Audio-motor training

As a proviso to any post I make regarding medical or physiological information, I am not medically trained, nor gifted with any in-depth knowledge of the matter. Since having six TIAs and a stroke in 2020, I have bumbled my way through rehabilitation, mainly, gleaned from academic and medical papers on subjects related to my condition, and my own aptitude for nutting stuff out. I was given a minimal amount of physio information after leaving hospital, that information came my way via a few emails. After some research, I discovered that the exercises given to me were not really applicable to my disorder. In sum, they were ineffective, and I was wasting my time applying them to my rehabilitation regime. After two years, one gets to know what is helping and what is not. So, I wanted to share something that has helped me, and to explain the reasoning behind it.

I wanted to add this to my Cerebellar Stroke in a Nutshell post but it seems that once a post reaches a certain age, it can’t be edited by the author. Never mind, I can link it all together as a hypertext post down the track.

Back in January of this year, I became interested in auditory biofeedback, this is a process similar to experiments conducted with behaviourism in the 1930s, using sound to provide signals to the brain in order to evoke a response. Auditory biofeedback is conducted with equipment, a device for producing frequencies and a device for recording and displaying degrees of physiological response. Well, that’s not practical for someone like me, so I thought that the principle could be modified in a more organic and natural way, but serving the same purpose.

Here is my layman’s theory on the subject, keeping in mind that I am focussed on rehabilitating proprioceptive (vestibular) and oculomotor issues, that is, spatial and visual problems. For most stroke survivors, it is the cognitive injury that results in a physiological problem, unless a physiological issue has developed from the brain injury. So, if your leg doesn’t work, for most stroke survivors, it is not the leg that is the issue, but the brain. Same with sight, the blurred vision is not because of eye deterioration but in light of the fact, a part of the brain that communicates focusing control over depth of field is out to lunch.

There are some parts of the body that are autonomous and do not require messages from the main brain but, on the whole, our physiological motor function is controlled by electrical messages passed on by neurotransmitters. I say main brain because I view us having three brains, our cerebrum, cerebellum, and stomach.

When I look up, my eyes know what to do. The oculomotor muscles shift my eyeball upwards, and I am looking up. My eyes know what to do because my brain has told them. My brain has translated the concept and the word up so implicitly that I don’t even have to consciously say it in order to produce a result. I don’t even have to consciously think it. The word up is an Old English word (mainly used as a preposition or adverb), related to the German word auf (on top of). It has been part of our language since we started to shift from Anglo-Saxon to Old English. It is embedded in every English speaker as a word that denotes something higher. Even it’s Proto-Indo-European root word upér has not changed much in the development of our lexicon. It is a rather brief word with only two phonemes, possibly because it was used primarily for situations involving danger or predatory behaviour, or for theological check-ins, or for agricultural reasons, or maybe just to talk about the weather.

I can use all its synonyms to produce the same result; upwards, above, skywards, high, overhead, aloft, &c. All these words will direct my oculomotor muscles to raise to the heavens. So finely tuned is this word that it behaves almost automatically, however, without presupposition, if I command a person to look aloft, their movement is slightly delayed compared to asking them to look up. So, were I to be asked to look pookporkle, what will my eyes do? They would look confused. My brain has no directory input for this word. My oculomotor muscles would sit idle, waiting for the right command, or they may just roll in the ridiculousness of the instruction. it’s not my eyes that have the issue, it’s that my brain is not using the right command to exercise the correct control needed to look to the sky.

Obviously, the function came before the word. We didn’t know the word up when we were babies reaching for the biscuit tin. However, I must mention that linguistic systems are established within our genetics and DNA, so it is sort of superfluous to tag that notion along with this post.

So, let’s use blurred vision as an example. As with looking up, my brain has established a dialectical connection between the word focus and sharpening images across our depth of field. My eyes can focus, there’s nothing wrong with their capacity in doing so. It’s the part of my brain that recognises focus as a function that is not giving my eyes the appropriate command. It is essentially telling my eyes to pookporkle when it needs them to focus. I know I have focus in my input directory because prior to the stroke, I was able to focus. My eyes have not deteriorated. I have had them examined twice now, and my eyesight, in theory, is one hundred percent. So, focussing is probable but it is a matter of shifting that input somewhere else in the brain, so that it can resume that function. The only way I can do that is to retrain my brain to establish that function, and the way I can do that is to use the word focus as auditory feedback, because I know my brain understands the word and associated purpose. In theory, it should be possible to reinstate that sensorimotor function by utilising the conscious voluntary part of my brain that understands that process in order to reestablish the unconscious involuntary function I once had before stroke. There is an exercise where we perform this activity by focussing near and far, in order to rectify problems with our accommodation-convergence reflex, but without audio feedback. This principle is the same, it retrains the brain to recognise the functions that it already knows how to use. Our brains understand the concept of near and far but we have to retrain it to recognise this concept again.

Anyway, this is just a burgeoning theory that I have been putting into practice. I’ve had some efficacy with steadying nystagmus through auditory feedback. I’ve measured this by looking into a bright light while my eyes have been flittering, closing my eyes so that the flittering impression of the light is on a black background, and telling myself to focus and steady the flittering light until it remains still. I have delayed photoreceptor processing, so the light remains visible in my photoreceptors for longer than before, so this makes it handy for observing control over light for longer periods of time.

Apologies if all this unravelling is spelling out the bleeding obvious. I must deconstruct my condition as per I see it, otherwise, I fail to grasp what I ought to do in order to rectify it.

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Phew! I’m worn out now having read that.
Interesting though and seems to make sense.

Now if you could tell me how to make the connection that tells my left hand and foot how to recognise the sense of touch I’d be eternally grateful :grin::+1:

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Shwmae @Ingo66, while the theory is not new, auditory biofeedback has been used for sensorimotor retraining for about ten years (I think) in a clinical environment, it is worth considering it as something that may be applicable in everyday rehabilitation. I don’t know much about tactile issues and the brain, due to my problems being visual-spatial. However, thankfully, we do have a vocabulary that is assigned to almost anything. Your brain already knows what soft, prickly, smooth, rough &c, feel like. It is just getting it to recognise those sensations again and translate them via the sensory cortex. I think tactile things are a bit more complex because they involve maps; multiple processes.

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@Rups I think I understand what you’re saying. The bit that particularly resonated with me was where you mentioned the leg. I have issues lifting my leg & have been told many a time by physios etc that my leg works perfectly well (& this is indeed the case if someone moves it for me) it’s the signals from the brain that are either scrambled or not getting through that stop it working on its own.
Very interesting.

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Diolch @Mrs5K, unfortunately, sometimes stroke survivors do acquire conditions after stroke. For instance, Hydrocephalus which is fluid build up in the brain can be acquired after cerebellar stroke. Acquired conditions complicate matters, but if a stroke survivor has no acquired conditions or an inflamed previous condition after stroke, then working physical function is purely a brain matter. Well, mostly, if in a jazz band, the drummer is out of time, it might cause the trumpeter to play bum notes, which in turn causes the pianist to play off key, and then the singer to sing out of tune. I think that is what makes rehabilitation harder than it seems in theory.

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(this at silly o’clock in the morning, yet again)

We have an organ, a function of the mind, which does not necessarily need words but does control much of what is going on here. In this forum on this page I will need words to express what I am describing, but the actual function requires no verbal input. Excuse me as I describe this with words.

The organ I refer to is the imagination. I will use words here to describe a process that you can try out for yourself. The linkage Rups refers to, a non-operative brain path can be reached by an operation of the imagination. As I am limited to my own experience, let me take you through this from my point of view. I have a fully functioning left hand, but a non-functioning right. I can imagine touching the forefinger of my left hand with the thumb of that hand. All of this non-verbally. I can command this to actually occur and tips of thumb and forefinger will come together.
Big problem. Try the same thing with my right hand and although I can imagine that process the performing of it does not link with the image.
Strangely, if I repeat this imagining I begin to feel connections being built. Not necessarily perfectly at first but definitely there. Persist and some slight ability begins to return. I cannot say whether neural pathways can be completely rebuilt in this way, I am only in the first stages of recovery, but there does seem to be a possibilty of some success.
I know I am opening myself up to being shot down, but I can only say what I see. The imagination is much maligned but is, I am sure much more capable than we ‘imagine’. As I say we get into an area which transcends words.

Whether I am communicating this in a successful fashion or simply cooking up a word stew, I do not know. So at this point I think I will just shut the f*** up.

Keep on keepin’ on

:crazy_face:

I always edit my posts later, sometimes I wonder if I should avoid the faff and simply delete them

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@Bobbi not able to sleep :sleeping: thanks for sharing. I feel my health conditions have spiralled out of control since the stroke. It’s one thing after another. Keep going :grinning:

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@Rups thank you for sharing a very in-depth thought.

I understand some of your theory but perhaps it has to have happened to the individual to understand more. As we all have suffered differently.

I had to read twice to process some of the information. I cannot retain information as well as I could before stroke. But thank you for sharing with us. :grinning: kind regards Loraine

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Bore da @Bobbi, this is also an aspect of stroke recovery I am interested in. When one imagines a thing happening, the neurotransmitters assigned to that function gently light up. It is well-known that musicians and athletes will run through their performance in the mind before the event. When I came out of hospital, before I knew about the neurotransmitters activating through imagination, I watched a lot of walking programmes like the Take A Hike series and Tony Robinson’s Walking Through History … in fact, I craved watching programmes on telly where people walked. Initially, I think I did this because I couldn’t yet, and wanted to experience that freedom again vicariously. Unbeknownst to me, my neurotransmission was blipping away to itself, and perhaps this may have contributed to my recovery with steps. One can’t say conclusively, but it didn’t hurt, and I enjoyed the shows anyway.

For cognitive spatial-visual issues like mine, the process of imagination is harder, as it is quite difficult to imagine the process of seeing but, having said that, as part of my fatigue management regime, I imagine every activity I am about to embark on before doing it. For instance, I must split rounds and stack the ricks this winter, I have begun this task daily, so in the morning I lie in bed imagining myself doing it before tackling it later on in the afternoon. Last night, as I lay in bed, ready to sleep, I imagined making the apple rack I plan on doing today. This has worked for me, in keeping fatigue at a manageable level. There are other reasons why this is beneficial, to do with memory, but I would be tempting fate of going down a rabbit hole of writing if I were to expound on that any further.

Hope you had a pleasant lark’s morning, I woke up at 9 am. I don’t like abrupt wake ups, so I have an alarm sound of a bird chorus, the only problem with it is that it is so pleasant, it drifts me back into sleep again.

Sleep on sleepin’ on (for me this morning).

Bore da @Loshy (Loraine), I’m exploring auditory biofeedback in everyday activity through language. Auditory biofeedback, including music biofeedback, has been studied as part of stroke recovery, especially gait and balance problems, for many years. However, it is something which requires technical kit. My interest is in applying the theory of it at home as part of the Stages of Change Model which is a medical model for managing habits and rehabilitating ruts. In our case, whatever symptoms we are stuck with at the moment.

From a writer’s perspective and someone who taught language for many years, I wonder about how language can affect stroke recovery, it encompasses auditory biofeedback as it contains phonemes and it also uses imagination as mentioned by @Bobbi - so it could be a useful tool for getting the brain back on track.

Don’t feel the need to digest everything I am rambling on about, as I am thinking aloud to everybody as I work through the process of exploring all this. Although, it is good brain exercise. There was a game I bought early on in my recovery, it was quite complicated and the character had to deal with a lot of information in order to get through the game. When I first tried to play it, I did so for about twenty minutes before I just couldn’t any longer. It was too much. My brain couldn’t retain all the information needed to play it, however, I returned to the game a year and half later, and it isn’t a problem now. We all progress at our own pace with our conditions.

Sorry to hear that you feel your health conditions are spiralling. I was thinking the other day, at how remarkable we all are as human beings. The blows we’ve been dealt, and the consequence of those blows, and yet here we are, a special breed perhaps? I look back on my life’s journey thus far, all the near misses, all the dramas, all the adventures, all the scrapes and scratches, all the dilemmas, all the frets and pickles, six TIAs and then a stroke … and like a weathered pirate, I am still at the helm of my ship. :grinning:

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@Rups thanks, I do try and digest most written on this forum as we are the SS and we know first hand so I feel more comfortable with all of us better than doctors.

Thank you for all your contributions it does help us all. You too @Bobbi.

Best regards

Loraine :upside_down_face:

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@Loshy and to a degree @Rups as well, though now it looks like I’m leaving someone out, which is not my intention.

While I was still receiving the care package handout, for which I suppose I ought to feel grateful, I was fending off a carer, being my usual difficult self, making a go of putting on my pullover. She was trying to tell me that I knew nothing and she had been doing this for years. My response, ungrateful that I am, was to insist I did it my way.
I have been struggling for independence above all else, unfortunately that means I can be left to struggle, however I’m not sure I don’t prefer that.

Someone on this forum mentioned something that had been said to him by a member of the cloth who had a ‘stroked’ father I think. (his stroked father could well be in heaven by now, but enough of this irreverence) I don’t always recall these things perfectly and quite easily I can set off to ramble. Here I will stick to the story as best I can. The upshot of which was that you, I, or any of us are wasting time trying to explain stuff to the ‘perfect’ unstroked, so just don’t bother.

That’s why this is such a haven, somehow there is room here for my ramblings, your ramblings and anyone else who cares to join or to ramble for that matter. There is even a chance you will find a glimmer of understanding. As Rups has said, it does give you somewhere to work through and chance to express the experience we all share in one way or another.

as ever
keep on keepin’ on

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@Bobbi here here!! Well said and I agree totally :100: :hugs:

I don’t know if this is applicable in this context but after visualising a potentially difficult hand or leg manoeuvre I reward that part of the body with a word of congratulation given verbally.My cat looks astonished but I feel it helps.The whole theory outlined here is constructive and valuable.PSI saw a young girl with stroke symptons on telly this morning and seeing her cope so cheerfully and adapting processes like hair style management -so important to young things–was truly inspiring.

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Shwmae @Sheila88, interesting, aye it is applicable. Motivational feedback is also used in stroke recovery but I hadn’t thought of it in the context to audio feedback. Diolch yn fawr for your input :grinning:

Cats are wonderful, post stroke companions. My two are blissfully responsive to my recovery needs.

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The same as Ingo66 i would also like to know how to apply your theory to my left arm and leg. Despite ongoing physio I have difficulty bending my knee when walking. It’s either a case of i forget to bend at the knee or it takes a lot of effort to bend and lift, so i find it easier and quicker to walk without bending

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@Cookie_joe Knee bending is a habit you will have to acquire. It definitely doesn’t come along automatically.

Here’s a couple of methods I have used to ‘remind’’ myself. When in bed move your leg to get a bend every so often. Give it a help by pulling it up with a hand or pushing it up with your good foot. No need to be obsessive about it, just have a go occasionally when you think about it.
Same thing when you are sitting. Lift that knee, again, giving it a help if you need.
No need to set up an exercise training session. Just do it a couple of times when you think about it. There’s no rush but you will find lifting that leg will be another of your achievements you can feel good about.
I can’t make any promises that your leg will lift automatically like your good one does but if you make the effort to remember and lift when you walk you will start to get a much better walk pattern.
If it is of any use to mention I’ll tell you about my rollator. I ‘train’ my leg to lift and move in a correct direction as I use the rollator for support. I still don’t get an automatic walk pattern but I have made advances and improved noticeably. When I walk without the rollator it comes together better now.

I’ve mentioned this to others and been told it hasn’t worked for them, so I can’t guarantee anything, but give it a try and, whatever, may good luck and good progress be yours.

Just one last thing, don’t expect it all to happen at once, give yourself time and, importantly, give yourself time to rest.

Keep on keepin’ on.

:+1:

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@Cookie_joe I have the opposite problem. I don’t straighten my leg when walking. It was ok when I got fitted for an AFO recently test I realised this as I was filmed walking. No matter how much I bend NY knee my foot still doesn’t leave the floor. This stroke is a weird thing isn’t it :thinking::thinking:

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Thanks for the advice. Guess I’ll just keep plodding on :+1:x

Shwmae @Cookie_joe, aye, you could give it a go. It’s not a case of willpower or using the force :grinning: In a passive environment, that is, somewhere like a living room you could put it into practice. I imagine it has to be applicable to tasks associated with the words used. So, I suspect you would sit down with your leg straight? Or can you bend it in the sitting position? When you lie down, can you bend your knee? Do you have to physically adjust your leg to bend at the knee? Just some questions, so I can think about how best it would work with your circumstance.