【脳卒中という病気と後遺症の片麻痺を徹底的に理解する⑭】被殻出血とモチベーションの関係・たぁまんさんのコメントにご返答・痛みの緩和と痙縮への対応・「脳を変える」アプローチ

[Key Points/Summary] ■ Response to Taaman's comment regarding "shoulder joint pain," and an explanation of the relationship between stroke (especially putaminal hemorrhage) and motivation/drive. 1. Main Causes of Shoulder Pain Stiffness of the subscapularis: This muscle lies between the scapula and ribs and functions to internally rotate (twist inward) the humerus. Hemiplegic patients are prone to having their arms pulled back by the latissimus dorsi and other muscles, which then internally rotate (twist) their arms by the subscapularis. When moving or opening the shoulder outward, the stiff subscapularis can be pulled, causing pain. This stiffness is often due to a pathological state of muscle tension known as spasticity. 2. Pain Relief and Spasticity Management Complete relief of pain on your own is difficult. Because the subscapularis muscle is deep within the body, it is difficult to completely relieve pain through self-training such as massage and stretching. Professional intervention is recommended. A "brain-changing" approach is effective in improving spasticity. Spasticity is a pathological condition caused by impairment of both postural and voluntary control. In some cases, a sense of rejection/fixation in response to pain (a normal response) may occur. It is important to approach the brain, not just massage the muscles. → Focusing on sensory information that reaches the brain, and practicing with enjoyment are effective. 3. Specific Self-Training Suggestions (Tabletop Exercises) Place your hand on a table: Place your affected hand on the table (extended, if possible). Move your body: Keep your hand still, but move your body relative to your hand. (Tilting your body forward and backward, or side to side) This allows the movement of the body, not the hand, to affect the scapula, which is expected to improve the flexibility of the subscapularis muscle. 4. Focus on Sensation: Focus on changes in sensations while moving. The sensation of weight on your hand The sensation of your arm wobbling The sensation of your skin moving, etc. For example, "I feel weight on this side now, so maybe I'll try removing half of it." This leads to conscious movement based on these sensations. 5. Goal Setting Break it down into small steps It's important to set small, achievable steps rather than a big goal like "I want to be able to use my hand." The priority here (first step) is "to eliminate pain." Once that is achieved, consider the next goal (second step), such as lowering your hand or straightening your elbow. Don't jump ahead and get the order and goals of your rehabilitation right. 6. Stroke Hemiplegia (Putamin Hemorrhage) and Motivation Lack of motivation is part of the illness. People with putaminal hemorrhage have difficulty experiencing dopamine-induced motivation, which is due to a pathological condition. It's not that they're lazy; rather, damage to the putamen, which receives dopamine, makes it difficult for the brakes on the regulatory nucleus to be released. Family and those around them should also understand that this lack of motivation is part of the illness. 0:16 Comment from Taaman: "My shoulder joint hurts." 1:14 The cause of the pain and the actual location of the pain are different. 1:49 Humerus and glenoid fossa (bowl, myofascial release stick, softball) 3:08 Cause of pain: In most cases, it's the subscapularis. 3:31 Subscapularis: The muscle that internally rotates the humerus. 4:12 Internal rotation: Twisting the shoulder inward. Hemiplegic patients have stiff pectoralis major. 4:34 The subscapularis muscle is located between bones, so it cannot be touched directly. 5:41 The latissimus dorsi muscle pulls and twists the arm, causing pain. 6:23 The tension on the pectoralis major and subscapularis muscles causes pain. 7:15 ★ Self-Training Suggestion: Practice Using a Table 7:53 Try moving your body back and forth and side to side without moving your hands. 8:07 Moving your body while keeping your hands on the table will soften your shoulder blades. 8:53 Spasticity: Muscle Tension (Caused by Illness) 9:30 Spasticity is a pathological condition caused by impairment of both postural control and voluntary movement. 10:16 "I don't want to move because it hurts" is a normal muscle response. 10:40 Actively using the extremities and selective exercises will develop sensation. 12:19 Goal Setting: Relieving Pain (Graded) 13:41 Putaminal Hemorrhage: Lack of Motivation (Pathological Condition) 14:15 Neurotransmitters (dopamine) 15:02 Parkinson's disease: Dopamine depletion 16:02 Three knowledge points: Anatomy, Kinesiology, and Neuroscience 17:24 Changing pathological muscle tension → Approaching the brain (sensory information) 18:28 Since the cause is subscapularis muscle spasticity, the aim is to use sensation to move and relieve it. ------------------------------------------------ ■Rehabilitation Studio WillLabo This is a private rehabilitation ...