Lower Leg Engagement Meets Function

We have identified 3 key areas to post stroke motor rehabilitation that need to be addressed prior to regaining walking function; fluid and comfortable sit-to-stands, standing balance and lower leg engagement of the effected side. Here you will find practice videos for standing plantar flexion into knee flexion, a key exercise/movement for both regaining lower leg engagement and sequencing the proper gait mechanics.

For Right Sided Weakness

For Left Sided Weakness

The Conklyn Method for Gait Reintegration

The following is an exercise program that addresses what we perceive to be the most limiting factors in gait rehabilitation, impaired sequencing and decreased proprioception.  Through the Conklyn Method for Gait Reintegration we have seen impressive results in a short amount of time at all stages of recovery. Music is the key element in the success of this program as it is the music that helps to drive each exercise, allowing for more efficient movements and faster integration of each piece of the walking pattern. Optimal results will be achieved with a Music Therapist trained in the Conklyn Method.

Conklyn Method for Gait Reintegration

We have identified 5 core exercises for relearning a more functional gait pattern and improved proprioception, irregardless of where you are in your recovery process, and should be done in this order.  These exercises are most effective when done barefoot.  If you are not comfortable doing these barefoot we recommend doing them in shoes without the use of any orthotics.  These exercises can be done using a counter, or balance bar, for support but as you gain strength and confidence we recommend trying these unassisted. For safety reasons please have someone there to assist when necessary.

  1. Forward and Back Rocking Weight Shift
  2. Standing Plantar Flexion
  3. Standing Knee Flexion
  4. Knee Drop
  5. Heel Strike

After completing the exercises we encourage you to walk a little, trying to put all of these elements into your walking pattern.

Walking After Stroke

Gait instability is often a symptom of a brain accident, such as a stroke.  There are two areas that have the biggest impact on walking impairment after such an accident, proprioception and being able to properly sequence the gait cycle.

Sequencing is one of the most important and integrated aspects of our lives.  From the firing of our neurons to the actions we take, from the sentences we speak to how we eat with a fork, everything in our lives is in some form, a sequence. Any type of brain incident causes a myriad of sequences to be disrupted.  Yet once the event has occurred and therapy begins it can be more difficult to assess at what levels our functional sequences need to be addressed. When working on improved walking, therapists often encourage patients to take a “step”, forgetting that the wiring previously used for the sequencing of that “step” has been damaged.  Unintentionally, this often leads to compensatory patterns that are far from “normal” walking.  Practicing the individual movements involved in taking a “step” is paramount to helping the brain rewire the appropriate sequence for walking.

Proprioception is the ability to sense stimuli arising within the body regarding position, motion, and equilibrium. The sense of proprioception is disturbed in many neurological disorders.  In the case of walking after a stroke, the area most affected by loss of proprioception is the foot on the weaker side.  This is often the most difficult area to improve, yet without it, it becomes virtually impossible to regain independent functional walking.  If you can’t tell where your foot is in space how do you know if you are, or aren’t, walking correctly?  And more importantly, how can you appropriately engage in your own therapy? This should be one of the first areas addressed when working on regaining walking.

The vestibular system is a sensory system that is responsible for providing our brain with information about motion, head position, and spatial orientation; it also is involved with motor functions that allow us to keep our balance, stabilize our head and body during movement, and maintain posture. Thus, the vestibular system is essential for normal movement and equilibrium. In many people with neurological disorders this system becomes impaired and impacts one’s ability to return to normal walking function.

Through our experiences working in both acute and chronic stroke care, we have identified 5 core exercises for relearning a more functional gait pattern and improved proprioception, irregardless of where you are in your recovery process. These make up The Conklyn Method of Gait Reintegration. We have also identified peripheral exercises that work to improve both proprioception and vestibular function.  Combined these can lead to a more independent and “normal” walking pattern.

I’ve been told my speech won’t improve, now what?

This is a difficult but common query.  There are varying opinions in the medical world regarding recovery of speech following brain incidents. One of the most prevalent theories taught today states there is a window of 6-12 months for optimal recovery and following this time period one should not expect to see much improvement.  With many recent research articles showing improvements outside this window, I believe we will begin to see a shift in education that describes a very different model for recovery, be it speech or motor.  In the meantime the key is finding professionals who can address your specific need(s).  In regards to speech I recommend the following self-assessment:

1. Try singing the words to Row Row Row Your Boat.

2. Now try speaking the words.

Was there any difference in these?   Did you find it easier to speak the words before or after you sang them?

Singing and speaking use the same set of words yet are conveyed through different mediums and initiated with different regions of the brain.  Many people with acquired speech deficits, whether Aphasia, Apraxia, or Dysarthria, say it’s easier to sing these words then to speak them.  Of those, a large percentage said they felt it was easier to speak them once they’d sung the words.  While overly simplified, this demonstrates an ability to improve on one’s speech production.

If you are interested in exploring this further feel free to contact me to set up an initial assessment.

 

Is this Speech Therapy?

This is not Speech Therapy, Physical Therapy, Occupational Therapy or anything other than Music Therapy. While addressing similar goals as other therapies, Music Therapy is quite different in practice and utilizes regions in the brain that process musical properties to achieve the desired results. Music Therapy education focuses on the intersection of music and function, whether that be speaking and singing, walking and rhythm, etc., and how the network connections for musical properties, such as melody and rhythm, can be utilized for positive improvement.  In the model I am educated in and utilize at DBC3, this also entails knowledge of neurological function, physiology, psychology, anatomy, the mechanics of the vocal apparatus and motor function.

Who should I see, a Speech Pathologist or a Music Therapist?

If you are having speech difficulties, chances are seeing both would yield the best results. Many research papers have demonstrated that multi-modal approaches to recovery show the best results. Speech pathologists often work on a wide range of communication goals, both verbal and non-verbal, whereas a Music Therapist is likely going to work predominantly on verbal communication. This can be a good team approach and allow for each therapist to compliment the other. Many of my clients have come to me after being discharged from Speech Pathology. However, as soon as there are improvements in verbal communication I recommend being re-evaluated by an SLP.

Happy Anniversary

July marks the first year anniversary for DBC3 Music Therapy and it has been a rather successful one, if I do say so myself.  When I started this venture the hope was to offer neurologic music therapy services to a wider range of clients while providing more consistent treatment, and overall I believe that has been achieved.  Through new clients, research and conferences we are looking into new areas that neurologic music therapy can have a positive impact on.  These include Fronto-Temporal Dementia and Aspiration/Dysphagia..  We also had some success in getting 3rd party reimbursement and had another article accepted for publication.  Over the next couple of weeks new posts will provide more information on all of these areas, including upcoming presentations, so stayed tuned!!

Up and Running

I’m proud to present the website for DBC3 Music Therapy, LLC.  DBC3 is a provider of Music Therapy services in the Northern Ohio region.  This website is designed to be informative to those interested in Music Therapy services while also being interactive.  Feel free to leave questions or input on things you would like to see and I will see what I can do.  Welcome to DBC3 Music Therapy and I look forward to meeting your Music Therapy needs.

What is Music Therapy?

We define Music Therapy as the use of music to achieve one’s current full health potential, whether physical, psychological, communicative, social and/or neurological.

The American Music Therapy Association defines music therapy as the following:

“Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”

The World Federation of Music Therapy defines music therapy as the following:

“Music therapy is the professional use of music and its elements as an intervention in medical, educational, and everyday environments with individuals, groups, families, or communities who seek to optimize their quality of life and improve their physical, social, communicative, emotional, intellectual, and spiritual health and wellbeing. Research, practice, education, and clinical training in music therapy are based on professional standards according to cultural, social, and political contexts. Source: WFMT, 2011.”

These, and other definitions, have changed and evolved through the years with new understanding and knowledge gained through research and clinical trial.  However, the following lines from “An Introduction to Music Therapy” (Davis, Gfeller & Thaut, 1999) remain true:

“Given the various ways in which music is used as a therapeutic tool, it is difficult to articulate a brief yet comprehensive definition of music therapy.” (pg. 6)

“The effectiveness of music as a therapeutic tool that is applied for particular use depends on the skill and knowledge of the therapist.” (pg. 6)

Just as in any other profession Music Therapists have a wide range of skills (these include musical, clinical and adminstrative), use a wide range of tools (musical: such as instruments and genres/types of music, clinical: such as behavioral or humanistic approaches, administrative: such as particular assessments and documentation), and serve a wide range of populations using their skills to address a myriad of goals and objectives.