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EMDR Therapy

Written by Onaolapo Adeyemi. Posted in EMDR

EMDR therapy involves focusing on three periods of time: yesteryear, present, and future.  The focus is offered to past disturbing memories and related events. Also, it’s given to current situations that induce distress, and to developing the relevant skills and attitudes necessary for positive future actions. With EMDR therapy, these items are addressed having an eight-phase treatment approach.

Phase 1: The first phase can be a history-taking session(s). The therapist assesses the client’s readiness and develops a therapy plan. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets might include related incidents previously. Emphasis is positioned about the progression of specific skills and behaviors that will be needed by the client later on situations.

Initial EMDR processing could be given to childhood events rather than to adult onset stressors or the identified critical incident in the event the client had a problematic childhood. Clients generally gain insight on their situations, the emotional distress resolves and they learn to change their behaviors. The length of treatment depends on upon a number of traumas and the age of PTSD onset. Generally, individuals with single event adult onset trauma could be successfully treated in less than 5 hours. Multiple trauma victims might require a lengthier treatment time.

 

EMDR_Therapy

EMDR Therapy

Phase 2: During the next phase of treatment, the therapist helps to ensure that the customer has lots of different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the customer may use during and between sessions. An objective of EMDR treatment therapy is to make a rapid and effective change while the client maintains equilibrium during and between sessions.

 

Phases 3-6: In phases 3 to 6, a target is identified and processed using EMDR therapy procedures. These involve the customer identifying three things:
1. The vivid visual image associated with the memory
2. A negative belief about self
3. Related emotions and the entire body sensations.

Furthermore, your client identifies a good belief. The therapist helps the customer rate the positive belief along with the power of the negative emotions. Next, the client is made to target the image, negative thought, and the entire body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets might include eye movements, taps, or tones. The type and period of these sets differ for each and every client. At this time, the EMDR client is expected to just notice whatever spontaneously happens.

After each pair of stimulation, the clinician instructs your client to permit his/her mind to go blank and to notice whatever thought, feeling, image, memory, or sensation one thinks of. Depending upon the client’s report, the clinician will select the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to assist the client in getting back on track.

If the client reports no distress related to the targeted memory, (s)he could be required to think of the preferred positive thought was identified at the beginning of the session. At this time, your client may adjust the positive belief if needed, after which focus on it throughout the next set of distressing events.

Phase 7: In phase seven, closure, the therapist asks the customer to keep a log during the week. The log should document any related material which could arise. It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made to date. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will need different responses

Power of the Brain

Written by Onaolapo Adeyemi. Posted in EMDR

Harnessing the Power of the Brain

by Glenn Patton
Best practice for assessment and treatment of gait and balance after stroke.

2011 – What would you do if you couldn’t walk? To learn about the best practices for gait and balance recovery, it is helpful to imagine one morning you step out of the house, and while walking to your vehicle, you suffer a potentially devastating injury to your brain: a stroke. After lifesaving medical treatments, you learn your rehabilitation program will begin. Though you can use your arm again, and speak and think clearly, you have great difficulty standing and walking. You might find it promising to know that approximately 80% of people who survive a stroke regain the ability to walk, with or without an assistive device.

1 Deeper research, however, indicates you may find yourself one of the fewer than 50% of survivors who progress to independent community ambulation.

2 Now, you want to know what you can do to harness the power of your brain in helping to recover these functions. After a review of the best practices that follow, imagine how you might create your plan of care for rehabilitation.

ASSESSMENT OF GAIT AND BALANCE

Emdr TreatmentStroke survivors who arrive at Sheltering Arms, the acute rehabilitation hospital where I work as a physical therapist, often need to relearn how to walk. Sheltering Arms has created a program of inpatient and outpatient services that implement the latest evidence for assessment and intervention called the i-Walk Recovery Center. The first step in evaluating a patient’s prospects for functional recovery is to determine what impairments most limit the ability to walk and maintain balance. Are there deficits related to strength and range of motion? Is there involuntary movement, or spasticity, that keeps the affected limb from moving appropriately? Does the individual respond appropriately to balance challenges? Some of these areas make a bigger impact on walking than others, and the answers to these questions often guide the treatment plan.

Finding all the key elements for independent community ambulation can help achieve optimum assessment of gait and balance. A basic function of walking is the ability to perform a reciprocal stepping action. This may be limited to individuals who have suffered a stroke for one of the following reasons: impaired ability to support the body against gravity; inability to move the lower limb; inability to sustain muscle contraction; or impaired spatial awareness. If stroke survivors can step with both legs, then they also must be able to maintain balance during movement of the body forward, as well as adapt to the environment. These functional abilities can be tested with standardized outcome measures for gait and balance, such as the BERG Balance Scale, Dynamic Gait Index, Ten Meter Walk Test, and Timed Up and Go.
EVIDENCE-BASED TREATMENT

After a thorough assessment to determine factors related to walking and balance, and after developing an understanding of the stroke survivor’s own goals, a treatment plan is initiated. The i-Walk Recovery Center utilizes a practice guideline to implement the use of innovative technologies related to the recovery of walking and balance. The use of these technologies is based on principles of motor learning and neuroplasticity. It was not always known that the brain is capable of modifications after injury. I advise patients that most importantly, stroke survivors need to specifically practice the task of walking in an intense, novel, and repetitive way.

I also advise that by practicing walking they may experience errors from which the neural pathways will be stimulated to learn. In addition, they will be exposed to progressive balance challenges to reintegrate balance reactions into functional abilities. As I explain to patients about the physical demands associated with regaining the ability to walk, I introduce them to technology used to aid in this process. Advanced technology allows patients to put these principles into use while a therapist skillfully determines which technology will work for a patient at any given point in recovery- ie, right patient, right tool, right time.

Certain tools are available to help patients perform exercises essential to gait and balance recovery.  Behrman and Harkema describe four principles of locomotor training that explain how walking can be task-specific:

A) Weight-bearing must be maximized in the lower extremities,

B) Kinematics, or movement of the body and limbs, must be normalized,

C) Sensory feedback and input must be maximized, and

D) Compensation through a use of altered patterns or devices should be minimized.

E) Technology can be useful to make walking retraining task-specific, even when a stroke survivor is unable to stand or move the involved limbs. For instance, we may put a patient in a robotic device that stabilizes the body and assists or performs the movement of the lower extremities. Sheltering Arms uses robotic-assisted gait training to help a severely impaired individual walk several hundred feet instead of only a few steps. The device provides control of variables such as the amount of body weight support, treadmill speed, and amount of guidance of the lower extremities. All can be modified to progress the intervention within the robot.

An excellent way to improve kinematics and sensory feedback for walking training is to apply functional electric stimulation (FES) to the lower leg to prevent toe dragging. Sheltering Arms frequently uses an FES device designed to work by applying electrodes to the muscle and nerve that flex the foot up at just the right time during walking. Often a patient simply needs to figure out “how” to move his or her body, and the FES device is designed to provide that feedback. After using the device, stroke patients sometimes remark: “Oh, that is what I am supposed to do.” This technology can provide therapists the freedom to get patients practicing task-specific walking earlier. We observe patients are often more engaged and have less fear of falling.

New research shows that more intense tasks produce neurophysiologic changes in the brain.  Repetition is also known to be important in optimizing benefits of neuroplasticity for stroke recovery.

3 By applying advanced technology that provides body weight support (BWS), a therapist can completely transform the type of walking practice performed. BWS systems have been used with a treadmill for many years, but new systems allow walking over the ground with a ceiling-mounted track for more adaptability in walking practice. The BWS system used by Sheltering Arms staff provides therapists much more freedom to let patients move on their own. That freedom allows therapists to increase the difficulty of the task the patient is performing while maintaining safety for the patient and therapist.

When individuals commit errors while attempting to learn new tasks, it is natural for those errors to actually help improve the performance of the new task. Currently, researchers are studying whether the brain will better learn how to produce corrections and permanent adaptations by having a therapist induce or magnify an error. One technology included in this study is the split-belt treadmill. The split-belt device used at the i-Walk Recovery Center is engineered with two belts running side-by-side that can be run at the same speed or independently at different speeds. Initial research is promising in demonstrating changes in gait over the ground after a stroke survivor practices walking faster while only the lower extremity is taking a shorter step. The result is often a more symmetrical pattern.

Discover What is Possible Diagnosing Mental Health

The future seems to promise more advanced medical treatment of stroke, and a greater ability to detect and enhance changes in a damaged brain. Through the use of evidence-based assessment and interventions performed by a physical therapist, augmented with advanced technologies, you can discover what is possible when you harness the power of the brain.

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