February 3, 2016

Update on Applying Make-up One-Handed

Rehab never ends!  Applying eye liner requires the ability to close one eye while you keep the other open.  I can only blink (close both eyes at once).  So I use mascara to give my eyes more definition.  My affected hand can squeeze tubular shaped objects between my index and middle finger so my sound hand can open the mascara.  Then I had to change to a non-irritating brand of mascara that comes with a funky handle. 
I kept dropping the curved top of the mascara.  This left dark stains on my rug.  I used too much carpet cleaner which left white circles (see black circle).    I put a bandaide that has texture around the top of the mascara to give me better traction. I have stopped dropping the mascara.
My balance is not good enough for me to lean close to the bathroom mirror.  Years ago I attached florescent lights to the mirror hanging over my dresser.  I have a mirror on my dresser with clear Dycem under it to keep it from moving.  Leaning my sound elbow on the edge of my tall dresser gives me good control when applying eye make-up.  A food container keeps make-up organized so it does not spread out on my dresser.  A small round container holds vertical objects upright.  It does not fall over because it is clipped to the square container with a small metal binder clip (see white circle) I got at an office supply store. 
A piece of non-slip shelf liner stops eye shadow and face powder from sliding when I open the container and sweep the brush side-to-side.  I did not know age would rob my lips of the pink color that keeps them from being the same color as my face. It is easy to apply lip gloss with a hint of color because I do not have to draw a precise outline like I do with lipstick.  Now I see lips on the bottom half of my face when I look in the mirror.

January 26, 2016

Outcomes That Stroke Patients Prefer

PROSPER stands for Patient-centered Research into Outcomes Stroke Patients prefer and Effectiveness Research.  A current PROSPER study is being conducted at Duke University in North Carolina.  A brief description of the study says the following outcomes will be measured in stroke survivors.  Primary outcomes: 1) death, 2) days at home after stroke, and 3) quality of life as measured by fatigue, depression, and "medication taking behaviors."  Secondary outcome: readmission.

A "patient investigator" in this study said "healthcare providers often measure our recovery with functional status...what these metrics cannot quantify is the tremendous loss felt by the driven career woman, the supermom and superwife or the free-willed adults that we all used to be."

Bottom Line: It is hard to see how measuring the absence of deficits such as depression and fatigue will capture the outcomes stroke survivors prefer.

January 13, 2016

Why Mice Are Not Men

The Dilemma.  Innovative treatments have helped mice who have been given strokes, but the results often cannot be duplicated in humans.  A researcher on TV helped me remember a fact I learned in college that partially explains these disappointing results.  Since the early 1900's researchers have bought specific strains of mice (e.g. B6).  These strains have been inbred for generations so there is very little variability in the sample.  Follow-up studies may use the same strain of mouse to eliminate sample differences as an explanation for why new findings confirm or refute the original study.  Researchers eliminate other alternative explanations for their results by keeping the cages, food, and activities the same for all animals in the study.  On the other hand, humans are a diverse group that has interbred for thousands of years.  Humans also have the freedom to vary their life experience which modifies their brains and bodies.  

Bottom Line #1.  Apple can send updates to improve their smart phones because the codes are identical in every iphone on the planet.  Using genetically engineered mice makes it easier to get consistent results in animal studies.  The freedom humans expect is a double-edged sword.

Bottom Line #2.  No treatment is 100% effective.  Even when a clinical trial is successful, some subjects do not respond positively to the treatment.  It is impossible to predict if you will be like the subjects who responded positively or the subjects who were not helped by the treatment.  A trial period is needed to see if a treatment protocol will help you. 

January 4, 2016

Snow Shoes for a Stroke Survivor

Since my stroke I am careful about venturing outside when it snows, but I am not trapped inside until spring comes either.  I never walk on snow covered concrete, gravel, or grass. because uneven slippery surfaces are a fall hazard.  Once streets, sidewalks, and access to my car are clear I wear boots over my shoes to protect them from the slush.  Boots I tried on at a shoe store would not fit over my leg brace.  My leg brace will not let me point my toes which is a pre-requisite for donning boots.  On-line I found the Neos overshoe with a Velvro opening that goes all the way down to my toes.  The Villager model is lightweight and designed for occasional use which is perfect for me.

A video at www.overshoesonline.com shows how to don this boot.  Warning #1: I do not put the boots on while standing as the video shows because I do not have good standing balance.  My boots go on safely while I am sitting.  A trick the video does not show is to make the ankle straps as long as I can before I put on the boots.  After I snap the straps closed I pull on the ends of the straps to make them tight.  Warning #2: The first set of boots I ordered was too big so they flopped around when I walked.  Bottom Line: I get good traction from the treads and do not arrive with soggy shoes.  I walk more slowly with boots on, but that beats not being able to keep important appointments like a visit to the doctor.

December 24, 2015

Keeping My Christmas Spirit

This is a photo of the Christmas tree I have put up every year since my stroke.  After I fell on my patio in October I looked for ways to reduce my risk for falling.  Denial faded weeks after the fall when I allowed myself to picture what would have happened if I had broken the hip I fell on. 

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 with the way 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 do not know why small things always make me happy.  I have held onto the decorations for my big tree so I still have options if I change my mind.

December 16, 2015

Pain is a Great Motivator

My PT made me realize the gluteus maximus (GM) muscle on my hemiplegic (paralyzed) side was as soft as unkneaded bread dough.  This buttock muscle is called a hip extensor because it extends the leg behind the body.  Only ballerinas and runners use the GM in this way. 

I am worried about this weak muscle because the GM helps other hip muscles keep the pelvis from wobbling as we swing our leg forward to take a step (1).  If the GM does not help stabilize the pelvis, low back muscles have to do it.  With my history of back pain, my GM has to get stronger.

I am also worried about the violent snapping of my hemiplegic knee when I walk.  For the past three months this knee has been painful and slightly swollen at the end of the day.  I recently learned the GM also slows the leg's forward motion when we swing our leg to take a step (1).  So the GM helps hamstring muscles (back of thigh) stop the knee from snapping into a fully straight position before we step onto that leg.  A recent x-ray shows I do not have arthritis in this knee yet.  I do not want knee replacement surgery so my GM needs to get stronger. 

To strengthen my GM my PT asked me to clench the two halves of my buttock together.  I could not feel where the muscle on my hemiplegic side was.  The inability to locate a muscle happened repeatedly after my stroke.  I had forgotten how depressing this is.  Thankfully, lots of repetition gave me sensory awareness so now I clench my buttock 12 times a day before I swallow 12 pills.

1. Wilson J, Ferris E, Heckler A, Taylor, C (2005). A structured review of the role of gluteus
     maximus in rehabilitation. New Zealand Journal of Physiotherapy, 33(3) 95-100.

December 2, 2015

Precision PT = Progress 11 Years After My Stroke

I started PT after injuring my back when I fell on my patio in October.  This is my first experience with precision PT.  Instead of having me do generic exercises like walk on the treadmill, Tony evaluated the individual muscles of my back and hemiplegic (paralyzed) leg.  Here are two of the many things I learned 11 years post stroke.

#1.  Back spasms are a future risk for me because abdominal muscles on my hemiplegic side are still very weak.  The stomach crunches I have been doing (photo) let me use many muscles to assist my stomach muscles.  Tony, my PT, had me repeatedly lift only my bent hemiplegic leg slowly while lying on my back and then lower my leg without touching my foot to the mat.  OMG. 
I felt increased muscle tone in my abdominals for hours.  Guess what I am doing every morning before I get out of bed. 
#2.  Tony discovered I developed the bad habit of locking my hemiplegic knee so my leg muscles do not have to work.  Now I stand with both knees slightly bent during 4 activities of daily living (ADLs) - brushing my teeth, putting curlers in my hair, putting on make-up, and standing in line at the store.  Standing in line with both knees slightly bent was the hardest to do consistently.  Putting both hands on the handle of the shopping cart is a cue that makes me compliant.  Retraining the brain requires lots of repetition.  This new habit is not automatic yet, but I have become aware of when I lock this knee so I can tell it to stop. 

Bottom Line:  I anchor each new exercise to a specific ADL which acts as a visual trigger.  It is wonderful not to have to think "I forgot/did not have time for X exercise" at the end of the day. 

November 26, 2015

Answering Machine Challenge

Opening voice mail requires a code.  I use an answering machine because all I have to do is push the blinking button on the machine to hear a message.  I also use an ear bud to listen and speak into the phone.  My wireless phone and ear bud allow me to go to the table to take notes and go to the couch to talk for an hour to friends and family hands free.  

Dilemma.  I thought I was being clever when I hung the ear bud on the antenna for the phone.  Hanging the wire in front of the phone makes the ear piece cover the blinking button (under red arrow).  I have made this mistake many times.  Then I missed a message from a dear friend who called me after her surgery.  Having my friend think I did not care enough to return her call made me change my behavior.  Maintaining relationships has been a valuable part of my recovery.

Solution.  Now I place the wire for the ear bud behind the phone and make sure the ear piece is not covering the blinking button (see red arrow).  Even this change was not enough.  I have to turn the phone so it points towards the corner of the counter (3rd photo) instead of being lined up with the edge of the counter (2nd photo).  Now when I walk in the front door I can see the blinking light as soon as I pass the TV.  

November 15, 2015

Tying Shoes One-handed

I shuddered when my OT put brown shoelaces on my beige shoes.  I had forgotten elastic shoelaces only come in black, brown, and white.  I want to wear the color-coordinated laces I paid for.  I refuse to wear shoes with Velcro straps that a 10 year old would be embarrassed to wear to school.  I was horrified when my PT suggested I wear jogging shoes.  It would upset me to give a professional presentation or go to a wedding with shoes that an able-bodied adult would not wear.

I pull the free end of the lace shown in photo #1 across the shoe and slip my index finger under the top horizontal lace (photo #2).  My index finger is pointing towards my body.  I use the tip of my index finger to drag the lace under the horizontal lace to make a loop.

Photo #3 shows I used my thumb to push the lace through the 1st loop to create a 2nd loop.  You cannot see the 1st loop because my thumb is in it.  I take my thumb out of the 1st loop and yank the 2nd loop side to side to tighten the half slipknot.

With time the shoe lace stretches so I tuck in the free end of the lace so I will not trip over it.

Dutton, R. (2013)  My Last Degree: A Therapist Goes Home After a Stroke, 2nd ed., pp. 90-95.  Bangor, Maine: Booklocker.

November 4, 2015

The Zipping Challenge is Not What You Think

Now that it is cold I need to zip my coat.  Velcro closures on my raincoat do not keep me warm.  When I sit, gaps form between the Velcro tabs which lets body heat escape.  I was surprised to learn the hardest part of zipping a coat is not grabbing the zipper tab.  The step that requires the most precise finger control is holding the bottom of the coat.  The 2nd photo below shows I am holding the bottom of the coat with three fingers in a 3-jaw chuck grasp.

Holding the bottom of a coat has to accomplish two things.  First, my bottom finger is keeping the joined tab and the zipper perfectly aligned.  ONLY IF you accomplish the 1st step do you get to proceed to the 2nd step which is holding the bottom of the coat still as the other hand pulls up the zipper tab.  Having a stroke does not stop zippers from being cantankerous.

Before zipping I use one remedial strategy.
To remember what I learned while doing finger exercises, I rehearse pinching my thumb and index finger together to wake up the muscles I need to zip.  I use 3 compensatory strategies.  (1) I don a rubber finger cot designed to sort money to get better traction.  (2)  My hemiplegic (paralyzed) thumb and finger grab a small piece of fabric that is attached to the zipper tab (see white rectangle above).  The fabric is less slippery than the metal tab.  (3) My hemiplegic hand can pull the zipper tab up only two inches.  Going higher requires wrist flexion which forces my hand to open.  After two inches I switch my hemiplegic hand to holding the bottom of the coat still while my sound hand finishes the zipping.  The 3rd photo shows you why I am not sad that I use a combination of remediating deficits and compensation.  I also hate being stared at when I stand next to a wall near a store exit so I will not get bumped by people as I zip my coat - another reason to speed things up with compensation + remediation.