11 Effective Spasticity Exercises: Regain Mobility in Your Hand and Arm from Flint Rehab

 My thoughts are this is just trying to appease patients and thus blame them for not recovering from spasticity! We need to CURE SPASTICITY! 

 Of course the infamous Dr. William M. Landau thinks spasticity is not worth treating. 

Do you believe in the do nothingism of Dr. William M. Landau on spasticity?  

His statement from here:

Spasticity After Stroke: Why Bother? Aug. 2004

Wonder if he will be singing the same tune after he becomes the 1 in 4 per WHO that has a stroke, will he be satisfied with not getting recovered?

The latest here:

11 Effective Spasticity Exercises: Regain Mobility in Your Hand and Arm

Medically reviewed by Elizabeth Denslow, OTR/L — written by Flint Rehab.

Last updated on March 6, 2025

Spasticity is a common challenge for those recovering from neurological conditions like stroke, cerebral palsy, and multiple sclerosis. It can cause muscle stiffness, tightness, and spasms, making everyday activities like dressing, eating, and writing difficult. Fortunately, targeted exercises can help loosen tight muscles, improve mobility, and restore functional movement.

The following exercises are meant to provide a guide for individuals experiencing spasticity in the hands, wrists or elbows. We hope that with regular practice of these exercises you will see improved mobility, reduced stiffness-related discomfort, and greater independence.

Getting Started: Essential Exercise Tips

Before jumping into the exercises, keep these key guidelines in mind:

• Move slowly and with control to prevent triggering spasms.
• Focus on deep, steady breathing to help your muscles relax.
• Stretch before strengthening to enhance flexibility and reduce stiffness.
• Perform each exercise 5-10 times, increasing gradually as tolerated.
• If you feel pain or excessive discomfort, stop and consult a healthcare professional.

Best Hand Exercises for Spasticity

Hand spasticity can make it hard to open the fingers or grasp objects effectively. Oftentimes, this can directly impact daily activities such as holding a glass or grasping a pen. The following exercises are meant to encourage greater flexibility as well as fine motor control in the affected hand.

1. Passive Finger Stretches

This stretch is ideal for individuals who experience severe finger stiffness, making it difficult to open their hands. It helps lengthen tight muscles and improve hand flexibility, which is crucial for performing daily tasks such as grasping objects or typing.

How to perform:

• Use your unaffected hand to gently extend and spread each finger apart. If it is hard to spread the fingers apart, start by intertwining your fingers, using the fingers of the unaffected hand to help separate those on your affected hand.
• Hold the stretch for 15-30 seconds.
• Avoid forcing any movement and apply gentle pressure.
• Repeat as needed to improve flexibility.

Provided you do not feel any discomfort, you can continue to practice this exercise as much as you feel comfortable.

2. Finger Extension with Resistance

This next exercise is a little more advanced but also beneficial for those who struggle to open their fingers due to persistent tightness. Finger extensions help to strengthen the finger extensors which can help counteract the tendency for the hand to remain clenched, improving overall dexterity.

How to perform:

• Wrap a rubber band around your fingers.
• Slowly spread your fingers apart, working against the resistance.
• Hold the position for a few seconds before releasing.
• Repeat several times to build strength and control.

(You're making an incorrect assumption that fingers will stay flat. Not possible with my level of spasticity.)

3. Hand Opening Against a Surface

For individuals with difficulty fully opening their hand, this exercise encourages gradual relaxation and extension. It can help in tasks like holding utensils or turning doorknobs more effectively.

How to perform:

• Place your affected hand flat on a table. You can use the unaffected hand or a caregiver to make sure it is flat.
• Gently press down to extend your fingers and palm.
• Hold for 10-20 seconds, ensuring a gradual and controlled motion.
• Repeat as necessary to enhance mobility.

4. Thumb Opposition Exercise

For individuals who struggle with gripping or pinching objects due to thumb tightness, this exercise may be beneficial. It can improve thumb mobility and fine motor skills necessary for tasks such as buttoning shirts and holding small objects. One thing to note is that it does require some control so it may be a little bit difficult for some.

How to perform:

• Touch your thumb to each fingertip one by one, forming an “O” shape.
• Hold each position for a few seconds before moving to the next fingertip.
• Repeat for multiple cycles to improve coordination.

This is a common exercise for many individuals in rehab following a stroke and is used throughout the MusicGlove rehab game to improve mobility in an engaging way.

5. Finger Tapping

If fine motor coordination is a challenge, this exercise helps improve control and finger independence, aiding in writing and other precision tasks.

How to perform:

• Place your hand on a table with fingers extended. (Not possible)
• Tap each fingertip to the surface, moving from the index finger to the pinky and back.
• Repeat for 10-15 cycles.

This exercise will require some existing motor control to be effective but overall is a great way to improve the fine motor skills and control in your fingers.

6. Finger and Palm Stretch

This last exercise for hand spasticity is another stretch to help individuals experiencing both overall hand stiffness and difficulty in grasping objects. It enhances flexibility and reduces tightness in the fingers and palm.

How to perform:

• Hold your affected hand with your other hand.
• Gently pull back the fingers and palm.
• Hold for 15-30 seconds, then relax.
• Repeat as needed to improve flexibility.

(I have probably done at least 1000 of these each day for the past 19 years, 6.9 million times! Hasn't lessened my spasticity one bit.)

You can also have a caregiver assist you with this stretch if you are unable to hold the affected hand. For a greater stretch, try straightening the elbow with the arm stretched out in front of you, then gently use your unaffected hand to extend the fingers, palm and wrist back toward you.

Of note, individuals with severe hand spasticity may benefit from using a splint, especially at night. If the hand is clenched and very challenging to open, it may be beneficial to roll a clean washcloth into the palm to gently stretch the fingers and prevent moisture buildup. Talk with your occupational therapist for more personalized recommendations.

For more hand exercises and stretches, check out our YouTube series on Best Hand Exercises for Stroke Patients!

Best Wrist Exercises for Spasticity

Wrist stiffness can limit movement and make everyday tasks like pouring a drink or using a computer mouse extremely difficult. The goal of this next group of exercises is to focus on improving flexibility and control for individuals experiencing wrist spasticity.

1. Passive Wrist Stretches

This first exercise for wrist spasticity is meant to help those experiencing limited wrist mobility. The goal is to try and restore a more functional range of motion or one that doesn’t limit regular everyday activities of living.

How to perform:

• Use your opposite hand to gently bend the affected wrist forward and backward.
• Hold each position for 15-30 seconds.
• Repeat daily to improve flexibility.

Remember to not push too hard either way and always stop if you feel pain or unnecessary discomfort. For a challenge, try completing this exercise with your arm stretched out in front of you with your elbow extended.

2. Wrist Flexion and Extension

If weakness and stiffness make it hard to move the wrist freely, this exercise can help restore strength and fluidity. This exercise will require some control and can help with both stretching and strengthening.

How to perform:

• Rest your forearm on a table with your hand hanging off the edge.
• Slowly bend your wrist upward (extension) and then downward (flexion).
• Perform 10 repetitions in each direction.

3. Wrist Figure 8s

This last exercise is meant to improve rotational flexibility and functional movement and should be appropriate for most individuals.

How to perform:

• Keep your elbow bent at 90 degrees.
• Slowly rotate your wrist outward and inward, as if making a figure 8 with your hand.
• Repeat 10 times each way.

Remember to move slowly and stop if you feel any pain or discomfort.

Elbow Exercises for Spasticity

Tightness in the elbow can make it challenging to bend or extend the arm fully. This next group of exercises focused on improving range of motion and reducing stiffness or spasticity in the elbow.

1. Passive Elbow Extension Stretch

This first stretch encourages gradual extension for those with difficulty straightening the elbow. It is appropriate for most individuals, however remember to go slow and stop if you feel any pain or discomfort.

How to perform:

• Use your opposite hand to support your affected arm out in front of you.
• Slowly straighten your elbow as much as possible, allowing gravity to gradually straighten it.
• Hold for 15-30 seconds before relaxing.

2. Assisted Elbow Bends

Alternatively, if the first stretch is too difficult on your own, a caregiver or therapist can help with an assisted elbow bend, described below.

How to perform:

• Hold your forearm with your opposite hand (or with the help of a caregiver).
• Gently bend and straighten the elbow, keeping the upper arm still.
• Repeat 10 times, ensuring smooth, slow movements.

This gentle movement promotes controlled flexibility and allows you to get the most out of the stretch in the safest way.

Final Thoughts

By incorporating these spasticity exercises into your daily routine, you can improve flexibility, reduce stiffness, and enhance mobility. Stretching, strengthening, and functional movement work together to create a comprehensive approach to managing spasticity. While those with severe spasticity may benefit from using a splint to provide a gradual stretch to the joints, these ideally would only be used temporarily.

You can consider other treatment options for spasticity here as well.

Patience and consistency are key to seeing progress. Keep practicing, and over time, you’ll notice improved control and comfort in your movements.

We hope these exercises are helpful!

Strokes rising in younger people, but 90% of strokes preventable

 More blame the patient for their stroke, rather than actually solving stroke to 100% recovery! Another fucking failure of  a stroke association not being a leader by not solving stroke recovery! Citing prevention stuff is not leadership; solving stroke to 100% recovery is LEADERSHIP!

Strokes rising in younger people, but 90% of strokes preventable 

Charity asking people to check blood pressure this Stroke Prevention Day

The Scottish Stroke Statistics published today1 (Tuesday, 28 January) are a sobering reminder that Scotland’s record for stroke is deteriorating, the Stroke Association warns.

In 2023/24, there were 9,792 strokes in Scotland compared to 9,851 in 2022/23. However, a higher proportion are in younger age groups. The proportion of people having a stroke aged under 65 has risen by 19.7% in the last 10 years, while the equivalent figure for the under 45s is a rise of 8.9% in the last 10 years.

The number of people dying from a stroke in Scotland is also rising. The stroke mortality rate has increased by 6.3% since 2022/23, which is the highest rise since 2016.

Nine in ten strokes are preventable2, with lifestyle factors such as diet, fitness, alcohol and smoking playing a big part. Certain health conditions such as diabetes, atrial fibrillation, high cholesterol and high blood pressure can also contribute.

To mark Stroke Prevention Day (Thursday, 30 January) the Stroke Association is focusing on the link between high blood pressure and stroke, as there is low awareness of the link and tackling high blood pressure can reduce the risk of a stroke.

John Watson, Associate Director for the Stroke Association in Scotland, said: “People in Scotland are significantly more likely to have a stroke than elsewhere in the UK, and more likely to die from it3.

“It’s a complex picture, but for Stroke Prevention Day the Stroke Association is simply asking people to check their blood pressure regularly. High blood pressure is the cause of around half of all strokes4 and checking for it could prevent life-changing disability and death.

“High blood pressure can be treated with medication while exercising, lowering salt intake, reducing alcohol consumption and quitting smoking can all pay dividends.”

High blood pressure often has no symptoms. All adults should have their blood pressure checked at least every five years. Anyone suspecting they have high blood pressure should check it regularly. Some GP practices will provide a blood pressure monitor to take home or they can be bought from pharmacies and other retail outlets.

The Stroke Association is part of the ‘Our Future Health’ partnership, which is a collaboration between the public, charity and private sectors to help everyone lead longer and healthier lives. It has already set up more than 100 UK clinics where people can get basic health checks, including nine in central Scotland.

In rare cases, high blood pressure may cause symptoms. Speak to your GP if you have symptoms of very high blood pressure including:

•headaches

•blurred or double vision

•regular nosebleeds

•shortness of breath

The Stroke Association supports stroke survivors and their families by phone, at home, and in the community. Find out more at www.stroke.org.uk

Case study

Ian Stark, 60, from Edinburgh is a Hospital Ambulance Liaison Officer, having worked with the Scottish Ambulance Service since 1991.

While working as a paramedic team leader in December 2017, he had a persistent headache and noted high blood pressure readings, which he put down to stress. The following morning, he felt strange while driving to work – almost as if he was drunk. When he arrived, his legs gave way and concerned colleagues put him in an ambulance and took him to the Royal Infirmary of Edinburgh.

Once there, a stroke clinician checked for signs of the condition and found Ian’s speech was slurred, he couldn’t raise his left arm, and his left leg buckled.

The next thing he knew he woke up that afternoon in the stroke ward. He had been given thrombolysis, which is a clot-busting drug, his speech had returned to normal, and his left side had started to recover. Ian was discharged from hospital within 72 hours and returned to work with the Scottish Ambulance Service a month later.

He says, “I should have paid attention to my high blood pressure sooner, and I might have prevented my stroke. I would have advised a patient very differently. I wholeheartedly support the Stroke Association’s advice to check your blood pressure regularly – it can point to potential health problems.”

Predictive utility of self-efficacy in early stroke rehabilitation

 This is all to 'blame the patient' for not recovering instead of blaming your stroke medical 'professionals' for not having the correct protocols for recovery. Got that? Blame the patient!

Predictive utility of self-efficacy in early stroke rehabilitation

Rachel M. Vaughn

,

Rachana Gangwani

,

Jasper I. Mark

,

Kelly Fletcher

,

John M. Baratta

&

Jessica M. Cassidy

Received 11 Dec 2023, Accepted 07 Sep 2024, Published online: 18 Sep 2024

• Cite this article
• https://doi.org/10.1080/10749357.2024.2403806
• CrossMark

 

ABSTRACT

Introduction

A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual’s belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs.

Objective

To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation.

Methods

Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level.

Results

Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R² = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R² = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model.

Discussion

Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual’s care.

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study

 

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! What multiverse do we need to send you back to where this research does ONE DAMN THING towards stroke recovery?

 

Quit blaming the patients for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

• learned nonuse (11 posts to May 2018)

• nonuse (14 posts to May 2013)

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study

Ryoji Otaki 1,2 , Yutaka Oouchida 1,3 , Naoki Aizu 1,4 , Tamami Sudo 1,5 , Hiroshi Sasahara 2 , Yuki Saito 6 , Sunao Takemura 6 and Shin-Ichi Izumi 1,7 * 1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan, 2 Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan, 3 Department of Education, Osaka Kyoiku University, Osaka, Japan, 4 Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan, 5 Department of Computer and Information Sciences, Tokyo University of Agriculture and Technology, Tokyo, Japan, 6 Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan, 7 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan  

 

Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body specific attention, as a marker of body representation of the paretic limb and revealed a decline in body specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in 25 patients with subacute stroke. Measurements were taken at baseline (T BL ), 2 weeks (T 2w ), 1 month (T 1M ), 2 months (T 2M ), and 6 months (T 6M ) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real world arm use was measured using accelerometers on both wrists. Body specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T 6M . Longitudinal changes in body specific attention were most remarkable at T 1M . Changes in body-specific attention up to T 1M correlated positively with changes in real-world arm use up to T 6M , and from T 1M to T 6M , and the latter more strongly correlated with changes in real-world arm use. Changes in real-world arm use up to T 2M correlated positively with changes in FMA up to T 2M and T 6M . No correlation was found between body specific attention and FMA scores. Thus, these results suggest that improved body specific attention to the paretic limb during the early phase contributes to increasing long-term real world arm use and that increased real-world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real-world arm use after stroke.

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

 

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! What multiverse do we need to send you back to where this does ONE DAMN THING towards stroke recovery?

 

Quit blaming the patients for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

• learned nonuse (11 posts to May 2018)

• nonuse (14 posts to May 2013)

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Marian E. Michielsen, MSc†, Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD ABSTRACT. Michielsen ME, Selles RW, Stam HJ, Ribbers GM, Bussmann JB. 

  Arch Phys Med Rehabil 2012;xx:xxx.  

Objective:  

 

To quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls.  

 

Design: 

 

 Cross-sectional observational study. Setting: Outpatient rehabilitation center. Participants: Patients with chronic stroke (n=38) and healthy controls (n=18).  

 

Intervention:  

Not applicable. (This is precisely why learned nonuse research should never be done! It does nothing to get survivors recovered! I'd have you all fired!)

 

Main Outcome Measures:  

 

Upper-limb use in daily life was measured with an accelerometry based upper-limb activity monitor, an accelerometer based measurement device. Uni- manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.  

 

Results:  

 

Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.  

 

Conclusion:  

 

Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.(As they should since you incompetently don't know about the research that shows using the good side helps recover the bad side!

Exercising the good side to recover the 'bad' side. December 2012)

Key Words: Ambulatory monitoring; Motor activity; Rehabilitation; Stroke; Upper extremity. © 2012 by the American Congress of Rehabilitation Medicine  

 

FIFTY TO 70% OF PATIENTS with stroke suffer from long-term motor deficits of the upper limb, 1 with a decreased use of the paretic upper extremity in daily life. 2 Be- cause this latter may have a great impact on the manner in which a patient is able to participate in daily life activities, maximizing purposeful use of the upper extremity in daily life is a key factor in motor rehabilitation following stroke. While it is clear that a decreased motor capacity of the paretic arm influences the use of both extremities, the exact changes in upper-limb use following stroke are not yet fully understood. Regarding the paretic upper extremity, many studies have shown that there is no 1-on-1 relation between motor impairment and functional use. 3,4 This may be related to the phenomenon of learned nonuse, 5 which describes how patients will have “learned” not to use the paretic side to its full capacity. 6 Brain injury causes structural damage to motor path- ways as well as depression of neural excitability near the lesion. Decreasing activity of the upper extremity leads to a further reduction in excitability and as such starts a vicious circle of decreasing excitability and decreasing activity. 7 Even less is known about the consequences of stroke on the nonparetic side. Motor performance of the nonparetic side may be impaired compared with that in healthy subjects, showing, for instance, decreased speed and consistency of performance. 8 In addition, it has been shown that patients with acute stroke have a more reduced use of the nonparetic side in daily life than do healthy subjects. 9 On the other hand, it is generally assumed that post stroke the nonparetic side will be used more to compensate for the decreased use of the paretic side. However, to our knowledge, this has not been investigated in patients with chronic stroke. Overall many questions on techniques to optimize the function of the paretic extremity after stroke still need to be answered. The optimal rehabilitation technique is still not defined, and different approaches in reducing upper-extremity paresis are distinguished. 7 Several therapies have been developed to improve the use of the nonparetic arm in daily life. For example, constraint-induced movement therapy (CIMT), 10,11 or forced use, 12 reported as a beneficial treatment option for motor recovery of the arm, 13 prevents the use of the nonparetic upper limb and aims to counterbalance the learned nonuse. CIMT is an augmentative technique, 7 a high-intensity, uni- manual training aiming to counterbalance the vicious circle of decreasing excitability and decreasing activity. Furthermore, CIMT has aspects of task specific exercising. Bilateral training programs have also been developed, for example, with rhythmic

 

More at link.

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study

Well shit, research is still uselessly going on about nonuse. It's just a convenient way to blame the patient for not recovering when the doctor should be blamed for not getting 100% recovery protocols created.  I consider upper limb monitors absolutely fucking useless and any research into nonuse a fireable offense! They are only used to shame the survivor about not using the affected arm. I never use my affected arm, it is totally useless for any tasks!

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

• learned nonuse (11 posts to May 2018)

• nonuse (14 posts to May 2013)

 

Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study

 
ORIGINAL RESEARCH
published: 22 February 2022doi: 10.3389/fnsys.2021.806257
 Edited by:
 Jun Ota,The University of Tokyo, Japan
 Reviewed by:
Hiroshi Imamizu,The University of Tokyo, Japan Anna Danielsson,University of Gothenburg, SwedenKohei Kaminishi,The University of Tokyo, Japan
*Correspondence:
Shin-Ichi Izumi  izumis@med.tohoku.ac.jp
 Received:
 31 October 2021
 Accepted:
 21 December 2021
 Published:
 22 February 2022
Citation:
Otaki R, Oouchida Y, Aizu N, Sudo T,Sasahara H, Saito Y, Takemura S and Izumi S-I (2022) RelationshipBetween Body-Specific Attention to aParetic Limb and Real-World ArmUse in Stroke Patients: A Longitudinal Study.Front. Syst. Neurosci. 15:806257.doi: 10.3389/fnsys.2021.806257
Relationship Between Body Specific Attention to a Paretic Limb and Real-World Arm Use in StrokePatients: A Longitudinal Study
Ryoji Otaki 1,2 , 

Yutaka Oouchida1,3, 

Naoki Aizu1,4, 

Tamami Sudo1,5, 

Hiroshi Sasahara 2,

Yuki Saito 6, 

Sunao Takemura 6 and  

Shin-Ichi Izumi 1,7*
1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan,
 2 Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan,
 3 Department of Education, Osaka KyoikuUniversity, Osaka, Japan,
 4 Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan,
5 Department of Computer and Information Sciences, Tokyo University of Agriculture and Technology, Tokyo, Japan,
6 Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan,
 7  Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body specific attention, as a marker of body representation of the paretic limb and revealed a decline in body specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in25 patients with subacute stroke. Measurements were taken at baseline (T _BL), 2 weeks(T _2w), 1 month (T _1M), 2 months (T _2M), and 6 months (T _6M) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real-world arm use was measured using accelerometers on both wrists.Body specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T _6M. Longitudinal changes in body specific attention were most remarkable at T _1M. Changes in body specific attention up to T _1Mcorrelated positively with changes in real-world arm use up to T _6M, and from T _1M to T _6M,and the latter more strongly correlated with changes in real-world arm use. Changes in real world arm use up to T _2M correlated positively with changes in FMA up to T _2M and T _6M. No correlation was found between body specific attention and FMA scores. Thus,these results suggest that improved body specific attention to the paretic limb during the early phase contributes to increasing long-term real-world arm use and that increased real world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real world arm use after stroke.

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Well shit, research is still uselessly going on about nonuse. It's just a convenient way to blame the patient for not recovering when the doctor should be blamed for not getting 100% recovery protocols created.  I consider upper limb monitors absolutely fucking useless and any research into nonuse a fireable offense! They are only used to shame the survivor about not using the affected arm. I never use my affected arm, it is totally useless for any tasks!

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist! Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

• learned nonuse (11 posts to May 2018)

• nonuse (14 posts to May 2013)

 

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Gerard Ribbers
2012, Archives of Physical Medicine and Rehabilitation
61 Views
7 Pages
1 File ▾
Activities of Daily Living,
Stroke,
Humans,
Chronic Disease,
Female
 ...more ▾
Show more ▾
Translate
Original PDF
Summary
Related
 
ORIGINAL ARTICLE
Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-LimbUse in Daily Life
 Marian E. Michielsen, MSc
†
 , Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD
ABSTRACT. Michielsen ME, Selles RW, Stam HJ, RibbersGM, Bussmann JB. Quantifying nonuse in chronic stroke patients: a study into paretic, nonparetic, and bimanual upper-limb use in daily life. Arch Phys Med Rehabil 2012;xx:xxx.
Objective:
 To quantify uni- and bimanual upper-limb use inpatients with chronic stroke in daily life compared with healthy controls.
Design:
 Cross-sectional observational study.
Setting:
 Outpatient rehabilitation center.
Participants:
 Patients with chronic stroke (n=38) and healthy controls (n=18).
Intervention:
 Not applicable.
Main Outcome Measures:
 Upper-limb use in daily life was measured with an accelerometry based upper-limb activity monitor, an accelerometer based measurement device. Uni-manual use of the paretic and the nonparetic side and bimanual upper limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.
Results:
 Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.
Conclusion:
 Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side.(As they should since you incompetently don't know about the research that shows using the good side helps recover the bad side!

Exercising the good side to recover the 'bad' side. December 2012)

Key Words:
 Ambulatory monitoring; Motor activity; Rehabilitation; Stroke; Upper extremity.©
 2012 by the American Congress of Rehabilitation Medicine
FIFTY TO 70% OF PATIENTS with stroke suffer from long term motor deficits of the upper limb,¹with a de-creased use of the paretic upper extremity in daily life.² Because this latter may have a great impact on the manner in which a patient is able to participate in daily life activities,maximizing purposeful use of the upper extremity in daily life is a key factor in motor rehabilitation following stroke.While it is clear that a decreased motor capacity of the paretic arm influences the use of both extremities, the exact changes in upper-limb use following stroke are not yet fully understood. Regarding the paretic upper extremity, many studies have shown that there is no 1-on-1 relation between motor impairment and functional use.^3,4This may be related to the phenomenon of learned nonuse,⁵which describes how patients will have “learned” not to use the paretic side to its full capacity.⁶Brain injury causes structural damage to motor path-ways as well as depression of neural excitability near thelesion. Decreasing activity of the upper extremity leads to afurther reduction in excitability and as such starts a viciouscircle of decreasing excitability and decreasing activity.⁷Even less is known about the consequences of stroke on thenonparetic side. Motor performance of the nonparetic side maybe impaired compared with that in healthy subjects, showing,for instance, decreased speed and consistency of performance.⁸In addition, it has been shown that patients with acute stroke have a more reduced use of the nonparetic side in daily life thando healthy subjects.⁹On the other hand, it is generally assumed that post stroke the nonparetic side will be used more to compensate for the decreased use of the paretic side. However, to our knowledge, this has not been investigated in patients with chronic stroke. Overall many questions on techniques to optimize the function of the paretic extremity after stroke still need to be answered. The optimal rehabilitation technique is still not defined, and different approaches in reducing upper-extremity paresis are distinguished.⁷Several therapies have been devel-oped to improve the use of the nonparetic arm in daily life. Forexample, constraint-induced movement therapy (CIMT),^10,11or forced use,¹²reported as a beneficial treatment option formotor recovery of the arm,¹³prevents the use of the nonparetic upper limb and aims to counterbalance the learned nonuse.CIMT is an augmentative technique,⁷a high-intensity, unimanual training aiming to counterbalance the vicious circle of decreasing excitability and decreasing activity. Furthermore,CIMT has aspects of task-specific exercising. Bilateral training programs have also been developed, for example, with rhythmic auditory cueing.¹⁴To evaluate and understand the effects of upper-extremity training in daily life conditions, detailed insight isneeded in unimanual and bimanual function of the arms in dailylife conditions. This is the topic of the current article.Several studies have included the measurement of upper-limb use in daily life. For example, Taub,¹¹Mark,¹⁵and Wolf⁵and colleagues used the Motor Activity Log (MAL) in their studies. However, although validated against an objective measure,¹⁶the MAL still is a subjective instrument that focuses on how well and how much patients use their most impaired arm in a defined category of activities, and the MAL does not include data on the amount of use of the nonimpaired arm and bilateral use. Another method for assessing upper-limb use in a home setting is provided by accelerometers and other portable devices providing the opportunity to assess how much patientswith stroke use their upper limbs in daily life for longer periods.²However, so far, studies using these devices assessed only the upper-limb use overall and not in detail. For example,many studies express actual upper-limb use only as a ratio between the use of the affected and the use of the unaffected side,¹⁷thus omitting information about usage times of the paretic side and the nonparetic side separately. Second, current devices do not differentiate between arm movements resulting from general body movements such as walking and arm movements during sitting and standing. Third, most measurement devices cannot differentiate between the duration of use and the intensity of use, and finally, most devices cannot or do not differentiate between unilateral and bilateral usage of the arms.The aim of the present study was to quantify uni- and bimanual upper limb use in patients with chronic stroke in daily life and compare this with healthy controls. By using an accelerometry based upper limb activity monitor,¹⁸we were able to give an insight into both duration and intensity of upper-limb use and to discriminate between upper-limb movements caused by whole-body movements and movements independent of whole body movements, thus providing an insight into the amount of functional and purposeful upper limb use in daily life conditions.

Proven Ways to Recover from a Brain Stroke Efficiently

Quit lying to yourself and stroke survivors. There are none. If something truly worked a Nobel prize would have been awarded. 

Proven Ways to Recover from a Brain Stroke Efficiently

by Biljana Denic October 9, 2023

A brain stroke, also known as a cerebrovascular accident (CVA), is a medical condition in which the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. This can damage or kill brain cells and can lead to a variety of physical and cognitive impairments.

Brain stroke is one of the most common illnesses among adults over the age of 40.  It is a very time-sensitive illness which means that once you or someone close to you is having a stroke, every second counts. On-the-spot decisions and prompt medical attention can save a life. For such occasions when a person is about to have a stroke, it is necessary to spot the symptoms. Symptoms of a brain stroke are:

• Sudden weakness or numbness on one side of the body, especially the face, arm, or leg.
• Droopy facial muscles
• Slur in speech or confusion
• Partial blindness in one or both eyes
• Sudden dizziness, trouble in walking, loss of balance
• Severe headache or sharp recurring pangs of pain

What to Do If a Brain Stroke Occurs?

Source: medium.com

Once a person is having a brain stroke, it is a race against time. Remember the word F.A.S.T:

F (Face): ask the patient to smile. If he is unable to smile or his facial muscles are drooping on one side then it is a stroke.

A (Arms): Ask the person to raise both their arms above their heads. See if both or one arm drifts downwards.

S (Speech): Ask the person to repeat a simple word or just their name. Notice if the speech is slurred.

T (Time): If you notice any of the above symptoms, call emergency medical services immediately.

Tips for Recovery

There are a number of things that stroke survivors can do to promote their recovery, including:

1. Take Nutritious Meals

It is very important to focus on a well-balanced nutritious diet. You need every bit of nutrition you can get, to empower your immune system. A well-balanced, healthy diet consisting of all major food groups in appropriate portions is very important to keep your nervous system healthy. Eat foods rich in omega-3 fatty acids such as seafood (tuna, salmon, mackerel, etc), vitamin D, and B12. Leafy green vegetables such as spinach, kale, and lettuce are also very beneficial. Eating a healthy diet is essential for overall health and well-being, but it is especially important for stroke survivors. A nutritious diet can help to improve energy levels, reduce inflammation, and boost the immune system. Stroke survivors should aim to eat plenty of fruits, vegetables, and whole grains, and limit processed foods, sugary drinks, and saturated and unhealthy fats.

2. Don’t skip medicines

Source: verywellhealth.com

The aftereffects of brain stroke are severe but can be managed and decreased by medicines and therapy. Take regular doses of prescribed medicines through CanadianPharmacyOnline.com and try not to skip a single dose. Make someone in charge of your medications or set a daily reminder if you live alone. Stroke survivors may be prescribed a variety of medications to help manage their condition, such as blood thinners to prevent future strokes, blood pressure medications to lower blood pressure, and cholesterol-lowering medications to reduce cholesterol levels. It is important to take all prescribed medications as directed, even if you are feeling well.

3. Diminish “Learned non-use”

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

 

When a brain stroke occurs, one side of the body is affected. If during recovery, that affected side or affected limb is not used or moved much, the brain wires itself to think that the body does not need that limb much and so the affected limb starts to become paralyzed. This phenomenon is called, “learned non-use”. During the recovery phase, keep the movement in your affected limbs to avoid this.

4. Try all rehabilitation methods

There are many rehabilitation methods for stroke patients to recover such as therapy, mirror therapy, gait training, and electrical stimulation. Try to get at least two sessions of all these methods and choose the one you feel most comfortable doing and which is yielding efficient results.

Rehabilitation is essential for helping stroke survivors to regain lost function and skills. Rehabilitation programs typically involve a combination of physical therapy, occupational therapy, and speech therapy. Physical therapy can help to improve strength, balance, and coordination. Occupational therapy can help to improve activities of daily living, such as dressing, bathing, and eating. Speech therapy can help to improve communication skills.

5. Managing stress and fatigue

Stress and fatigue can make it difficult to recover from a stroke. It is important to find ways to manage stress and fatigue, such as getting regular exercise, getting enough sleep, and practicing relaxation techniques.

Additional Tips

Source: thelecc.com

In addition to the tips listed above, there are a number of other things that stroke survivors can do to promote their recovery, such as:

1. Staying positive: Having a positive attitude can make a big difference in the recovery process. Stroke survivors should focus on their accomplishments and set realistic goals for themselves.
2. Building a support system: Having a strong support system of family and friends is important for stroke survivors. Support can help to provide emotional support, practical assistance, and motivation.
3. Educating yourself about stroke: Learning more about stroke can help stroke survivors understand their condition and make informed decisions about their care. Stroke survivors can find information about stroke from their healthcare providers, support groups, and online resources.
4. Try different types of exercise: Exercise is important for everyone, but it is especially important for stroke survivors. Exercise can help to improve strength, balance, coordination, and cardiovascular health. Stroke survivors should talk to their doctor about what type of exercise is safe and appropriate for them.
5. Find hobbies and activities that you enjoy: Engaging in hobbies and activities can help to improve mood, reduce stress, and promote social interaction. Stroke survivors should choose activities that are appropriate for their abilities and interests.

Don’t give up. Recovery from a stroke takes time and effort. It is important to be patient and persistent. Stroke survivors should celebrate their accomplishments and keep working towards their goals.

Conclusion

Recovery from a stroke is a challenging process, but it is possible. By following the tips above, stroke survivors can improve their chances of making a full recovery. If you or someone you know has had a stroke, please know that you are not alone. There are many resources available to help you on your journey to recovery.

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. Quit blaming the patient for not recovering and blame the doctor and therapists for knowing nothing on how to get survivors recovered! 

Do you blithering idiots ever actually think about why stroke patients don't recover?

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

Marian E. Michielsen, MSc
†
 , Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD
ABSTRACT. Michielsen ME, Selles RW, Stam HJ, RibbersGM, Bussmann JB.  Arch Phys Med Rehabil 2012;xx:xxx.
Objective:
 To quantify uni- and bimanual upper-limb use inpatients with chronic stroke in daily life compared with healthy controls.
Design:
 Cross-sectional observational study.
Setting:
 Outpatient rehabilitation center.
Participants:
 Patients with chronic stroke (n

38) and healthycontrols (n

18).
Intervention:
 Not applicable.
Main Outcome Measures:
 Upper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Uni-manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Outcomes were expressed in terms of both duration and intensity.
Results:
 Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondominant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side.
Conclusion:
 Our data show considerable nonuse of the paretic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronicstroke. Patients do compensate for this with increased use of the nonparetic side.
Key Words:
 Ambulatory monitoring; Motor activity; Reha-bilitation; Stroke; Upper extremity.©
 2012 by the American Congress of Rehabilitation Medicine
F
IFTY TO 70% OF PATIENTS with stroke suffer fromlong-term motor deficits of the upper limb,
1
with a de-creased use of the paretic upper extremity in daily life.
2
Be-cause this latter may have a great impact on the manner inwhich a patient is able to participate in daily life activities,maximizing purposeful use of the upper extremity in daily lifeis a key factor in motor rehabilitation following stroke.While it is clear that a decreased motor capacity of theparetic arm influences the use of both extremities, the exactchanges in upper-limb use following stroke are not yet fullyunderstood. Regarding the paretic upper extremity, many studies have shown that there is no 1-on-1 relation between motor impairment and functional use.
3,4
This may be related to the phenomenon of learned nonuse,
5
which describes how patients will have “learned” not to use the paretic side to its fullcapacity.
6
Brain injury causes structural damage to motor path-ways as well as depression of neural excitability near thelesion. Decreasing activity of the upper extremity leads to afurther reduction in excitability and as such starts a viciouscircle of decreasing excitability and decreasing activity.
7
Even less is known about the consequences of stroke on thenonparetic side. Motor performance of the nonparetic side maybe impaired compared with that in healthy subjects, showing,for instance, decreased speed and consistency of performance.
8
In addition, it has been shown that patients with acute strokehave a more reduced use of the nonparetic side in daily life thando healthy subjects.
9
On the other hand, it is generally assumedthat poststroke the nonparetic side will be used more to com-pensate for the decreased use of the paretic side. However, toour knowledge, this has not been investigated in patients withchronic stroke.Overall many questions on techniques to optimize the func-tion of the paretic extremity after stroke still need to be an-swered. The optimal rehabilitation technique is still not de-fined, and different approaches in reducing upper-extremityparesis are distinguished.
7
Several therapies have been devel-oped to improve the use of the nonparetic arm in daily life. Forexample, constraint-induced movement therapy (CIMT),
10,11
or forced use,
12
reported as a beneficial treatment option formotor recovery of the arm,
13
prevents the use of the nonpareticupper limb and aims to counterbalance the learned nonuse.CIMT is an augmentative technique,
7
a high-intensity, uni-manual training aiming to counterbalance the vicious circle of decreasing excitability and decreasing activity. Furthermore,CIMT has aspects of task-specific exercising. Bilateral trainingprograms have also been developed, for example, with rhythmic
 auditory cueing.
14
To evaluate and understand the effects of upper-extremity training in daily life conditions, detailed insight isneeded in unimanual and bimanual function of the arms in dailylife conditions. This is the topic of the current article.Several studies have included the measurement of upper-limb use in daily life. For example, Taub,
11
Mark,
15
and Wolf
5
and colleagues used the Motor Activity Log (MAL) in their studies. However, although validated against an objective mea-sure,
16
the MAL still is a subjective instrument that focuses on how well and how much patients use their most impaired arm in a defined category of activities, and the MAL does not include data on the amount of use of the non impaired arm and bilateral use. Another method for assessing upper-limb use in a home setting is provided by accelerometers and other portable devices providing the opportunity to assess how much patients with stroke use their upper limbs in daily life for longer periods.
2
However, so far, studies using these devices assessed only the upper-limb use overall and not in detail. For example,many studies express actual upper-limb use only as a ratio between the use of the affected and the use of the unaffected side,
17
thus omitting information about usage times of the paretic side and the nonparetic side separately. Second, currentdevices do not differentiate between arm movements resulting from general body movements such as walking and arm movements during sitting and standing. Third, most measurement devices cannot differentiate between the duration of use and the intensity of use, and finally, most devices cannot or do not differentiate between unilateral and bilateral usage of the arms.The aim of the present study was to quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life and compare this with healthy controls. By using an accelerometry based upper-limb activity monitor,
18
we were able to give an insight into both duration and intensity of upper-limb use and to discriminate between upper-limb movements caused by whole-body movements and movements independent of whole-body movements, thus providing an insight into the amount of functional and purposeful upper-limb use in daily life conditions.

More at link.

'People are not accessing care in hospital quickly enough.'

 Oh great! Blame the patient rather than putting the blame on the hospital for not having 100% recovery protocols regardless of when the patient arrives. I'd be screaming my head off for such a display of evading responsibility!

'People are not accessing care in hospital quickly enough.'

By Mark Isherwood

MS for North Wales

During a meeting with the Stroke Association, the key concern raised was that people are not accessing care in hospital quickly enough.

The most recent assessed grades by the Sentinel Stroke National Audit Programme (SNNAP), covering July to September 2022, which are scored A to E for each stroke unit, showed overall grades of ‘D’ at Wrexham Maelor and Glan Clwyd Hospitals, and ‘E’ at Gwynedd Hospital’.

The SSNAP also graded the hospitals with grades of E’ (Wrexham Maelor), ‘E’ (Glan Clwyd) ‘and ‘C’ (Gwynedd) for ‘Admission to Stroke Units’.

Although quicker admission to stroke units improves a stroke patient’s outcomes, admission to stroke units in Wales is consistently slower than in other parts of the UK, and both Wrexham Maelor and Glan Clwyd Hospitals were slower than the Wales average.

We also discussed Welsh Government proposals for the future of Stroke Services and the need to ensure that every stroke patient in Wales has equitable access to stroke acute services, wherever they live.

The meeting was also attended by a Stroke survivor member of ‘Chatterboxes’ Buckley Communication Group, who shared his experience. ‘Chatterboxes’ is a communication support group offering help to people who have had a brain injury or stroke and may be experiencing language difficulties and aphasia, volunteer-led and affiliated to the Stroke Association.

In a meeting with Betsi Cadwaladr University Health Board’s Assistant Director of Public Affairs and Partnerships, and CAHMS Associate Director in the east, we discussed issues relating to constituents living in the area and the wider position of the Health Board currently.

A Statement I received on behalf of all the former Independent Members of the Health Board after the Health Minister forced them to resign states 'We believe she is setting healthcare in North Wales back a decade', and includes 'Each CEO has told us that they have found the Executive Team unmanageable, made worse by ineffective workforce HR support. We therefore sought the advice of Welsh Government officials. On each occasion, as with all matters relating to the Executive Team, we are required to have explicit Welsh Government support and approval’ and ‘Some well-intentioned executives have been tarnished and undermined by the behaviours of their colleagues, such that the team itself became dysfunctional and ineffective as a group’.

Other engagements included a meeting with the Royal British Legion’s Public Affairs and Campaigns Manager Wales for an update on the Legion, and to discuss Veterans’ affairs and the Armed Forces Community in Wales.

For my help, email Mark.Isherwood@senedd.wales or call 0300 200 7219