July 31, 2014

Back Pain + Stroke = Disaster

I herniated a disc in my back and had sciatica 20 years ago so I've been stretching my back for years.  After my stroke I was worried my back pain would come back.  It did.  A recent bout of back spasms taught me stretching my back every morning is not enough.  Freezing in place when a back spasm hits and hoping I can walk slowly to sit down without dropping my cane is scary. 

My PT showed me I arch my back because my abdominal muscles on my paralyzed side are weak (bottom half of red line on left).  To stop myself from falling forwards while standing I lean back (top half of red line).  I also arch my back every time I lift my leg to walk.  Leg muscles (small arrow pointing upwards) need a stable base to pull on.  Abdominal muscles (arrows pointing downwards) are suppose to hold the pelvis and spine still when my leg moves.  

It gets worse.  I discovered I arch my back when I lean down to pick up an object, like when I reach down to get a pot from a bottom cabinet, get milk from the bottom shelf of the refrigerator, or pick up something from the floor.  I arch my back when I wash a dish because I am leaning my stomach on the edge of the counter for support.  

My PT taught me to do leg lifts with bent rather than straight knees.  I decided to intensify the workout.  I clasp my hands together, lift both arms over head, and lift my head while twisting to the left until my right shoulder blade lifts off the bed.  Before I start doing a leg lift I press my low back against the mattress and take a deep breath.  When I move I slowly let my breath out through pursed lips.  Holding my breath would increase my blood pressure.  I was dismayed that my NDT certification course did not teach that hand function comes from my gut.

Bottom Line: It takes both stretching my tight back and strengthening my weak abdominals to keep back spasms away.

July 27, 2014

Writing Aids I Cannot Live Without

The long boring weekends in the rehab hospital drove me crazy.  When Kathy, my recreational therapist, gave me an opportunity to practice writing with my sound, non-dominant left hand I jumped at her offer.  My friend Arlene did not volunteer to write checks to pay my bills for the rest of her life.  Kathy helped by bringing me clear Dycem and crossword puzzles she had enlarged on a Xerox machine to make the spaces bigger.  Colored Dycem is thick and rubbery.  Clear Dycem is thin and slightly sticky so it holds the paper still as I write.  Solving crossword puzzles was more fun than writing letters of the alphabet over and over like I did as a young child in school.

When I got home I found clear Dycem at www.pattersonmedical.com but was shocked at the price.   However, I splurge on a small roll of clear Dycem which costs $55 + shipping and handling because it is a writing aid I cannot live without.  I have pieces of it every where I sit down to take phone messages, pay bills, do crossword puzzles, write reminders on Post-It Notes, etc.  I make it last longer if by washing it.  A small roll (8 inches x 2 yards) lasts almost two years. 

I keep a small piece of clear Dycem in my purse (see arrow) to hold credit card slips still when I sign them.  As you can see, this dirty piece of Dycem is well used.  I also splurge on gel pens that cost $15 a box.  Gel pens are more forgiving that ball point pens that must be held at a precise angle to make the ink flow.
When I eat at restaurants that have tables with slippery surfaces this small piece of clear Dycem stops my plate from sliding as I cut food.  I appreciate not having to whip out a big brightly colored Dycem placemat to announce to everyone in the restaurant that I am disabled.

July 16, 2014

What a Fractured Arm Taught Me

I fell in the laundromat while struggling to move a queen-sized comforter.  I broke a forearm bone called the radius.  To heal the radius I had to stop using my hemiplegic (paralyzed) hand.  I was not able to do SaeboFlex exercises because this splint has a cuff that puts pressure on the forearm.  I lost lots of hand function and the ability to turn my hand palm up.   Below are four lessons I took away from this experience.

1.  It is too risky for me to do heavy housework anymore.  I tried to find a cleaning person in the past, but friends were reluctant to give me their housekeeper's phone number.  My broken arm moved a friend to take pity on me.  When I learned Isabel would charge $70 I gulped.  Even though she makes my home spotless, it took me 3 months to be at peace with this indulgence.
I finally relaxed when I realized I would be paying an assisted living facility $3,000 or more every month to get a cleaning lady.

2.  My fall at the laundromat began with a turn.  Weeks later I felt my back arch before I made a partial turn and fell against the kitchen counter. I realized I have been bouncing off my kitchen counters for a long time.  Hitting the floor of the laundromat has made me turning more slowly. 
3.  I felt my stomach push me away from the bathroom counter while I put rollers in my hair -- one more example of arching my back to lean on a counter so I will not lose my balance.  Now I place my hemiplegic hand on a piece of Dycem to make my abdominal muscles hold me away from the counter when I use curlers.  Arching my back contributes to back spasms
4.  Thank God for out-patient OT.  I could not have coped emotionally or physically with this setback on my own.  Cathy used contrast baths, retrograde massage, and gentle active range of motion to bring down the painful swelling, and help me regain strength in my shoulder and elbow.  When my forearm bone healed she began resistive exercises.  

July 5, 2014

Pictures Can Explain What OTs Are Doing

Aphasia is the inability to understand the spoken word and/or to express oneself verbally. Yet aphasic clients may retain procedural knowledge.  This is the ability to execute the steps of a task that often requires visual information.  We do not talk ourselves through the steps of tying shoelaces.  We remember what the steps look like and what our hands do.  Visual-motor information is stored in a different location than language so procedural knowledge may be spared after a stroke.  Printing out clip art or photos found on the Internet may help OTs explain what they are doing to help their clients.  Here is an example. 

If clients want to go home to eat a home cooked meal I am pretty sure they are not picturing themselves eating in bed wearing sweaty pajamas while the family eats at the dinning room table. 

To close the deal salesmen offer customers something they want.  Guessing what a person wants is risky.  Better to show a client pictures of hugging a child, petting a cat, sitting on the patio, etc.  It would be ideal if the family could bring in photos of activities the client enjoys. 
Good salesmen watch a customer's face to see what makes his or her face light up.