December 27, 2017

Walking in Snow with a Cane

Bottom Line: I am not ready to go to an assisted living facility were the van will take me to Wal-Mart once a week.

Warning: I do NOT poke my cane through the snow.  I wait until a neighbor I pay shovels my walkway and digs out my car.  I must be able to see the ground to tell if there is an icy patch that could make the spikes slip.  Checking the ground for ice slows me down, but it gets me to my car safely so I can drive.

The photo on the left shows the Briggs Ice Cane/Crutch Attachment.  I bought it at a medical supply store near my home.  The advantage of buying it in a store instead of on-line is the saleswoman got out a screwdriver and fastened the device to my cane.  It stays out of my way in the up position.

To lower the prongs, I place the cane in my hemiplegic (paralyzed) hand which holds the cane while my sound hand pushes the device down until I hear it snap into position.

The device makes my cane slightly heavier which slows me down which is not as bad thing.

I use another cane during warm weather rather than take this device off and put it back in the same place each winter.

December 18, 2017

What a Therapist is Really Doing

Writing step-by-step instructions for how to treat stroke survivors would be like writing step-by-step instructions for how to play basketball.  The basket stays in the same position, but a player has to respond to players on the opposing team and make changes second by second.  Therapists face the same dilemma.  Haarman studied what therapists do when they walk stroke survivors (1).  Sensors on a stroke survivor's body found PTs used their hands to provide a corrective shift of 
only 2% of a client's body weight.  These tiny corrections lasted an average of 1.1 seconds.  Experienced therapists know bad things can happen if they wait to correct abnormal movements until they get larger.

Therapists also react to client behaviors that hinder recovery.  
I had clients who thought they were helping by standing up quickly and  launching themselves towards the bed.  I had fearful clients who pulled back the minute they felt me pull them forwards to do a transfer.  Add in day-to-day variables like fatigue and changes in muscle tone - guidelines are the best that can be provided for this logistical challenge therapists solve every day.

Even though I was an OT, I was not aware of my therapists' subtle, brief corrections after I had a stroke.  Stroke survivors have to concentrate fiercely to tell every body part what to do when we are relearning a movement.  When my PT walked me, I did not have one brain cell left to pay attention to what she was doing.  This led me to complain to my PT that walking was not getting easier as the days passed.  She told me I was improving because she was gradually giving me less and less assistance.  I never thought to tell this to my clients either.

1.  Haarman JA, et al.  Manual physical assistance of therapists during gait training of stroke
     survivors: characteristics and predicting the timing. Journal of NeuroEngineering and 
     Rehabilitation.  2017:14(125).