Feeling dizzy after a stroke is more common than you think. Learn more about post-stroke dizziness and how vestibular therapy can improve your function.

 Post-Stroke Dizziness: How Vestibular Therapy Can Help

Dizziness is a common symptom in stroke survivors, but it is rarely addressed as
the main concern in rehabilitation programs. Consequently, many people are left
with dizziness that lingers beyond recovery and affects day to day activities.

Post-stroke dizziness can leave survivors sidelined from their regular routines.
Feeling dizzy after a stroke can be caused by different factors. To understand
more about post-stroke dizziness, let’s take a deeper look at factors that may
be involved and which treatments can help.


Dizziness After Stroke: Your Questions Answered
 * Why do people experience dizziness after stroke?
 * How does a brainstem stroke cause dizziness?
 * What treatments are available for post-stroke dizziness?
 * How can vestibular therapy help with post-stroke dizziness?
 * What is the prognosis for post-stroke dizziness?


Why do people experience dizziness after stroke?

Post-stroke dizziness can be a consequence of different medications, long
periods of inactivity, or sudden changes in blood pressure when we change
positions. People can also experience dizziness if the stroke affected certain 
structures in the brain
[https://www.neofect.com/us/blog/brain-anatomy-101-major-structures-and-functions]
. This specific type of stroke is known as a brainstem stroke. 


Major parts of the human brain include the four lobes of the cerebral cortex,
the brainstem, and the cerebellum.
A brainstem stroke occurs when blood flow to the brainstem is disrupted. The
brainstem, which is responsible for maintaining the body’s automatic functions,
is located near the base of the skull and found deep within the brain. It is
home to several important structures and connections that allow our bodies to
perform vital functions without conscious thought, also known as involuntary
activities. Simple involuntary activities like eating, breathing, and
controlling our heart rate are regulated in the brainstem. 

You can also think of the brainstem as a bridge between higher-level brain
activity and the rest of the body. Because of its location and important role in
sustaining life, any injury or trauma to the brainstem can have profound effects
on the body. 



How does a brainstem stroke cause dizziness?

Any disruption in the blood flow to the brainstem can also affect a nearby
structure known as the cerebellum. The cerebellum is responsible for creating
and coordinating movement after receiving information from our inner ear, eyes,
and sensory receptors in the body. Dizziness can occur when the brain is unable
to correctly interpret the information which, in turn, affects eye movements
and/or balance. 


What treatments are available for post-stroke dizziness?

Treatment for post-stroke dizziness depends on the cause. Certain medications
may be prescribed, or your healthcare provider can show you specific strategies
to help decrease dizziness that results from position changes. Vestibular
therapy can also be an effective treatment for post-stroke dizziness that
originates from the brainstem and/or cerebellum.


How can vestibular therapy help with post-stroke dizziness?

Vestibular therapy, a specialized form of physical therapy, addresses problems
that may arise in the vestibular system
[https://www.neuroscientificallychallenged.com/blog/know-your-brain-vestibular-system]
. For stroke survivors, vestibular therapy can be helpful in reducing dizziness
with head movements, sensitivity to busy environments, and loss of balance.

A bustling grocery store can provoke dizziness for those sensitive to busy
environments.
The vestibular system is an elaborate network of information that sends signals
to our brain related to motion, head movements, and body awareness. While that
information is processed, the vestibular system makes sure that the body remains
balanced and stabilized, also commonly referred to as equilibrium. 

When you are a passenger in a moving vehicle, your vestibular system is working
hard to process visual information about the passing vehicles and scenery while
making sure your body remains upright within the car. 

When the vestibular system is not working properly, many people will report
dizziness with head and/or eye movements, loss of balance, feeling dizzy in busy
environments like a grocery store, or a false sensation of movement that can
occur at any time. Others may feel a heightened sense of anxiety in crowds or
motion sickness on a moving platform, like an escalator or elevator. 

Vestibular therapy uses specific exercises using head and eye movements to
retrain the vestibular system and decrease sensitivity to visual movement. Doing
this helps to reteach the body how to coordinate movement and balance while the
head is moving. Vestibular therapy uses two strategies, known as habituation
and
adaptation [https://www.asha.org/Articles/Vestibular-Rehabilitation/], to create
these changes and improve your ability to perform everyday activities or
complete work responsibilities. 


A vestibular therapist may instruct a patient through a series of head-turning
exercises as part of an adaptation program to reduce dizziness.
Here is one way to test your vestibular system. Stand and hold your thumb in
front of you at an arms-length away. While keeping your eyes on the tip of your
thumb, slowly move your head back and forth like you are telling someone “no.”
You should be able to shake your head and maintain clarity of your thumb without
feeling dizzy or off-balance. If so, then a part of your vestibular system,
known as the Vestibulo-Ocular Reflex, is working properly! 


What is the prognosis for post-stroke dizziness?

With the right treatment approach, stroke survivors can see improvements in
post-stroke dizziness. Vestibular therapy can play a large role in helping
patients to regain independence and decrease symptoms of dizziness and imbalance
with everyday activities. 

Other prognoses for post-stroke dizziness unrelated to the vestibular system
will vary, depending on the cause of dizziness and available treatments. In
these cases, vestibular therapy may not be effective, especially if the
vestibular system is working properly. Your healthcare provider will be able to
provide more information on treatment options that are specific to you and your
needs.


Further Reading: 
How do I know if I have a vestibular disorder?
[https://vestibular.org/sites/default/files/page_files/Documents/How%20Do%20I%20know%20if%20I%20have%20a%20vestibular%20disorder.pdf]
Find a vestibular therapist in your area
[https://kaylacovertpt.wixsite.com/dizzydoc/post/what-is-vestibular-physical-therapy]


Looking for more ways to improve balance after stroke? Check out the Neofect
Smart Balance [https://www.neofect.com/us/smart-balance]! Call (888) 623-8984 or
email info@neofect.com for more information.

Dizziness

Post-Stroke Dizziness: How Vestibular Therapy Can Help

Functional recovery is possible, even years after a stroke. Learn how to harness neuroplasticity through repetitive exercise, and the all-around health benefits of staying active after stroke or brain injury.

The Ultimate Guide to Stroke Exercises

Having a stroke is a mentally and physically taxing experience. According to the
World Health Organization (WHO), 15 million people suffer from stroke worldwide
each year. Of these, 5 million people die, and many survivors are left
permanently disabled.

Stroke survivors may lose physical abilities and cognitive skills or undergo
behavioral changes because strokes cause temporary or permanent damage to the
brain areas that control those functions.

But here is the good news: the brain is able to recover after stroke, whether
initially or months to years later. While short-term recovery after stroke
(called spontaneous recovery) is limited to the first six months, long-term
functional recovery can occur at any point thereafter
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020059/#B100]. Stroke survivors
who continue to engage their affected side in daily activity and exercise can
capitalize on functional recovery potential throughout their stroke journey.

The Importance of Stroke Exercise for Rehabilitation and Recovery
The brain is capable of rewiring and repairing itself even if its cells are
damaged. The undamaged parts step in to perform the tasks that the damaged parts
were performing. This phenomenon (called neuroplasticity
[https://www.neofect.com/us/blog/tips-for-unlocking-neuroplasticity-after-stroke-part-1]
) allows stroke survivors to regain lost movement and function. The key to
neuroplasticity is the consistent performance of repetitive tasks so that the
brain can relearn how to perform these tasks through different neural pathways.

In simpler words, stroke exercise is one of the most effective means by which
stroke patients can heal themselves, get stronger, improve the quality of their
lives, and maximize their recovery from stroke. Because lifestyle factors
[https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/stroke-risk-factors-and-prevention#:~:text=Lifestyle%20factors%20that%20increase%20your,diet%20and%20lack%20of%20exercise.] 
like being overweight and having high blood pressure are a common cause of
stroke, daily exercise becomes even more important in reducing the risk for
recurrent stroke and other complications. 

No matter the severity of the stroke, survivors can improve their quality of
life through healthy lifestyle changes and engagement in restorative activities.
Whether implementing big changes or small ones, the key to meaningful functional
recovery is engaging in your post-stroke routine changes consistently. 

The Physical and Mental Health Benefits of Stroke Recovery Exercises
Let’s look at some of the important physical and mental health benefits of
engaging in stroke rehabilitation exercises. Post-stroke exercise is shown to
produce many positive outcomes, which may include:

Physical benefits
 1. Speeds up all-round stroke recovery
 2. Recovers strength
 3. Improves endurance
 4. Increases walking speed
 5. Improves balance
 6. Boosts the ability to perform daily routine activities
 7. Prevents the recurrence of strokes.

Mental benefits
 1. Reduces depression and enhances mood
 2. Boosts brain health
 3. Relieves stress
 4. Helps in increasing a sense of self-worth and self-reliance that can
    decrease after a stroke
 5. Gives patients a sense of purpose and a goal to work towards.

Exercises to help Patients in Stroke Recovery at Home
The positive effects of post-stroke exercise are undeniable. However, when
setting up an exercise routine as a stroke survivor, it is important to
incorporate both cardiovascular fitness and muscle strengthening to ensure the
most effective outcomes.

Stroke exercises are always safer to do with a loved one or caregiver around.
However, if that is not possible, patients can modify an exercise program to
ensure safe performance. For instance, completing exercises from sitting as
opposed to standing to avoid loss of balance. It is also wise to consult a
doctor or a therapist should any uncertainties about any of the stroke exercises
arise or if you have any other underlying health condition.

Cardiovascular Fitness
Aerobic exercise is fundamental to building a healthy heart, improving
endurance, and maintaining healthy lungs. Cardiovascular exercise can also
improve the sensory perception and motor skills of stroke survivors. Walking
outside or on a treadmill, stationary cycling, recumbent cross training and many
other forms of exercise that get your heart pumping are extremely beneficial for
stroke recovery.

Stroke survivors must get at least 20-60 minutes of light to moderate aerobic
exercise (50 to 80% of your maximum heart rate) 3 to 7 days a week to improve
the chances of stroke recovery. Patients can choose to do aerobic exercise at
one go or in smaller sessions during the day.

Resistance Exercises for Strengthening Muscles
Resistance training or muscle strength training plays a crucial role in
post-stroke recovery, as it helps to recover physical strength, stamina,
stability, and improve range of motion.

Here are some commonly prescribed exercises for stroke recovery at home:

1. Wrist Curls
Equipment: A stable chair with armrests (preferably padded), light weights, or
any household object which can provide some resistance and is easy to grip.

How To Do It: Sit up straight on the chair. Place your arms on the rests with
your palms facing upward. Let your wrists dangle over the edge of the armrests.
Grasp the weights firmly and comfortably, and with slow controlled movements,
bend your wrist up towards your forearm and back down again (only your wrists
should be moving).

Benefits: Wrist curls are isolated movements that build forearm strength,
improve range of motion, and enhance gripping ability.

2. Wrist and Hand Stretch
Equipment: Stable chair with armrests.

How To Do It: With your arms facing downward and your wrists dangling over the
edge of the armrest, drop your hand down and use your other hand to gently lift
your wrist up and down and side to side.

Benefits: This simple movement stretches the ligaments in the wrist and forearms
to maintain range of motion.

Modification: If you add a weight while completing this exercise, you are
completing a reverse wrist curl, strengthening the muscles on the opposite side
of your forearm.

3. Shoulder Openers
Equipment: Light weights or any light object that can be gripped easily and will
provide some resistance.

How To Do It: Grasping your weights (make fists with your fingers facing
inwards), hold your arms at your sides, and bend your elbows 90 degrees. With
slow controlled movements, move your fists outwards while keeping your arms in
position at your sides (like you are opening a door). Bring your arms back to
your starting stance. (Can be performed both sitting or standing).

Benefits: This exercise improves range of motion and strength in the shoulders.

4. Table Towel Slide
Equipment: Folded Towel and table.

How To Do It: Place the towel in front of you. With your weaker hand on the
towel and your stronger hand on top of it, slide the towel away and towards you
(using your stronger hand to guide and push). Apart from going back and forth,
you could also go clock and counter-clockwise, forming circles on the table.

Benefits: Stretches and strengthens shoulder and arm muscles and promotes
neuroplasticity through improved arm coordination.

5. Trunk Bends
Equipment: A stable chair.

How To Do It: Sit on the edge of your chair with your feet planted slightly
apart but firmly on the ground. Bend forward as far as you can, and try to reach
your ankles or the floor between your legs. Then use your core muscles for
sitting back up as straight as you can.

Benefits: Improves core strength and helps with weight shifting.

6. Knee Rotations
Equipment: Firm, flat surfaces such as a bed or a mat.

How To Do It: Lie on your back and rest your hands by your sides. Bend your
knees with your feet flat on the floor. Keeping your knees together, drop them,
slowly, to the left then, bring them back to the center. Then drop them to the
right and back to the center.

Benefits: Improves core, back strength, coordination, and balance.

7. Hip Abduction
Equipment: Stable chair.

How To Do It: Sit up straight on the edge of your chair. Gently tighten your abs
and straighten one knee. With your toes pointed to the ceiling, slowly move your
foot out to the side. Return to the starting stance, then repeat on the other
side. You can decrease the intensity by lying down and performing this exercise
or make it more difficult by attempting this from standing, if you are capable.

Benefits: Strengthens hips, core, leg, back, and improves coordination and
stability.

8. Standing Knee Raises
Equipment: A firm surface to hold on to.

How To Do it: Stand with your back straight and hold on to a firm surface.
Shifting your weight to one leg, bring the other leg up in front of you while
bending your knee to a 90-degree angle. Hold for a few seconds and resume the
starting position. Then switch legs.

Benefits: Strengthens upper and lower abs, hips, and back. It also helps with
posture, balance, and coordination.

9. Sit to Stands
Equipment: Stable chair.

How To Do it: Sit up tall in your chair with your knees bent (90 degrees). Place
your feet firmly on the floor shoulder-width apart. Slowly rise to a standing
position while ensuring that your knees never cross the tips of your toes. Sit
back down slowly and in a controlled manner. To make it less intense, use your
arms for support, and to make it more difficult, cross your arms on your chest.

Benefits: Strengthens core and upper thigh muscles, improves weight shifting and
balance.

10. Hip Thrusts



Equipment: A flat, firm surface like a bed or a mat.

How To Do it: Lie on your back with your feet flat on the ground and knees bent.
Place your arms by your sides, palms down. Gently contract your abs and squeeze
your glutes (backside muscles) to lift your hips and make a bridge. Hold on this
position for a few seconds and lower to the starting stance. You can make it
easier by straightening your legs and placing a rolled-up towel under your
knees, then squeezing and lifting your hips. You could also make it more intense
by lifting one foot at a time while holding the bridge.

Benefits: It boosts the strength of the core, glutes, lower back muscles, and
muscles that support the spine.

Frequency and Intensity of Stroke Exercises
Stroke exercise is most beneficial if done consistently and repetitively. It is
always best to consult your medical team about the type and frequency of
exercises that are optimal for your unique situation. Do not risk your safety by
attempting things that you are unsure about.

As a guideline, resistance exercises should be done 3-5 times a week. 2-3 sets
of 12-15 repetitions (of each exercise) should be completed to achieve
noticeable results. A survivor who is new to exercise post-stroke exercises may
have to work up to the ideal frequency of exercise over time. 

Stroke exercise should never cause pain. Pain may indicate that you are causing
new or lasting damage to your muscles and joints. If your exercises produce a
burning, shooting, or otherwise uncomfortable sensation, stop immediately and
modify the activity (ex. reduce weight, perform the exercise within a smaller
range of motion). If it is not possible to perform the activity without pain,
remove it from your program and ask your doctor. 

Conclusions
A stroke results in drastic and sudden changes in life that can leave survivors
struggling physically, socially, and emotionally. However, proper stroke
exercise is the path to reclaiming the body, mind, and quality of life. With
determination and hard work, there is light at the end of the tunnel and a more
promising future ahead.



For more information, support, or to know more about the latest developments in
stroke recovery, give us a call at (888) 623-8984 or email at info@neofect.com.

Post-Stroke

A brain injury can double your risk of developing dementia. Learn about what causes dementia, different types of dementia, and how to lower your risk.

Stroke, Brain Injury, and Dementia: is there a link?

Experiencing a stroke or a brain injury is a huge, life-altering event. But even
after the rehab, the outpatient therapy, and the lifestyle modifications, there
can be another fear- will having a stroke or brain injury lead to dementia in
the future?

In this article
 * What is the link between stroke or brain injury and dementia?
 * Why might a stroke or brain injury lead to dementia?
 * Who is at risk of developing dementia post-stroke?
 * What can be done to reduce the risk of developing dementia?
 * Resources for people with dementia

 What is the link between stroke/brain injury and dementia?
Dementia is an umbrella term for a collection of cognitive and communicative
deficits. Memory loss, executive functioning deficits, communication impairments
and challenging behavior are the hallmarks of a dementia diagnosis. This can be
extremely difficult for the person and their family, who have already endured a
stroke or brain injury.

The link between stroke/brain injury and dementia is clear. Dementia affects 50
million people worldwide, and studies show that people who sustain an injury to
the brain are twice as likely to develop dementia post-injury.

Both stroke and dementia can cause brain atrophy, disrupting brain cell
connections and communication.Why might a stroke or brain injury lead to
dementia?
Why certain injury to the brain can cause dementia in older age is not always
clear, though there are many working theories.

Alzheimer’s disease (AD) is the most common form of dementia, estimated to
affect 5.5 million people in America today. AD accounts for between 60-80% of
all cases of dementia, and is caused by an abnormal buildup of proteins in the
brain, which interrupt and disrupt the messages being sent within the brain
itself.

Some research shows that injury to the blood-brain-barrier, a membrane that
selectively filters nutrients from the bloodstream into the brain, has a strong
link to subsequent development of Alzheimer’s. The blood brain barrier can be
damaged by hypoxia- oxygen deprivation that may be caused by a blockage- or by a
traumatic brain injury.

Vascular dementia (VD), the second most commonly experienced dementia, is a
step-wise decline in function as a result of several strokes. Strokes often
cause temporary or long-lasting damage to the tissues in the brain, and the
amount of recovery to these tissues may vary. When multiple strokes or brain
injuries occur, the brain is not be able to heal fully, in time leading to VD.

Chronic Traumatic Encephalopathy (CTE), is a brain condition associated with
multiple blows to the head and sometimes experienced by football players,
boxers, or those with repeated falls. CTE has been linked with early onset of
dementia, likely owing to some of the reasons above- non-healing injuries, and
disruption to the BBB leading to accumulations of protein tangles in the brain.

From left to right: a healthy neuron (brain cell), a neuron with amyloid plaque
buildup as seen in Alzheimer's disease, and a dead neuron being digested by
microglia cells.Who is at risk of developing dementia post-stroke?
The incidence of those who develop dementia after a stroke or brain injury is
estimated to be about two-fold of those in the general population. The risk
factors that may make someone more susceptible to dementia include:

 * a Hemorrhagic versus Ischemic stroke (a bleed versus a blockage). This may be
   linked to the diffuse nature of a bleed, and the possible disruption of the
   blood-brain-barrier.
 * a stroke occurring at a younger age; regardless of type of stroke, people who
   sustain a stroke at a younger age are at an increased risk of developing
   dementia over the course of their lifespan.

Persons are also at the highest risk of dementia one year post-injury. After the
one year mark, the increased risk persists across all types of stroke/brain
injury, but at lower levels than before.

What can be done to reduce the risk of developing dementia?
Decreasing the risk of developing dementia when a stroke or brain injury has
occurred is all about working on brain health and recovery. Keeping the brain
healthy and allowing the damaged tissues to repair to their fullest extent may
delay or even arrest later development of dementia.

The gold standard of dementia risk reduction includes physical activity, healthy
living, cognitive engagement, and taking control of the reasons that a stroke or
brain injury may have occurred in the first place.

Physical rehabilitation post-stroke/brain injury is essential to make sure that
physical and medical issues are addressed. It is so important to be able to
operate at the highest level possible, to live as healthfully as possible, even
after a stroke/brain injury. Regular cardiovascular exercise
[https://www.alzheimers.org.uk/get-support/daily-living/exercise/early-middle-dementia] 
will increase oxygenation in the body, which is necessary to help heal and
improve brain health.

Eating more healthfully and avoiding overly fatty and processed foods will also
improve brain health. Some research shows supplementation with vitamins,
especially Vitamin K and Omega-3s, can help reduce risk of developing dementia.

Challenging your cognition
[https://www.cherrywoodpointe.com/brain-games-for-dementia-patients-keeping-a-sharp-mind/#:~:text=The%20options%20are%20nearly%20endless,specifically%20for%20people%20with%20dementia.]
, and maintaining engagement with cognitive tasks will also help to strengthen
your brain. The process of learning may increase neural connections in the
brain, essential for communication, memory, and other cognitive functions.

Meditation and mindfulness
[https://www.lcbseniorliving.com/blog/mindfulness-exercises-for-seniors/] has
been shown to increase grey matter in the brain, unequivocally improving
cognition and brain health.

Resources for those at risk
Family conflict [https://arcseminars.net/support-caregivers-dementia/] abounds
in the diagnosis of dementia- seek out support groups through the Alzheimer's
Association [https://www.alz.org/help-support/community/support-groups].

Looking for cognitive solutions for someone with a stroke? Check out Neofect
Cognition [https://www.neofect.com/us/cognition] and the Neofect Smart Pegboard
[https://www.neofect.com/us/smart-pegboard].

Ataxia refers to the loss of control of voluntary movements of the body, including the limbs, face, or eyes. It is usually considered a symptom of an underlying diagnosis.

What is Ataxia?

Ataxia Overview
Ataxia refers to the loss of control of voluntary movements of the body,
including the limbs, face, or eyes. It is a rare disorder with many proposed
forms that are thought to affect common actions including walking, reaching,
speaking, and seeing. Ataxia develop by itself, or after a experiencing a brain
injury, like a stroke. For purposes of this article, we will discuss ataxia as a
neurological symptom of stroke, its effects on upper and lower extremity
function, and supportive strategies to improve daily living skills while living
with ataxia.



What causes ataxia?
Ataxia often results from damage to a brain area called the cerebellum, a
structure that regulates coordination of movement and balance. It can affect one
side of the body (known as hemi-ataxia) or both, and can occur at any age
depending on its underlying cause. Ataxia can present quickly, following an
acute event, such as a stroke. At this time, there is no cure for ataxia;
however, prompt therapeutic intervention can improve functional outcomes.



What does ataxia look like?
Ataxia symptoms can make an individual look as if they are clumsy. Ataxia
affecting the arms can cause difficulty holding and using objects as well as
decreased accuracy in reaching targets. Symptoms of ataxia affecting the core
and legs might present as impaired sitting or standing balance, unsteady
walking, and falling. Unlike apraxia
[https://www.neofect.com/us/blog/what-is-apraxia], another coordination
disorder, individuals with ataxia remain aware of the purpose of their actions
and associated tool use; however, their muscles do not respond in the correct
way to accomplish the desired task efficiently.

Therapeutic Treatments for Ataxia
There are many different options for treating ataxia with the help of an
occupational or physical therapist. Conventional OT and PT services aim to
improve independence and safety with daily living tasks. Occupational therapy
focuses on life skills from the basics, like eating, dressing, and grooming, to
bigger-picture tasks related to performing optimally at school or work. Physical
therapy addresses posture, balance, and walking so the individual can move
around with less assistance. Both OT and PT may incorporate strengthening and
cooridnation exercises as well as adaptive equipment or assistive device
recommendations into their treatment plans.



Constraint Induced Movement Therapy (CIMT)
CIMT
[https://blog.neofect.com/using-neofect-smartglove-to-maximize-constraint-induced-movement-therapy/] 
is a therapeutic intervention that can improve grasping, reaching, and in-hand
manipulation skills by constraining an individual’s less affected arm in a mitt,
cast, or sling, thereby forcing them to use their more affected side for the
majority of the time. A therapist will then lead the individual through
intensive training involving repetitive task performance to promote improved
functional use of the limb and increased motivation to use it when not
constrained.

Hippotherapy
Also known as equine assisted therapy, horseback riding under the direction of
an occupational or physical therapist is another treatment that is shown to
improve mobility and coordination for individuals with ataxia. This intervention
engages multiple body systems through incorporation of activities including
achieving and changing positions while on horseback. Hippotherapy promotes
improved core strength and posture that extends into better walking skills and
more accurate reaching to targets.

Virtual Reality (VR)
VR therapy is a newer approach to treating coordination disorders using a fun
and stimulating video game environment. Systems including the Nintendo Wii, XBox
Kinect, and NEOFECT Smart Glove
[https://www.neofect.com/en/product/stroke-therapy-hand/] and Smart Board
incorporate motion-sensing technology to alter gameplay and provide feedback
about the quality of movement during repetitive task training. Studies
evaluating consistent use of these systems have shown that daily gameplay can
produce lasting improvements in arm and finger function for daily tasks.



Ultimately, ataxia can be a challenging symptom to address due to the variety of
diagnoses that it may stem from. However, therapeutic interventions have shown
promise in reducing ataxia-related incoordination or providing means to
compensate for it. If you think you might be experiencing ataxia and are seeking
treatment options, please discuss your concerns with your medical team.

The NEOFECT [https://www.neofect.com/en/] line of Smart Rehabilitation Solutions
can assist with coordination difficulties stemming from stroke. Our
neurorehabilitation products include support from occupational therapists to
maximize functional gains. Please call (866) 534-4989 or email 
contactus@neofect.com for further inquiry.

 1. Columbia University Department of Neurology. (2015). Ataxia. Retrieved from 
    http://www.columbianeurology.org/neurology/staywell/document.php?id=35869
 2. Ashizawa, T., & Xia, G. (2016). Ataxia. Continuum (Minneapolis, Minn.),
    22(4), 1208–1226. doi:10.1212/CON.0000000000000362
 3. Brunberg JA; Expert Panel on Neurologic Imaging. Ataxia. AJNR Am J
    Neuroradiol. 2008 Aug;29(7):1420-1422.
 4. Fernandez, H. (2019). Ataxia. Retrieved from 
    http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Ataxia.htm
 5. National Ataxia Foundation. (2019). What is Ataxia? Retrieved from 
    https://ataxia.org/what-is-ataxia/#ataxiaSymptoms
 6. NORD National Organization for Rare Disorders. (2003). Apraxia. Retrieved
    from https://rarediseases.org/rare-diseases/apraxia/
 7. Reiss, A. P., Wolf, S. L., Hammel, E. A., Mcleod, E. L., & Williams, E. A.
    (2012). Constraint-Induced Movement Therapy (CIMT): Current Perspectives and
    Future Directions. Stroke Research and Treatment, 1–8. doi:
    10.1155/2012/159391
 8. Shurtleff, T. L., Standeven, J. W., & Engsberg, J. R. (2009). Changes in
    Dynamic Trunk/Head Stability and Functional Reach After Hippotherapy.
    Archives of Physical Medicine and Rehabilitation, 90(7), 1185–1195. doi:
    10.1016/j.apmr.2009.01.026
 9. Hartley, H., Cassidy, E., Bunn, L., Kumar, R., Pizer, B., Lane, S., &
    Carter, B. (2019). Exercise and Physical Therapy Interventions for Children
    with Ataxia: A Systematic Review. The Cerebellum. doi:
    10.1007/s12311-019-01063-z

For more information on Ataxia
National Ataxia Foundation - What is Ataxia [https://ataxia.org/what-is-ataxia/]
Mayo Clinic - Ataxia
[https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652]
Johns Hopkins Medicine - Ataxia
[https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/ataxia/conditions/index.html]
WebMD - Ataxia: What Are the Types?
[https://www.webmd.com/brain/ataxia-types-brain-and-nervous-system#1]

What is Post-Stroke Ataxia?

Apraxia is a disorder that can result from a stroke, brain injury, brain tumor, or neurodegenerative disease. This condition usually results from damage to the left hemisphere of the brain.

What is Apraxia?



What does it mean to have apraxia?
Throughout the course of a day, the human body is constantly coordinating
movement. Routine actions that might seem effortless, like waving hello,
catching a ball, or using a toothbrush, are actually the result of the brain
sending a precise series of messages to the limbs to move the muscles.
Therapists often use the term “motor planning” to refer to the ability to
perform movements in the right order to form actions. (1) However, when brain
areas controlling movement are damaged, a breakdown in motor planning can occur.
This breakdown can also be referred to as apraxia.

Apraxia is a disorder that can result from a stroke, brain injury, brain tumor,
or neurodegenerative disease. This condition usually results from damage to the
left hemisphere of the brain and can affect one or more areas of the body,
including the arms, legs, or even the face. (2) The scientific community has not
yet reached an agreement on the many proposed forms of apraxia or how to
classify them. (3) For purposes of this article, we will explore how apraxia can
affect actions related to arm movements and how this condition can be treated by
therapists and caregivers alike.

How can you tell if someone has apraxia?
Apraxic movement errors are not caused by one-sided arm weakness
[https://www.neofect.com/us/blog/hemiplegia-vs-hemiparesis] related to a
neurological event. In fact, a person who has apraxia might not have noticeable
arm weakness at all. Instead, they might look like their arm movements are
slowed down or clumsy. This is because their brain has lost the ability to
smoothly motor plan actions from start to finish. They may now need to spend
more time thinking through the individual steps of a task.

Apraxia can affect a person’s ability to perform or copy a gesture, even after
being asked and given a visual demonstration. Someone with apraxia may not be
able to mimic the thumbs up or down sign or wave upon command. Apraxia can also
cause reduced understanding of the purpose of objects, resulting in incorrect
tool use. (4) For example, a person with apraxia might demonstrate using a
hammer by holding it upside down or raking it across a table. They might bring a
hairbrush to their mouth or brush their hair in upward strokes instead of
downward.


Copying a simple gesture might be difficult for someone with apraxia, as they
may no longer understand its meaning.

The automatic ability to perform a familiar movement or use a common object may
be preserved despite apraxia. A person with apraxia might be able to pick up a
telephone as it rings or spontaneously wave goodbye to a family member even when
they cannot demonstrate either action upon command. Automatic performance of arm
movements may not always be present or retained consistently. (5) Regardless,
when working with people with apraxia, it is best to practice re-learning simple
tasks in their natural context for maximum skill carryover.

How can I help my loved one with apraxia?
A good approach to helping someone with apraxia is establishing a consistent
routine of daily tasks. (6) A well-rounded routine can include eating meals,
getting dressed, performing hygiene, and completing familiar chores or leisure
activities. It is advised to structure basic tasks in the same order every day
as able and to minimize distractions in the environment (limit unnecessary items
and noise) so the affected person can stay focused. Provide hand-over-hand
guidance in addition to verbal instructions if the person with apraxia seems
stuck on a movement or begins to perform it incorrectly. Once you have begun
guiding the correct movement pattern, attempt to fade guidance to see if the
individual can continue the step of the task or perform the remainder of the
action by themselves.


Remove clutter and unnecessary items in common workspaces to maximize success.

Through repetition of familiar actions and task grading (adjusting a daily
routine to include easier or more complicated tasks based on performance) it is
thought that movement patterns can be restored so that actions are performed
more automatically. However, for some, apraxia will be a long-lasting condition.
(7) It is important to be patient and understanding when interacting with
someone with apraxia, as they might need more time or some extra physical help
to get started doing the things they want to do.

As apraxia often occurs alongside aphasia
[https://www.neofect.com/us/blog/stroke-lingo-part-1], a communication disorder,
it is important to provide multiple ways to understand the task at hand whether
it is verbal, written, or visual instruction via demonstration or pictures. (8)
It is also advised to consider related coordination disorders when diagnosing
apraxia, including ataxia [https://www.neofect.com/us/blog/what-is-ataxia]. If
you are unsure whether the symptoms you or a loved one is exhibiting are related
to apraxia, discuss your concerns with a medical or therapy team.

The NEOFECT [https://www.neofect.com/en/] line of Smart Rehabilitation Solutions
can assist with coordination difficulties stemming from stroke or other
neurological diagnoses. Our neurorehabilitation products include support from
occupational therapists to maximize your functional gains. Please call (866)
534-4989 or email contactus@neofect.com for further inquiry.

 1. Wong AL, Haith AM, Krakauer JW. Motor Planning. The Neuroscientist.
    2014;21(4):385-398. doi:10.1177/1073858414541484.
 2. Gross R. G., Grossman M. (2008). Update on apraxia. Curr. Neurol. Neurosci.
    Rep. 8 490–496. 10.1007/s11910-008-0078-y
 3. Petreska B, Adriani M, Blanke O, Billard AG. Apraxia: a review. Prog Brain
    Res. 2007;164:61–83.
 4. Fernandez YM, Frucht SJ. Primary progressive apraxia: an unusual ideomotor
    syndrome. Journal of Clinical Movement Disorders. 2017;4(1).
    doi:10.1186/s40734-017-0064-0.
 5. Rapcsak S, Ochipa C, Beeson P, Rubens A. Praxis and the Right Hemisphere.
    Brain and Cognition. 1993;23(2):181-202. doi:10.1006/brcg.1993.1054.
 6. Heugten CV, Geusgens C. Strategies to Compensate for Apraxia Among Stroke
    Clients. International Handbook of Occupational Therapy Interventions.
    January 2009:241-248. doi:10.1007/978-0-387-75424-6_22.
 7. Donkervoort M, Dekker J, Deelman B. The course of apraxia and ADL
    functioning in left hemisphere stroke patients treated in rehabilitation
    centres and nursing homes. Clinical Rehabilitation. 2006;20(12):1085-1093.
    doi:10.1177/0269215506071257.
 8. Kobayashi S, Ugawa Y (2013) Relationships between Aphasia and Apraxia. J
    Neurol Transl Neurosci 2(1): 1028.

For More Information on Apraxia:
WebMD - Apraxia: Symptoms, Causes, Tests, Treatments
[https://www.webmd.com/brain/apraxia-symptoms-causes-tests-treatments#1]
Wikipedia - Apraxia [https://en.m.wikipedia.org/wiki/Apraxia]
National Organization of Rare Disorders - Apraxia
[https://rarediseases.org/rare-diseases/apraxia/]

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intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
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