On a 400 meter oval track, actually only the Lane 1 runner starts and finishes at the exact same point. The other starting points are staggered in Lanes 2-8 so no one sprinter has any advantage (or disadvantage) compared to the other runners. Each runner has his own lane and has to run his own race. Each individual knows why he is running his race — what his trophy is — maybe a personal best, maybe a school record, maybe a gold medal. Each runner starts with nothing but an ambition. Each runner runs for a prize. Knowing what you work and train for is indispensable when race day arrives.
Generally, nothing in the medical paradigm prepares any person for a stroke event. Modern medicine is riddled with tests and medications and surgeries to fix things for patients. Patients are passive participants in most medical processes.
Neurorehabilitation specialists must be prepared to coach and train stroke patients in an active process around the rehabilitation oval. It is genius to begin with the prize, the salient task, so the patient knows what he/she is working for, training for, competing for. It is the way a race always starts…each individual knowing the prize, record, or goal they have chosen.
The stroke rehabilitation oval is not really just 400 meters nor is it a sprint. It is more like a distance event with hurdles, regularly placed hurdles and some thrown in along the way. The stroke event is usually a grueling race and it has to mean something and be for something specific — from the beginning — or it won’t be worth the hard work involved to get to the finish line. The patient and the therapist have to partner to get around the oval, over the hurdles, and into the finish.
Therapists working in neurorehabilitation have become accustomed to adhering to the pacing of the payers, the regimentation of training by “evidence”, and the risk aversion of institutions. Go fast (code for: get the patients out of the hospital), don’t do anything that doesn’t have evidence and, at all cost, do NOT take any chances! How have these become the guiding principles around the oval of stroke rehabilitation?
NeuroPros know that smart goal setting and effective coaching are dependent on different principles. The goal is made by the patient who has to run the race. The therapist/coach agrees to help with the patient’s hopes and dreams, not the payer’s financial goal. The start of training identifies the patient’s lane, their unique path, to run for their unique prize. It will require ingenuity on the part of the therapist and trying things that have never even been thought of, much less researched with mountains of evidence. Patient safety has been emphasized to a fault. If we just push the patients around the oval in their wheelchairs, they will never learn to walk or run. NeuroPros welcome the challenges around the oval of rehabilitation and know how to make risk/reward assessments. By our actions and confidence, we teach the patients how to be courageous and keep running toward their prize.
Stroke rehabilitation is a marathon sometimes. Therapists, we have to go the distance…from the start…until we arrive back at that line where the prize is claimed.