There has never been a better opportunity for chiropractic medicine?and it’s going to get even better!

Living in Southern California the ocean waves and the surfing environment inspire you. You cannot help but draw the analogy of “catching the wave” during the most exciting time I have experienced in chiropractic medicine over the past 15 years.

There has never been so much opportunity in the history of physical therapy! State-of-the-art equipment like the 830Laser, a cold laser therapy device, provides unprecedented options in healing from arthritis pain to carpal tunnel syndrome treatment. Most significant, the public is becoming aware of the benefits. Good health and pain relief, without side effects, has finally become important to the public at large.

Insurance companies are realizing that to keep providers they will have to pay for new modalities that reduce overall insurance costs. Fees have finally risen to the point that chiropractors receive what they deserve for the products and services they deliver. I have never seen a better opportunity for chiropractors and physical therapists to be financially and professionally rewarded for practicing their chosen profession, and it’s going to get even better! If you haven’t already, you need to catch the wave!

More and more clinicians are retiring, and fewer and fewer full-time physical therapists and chiropractors are replacing them. At the same time the potential patient population continues to grow. Educated consumers are becoming more aware and more desirous of quality care and they are willing to pay for it!

Are you taking advantage of these new opportunities to grow your practice? Here are some questions you might ask yourself:

Are you ready to catch the wave?

Do I have something new and exciting to tell my patients? Have I identified my target patient and is my marketing plan attracting that patient?

Do I have patients in my practice who are obstructing the system? Are they accepting my treatment plans, keeping appointments, and following through with treatment?

Am I accepting reduced fees for my services? If so, why? Am I providing a way for my patients to financially afford the treatment desired?

Are my clinical skills, equipment, and materials state of the art?

Is my team working with me to achieve the values and vision that I have for my practice?

If you can answer yes to these questions, I am sure you are experiencing the rush of riding the “big one” we have in chiropractic medicine and physical therapy today. If you answer no to any of these questions, you may miss the greatest opportunity that clinicians have ever had to offer.

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When Dorothy followed the yellow brick road, she was told to do so by those who wanted her to get where she wanted go. Well as humans when we blindly follow recommendations even by individuals who have good intentions, it may not always be your best option. So I’m preparing this article to compare and contrast what are known as traditional treatments vs. complementary or alternative treatments for back pain. Remember there is rarely only one reason for your back pain and almost never one silver bullet fix? you may need to try several approaches till you find what works for you.

So when reading this article and thinking back on your visits to medical professionals, did you have the big picture or were you just following that yellow brick road? If you have been down that road, or if you are just starting to suffer from back pain it’s never too late to seek out new and more encompassing information about your condition when trying to find a solution that works for you. Don’t say you’ve tried everything because you haven’t… your solution is out there and you just have to find it!

Orthopedic Care

One of the first places many people go when they experience back pain is the orthopedic specialist (surgeon) and a visit usually last 5-10 minutes. They will typically look at the problem/symptomatic area and often fail to look at the body as a whole. If you’ve been to an orthopedic specialist for your back pain, did they do a full body physical evaluation (takes 30 mins. or more)??? Not likely.

Here are some of the common treatments used / prescribed by orthopedic specialists:

Cortisone Shots

Cortisone is a catabolic steroid which is intended to reduce inflammation by killing off the tissue in the inflamed area? now let me ask you, does that make any sense to you at all?

Not only are these injections quite painful, but they rarely result in any pain relief and if they do it is short lived, usually 1-2 weeks if at all. Plus, it does NOTHING to identify or address the cause of the pain? it is only intended to treat the symptom. It’s for those reasons that we do not recommend them.

Anti-inflammatory Drugs

Just the name should scare you away? just like cortisone shots, anti-inflammatory medications do not identify or address the cause of your pain and for many people, they deliver little pain relief. These medications also deliver serious side effects! The main reason they are prescribed is money? and if you don’t believe me, do the research and you’ll see for yourself. The drug industry is huge and unfortunately, they have a huge influence on the whole medical community, including the doctors.

I challenge you to find a drug that will fix your back problem? you’ll be looking forever because there is no way a medication can fix a physical problem so avoid medications at all costs!

Back Surgery

Surgery for back pain is very common and more often than not, the individual still has pain afterwards (or it returns within weeks) and sometimes even new problems! Very rarely is a surgery the answer…

for example, many people have surgery for herniated discs. The logic behind the surgery is if you remove the piece/portion of the disc that is putting pressure on the nerve the problem is solved. Unfortunately, the same forces that forced that disc to protrude or bulge will likely force more of the disc out, or another disc out.

Surgery should always be the last resort… and even then I’d question it!

Physical Therapy

Physical Therapy is traditionally the next step after seeing an Orthopedic Doctor. That is if surgery is not recommended. So what should you expect? The process will start with an evaluation and here may be the start of the problem? here is why?. the doctor has to write a prescription with a diagnosis on it. You give the prescription to the PT and he or she will perform an evaluation… chances are the PT will simply confirm the diagnosis from the doctor, however the hope should be that they take the extra step to look for the root cause of your pain. They may but chances are they have several other clients in the office at the same time and simply do not have the time.

So without a comprehensive evaluation to identify the root cause of you pain they will simply treat your symptoms. We have just identified the second problem. The health care industry is required to show improvement with each and every session so the push is to reduce your symptoms to show progress in order for them to get paid. The long and short of it is that yes your pain can be reduced but the root cause rarely gets addressed, meaning that the pain and your suffering will return again and again.

So what should you do? When selecting a Physical Therapy office you may want to ask how many patients the office sees in a day and how many PTs they have on staff… then ask how many patients can a PT work with in an hour. Do not be surprised to hear that a PT can see up to three patients in an hour. That’s you and two others at the same time. Do you think you will get the attention and proper treatments you need? I doubt it.

There is a little joke in Physical Therapy when treating patients and it has to do with what course of modalities you will get. The joke is called Shake and Bake and it refers to everyone gets the same treatment protocol? that way it can be timed so that your PT can see other people simultaneously. What goes into a shake and bake treatment? It may start with a spin on a stationary bike or a trot a treadmill than you will get a 3 to 5 minute Ultrasound over the effected area followed by Electrical Stimulation to the area with a little Ice strapped to your body and to finish off your session you will get a hand out with exercises you should do at home. Certainly not a recipe for success!

Chiropractic Care

One of the most common treatments for back pain is Chiropractic Care. The approach consists of physical manipulations of bones and joints in an attempt to line things back up and it’s recommended typically 2-3 times per week.

The problem with this approach is that the same forces (muscles, tendons, and ligaments) will likely pull the bones and joints right back out of place again. Also, most (not all) chiropractors will spend 15 minutes with you if your lucky.

Ask people who see a chiropractor how long they’ve been going? I hear of people who have been going for 10-15 years and still don’t have a healthy back. Look, the fact is chiropractic care is lacking?

Unless the chiropractor combines the two approaches, it doesn’t make sense?

The ONLY way chiropractic care makes sense is if you are addressing the muscle imbalances that are pulling the bones and joints out of place to begin with and that requires strengthening and stretching exercises that are chosen specifically to correct your muscle imbalances.

Alternative Treatments for Treating and Eliminating Back Pain

Massage Therapy

Massage therapy, if done correctly can work wonders for people with back pain. This is not to say that it is the best choice and that it will work for everyone? however, most people will get great results from it if the massage therapist has a good understanding of muscle imbalances and how to work on them.

NOTE: Not all massage therapists are the same! Just like any profession, there are varying degrees of training and qualifications. When selecting a massage therapist please check to see if they are licensed and insured in the state where you will be seeing them. You should also ask the massage therapist if they have training in one of the following areas: Orthopedic massage, Medical massage, St. Johns technique and/or has a comprehensive knowledge of muscle imbalances relating to back pain. With that said the benefits are as follows. The root cause will be identified, your discomfort will be addressed and you root cause will be corrected all in an attempt to make you pain free and give you the tools you need to keep you that way. What to expect when you see a massage therapist.

All massage sessions are one on one allowing you the opportunity to converse with the therapist as well as get the attention you need to get results. You can ask questions about how you compare to other people. Feel free to ask the therapist what approach they will be taking so that you know what to expect. The massage therapist has many different techniques they can use when to dealing with you back pain and some are better than others. On the down side sometimes a therapist can get distracted with other problem areas, it is in your best interest to keep them focused on you back and associated problem areas. Like anything else you may need to try several different therapists before finding the one that works best for you and with you.

Post-rehabilitation Fitness Training

Another overlooked form of treatment that is very effective is post-rehabilitation fitness training. This includes targeted strength and flexibility work to correct / improve the individuals muscle imbalances. This service can only be performed by certified post-rehab fitness trainers and there are limitations to what they can do for you. For example, they can not diagnose a condition, prescribe any medications take x-rays, etc? however, if they are well trained they can pinpoint your muscle imbalances quickly and get you started on a fitness program that will restore balance to your body and likely eliminate your back pain.

Often times this can be combined with massage therapy and/or manual physical therapy for a total solution. If you decide to go this route, which I recommend you do, be sure to thoroughly check out the fitness trainer and ask to see their certification, insurance, references, etc.

Manual Physical (muscle) Therapy

Manual Physical Therapy is NOT the same as regular physical therapy? there are some major differences and here are just a few:

1. Manual therapy consists of hands on muscle work primarily whereas traditional physical therapy consists of heat, ice, ultrasound, electrical stimulation, etc

2. Manual therapist will typically perform a much more thorough physical evaluation

3. Manual therapists will usually be able to spend more time with each patient

4. Manual therapy is more holistic in it’s approach and focuses the body as a whole unit? something lacking from nearly all traditional treatments for back pain.

So before you say, “I’ve already tried physical therapy”? did you try manual physical therapy? They are two very different treatment approaches and I highly recommend you consider manual physical therapy.

Conclusion

As you can see traditional treatments are the main stay of modern medicine? not necessarily for the patients benefit, but it’s just how the system works best for itself. The system will not change until the system is confronted with a very powerful competitive force. That force may well be complementary or alternative care from the likes of Personal Trainers, Acupuncturists, Massage Therapists, Manual Physical Therapists, and the like.

So that’s what we’ve tried to do? force change. The traditional treatments that people have been receiving for decades just doesn’t work, and we have found a combination approach that not only works the best, but it’s safe, natural, and inexpensive. Check out our “Lose the Back Pain” video now? it will show you how to identify the cause of your back pain and the show you the exact combination of steps to take to eliminate it.

If you have tried other treatments with little or no relief/improvement, you owe it to yourself to try this approach? so take charge of your health and get started now working towards not only a pain free back, but a healthy and balanced body! Only you can fix your back? all you need is the right approach!

Warning: This article is not intended to be medical advice however its intent is to make you a better, smatter and more informed client. The more you know and understand about your medical condition the better off you will be when it comes time to make the hard choices. As well as communicating with medical professionals…. believe me it will make a world of difference.

Tendons are ropes of fibrous tissue that connect muscles to bones. It is this connection that permits joint motion. When muscles contract, they pull on the tendons which cause the bones to move. In order for tendons to glide they move inside a lubricated sheath of tissue that is lined with synovial tissue. This synovial tissue is the same type of tissue that lines the inside of joints. Tendonitis refers to a condition where the sheath through which a tendon glides becomes inflamed. This leads to severe pain. The pain usually gets worse with use of the affected joint. However, when tendonitis becomes severe, there may be pain at rest.

Since muscles and tendons surround most joints, tendonitis is rather common. The diagnosis of tendonitis is relatively simple for the experienced clinician. Genrally, the diagnosis is made by history and physical examination. In difficult diagnostic cases, magnetic resonance imaging is helpful in confirming the diagnosis.

Some of the more common types of tendonitis are:

Shoulder tendonitis. The tendons in the shoulder that are most often affected are the rotator cuff and the biceps tendon. The rotator cuff consists of four tendons that sit on top of the upper arm bone. The location of these tendons and the muscles they attach to are what give the shoulder such an expansive range of motion. Rotator cuff tendonitis may occur as a result of repetitive activity or tendon degeneration. Pain is felt with most movements and is located on the outside part of the shoulder. The biceps tendon allows the arm to be flexed at the elbow. Biceps tendonitis also occurs due to repetitive activity and pain is felt in the front of the shoulder. Shoulder tendonitis can be treated successfully with anti-inflammatory medication, physical therapy, and occasionally glucocorticoid injection.

Tendonitis in the elbow is usually located either on the outside and is called lateral epicondylitis or tennis elbow. It may also occur along the inside part of the elbow- medial epicondylitis. This is called golfer’s elbow. Treatment consists of physical therapy, stretching and strengthening exercises, splints, and injections. Rarely, surgery is required.

Tendonitis in the wrist arises because of repetitive motion. A special type of tendonitis, called Dequervain’s tendonitis, is felt on the out side of the thumb. Tendonitis in these areas is managed with glucorticoid injections and immobilization with a splint. Other physical therapy modalities may be helpful. Sometimes surgery is required. Tendonitis in the fingers can lead to catching of the fingers. This is termed “trigger finger.” Trigger finger usually responds to injection but may require operative intervention.

Tendonitis in the knee may affect the patellar tendon. This is the tendon that connects the knee cap to the tibia (lower leg bone). Patellar tendonitis usually occurs because of excessive jumping and is actually called “jumpers knee.” This is treated with rest, anti-inflammatory medications, and physical therapy.

Tendonitis in the ankle can occur along the outside of the ankle (peroneal tendonitis), the inside of the ankle (posterior tibial tendonitis), or at the back of the ankle (Achilles tendonitis). The tendonitis that occurs along the outside or inside of the ankle can occur because of trauma or because of mechanical instability. Another potential cause is an underlying arthritis condition. Achilles tendonitis often occurs as a result of excessive stress and repetitive trauma. The Achilles tendon is the thick cord at the back of the ankle that connects the heel bone to the calf muscle. Treatment involves rest, elevation of the heel to take the tension off the Achilles tendon, and physical therapy. Glucocorticoid injection should be avoided because of the danger of Achilles tendon rupture. Anti-inflammatory medication may be helpful.

Whether you’re a weekend athlete, or a gardener that overdid it, or a person with arthritis, there’s hope for you. According to Dr. Nathan Wei, Clinical Director of the Arthritis and Osteoporosis Center of Maryland, “Shoulder problems are one of the most common afflictions of modern times. Fortunately, there are many ways of helping people feel better.”

The shoulder is the largest, most complex, and most mobile joint in the body
Four muscles and their tendons (ropes attached to the top of the humerus), collectively known as the rotator cuff allow the shoulder to move as it does. The rotator cuff also plays a role in stabilizing the arm bone to the shoulder blade.

Shoulder pain doesn’t always come from the shoulder!
Examples include pain referred from arthritis of the neck, diseases of the chest such as pneumonia and diseases of the abdomen like gall bladder problems can cause pain to be referred to the shoulder. Even ectopic pregnancies have caused shoulder pain!!! Finally, heart conditions can cause referred pain to the shoulder, particularly on the left side. A specialist’s physical exam is important. Dr. Wei relates this story. “I saw a patient who had shoulder pain. The pupil of the eye on the same side of the shoulder was enlarged. That set off alarm bells so I got a chest x-ray. He tuned out to have a lung cancer. This combination is called Horner’s syndrome.”

Most causes of true shoulder pain fall into 3 categories
? tendonitis/bursitis- With repetitive motion, the bursae (small fluid-filled sacs) surrounding the shoulder joint can become inflamed. This condition is called bursitis.
? injury/instability- Keeping your arms extended above your head; chronic compression , ie. forcing the shoulder into its socket; muscle imbalance- if one of the muscles is extra weak, that can cause the rotator cuff to function poorly.
? arthritis- Usually a function of aging.
Patient tips:
? Try to limit the number of overhead reaches.
? If you’re wheelchair-bound, tuck your arms a bit closer to your body as you push.
? Avoid repetitive motion.
? Work on rotator cuff strengthening. Range-of-motion exercises are important!
? Use correct posture!

One tip that might help if you have chronic shoulder pain and have a “frozen shoulder” is to use a broomstick for stretching and range-of-motion exercises.
Oral anti-inflammatory medicines are sometimes, but not always, helpful. Patients may require a steroid injection. For people who don’t respond to medicines, injections, and physical therapy, another option is surgery. Any type of surgery should be done by a skilled shoulder surgeon. “The shoulder is the most complex joint so make sure whoever works on your shoulder is an expert with shoulders,” advises Dr. Wei.

The 1st 2 weeks of recovery from ACL Reconstruction are a very sedentary period - there is much rest, much sleep, much discomfort and most likely quite a bit of pain. However, the beginning of physical therapy signals the first true step (pun intended) to recovery - it is where you will retrain yourself to walk on your repaired knee and where you will work to get your injured leg in a pre-surgery state. Even though your leg has only been immobile for 14 days - possibly less - you will most likely have at least some atrophy in the repaired knee that will need to be remedied via physical therapy.

The start of therapy will be exciting, at times grueling and quite possibly scary to go into. But, with a dedication and commitment to the mandate that you will help yourself heal, you will soon be back to your active lifestyle, even stronger than you were before surgery.

As you are about to enter your first therapy sessions, keep the following points in mind:

1. You need to trust yourself. You are soon going to be asking your newly repaired leg to do things that it hasn’t done in a couple of weeks - lifting, some bending, some kneecap exercises and maybe even a little bit on a stationary bike. Have faith in your healing process, and know that you can get through whatever lies ahead.

2. You need to trust your physical therapist. They are going to be asking you to do the activities listed above along with some others. Initially you may think that they are crazy to ask you to do such activities. However, keep in mind - they are professionally educated to help you recuperate, and they know what you need to do to have a successful recovery. Also - they may very well have some other ACL reconstruction patients in their current workload. In fact, take a look around your therapy room as you are doing your work - odds are you are going to see some other patients who are in If you have young children, prepare them for the fact that you are going to be immobile for a period of time and that they cannot rough-house around you while you are recovering. You will soon be doing some of the more advanced exercises that they are doing.

3. Concentrate on your form while you perform your exercises, and ensure that you follow the instructions of your therapist. Subtle changes to your form or a lack of concentration can greatly reduce the effectiveness of a particular routine.

4. Make sure to ice and elevate your knee. Much like in the first 2 weeks, it will be important that you have a good regimen of icing and elevating, especially after therapy sessions.

5. Don’t push yourself too hard. You may be tempted to overachieve, but it will be crucial that you listen to your therapist as to what you should and should not do.

6. Make sure to take your prescribed medications and over-the-counter medications as needed and as instructed. By taking the proper medication, you will continue to allow yourself to heal, will help maximize your comfort (and minimize your discomfort) and will allow you to go through physical therapy with a reduced level of pain.

7. Do your home exercises between therapy sessions as instructed by your physical therapist. I cannot stress how important this is. You will largely be trying to regain your flexibility and range of motion in the first month of therapy, and your home exercises will greatly contribute to a complete recovery.

8. Gauge the difference between good pain and bad pain. There will be times that you have feelings in your knee that you have never felt before. Make sure to keep your therapist abreast of any pains that feel stronger, more intense or sharper than expected.

9. Similar to your post-op period, ask your doctor if a stool softener would be appropriate for you. Some of the medicines that are prescribed to alleviate pain and swelling may cause constipation, and a stool softener will help counteract this possibility.

10. Continue maintaining your fluid intake.

Once you advance in your stretching and range-of-motion exercise, you will be able to move onto the next stage of therapy - strengthening.

The information in this article is for educational purposes only and does not constitute medical advice or medical services. If you have or suspect that you have a medical problem, contact your doctor promptly.

The ACL or anterior cruciate ligament is one of the major ligaments in the knee. Damage to this ligament often occurs after a blow to the knee. This often happens in sports related injuries and is seen a lot in American football players after experiencing a side tackle. Other sports such as soccer, skiing, basketball, cheerleading and rugby also have high instances of players suffering ACL injuries. The effects of this injury are debilitating and can take an extended period of time for recovery.

To determine if there is an ACL injury there are three common types of tests a physician may employ. The anterior drawer test and Lachman tests are where the physician flexes the leg and manipulates the tibia to determine greater movement than normal. An MRI can also be used to determine damage. If damage is found, a course of treatment will be prescribed. Small tears will usually be allowed to heal by naturally, but more severe injuries will require surgery and ACL reconstruction.

ACL surgery is done arthroscopically, which is a less invasive type of surgery. Only small incisions are made which can reduce recovery time for the patient. There are three main types of ACL reconstruction to graft tissue to the knee. These types include patellar tendon, hamstring tendon and cadaver.

The patellar tendon connects the kneecap to the shin and is very strong and large. The graft is typically made from the injured knee, but in cases of a possible second surgery this may be taken from the other knee. The piece is positioned and then screwed into place. This type of surgery is popular with athletes because it is the fastest way to return the knee to its peak performance. However, it is generally very painful.

The hamstring tendon is similarly locked in place by screwing end loops of a graft from the hamstring to the tibia and femur. The hamstring is not as strong as the patellar tendon so it will force use of a brace for approximately two weeks. This will immobilize the knee to allow for healing. This surgery is significantly less painful and is a viable option to the patellar tendon. Over time, studies indicate this surgery is just as effective but it takes longer for a person to be able to resume normal activities.

The cadaver surgery is when the tendon is removed from a cadaver to use in place of the patient’s own tendons. Because the removal is the most painful part of the surgery, this type reduces the post operative pain associated with ACL reconstruction. Because this is being taken from another body, however, there is a risk of rejection that can cause complications.

ACL reconstructions are commonly performed and are highly successful. Care should be taken to reduce the amount of stress put on the knee from blows, jumping or changing position quickly. Resuming walking can occur after approximately three weeks, more intense activity after four months, and full recovery is typically complete after six months.

In a landmark study, researchers at the University of Alabama at Birmingham used a randomized controlled trial — the gold standard method for evaluating the effectiveness of a treatment — to show that immobilizing the good arm of stroke patients and intensively exercising the weakened arm actually improved recovery, even when performed long after the stroke occurred. At one level, randomized controlled trials in the field of rehabilitation medicine have been so rare that the publication of each and every one should be applauded. At another level, the outcome of this study is so satisfying in terms of what we think we know about brain physiology (function) that even if the results turn out not to be true, they ought to be.

A controlled trial is one in which there is a comparison group of patients that is either untreated or is treated differently. When a controlled trial is also randomized, it means that upon entering the study, participants agree to be assigned to one group or the other based on the equivalent of a coin-toss. Randomization eliminates bias that might otherwise come from (knowingly or unknowingly) assigning more promising patients to one group and less promising patients to the other.

Publishing their results in the March 2006 online issue of Stroke, a medical journal, Edward Taub, PhD, and co-workers studied 21 patients treated with “constraint-induced movement therapy” (CI) and compared their outcomes to another 20 stroke patients who received placebo treatment.

In strokes a loss of circulation damages a portion of the brain, resulting in impairment of whatever mental or bodily function that part of the brain controls. Strokes often cause weakness in an arm with or without concurrent numbness. Strokes are the leading cause of long-term disability in the U.S.

The researchers included stroke victims in their study who had mild to moderate impairment in use of their affected arms, but excluded those with severe impairment. The research subjects varied widely in age, averaging in their fifties. The investigators selected patients whose stroke had occurred a minimum of one year earlier with an average interval between stroke and treatment of 4.5 years. Patients with concurrent numbness were included, but those with poor walking or balance were excluded, as were patients with excessive confusion or too much additional impairment caused by other medical conditions.

The CI treatment was administered over a 2-week span, during which the good arm was immobilized about 90% of the time with an arm-sling and a hand-splint. CI patients had 10 weekday sessions with therapists, lasting 6 hours each. During those sessions, patients received one-on-one therapy that was individualized to their needs and abilities and involved specific, practical tasks of gradually increasing difficulty. The therapists praised patients each time their performances improved even just slightly. By contrast, placebo-treated patients received a more general program of physical fitness, cognitive and relaxation exercises over the same schedule.

The abilities of CI and placebo-treated patients were compared in two main ways. In one, the research subjects were videotaped in the laboratory while attempting specific tasks like holding a book, picking up a glass and brushing teeth. Their performances were rated by viewers who were purposely not told which treatment the subject received. The other rating, called the “real world outcome,” came from structured interviews of the patients and their caregivers concerning performance outside the treatment facility.

The researchers found significant improvements in CI-treated patients compared with both their own initial abilities and those of patients receiving placebo treatment. The CI patients showed a moderate improvement in their laboratory skills and a large improvement in use of the affected arms in their daily lives. Improvement was still evident 4 weeks after treatment, and even after 2 years in the 14 of 21 CI patients who could be retested at that time.

The researchers interpreted the improvement as due to two factors. The first factor, probably more important for faster gains, was in overcoming “learned non-use” of the weaker arm. The idea is that after a stroke, patients quickly learn to avoid using the weaker arm to a greater extent than its impairment might warrant, and CI training forces them to put it back into action. The second suspected factor, developing more slowly, was “neural plasticity” or actual rewiring of the brain. In neural plasticity surviving brain cells — previously uninvolved or less involved in controlling use of the arm — attempt to make up for the lost brain cells either by creating new contacts with other brain cells or by modifying the effectiveness of existing links.

In 1992 researchers at the Hammersmith Hospital in London used positron emission tomographic (PET) scans to examine patterns of brain use in stroke patients. PET scans are good at showing which parts of the brain are most engaged by specific tasks. Investigators compared PET scans in 10 patients who recovered from a stroke to those of 10 patients who never had a stroke. In this study subjects repeatedly moved one hand (which in the stroke patients was the affected hand) while their brains were being scanned. Compared to non-stroke patients, stroke patients used more areas on both sides of the brain to perform the requested movements, as if the surviving brain cells were trying to fill in for their fallen comrades.

Taub and collaborators at the National Institute of Neurological Disorders and Stroke used similar methods to compare patterns of brain activation in 9 CI-treated stroke patients with those in 7 less-intensively treated stroke patients. In this 2003 study, CI-treated patients showed a shift in the extent to which different parts of the brain participated in moving the fingers of the weakened hand. Thus, CI treatment seemed to modify the brain pathways responsible for the finger movements.

(C) 2006 by Gary Cordingley