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Wednesday, Apr 26th

Brotherly love... and the stroke victim healed by his own family: As revealed in a fascinating new book that will give hope to patients everywhere

•David Dow, from North Carolina, had a massive stroke at the age of ten

•Brother Dr Mike Dow, a psychotherapist, wrote a book with David about recovery

•It was caused by Moyamoya disease, where blood vessels become narrower

By Lucy Elkins for the Daily Mail

Published: 23:09, 24 April 2017 | Updated: 19:41, 25 April 2017

David Dow strolled into the office of his new doctor. For most of us, that wouldn’t be a noteworthy feat, but it left his neurologist open-mouthed.

‘You’re David Dow?!’ he said, surprise clear in his voice. ‘You can’t possibly be! You shouldn’t even be walking.’

The neurologist was seeing David for the first time for a check-up, and held his brain scans in his hands: on the left side of David’s brain, where there should have been white coils of brain tissue, there was a black void instead.

"David Dow had a massive stroke at the age of ten but his brain was able to rewire itself. David, 32, and his older brother Dr Mike Dow, a U.S. psychotherapist, have written a book about how to maximise recovery from a stroke"

David Dow had a massive stroke at the age of ten but his brain was able to rewire itself. David, 32, and his older brother Dr Mike Dow, a U.S. psychotherapist, have written a book about how to maximise recovery from a stroke

Aged ten, David had a massive stroke and his family was told he should spend the rest of his life in a home.

That he didn’t is testimony to the extraordinary ability of the brain to rewire itself — and the extraordinary dedication it took from David and his family to encourage this.

Now, David, 32, and his older brother Dr Mike Dow, a U.S. psychotherapist, have written a book about how to maximise recovery from a stroke, based on the opinions of experts, Dr Dow’s experiences of working with affected families and, of course, what David went through.

Strokes occur when the blood supply to the brain is interrupted, usually by a blood clot. This can prove fatal. Around 100,000 people a year have a stroke in the UK and 40,000 die as a result.

Many who survive are left with life-changing disabilities: almost two-thirds leave hospital with a disability.

The effects of David’s stroke were instant and brutal. He remembers lying down for an afternoon sleep, feeling as if he was getting the flu.

"The stroke was caused by Moyamoya disease, where the main blood vessels to the brain become narrower, which led to a blood clot. Around 100,000 people a year have a stroke in the UK" class="blkBorder img-share"/>

The stroke was caused by Moyamoya disease, where the main blood vessels to the brain become narrower, which led to a blood clot. Around 100,000 people a year have a stroke in the UK

‘When I woke a few hours later, I could no longer talk and my right side was dragging,’ he says. ‘I didn’t understand what was going on or what people were saying. It was like waking up in a country where you don’t speak the language.’ This inability to talk or even understand what’s being said is known as global aphasia.

David spent three months in hospital and left in a wheelchair, unable to walk and barely able to speak. For months, his main form of communication was a picture board he used to nod at ‘yes’ or ‘no’ in response to questions such as ‘are you thirsty?’

Dr Dow, now 37, was 15 when David’s stroke occurred. ‘I couldn’t really take in what had happened. We had been close — fighting over who played with the Nintendo, then suddenly, my little brother couldn’t walk or talk,’ he says.

The stroke was caused by Moyamoya disease, where the main blood vessels to the brain become narrower, which led to a blood clot. David and his family had no idea he had the condition until after his stroke. They were told he would improve for the first six months. After that, progress would come to a ‘screeching halt,’ as Mike puts it.

‘Soon after my stroke, one doctor recommended my parents move me to a nursing home for the rest of my life,’ adds David, somewhat triumphantly — and justifiably so.

For not only can he walk and talk, he lives an independent life, with his anaesthetist partner John in North Carolina. He travels extensively and has started a not-for-profit organisation to help others with aphasia (speech difficulties).

David lives an independent life, with his anaesthetist partner John in North Carolina. He travels extensively and has started a not-for-profit organisation. Pictured, David aged 10" class="blkBorder img-share"/>

David lives an independent life, with his anaesthetist partner John in North Carolina. He travels extensively and has started a not-for-profit organisation. Pictured, David aged 10

"David's mother Carol even rented a harp to encourage him to move his right arm to strum the chords. She also hired an art teacher to improve his non-dominant left hand by painting" class="blkBorder img-share"/>

David's mother Carol even rented a harp to encourage him to move his right arm to strum the chords. She also hired an art teacher to improve his non-dominant left hand by painting

His remarkable recovery may be partly due to his age, but also the sheer dedication put into his rehabilitation.

Over the years, he had numerous therapies — from speech and language to physiotherapy — to get some movement back into his right side.

His mother Carol even rented a harp to encourage him to move his right arm to strum the chords. She hired an art teacher to improve use of his non-dominant left hand by painting. His persistence in practising these therapies paid off.

‘He never stopped stimulating his brain,’ says Dr Dow. ‘That’s why he beat the odds.’

Dr Dow is frustrated that stroke patients are still told they may not recover beyond six months. ‘It’s possible to continue making gains for years.’

"Indeed, David describes the first two years after his stroke as a ‘gradual awakening’ — most of his recovery happened after that" class="blkBorder img-share"/>

Indeed, David describes the first two years after his stroke as a ‘gradual awakening’ — most of his recovery happened after that

Indeed, David describes the first two years after his stroke as a ‘gradual awakening’ — most of his recovery happened after that.

It used to be thought the brain could not heal, but it’s now known it can form new connections around the damage, known as neuroplasticity. This means a patient can regain lost functions.

Despite massive improvements, David still has a poor memory and cannot use most of his right shoulder, arm and hand — but he finds ways round that. ‘I can pretty much do as much as anyone with two hands can, by using my left.’

By writing the book, David hopes his story can inspire others. ‘It goes to show you should never give up,’ he says. ‘There is no easy way, you need to keep challenging yourself — then anything can happen.’

Here, in an extract from the book, we explain strategies that might help you or your loved one recover from a stroke.

DON’T START TOO SOON

It’s tempting to think the sooner rehabilitation starts, the better —but studies suggest starting it in the very first days could have a negative effect.

‘There is a window immediately after a stroke during which intensive (or even normal) physical, occupational or speech therapy may be harmful,’ says Dr Tom Carmichael, a neurologist and neuroscientist at the University of California. ‘That’s because the stroke destabilises the brain, and it needs a while to settle.

‘Around three to five days after a stroke is when we can start to transition patients into more vigorous physical therapy.’

David says stroke victims shoudl wait between three and five days before they start trying to get better. Straight after a stroke, physical therapy may be harmful" class="blkBorder img-share"/>

David says stroke victims should wait between three and five days before they start trying to get better. Straight after a stroke, physical therapy may be harmful

RUN YOUR HANDS THROUGH RICE

It can take longer to get improvement in a paralysed arm and hand than a leg or foot, says Dr Mary Stoykov, a researcher into post-stroke paralysis at Rush University, Chicago. That’s because moving hands and arms involves more muscles, and, therefore, more brain stimulation, than flicking the leg forward.

And around 50 per cent of strokes occur in the middle cerebral artery (as it’s the biggest artery in the brain) in the areas of the brain that control the arms and hands.

‘It helps to “flood” the affected hand with sensory feedback by, for example, rubbing a towel on it, or putting it in uncooked rice,’ says Dr Stoykov.

Sit on patient's 'bad' side

In hospital, family and friends should interact with the person on their affected side, says Dr Michelle Ploughman, an assistant professor in rehabilitation at Memorial University, Canada.

‘Encourage them to look to their affected side and touch them on their affected side,’ she says. This encourages stimulation on the affected side of the brain.

When the patient gets home, be supportive, but try to encourage independence. ‘Ask what they want help with, rather than just doing it,’ she says. If the person has trouble speaking, it does not necessarily mean they have cognitive issues, so don’t talk down to them or use baby talk.

Think of talking to someone who doesn’t speak English as their first language. Use simple, clear terms, be patient and give time — several seconds — for them to reply.

‘It’s not uncommon to need ten or 20 seconds to get going,’ says Dr Jacqueline Hinckley, associate professor emeritus of speech therapy at the University of South Florida.

‘Even if the hand is not ready to move when the brain signals it to, you can put sensation in that hand so it sends a message to the brain to strengthen neural connections.

‘Keep trying. You may get some movements, but not a fully functional hand. I’ve seen people get movement back after five years.’

DO EXERCISES IN YOUR HEAD

‘When stroke survivors mentally rehearse activities they do in therapy, they get twice as much practice and their outcomes are better,’ says Dr Stephen Page, an occupational therapist and Ohio State University professor.

"Keep practising every day — even when therapy stops. Without using the actions gained, patients can be in worse shape five years after their stroke than they were after three months, says Dr Carmichael" class="blkBorder img-share"/>

Keep practising every day — even when therapy stops. Without using the actions gained, patients can be in worse shape five years after their stroke than they were after three months, says Dr Carmichael

THE BRAIN- HEALING DIET

‘After any brain injury, there’s a sizeable amount of protein loss (when brain tissue is destroyed), so we urge people to eat protein,’ says Dr Elliot Roth, chair of the Department of Physical Medicine and Rehabilitation at Northwestern University in the U.S.

He typically recommends a gram of protein, such as lean meat, fish, turkey, peanut butter or eggs per kilogram of patient body weight per day. So someone weighing 80kg (12.5 st) should eat 80g (2.8 oz) of protein a day.

‘There is also evidence that the Mediterranean-style diet — i.e. low in processed carbohydrates and saturated fats and high in fruit and veg — may be beneficial,’ says Dr Mike Dow.

A study in the journal Frontiers in Nutrition last year found the Mediterranean diet improved language, memory and attention.

‘A clinical trial is now under way to examine the effect of a low-carbohydrate diet on post-stroke recovery,’ adds Dr Dow.

‘It’s early stages, but the low-carb part makes sense as it can improve brain health by increasing circulating levels of ketone bodies (energy sources for cells) and numbers of mitochondria (the cell “batteries”) in brain cells.’

MIRRORS CAN TRICK BRAIN

Mirrors can help to trick your brain into working better. Place a mirror between the two sides of your body, the mirror facing your good arm, and put the affected arm behind the mirror so you don’t see it.

When you look at the mirror, you see the good arm moving, but your brain thinks it’s the affected arm. This may simulate new connections in the brain.

‘Try this with an occupational therapist to see if it’s right for you and how to do it at home,’ says Dr Stoykov.

Around 30 per cent of those who have had a stroke develop depression and do not recover as well. Pictured, David aged 10" class="blkBorder img-share"/>

Around 30 per cent of those who have had a stroke develop depression and do not recover as well. Pictured, David aged 10

USE IT OR LOSE IT

Keep practising every day — even when therapy stops. Without using the actions gained, patients can be in worse shape five years after their stroke than they were after three months, says Dr Carmichael.

As stroke patients practise activities, the brain forms new networks of brain cells to perform the lost function. Without practice, these new connections break down: it’s use it or lose it.

‘It’s obviously harder to do the physical things you used to, yet it becomes more important than ever to do them,’ says Dr Carmichael. ‘A good stroke team can work with patients to identify activities that are pleasurable so the motivation remains high.’

NEVER IGNORE DEPRESSION

Approximately 30 per cent of those who have a stroke develop depression, not just because their life may have changed.

The damage a stroke does can interfere with how we control our emotions. Treating the depression is important.

‘People who are depressed after a stroke do not recover as well,’ says Dr Carmichael. This is possibly because they’re less likely to fully participate in rehabilitation.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) such as Prozac may help: ‘A clinical study suggested that Prozac, given in the first 90 days after a stroke, may enhance recovery,’ adds Dr Carmichael.

•Extracted from Healing The Broken Brain: Leading Experts Answer 100 Questions About Stroke Recovery, by Mike and David Dow, published by Hay House on May 2 at £12.99. © Mike Dow and David Dow 2017. Pre-order a copy at £9.09 (offer valid till May 2) at mailbookshop.co.uk or call 0844 571 0640. P&P free on orders over £15.

Read more:

•Healing the Broken Brain: Leading Experts Answer 100 Questions About Stroke Recovery: Amazon.co.uk: Dr Mike Dow, David Dow, Megan Sutton: 9781781808122: Books

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6 Replies

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  • My goodness, Jules, you have posted the whole article!!!

  • If you ignore all the repeated paragraphs, this is a fascinating article, and should give optimism to all stroke survivors. The part about the mirror (exercising the good arm in front of a mirror to trick the brain into sending positive signals to the affected arm) is just genius !

    I'm going to copy & paste it then edit out the repetitions, then print it out for my computer illiterate neighbour who's struggling after a stroke.

    Thanks Jules and Jan for this. xxx

  • Think i will do that and print it out for mum too Cat

  • Yes Jules it's full of ideas for rehab that are so simple & accessible, and having it on paper to just pick up and browse makes it even more so. xx

  • brill x

  • Hi Jules,

    Have just read your article - some great insights and novel ideas on how to nourish and retrain the brain ( I particularly liked the 'mirror image' trick ) Neuroplasticity is one of my favourite topics - I am a big believer : ) I assume that this can be applied to all brain injury, no matter what the cause ? Practice certainly helps improvement, I have found in my own case !

    Thanks so much for sharing : ) Angela x

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