- Bob and Brad
the two most famous physical therapists on the internet.
- Hi folks.
I'm Bob Schrupp, physical therapist
- Brad Heineck physical therapist.
- We are the most famous physical therapists on the internet
- in our opinion of course
- Mr. Heineck, today, you wanted to talk
about how to treat somebody.
Who's had a stroke and they have neglect
- Right So if you're not familiar with this
if you have neglect
- It's a strange phenomenon
- Right? It, it is.
- It's a little hard to understand
- It is.
So if you had a stroke
on your right side, your left side,
- If you had a stroke on the right side of the brain,
it affects the left side.
- Exactly.
- Yeah. So that means the left arm won't work.
The left leg won't work so well, but with neglect
not only do the muscles not contract, right.
But the person literally neglects what happens
on the left side.
- They side don't see it.
They can run into a wall on this side, not even see it.
- It's really kind of a strange, phenomena like we said
- And if you know some of that has this
you know exactly what I'm talking about.
And if you don't
I'm gonna show you a few things that will demonstrate that.
But before we go any farther, Bob
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- Let's carry on with the stroke.
- All right, let's go on that with the stroke.
- Okay. So technically there's a lot of different names
for this.
A common one is Hemispacial neglect, and 80%
of the people that have this is it's on the left side.
Okay. So we're gonna, we're gonna refer to it.
- So obviously it's a right brain thing
that something's wrong
with the right brain that causes this neglect.
- Exactly. Now Bob has a sling on
so that's a reminder that that's his involved side.
When we go through some of these.
- This is the side that's weak.
This is the side I'm having neglect on.
- Exactly. So one test, I got a couple simple tests
you can do to find out if someone has it.
And this is really amazing.
If you work with someone, can you hold that Bob?
- Sure. Okay.
- So if Bob was, I said, Bob, here's a line.
I want you to draw a line right down the center of it, Bob.
Okay. So someone with the neglect, their mind
will ignore this part.
So to them, they only see this.
So they're gonna draw the line,
the bisecting line way off to
- Yeah, so it's an easy test for you to do on them.
They're gonna put it way to the right.
They're gonna neglect all this side.
- Now, Bob, another question for this.
This is the face of a clock.
Can you put one through 12 on that face?
And this is exactly what they'll do.
They'll put the numbers one through 12
only on half of the, the face of the clock.
- Yep, again they're gonna ignore the whole left side.
- Another thing is like
if they're eating their plate of food, they'll eat half,
They'll eat the right half of the plate.
And the left half of the plate will have food on it.
They're still hungry and they still want more food.
- They'll eat the right half of the food
not the right half of the plate.
- If they're really hungry, they might eat the plate.
Thanks, Bob.
Yeah. Now this is another really interesting way to test it.
So I'll be, I want find out how is visual
if he has visual neglect
So you take a tennis ball or a colored ball like this
and Bob, I'm gonna go on,
I'm not gonna tell him what side.
When can you see this ball?
- Now.
- Okay. Right over his peripheral vision's good.
- Supposed to look forward straight.
- Very good.
Yep. So again, he's looking straight ahead.
Can you see?
- Yes. There you go.
- Now and you might even
Do upper quadrant and the lower quadrant.
Because those quadrants can be different too.
- Yep.
So, and now I'm gonna test the left side.
Tell me when you can see it
- Now.
- So, and this is exactly what'll happen.
- Now.
- There you go.
So as soon as I cross the midline right down the center
- That's when I see it.
- But the interesting thing is Bob
and you can correct me if you've
or if you've had this experience, you can put the ball here
and you can say, can you see the ball right here?
- Yeah. They can see it.
- They can see it.
If you bring their attention to it.
- It's not a visual thing.
It's a neglect thing.
It's they see things over here, but they neglect the side.
It's a strange, again, strange thing.
- So, how do we, how do we deal with this as therapist?
And if you're a family member
at home and you want to help this out
there's some simple things you can do.
But before we go to that let's talk about the stroke.
And this is an analogy of how a stroke affects the body.
- It's a good visual demonstration, right?
- Okay. So here we have a Maze.
- It's a nerve maze
- A nerve maze.
Because a stroke involves the nerve, the brain,
the nervous system, and the brain is full of millions
and millions of nerves and synapses.
And there's so much going on.
For example, if you just reach up the scratch of your nose
your brain will start here to the command center
we're gonna call it.
And it sends a signal and to get from your brain
to that muscle, to contract, to get your nose,
it has to go through a number of pathways
in the brain itself
through the cortex and through the cerebellum
and down the spinal cord and around through the muscle.
And finally it gets
- Gray matter, white matter.
- Yep. It's very complicated.
But believe me, it goes to here.
So since you were born
and you were old enough to do that motion
your body has established pathways to do that motion.
Same with vision.
Same with anything you do.
Now, when you have a stroke
all of a sudden the brain gets damaged because a lack
of blood and we may have this now look what happened?
- The pathway got cut off.
- So we no longer can do whatever that part
of the brain was functional.
But as therapists, we want to get this to
either establish new pathways or heal the broken pathways
- Right. And often it's a new pathway.
And that's why quite often the younger you are
the more easier it is to reestablish pathways.
Your brain is what they call more plastic.
It can easily regenerate the new pathways.
- Exactly. For example, my nephews
they were born premature.
They're twins, born three months premature.
One of 'em did have a brain bleed and had a stroke.
Did not affect him at all.
They're both six, seven
- so young.
They, they just grew right back.
- You're not so fortunate when you're in
sixties seventies in age.
- A little tougher.
Not impossible though.
Just tougher.
- So again, as the brain heals the maze
will start to reform again.
And when you ask the person to do something,
move that same motion that they did before
this has to be reestablished.
It keeps bumping into walls.
And it's like, we've gotta get over to here to
just get to this old pathway and get back down to here.
And this may take repetition after repetition.
- [Bob] And that's why repetition is
so important after a stroke
cuz they just keep redoing things.
And trying to get the brain to re reconnect.
- [Brad] And then finally, when you make that connection
then you need to work
with it sort of establishes and it stays there.
And this is where patience is really
important when you're working with stroke rehab.
And I don't.
Yeah. No pun on words.
- Yeah. Yeah.
It, it, it takes a long time.
It can.
- If you have someone that has
- The neglect on the left side.
- What you can do to get that,
say we're working with the arm
we're gonna work with that left arm.
That's not working very well.
You can take a sling and put it on their right arm
the good arm, and that's gonna immobilize it.
Okay. This is called constraint induced therapy.
And then with Bob, I'm gonna have
I'm gonna have him do some kind of activity, Bob
- And you might even put an eye patch
over my good eye, right?
- Yeah. So you're gonna work the visual,
as well as the, the muscular in the arm.
- And this is assuming that you have some motion
in the arm how that you have some movement
- And you could put something on, you know
things on a table, objects on a table to grab
I'm just gonna have Bob, can you grab that?
And it forces him.
He's gonna wanna do it with the right arm
but we're gonna constrain that one.
- So if you can do this a couple hours a day when
they're not even in therapy, even too, that they
forced them to.
You know, again, the pathways have to be formed.
- For example, brushing your teeth.
Put the sling on, let, 'em go brush their teeth.
Then they have to do it that arm.
Or it's a reminder.
If someone's walking down the hall, it's amazing.
They'll neglect.
And they'll keep bumping into the wall on the left side.
So a continual reminder, keep going straight.
And again, you can ask them
can't you see the wall that you're bumping
into and they'll look and say, yeah, it's right there.
And then they'll walk and they'll bump into it again.
- Turning pages of a magazine is a real good one.
- Very good.
Cuz you got some vision involved with it.
- Exactly. Lot of good little tips there.
- TV where you put the TV, if they're laying in bed
and the TV is on the right side and we wanna get
that left side, the attention to go to there, move the TV
over to the left side.
It's one of those sneaky ways to gain that
attention to that direction.
- And when you talk with this, this individual,
you wanna go to their left side.
You want to force them to converse with you in turn
and look at you this way.
All day long, make sure you know the radio
on this side, everything, everything on this left side.
So that he has to, you know, find it, or she
- Cause remember those synapses are trying to
find the old pathway.
And if you continue to work with it
it forces the mind to work
to find through that maze into the right pathway again.
So you become
that normal person once again, as you were
- Well, anything else you wanna say, Brad, what say you?
- Yeah, exactly.
Bob, no, a stroke is something that, you know
it affects the whole family, but the whole family
if you understand a little bit and
and don't get frustrated with it
cuz this really can be frustrating even for a therapist.
- Yes it can
- Take your time with the understanding of it.
It'll help you get through and have some success.
- So, all right thanks for watching.