September 30, 2015

Bathing When I Travel

Caution.  This folding stool may not be safe if you are heavy or need physical assistance to stand up and sit down. 

Thank God I found a folding shower stool I can bring when I visit people who do not have a handicapped bathroom.  Thank God a luggage saleswoman suggested I transport the stool in a nylon garment bag because the stool is too wide for anything but the widest suitcase.  I bought this stool at a local medical supply house instead of buying it on-line.  I wanted to (a) see if I could open it myself and (b) feel how sturdy it felt when I sat on it.  After I'm done showering I drape a bath towel over the closed toilet lid, place the folded stool on the towel, and use the ends of the towel to wipe off the water.  I drape the towel over the folded stool and find a place in the bathroom to keep it out of people's way. 

Is a shower stool compensation for my bad balance?  Yes.  Does this make me sad?  No. 
This adaptive device has allowed me to travel to see family and friends, present at conferences,
go on vacation, and find shelter when the power goes out (e.g. hurricane Sandy).  

September 27, 2015

The Flexion Synergy Can Be Good

At first, an arm paralyzed by a stroke is limp (Brunnstrom Stage 1).  Stage 2 is exciting because stroke survivors see small limb movements.  In Stage 2 I could fling my hand onto my thigh, but my hand slid off because my arm muscles were too weak to hold it there.  Small movements turn into a synergy (Stage 3).  Synergy means muscles work together, but a stroke creates abnormal synergies that produce only one movement pattern.  This is bad because you cannot change where you place you hand.  The photo shows one version of the flexion synergy that affects the arm.  There are many versions so your movement pattern may look different.  The flexion synergy is also bad because to move one joint you have move the whole arm whether you want to or not.  This is exhausting.  When Stage 3 becomes full blown the hand is fisted and the arm is close to the body.

An electrical stimulation device called NeuroMove that has a biofeedback component and a spring-loaded hand splint called SaeboFlex helped me modify Stage 3 to make it functional.  They helped me retrain my brain to open my hand a few inches so I could receive an object from my sound hand.  Hand-to-hand transfers let me hold an object close to my body so my sound hand can manipulate the object.  Hand-to-hand transfers made me independent in 18 Activities of Daily Living (ADLs).

Brunnstrom Stage 4 brings more shoulder, elbow, and forearm motions that move the hand farther away from the body (photo on left).  My hand is still synergy bound which means I cannot open my hand unless I also move my arm.  My Stage 4 skills are: 1) keeping my hand open when I reach at waist height and
2) partially rotating my forearm to orient my hand to different positions objects require.  Bringing a partially open hand to an object is very important because the non-dominant hand assists the dominant hand thousands of times in a life time.

I was stunned to learn my hand is useful without achieving Stage 5 (relative independence from synergy).  The Neurodevelopmental Treatment Approach (NDT) says the hand needs good shoulder control.  This is true if you want to swing a hammer without hitting your thumb.  Many ADLs do not require this kind of precision.  Why defer hand use when ADLs can make do with emerging arm and hand movements?  As an OT I knew that stroke survivors learn to walk using the extension synergy in the leg, but I was taught the flexion synergy in the arm was bad.  I had to have a stroke to see the flexion synergy in the arm in a more positive light. 

September 16, 2015

Walking in the Dark, Part 2

I went to a great concert with a friend.  The old auditorium was beautiful.  However, we had to walk four blocks to the car in the dark.  The street lighting was so poor in certain sections that I could barely see the sidewalk.  The darkness was intensified by the low light of a new moon.  Decreased light is a fall hazard for me because my stroke damaged the bridge to the cerebellum (pons) that controls balance.  I learned I stay vertical by using my vision when I toured a huge Christmas light display with my brother three years ago.  This experience gave me the foresight to prevent a fall by asking my friend if I could put my sound hand on her shoulder as we walked.  When I maintain physical contact with an object that is vertical I know I am vertical.

The four block walk to the car was a wake-up call.  I have let my walking endurance decline so my hemiplegic (paralyzed) leg tired quickly.  I started scuffing my toe because I did not lift my leg high enough.  My walking improved when I handed my cane to my friend.  My hemiplegic hand can usually hold onto my cane while I drag the rubber tip on the ground - but not tonight.

Bottom Line: Once again I learned that mobility in the community = motor control + problem solving.

September 4, 2015

Home Programs Are Like Dieting

Home programs for stroke survivors are like dieting.  Both are "shoulds" that make me feel guilty when I don't do them.  Even though I'm an OT being a good patient gets boring after a few weeks. Yet I'm doing home exercises 7 years after my stroke because each one is anchored to something I want.

Here is an exercise I've recently added to my home program that illustrates what I mean by anchored.  After I felt my OT massage a painful knot out of my shoulder I was determined to stop it from coming back.  The painful knot formed because I was using my shoulder to lift my arm instead of using my elbow to lift my hand.   My OT taught me how to keep my shoulder relaxed. 

I start with my arms down at my sides and raise both hands to the middle of my chest using only my elbows.  Now I'm putting less stress on my shoulder muscles when I lift my hand.  Avoiding pain is a powerful anchor.  I do this exercise three times before I take my pills with yogurt each day.  I set out the yogurt, spoon, and pills before I start.  I'm afraid I'll lose the sensation of what normal movement feels like if I stop to gather supplies.  An anchor that feels personal turns "I should" into "I want to."