SECRETS FOR MAXIMIZING STROKE AND BRAIN INJURY REHABILITATION

As we race into the 21st Century embracing the latest advances in gene therapy, stem cells, hyperbaric oxygen and other high tech Acure-alls@, we shouldn't forget the basics. When our health falls into the ditch on the road of life, we need more than a good Samaritan to help us get back on track. Often a whole healthcare team needs to be utilized to get us on the right road again. That Healthcare team's attitude is all important since negative attitudes quickly make the patient believe that all hope is lost and failure follows. The healthcare team, the patient, family and caregivers all must share the same positive attitude for success. Working together means that everyone has to have the belief that successful rehabilitation is possible for even the worst possible case.

Positive thinking creates positive results. The power of positive thinking is especially important for quadriplegics and "locked in" patients and their caretakers to appreciate . If a person imagines moving an arm or leg, s/he is activating the same neurological pathways in the brain as if s/he were actually moving the paralyzed limb. Imagining the movement as occurring stimulates the brain injured areas (since it takes work by the brain to move the limb), and promotes the return of function by stimulating the nerve pathways. All of these positive changes in the brain and nerves can be demonstrated to be occurring with electrical detection techniques such as quantitative EEG.

In contrast, negative thoughts lead to despondence and despair and fatigue. Depression throws a Monkey wrench into the injured brain cell's energy producing machinery. This loss of energy is reflected in the person appearing apathetic, tired, sleepy, losing their appetite, being unable to move, to not want to leave their bed and failure to have any joy in their life. Joy and happiness occur when a person's energy level is high. Successful rehabilitation requires bringing joy back to the patient's life while they are engaged in the struggle to improve.

If imagining activates the injured brain areas, imagery carried through to the completion of the motions is even better. Research has demonstrated that if a paralyzed animal moves a limb 10,000 times, that limb will regain its function. The same is true for humans. Daily, repetitive movements of the paralyzed arm or leg lead to long-term success especially if the patient activates the process and carries out the motion by him or herself. This is why the device the "automove" is so helpful in helping the stroke patient regain the use of their paralyzed arm and why it is FDA approved for this purpose (put "automove" in your web search engine for different vendors). Seeking out items such as the "automove" are extremely important since everything that can be used to help the person see improvement rapidly re-enforces the value of the rehabilitation program they are enrolled in.

Anxiety and depression are emotions that produce stress. Stress stimulates the production of "stress steroids" which damage and even kill neurons in the part of the brain (hippocampus), which involves a person's short-term memory. Depression in stroke patients is associated with a poor outcome due to these cell killing stress steroids and the fact that a depressed patient will not do the therapy that is required to get results. In most cases a negative attitude can be reversed by the physician with his/her bag of medical tricks. A little known fact is that certain antidepressants have an almost magical way of transforming negative-minded brain injured patients into positive and energetic go-getters! Contrary to what many people believe, antidepressants are not habit forming for these people and their good far out ways the bad in most cases. Not only do antidepressants help a person become more motivated to do their various therapies but also these drugs actually help speed up and increase the amount of brain healing that occurs! They do this by increasing the metabolism of the mitochondria that are in the injured parts of the brain (they pull the monkey wrench out of the cell's metabolic machinery). This increase in metabolism produces more energy for the damaged cells and this energy is then used for self-healing and renewal!

In addition to antidepressants, we and others over the last forty years have found that daily hyperbaric oxygen treatments help the rehabilitation of brain injured patients- months and even years after their injuries. Hyperbaric oxygen is pressurized oxygen that is breathed daily by the patient through an ordinary oxygen mask. This super concentrated oxygen forces oxygen into the clear fluid part of the blood (plasma) and this oxygenated plasma then carries the oxygen into the brain damaged tissues. Once the oxygen reaches the starved injured brain tissues the mitochondria can use the oxygen to make the energy needed for healing to occur. In my experience of 30 years of practice, hyperbaric oxygen is the most useful therapy I have ever found for helping stroke and brain damaged individuals regain their lost functions. Of course, like other therapies, it should be used in combination with good doctoring and other helpful therapies for healing the brain such as brain healing nutrients, specific growth factors and the elimination of all infections and other stressors.

Stem cells are the hottest and most promising new therapy in medicine but you don't have to fly to Russia for them. Did you know that brain stem cells can be stimulated to grow and to migrate into damaged areas of the brain by exercise? Bicycling and jogging seem to be the most effective in stimulating stem cell growth. This is probably the reason why people who exercise routinely are mentally sharper and have better memories than those who do not exercise.

A nutritional diet and supplements that promote brain function are an integral part of recovery from a stroke or traumatic brain injury. When a knowledgeable physician prescribes vitamins, these nutrients are special. They have been selected for optimizing new blood vessel growth, stem cell growth and nerve regeneration. A silver Centrum is good but a specific program designed to optimize the brain=s healing is much better. Some of these ingredients may include copper, niacinamide, vitamin C, blueberries, cobalt, magnesium, calcium, DHA, DHEA, HGH, vitamin B1 (thiamin), vitamin B6 (pyridoxine), liquid oxygen, wheat germ extracts, neuropeptides, amino acids, etc.

Just as there are foods and drinks and supplements that help with brain repair, there are foods and drinks that do the opposite. Candy, alcohol, chocolate, ice cream, sugars, fruit juices, cakes and pies cause a roller coaster ride of emotional highs and lows. After enjoying these sugars, we often feel great with more energy and better thinking ability for a short period of time but later, we crash. We might get away with this type of diet for a few weeks, months or even years but sooner or later, we will have to Apay the piper@ and will begin to suffer from chronic fatigue, falling asleep after eating, internal nervousness, panic attacks, anger, depression, headache, etc. These are symptoms of Ahypoglycemia@ and indicate that the pancreas has been over stimulated for too long and now releases excess amounts of insulin (which lowers the levels of glucose). Brain cells are damaged by low glucose levels, and even more easily damaged by low blood sugar if they have already been injured by stroke or severe trauma. I have seen a number of stroke patients= paralysis worsen as an immediate result of a low blood sugar attack. Oxygen and glucose are both extremely important to cell survival. The optimum diet for rehabilitation in general is a high fiber diet that includes white chicken, white turkey, vegetables, grains, nuts, seeds and legumes with very little sugars and salt. Alcohol needs to be mentioned specifically since so much is said about a glass of wine per day being beneficial to a person's heart. In my experience no patient who continued to drink alcohol in any form or amount on a daily basis during their two month rehabilitation program at our clinic improved. That's right- 100% failure of patients who drink alcohol daily! Patients can spend thousands of dollars on the best therapies possible, but if they drink during the program, the money is wasted. Alcohol is directly toxic to neurons. It blocks growth factors, damages synapses, and increases a cascade of events that end in neuronal death. Without question, these patients fail in their quest of climbing out of the ditch to get back on the road to recovery.

Of course there are other factors that slow down or actually prevent the brain healing process from occurring. Air pollution, heavy metal poisoning, carbon monoxide from car exhausts, infections, autoimmune problems, allergies, high blood pressure, diabetes, heart diseases, circulation problems and driving on the freeway for more than an hour per day are all detrimental to the healing process. A thorough medical examination prior to starting our rehabilitation program is mandatory in order to diagnose any of these inhibiting factors and to correct them as soon as possible. Many of our patients or their families realize the importance of achieving the maximum in health prior to their arrival at our clinic. These forward thinking people want to hit the ground running instead of getting to our facility and discovering that the clinic is spending most of the time treating problems that were missed by other physicians. To facilitate this we offer telephone consultations in combination with patient medical record reviews at which time we recommend a variety of tests in order to help get the patient in the best health possible before they arrive.

There are many obstacles that patients face as they struggle to get out of the ditch and back to the highway of life but with a positive attitude everything gets better!

References:
Aboody, Karen et al. ANeural stem cells display extensive tropism for pathology in adult brain: Evidence from intracranial gliomas.@ Proceedings of the National Academy of Sciences, 2000, 97(23): 12846-12851.

Bonfanti, Luca et al. AMultipotent stem cells in the adult central nervous system.@ In Rao, Mahendra (ed), STEM CELLS AND CNS DEVELOPMENT, Humana Press, Totowa, New Jersey, 2001.

Chen, W.J. et al. AZinc supplementation does not attenuate alcohol-induced cerebral Purkinje cell loss during the brain growth spurt period.@ Alcohol Clin Exp Res, 2001, 25(4): 600-605.

Crews, Fulton et al. AEthanol, stroke, brain damage, and excitotoxicity.@ Pharmacology, Biochemistry, and Behavior, 1998; 59(4): 981-991.

De La Monte, S.M. et al. AMitochondrial DNA damage and impaired mitochondrial function contribute to apoptosis of insulin-stimulated ethanol-exposed neuronal cells.@ Alcohol Clin Exp Res, 2001, 25(6): 898-906.

Gavin, Timothy et al. AEffect of short-term exercise training on angiogenic growth factor gene responses in rats.@ Journal of Applied Physiology, 2001, 90: 1219-1226.

Gould, Elizabeth et al. AProliferation of granule cell precursors in the dentate gyrus of adult monkeys is diminished by stress.@ Proceedings of the National Academy of Sciences, 1998; 95: 3168-3171.

Hesse, S. et al. ARestoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support.@ Arch Phys med Rehabil, 1994; 75(10): 1087-1093.

Hugdahl, K. et al. ACommon pathways in mental imagery and pain perception: an MRI study of a subject with an amputated arm.@ Scand J Psychol, 2001; 42(3): 269-275.

Karten, Y.J. G. et al. ALong-term exposure to high corticosterone levels attenuates serotonin responses in rat hippocampal CA1 neurons.@ Proceedings of the National Academy of Sciences, 1999, 96(23): 13456-13461.

Kempermann, G. et al. AActivity-dependent regulation of neuronal plasticity and self repair.@ Prog Brain Res, 2000, 127: 35-48.

Lotze, M. et al. AActivation of cortical and cerebellar motor areas during executed and imagined hand movements: an fMRI study.@ J Cogn Neurosci, 1999, 11(5): 491-501.

Luo, Jia et al. AGrowth factor-mediated neural proliferation: target of ethanol toxicity.@ Brain Research Reviews, 1998; 27: 157-167.

Morris, P.L. et al. AClinical depression is associated with impaired recovery from stroke.@ Medical Journal of Australia, 1992; 157(4): 239-42.

Olney, J.W. et al. AEthanol-induced apoptotic neurodegeneration in the developing brain.@ Apoptosis 2000, 5(6): 515-521.

Roth, M. et al. APossible involvement of primary motor cortex in mentally simulated movement: a functional magnetic resonance imaging study.@ Neuroreport, 1996, 7(7): 1280-1284.

Sabbah, P. et al. AFunctional MR imaging and traumatic paraplegia: preliminary report.@ J Neuroradiol, 2000, 27(4): 233-237.

Sapolsky, R.M. AGlucocorticoids, stress, and their adverse neurological effects: relevance to aging.@ Experimental Gerontology, 1999, 34(6): 721-32.