January 14, 2017

Snow At My Door

Sometimes I can wait 1 or 2 days for the snow to melt when my area gets a warm spell after it snows.  This snow storm was followed by a 5 day cold spell.  Adding 2 more days for the snow to melt means I could have been home bound for a week.  Fortunately, this snow storm dropped only 3 inches of light, fluffy snow.

I handle this much snow with a broom and child-sized shovel (red handle) that I keep outside my front door.  With my sound hand and armpit, I sweep snow off my steps, push the snow off my walkway, and make a path to the door of my car.  I get rid of the accumulating pile of snow by using the shovel to flick the snow onto my lawn or make a pile in the street.  My neighbor does not drive so I do not feel guilty about making a low pile of snow in her empty parking space.

To clean snow off my car, I wear an apron so I can lean against the car without getting my coat dirty.  I hang the apron around my neck but do not tie the strings behind me.  I shove the snow off my car with the tool designed to clean wind shields.  It is easy for me to control because it is light and the handle is short.  It has a soft side that will not scratch the paint on my car and a blade side to clean the windshield.  Pushing snow off my car dumps snow on my feet so I don my snow boots (see previous post).  When I get snow on my hand I am grateful for the super warm mittens I used when I was skiing.

I keep a container of ice melting crystals next to my front door.  This large container has a spout designed for sprinkling, but the container is too heavy for me to control.  I use a funnel to pour a manageable amount in a small container.  I place the small container and funnel in my bathroom sink to make the transfer.  Compensation does not make me sad - it keeps me in my home.  

January 3, 2017

STILL Being Undressed Like a Baby

Babies are not asked if they want to be undressed - they are expected to submit when people start pulling off their clothing.  I cannot believe doctors have been undressing me like a baby since I had a stroke 12 years ago.  I recently saw a doctor who reached down and undid the top strap of my leg brace so he could look at my lower leg.  To hide my anger, I told him I have taken off my brace and shoe 10,000 times and can do it faster than he can.  Yelling at a surgeon who is going to cut me open to repair a torn meniscus in my knee is not wise.  

Here is the script I will try the next time a doctor starts undressing me.  "If you were a gynecologist you would not undress a female patient.  But I understand your dilemma.  I specialized in stroke rehab and cannot tell what stroke survivors can do while they are sitting.  I would ask "Do you need help with.........."  (Dean, Mark -  have doctors tried to undress since you had a stroke?)

If the doctor asks me if I need help I will say "I can do it but thank you for offering."

December 23, 2016

Walking in the Dark

My love of being outside at night began when my mother decided I was old enough to sit on the front porch on cool summer evenings.  I loved watching the street lights sparkling through leaves on the trees and being a part of quiet conversations.  So when my brother suggested we see the Christmas lights at the Brookfield Zoo I was eager to go.
I did well while it was still dusk (photo on left).  When the sun went down (photo below) I had trouble seeing where vertical was.  My stroke hit the pons which is the bridge to the cerebellum where balance is controlled.  My cerebellum gets so little information from my inner ears that I need visual input to tell if I am vertical.  
As it got darker I started guessing by watching the dark outlines of people walking in front of me.  This made me lurch from side to side to correct the poor guesses I made.  This rocking motion wore me out and brought my walking to a halt.  Walking for years down well lit streets did not prepare me for the balance challenge that real darkness creates.

I am going to restrict myself to night time activities that require sitting --- like watching people skate.  I got to see children smile when their parents kept them from falling.  I got to watch funny interactions among dating couples who had unequal skating skills.  I got to look at Chicago's beautiful Michigan Avenue.  I got to breathe the crisp night air and appreciate my warm coat, mittens, and scarf.  I got to enjoy a fun evening with my brother.  I learned the hard way that walking requires problem solving as well as mobility.

December 16, 2016

Organizing My Purse is a Vital Shopping Strategy

Jupiter, Mars, Venus, and Mercury line up every 50 to 100 years.  This rare celestial event will happen before I go digging through my purse one-handed.  Organizing my purse eliminates frustration when I go shopping.  Every woman organizes her purse differently so this is not a
how-to post.  The examples are intended to help stroke survivors realize that a purse does not have to be a buzz kill.  Holiday shopping is supposed to be FUN.

My car key has its own compartment.  The green wrist coil makes it easy to retrieve quickly.  My house key is attached to a straight flexible coil that hooks on my purse.  I pull on this coil to make my house key slip out of its pocket.  I do not want to be an easy target because I am digging through my purse looking for a key.  

I can handle credit cards quickly because I keep them in a zippered compartment that holds ONLY a credit card, driver's license, ATM card, and library card.  While sitting in my car I get out the card I need and place it vertically so it stands out from the other cards that are horizontal.  Cards go back in this zippered compartment in a flash.  Less frequently used cards like my health insurance card are in another compartment.  I do not want to hear the people behind me in line moan because I am struggling with my credit cards.

December 4, 2016

Keeping My Christmas Spirit

This is a photo of the artificial Christmas tree I have put up every year since my stroke.  After I fell on my patio last October I looked for ways to reduce my risk for falling.  Denial finally faded so I could allow myself to picture what would have happened if I had broken my hip. 

I had already made myself safer by keeping furniture sliders under the lounge chair next to this window so I can move it out of my way.  This allowed me to place a folding chair next to the tree so I could sit down when decorating the bottom of the tree.  However, decorating this six foot tree is tiring.  I know fatigue is one of my triggers for falling so I ordered a small table top tree.

I am happy  the figures of the magi and shepherd visiting the Christ child create a Christmas tableau in front of the tree.  I made these figures years ago when my hobby was needlecraft.  I also love the tiny Christmas tree balls.  I am always amazed by how happy small things make me.

I have held onto the decorations for my big tree so I still have options if I change my mind - probably denial still at work.

November 29, 2016

Why Should People Care What I Do?

People need to know why they should care about what happens to me.  So I do not start by talking about how to put on a bra with one hand.  First I write about clothes that do not fit when my breasts are closer to my waist than I ever thought possible.  I write about how I would feel about saying
"I'd love to come to dinner if you hook my bra when I get there."  I live alone so donning a bra enhances my social life.  Describing how problems affect my life reveals anchors that motivate me. An anchor is anything people want so much that they are willing to work hard to get it and keep it.  

Therapists must write goals for Activities of Daily Living (ADLs) because this is how they get insurance companies to pay for our care.  They must also think about deficits because how they treat one deficit, like muscle weakness, is different from treating another deficit, like visual neglect. However, having a stroke helped me understand why clients have a different point of view.  As a stroke survivor, improving dressing skills and grip strength are methods not goals.  

A statement that links a functional goal to a personal anchor can make clients happy.  For example, "don pants so you can sit on the patio and feel the sun on your face" links a mundane ADL to a valued activity for a client who has been kept inside for three months.  Therapy gains do not feel personal if therapists do not encourage clients to share their concerns.  Caregivers and clients should tell OTs what they really want and stop worrying their concerns may sound trivial.  Living life to the fullest means turning "I should" into "I want to."

November 24, 2016

ADLs Are Where the Repetitions Are

Brain plasticity is amazing, but rewiring the brain requires thousands of repetitions (reps).   Activities of Daily Living (ADLs) are a great way to get the reps needed to retrain the brain.
Four examples show why two sets of ten cannot compete with ADLs.

1) Twice a day I open my hemiplegic hand to grasp a tube of toothpaste so my sound hand can remove the cap.  In nine years I have opened my hand over 5000 times before brushing my teeth.

2)  I have to turn 14 times to prepare cereal with a sliced banana.  I have made this same breakfast for nine years so I have made over 45,000 turns.  Add making a sandwich for lunch and preparing a hot meal for dinner and the number of turns I have made in the kitchen are in the hundreds of thousands.

3)  Shopping is therapy for my hand.  I open my hemiplegic hand to let go of the cart and reach for items with my sound hand.  My hemiplegic hand opens a 2nd time when I grab the cart to move on.  I open my hemiplegic hand to let go of the cart so my sound hand can empty the cart in the check-out lane and again to load food into my car.  Buy 30 items + empty cart + load car = open hand 64 times.  64 x 2 visits a week x 9 years means I have opened my hemiplegic hand 59,904 times in the grocery store.

4)  The distance I have walked at the grocery store is huge.  I step away from the shopping cart and bend down or reach up to get items I want.   The S-shaped curves I make to detour around people and other carts require more steps than walking in a straight line.  According to my pedometer I walk 2,000+ steps each time I visit the grocery store.  2,000 x 2 visits a week x nine years = 1,872,000 steps!

November 18, 2016

Caregivers Readiness

Forty caregivers of stroke survivors reported they often felt abandoned and wished they had someone they could call with questions (1).  This may sound surprising unless you understand that staff at different agencies do not communicate with each other.  This means each round of therapists has to do initial evaluations of the client.  This does not leave much time for talking to the caregiver.  This lack of communication is a problem.  Lutz found that "during rehabilitation many
of these caregivers still hoped and expected that the stroke survivor would return to pre-stroke function (p. 8)."  When caregivers realize what they have to do, the primary focus on the client is already entrenched.  

Reading this article on caregiver readiness reminded me that I was clueless when I was an OT.
It took having a stroke to teach me that caregivers are pummeled by a quadruple whammy.  They have to: 1) do the chores they have always done, 2) take on their partner's role, 3) be a therapist, and 4) be a case manager. A wife may take out the garbage, take the car to have the oil changed, and change the batteries in the smoke detectors.  A husband may go grocery shopping, cook and do laundry.  When they are therapists, caregivers may help with self-care like bathing, set up and supervise home exercises, and deal with a stroke survivor's bad moods.  As a case manager, caregivers may have to schedule multiple doctor appointments, deal with insurance companies, and make multiple trips to the drug store to pick-up multiple drugs.  Many caregivers do this without professional psychological support or respite care.  Now I see caregivers as angels.  

(1).  Lutz B et al. Improving stroke caregiver readiness for transition from inpatient rehabilitation
        to home. The Gerontologist. 2016; Vol 00:No.00,1-10. doi10.1093/geront/gnw135.

November 8, 2016

I Cannot Use Salt to Make Food Tasty

I had a 2nd stroke two years after my 1st stroke so I got serious about lowering my blood pressure with a low salt diet.  Low salt food tastes terrible so I learned to jack up the flavor of food with aromatics like onions and garlic.  Peeling garlic is a challenge even for able-bodied people.  I use the smooth side of meat pounder to smash the garlic open so I can remove the peel with
my sound hand.  This means my days of creating beautiful, thinly sliced garlic are over.  

I chop garlic with a large kitchen knife.  Rocking the knife over the garlic creates a mix of small and medium size pieces.  I place a food scraper in my hemiplegic hand so my sound hand can scoop up chopped food and slide it into a mixing bowl or pot.  But sometimes I want small uniform pieces of garlic that are evenly distributed in a dish.  I spice up turkey burgers by stirring crushed garlic into an egg before adding it to the raw meat so I will not bite into a big hunk of garlic.  However, a garlic crusher takes lots of hand strength to squeeze the two arms of the crusher together.

I rest the bottom arm of the garlic crusher on my cart and put my sound hand on the top arm.  Leaning on the top arm lets me press down with the strength of my whole arm.  I catch pieces of falling garlic by putting a piece of saran wrap** under the garlic crusher.  To get garlic clinging to the crusher into a bowl or pan, I place the crusher in my hemiplegic hand so my sound hand can use a knife to scrape off the garlic. 

Cleaning a garlic crusher is easy if it has a plastic grid that pushes the remnants out of the holes. I hold one arm of the garlic crusher in my hemiplegic hand and stabilize the 2nd arm against my stomach. Then my sound hand can use the tip of the knife to dig out remnants so they fall on the saran wrap.  I fold the saran wrap and put it in the garbage.

** To see how I tear off a sheet of saran wrap with one hand
click on this post.

November 2, 2016

Mrs. Bobath was wrong - hand use comes from my gut

I was dismayed that my NDT certification course did not teach me hand function comes from my gut.  I learned this when a PT had me do abdominal exercises after my back spasms returned.
I was surprised to feel abdominal muscles on my paralyzed side burning from effort.  My ability to reach improved after my abdominals got stronger. 

When you reach for an object (shoulder flexion) the shoulder blade (scapula) helps the arm by sliding forward.  Scapular muscles are attached to the ribs so if weak abdominal muscles do not keep the ribs still, the scapular muscles have a wobbly home base. Having weak stomach muscles meant my shoulder and elbow muscles were overworked when scapular muscles could not do their job.  I repeatedly got tendonitis in the long head of the biceps because this elbow muscle assisted weak shoulder muscles.  My biceps tendon used to swell so badly that it made a popping sound when it slipped out of its groove.  Exercise sessions had to end with ice to reduce the swelling.

I wonder how much faster I would have progressed if my OTs had worked on abdominal strength.  I do not blame my OTs.  As an NDT certified OT I do not know of a motor theory that links hand function to core muscles.  However, athletes like weight lifters and javelin throwers who need superior arm strength know how important abdominal strength is to upper extremity performance.  Stroke survivors exert this same kind of extreme effort when they lift their arm with paralyzed muscles.  Don't believe me?  Therapists use two hands to lift a paralyzed arm.  Even they are challenged when lifting all that dead weight.