January 28, 2015

Are Sadness and Anger Bad?

I used to think emotions like joy and love are good while emotions like sadness and anger are bad.  Now I believe that how I react to my emotions is what is good or bad.  It is bad when I am so pre-occupied by mental chatter that I let moments of joy fly past me unnoticed.  It is good when I stop what I am doing and take a few seconds to appreciate when I am happy.  It is bad when I rerun upsetting episodes in my head.  It is good when I use anger to propel me towards a solution.

IF I could go back and tell my younger self  to stop rerunning memories that upset me, I doubt it would make any difference.  First, when I was young I had the tremendous energy it takes to sustain emotional drama.  Second, being snubbed recently reminded me of how intense emotions can be.  Emotions can feel so real that they seem unstoppable. 

A stroke took away the energy I need to stay upset for a long time.  I was upset the day I was snubbed.  By the next day -- not so much.  By the third day I remembered that letting this person upset me gives her power.  By the fourth day I remembered I was upset for decades but can no longer remember most of what upset me.  Hence the irritating platitude -- this too shall pass.  My heart does not get to choose which emotions I experience, but I have learned that how I react to those emotions is a conscious choice.  My stroke has both taken away and given. 

January 26, 2015

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).  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.

January 17, 2015

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."

January 4, 2015

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.