July 25, 2016

Fixing Cars and Smart Phones is Easy

Can you imagine auto mechanics trying to fix cars if every car has a slightly different electrical system?  Can you imagine Steve Jobs telling his staff to create a code that is slightly different for every iphone?  Yet millions of years of evolution has done this to the human brain.  The brain anatomy that is taught in schools is a general map - not a blue print for your brain.  Functional connectivity magnetic resonance imaging (fcMRI) can tell us which circuits are used during a task on a particular day, but the brain rewires itself in response to demands.  For example, the brain initially divides a complex task into small actions.  But with repetition, individual actions are rewired into groups that are implemented more efficiently than thinking about each step separately.
Brain plasticity is like cars and phones that rewire themselves after they leave the factory.

I had to decide how to deal with the current uncertainty in stroke rehab.  What has helped me recover is to stop asking how much recovery I will eventually get.  Focusing on short-term goals has been more helpful.  Therapists are required to write short-term goals that are individualized for each client, but do not share them.  Ask about the short-term goals your team is working on. 

However, setting short-term goals does not go far enough.  Therapists need to show stroke survivors how small gains can improve their lives.  As soon as I make a small gain, I try to discover what I can do with it at home and in the community.  Then I tell my therapist about what worked.
I have even brought materials from home to demonstrate what I can do with a new rehab gain. 
I NEVER WAIT until after I am discharged to begin asking what I am getting from therapy. 

Doctors and therapists would stop saying "all strokes are different" if they knew how it feels to be on the receiving end of this statement.  It sounds like an excuse that closes down a discussion of what is possible.  Individual differences in the way brains are wired and the varied location and size of strokes make it difficult for rehab professionals to tell stroke survivors what will happen in the long run, but therapists can talk about what they think is possible now.

July 16, 2016

Comparing a Garmin GPS to a Smart Phone GPS

I have two superb qualifications for comparing a Garmin GPS to an iphone GPS.  Since my stroke: (1) I cannot hold a map or an iphone in my right hemiplegic (paralyzed) hand and (2) I have driven 150,000+ miles through 15 states without a passenger to be my navigator. 

Both a Garmin Drive Smart 50 GPS and an iphone can be controlled with voice commands and a touch screen that lets your fingers move the map and zoom in and out.  However, an iphone GPS has problems with reliability, accuracy, spoken instructions, and road selection.

Reliability.  A Garmin GPS I have used for 11 years has always been able to connect with the GPS satellite overhead.  My iphone has repeatedly been unable to connect with a cell tower so I cannot use the GPS program.  These dead zones also make it impossible to pull up my maps history.  Who memorizes addresses any more?  When I am 400 miles from home this is unacceptable.

Accuracy.  In 11 years I have never been given wrong directions by a Garmin GPS.  My iphone occasionally gives me wrong directions.  For example, when I was driving on Route 138 East,
my phone said "stay on 138 West."  When I am 400 miles from home this is unacceptable.

Spoken instructions.  I have learned to ignore my Garmin when it gives me too much information.
If I know I have to drive 300 miles on a road, I do not need to be reminded to stay on that road every time I cross a major highway.  On the other hand, my iphone GPS has repeatedly not provided critical voice instructions.  For example, I saw a fork in the road but my iphone was silent.  Missing a major road change when I am 400 miles from home is unacceptable.  

Road Selection.  My Garmin Smart Drive 50 allows me to choose any route I want by touching the road I prefer.  This is important because suggested roads have the shortest travel time, but are not rated for the number of idiots on that road.  I am talking about people who drive 20+ miles per hour above the speed limit and who squeeze into a one car length opening only because I step on my brake to keep from hitting them.  By comparison, an iphone GPS chooses 2 or 3 alternate routes.
I do not ever want to drive Interstate 95 through Connecticut again.  A Garmin Smart Drive 50 GPS will make sure this never happens for as long as I live.

The 20 year old who scoffed at me for buying a Garmin GPS probably thinks senior citizens are not up on technology.  He had better be a homebody or be resigned to getting lost in Oklahoma.

July 6, 2016

The Only Magic Bullet I've Found

Stroke survivors tune people out but not necessarily for the reason you think.  When I am struggling with a task I start talking to myself.  When I hear my hemiplegic foot scuffing the floor because I am not lifting my leg high enough I start silently saying "knee up, knee up."  If someone is talking to me at that moment I do not hear what that person is saying.  I cannot listen to someone while I am talking myself through a task that able-bodied people do without any thought.  For a stroke survivor multitasking can be walking and talking at the same time.
 
After twelve years of living with a stroke the only magic bullet I have found is to stop multitasking.  If you want me to process new information or I want to participate in a discussion, I need to sit down.  Eliminating multitasking is a magic bullet because it has an immediate effect.  By not dividing my attention, I can focus all my energy on the part of my brain I need right now.  

I do not feel bad about not multitasking. This strategy keeps me safe and improves my performance. When I take a hot dish out of the the oven I stop talking to guests.  I need to make sure my hemiplegic (paralyzed) hand maintains a firm grip on the 400 degree handle.  When I drive during rush hour I turn off the radio.  I need to respond quickly to aggressive, unpredictable, impatient drivers.   .

I am not saying stroke survivors can never multitask.  However, it takes many repetitions before a task becomes so automatic that I can pay attention to a second task.  After a month of winter I can zip my coat  AND  talk to friends as we get up to leave a restaurant.

July 1, 2016

Is It Rehearal or Exercise? - Labels Matter

The labels we use can affect our behavior.  The word rehearsal implies I am getting ready to do something I want.  The word rehearsal stops me from feeling like I am exercising for no good reason.  Here are three examples.  (1) I live alone so I warm up my voice before I make the first telephone call of the day.  I sing the alphabet song and practice saying letters that are hard for me like the letter  "s."  (2) I stretch my ankle every morning as soon as I get out of bed.  This makes it easier to don my leg brace and walk to the kitchen for breakfast.

(3) It is hard to open my hand in the morning.  My hand does not always open far enough to grasp the deodorant bottle.  In sitting I rehearse opening my hand while pressing the back of my hand on the bed with my wrist fully bent.  Then it is easier for my hand to open to grasp the deodorant bottle so my sound hand can take the cap off.