December 31, 2015

Cheating Safely Saves My Christmas

Christmas was stressful because a stroke took away my ability to push through my fatigue.  Unfortunately I have accumulated two large boxes of Christmas decorations over the years.  I was exhausted after putting up all my decorations.  So instead of packing and repacking to get every item back in my crowded boxes, I set aside nice items that I no longer feel an attachment to for my church's spring sale.  I raised money for charity and send nice decorations to families that I hope will love them.  
I kept items: 1) that are handmade like Santa made from a mop, 2) that remind me of a happy memory like sledding with my brothers or 3) can be arranged in a tableau like the reindeer (photo below). 
Stroke survivors are not the only people who need to let go.  A workshop at my church was called "Simplify the Holidays."  The flyer said "Do you find the holidays are filled with shoulds and to-do lists?  Are you struggling with maintaining old traditions that no longer have meaning in your family life?"  The choices I make can make holiday more enjoyable.    

December 27, 2015

Not Making Exercise Personal = Non-compliance

Even though I am an OT I stop doing a home exercise if I do not see what I hope to get from it.
I think non-compliance is more likely when exercise does not feel personal.  My OT had me slide a towel on the table with my hemiplegic hand.  That exercise was to help me........  what was that exercise for?  The hand can reach to pull up pants or sign a credit card slip.  Unlike the foot, the hand is so versatile it is hard to know what sliding the towel on the table would do for me.    

Here is another example of how confusing exercise can be.  My neighbor complained to me about OT.  Her OT had her put clothespins on a clothesline.  My neighbor said "I told that young girl I had a clothes dryer, but she made me use the clothespins anyway."  As an OT I knew her therapist was working on tip pinch.  However, I did not know my neighbor well enough to know why she needed a strong tip pinch in her non-dominant hand.  If one OT cannot tell what another OT's end game is how can clients understand the value of the exercises we prescribe? 

Linking a specific Activity of Daily Living (ADL) to a specific exercise motivates clients. 
Stretch shoulder = Don shirt.  When my shoulder was tight I laid on my back on the bed and stretched it while I rested after a shower.  Stretching my shoulder just before I dressed made it easier to get my arm in the sleeve when I donned a shirt. 
Leg lifts = Boardwalk. Before I walk on the boardwalk at Point Pleasant Beach, I hold onto the railing and do a few leg lifts to wake up the weak hip flexors and abdominals on my hemiplegic side.  Leg lifts keep me from stubbing my toe on the edge of boards that stick up.  

December 16, 2015

Pain is a Great Motivator

My PT made me realize the gluteus maximus (GM) muscle on my hemiplegic (paralyzed) side was as soft as unkneaded bread dough.  This buttock muscle is called a hip extensor because it extends the leg behind the body.  Only ballerinas and runners use the GM in this way. 

I am worried about this weak muscle because the GM helps other hip muscles keep the pelvis from wobbling as we swing our leg forward to take a step (1).  If the GM does not help stabilize the pelvis, low back muscles have to do it.  With my history of back pain, my GM has to get stronger.

I am also worried about the violent snapping of my hemiplegic knee when I walk.  For the past three months this knee has been painful and slightly swollen at the end of the day.  I recently learned the GM also slows the leg's forward motion when we swing our leg to take a step (1).  So the GM helps hamstring muscles (back of thigh) stop the knee from snapping into a fully straight position before we step onto that leg.  A recent x-ray shows I do not have arthritis in this knee yet.  I do not want knee replacement surgery so my GM needs to get stronger. 

To strengthen my GM my PT asked me to clench the two halves of my buttock together.  I could not feel where the muscle on my hemiplegic side was.  The inability to locate a muscle happened repeatedly after my stroke.  I had forgotten how depressing this is.  Thankfully, lots of repetition gave me sensory awareness so now I clench my buttock 12 times a day before I swallow 12 pills.

1. Wilson J, Ferris E, Heckler A, Taylor, C (2005). A structured review of the role of gluteus
     maximus in rehabilitation. New Zealand Journal of Physiotherapy, 33(3) 95-100.

December 2, 2015

Progress 11 Years After My Stroke

I started PT after injuring my back when I fell on my patio in October.  This is my first experience with precision PT.  Instead of having me do generic exercises like walk on the treadmill, my PT Tony evaluated the individual muscles of my back and hemiplegic (paralyzed) leg.  Here are two of the many things I learned 11 years post stroke.

#1.  Back spasms are a risk for me because abdominal muscles on my hemiplegic side are still very weak.  Stomach crunches I have been doing (photo) let me use many muscles to assist my stomach muscles. Tony had me slowly lift my bent leg while lying on my back and then lower my leg without touching my foot to the mat. I felt increased muscle tone in my abdominals for hours. Guess what I am doing every morning before I get out of bed. 
#2.  Tony taught me that I developed the bad habit of locking my hemiplegic knee so my leg muscles do not have to work.  Now I stand with both knees slightly bent during 4 activities of daily living (ADLs) - brushing my teeth, putting curlers in my hair, putting on make-up, and standing in line at the store.  Standing in line with both knees slightly bent was the hardest to do consistently.  Putting both hands on the handle of the shopping cart is a cue that makes me compliant.  Retraining the brain requires lots of repetition.  This new habit is not automatic yet, but I have become aware of when I lock this knee so I can tell it to stop.