May 28, 2019

Home Programs Are Like Dieting

Home exercise programs are like dieting.  Both are "shoulds" that make me feel guilty when I do not do them.  As an OT I know exercise is important, but home exercises get boring after a few months.  I am still doing home exercises because each one is anchored to something I want.
For example, avoiding pain is a powerful anchor.

After I felt my OT massage a painful knot out of my shoulder I was determined to stop it from coming back.  The painful knot formed because I was repeatedly using my shoulder (see photo) to lift my hand. 

I start with my arms down at my sides and raise both hands to the middle of my chest using only my elbows.  This put less stress on my shoulder muscles when I lift my hand.  I do this movement 3 times before I take my pills with yogurt each day.

I set out the yogurt, spoon, and pills before I start exercising.  I am afraid I will lose the sensation of what normal movement feels like if I stop to gather supplies.  An anchor turns "I should" into "I want to."

May 11, 2019

Bad Knees Complicate a Stroke

An MRI confirmed I have almost no cartilage behind the knee cap in what used to be my good knee.  After PT  did not solve this problem I got three gel shots in this knee.  Three weeks after the last shot I had significant knee pain that lasted an entire day.  The evening before I had made dozens of turns in the kitchen while cooking a complex recipe.  When I saw the doctor a week later he dismissed cooking as an explanation for my pain and said "we'll call it a blip."

After the pain disappeared I tried another complex recipe, but I cut down the number of turns I made by using my kitchen cart.  Instead of making my knee twist as I turned multiple times, I went around my kitchen in two slow turns to collect supplies I needed.  Knee pain showed up the next day but it was much less intense.

I also reorganized my kitchen so less turning is required.
For example, I use to keep measuring spoons in a drawer.  Now they are in a small box placed next to the spices.  I prepare homemade dishes like turkey chili because I had a 2nd stroke.  I was not paying attention to the high levels of salt in canned and frozen food which elevates blood pressure.

May 3, 2019

The Cruel Part of Having a Stroke

The American OT Association has issued guidelines that tell OTs they should not "provide intervention activities that are non-purposeful (e.g., cones, pegs)."  To retrain my brain I had to open my hand 100 times each day with the help of a spring-loaded SaeboFlex splint.  I initially had to wait 3 to 5 seconds for my hand to open.  Dropping hundreds of balls in a crate allowed me to experience the glorious sensation of my hand opening quickly and smoothly.

HOWEVER, I used task modification to do bimanual ADLs while I still had a precarious grasp.  For example, grabbing a tube of toothpaste with my thumb and middle finger did not stop me from dropping the tube.  Two task modifications made my hand functional.
1) I pressed the end of the tube against my stomach.  2)  I used a hand-to-hand transfer.  My sound hand picked up the tube, placed it in my open hemiplegic hand, and received the tube after my hemiplegic hand opened again.

Why have I been doing exercises for 16 years?  The cruel part of having a stroke is that abnormal muscle tone does not just fade away.  Doing finger extension exercises every day allows me to risk closing my hand on objects during 100+ bimanual activities.