Welcome to LindaRusby.co.uk

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Blood Pressure

What is blood pressure?
Blood pressure is the pressure of blood in your arteries. Your heart is your body’s main pump and it pushes blood through your arteries by contracting and relaxing. When it contracts, it forces blood through your arteries and pushes the pressure of the blood to the highest point called the systolic pressure. When your heart relaxes between beats, your blood pressure is at its lowest called diasystolic pressure.

The two pressures are written as two numbers, with the higher pressure first. So, if your blood pressure reads 120/80 mmHg (millimetres of mercury), this means your systolic – or upper – pressure is 120, and your diasystolic – or lower – pressure is 80. Ideally, your blood pressure show be below 140/85 but if you’ve had a heart attack, stroke, have diabetes or diagnosed with coronary heart disease, your blood pressure should be below 130/80. We as part of our standard assessment will take your blood pressure measurement so that we and you know what your normal reading is.

High blood pressure?
High blood pressure called hypertension means that your blood pressure is constantly higher than the recommended level. High blood pressure rarely has any symptoms, so while you might feel well, over time your heart may become abnormally large and beat less effectively. High blood pressure also increases your risk of having a heart attack or stroke.

There isn’t always an explanation for the cause of high blood pressure, but the following can play a part:
Inactivity - We are here change that for you by giving you practical exercise programs to suit your personal requirements.
Being overweight - We through a workable healthy eating program will design a healthy eating program to suit your personal needs, likes and dislikes.
Eating too much salt - We will support this progress without ruining your enjoyment of eating.
Drinking too much alcohol - We can advise on this and support you with reducing your consumption if required.
Not eating enough fruit and vegetables - All our eating programs will look at this issue.
A family history of high blood pressure - We can not help in changing your parents, but we can advise your whole family on healthy living as a group booking at the same cost as advising one person.

What can I do and WE do to reduce your blood pressure?
If you know you have high blood pressure or we discover that for you in our assessment then we will advise you see your GP. He/she is likely to encourage you to make some lifestyle changes to help reduce it. They may include all or any of the following.
Increasing your physical activity
Keeping to a healthy weight
Reducing the salt in your diet
Cutting down on alcohol
Eating a balanced, healthy diet.

We will support you in all these changes.
If your blood pressure remains high, your doctor is likely to prescribe medication to control it and to protect your heart. If then through lifestyle changes you may with your GP’s consent reduce or even stop the medication.
Even if you don't have high blood pressure, making the lifestyle changes suggested above may prevent you developing it in the future.

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High Cholesterol?

Cholesterol is a fatty substance which is found in the blood. It is mainly made in the body. Cholesterol plays an essential role in how every cell in the body works. However, too much cholesterol in the blood can increase your risk of heart problems.
LDL cholesterol and HDL cholesterol

Cholesterol is carried around the body by proteins. These combinations of cholesterol and proteins are called lipoproteins. There are two main types of lipoproteins:
LDL (low-density lipoprotein) is the harmful type of cholesterol.
HDL (high-density lipoprotein) is a protective type of cholesterol.
Having too much harmful cholesterol in your blood can increase your risk of getting cardiovascular disease. The risk is particularly high if you have a high level of LDL cholesterol and a low level of HDL cholesterol.

Triglycerides
Triglycerides are another type of fatty substance in the blood. They are found in foods such as dairy products, meat and cooking oils.
They can also be produced in the body, either by the body’s fat stores or in the liver.
People who are very overweight, eat a lot of fatty and sugary foods, or drink too much alcohol are more likely to have a high triglyceride level.
People with high triglyceride levels have a greater risk of developing cardiovascular disease than people with lower levels.
What causes high cholesterol?
One of the causes of high blood cholesterol levels amount people in the UK is eating too much saturated fat.
The cholesterol which is found in some foods such as liver, kidneys, eggs and some types of seafood such as prawns, does not usually make a great contribution to the level of cholesterol in your blood. It is much more important that you eat foods that are low in saturated fat.
However, some people have high blood cholesterol even though they eat a healthy diet. For example, they may have inherited a condition called familial hyperlipidaemia (FH).

How can I reduce my cholesterol level?
To help reduce your cholesterol level, our healthy eating programs cut down on saturated fats and trans fats and replace them with monounsaturated fats and polyunsaturated fats. We will support you reducing the total amount of fat you eat.
Oily fish provides the richest source of a particular type of polyunsaturated fat known as omega-3 fats which can help to lower blood triglyceride levels and also helps prevent the blood from clotting, and help to regulate the heart rhythm.
Eating a high-fibre diet. Foods that are high in 'soluble fibre' such as porridge, beans, pulses, lentils, nuts, fruits and vegetables, can help lower cholesterol.
Doing regular physical activity can help increase your HDL cholesterol (the 'protective' type of cholesterol).
Will eating sterol-enriched foods help reduce my cholesterol level?
There is evidence to show that substances called ‘plant sterols’ and ‘stanols’ may help reduce cholesterol levels. They are added to certain foods including margarines, spreads, soft cheeses and yoghurts.

I've heard that eating too many eggs can raise your cholesterol - how many can I eat?
The recommendation on how many eggs you can eat has changed over the years and is a common source of confusion. In the past there has been recommended a restriction on eggs because we thought that foods high in cholesterol (including liver, kidneys and shellfish, as well as eggs) could have an impact on cholesterol levels.
However, as research in this area has developed so has the understanding of how foods that contain cholesterol affect people’s heart health. This means it has changed the recommendation and there is currently no limit on the number of eggs that can be eaten in a week.
For most people, the amount of saturated fat they eat has much more of an impact on their cholesterol than eating foods that contain cholesterol, like eggs and shellfish. So, if you like eggs, we can include them as part of a balanced and varied diet.
Will I need to take medication?
Whether you need to take cholesterol-lowering drugs or not depends not just on your total cholesterol, HDL and LDL levels, but also on your overall risk of coronary heart disease.
Cholesterol-lowering medicines such as statins are prescribed for people who are at greatest overall risk of suffering from coronary heart disease.

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Strokes

Therapy For Stroke Recovery &

Stroke Rehabilitation Service.

What do we offer different to Physiotherapy?
Physiotherapists offer what in most cases can be a life changing service for Stroke patients. They work to train you in gaining back basic life skills. Standing up, walking, walking up and down stairs and when you need aids to support this such as Walking Frames then they ensure you can obtain these aids. The savings to the NHS alone in reduced care cost as a result of supporting a stroke patient would be worth millions of pounds per year.
What do we offer different from your Doctors or GP?
Your doctors and GP will be offering drug therapy to help prevent more strokes occurring and medication to support any other health concerns, they will also be ensuring an after care service.

So what we offer are exercise programs to work both the good and the poor functioning muscles and joints. We offer support for you to regain life skills but we give you an exercise program that can be done safety by yourself without any help required. The exercises are done while you are in a chair or bed or both. One thing many stroke patients have is time. Unable to work, gardening, do house work and in some cases unable to walk unaided, can soon make anyone feel low. So our programs can support you in regaining self worth. We offer no drug therapy but we can chat about diet changes and other healthy living changes such as relaxation techniques.

We also can offer bilateral training, studies are showing that this can support stroke patients to recover. This training is done along side and apart of our exercise programs. For more details of bilateral training click here. We will use bilateral training on all parts of the body from the face down to the feet.

Also we can offer massage, done while fully dressed while seated or lying down. We use an adapted form of Thai Massage to help release muscles and improve joint function. It can also be used to ease painful areas caused by the Stroke.

Exercise and Therapy bands are used in many centres, such as sports clubs,
physio departments, hospitals and by therapy trainers. They comprise basically
of strips of heavy duty rubber which are colour coded. The colours correspond
to the thickness of the rubber and how much resistance they provide.
Available in individual lengths or rolls, these can easily be cut to the
length required of the roll so that the patient/client obtains the correct
length required for their treatment. Also used by professional sports
people and in Yoga and Pilates, they are ideal for stretching or warming
up before and after exercise.

We use these bands along with stretches, diet and other advice to aid recovery.

Most Strokes are of to main types. The most common type of stroke is a blockage, called an ischaemic stroke. This happens when a clot blocks an artery that carries blood to the brain. It may be caused by either
A cerebral thrombosis, when a blood clot (thrombus) forms in a main artery to the brain.
A cerebral embolism, when a blockage caused by a blood clot, air bubble or fat globule (embolism) forms in a blood vessel somewhere else in the body and is carried in the bloodstream to the brain.
A blockage in the tiny blood vessels deep within the brain (lacunar stroke).

The second type of stroke is a bleed, this is when a blood vessel bursts causing bleeding (haemorrhage) into the brain. Called a haemorrhagic stroke. It can be caused by
An intracerebral haemorrhage, when a blood vessel bursts within the brain.
A subarachnoid haemorrhage, when a blood vessel on the surface of the brain bleeds into the area between the brain and the skull (subarachnoid space).

Full supportive advice and full information on Strokes can be found at
www.stroke.org.uk

Preventing a stroke
This section tells you how you could reduce the risk of stroke for yourself or someone you care for.
As with any disease some people are more at risk of stroke than others. There are factors that can not be changed such as your genes and your age.

However, many simple lifestyle changes may prevent you from having a stroke. If you have already had a stroke, then these changes may help prevent another stroke happening again.

Exercise
Just taking more exercise, simple for most but harder if you are now disabled by a Stroke. We can support you by instruction, use of training aids, motivation and all this offered within your own home. Regular physical activity helps to lower blood pressure and creates a healthy balance of blood fats as well as improving your body’s ability to handle insulin.

Our long term objective will be to get you choosing activities you enjoy and we will help support you back into these activities.
Things like walking, or harder things such as dancing, swimming, cycling, tennis or even golf. Any activity that makes you feel warmer and slightly out of breath will be a start in the right direction.
We will ensure you do not overdo it to start with.

Taking it slowly at first and especially if you’re not used to physical activity. We start at what you can do and build on that.
Just 30 minutes of activity five days a week is enough to reduce your risk of stroke. You don’t have to do it all in one go – it is just as effective to exercise a few times a day in 10-, 15- or 20- minute sessions.
We train you in ‘Warm up’ and ‘Cool down’ to prevent muscle cramp and stiffness. A warm-up (gentle stretching exercises and movement) and slowing down gradually (again with stretches) at the end to allow your heart rate to return to its normal resting rate.
Exercise Partner/Carer
Exercising with a friend, partner or carer makes it more fun, as well as helping keep up your motivation. We can teach them to work with you. Different activities exercise different muscles, we will look at your weakness muscles groups but will also ensure balance throughout all of your muscle groups and just as important keeping your mind alert.

Smoking
Smoking doubles your risk of a stroke because it causes the arteries to fur up (atherosclerosis) and makes the blood more likely to clot. These increase the risk of a stroke.
No matter how old you are or how long you have smoked. It is worth the effort to at least reduce the amount of smoking you do to improve your health.There is loads of help is available to support you stopping smoking.
We can recommend Self-help books for tips and advice, supply Information leaflets. Nicotine replacement therapy such as chewing gums, sprays and patches. Please note that nicotine may not be suitable for people who have already had a stroke. Your doctor advise you.
As important as giving up smoking can be as smoking is one of the most important things you can do to avoid a stroke, we will help you to reduce the amount you smoke.

Healthy eating
Healthy eating is essential for a healthy heart and bloodstream
Snack on fruit and vegetables, eat as much fresh fruit, vegetables, and dried fruit as you like. We can help ensure this is availably to you. You should aim for at least five portions of fruit and vegetables each day. A portion is about 80 grams (3 ounces). An apple, an orange or a glass of orange juice, a large carrot, two broccoli florets, a handful of grapes or three tablespoons of peas are about 80 grams each.
Choosing low-fat proteins
Avoiding eating too much red meat, instead choosing fish, poultry (with the skin removed), game or vegetarian alternatives instead. Most red meat is high in saturated fat which contributes to the arteries furring up.
Reducing your salt as salt raises blood pressure. Limiting adding salt to your food and avoid processed foods which can contain a lot of salt.
Foods high in fibre help control blood fat levels. Trying whole-grain cereals, porridge, brown rice, whole wheat bread and pasta, and grains such as couscous.Limiting the amount of fat you eat. We need some fat in our diet, but too much can clog up your arteries and add to weight problems. Limiting the amount you use and sticking to vegetables, seeds and nut oils rather than margarine and butter.Being overweight is a risk factor for high blood pressure, heart disease and diabetes, all of which increase your risk of a stroke.

A healthy diet and regular exercise will help control your weight. We support well controlled weight loss programs suited to YOU, your desires, needs, likes and dislikes and just as important that is practical for you to follow. Many disabled people can lose choice when they rely on others to care for them. We support the process to give you back free will.

Our Funding.
We as yet receive no funding for the NHS or any charities. We intend to never rely on any one kind of funding as these will always have a limit to what funding they can offer so will always reduce what services we can offer.
We at present charge for our service, however we do offer discounts for those that can be shown as unable to pay the full charges. To protect our clients we always offer -

A free assessment session to start with. This enables us to see what help we can offer the client.
A full program to suit your needs with the coast clearly stated in advance.
If you are on a GP referral, then this program with costs will be forwarded to your GP as well as updates on your progress.

As part of our support and to correctly assess your ability to pay for our services we will ensure you are receiving all of the funds that you may be entitled to by LAW. These are as follows;

Disability and sickness benefits
Most people who have had a stroke will be entitled to some sort of income, either from their employer or from the Department for Work and Pensions (DWP). Statutory Sick Pay (SSP)
If you are employed, you may be able to claim Statutory Sick Pay (SSP) from your employer, depending on how long you've been employed, your age and how much you earn. SSP can be paid for up to 28 weeks of sickness. When your entitlement to SSP ends, you may be able to claim Employment and Support Allowance, a new benefit (replacing Incapacity Benefit and Income Support from 27 October 2008). If your stroke (or illness) happened before 27 October 2008 and you are under State Pension age you may still be able to claim Incapacity Benefit. Department for Work and Pensions benefits
Contact the Benefits Agency, Department for Work and Pensions, for more information on the following:
Employment and Support Allowance (ESA) replaces Income Support and Incapacity Benefit from 27 October 2008 and is paid to people who cannot work because of illness or disability.

There is more information about this new benefit at http://www.direct.gov.uk/en/DisabledPeople/FinancialSupport/esa/index.htm
Disability Living Allowance (DLA) is for people under 65 to help with personal care and mobility. It can be claimed alongside other benefits and income, and is not based on financial circumstances
Attendance Allowance (AA) is for people 65 and over who need help with personal care. Payment starts six months after a stroke but can be claimed beforehand
Someone who cares for a disabled person for more than 35 hours a week may be entitled to Carer's Allowance (CA), depending on other benefits and their income.Benefits Agency enquiry line
Freephone: 0800 88 22 00
Textphone for people with hearing difficulties: 0800 24 33 55Low-income benefits:
Income Support, If you are aged 16-59 (contact your local Jobcentre)
Working Tax Credit (contact HM Revenue and Customs on 0845 300 3900)
Pension Credit, if you are over 65 (phone the Pension Credit helpline on 0800 99 1234)
Help with payment of mortgage interestLocal council benefits
Apply to your local council to see if you can claim Housing Benefit (for help with rent) or Council Tax Benefit (for help with Council Tax bills).
Local council benefits and low-income benefits are paid to couples, so each partner's income is taken into account.Our fees are as follows
Free assessment of between 30 and 60 minutes.
Free financial assessment.
Free program reports and updates to GP via a GP referral.
£35 for an hour session
£25 for a 30 minute session
Free follow up phone calls to a home phone number, cost to mobiles will be the at cost.

A full 3 month program will be drawn up with agreement with the client showing all sessions and the fees involved including payment times and method. As a rule the fees should never need to exceed £60 in any one week or £240 in any one month or £580 in the first three months. Our aim is for to be able to follow our programs without needing us other than phone support after the first three months. Of course we will be there is you still need us after the three months.

Discounts of 50% can be made available if required after our financial assessment. Funding support from a charity may be made available but no promises as this is out of our control.

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Diabetes

What is diabetes?
Diabetes means that there is too much glucose (sugar) in the blood. Your body usually produces glucose when you digest your food, and a hormone called insulin takes the glucose from your blood and helps it enter your cells where it used. As the insulin takes the glucose, your blood glucose level reduces. Diabetes develops when your body doesn’t produce enough insulin, which leads to the level of glucose in your blood becoming too high.

There are types of diabetes?
Type one diabetes is when your body cannot make insulin. This type usually affects children and young adults.
Type two diabetes is more common, and occurs when you can’t produce enough insulin or it doesn’t work properly. Type two diabetes tends to develop gradually as people get older and usually after the age of 40. It is closely linked with being overweight and not being physically active. People are also more likely to develop this condition if there is a family history of diabetes.

Almost two million adults have been diagnosed with diabetes in the UK, but this number is rising. Worryingly, type two diabetes is now being diagnosed in younger people. It is estimated that by 2010 about three million people will have been diagnosed with diabetes. Some ethnic groups have a much higher rate of diabetes - particularly people of Afro Caribbean and South Asian origin.

Diabetes is linked to heart disease?
Diabetes increases your risk of developing cardiovascular disease. High glucose levels can affect the artery walls, encouraging fatty deposits (atheroma) to develop. If you have diabetes, you are more likely to have high cholesterol levels and high blood pressure. Diabetes also increases the effect of some of the other risk factors for cardiovascular disease – such as smoking and being overweight.

What can I do?
If you don’t have diabetes, you can greatly reduce your risk of developing it by controlling your weight and doing regular physical activity.
If you do have diabetes, it’s very important to make sure that you control your blood sugar, blood pressure and cholesterol. This will help to keep your risk of cardiovascular disease as low as possible. You can also:

Do more physical activity
Eat a healthy, balanced diet
Control your weight and body shape
Give up smoking
If you are diagnosed with diabetes, you may also need to take medication such as statins (a cholesterol-lowering medicine) to help protect your heart.

More information - http://www.diabetes.org.uk Tel: 0845 120 2960

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Heart & Lung Conditions

Being diagnosed with a heart condition can be frightening for anyone and you may have many questions running through your mind. You may find it helpful to understand your condition to reassure yourself as well as your friends and family.

Sometimes, just understanding the condition - its symptoms, treatment and the recovery process - can help you feel more in control of what's happening to you and help to reduce some of the anxiety that you may be experiencing. There are many heart conditions and even the same conditions can be very different for each person. For full information go to www.bhf.org.uk We will help you understand your condition and give you positive ways to help you to recover, along side your GP and any Special Heart Team from your local hospital. Action taken now can support your recoverly.

Stress
We all find different things stressful and experience different symptoms of stress. While we all crave a stress-free life, a degree of stress is necessary to keep us motivated and enthusiastic. Getting the balance right helps us lead a healthy, active lifestyle and cope with stress in a positive way.

How does stress affect the heart?
Stress is not a direct risk factor for cardiovascular disease, but it’s possible that stress may contribute to it depending on your coping mechanism for stress. Some people cope with stress with destructive behaviour – such as smoking, drinking too much alcohol and overeating. These increase your risk of cardiovascular disease.
There is no evidence to suggest that stress causes coronary heart disease or heart attacks, but if you have coronary heart disease and experience feelings of anxiety or are under lots of stress, it may bring on symptoms like angina.

What you can do?
Changing your lifestyle in a positive way can help you feel physically fitter and better able to cope with some of the demands put on you. A balanced diet and regular physical activity will help you cope with stress.
If you often feel stressed or anxious, it is important to learn how to relax. Some people find that physical activity, yoga or other relaxation techniques can help. You could make a list of things that help you to relax and schedule one every day.
There is plenty that you can do to manage stress or anxiety. You may need to identify situations that make you feel stressed at home or at work and try to avoid them if you can.
You may find it helpful to learn about techniques for managing stress. If you think you are stressed or very anxious, then by all means talk to your GP who will be able to help you decide on the best way to deal with it. For help with the ways you can deal with stress,then contact us now.

Exercise and the lungs
The amount of air you need to breathe in depends on how active you are.
When you are sitting down you only take in about 15 breaths a minute, giving you around 12 litres of air (a litre is one and three-quarter pints). From this your lungs will extract just one fifth of a litre of oxygen.
During exercise your breathing and heart rate increase. Exercising flat out, a top-class athlete can expect to increase his/her breathing rate to around 40 to 60 breaths a minute. This means they take in an incredible 100 to 150 litres of air, extracting around five litres of oxygen every single minute.
Even those of us with more modest goals need to double our lung intake when we exercise. Our lungs must be able to respond to our body's increased demands for oxygen.

What happens when you exercise?
As you start to move about, the muscles in your body send messages to your brain that they need more oxygen. Your brain then sends signals to the muscles that control breathing called your diaphragm and the muscles between your ribs so that they shorten and relax more often. This causes you to take more breaths.
More oxygen will be absorbed from your lungs and carried to the muscles you are using to exercise, mainly your arms and legs.

Why do muscles need more oxygen?
For you to become more active your muscles will need to produce more energy. They do this by breaking down glucose from your food, but to do this they need oxygen. If there is too little oxygen they will try to produce energy in a different way. But this can lead to a build-up of a chemical called lactic acid, which causes cramp - something that many athletes are all too familiar with.
Athletes train so that their lungs and muscles become more efficient and it takes longer for lactic acid to build up. This means that their muscles can work harder. In fact, everyone can benefit from exercise to strengthen their lungs and muscles.What happens when your lungs don't work properly?
People with long-term lung problems such as COPD (Chronic Obstructive Pulmonary Disease), may find their lungs unable to provide enough oxygen for their muscles to perform even simple activities. When walking short distances their lungs may struggle to keep up, which causes breathlessness.

Physical training.
Through exercise you can train your body so that more oxygen is delivered to your muscles.
Unfortunately, many people with long-term lung problems are afraid to exercise. This is partly because they are worried that being breathless may be harming them. This isn't true. By gradually building up the exercise you take, you can help to improve your breathing and feel better.
People with severe lung problems benefit a lot from even small amounts of exercise, so it really is worth keeping as active as possible.
We can begin slowly by teaching small arm and leg movements while you are sitting down. Then together we will set you targets for walking, starting just from room to room, going to the front door, the bottom of the garden, down the road and so on if that is all you can do to start with. It will be surprising how quickly you'll be able to do more each week.

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Smokers are almost twice as likely to have a heart attack as people who have never smoked.
It can increase the risk of developing several different types of cancer and is the main cause of some lung diseases.

How does smoking damage your heart?
Smoking harms your heart by damaging the lining of your arteries, leading to a build up of fatty material (atheroma) and a reduced space for blood to pass through the carbon monoxide in cigarette smoke reduces the amount of oxygen that the blood can carry to your heart and body. The nicotine in cigarettes stimulates your body to produce adrenaline, which makes your heart beat faster and raises blood pressure, so your heart has to work harder. It also makes your blood more likely to clot.

The dangers of smoking
The tar in cigarette smoke damages cells in the airways of your lungs. Eventually this damage can produce cells that grow uncontrollably - leading to cancer of the lung or voice box (larynx).
Because of this, your body sends protecting cells to your lungs to try and defend them, but cigarette smoke destroys them. The dead cells then release substances that damage the structure of the lung. This leads to Chronic Obstructive Pulmonary Disease (COPD).
Cigarette smoke also releases substances into your bloodstream that damage other organs. The arteries can be affected in your heart, brain and other places. This can lead to angina, heart attacks, strokes and poor circulation. It also increases your chances of developing cancer in other areas of the body, such as the gullet or bladder.

Passive smoking
Passive smokers inhale smoke breathed in and out by smokers. They also breathe in the smoke from the burning tips of cigarettes. This smoke contains more of the harmful chemicals than the smoke which has passed through the cigarette filter.
Passive smoking often troubles non-smokers, especially if they have asthma or other lung problems.
Children growing up with parents who smoke are more likely to develop lung problems. The risk of sudden death in young children is also increased when their parents smoke. There is a small increase in the risk of lung cancer in non- smokers who are in close contact with smokers for a long time.

The benefits of stopping
The sooner you stop, the less likely it is that your heart, lungs and other organs will be damaged. Symptoms such as coughing can get better within days or weeks. If COPD has started to develop, stopping smoking will prevent further damage. Continuing to smoke causes a steady increase in shortness of breath. This limits your activity and increases the risks of lung and heart failure. It is never too late to think about stopping.
The risk of lung cancer increases the more you smoke, and the longer you smoke. Once you stop, the risk of lung cancer starts to go down. After ten years off cigarettes, the risk is halved compared to the risk if you had continued smoking.
Whilst some people go through life unaffected by smoking, millions do not. Too many people think 'It will never happen to me' - until they develop cancer or have their first heart attack.

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STROKE STUDY FINDS THAT REPETITIVE BILATERAL TRAINING ACTIVATES REGIONS OF THE BRAIN INVOLVED IN MOTOR FUNCTION
Findings suggest that new avenues of therapy may help disabled stroke patients
A new study led by investigators at the University of Maryland School of Medicine shows that a rehabilitation program for stroke patients, which involves repetitive, simultaneous movement of both arms, activates new pathways in the brain. This indicates that parts of the brain can be trained to take over the function of damaged areas. Two-thirds of the patients in the study who had this type of therapy, called Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC), also showed functional improvement, even though their strokes occurred an average of four years earlier. Results of the study are published in the Oct. 20, 2004, issue of the Journal of the American Medical Association.
“This study provides evidence that in stroke patients, the brain can be trained to use new neuromuscular pathways in response to a training regimen,” says Jill Whitall, Ph.D., a professor in the Department of Physical Therapy and Rehabilitation Science at the University of Maryland School of Medicine, and principal investigator of the study. “These findings provide hope that with specific training, more people can regain function even years after a stroke.”

The randomized, controlled clinical trial included 21 people who were paralyzed on one side of the body. Nine of the participants received BATRAC, a therapy that involves rhythmic reaching and retrieving actions with both arms (including the disabled arm) moving to the beat of a metronome. The rest of the participants were in an alternative therapy group, which performed a set of different exercises with just the disabled arm. Both therapies were conducted for one hour, three times a week, for six weeks.
The researchers used functional Magnetic Resonance Imaging (fMRI) to examine the impact of the exercises on brain function. The imaging tests were performed both before and after the six weeks of therapy.

“Six out of the nine patients who received BATRAC training showed increased and new sites of activation in the brain, mostly on the undamaged side, as if new pathways were created,” says Dr. Whitall, a co-inventor of BATRAC and a research investigator at the Geriatric Research, Education and Clinical Center (GRECC) at the Baltimore VA Medical Center. She adds that no new sites of activation were seen on the imaging tests in the group that received therapy on just the disabled arm.
However, the researchers observed that overall, following the study, most patients in both therapy groups were better able to move their affected arm, even though they were well past the usual three- to six-month time frame following a stroke when therapy is stopped and spontaneous recovery is complete.
The training portion of the study was conducted at the Baltimore VA GRECC. The University of Maryland investigators collaborated with researchers from the Johns Hopkins Brain Injury Outcomes Division, the Kennedy Krieger Brain Imaging Center and the University of Tubingen, Germany.
“This study leads us to believe that the brain may have a functional reserve capacity for rejuvenation after a stroke,” says Andrew P. Goldberg, M.D., professor of medicine and director of the National Institute of Aging Claude D. Pepper Older Americans Independence Center at the University of Maryland School of Medicine. “If we learn to harness that reserve through specific rehabilitation regimens, we may be able to help many patients restore function and vastly improve their quality of life,” adds Dr. Goldberg, who is a co-author of the study and director of the Baltimore VA GRECC.
One unresolved question is why three of the participants who had the BATRAC training did not show any improvement in motor function changes or new brain pathways. Dr. Whitall says that may be related to the slow speed chosen for the BATRAC training in this study. “Perhaps a higher level of intensity in the training would have helped the remaining three patients in that group,” she says, adding that in a future study, researchers will increase the frequency of arm movements and the amount of exertion required of patients during the exercises.

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Contact:
lindarusby@lindarusby.co.uk
Tel: 01903 751106
Sompting, Lancing, West Sussex, UK

Training and Qualifications
Personal Training & Advanced Instruction Reps Level 4
Low Back Pain
Gym Instruction NVQ Level 2
Nutrition For Sport & Exercise
GP & Exercise Referral Reps Level 3
Mat Pilates Fundamentals OCR Level 2
Circuit Training
Torso Training & Core Stability
Psychology Of Behaviour Change
INWA Nordic Walking Instructor

Andrew Gadd- Training and Qualifications
Vocational Related Qualification (VRQ) in Fitness Instructing for West Sussex Fire & Rescue.
Traditional Thai Massage Therapist trained at Wat Po Massage School, Bangkok, Thailand.
Member of the Independent Professional Therapists International - Insured by AXA Insurance UK plc.

Sports and Holistic Massage Therapist - Sally Tarr

Broadwater Osteopathic Practice

| Linda Rusby | Andrew Gadd|