July 28, 2020

Not Making Exercise Personal = Non-compliance

Even though I am an OT I do not continue to exercise if I do not see what I get for it.  Linking a specific valued activity to a specific exercise motivates clients.  Leg lifts = boardwalk.  Before I start walking on the boardwalk at Point Pleasant Beach I hold onto the railing and do a few leg lifts to warm up hip flexors and abdominals on my hemiplegic side.  Leg lifts help with MANY TASKS, but what I care about is that they keep me from stubbing my toe on the edge of boards that stick up.

Here is another example.  My neighbor complained to me about OT.  Her OT had her put clothespins on a clothesline.  My neighbor said "I told that young girl I had a clothes dryer, but she made me use the clothespins anyway."  As an OT I knew her therapist was working on tip pinch.  However, I did not know my neighbor well enough to know why she would want a strong tip pinch in her non-dominant hand.  If one OT cannot tell what another OT's end game is how can clients see the value of exercise after the therapist is no longer there to ensure compliance?   A stroke taught me that hope and compliance fade quickly when there is no incentive.    homeafterstroke.blogspot.com

July 20, 2020

Another Thing I Did Not Know About Stroke

When I was an OT who specialized in stroke rehab I did not know the temperature of my hemiplegic foot could vary widely.  Two studies found a stroke survivor's hemiplegic leg may have atrophy of the superficial femoral artery which reduces blood flow (1, 2).  This may explain why my hemiplegic foot feels ice cold by bedtime in the winter.  However, poor leg circulation does not explain why my hemiplegic foot is hot and red by bedtime in the summer, even though I have air conditioning.  Sometimes my brain interprets this high heat as pain so then I walk barefoot after dinner with my quad cane.  The quad cane has four feet that force me to walk slowly which is irritating.  A stroke taught me things I did not learn from an advanced certification course or treating stroke survivors.  homeafterstroke.blogspot.com

1. Durant MJ, et al. Superficial femoral artery atrophy and reduced lower limb blood flow in
    subacute stroke survivors. Stroke. 2020(Feb);51:ATP484.
2. Ivey FM, et al.  Impaired leg vasodilatory function after stroke.  Stroke. 2010(Oct);41:2913-2917.

July 12, 2020

What Therapists Do Not Know About Falling

I recently heard a doctor on TV say elderly people should not look down when they walk.  He said using vision to prevent falls weakens the balance system.  Yet stroke survivors look down because even tiny obstacles can be a challenge.  Able-bodied people look down only when they encounter extreme fall hazards.  When hiking on a trail they look down so they do not trip on a tree root or rock.  Here is an example of how tiny barriers can make stroke survivors fall.

I had a terrible fall while walking on a slate walkway.  I fell after I stubbed my toe on the edge of a slate tile that was tilted up about an inch.  I hit the ground so hard that I had dirt and pieces of grass caught under my glasses after my face hit the lawn.  I did not fall forward and smack my forehead on the slate sidewalk because I instinctively dropped my cane and threw my sound arm forward to try to catch myself.  This sudden arm movement was enough to rotate my body slightly to the right.

Therapists may not know how violently stroke survivors can fall.  Human subjects committees would not allow researchers to put test subjects on a tilt plate that can cause a sudden fall without first putting test subjects in a safety harness.  PTs have to be conservative when they walk stroke survivors because they cannot have anyone fall on their watch.

However, I took the doctor's advice to heart because disuse atrophy is never good.  I am trying a hybrid strategy to reduce my use of vision to prevent falls when I walk around my neighborhood at 7 a.m.  I walk in the street because there are no sidewalks.  These streets have numerous potholes covered with lumpy patches.  Instead of looking down during the entire walk I look straight ahead until I spot uneven ground.  When I am about 10 feet from uneven ground I start glancing down with my eyes to see how far I am from the fall hazard.  When I get close I turn my head downwards so vision can tell me when to lift my hemiplegic foot over the obstacle.  I feel safe but repeatedly forget to use this new strategy.  I have been looking down when I walk for a long time but expect to change my behavior eventually.  homeafterastroke.blogspot.com

July 3, 2020

Solutions I Never Considered

When I visited Scotland people were wearing t-shirts and shorts when it was 68 degrees F because they thought it was hot.  I finally understood why I sweat when it hits 70 degrees.  My Norwegian ancesters who emmigrated to northern Scotland gave me the muscular calves and thighs you would see on a soccer player.  Big muscles create heat.  I am a polar bear living with the gazelles in New Jersey.

So for 16 years I have exercised by pushing a shopping cart through large air conditioned stores
2 to 3 times a week.  I would buy only $20 of merchandise so I had to make many returns trips.  Now stores may have covid-19 virus in the air and on surfaces.  I switched to walking around my neighborhood while the weather was mild, but now the summer heat is here.  I have to walk in the early morning when it is cool.  The catch is that I have never been a morning person.  All I can do is grunt if a person talks to me during the 1st hour I am up.  I felt groggy and sluggish so I decided to drink 16 ounces of water before I walked.  Surprisingly it helped.  I wore my pedometer and was pleased to see a high number.  I do not know what I will do when snow covers the street, but I will worry about that later. 

After my stroke I did not go to a gym because it has machines that require 2 good arms or 2 good legs.  Doing half of a yoga posture while sitting felt stupid and reinforced the asymmetrical strength my stroke created.  I freak out about walking barefoot without my leg brace on slippery ceramic tile at a pool.  I also do not want to learn how to put on and take off a swimsuit one-handed.