The Ballyshannon-based doctor helping to transform the lives of stroke survivors

A Ballyshannon-based doctor is helping transform the lives of stroke survivors and their caregivers, as his lengthy research has led to the publication of a new book that aims to help stroke survivors recover at home.

Dr Kenneth Monaghan, chartered physiotherapist, and director of the ‘Neuroplasticity Research Group’ at Atlantic Technological University, is guiding caregivers and stroke survivors to recovery physically after stroke - in their own homes.

A native of Rathcormac, Co Sligo, he lives in Ballyshannon with his wife Maria and two children - James (17) and Ellen (14).

"Most stroke survivors feel devastated when they are discharged home after their stroke because they believe that this signals the end of their chance for a complete recovery,” he says.

"Your home has largely unknown advantages for utilising neuroplasticity and recovering brain function after a stroke because of the hormones that are created in a stroke survivor's brain in response to the familiar sights, sounds and smells,” he told The Sligo Champion from his lab.

Dr Monaghan first came into contact with the difficulties encountered by stroke survivors while working as a clinical specialist neurology physiotherapist in rehab centres in Ireland and the US. Then, when treating a neighbour who had a stroke, he had a realisation that there was a need for a book that could help.

"While developing new medical devices in my research group, I saw how frustrated my neighbour was following his discharge home after a stroke,” he says. "I saw how unclear his caregiver wife was about what therapy programme to undertake and also how paralysed they felt, in case they did the wrong thing and caused another stroke,” he added.

“I knew there was a need for a book that gave caregivers confidence and stroke survivors a roadmap of what safe programmes to undertake. That was my spark to want to write this book.”

Now the Director of the Neuroplasticity Research Group at Atlantic Technological University Sligo, Dr Monaghan has supervised a team of eight PhD researchers dedicated to stroke rehabilitation as he saw the room for bringing on new treatments.

He says there is a perception that once you hit six months post-stroke rehabilitation, that’s it. But he is changing that.

The latest clinical guidelines from the UK/Irish Stroke Associations recommend that stroke survivors aim to complete twp to three hours of daily therapy where ‘repetitive practice’ of safe movements and strengthening exercises is the goal.

However, the new evolving therapies that have been studied intensely by Dr Monaghan and his team can be performed in a cost-effective way in a stroke survivor’s home and this has been a major goal of ‘Lights, Mirrors, Action’.

The innovative therapies that are suggested include ‘Mirror Therapy’ where a stroke survivor watches a reflection of their mobile limb in a mirror, to stimulate their brains to improve movement and function in their affected limb.

This is an extraordinary therapy and can be completed with the use of a simple €10-15 mirror at home.

Dr Monaghan explains: “It appears as if I’m moving my good hand, so I’m getting positive visual feedback telling my brain that I have two fully functioning and moving hands.

“It effectively tricks the brain into believing that your hand is working again. Or it’s tricking the brain into believing that I’m walking in a proper pattern again and that my weak leg is now working properly,” he says.

The result is that it stimulates the motor function areas of the brain, prompting it to send energy and to activate that damaged hemisphere.

“It creates new pathways in your brain. It can re-ignite old pathways or establish new ones that help your limb function,” he says.

The mirrors work for arms and legs and it’s surprising how quickly - after just 30 seconds - that the brain can be fooled into thinking both limbs are functioning again. Sensory Substitution is the term given to another innovative therapy that has been explored in Dr Monaghan’s lab.

The 'Sensory Substitution Effect' in stroke rehabilitation refers to the use of alternative sensory modalities to compensate for lost or impaired senses.

The research evidence from Dr Monaghan’s lab has suggested that vibration or tactile/touch sensation and sound/auditory sensations are the best choices for stroke and orthopaedic patients. This technique involves replacing the function of a damaged sensory system with input from another sensory modality. For example, touch and auditory feedback can be used to enhance proprioception (sense of body position) in stroke patients.

By providing this alternative sensory input, patients can improve motor control, balance, and spatial awareness.

The effect leverages the brain's plasticity, helping it reorganize and adapt to new sensory information, ultimately aiding in the recovery of functional abilities.

"The first time we used our new ‘Sensory Substitution technology with stroke survivors I saw instantly the effects that it had, making patients take appropriate weight through their limbs for the first time in months.

"For me that was amazing and stroke survivors were so surprised with how well it worked.”

However, measuring progress on a regular basis was an important aspect of assisting patient motivation, according to Dr Monaghan.

‘When stroke survivors know how much they are improving it acts as a huge motivation to keep going,” he says.

"Although choosing an appropriate list of safe therapies that can be undertaken in your home is important, measuring regular progress becomes an essential component of a successful rehab programme.

"While I was writing ‘Lights, Mirrors, Action’, I was working together with three stroke survivors and their caregivers. I was asking these patients to read my chapter drafts and it was amazing how much useful feedback they gave me about how the information could be structured to educate them properly.

"Sometimes it wasn’t what they said but the way in which they acted when asked about the draft chapters and this was hugely beneficial towards reaching the finished book.

"We are hearing from stroke survivors that the flexibility of being at home, the opportunity to take frequent rest breaks and also to sometimes start therapy at a later time depending on how tired a stroke patient feels when they wake up has become a huge benefit to home therapy.

“The beauty of home therapy is that it cuts down on expense. You don’t need a therapist; you can use it yourself at home. You can put these inexpensive devices e.g. mirrors, resistance bands, and digital weighing scales into your home and you can start a daily ‘Morning’ and Evening’ programme.

"The caregiver leads the way because they have been instructed in how to supervise a simple programme. That’s the beauty of it,” adds Dr Monaghan.

Caregivers become confident that they are able to explain certain concepts to their stroke survivors and assist them in understanding why their therapy will work.

So ‘Lights, Mirrors, Action’ gives caregivers the confidence and guidance to supervise a home-based physical programme and Dr Monaghan is in talks with other publishers to write a series of books that target other neurological conditions e.g. Multiple Sclerosis, Parkinsons' Disease.

Dr Monaghan explains: “One important developing area of medicine and physiotherapy is the area of ‘Expectation Priming’. This involves explaining to each stroke survivor the value of their treatments, and the mechanism of how they will work.

"This will enhance the benefit of any therapy because it primes or prepares the patient’s brain in a positive way. I expect that in years to come, Pre-Expectation Priming will become part of any normal treatment regime and will essentially enhance the benefits of the existing therapies. All by simply explaining why and how the therapies work,” says Ken.

Dr Monaghan says ‘Lights, Mirrors, Action’; is a unique book that should be given to all stroke survivors one to two weeks prior to their discharge home from the hospital or their rehabilitation clinic.

"When they take that first step through the front door they need to already understand what neuroplasticity means, how it is promoted in the brain, why their home has additional benefits for creating new pathways in the brain and a very definite four-week starting programme of physical exercises to undertake.

He says the beauty of the book is that the ‘Lights, Mirrors, Action’ model of care suggested takes into consideration the sequencing of therapy and places this as more important than the actual therapies that are undertaken.

Dr Monaghan has built up a large platform on LinkedIn and writes daily posts and weekly newsletters that discuss many of his innovative techniques.

"The feedback so far has been enormous and gives me great confidence. My hopes are that every stroke survivor gets to read a copy of this book prior to discharge home. The hope will be that this happens in all hospitals worldwide.”

Dr Monaghan's book can be purchased online via Amazon, on Lights, Mirrors, Action website and in local bookshops.