February 24, 2017

It Isn't Failure - It's Rehearsal

Quotes like "If you're not prepared to be wrong, you'll never come up with something original"
(Ken Robinson) are not really helpful.  A more practical way to see failure as positive is to call it rehearsal.  When struggling with a new challenge it does not help to feel bad about the mistakes I make.  The purpose of my 1st attempt is to give me ideas about how to make my 2nd attempt awesome.  To be honest, I feel frustrated the 1st time I try something new and may even quit.  When I was able-bodied I was totally unaware of how often I used both hands or needed good balance so I am often unprepared for the challenges a stroke creates. Trying the task again the next day accomplishes two things.  My frustration has receded so I am calmer and the mistakes I made the 1st time give me ideas about what to do differently.

I still get frustrated when I try something new BUT I quickly hear myself say "it's a rehearsal."
This calms me down and reminds me that rehearsal has the potential to propel me to success
if I change the way I think about what is happening to me.

February 14, 2017

Counting Down to Knee Surgery

I alternated between sheer terror and wanting arthroscopic knee surgery.  At three in the morning I would wake up with a feeling of dread that I would have another stroke.  Yet the pain and fatigue I feel and the slow walking I have to do all day tells me surgery is necessary.  I used to be able to walk five steps from my bed to my en suite bathroom in my bare feet with no cane.  Now I have to take small steps with the help of a quad cane.  I have to be vigilant when I take the first two steps every time I stand up because this is when I feel a sharp pain that can make my knee collapse. 

A recent visit to a new neurologist made me feel better.  My vertebral artery which reaches the brain by snaking through neck bones is narrowed by stenosis.  This means my brain will not receive enough blood IF my blood pressure drops too low to push blood through this narrow blood vessel.  While doctors are typically alarmed by high blood pressure, this neurologist wants my blood pressure to remain normal.  For me normal is 130/75.  He also increased my aspirin from 81 to 325 mg to discourage blood clot formation.  I can take this aspirin right up to the day before my surgery.

February 7, 2017

Opening Cans With One Hand

I do not use lots of canned food because most are heavily salted.  However, I love to make homemade spaghetti sauce and chili which require some canned food.  I make a big batch and freeze it in individual food containers that can be heated in the microwave.  Since I cannot make food taste better with butter or cream sauces I add lots of veggies to these one pot recipes.

I use an electric can opener made by Krups that uncrimps the metal rather than cutting it.  This leaves a smooth edge so the top can be put back on if you want to use the contents later.  The photo on the right shows how a right-handed person holds it while the photo below shows how my left hand holds it so I can see what I am doing.

Short cans do not have the clearance I need so I put them on a food storage container.  Since I do not open cans that often I have trouble finding the exact angle the opener requires.  I have to try two to three times before my wrist remembers the correct angle.          I know when I get it right because the noise changes from a high pitched whine to a low pitched growl.  The only time this can opener has let me down is when a hurricane has cut my electricity.

February 2, 2017

Research on Therapy Can Be Misleading

Researchers found stroke survivors regained hand function after Wii therapy (1).  They targeted clients who already had some finger movement before treatment began.  I know this for two reasons.  First, subjects must have small finger movements to be eligible for the modified constraint therapy given to the control group.  Second, the outcome measure was the Wolf Motor Function Test which is loaded with high level test items (e.g. turn key in lock, pick up a paper clip).  Only stroke survivors with significant hand recovery can perform test items on the Wolf Test.

An efficacy study of the Smart Glove also used subjects who were high functioning enough to pass items on the Purdue Pegboard Test, the Jebsen-Taylor Test (e.g. write, scoop up beans with a spoon), and the Fugle-Meyer Test, distal items (e.g. pick up Coke can and piece of paper) (2). 

Treatment may be appropriate only for a particular sub-set of clients so you should always read the description of the sample and outcome measures used in the study.  Researchers of therapy approaches may have used a sample of high functioning subjects for their proof of concept study.  This makes the treatment look good, but can create false hope.

1) Trinh T, Scheuer S, Thompson-Butel A, Shiner C, McNulty P. Cardiovascular fitness is     
    improved post-stroke with upper-limb Wii-based movement therapy but not dose-matched  
    constraint therapy. Top Stroke Rehabil. 2016; June 23(3):206-16.
2) Shin J, Kim M, Lee J, et al. Effects of virtual reality-based rehabilitation on distal upper    
    extremity function and health-related quality of life: a single-blinded, randomized controlled     
    trial. jrneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0125-x. Accessed   
    January 31, 2017.