vasa concept - stroke rehabilitation - recovery of sensory motor control

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In the modern times with state-of-the-art machines available for rehabilitation, yet 21st century stroke patient is suffering from loss of sensory motor control like a fellow stroke patient in the last century.Vasa Concept: Vasa Concept teaches the stroke patients how they can restore loss sensory motor control by using their own brain as the best tool, freely available, at any given point of time.For more information, visit: http://www.brainstrokes.com

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Is there a connection between increased degrees of freedom from flaccidity following stroke, and development of passive tissue contracture and spasticity?By

Rajul Vasa, B. Sc. PTClinical scientist, applied motor control INDIA Website: www.brainstrokes.com

"All truth passes through three stages: First, it is ridiculed; Second, it is violently opposed; and Third, it is accepted as self-evident". - (Schopenhauer)

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Abstract

AbstractSimilar to the patients of yester-year, stoke patients today still continue to struggle to regain sensorymotor control and constantly struggle to get rid of spasticity. Therapeutics in the modern times with most modern machines remains to be palliative and focus on negative and positive symptoms. Passive tissue contracture, synergic grouping, spasticity, associated reactions, depression, spatial neglect, Paraesthesia and central pain are assumed to be part and parcel of the condition. Spasticity is well defined by physiologist in the last century yet, there is no effective treatment of spasticity till date. I think time is ripe in this 21st century for clinicians to relook into stroke symptoms and revisit spasticity. Burning desire in me to help stroke subjects made me clinically experiment in unchartered waters of stroke rehabilitation to find root cause of all complex problems of stroke patients. Theoretical underpinning of Vasa Concept evolved with new clinically applied definition of spasticity. This led me to evolve a new solution to complex problems of sensory motor control and getting rid of spasticity by rereorganizing the stroke brain with Vasa Concept. New clinically applied definition of spasticity and theoretical underpinning of Vasa Concept is described with what to exploit, what to do and what not to do to a self organized brain and how to re-reorganize it.

Clinically Drawn Conclusion:1. Increased degrees of freedom of paretic flail MSS (Musculoskeletal system) of one side of the body from a small lesion in CNS make self organizing dynamic system unstable from within. 2. Action plans of self organizing stroke CNS and MSS to re-stabilize the system and to combat external forces like gravity to control and defend COM (Centre of Mass), a priority of all living organisms, becomes the added constraints to restoration of lost control besides the presence of lesion acting as a catalyst. 3. Self organizing stroke CNS exploits anticipatory postural activity to induce muscle contraction in chain of paretic muscles during functional acts with slightest movement of COM whereas muscles velocity dependant spastic behavior in laboratory set up in unloaded condition when the limb segment is moved passively by examiner is a reflex action. o Synergic extended anticipatory activity in chain of paretic muscles known as spasticiy, and passive tissue contracture help restrict and reduce increased degrees of freedom from flaccidity and help defend COM. Spasticity, synergic grouping and contracture act optimally as a BRAKE on the fluid movement of COM for safety a priority. Self organizing stroke CNS promotes automatic central postural control of global COM with synergic grouping of chain of muscles in priority over the development of selective control on segmental COM. Automatic muscle activities allow segmental COM to move only in the direction towards

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Clinically Drawn Conclusion the central axis for egocentric reference and do not yield in other direction for safety of COM and for COM to remain within the narrow BOS (Base of Support) 4. Microscopic morphological changes like contracture, loss of viscosity, stiffness in paretic muscles, in connective tissue and in basic fabric (the fascia) that binds the entire skeleton together at the central axis, the spine enable the paretic side MSS anatomically connected to non paretic MSS to get mechanically bound together for a macroscopic change in behavior of paretic MSS for, The whole is bigger than sum total of its individual parts. Meaning that the system as a whole determines in an important way how the parts behave. o Macroscopic change in behavior of paretic MSS can be compared with passive Towing by non paretic MSS when muscle motors of paretic MSS fail. Towing the huge mass of paretic MSS by non paretic MSS becomes easy with contracture in widely spread Thoraco-lumbar fascia that spans both sides of the central axis and houses large trunk muscles bilaterally with bilateral innervation helping to bind both paretic and non paretic MSS together at the central axis with contracture and contraction.

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5. Contracture in muscles of limbs that has an origin on the trunk like lattissimus and pectoral and iliopsoas enable the limbs to get bound to the trunk with microscopic morphological changes like stiffness, loss of viscosity, loss of sarcomere, thus binding entire paretic MSS with non paretic MSS. o Lattissimus muscle is anatomically well placed in terms of connecting scapula and the pelvic girdle together and is attached on to Humerus bone and is in continuity with the gluteus maximus on the opposite side (al A. V.). It is interesting to see that self organizing brain exploits anatomical advantage of Lattissimus to bind two girdles together like a log by turning it spastic to restrict dissociation between two girdles for safety of COM, a priority for all living organism. To make the lattissimus muscle spastic or to induce extended continuous contraction with anticipatory activity in lattissimus muscle, brain exploits continuity of left paretic lattissimus with the right normal gluteus maximus on the opposite side to trigger extended continuous contraction in paretic lattissimus with its own inertial mass acting as a stimulus with every step taken while walking and standing up using good leg muscles, creating constant pull and stretch on paretic lattissimus.

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6. Self organizing stroke brain exploits un-opposing pull of normal trunk muscles pulling the torso away to sustain the head, arm and trunk mass (HAT) onto the normal hip thereby reducing weight bearing on paretic limb failing all therapeutic efforts to weight shift on paretic LL. 7. Reduced weight bearing on paretic leg is a huge problem in therapeutics unless paretic LL relearns to gain control on COM in all 3 Cartesian coordinates with paretic muscles. Restoration of sensory motor control of the paretic UL is dependent on the restoration of control on COM by iv

Clinically Drawn Conclusion paretic LL. Coupling of paretic Lattissimus muscle with opposite normal gluteus, the paretic Lattissimus gets constantly stretched, to develop abnormal flexion posture at every step taken by the paretic LL in walking, in standing up and in sitting down without having control on COM in all 3 Cartesian coordinates. 8. New functional behavior; Towing of paretic MSS by non paretic MSS makes exchange of dominance between two MSS impossible. This makes Normally Abnormal, to be Normal. In a stroke condition towing disturbs spatiotemporal efficiency and energy economy and subconscious automatic control on COM becomes forced control, wherein one side MSS leads and the other side MSS follows. 9. Towing of paretic MSS makes it dependent on non paretic MSS for geocentric reference.This allows non paretic MSS to lead uninterruptedly with paretic MSS turning supportive by trailing behind and acting as a brake on COM movement. 10. New functional integration between two MSS one leading and controlling the COM all the time and the other trailing behind and following all the time ensure safety of COM always a priority during postural and supra postural tasks. 11. Added safety to COM is provided by passive inertia of paretic mass. 12. Impedance to movement from spasticity, rigidity and stiffness in muscle and contracture in passive tissue and muscle is a defensive strategy of the self organizing CNS in prioritizing safety of COM. 13. Associated reactions apparently seem to be helping to tow paretic MSS. 14. Paretic UL is dependent for its recovery on ability of paretic LL to control and accelerate COM. similarly paretic UL can be abused at every step taken by paretic LL without its ability to control COM with sub-cortical postural reorganization, spino-spinal reorganization and physiological constraint inter limb coupling. 15. Sensory reweighting for balance is an automatic solution by self organizing brain at a heavy cost of making Normally Abnormal, to be Normal. 16. Power of self organizing brain is mightier compared to any therapeutic efforts made by rehabilitation team unless therapeutics are designed to re-reorganize the self organized brain by exploiting the priority of self organizing brain, to control and defend COM using paretic MSS as the window to the brain, to channalize the dialogue between brain body and the external environment.

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Acknowledgement

AcknowledgementI want to thank my husband Vivek for all his unconditional support all these years in my mission to find solution for complex sensory motor problems of stroke without any expectation. I also want to thank Prof Christian Bayeart (Laboratoire de Physiologie Facult de Mdecine de Nancy France) for understanding Vasa Concept as a treasure at the first go several years ago and for his efforts to spread the knowledge in France. I thank all the students and physiotherapist friends from Uppsala, Stockholm, Orebro, Lund, Gothenburg, and SatraBrunn to believe in me and to let the wind of change to start to blow against all odds in Sweden and to Danderyds sjukhus therapists for naming my teachings as Vasa Concept way back in 1995. I want to thank Sandeep Ram, my domestic help at home, to take care of me and our home with dedication and love and my two Dogs Lucky and Radha whom I love. I want to specially thank Dr Vaishali Jadhav to help me overcome bad health. I want to thank all patients and their f

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