learning; Above all, allows the child / person to be an active participant rather than a passive observer.” — Diamond, Marian and Janet Hopson (2007) Characteristics of an Enriched Environment From Magic Trees of the Mind.
Rehabilitation medicine is entering a new era, based on the knowledge that the central nervous system has a substantial capacity for repair and regeneration. This capacity is used in 3 distinct but overlapping situations: (i) routine housekeeping throughout life (i.e. taking care of normal wear-and-tear); (ii) older age, when functional reserves of various kinds are depleted, resulting in cognitive, motor, and other deficits; and (iii) contexts in which a neurological deficit reflects an acute or chronic pathological process, such as neurotrauma, stroke, or neurodegenerative disease.
The positive message here is two-fold. First, some aspects of regeneration occur even in the adult and ageing brain and spinal cord, and we are starting to unravel the underlying molecular mechanisms.
This review attempts to sum up the present knowledge about an enriched environment, currently the single most efficient plasticity- and regeneration-promoting paradigm. It also summarizes research showing that astrocytes — considered only years ago merely to nurse and support neurones — are a novel and highly interesting target for regenerative strategies in the brain and spinal cord. — Nilsson, M. and M. Pekny (2007). “Enriched environment and astrocytes in central nervous system regeneration.” J Rehabil Med 39(5): 345–52.
Neural plasticity is an intrinsic property that enables the mammalian brain to adapt to environmental changes during development and adulthood. Plasticity is not static. It is an active, continuous process throughout life. — Hummel FC, Cohen LG. Drivers of brain plasticity. Curr Opin Neurol 2005; 18: 667–674.
By design, the brain is remarkably responsive to environmental stimuli, physiological modifications, and experiences, (Pascual-Leone,2005) and its structure can be altered by experience in several measurable ways. In animals and humans, some regions in the normal adult brain, particularly the cortex, can alter their biochemistry, structure, and function — for example, during learning or in response to an enriched environment. (Ward,2004) and (Nilsson,2007).
— Pascual-Leone A, Amedi A, Fregni F, Merabet LB. The plastic human brain cortex. Ann Rev Neurosci 2005; 28: 377–401
— Ward NS, Cohen LG. Mechanisms underlying recovery of motor function after stroke. Arch Neurol 2004; 61: 1844–1848
— Nilsson, M. and M. Pekny (2007). “Enriched environment and astrocytes in central nervous system regeneration.” J Rehabil Med 39(5): 345–52.
Strokes and Disability
Stroke remains the leading cause of disability in the US. In this study, “Stepwise regression models including impairment and behavioral measures were strong predictors of function, disability, and quality of life. Involved-extremity muscle strength and power and self-efficacy were independently associated with function, whereas depression and self-efficacy were strong predictors of disability and quality of life. — LeBrasseur, N. K., S. P. Sayers, et al. (2006). “Muscle impairments and behavioral factors mediate functional limitations and disability following stroke.” Phys Ther 86(10): 1342–50.
Significance of the Middle Cerebral Arteries, Anatomy and Fistulas
Anatomy can be interesting to use in visualizing healing and tells the manual therapist where to focus their hands and intention. There is an idea in Traditional Chinese Medicine that where the mind goes, energy follows. And where the energy goes blood flow follows.
Reports of aneurysms of the middle cerebral artery and the surgery to correct damage to the MCA appear in the literature in the 1950’s. (Guiot,1955). Later there is research looking at fistulas between the MCA and the cavernous sinus. (Shaw,1968).
— Guiot, G. and Y. Le Besnerais (1955). “[Obliteration of the middle cerebral artery without neurologic sequels; remarks on factors influencing the effectiveness of peripheral anastomosis.].” Neurochirurgie 1(3): 287–91.
— Shaw, C. M. and E. L. Foltz (1968). “Traumatic dissecting aneurysm of middle cerebral artery and carotid-cavernous fistula with massive intracerebral hemorrhage.” J Neurosurg 28(5): 475–9.
The clinical course and postmortem findings in a case of fatal traumatic dissecting aneurysm of the right middle cerebral artery in a 12-year-old boy are described. Possible mechanisms and predisposing causes leading to this injury are discussed, with reference to similar cases described in the literature.
— Johnson, H. R. and J. R. South (1980). “Traumatic dissecting aneurysm of the middle cerebral artery.” Surg Neurol 14(3): 224–6.
— Kopczynski, S. and K. Kamraj-Mazurkiewicz (1972). “[Recurrent symptoms of cerebral circulatory insufficiency in a child with arteriovenous communication between the middle meningeal artery and the transverse sinus].” Neurol Neurochir Pol 6(5): 905–8.
— Occhiogrosso, M., A. Carella, et al. (1980). “Fistula between traumatic pseudoaneurysm of the middle meningeal artery and middle cerebral vein.” Acta Neurol (Napoli) 2(1): 58–65.
“A 66-year-old man suffered from subarachnoid hemorrhage due to the rupture of a right middle cerebral artery aneurysm
Incidentally, postoperative DSA demonstrated dural arteriovenous fistula in the left anterior cranial fossa, which was fed by the left anterior ethmoidal artery and drained into the superior sagittal sinus via the cortical vein of the left frontal lobe.
Subsequently, he underwent a ventriculo-peritoneal shunt and was discharged without any neurological deficits. We reviewed reported cases of rare association of ruptured cerebral aneurysm and dural arteriovenous fistula in the left anterior cranial fossa.” — Horie, M., K. Yamashita, et al. (2003). “[A case of ruptured aneurysm of the middle cerebral artery associated with dural arteriovenous fistula in the anterior cranial fossa].” No Shinkei Geka 31(10): 1099–103.
Originally published at https://www.linkedin.com on September 6, 2017.
