253Glossary
Active movement
Movement done with the stroke survivor’s own muscle power.
Active range of motion (AROM)
The arc of movement of a joint that the stroke survivor can perform with his or her own power.
Acute phase
Broadly, the first seven days after stroke. After the acute phase is the subacute phase.
Adaptive equipment
Any equipment that makes the life of stroke survivors easier or gives them the ability to do a task that they would not otherwise be able to do. This term tends to be used interchangeably with assistive devices.
AFO
See ankle-foot orthoses.
Ankle-foot orthoses (AFO)
An orthotic designed to lift the foot and stabilize the ankle during walking.
Aphasia
A general term for the inability to either speak (expressive aphasia) or understand speech (receptive aphasia). Aphasia affects approximately 20 percent of survivors who have had a left-sided stroke (right side of the body affected). Used interchangeably with the word dysphasia.
Apraxic (apraxia)
Survivors with apraxia have two problems: They (1) cannot tell where their limb is in space without looking at it and (2) have an inability to plan movements. Apraxia makes quality movement difficult or impossible, even when survivors have enough active range of motion and strength.
254Assistive devices
Any equipment that makes the life of stroke survivors easier or gives them the ability to do a task that they would not otherwise be able to do. This term tends to be used interchangeably with the term adaptive equipment.
Balance training
Any recovery technique used to increase balance after stroke. Traditionally, balance training is done in a rehabilitation facility by a physical therapist.
Bilateral
Using either both of the upper or both of the lower extremities at the same time.
Bilateral training
Any recovery technique that involves repetitive and predictable patterned movement of either both of the upper extremities, or both of the lower extremities at the same time. Bilateral training falls into two main categories: (1) equal and at the same time (as in conducting an orchestra) and (2) equal and alternating (as in drumming using alternating hands).
Biofeedback
A system that allows for continuous monitoring of a body system in order to control that body system. Biofeedback happens all over the body all the time. For instance, in a simple biofeedback loop, to relax a muscle, you send signals to the muscle to contract and the muscle sends back a signal that tells you that the muscle is relaxed. Biofeedback is traditionally used to allow for control over systems in the body that are not normally controllable, like heart rate and blood pressure. In stroke survivors who want to move better, biofeedback can be used to monitor the contraction of a muscle or group of muscles that are not responding in order to encourage muscle contraction. An example of biofeedback used in stroke recovery is electromyography-based biofeedback machines.
Brain derived neurotrophic factor (BDNF)
Neuroscientists refer to be BDNF as “Miracle Grow™ for the brain.” BDNF is naturally produced by the brain after brain injury, including stroke. BDNF is an essential ingredient to driving the necessary neuroplastic change for motor recovery (relearning of movement) after stroke. BDNF helps neurons (nerve cells) in the brain form (synaptic) connections. A small percentage of survivors do not produce BDNF after their stroke. There is a genetic test to determine if a particular survivor produces BDNF. If the survivor does not produce BDNF, clinical decisions about rehabilitation can be based on that information.
255Brunnström, Signe
Signe Brunnström, a Swedish Fulbright scholar and pioneer physical therapist was the first to map out the predictable stages of recovery from stroke. Although Hippocrates described stroke some 2,400 years earlier, Brunnström was the first to describe the landmarks on the road to recovery. These predictable stages of recovery are commonly called “Brunnström’s stages of recovery.” Some of the tests that Brunnström developed decades ago are still used in rehabilitation research, and the results of those tests tend to correlate well with more sophisticated computer-driven tests like testing of neuroplasticity by functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS).
Brunnström’s stages of recovery
The six predictable stages that stroke survivors experience during recovery from stroke. These stages go from Stage 1, in which the stroke survivor is flaccid, to Stage 6, in which the stroke survivor is fully recovered.
Cardiovascular
Having to do with the heart and blood vessels. The term cardiovascular tends to be used to describe endurance of the heart and lungs.
Cardiovascular training
Training focused on increasing endurance of the heart and lungs.
Central obesity
Described as apple-shaped, a body shape where the waist is larger than the hips. This shape, as opposed to carrying weight around the hips, has been shown to have increased risk of high blood pressure, diabetes, heart disease, and stroke.
Chronic phase
The term used to describe a stroke survivor’s time since stroke. The chronic phase after stroke is usually considered to be the period that is more than three months to a year after stroke. The harkening of the chronic phase is the plateau; once the survivor’s recovery plateaus, that survivor is said to be in the chronic phase. The chronic phase continues to the end of life. Before the chronic phase is the subacute phase. The subacute phase is usually considered to be the period from seven days to three months after stroke.
Complex regional pain syndrome (CRPS)
In stroke, CRPS is often in the arm and hand and is triggered by the trauma inflicted on the shoulder joint by the stroke. In this case, CRPS it is typically called shoulder-hand syndrome (SHS). Up to 25 percent of all stroke survivors get SHS. Symptoms of SHS include pain; swelling; stiffness; 256considerable reduction of movement in shoulder joint, wrist, and hand; discoloration of the skin.
SHS usually starts one to six months after stroke. Pain usually starts in the shoulder and moves down the arm to the hand. SHS tends to get worse over time and can make movement very painful. The pain limits the amount and type of movement the survivor is willing to do, which can affect recovery. If left untreated, SHS can result in deformity and “frozen shoulder” (the tissue around the shoulder becomes stiff and movement at the shoulder becomes painful).
Research suggests SHS is caused by the changes in how the shoulder moves after stroke. Poor quality of movement of the shoulder causes microscopic injury to the shoulder joint. The injury to the shoulder effects the nervous system. The nervous system reacts to the injury by sending intense pain signals to the arm and hand. Treatments include: passive range of motion exercises; corticosteroids (steroids); NSAIDs (aspirin, ibuprofen, naproxen sodium, etc.); centrally acting analgesics; and physical and occupational therapy.
Compensatory movement, compensation
Relying on the unaffected limbs to do the activities of daily living.
Component parts (of a task), practice of
Also known as part-whole practice, individual movements that, when put together, form the movements needed to do a task. This concept is used in constraint-induced therapy. The entire task is broken down to component parts. The component (individual) parts (movements) are practiced individually. Once those components parts are individually mastered, they are put together to do the entire task. The thinking is, if a survivor attempts to do the whole task it will be "overwhelming to the nervous system,” and the survivor will get frustrated and fail. But if the complex task is broken down to its component parts, the parts are easier to learn.
Constraint-induced therapy (CIT) for the arm
Traditional CIT is a stroke-recovery technique that involves constraining the “good” arm and hand and having the stroke survivor only use the affected arm and hand in a clinical setting.
Constraint-induced therapy for the leg (leg CIT)
Four different schools of thought debate the exact definition of leg CIT: providing extensive and intensive exercises of the affected leg; partial weight-supported walking; electrical stimulation ankle-foot orthoses; or 257providing a shoe lift or some other type of orthotic on the unaffected side, forcing weight onto the affected side.
Contracture
A shortening of soft tissue (e.g., muscle, nerves, blood vessels). A contracture happens when a joint is left flexed for too long and the soft tissue shortens. In stroke survivors, contracture may occur in response to spastic muscles, which are in a constant state of contraction.
Conventional therapy
The usual care offered in a particular setting. After stroke, survivors are usually offered conventional therapy, which consists of standard occupational, physical, and speech therapies.
Comorbidity (comorbidities)
Besides the stroke, all the other illnesses (including behavioral or mental) and/or injuries the survivor has. Examples include diabetes, hip pain, and chronic headaches. Comorbidities can have a profound impact on recovery.
Core
The portion of the brain killed by the stroke. Contrast with penumbra.
Discharged
Released from therapy. “Discharged” is the technical term that therapists use to describe the point at which therapy is ended. Different therapeutic disciplines (e.g., physical, occupational, speech therapies) may end at different times, depending on the progression, or lack of progression, of the stroke survivor. Therapists will usually continue therapy until they perceive that progress toward recovery has ended. Therapists call this lack of progress a plateau. The point at which any patient is discharged for any therapy is also dictated by the strict parameters set up by insurance companies, both private and governmental.
Distributed practice
A schedule of practice in which learning a new movement or skill is spread out over time. Distributed practice schedules are typically used in rehabilitation facilities. For instance, a typical rehabilitation schedule might be three sessions per week, 45 minutes each session, or five sessions a week for one hour. Contrast with massed practice.
Dorsal root rhizotomy (selective dorsal rhizotomy)
Neurosurgery that selectively destroys nerve roots (parts of the nerve) in the spinal cord and leads to a reduction or elimination of spasticity. It is most often used in children with spastic cerebral palsy. However, it 258is also effective in adults with profound spasticity after stroke. It is not reversible (once the nerve roots are cut you cannot put them back together again). Also, dorsal root rhizotomy (DRR) eliminates sensation because it destroys the nerve roots that transmit sensation from the muscle to the spinal cord. It should be considered in survivors with profound spasticity that is painful and risks injury to skin (pressure sores).
Dorsiflexion
The movement of the foot upward when only the ankle joint is moved. If you are sitting in a chair with your feet on the ground and you want to tap your foot, the first movement of the foot, upward, is dorsiflexion. In many stroke survivors, this movement is limited or lost. The verb is “dorsiflex.” A lack of ability to dorsiflex is called drop foot or foot drop.
Drop foot or foot drop
A reduced or eliminated ability to lift (dorsiflex) the foot at the ankle. The result of drop foot is toe dragging.
Dysarthria
Weakness or paralysis of the muscles of the mouth that form words. Dysarthria refers to impairments in speech caused by a reduced ability to use the muscles associated with speech. Dysarthria may affect the muscles of the mouth, lips, tongue, face, and respiratory system. Dysarthria is caused by damage, from the stroke, to the part of the brain that controls the movement of the mouth. Dysarthria can be reduced by the same mechanisms that reduce disability in the limbs, including repetitive practice. Contrast with expressive aphasia.
Electrical stimulation
See neuromuscular electrical stimulation.
Electrical stimulation ankle-foot orthosis (or “orthotics”)
A group of commercially available orthotics designed to use electrical stimulation to lift the foot (dorsiflexion) in people with drop foot.
Electromyography (EMG)
The testing of muscles as they contract (flex) and relax. Electromyography is often used to evaluate spastic muscles. It is also used in some electrical stimulation stroke-recovery machines to provide feedback to the machine regarding the amount of muscular effort by the stroke survivor.
Electromyography (EMG)-based electrical stimulation
Electrical stimulation that “rewards” the stroke survivor who tries to move a limb that is (or is nearly) immobile. If the stroke survivor 259tries to move the limb, electrical stimulation is sent to the muscles that complete the desired movement. Some of these machines are quite sensitive and can detect a signal even when no movement is visually apparent. Machines in this class include Mentamove, the Biomove 3000 system, and NeuroMove™.
Embolitic stroke
A stroke caused by an embolism (usually a blood clot) that travels from another part of the body and lodges in and clogs an artery leading to the brain or in the brain. The embolism cuts off the blood supply to part of the brain, causing stroke.
E-stim
Electrical stimulation. See neuromuscular electrical stimulation.
Evidence-based practice
Basing treatment of a patient on the best available research, as well as sound clinical judgment. It is of considerable benefit for stroke survivors to make sure that the treatment techniques they are using, with or without administration by a therapist, are evidence based.
Expressive aphasia
The loss or limitation of communicating, either through the spoken word or the written one. Expressive aphasia is caused by damage to the language centers of the brain. Stroke survivors sometimes have expressive aphasia if they have had a left-sided stroke (right side of the body affected).
FES
See functional electrical stimulation.
Foot drop
An inability to dorsiflex (lift the foot at the ankle).
Forced use
Having the survivor constrain the “good” arm/hand using a sling and/or mitt for most of their waking hours. Forced use is different from constraint-induced therapy (CIT). CIT involves forced use. CIT also involves supervised task practice. Forced use does not involve supervised task practice.
Functional
A term used by insurance companies and therapists to describe the ability to do a real-world task. For instance, if stroke survivors are able to dress themselves, no matter how they do it, they are said to be functional in dressing. The word “functional” does not address the deficits of the affected (“bad”) side of the stroke survivor.
260Functional electrical stimulation
Low levels of electrical stimulation run from a machine, through wires, and into electrodes put on the surface of the skin overlying the muscles involved in a functional task. The electricity contracts the muscles in a precise pattern that allows for a specific task to be accomplished.
Greater trochanter
A large bump that is at the top of the femur (the large bone that forms the top half of the leg). This bump is the surface that often hits the ground first when someone with a stroke falls. Discreet hip pads that can be worn inside undergarments will protect the vulnerable part of the hip during a fall.
Hemiparesis
Half the body is partially paralyzed. Hemiparesis is often incorrectly used to describe hemiplegia.
Hemiplegia
Total paralysis of the head, arm, leg, and trunk on one side of the body, whereas hemiparesis is weakness on one side of the body. Hemiplegia is often incorrectly used to describe hemiparesis.
Hemorrhagic stroke
A stroke in which a blood vessel bursts and blood is released into the brain. Hemorrhagic strokes make up approximately 20 percent of all strokes. The classic question to determine the type of stroke that a stroke survivor had is, “Was your stroke a bleed (hemorrhagic) or a block (ischemic)?”
Home Exercise Program (HEP)
Traditionally, therapists have viewed the home exercise program (HEP) as a series of exercises that followed two rules: (1) The exercises given to the stroke survivor right before the therapist discharged the survivor, and (2) the exercises were the same exercises that the stroke survivor had done with the therapist in the clinic. These are the same exercises that have precipitated the plateau that caused the survivor to be discharged. If done correctly, a HEP can provide two important ingredients to the process of recovery: (1) A robust HEP can allow the survivor to continue to recover even after they’ve been discharged from therapy, and (2) while in therapy with the therapists, a HEP can expand the amount of practice time per day. In this way, the HEP expands the therapeutic experience the same way a child’s homework expands the time allotted to learning a subject.
Hyperacute phase
The hyperacute phase is broadly from the first symptom through the first six hours after stroke. This phase is “hyper” important because “Time is brain.” That is, the faster the survivor can get to the hospital, the more 261brain can be saved. This phase includes the only period of time in which strong clot-busting medications (like tissue plasminogen activator, or TPA) can be administered. Immediately following the hyperacute phase is the acute phase.
Imagery
See mental practice.
Intensity
In exercise physiology, intensity refers to the frequency and duration of training as well as the amount of energy expended when exercising. With regard to stroke rehabilitation, intensity has shown to positively affect recovery. Human and animal studies indicate that increased intensity nets increased changes in cortical reorganization (brain plasticity).
Ischemic stroke
A stroke in which blood is blocked from going through an artery that leads to or resides in the brain. The way the artery is blocked further distinguishes between two separate types of ischemic strokes: (1) thrombotic stroke and (2) embolic stroke.
Learned nonuse
The result of trying and failing a movement so often that the stroke survivor believes that the effort is futile. With lack of attempt comes shrinkage of the part of the brain that was used for that movement prior to the stroke. Researchers believe that survivors can overcome learned nonuse with interventions that force use, such as constraint-induced therapy.
Mass synergies
A large set of movements where no single movement can be done alone. In stroke survivors, during some periods in the arc of recovery, movements cannot be isolated. That is, stroke survivors cannot just do one (e.g., reaching forward) without doing a whole series of movements (e.g., the upper arm coming away from the body, the elbow bending). All the movements, when taken together, define mass synergies. See also synergistic movement and synergy.
Massed practice
A schedule of practice in which learning a new movement or skill is done many hours a day, usually over a two- to three-week period. Massed practice schedules are not typically used in rehabilitation facilities. However, constraint-induced therapy (CIT) is usually done using a massed-practice schedule. CIT has traditionally used a schedule of five to eight hours per day, for two to three weeks. Contrast with distributed practice.
262Melodic intonation therapy (MIT)
A speech therapy that uses simple and exaggerated melodic elements to recreate speech. Because the area of the brain that typically processes music is on the opposite side of the brain that typically processes language, MIT aims to use undamaged parts of the brain to compensate for the language areas of the brain affected by stroke.
Mental practice
A technique long used by athletes and musicians to precisely imagine physical movements in an attempt to enhance performance during the actual event. Traditionally known as “imagery,” mental practice consists of deep relaxation followed by a disciplined practice of imagining moving the same way as prior to the stroke. Research indicates that mental practice may increase quality of movement in stroke survivors.
Meta-analysis
Essentially, a “study of studies” where all the available studies of a subject are evaluated based on a set of pre-established criteria. Once the studies are evaluated, they are given a certain weight and run through a mathematical formula. A meta-analysis dedicated to stroke recovery gives scores to all the recovery strategies for which there is available research and distinguishes “winners” from “lemons.” The definitive stroke recovery meta-analysis is the Evidence-based Review of Stroke Rehabilitation by Dr. Robert Teasell and colleagues at the University of Western Ontario, Canada. This amazing stroke-specific document can be found on the web at www.ebrsr.com.
Mirror therapy
A therapy in which the stroke survivor copies the movement of the “good” upper extremity with the “bad” extremity while looking at the unaffected side via a mirror. The mirror gives the optical illusion that the affected extremity is moving perfectly. This therapy is thought to provide the brain with fake, but normalizing, information, fooling the brain into rewiring in a way that allows for more normal movement.
Modified constraint-induced therapy (mCIT)
A form of constraint-induced therapy that uses a schedule that is available within the normal schedule of typical outpatient settings. Developed by noted stroke researcher Dr. Stephen J. Page (with the help of the author of this book), mCIT involves the stroke survivor seeing a therapist three times a week for half-hour sessions. At home, the stroke survivor constrains the affected arm for five hours during a time when he or she is wakeful and active. Many rehabilitation facilities have modified mCIT 263even further in order to reflect the particular skills of their therapists and to reflect the particular resources available at their facilities.
Motor learning
A form of learning that involves the cognitive endeavor of learning new movements. For survivors, motor learning is a combination of motor learning and motor relearning. Motor learning involves establishing new brain pathways, while motor relearning involves re-establishing brain pathways that existed prior to the stroke.
Necessity drives recovery
A phrase that describes the fact that needing to do a valued, real-world task (necessity) promotes recovery. The more essential a task is to a survivor, the more the task can be used to focus efforts toward accomplishment of the task.
Neuro
A prefix that means “nerve.” Neuro is used as a prefix for anything that has to do with nerves, as in neurorecovery or neuroplasticity. Stroke is damage to the nerves of the brain.
Neuromuscular electrical stimulation (NMES)
The sort of electrical stimulation that causes muscles to contract. A machine delivers specific amounts of electrical stimulation down a wire and into an electrode that, with the use of a sticky gel, attaches to the skin overlying the muscles that are to be stimulated. Even muscles that are paralyzed after stroke respond to NMES. This treatment has shown promise as a way of retaining range of motion, muscle strength, and may even help jump start movement in paretic limbs. Neuromuscular electrical stimulation can be used in the arm or leg. Many companies are developing machines that provide NMES in orthotics, which allow the stroke survivor to move and practice everyday tasks, often with independence from tethering wires.
Neuroplasticity, neuroplastic, neuroplastically
The ability for neurons (nerve cells) to communicate with each other in new and ever-changing ways. Research using brain-imaging techniques has shown that neuroplasticity allows stroke survivors to recover by rearranging neuronal connections to “go around” the area of the brain damaged by stroke. It has been demonstrated that with the correct type, intensity, and schedule of practice, neuroplasticity can reallocate a part of the brain to any task practiced.
Paralysis
The complete loss of muscle control.
264Paresis, paretic
Partial loss of muscle control. The adjective is paretic.
Partial weight-supported treadmill training
The stroke survivor wears a harness attached to risers that are then attached to a suspension device so that the stroke survivor can be suspended over a treadmill on which he or she walks.
Part-whole practice
See Component parts (of a task), practice of
Partial weight-supported walking (PWSW)
Walking while part of the weight of the stroke survivor is reduced, which lessens the effect of gravity and protects the stroke survivor if balance is lost. The reduction of body weight can be accomplished in two ways: (1) Having the stroke survivor wear a harness that is attached to risers. The risers are attached to a suspension device so that the stroke survivor can be suspended over a treadmill. (2) Having the stroke survivor supported through the pelvis in a mobile wheeled device. Once the stroke survivor is secure in the device, the device provides adequate lift to allow walking over ground. The KineAssist™ and NeuroGym® Bungee Walker are examples of this technology.
Passive movement
Movement that is not performed by the person’s own muscular power. For example, passive movement of the elbow would involve someone besides the stroke survivor moving the joint. However, passive movement can be done by the stroke survivor himself or herself, as well. For instance, if the stroke survivor moves the affected elbow with the unaffected hand, then the “bad” elbow is said to be involved in passive movement. Passive movement of the affected limbs is often an important part of reducing the risk of contracture and retaining passive range of motion. Some research indicates that passive movement may drive positive neuroplastic change.
Passive range of motion (PROM)
The amount of movement available in a joint when the joint is moved with passive movement. For example, the PROM of the elbow would be the amount of movement measured from the angle of the most flexion (elbow bent) to the angle of the elbow when it is most extended (elbow straight).
265Patient driven
The term used to describe two separate ideas: (1) Neuroplasticity in the brain is “driven” by the stroke survivor. Stroke survivors “drive” their own nervous systems during voluntary effort, and through this process, neuroplastic changes in the brain occur. (2) Therapies are said to be “patient driven” when, with little training and/or set up, the patient can do the therapies by himself or herself.
Peer-reviewed
The term used for research articles that have been scrutinized by experts in the field. For instance, an article about a new treatment for the recovery from stroke might be published in a peer-reviewed journal. If so, this article has a high chance of being accurate and reliable. However, much of what is published, either in books, newspapers, and magazines and on the Internet, does not go through the peer-review process and, therefore, is not considered as reliable as peer-reviewed information. If the source is simply reporting what a peer-reviewed article said, then it may be a reliable resource. Keep in mind that the mainstream media may misinterpret what was originally published in a peer-reviewed article. In any case, when researching different ways of recovering from stroke, look for information that was originally published in journals that are peer-reviewed.
Penumbra
The area next to the part of the brain killed by the stroke. The penumbra contain cells that are “stunned”—not dead, but not functioning. In the subacute phase after stroke, the penumbra begins to resolve, and as it does, recovery is often rapid. The penumbra is an area of the brain that can either be useful (be used much of the same way it was prior to the stroke) or be useless (be used very little after stroke). The process of rendering the penumbra as useless is known as learned nonuse.
Percutaneous
A medical procedure, where the skin is punctured to access tissue under the skin.
Percutaneous NMES (perc-NMES)
A form of neuromuscular electrical stimulation where the stimulation is delivered under the skin to the muscles. For instance, percutaneous electrical stimulation is sometimes used to reduce shoulder subluxation (shoulder dislocation) after stroke.
266Physiatrist
A medical doctor specifically trained in physical medicine and rehabilitation. Often called “stroke doctors” by stroke survivors, these doctors have special medications, measurements, and treatments to help stroke survivors recover.
Plateau, plateaued
A word that means “flattening out,” used to describe the point at which a stroke survivor is no longer making progress. Different therapeutic interventions (e.g., physical, occupational, and speech therapy) may plateau at different times. A plateau in progress may be more reflective of ineffective treatment options, ineffective implementations of treatment options, or incorrect dosages, rather than an actual halting of potential.
Proprioception
The feeling of where parts of the body (e.g., arms and legs) are in space without actually looking at the specific body part. The information about where the body is in space is delivered to the brain from little organs in the muscle and tendons called proprioceptors.
Range of motion (ROM)
The largest arc of movement of a joint. Range of motion is broken down into two categories: active range of motion (AROM) and passive range of motion (PROM).
Receptive aphasia
An inability to understand spoken language. Stroke survivors sometimes have receptive aphasia when they have had a left-sided stroke (right side of the body affected).
Reciprocal innervation
A phenomenon first described by Nobel laureate Sir Charles Sherrington that describes the fact that for a muscle (agonist) to contract, the muscle that opposes that muscle (antagonist) has to relax. For instance, in order for the muscles that bend the elbow to work, the muscles that straighten the elbow must “agree” to relax. This intricate dance between muscles is controlled subconsciously by the spinal cord, not the brain.
Repetitive practice
Repeating a movement or series of movements in order to drive neuroplastic change to benefit future attempts at the same movement.
267Resistance training
Any training in which muscles work against an opposing force. The most common type of resistance training is weightlifting. This sort of exercise is essential to recovery from stroke.
Resolution of the penumbra
A reduction of swelling in the brain that leads to rapid recovery in the few weeks to months after the stroke. The penumbra, the area in which swelling is reduced, is next to the nerve cells in the brain killed by the stroke.
Rhythmic auditory cuing
Using a steady beat generated by a metronome, drum machine, or music to establish a tempo that the stroke survivor tries to match by doing a particular movement or set of movements on the sound of the beat.
Rhythmicity, Rhythmic
The inherent rhythm in something. In recovery from stroke, rhythm can be used to motivate and provide an auditory cue. For instance, having one hand reach out and hit a target may help the stroke survivor learn to move, but if the same exercise is done while trying to hit the target on the snare beat for an entire song, then the exercise becomes motivating and more challenging.
Serial casting
A proven method for increasing the length of muscles shortened by spasticity and/or weakness. During serial casting, a cast is placed around a joint in a lengthened position so that the muscle is gradually and continually stretched.
Sherrington, Sir Charles
The scientist who, in the late 1800s and early 1900s, developed the foundation of modern physical and occupational therapy. In addition to a huge amount of neurological discoveries and observations, Nobel Prize winner Sherrington described reciprocal innervation and proprioception, two essential concepts in the recovery from stroke.
Shoulder-hand syndrome (SHS)
See complex regional pain syndrome (CRPS)
Soft tissue
The “meat” of the body that surrounds organs and bones. Included are muscles, tendons, ligaments, fat, fascia, nerve fibers, blood vessels, and joint tissue. In stroke survivors, soft tissue has the potential to 268irreversibly shorten because the affected joints are held in flexed postures. A comprehensive stretching program is essential to keeping soft tissue long enough so that, if and when control over the joints is re-established, there is enough soft tissue length to accommodate the “new” movement. If soft tissue is not stretched enough, an irreversible shortening of soft tissue, called a contracture, can develop.
Spasticity, spastic
Tight and sometimes locked muscles caused by impulses from the spinal cord. The part of the brain that normally communicates with the muscles dies during the stroke. The muscles need protection from being torn, so the spinal cord sends endless signals to the muscles to contract. There are many temporary ways to reduce spasticity, including medications, but there is only one way to end spasticity: re-establishing brain control over the spastic muscles.
Speed-intensive gait training (SIGT)
Gait (walking) training that is done at speeds that are faster than typical gait training. Some researchers believe walking speed and quality will improve when gait training occurs at faster speeds.
Spontaneous recovery
Recovery with little effort. Spontaneous recovery is usually a result of neurons “stunned” during the acute phase coming back on line during the subacute phase.
Stages of recovery
See Brunnström’s stages of recovery.
Stretch reflex
The immediate muscle-protection reaction caused by impulses from the spinal cord. Stretch reflexes protect muscles from being over-stretched and torn. The patellar stretch reflex, in which a clinician will use a reflex hammer to tap just below the kneecap, is an example of a stretch reflex.
Stroke survivor
A person who has a stroke but does not die from the stroke.
Subluxation of the shoulder
Dislocation of the shoulder joint as the head of the humerus (upper arm bone) separates from the glenoid fossa of the scapula (shoulder blade bone). Width of separation is usually measured in fingerbreadths. Shoulder subluxation may or may not be painful.
269Subacute phase
The subacute phase broadly runs from seven days to three months. It is a time of relatively rapid recovery. This rapid recovery corresponds to the resolution of the penumbra. For some survivors, the subacute phase can last beyond the first year.
Synergistic movement
Movement that does not allow isolated movement of just one joint, but requires the movement of all the joints in the limb in order to perform that one movement. See also mass synergies and synergy.
Synergy
The combination of more than one action that always happens together, usually in a complementary way. In stroke survivors, synergy, synergistic movement, and mass synergies are used to describe movements that are necessarily bundled together in a way that makes isolated movement impossible.
Task-oriented therapy
See task-specific training.
Task-specific training
The practicing of tasks that are meaningful to the stroke survivor. For instance, if a stroke survivor is a golfer, practice that involves some aspect of golf, or tasks that have the potential to lead to some aspect of the game of golf, are said to be task specific. In research with both humans and animals it has been shown that recovery efforts that incorporate tasks that are meaningful may drive neuroplastic change along with increased active movement.
Taub, Edward, PhD
The originator of constraint-induced therapy. Dr. Taub worked for decades with lab animals, proving that constraint-induced therapy could work prior to introducing the therapy to human populations.
Thrombolytic stroke
A stroke caused by a clot formed inside a blood vessel in the brain or leading to the brain.
Transient ischemic attack (TIA)
Just like a full-blown stroke, a TIA is interruption of blood flow to the brain. However, the blood flow stops for less than 24 hours. In most cases, blood flow is stopped for one to two hours. Symptoms resolve 270within 24 hours. Approximately one third of people who have had a TIA eventually have a stroke. Five percent of people will have a stroke within two days after TIA. Five percent to 10 percent of patients that have had a TIA will have a stroke within the following week. A TIA is seen as a warning sign for future stroke. It also presents an opportunity to implement lifestyle changes to reduce the chances of having a stroke.
Treadmill training (TT)
A form of gait (walking) training that incorporates a treadmill. Treadmills offer “endless parallel bars,” a predictable and nonslip walking surface, and gradation of incline or speed—all with indoor safety and comfort.
Tremor
Involuntary, usually rhythmic, movements.
Unilateral spatial neglect (USN)
Also known as hemineglect, hemispatial neglect, hemiagnosia, unilateral neglect, spatial neglect, unilateral visual inattention, hemi-inattention. A survivor who has unilateral neglect is less aware or completely unaware of the affected side. Even after they are reminded to look at the hand, they often will only glance at it as if it holds little interest to them. USN can be dangerous; the survivor will bump into or ignore objects on the affected side. Sometimes USN can extend beyond the body of the survivor so that the whole space on the "bad" side of the body is ignored. Constraint-induced therapy and mirror therapy may be helpful in reducing USN.
Waist-to-hip ratio
The relationship between the measurement of the stomach and the hips. To calculate, divide the measurement around the belly by the measurement around the hips. The belly is measured at the belly button, and the hips are measured around their widest point. The calculation is:
(Waist measurement) ÷ (Hip measurement) = (Waist-to-hip ratio) There are many waist-to-hip ratio calculators on the web (Google: “waist-to-hip ratio calculator”). Research has shown that the waist-to hip ratio is one of the best indicators of cardiac (heart attack) risk.
Wolf’s law
A widely accepted theory that the more stress put on a bone over time will reshape that bone to better handle that stress. Bone will get thicker and stronger if one does resistance exercises (weight training or working 271muscles against any resistance such as gravity or resistance bands). Stroke survivors tend to have weaker bones (osteoporosis) on the affected side, coupled with the fact that when stroke survivors fall, they tend to fall toward the affected side. Since the bones on that side are weak, there is increased risk of fracture. Wolf’s law can be used to make bones thicker and stronger, reducing the risk of fracture.272