September 28, 2019

What I Learned About Splints as a Stroke Survivor

When spasticity from a stroke holds muscles in one position, muscle fibers become short which restricts motion.  Lannin (1) concluded "splinting has little or no effect on the loss of range of motion" (p. 113).  Unfortunately, Lannin told therapists to stop all passive stretching and restrict active hand exercises to 10 minutes a day.  So the data does not tell us if a resting night splint is a useful addition to standard therapy.

I wondered what would happen if I continued to do passive stretching and active hand exercises, but stopped wearing my resting splint at night.  After a month of not wearing this splint I could feel my thumb getting tighter.  I resumed wearing my splint and the next morning I woke up with a wicked ache in my thumb.  Opening and closing my hand all day makes my thumb tight by bedtime so my splint has not eliminated spasticity.  Placing my hand in one static position does not retrain my brain to produce active range of motion.  Yet I believe my splint has prevented a painful permanent contracture.

I love my new SaeboStretch resting splint that I wear at night.  The new soft straps do not cut into my skin the way the old plastic straps did.  This version also uses a new kind of "Velcro" that does not have spiky hooks that scratch my bare thigh.  There are two thumb straps and three finger straps. The third strap holds down the little finger.  The cover zips off so it can be washed.

1.  Lannin N, Cusick A, McCluskey A, Herbert R. Effects of splinting on wrist contracture after
     stroke. Stroke. 2009;38:111-116.

September 11, 2019

First Painless Car Inspection Ever

When I bought a new car I did not have to worry about a car inspection for four years.
I dreaded having to explain that I have a car with a devise that blocks the accelerator pedal on the right.  When I step on the 2nd accelerator pedal on the left, a metal arm pushes down on the real accelorator pedal.  Unfortunately, this puts the accelerator pedal to the left of the brake.  A lifetime of stepping on the left pedal to brake is a difficult habit to suppress.  The 1st man who insisted he could drive my modified car drove it into another car.

I was thrilled that the state inspection station now has a special line that allowed me to drive the car myself.  I did not hold up the line while dozens of people watched me lean down to pull on the ring that removes the entire device.  The brake test that required an abrupt stop on a pressure plate has been eliminated.  My trip through the inspection line ended peacefully with watching a technician put a new sticker on my windshield.

September 3, 2019

The Canary Died

When the canary died, miners knew there was poisonous gas that they could not smell.  Every morning I use a deodrant bottle to test if the muscles that make a fist are getting too strong.  For a long time my index finger was curved instead of straight when I opened my hand.  The day I had to pry my hand open so it could grasp the bottle was a red flag.  I worked too hard for 2 years to make this hand functional.  I do not want to go back to holding an object by putting it in my mouth or squeezing it between my thighs so my sound hand can manipulate the object.  

My OT designed these exercises to remediate my specific weaknesses.  
The black arrow on the left points to a muscle that forgot how to straighten my thumb.  
I need a vibrator to wake this muscle up.  Stroking the tendons of muscles that straighten my fingers also wakes those muscles up.