January 31, 2017

Community Ambulation Falls Thru the Cracks

Stroke survivors have to figure out how to walk safely in the community.  Walking in PT gyms and on deserted sidewalks did not prepare me for walking in community settings.  I had to teach myself how to maneuver around carts and people in a grocery store, squeeze past closely placed chairs and tables in a restaurant, and deal with children in a shopping mall who do not look where they are going.  PTs do not know that walking requires divided attention because they walk clients in wide empty spaces that provide no cognitive challenges.  Equally unfortunate, OTs who are trained to assess and treat cognitive issues do not assess community ambulation because walking is PTs domain.  So community ambulation falls through the cracks. 

A recent study simulated the unpredictability of walking in the community.  Inness learned what stroke survivors did when they experienced an unexpected balance challenge (1).  Subjects were asked to stand with their feet on two force plates.  At an unexpected time the force plates were tipped forward and subjects had to recover their balance by stepping forward onto a third force plate.  Traditional clinical tests like the Berg Balance Test did not have a significant correlation with the unexpected stepping test.  The Berg Test does not measure real world balance because it allows clients to concentrate fiercely on their own body and decide when they want to initiate movement.

Bottom Line: Being afraid to walk in crowded environments is a major barrier to participating in valued community activities.  Limiting gait training to walking in the home contributes to social isolation and depression. 

1.  Inness E, Mansfield A, Lakhani B, Bayley M, McIlroy W. Impaired reactive stepping among
     patients ready for discharge from inpatient stroke rehabilitation.
     http://ptjournal.apta.org/content/early/2014/08/06/ptj.20130603.abstract.

January 26, 2017

We All Can Help Emergency Responders

A presentation by an emergency responder taught me they need our help.  He recommended we keep a list of medications and contact numbers stuck to the refrigerator door with a magnet. 
I did this and added a copy of my living will.  I hope the gaudy turtle magnet catches their eye.




When I am out I have a special compartment in my purse that holds emergency information.

# 1 (green paper) is a list of phone numbers I need.
# 2 is a copy of my living will that includes contact
information for my brother who has the power of attorney for my health care.
# 3 is a list of  my medications.  My mother was wrong.  Contact information, a living will, and a list of medications are more important than having clean underwear when visiting an emergency room.
# 4 is a gel pen that is one of the writing aids I cannot live without.  I use this pen to sign credit card slips and write notes on a small index card I keep in this compartment. 

January 14, 2017

Snow At My Door

Sometimes I can wait 1 or 2 days for the snow to melt when my area gets a warm spell after it snows.  This snow storm was followed by a 5 day cold spell.  Adding 2 more days for the snow to melt means I could have been home bound for a week.  Fortunately, this snow storm dropped only 3 inches of light, fluffy snow.



I handle this much snow with a broom and child-sized shovel (red handle) that I keep outside my front door.  With my sound hand and armpit, I sweep snow off my steps, push the snow off my walkway, and make a path to the door of my car.  I get rid of the accumulating pile of snow by using the shovel to flick the snow onto my lawn or make a pile in the street.  My neighbor does not drive so I do not feel guilty about making a low pile of snow in her empty parking space.

To clean snow off my car, I wear an apron so I can lean against the car without getting my coat dirty.  I hang the apron around my neck but do not tie the strings behind me.  I shove the snow off my car with the tool designed to clean wind shields.  It is easy for me to control because it is light and the handle is short.  It has a soft side that will not scratch the paint on my car and a blade side to clean the windshield.  Pushing snow off my car dumps snow on my feet so I wear snow boots (see previous post) that I can don one-handed.  When I get snow on my hand I am grateful for the super warm mittens I used when I was skiing.

I keep a container of ice melting crystals next to my front door.  This large container has a spout designed for sprinkling, but the container is too heavy for me to control.  I use a funnel to pour a manageable amount in a small container.  I place the small container and funnel in my bathroom sink to make the transfer.  Compensation does not make me sad - it keeps me in my home.  

January 3, 2017

STILL Being Undressed Like a Baby

Babies are not asked if they want to be undressed - they are expected to submit when people start pulling off their clothing.  I cannot believe doctors have been undressing me like a baby since I had a stroke 12 years ago.  I recently saw a doctor who reached down and undid the top strap of my leg brace so he could look at my lower leg.  To hide my anger, I told him I have taken off my brace and shoe 10,000 times and can do it faster than he can.  Yelling at a surgeon who is going to cut me open to repair a torn meniscus in my knee is not wise.  

Here is the script I will try the next time a doctor starts undressing me.  "If you were a gynecologist you would not undress a female patient.  But I understand your dilemma.  I specialized in stroke rehab and cannot tell what stroke survivors can do while they are sitting.  I would ask "Do you need help with.........."  (Dean, Mark -  have doctors tried to undress since you had a stroke?)

If the doctor asks me if I need help I will say "I can do it but thank you for offering."