Muscle Memory Finally Kicked In

I am stunned.  Eleven years after a stroke my muscle memory still works.  For months I have been doing abdominal exercises to prevent back spasms (click here and here).  However, arching my back while leaning against the kitchen counter persisted so I used a memory aid to stop this bad habit.  I leaned on my arm after placing my hand on a piece of Dycem.  This created a space between my stomach and the sink.  A few weeks ago I became aware of my body telling me the twisted way I was standing at the sink did not feel good. 
I immediately stood up tall and straight.  I do not know how long I have been doing this because I no longer have to tell my back and stomach muscles what to do. 

Athletes call the ability to quickly execute a practiced movement muscle memory.  Muscles do not remember - the brain remembers.  A part of the brain called the cerebellum stores motor memories so it can automatically tell muscles what to do.  Motor memory kicked in during the first few years after my stroke, but I did not know this could still happen to me.  Relearning movement is mentally exhausting because stroke survivors have to tell their body to do EVERY LITTLE movement.
Moving without thinking about it is a blessing.

Bottom Line: My back and my brain are happy about this unexpected development.

Part of OT is Hidden

Some people think OTs are the dressing or handwriting guys.  Yet OT's official slogan is Living Life to Its Fullest (R).  The disparity between what people think OT is and how OTs see themselves occurs because OT is like an iceberg.  An important part of what OTs are trying to accomplish is hidden.  There are three components of OT treatment, but you see only two in an OT session.

1. The Preparation.

Preparation addresses each client's individual deficits.  Examples include exercises to open the hand while reaching, scanning strategies for visual neglect, learning what the parts of a memory notebook are for, and learning how to stop negative self-talk.  

2. The I Shoulds. 
Many people have the same shoulds.  We all should get dressed so we can leave the house, do laundry so we have clean clothes, write legibly so we can sign credit card slips, and have good memory strategies so we get to appointments on time.  OTs call "I shoulds" functional outcomes.  Insurance companies will not pay for therapy if clients do not show some functional gains.

3. The I Want Tos.

"I want to" is personal, like petting a beloved cat.  Valued activities occur outside of therapy so clients may not see how they are connected to OT.  OTs need to make linking statements so clients understand the full value of OT.  A linking statement might be "don a bra so I will not be embarrassed when I eat lunch with friends."  I live alone so donning my bra enhances my social life.  If a client wants to feel the sun on his or her face, pointing while saying "leg brace - patio" can make a client's face light up. 

Preparation and functional training are essential but they do not sustain our commitment to action when we recover slowly.  Practicing a tip pinch so I can zip my coat needs to be followed by "because I want to..........."  Valued activities help us maintain the physical, cognitive, language, and social skills we work so hard to regain.  Living life to the fullest does not mean going to Paris.  It means satisfying deep human needs like feeling needed and having fun.  It means turning
"I should" into "I want to."

Kinesio Taping Reviewed

A subluxed shoulder is painful because the upper arm (humerus) has slipped out of the shoulder socket.  Subluxation is rated by how many fingers you can fit in the space created by this abnormal shoulder separation.  I had a one finger subluxation so the hospital staff put a small lap tray that slid over one armrest of my wheelchair.  I made sure the staff put the tray on every day because I knew nerve damage can occur if nerves in the shoulder are stretched too much. 

The lap tray could not support my shoulder when I walked and did exercises while sitting on a mat table.  My shoulder ached constantly during these times until my OT bound it up with Kinesio tape. This wide tape provides support but is stretchy enough to allow movement.  I wore the tape 24 hours a day - even in the shower.  It eventually came loose and had to be replaced every third day.

Hanger and associates found stroke survivors who had their shoulder Kinesio taped had less shoulder pain (1).  The improvement got very close to statistical significance (p = 0.11 instead of the required 0.10) because some people were helped while others were not.  I am glad Kinesio tape worked for me because having a subluxed shoulder felt like someone had punched my arm very hard. The only thing that made that constant ache go away was Kinesio tape.

1.  Hanger H, Whitewood P, Brown G, Ball M, Harper J, Cox R, Sainsbury R. A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clinical Rehabilitation. 2000;14(4):370-380.

Is the Glass Half Full or Half Empty?

Major holidays raise our expectations for happiness so it feels like an appropriate time to ask
"is my glass half empty or half full?"  I did not know being an OT made me a glass is half empty person.  Insurance companies do not reimburse therapists for documenting assets so they focus on what no longer works.  This is why I hate being in a crowd of therapists.  They can not see that every head is turned in my direction as I walk by.  They are evaluating my deficits.  They can not help it.  It is what they do for a living.  I prefer to be around able-bodied people because most of the time they see my assets.  When I join friends and family they notice when I do not ask for help.

Having a stroke transformed me into a glass is half full person.  One of the greatest skills therapists have is the ability to see short-term goals that have a good chance of being realized.  Unfortunately I lost this skill when I had a stroke.  I have to concentrate fiercely to make my hemiplegic side do movements that were once automatic.  While doing a task for the first 100 times I do not have
one brain cell free to evaluate my skill.  I need a therapist to tell me what new skills are possible for me.  Yet at every stage in my recovery I thought my therapists were crazy because I thought they were asking me to do the impossible.  If you ever wake up and discover your leg feels like it weighs 100 pounds (45.4 kg) you will understand my reaction.  Thank God my response to what I thought were crazy requests was "I'll try."  My once flaccid hand can now do this (see photo below).  I became a glass is half full person because wonderful therapists helped me regain skills
able-bodied adults take for granted.  Working in a nursing home years ago helps me appreciate that therapy and my hard work made it possible for me to be in my home at Christmas time.

                                                                            If you want to read about the Releas splint I am wearing on my hemiplegic hand click here.    

A Peaceful Christmas by Design

The holidays can be both joyful and exhausting.  I prevent the fatigue that drains my Christmas spirit by simplifying how I decorate.  Smart choices make it less tiring to put up, take down, and pack away Christmas decorations.  I put fewer ornaments on the tree and no longer add tinsel.  The sparse look took some getting used to.  However, feeling happy when I turn on the tree lights and play Christmas music is wonderful.  I no longer think "I will not decorate next year."     

To see how I prevent falls when I decorate the tree click here.  Falls also do not make a peaceful Christmas.

Constraint Therapy is Good and Bad

When a new graduate told a blogger that stroke recovery happens in the first two years I decided to write about constraint therapy.  It was designed by a psychologist named Edward Taub who did not assume recovery after a stroke is time limited.  Briefly, constraint therapy means putting a mitt on the sound hand during 2 hours of therapy for the hemiplegic hand PLUS leaving the mitt on the sound hand for 3 to 6 hours each day.  This forces the hemiplegic hand to work.  Since 1993 many constraint therapy studies have found clients can recover hand function for years after a stroke.  

Constraint therapy is good because it challenged long held beliefs about stroke recovery.
Constraint therapy is bad because it was designed by a man who grew up in a culture where men
can expect women to take care of them.  It would be nice if every husband would go grocery shopping, cook, and do laundry while their wives constrain their sound hand every day. 

Current research offers an alternative.  Hayner found guiding both hands to work while making lunch, eating, and cleaning up helped stroke survivors improve as much as subjects whose hand was constrained during the same activity (1).  Hayner concluded the duration of forced hand use is what matters.  Sterr reported a similar finding (2).  Stroke survivors who were helped to use their hemiplegic hand for 90 or 180 minutes improved as much as subjects who received constraint therapy for the same amount of time.  

How can stroke survivors force this much hand use?  I do exercises with a spring-loaded splint called SaeboFlex that helps me open my hand 100 times.  Now my hemiplegic hand can open to hold over 100 objects while my sound hand manipulates those objects.  Brief hand use adds up.  In 11 years my hemiplegic hand has opened to hold a tube of toothpaste 16,060 times so my sound hand can take the cap off and put the cap back on after I put toothpaste on my toothbrush. Bottom Line: More than one type of forced use can improve hand function years after a stroke.  Rehab professionals and stroke survivors need to let go of old myths.

Reminded Again to Put Memory Aids in My Face

Lately I have been forgetting to do tasks.  These errors helped me relearn the value of putting memory aids in my face. 
I see my calendar with plans for the days as soon as I sit down at the table to eat breakfast (see photo).  Before my stroke this morning review was enough to help me remember things I wanted to do later in the day.



Error #1.  The To-Do list for the day goes right out of my head.
Solution # 1.  Immediately after breakfast I move my calendar and the yellow To-Do list to the couch where I sit everyday. For an extra cue I put the TV remote on top of these memory aids.

Error # 2.  I kept forgetting to check my new shoes to see if the tongue is sewn on correctly.  The tongue needs to be long enough (see arrow) so the top row of laces will not slip off the leather and dig into my ankle. 
Solution #2.  I put the new shoe on my couch where I sit to read and do crossword puzzles. 



Bottom Line: Using the environment as a memory aid can make people happy.  Don't able-bodied people place objects they must not forget near the front door at night?  I have a place where I sit every day so why not exploit it?

Seven Strategies Keep Volunteers Coming Back

If I live long enough I may need to go to a nursing home.  Nursing home residents who constantly complain or who are hostile find themselves medicated so they are less "anxious."  I do not want the aggravation of seeing my favorite sweater on another resident or being told "we do not do it that way here."  Treating my volunteers with kindness makes it more likely they will continue to help so I can stay in my home longer.  I use 7 strategies to keep my volunteers from burning out (11 years and counting).

1. Prioritize.  I cut down on the number of requests by identifying need versus want.  I need someone to get on a ladder to change the batteries in my smoke detectors.  These detectors are connected to my electrical system that maintains an ear-splitting screech when the battery dies.

2. Build trust.  People do not need special rehab training to know when they are being taken advantage of.  When I ask for help I let my volunteers know I always do everything I can before I contact them.  For example, when I asked Peggy to tape a bag shut so I could return a coat, I explained I had affixed the return label but did not trust my sound hand to tape the end of the bag securely.  People feel good about helping when they know they are really needed.  This strategy builds trust.

3. My husband would groan rule.  I cannot ask people to do things that would make a husband groan.  I cannot ask someone to buy a live tree, transport it, drag it into my house, use an axe to trim the base so the tree fits in the stand, and tighten and loosen the tree stand to reposition the tree until it is straight.  After having live trees my whole life
I bought an artificial one.  John takes it out of the box and snaps the four pieces together.  This rule helps me identify tasks I need to hire a handyman to do, like clean out my gutters. 

4. Let them choose WHAT to volunteer for.  I e-mail a request and let people choose things they want to do. This makes my request less of a burden.  Peggy who loves to sews repaired the sleeve on my raincoat.  Barbara who is a computer technician volunteered to help me set up the Bluetooth system in my new car.  Parts of a large task that a volunteer hates will not get done, but letting people choose what to do means I do not risk rejection because I have asked the wrong person.

5. Let them choose WHEN to volunteer.  After they volunteer I ask them when would be a good time for them.  Everyone has busy lives so it is less of a burden when I fit into their schedule.

6. Make a list and stick to it.  Before someone comes I make a list of the things I need done so my volunteer knows when he or she is done.  I stick to the list instead of looking around and saying "there is one more thing I need you to do."  This list also reminds me to get materials my volunteer needs.  Before John comes to replace the batteries in my smoke detectors I buy 9-volt batteries.

7. 80% rule.  The 80% rule means some things can be mostly correct rather than perfect.  After my stroke I gave myself permission to not make everything perfect.  For example, I do not make multiple trips around my bed so the bedspread is perfectly straight.  The seam of my bedspread is supposed to be where the edge of the mattress is (see the black line).  I think it is only fair to extend the 80% rule to my volunteers. Nobody wants to hear they did not do something the way I used to do it.

Addendum - Walking in Snow with a Cane

Bottom Line: I am not ready to go to an assisted living facility were the center's van will take me to Wal-Mart once a week.

The photo on the left shows the Briggs Ice Cane/Crutch Attachment.  I bought it at a medical supply store near my home.  The advantage of buying it in a store instead of on-line is the saleswoman got out a screwdriver and fastened the device to my cane.  It stays out of my way in the up position until I put it down.(photo below). 
I place the cane in my hemiplegic (paralyzed) hand which holds the cane still while my sound hand pushes the device down until I hear it snap into position. 

The device makes my cane slightly heavier which slows me down.  I use another cane during warm weather rather than take this device off and try to get it back in the same place each winter.

Warning #1: I do NOT poke my cane through the snow.  I wait until after a neighbor I pay shovels my walkway and digs out my car.  I must be able to see the ground to tell if there is an icy patch that could make the spikes slip.  Checking the ground for ice slows me down, but it gets me to my car safely so I can drive. 

Warning # 2: People who plow store parking lots do not always do a good job of removing ice from handicapped parking spots.  Before I get out of my car I open the door and look at the ground to see if I want to leave the device down or push it up out of my way.

Will I Be Homebound This Winter?

Trenton, New Jersey used to have such mild winters that officials closed the schools when there was only 2 inches of snow on the ground.  The dip in the jet stream that brings cold Artic air south shows why Trenton was lucky (black dot = Trenton).  Last winter Trenton had six major snow storms in six weeks that were measured in feet instead of inches. Strong storms in the Artic now blow the jet stream farther south to include me.  So much pack ice has melted due to global warming that the air is saturated with water vapor which turns into snow on my street. 
I want people who have recently found my blog to see this post about one of my winter strategies.  Also see my next post on using a cane in the snow.

 

Since my stroke I am careful about venturing outside when it snows, but I am not trapped inside until spring comes either.  Warning #1: I never walk through snow covering the sidewalk or street because it is 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 did 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 which is perfect for me.

A video at www.overshoesonline.com shows how to don this boot.  Warning #2: I do not put the boots on while standing as the video shows because I do not have good standing balance.  I don my boots safely while 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 #3: The first set of boots I ordered were 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 appointments like a visit to the doctor.