Repetition gives improvement, lovely to hear about somebody doing progress several years after stroke, sometimes we/patients maybe give up to early

I have another question. Let's say that the patient goes to bathroom only 15 times a day, which is half of 30 times. One would expect that the cell improvement in his brain, digestive system, immune systems, etc. will be halved. Improvement of his weak muscles will be halved also. I don't have questions on that. But, if he doubles the number of bathroom visits (10 feet away) to 60. Would you think that his health improvements will be doubled as well? If you look at results of all the simple stretching exercises (including simple Yoga poses), and all the shock treatments (including hyperbaric treatment, electroconvulsive treatment, faked faith healing, cupping, and part of acupuncture) which are to raise heart rate, you may have a different view. Their good effects never last very long unless you increase the intensity every 2 to 4 weeks.

This purely neurophysiology. It is unfortunate that the potentials of this patient had never been capitalised upon to effect functional changes and improved quality of life in the patient. This is basically principle of repetition, overloading, anticipation and expectation. I have shown it in some of my previous studies that functional performance in stroke patient will continue to improve beyond the assumed 'window period' only if clinicians learn how to use the principle of repetition and irradiation. We should also know that if an information passes through a pathway continuously for a million times or more, there will be a permanent change in the neural information and consequently, a change in behaviour of the nerve. This will surely results in functional changes in the direction of the impulse.

This is just telling us that we should not stop the rehabilitation process for a stroke patient at any time. In some of my previous publications, I said that though the motor performance change may not be statistically significant, it will definitely bring a clinically significant change to the functionality and quality of life after stroke.

I am really surprised that a patient who can walk to the bathroom to clean up is wheelchair bound. I think the major gap here is that the rehabilitation team have undermined the principle of task oriented approach in improving functional performance. Functional performance is anticipatory and on-going. We should challenge the capacity of the patient by creating goal-specific functional re-orientation. We should create and discuss incentives of achieving a task with a patient while we create a barrier for the patient to overcome in order to earn the incentive(s). By doing this, we are creating an atmosphere for improvement in function. I need to stop here before this writing becomes a manuscript on its on.

I totally agree with you Caleb, I am working with children now but earlier I worked a lot with patients that had stroke, interesting and challenging

You may look into the research of Dr. Stacy Fritz at the University of South Carolina. Her research with stroke patients suggests that intense mobility training & constraint-induced movement therapy can improve mobility in individuals with a stroke.

I must clarify that the man did not have improvement on mobility. If you just look at his appearance, he looks like a healthy person with bright eyes, nice skin, and a feeding tube, which shows remarkable improvements from previous years. Because of weak muscles, he still sits on his chair (not a wheelchair) most of the time. I really doubt that the repetitive principle can apply here (i.e. visiting bathrooms 30 times spread out in a day). Otherwise, all skincare companies will have to close shop.

I believe your reluctance to believe that only 30 daily repetitions are enough to bring about the possibility of further potential improvement is based upon a lack of peer-reviewed evidence showing such changes. Home care and long term care clinicians who use task specific repetitive approaches see this phenomenon regularly. It is known to occur clinically, but has not been subjected to a scientific approach. It is unfortunate, but a wide gap for researchers to study.

Yes, there should be more researches to be done on cognition and chronic diseases besides the motor functions. My idea of the 30 bathroom visits is a treatment same as doing taichi or yoga. In this case, it is more like yoga stretching which can stress up your heart rate when you hold on to one pose. When you don't move, microcirculation can improve in brain and other organs(when precapillary sphincters and pericytes are opened) until heart rate comes down again. I also mentioned this in my Pao's Law of Exercise under the start-stop method (see attachment below). A friend just called up and said that my start-stop method can explain why the Aerobic Interval training is better than a sustained aerobic exercise or marathon. I have to look into this later.

Article A Brief Introduction to "Taichi Healing & Pao's Law of Exerc...

After checking through available data on aerobic interval training, I have found that most people use this method to build muscles or lose weight. Hence, they prefer to do high-medium intensity intervals or start-stop high intensity intervals. For the latter, most of them stop (or rest) for seconds, which is too short for stress hormone to dissipate. So, blood will be blocked by pre-capillary pericytes or sphincters in all internal organs. To pump blood to internal organs with higher heart rate while resting, I'll need to set up my own type of start-stop interval training later. I shall call it the Start-Stop (Low or medium Intensity) Interval Training for Organs (e.g. brain, skin, liver, kidney, and so on), 30 intervals per day. This will add 30 minutes of quality microcirculation time to each organ, which will enable healthy cell growth.

It is completely based on the principle NeuroPlasticity .And the Brain recognises the actions or activities done by the patient regularly stored in the remote cortex but not the muscle movement.

So i conclude that this is because of the neuroplasticity principle

Neuroplasticity won't work on skin cells and many other organ cells. Moreover, on neurons, plasticity can only help to find or train a new thinking path for motor skill. It may be good for cognition as well, But it won't make neurons or other brain cells healthier. If someone has all the weak cells in his brain because of a chronic anemia condition, neuroplasticity may not work on him at all because he is not able to concentrate well. In this case, you must improve the blood supply to his brain first before you try neuroplasticity.

The effects of mobility, like you are seeing in this case, go beyond improved brain control and neuroplasticity. We know, for example, that patients admitted to the ICU who are mobilized (sit at edge of bed, walk, etc.) have much better outcomes than those that that are sedated and on bed rest (regardless of the underlying diagnosis). This includes decreased mortality and reduces disability. The literature is strong on the effects of Rehabilitation. In a chronic case, the improvement rate is going to be different but having a more active lifestyle (even when that is only walking to the bathroom) can result in tangible multi-system improvements. Quantifying all these benefits and tracing it back to physiological changes is difficult.

If people can’t think out of the box, they can’t never find new ways or old ways to solve mysteries. One apparent problem with all lab tests on animals is that you can never train animals to sit still (or do VERY low taichi or yoga stretching) for half an hour. Without this training, a lab researcher can never see that there is one sure way of sending more blood to capillaries in brains and other organs. That is to raise up heart rates without body movements (or VERY slow body movements). Hope that more researchers and scientists can cooperate with cardiologists and neurologists and uncover more truth in the future.

Pao Yen: Thank you for both topics on (1) "getting to the bathroom" which, I may add, the hospital staff do not agree to perform or assist with in our area in the hospital, and (2) tai'chi which is acceptable in more modern and educated circles. In my area, supported employment has been in rehabilitation medicine (very sound community service with a good health aspect to it), but when near brain injury, exits as astronomical costs without community staff (new physiatrist)!! I would suggest at that gate, that the employment program gets its own name and model from the new professionals involved...it is no longer the same program, and taking the community funds is not welcomed. Rehabilitation medicine has been super at sports medicine and physical rehabilitation, does not accept psychiatric rehabilitation or rehabilitation counseling, and also supports rehabilitation centers, but usually in a congregate mode. Field of greatest potential for health and medicine...

It is a mind muscle connection problem that can be addressed through

Anytime you want to create movement from the muscle it begins with thought and nerve impulse from an active motor neuron or nerve cell which stimulates part of a motor unit which in turn the nerve cell or motor neurons sends an impulse down to a muscle fiber where it meets at the neuromuscular junction for the motor input. That stimulus travels through the fiber down to the T tubules and the biochemical method, which releases calcium from the sarcoplasmic reticulum, which is causing your contraction. With this problem we can send the stimulus from one end of the brain to the fiber to create activation. But if that is not longer happening due to what is happening inside the muscle fiber: the proprioceptors, Golgi tendon organ and muscle spindle fibers. They tell you the length and tension relationship of the muscle fiber or where you are in three-dimensional space. By applying different forces of resistances we can create tension and we create a change in length in the fiber. That’s then the stimulus back from the muscle. There is nothing wrong with the muscle, but something wrong with the stimulus heading to the muscle. If you say it is the problem with the sympathetic nervous system or the cerebellum or a person with brain issues, any of those, the stimulus problem is creating the activation from the brain, the actual motor neuron and getting stimulus to the fiber. Or with a stroke person, the brain is working fine, stimulus is fine, but it can’t travel down the pathway to the fiber. In both cases, there is nothing wrong with the afferent (receptor neurons that respond from the dorsal root ganglion dealing with pain through the peripheral nervous system); the problem lies within efferent (dealing with muscle control) is traveling away from the brain to the muscle. There is nothing wrong with the afferent, taking the proprioceptors inside the muscle (Golgi tendon organ and muscle spindle fibers) and getting information back to the spinal column and the brain so it understands relationship and where it is in space. Where traditional PT works to fix the muscles, the needs is a neurological re-activation, reminding the efferent that there is a muscle there that needs to be activated. In a sense, bringing muscle movement from the subconscious level to the conscious level during an intense forced repetition that focuses on the brain reactivating through isolation and focus, in turn elevate the number of fibers being fired or active motor units being fired to increase the number of fibers in that area to be activated. In combination with taking the body through movements that create afferent stimulus that give the brain an understanding of where the fiber is, how the fiber should fire, and then once we get the brain to find the place and activate the efferent it increases the number of fibers that are firing, stopping the over compensation and developing a sync again with the body.

I must clarify again. We are not discussing about mobility and muscle cells here. We talked about internal organs. To me, muscle cells in skeletal muscles are easy to handle because they do not have the same microcirculation dilemma problem as in organ cells. Anyway, I checked thru all the interval trainings available to date but they are all for muscles. So, I wrote my own interval training for internal organs (see below). After you read it, you'll understand why some people can get well by doing certain exercises but other people cannot get the same results. The reason is that they don't tell you what they do for the rest of the day. There is a big difference if you just sit or go here and there for the rest of the day. Anyway, let me know your feedback.

Article The 30-Time Start-Stop Interval Training For Internal Organs...