Oh Snap!

A podcast with a retired astronaut taught me the next phase of "BILLIONAIRES IN SPACE" is going to hit a big snag.  Rich people do not know that visiting the International Space Station (ISS) means living with a bunch of really smelly people - something they would never do on Earth.  The astronaut said there is no bathing in space.  After exercising for 2 hours every day, the crew tries to get clean by using wipes and removing what they can with towels.  This is not the really bad news.  Everyone wears the same clothes for days until they become "almost unbearable" (smelly, crusty, both?).  The crew puts the dirty clothes in a bag which is incinerated after it is ejected into space.    I love my shower chair and hose more than ever.

After seeing a female astronaut on the ISS with her pony tail fanned out in 6 long clumps behind her head, I knew the beautifully coiffered hair I saw in science fiction movies was fiction.  Bummer!  homeafterstroke.blogspot.com.

Reducing Spasticity Without Needles

Many stroke survivors suffer with painful muscle spasticity.  

For example, the photo shows that spasticity can force stroke survivors to point their toes every time they straighten their knee to take a step.  Spasticity has been treated with Botox shots and repeatedly sticking needles into the painful area (needling).  

Researchers found a less painful way to treat spasticity (1).          Both the experimental group (n=25) and control group (n=25) got 30 minutes of exercise followed by 30 minutes of wearing a TENS unit that provided relaxing muscle stimulation.  The experimental group then had their ankles taped in the bent position to stop them from pointing their foot.  The tape was replaced every day.  Treatment was given 5 days a week for 6 weeks.

After treatment both groups showed reduced ankle spasticity and faster gait.  However, the group that also had their ankle taped improved significantly more (p < 0.05).  Creating a less painful way to treat a painful condition would be my preference.  homeafterstroke.blogspot.com

1. Tae-Sung In, Jin-Wae Jung, Kyoung-Sim Jung, Hwi-Young Cho. Effectiveness of transcutaneous electrical nerve stimulation with taping for stroke rehabilitation.  Biomed Research International. 2021; Article ID 9912094. doi:10.1155/2021/99112094.

Kalamazoo

After living alone for 18 years with a stroke I am tired of dealing with home and yard maintenence, parking my car on the street which forces me to deal with snow, struggling to get groceries up my front steps, and cooking one-handed.  In September I was going to visit an independent living site I like in Kalamazoo after the summer road repairs on I-80 were finished.  I like the information I got from the website and the sales rep, but independent living is too expensive to buy into sight unseen.  

When the delta variant sent covid cases soaring I canceled my visit.  I know the odds of catching break-thru covid are low after my 2 vaccine shots.  However, I am afraid to be alone 750 miles from home with covid.  I could be too sick to drive myself home.  Do Uber drivers deliver to the front desk of a hotel?  Would hotels allow me to quarantine with them?

Another sign that this is not a good time to visit is that the facility posted an activity schedule for May, June, and July, but not August.***  Kalamazoo county currently has twice as many new covid cases as my county which has 100,000 more people.  With the covid surge and potentially bad winter weather, my visit is delayed until spring.  homeafterstroke.blogspot.com

*** The activity schedule for September was finally published.  YEAH!  

ADLs Are Where the Repetitions Are

Brain plasticity is amazing, but rewiring the brain requires thousands of repetitions.   Activities of Daily Living (ADLs) are a great way to get those reps. The examples below show why three sets of ten each day cannot compete with ADLs.

1) Twice a day I open my affected hand to grasp a tube of toothpaste so my sound hand can remove the cap.  My affected hand opens again to hold the tube while my sound hand puts the cap back on.  In nine years I have opened my hand over 5000 times before brushing my teeth.

2)  Shopping is therapy for my hand.  I open my affected hand to let go of the cart to reach for items with my sound hand.  My affected  hand opens a 2nd time when I grab the cart to move on. My affected hand opens a 3rd time so I can empty the cart in the check-out lane and again to load food into my car.  Pick uping 30 items + empty cart + load car means I open my hand 60 + 2 + 2 = 64 times.  64 x 2 visits a week x 9 years means I have opened my hemiplegic hand 59,904 times in the grocery store.

3)  The distance I have walked at the grocery store is huge.  I step away from the shopping cart and bend down or reach up to get items I want.  The curves I make to detour around people and other carts require more steps than walking in a straight line.  According to my pedometer I walk 2,000+ steps each time I visit the grocery store.  2,000 x 2 visits a week x nine years = 1,872,000 steps!
homeafterstroke.blogspot.com

Micro Aggression

Having my car inspected was not pleasant this time.  When I showed up before the facility opened there were at least 15 cars ahead of me.  The line I was eventually assigned to moved very slowly.  I heard an employee say the computer was running slowly.  A supervisor had to come to reboot the computer.  By the time I started my inspection, all the cars in the three other lines were gone.  

When I heard the employee assigned to inspect my car say to his supervisor "I do everything right because I know you want to get into it" I understood why he treated me with microaggression.  Years ago I was asked to visit all the state facilities for the retarded.  I was surprised to learn that if the staff were friendly, the administrator was friendly.  If the staff were paranoid about me being there, the administrator was paranoid about me being there.  This experience taught me that how administators treat people under them cascades down to the entire staff. 

Here are examples of the microaggression I experienced.  When I tried to tell the employee that I have a modified car he could not drive he started talking over me.  When I stopped talking he said  "we do not talk to drivers until they put their car in park."  I did not believe him but did what he asked.  Then he asked me to tell him how my car was modified.  I have never been asked this question at previous inspections.  He asked me how many miles I had on my car.  When I told him 45,000 he barked "show me."  Then he said "put on your mask."  I did not see other customers wearing masks and the building had good ventilation because of 8 giant garage doors and multiple fans.  Not happy.  homeafterstroke.blogspot.com

Are You Disabled?

A physical deficit may be permanent but feeling disabled can change depending on the expectations and resources of a specific environment (1).  Let me give you an example.  I heard people in the hospital say they cannot wait to eat a home-cooked meal.  But there is a catch.  At home people may be dismayed if "pop-pop" shows up for a meal when he needs a shower and a shave, is dressed in his pajamas, and has bed head.  I do not think dietary staff who deliver our meals expect patients to look good.  Resources can also be different in different situations.      In the hospital, aides help people with A.M. care and the dietary department cooks.  At home, the person who cooks and assists someone with an impairment may be the same person.  You may feel more disabled at home because your family has different expectations and resources than the hospital.  

Whether you are disabled also depends an whether you think independence should always be the goal.  Phalen says no one is truly independent (1).  Many people do not cut their hair, change the oil in their car, or prepare their tax returns.  However, able-bodied people help each other by dividing up a list of tasks.  Stroke survivors who have only one good hand may not be able to finish what they started unless they get help for specific steps during a task.  Repeatedly waiting for help during a task can get on your nerves.  My thumb leans on the independence side of the scale.  homeafterstroke.blogspot.com

1. Phalen SK. Constructions of disability: A call for critical reflexivity in occupational therapy. Canadian Journal of Occupational Therapy. 2011;78, 164-172. doi:10.2182/cjot.2011.1.78.3.4.

Practical Guide to Giving Assistance

Activities of daily living (ADLs) evaluations divide assistance into mimimal, moderate, and maximal.  The Functional Independence Measure defines these levels by the percentage of a task a client can do independently like 25 - 49%.  OTs can guesstimate these percentages because they see hundreds of clients which helps them judge a client's performance.  Caregivers need a more practical way to know how much to help.

Minimal assistance = you can multitask because your loved one can do a lot, but stay near by.      Moderate assistance = sit or stand in front of loved one because they will need repeated help.  Maximum assistance = look for ways for your loved one to help you ( e.g. have them put their arm around you to help you scoot them to the front edge of the wheelchair before you stand them up).

OTs have an incentive to keep their hands in their lap - every time they help it lowers a client's ADL score.  Caregivers have different incentives for waiting to see how much their loved one can do.  Caregivers need energy to do chores their loved one usually does, like cleaning toilets and mowing the lawn.  Caregivers also need energy to make doctor and therapy appointments, arrange transportation, deal with health insurance bills, pick up medications, set up home exercises, and deal with a loved one's difficult emotions. 

When therapists say a client needs assistance, caregivers need to think about asking for help before they get into trouble.  Nurses gave caregivers a preparedness questionnaire before discharge from rehab and asked them what they were thinking as they answered each question (1).  A dialogue is much better than a handout.  homeafterstroke.blogspot.com

1. Carmicia M, Lutz B, Harvath T, Joseph J.  Using the Preparedness Assessment for the Transition Home After Stroke Instrument to identify stroke caregiver concerns predischarge: Uncertainty, anticipation, and cues to action.  Rehabilil Nurs.  2021;Jan-Feb 46(1);33-42.  

Reheating Food Safely

Warning: Using a microwave requires safety awareness

The problem with family or friends leaving a dish for a stroke survivor to heat up in the microwave is that the thumb knocks the lid off when you pick up a dish one-handed.  Heating uncovered food in the microwave makes a mess. 

When I take a hot dish out of the microwave my sound hand is protected by a hot mitt and my hot mitt is protected by plastic wrap on the contaner.  You might wonder why a stroke survivor would use plastic wrap when it gives people with two good hands a run for their money.  Before I started using plastic wrap I had to wash my hot mitts repeatedly.  The mitt would get dirty when I slid my thumb into the dish so I could get a firm grip on the edge.

Go on-line to see the  "food wrap box."  It cuts the plastic wrap in one blow when I shut the lid.  Stretching the wrap over the dish is easy too.  I place the box next to the dish.  As I pull the plastic wrap out, the weight of the dish holds the food wrap box still.

Using plastic wrap also means I do not need a food strainer.
I use a hot mitt on my sound hand to hold he dish over the sink to let the water drain out.  The arrow is pointing at a flap of plastic wrap that is open.  I did not do this.  The water did it for me.
I lose a couple of pieces of small food now and then, but keeping my sound hand safe while handling hot dishes is priceless.
homeafterstroke.blogspot.com

I Am Angry

An article in Stroke magazine made me angry.  The authors said they could predict independent walking three months after a stroke based on early status after the stroke (1).  These predictors included younger age, good leg strength, good sitting, continence, no cognitive impairment, no neglect, and independence in activities of daily living. 

What made me angry is that the authors recommended these data be used to decide who should get rehab and who should go straight to residential care (1).  Data that describe groups of people cannot accurately predict which group a specific individual will end up in.  For example, data that says a chemotherapy treatment is 80% effective does not tell you if a client if will be in the 80% that will be cured or in the 20% that will die.  

There is no such thing as a perfect prediction because unaccounted for variables can change an outcome.  For example, years ago I went to the nursing floor and found two nurses transferring my client from a wheelchair to the bed.  When I asked why I could transfer him with minimum assistance but he needed two nurses to do it he said "therapists make you do things for yourself and nurses do things for you".  He did not show the least bit of embarassment when he said this.    I wondered which rationale he applied to his wife.  

To withhold care because of early status is *****!   It it fairer and more accurate to make decisions based on the amount, speed, and consistency of improvement.  homeafterstroke.blogspot.com

1. Preston E, Ada L, Stanton R, Mahendran N, Dean C.  Prediction of independent walking in people who are nonambulatory early after stroke: A systematic review.  Stroke. 2021 July. doi: 10.1161/STROKEAHA.120.03245.

An Unexpected Source of Joy

My parents never had a newspaper subcription so I did not grow up reading comics.  However, I am glad gocomics.com/comics/a-to-z gives me free access to comics from several newspapers.  My 1st favorites are curmudgeons like Garfield and Shoe.  Their cranky mood mirrored how I was feeling during the covid-19 pandemic.  My 2nd favorites are nitwits like The Wizard of Iz.  The endless sillyness of nitwits is amazing.  My 3rd favorites are family stories like For Better or Worse.  Teenage and pre-school drama is a lot funnier when it is not happening to you.  Besides,    I want to know what happens to these characters I know so well.  My 4th favorites are comics that make me reflect on life like Speed Bump.

I was surprised to learn I do not like black and white comics.  I need a pop of color to cheer me up.  I also do not read comics with long dialogue printed in small letters.  After my cataract surgeries I chose lens that help me see mid and long distances.  When driving I need help reading street signs.  Reading comics with small print force me to squint even when I increase the font size          - not fun.  homeafterstroke.blogspot.com