Jill Stewart followed up the last presentation on Saturday morning with Individualizing Rehab after Stroke: Role of Genetic Variation. She built on what Steven was talking about. She mentioned that the importance of genetics in therapy is it’s predictive role. It could predict risk for disease, drug response, potential for neuroplasticity, response to exercise or a disease’s severity. She also expounded on the BDNF chemical (in which the brain is bathed during learning/neuroplastic change. The release of BDNF requires the person to be actively engaged in an activity. No passive release here! She then moved on to the BDNFmet66 SNP, stating that it is present in approximately 5% of the “white” population. It is more common in Asian populations, although how common, she didn’t mention. People that have the BDNFmet66 SNP are showing signs of little effect to transcranial estim, which is an up and coming treatment option. It hasn’t been approved for use outside investigational research yet by the FDA, but with all the stuff I’ve been seeing on it, I bet it’s coming soon. She also reiterated what Steven said previously, that although the folks with the BDNF met66 SNP learn/make neuroplastic changes slower than those without, long term motor outcomes are not effected. She said that the purpose of knowing these genetic biomarkers clinically would be drive decision making. Not necessarily to remove treatment all together (like some audience members were thinking), but to think about changing treatments or altering treatment dosages (FITT principles) to possibly change the outcomes.
That was the main bit, but she also mentioned that a lot of stroke research is using the modified Rankin scale to quantify disability after stroke. And it is so non-specific that it is truly completely useless. I remember making a similar comment to myself when I reviewed it for the NCS exam. It’s just an ordinal scale of 0-7 with 0 being “no disability” and 7 being “dead.” That is not helpful. Also she mentioned that the TOAST classification for Ischemic Stroke into large artery atherosclerosis, small artery occlusion (lacunar), cardioembolism, other determined etiology and other undetermined etiology is likewise not specific enough and good place for therapists to jump in with our movement system diagnoses to better describe stroke patients.
So that was the second session on Saturday morning!