May 31, 2015

Getting to See My Family

I am going on a ten day trip to see my brother Mark.  We have not seen each other for two years because the horrific snow storms last winter made it too difficult to travel at Christmas.  He is looking forward to showing me his new boat and doing fun things together in Michigan.  We keep in touch via telephone, but I am looking forward to seeing him in person and giving him a big hug. 

My brother was four years old when I left home for college.  My memories of him were about helping take care of him.  We did not really get to know each other until we were both adults.  I was surprised to learn that our personalities are amazingly alike and we like many of the same things.
I have seen families drift apart after both parents die so I do not take his friendship for granted.  

I will be traveling with a GPS device.  Since my stroke I cannot hold a map or written directions while driving because I cannot let go of the spinner knob on the steering wheel (see arrow) that lets me steer one-handed.  I am glad my GPS device gives specific directions, like "turn right at Exit 29B to Monroe."  It is reassuring to see a sign that says "Monroe Exit 29B" a few seconds later 

May 26, 2015

Smart Phones and Stroke, Part 1

Part 1 is about how a stroke limits what I can do with a smart phone and how I feel about it. 

I do not have to worry about falling while staring at my smart phone as I walk.  My one good hand is busy controlling the cane I walk with due to my poor balance.

My sitting balance is not as good this guy on the boat.  I do not have to worry about missing a whale because I cannot stop staring at my smart phone. 

I use my one good hand to hold the spinner knob that controls the steering wheel.  Letting go of the spinner knob to use my phone would be a new definition of hands-free driving.

I can use my smart phone to ignore people.  However, after my stroke visiting with others is such a treat that I have never done it.  Years ago I read a science fiction book about a time when people interacted only as 3-D holograms.  Anyone who craved face-to-face human contact was considered mentally ill.    I remember thinking I would be dead before technology made this future happen.  Then I saw eight twenty-somethings playing with their smart phones after they finished eating in a restaurant.  The zone of silence was eerie. 

I am still learning how to take photos with my smart phone.  The touch screen is so sensitive that the phone takes seven copies of the same picture before I can take my thumb off the button.  My four other fingers struggle to cradle the phone.  I am learning to put less pressure on the screen and remove my thumb more quickly, but I still love my camera that is perfect for a stroke survivor.

May 17, 2015

Walking in a Barren Environment

All my PTs work in a barren environment that does not make them aware of the cognitive demands I have to deal with while walking.  In-patient and out-patient PTs walked me in gyms that have equipment and people sitting around the periphery.  When two clients who are walking approach each other the PTs look at each other and decide who will stand still while the other person moves first.  This gave me the luxury of concentrating fiercely on my hemiplegic leg.  Home health PTs walked me around the block in the middle of the day when nobody was outside.  Walking in wide empty spaces did not prepare me for tasks that require me to think while I am walking.

My fantasy is that home health PTs will meet clients in the community in the middle of the day.
At a restaurant they will help stroke survivors walk sideways between tables and go down stairs that have a railing only on the hemiplegic side.  At a store - walk in circles around racks of clothing and stop for people who are not watching where they are going.  At a hair salon - sit down in the chair without tripping over the big metal footrest.  At church - get into a pew and turn around to sit on the toilet regardless of which side the grab bar is on.  A PT cannot be with me every time I try a new activity.  However, PTs can make clients safer by helping us understand that walking requires problem solving as well as physical mobility.  After you rehearse dealing with barriers in the community go home to rest and plan a real outing.

Football coaches do not stop after they have players throw and catch footballs and do foot agility drills.  Football players eventually have to stop concentrating on their body and start thinking about strategy as they move so coaches have them play football with their teammates.  Athletes and musicians also have rehearsals to make the transition from exercise to function.  Why are stroke survivors not getting the same kind of help?

May 5, 2015

Resting Splints Revisited

When I joined the staff of a nursing home as their first OT I opened a stroke survivor's hand after her fingernails grew into her palm because the nursing staff did not know how to inhibit her high muscle tone.  I remember that visual image when I read that stroke survivors get no benefit from wearing resting splints.  This conclusion is based on studies that looked only at hard plastic splints which are static (does not move).  After my spasticity broke two hard plastic splints, I bought a dynamic (moves) resting splint called SaeboStretch.  It bends when my muscle tone increases and goes back to its original shape when my muscles relax. 

Andringa studied a dynamic resting hand splint made by Ultraflex in Pottstown, Pennsylvania (1).  Six stroke survivors wore the dynamic Ultraflex splint for six hours during the day for six months.  Subjects reported significantly less pain at 3 and 6 months (p< 0.05).  Passive wrist extension
did not increase significantly at 3 months but was significantly greater at 6 months (p< 0.05). Subjects wore the Ultraflex splint during the day so forced disuse may have slowed recovery.  

One of Andringa's subjects illustrated the ultimate challenge of hand splinting.  He stopped wearing the splint after 4 months because it did not meet his expectations of what he thought the splint would do (1).  When clients are not told what they can expect when they wear a hand splint they are free to imagine the outcome.  Read the rationales for splinting in Are Resting Splints a Waste of Money?

 1. Andringa A, Ingrid G, Van de Port, Meijer J. Tolerance and effectiveness of a new dynamic
    hand-wrist orthosis in chronic stroke patients. NeuroRehabilitation. 2013;33(2):225-231.