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Adélie’s injury has long been an uneasy subject for me, especially when we were still in the hospital hearing details about her injury and recovery from her neurological team. Having already lost my little Zackaël and suffering a deep depression, I found it difficult to stand up when discussing results (such as an MRI) about Adélie’s brain. The main subject of this post isn’t about the details of her injury, in fact I don’t even have all of those details. Instead, I will discuss a type of therapy we are undertaking with Adélie.
Our little Adélie suffered a traumatic brain injury (TBI) when the moose impacted on the left side of her head, which unfortunately resulted in permanent damage. In a previous post, Adélie’s Update, I talked a bit about some of Adélie’s disabilities, specifically on the right side.
Hemiparesis: a condition caused by brain damage or spinal cord injury that leads to partial paralysis or weakness on one side of the body. It causes weakness, problems with muscle control, and muscle stiffness.
For Adélie, the damage to the left side of her brain resulted in hemiparesis of her right limbs. As she began her recovery, Adélie used neither her right hand nor her right arm, instead using the left side for everything. Fortunately, her young age works in her favour (she was 2 at the time of the accident). The damaged brain tissue cannot regain its functionality, but other parts of her brain may take over some of the responsibilities of the damaged area. Rehabilitation is therefore important in order to facilitate this learning process.
Constraint-induced movement therapy (CIMT)
In the early 1990s, a study involving monkeys, supervised by a neuroscientist Edward Taud, made major breakthroughs in the area of neuroplasticity. He discovered and developed the constraint-induced movement therapy (CIMT) which helps people who have developed a “learned non-use” as a result of a neurological injury. CIMT is used to help people suffering from hemiparesis to retrain the arm and hand of the paralyzed side of their body.
In the study, the scientists immobilized (restrained) the monkeys’ stronger limbs, which many would have thought would leave the monkeys helpless. The monkeys were therefore forced to use their affected limbs, their “weaker side”. To the surprise of many, the monkeys gradually all started using their weaker side to eat, play and function.
With CIMT, the repetitive exercises induce the development of new neural pathways in the brain, and the patients learn to use the paralyzed limb again. Taub’s reasoning was that a monkey will not use the weak arm if it can rely on its good arm instead. If both arms are weakened, however, it will be forced to use them. This might seem paradoxical, but the hypothesis was confirmed by the experiments.
CIMT might be beneficial for patients who encountered the following conditions:
- Traumatic Brain Injury (ex. Adélie)
- Cerebral Palsy
- Multiple Sclerosis
- Spinal Cord Injury
- Other neurological conditions
Patients with Hemiparesis will often be discouraged from using the affected limbs because of the difficulty they encounter. We experienced this with Adélie, she was involuntarily starting to develop this “learned non-use” which can actually lead to further deterioration of her unused limb. It was so easy for her to use her left hand, but extremely hard for her to even lift her right hand. For a long period of time, her right hand used to be completely clenched and she seemed unaware that her right hand even existed.
During her hospital stay, in addition to the physio, Carl and I would stretch her hand several times per day. Her right hand would often be cold and blueish from no circulation. We finally began to see signs of her being aware of her right hand months after the accident.
The TCIM was suggested to us for Adélie. We figured Adélie would be ready for IMCT once she learned to walk again. However, Covid and the cancellations of its therapies meant that the TCIM trial had to be postponed. So it was in October 2020 that we were finally able to move forward with this therapy.
We had the option of a permanent or removable cast. As we know how determined our little Adélie can be, we opted for the permanent cast. With a removable, it could get difficult take it off and put it back on if she didn’t cooperate. With a permanent one, we have no choice, it cannot be taken off and it will be on her 100% of the time.
On October 6, Adélie’s left arm (“her strong side”) was completely cast all the way down to her fingertips to force her to use her right side, her “weak side”. The right hand was thus used intensively, after having been barely used at all by Adélie for almost a year since the accident.
CIMT was difficult during the first few days, especially at bedtime. Adélie was crying and begging me to take her off the cast, “enlève” she cried. It was uncomfortable for her. She would get frustrated because her right hand was very limited in what it could do. We therefore had to help her more and comfort her while explaining that it couldn’t be removed.
Adélie got used to it pretty quickly. She is a true champion. Unfortunately, during the time of her therapy, she contracted a urinary tract infection from a very resistant bacteria. This made her feel unwell (fever, lack of energy, etc), so we decided to stop the therapy after 18 days, only a few days shy of our planned 3 weeks of CIMT.
We are planning another CIMT in mid-January. The therapy will probably be repeated a few times a year. At this point, we don’t know if Adélie’s hand and arm will ever be able to return to normal. CIMT is still a therapy which is recent and is still the subject of several ongoing studies.
For Adélie, the rehabilitation will continue for several years. She has made so much amazing progress already, in all aspects of her life, and we’re confident that her little brain will continue to rewire and pick up neurons from elsewhere to make up for those damaged on her left side of her brain
We will always continue to work hard with Adélie. In fact, over the past week we have received lots of positive feedback from his therapists and educators at the daycare. We all noticed impressive improvement in her right-side limbs. She is using her right hand more and more for the activities she does. Bravo Adélie, we are proud of you!
That’s it for now!
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Source: A Scientist’s Pink Cast Leads To Discovery About How The Brain Responds To Disability, Jon Hamilton, June 18, 2020, https://www.npr.org/sections/health-shots/2020/06/18/877621475/a-scientists-pink-cast-leads-to-discovery-about-how-the-brain-responds-to-disabi,