December 31, 2014

Cracks on the Ends of My Fingers

Winter is finally here and I have a crack in the skin at the end of the fourth finger on my sound hand.  Every time the end of my finger contacts an object the crack opens painfully.  I wash my sound hand so often that my skin is as rough as sandpaper.  I felt desperate because my thumb develops an even bigger crack which is even more painful. 

I Googled paraffin bath because warm wax softens the skin.  On-line users said it takes 6 hours for the wax to melt.  To prevent burns, the heating element is too weak to melt the wax quickly.  This means leaving the unit on 24 hours a day to keep the wax liquid.  Then there were users who said wax leaked out of the bottom of their unit.  

Bath and Body Works makes a product called True Blue Super Softening Hand Lotion with paraffin.  The sandpaper rough skin on the end of my thumb disappeared after one application. 
It took 5 days for the crack on my fourth finger to close up after using one small dab the size of a pea each day.  This is good because the lotion costs $12 for a 2.5 fluid ounce tube.

I let the lotion sink in after I go to bed at night.  I put a dab of lotion on the back of my hemiplegic hand, use the remote to turn off my ceiling light, and get into bed.  I use the index finger of my sound hand to transfer the lotion to the ends of my fingers.  I need all five fingers working on my sound hand.

December 16, 2014

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.

December 4, 2014

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 Edward Taub who did not believe recovery after a stroke is time limited.  Constraint therapy involves putting a mitt on the sound hand for 1+ hours of therapy that focuses exclusively on the hemiplegic hand plus leaving a mitt on the sound hand for 3+ hours at home each day to force 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 neuroplasticity.  However, it is appropriate for a limited pool of clients.  1. Stroke survivors must already be able to extend (straighten) their fingers 10 degrees and their wrist 20 degrees.  2. It is good for men who have 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 at home every day.  3. Some stroke survivors experience crushing fatigue.  I had to decide what NOT to do every day for two years.   

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).  Sterr reported that 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 (2).  These and other studies have shown that mass practice can be less intense and come in several forms and still produce recovery.  

How can stroke survivors force so much hand use?  I do exercises with a spring-loaded splint (SaeboFlex) that helps me open my hand 100 times.  I live alone so my hemiplegic hand opens to hold 100+ objects while my sound hand manipulates those objects.  Even 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: Taub showed therapists and stroke survivors they need to let go of old myths.

1. Hayner K, Gibson G, Giles G. Comparison of constraint-induced therapy and bilateral treatment
    of equal intensity in people with chronic upper-extremity dysfunction after cardiovascular    
    accident.  American Journal of Occupational Therapy. 2010;64(4):528-539.
2.  Sterr A, Oneill D, Dean P, Herron K.  CI therapy is beneficial to patients with chronic low-
     functioning hemiparesis after stroke. Front. Neurol. 2014;5: