September 26, 2020

Hard to Stay Motivated to Do Hand Exercises

It is hard to stay motivated to do hand exercises because most hand tests have many difficult items that require substantial recovery to show progress.  Comparing the Arm Motor Ability Test (AMAT) and the Test of Early Bilateral Hand Use (TEBHU) illustrates what I mean.  The TEBHU showed I was gradually regaining the ability to do over 100 bimanual tasks (1).  When I was able-bodied
I did not realize how many times each hour I briefly need two hands.  This progress kept me motivated to do hand exercises for 2 years after my stroke.

AMAT: Cut food with knife and fork, scoop up beans with spoon, button, draw line with pen & ruler, squeeze toothpaste on toothbrush, comb hair

Affected hand may stay more relaxed and open more easily when reaching in standing which requires less shoulder motion than reaching up to table height while sitting
            Standing: Reach/grasp/hold pot handle while sound hand stirs             
            Standing: Reach/grasp/hold carrot while sound hand peels
            Standing: Reach/grasp/hold food scraper as sound hand pulls chopped food onto scraper

Sound hand puts object in affected hand which holds object still (i.e. hand-to-hand transfer)
            Sitting: Put deodorant bottle in affected hand resting on lap so sound hand can remove cap
            Sitting: Put pill bottle in affected hand resting on lap so sound hand can remove cap
            Standing: Put toothpaste tube in sound hand so sound hand can remove cap

Affected hand traps object on a surface to hold object still
            Sitting: Affected hand traps wad of toilet paper on thigh so sound hand can tear paper
            Standing: Hand traps envelope on table so sound hand can tear open envelope of card
            Standing: Affected hand traps purchase on table so sound hand can cut hard plastic shell
                            open with scissors

P.S.  To prove that a treatment is effective, researchers who use a test with many difficult items have to cherry pick high functioning clients who already have some hand recovery before treatment begins.  

1.  Dutton, R.  My Last Degree: A Therapist Goes Home After a Stroke. 2nd ed.  Bangor, Maine: 

September 19, 2020

Cheap Equipment That Prevents Spills

Stroke survivors can prevent messes when they cook by using cheap objects instead of buying expensive adaptive devices from a medical catalogue.  For example, my hemiplegic (paralyzed) hand cannot reach up and hold the handle of a pot to keep the pot still when I stir food or flip food with a spatula.  So I slide pots off the burner onto a heat-resistant fabric hot pad before I stir or flip food.  Friction has always kept the pot still.  Now I use a cheap silicon hot pod to hold things still (see below).

An even more delicious way to save money is to use the plastic lid from a peanut butter jar.  This lid catches spills when I measure spices or messy food like olive oil.  It is frustrating to stop to clean up a mess I just made on my counter top.  Using spices is a matter of life-and-death because I am on a low salt diet to help control my high blood pressure.  Low salt food tastes awful without lots of spices.

September 9, 2020

I Am Really Angry

Strokes that affect blood vessels at the back of the brain are associated with significant diagnostic error (1).  This finding mirrors my stroke experience.  Sixteen years ago my brainstem stroke started when I repeated fell back on my bed while putting on eye make-up.  In the emergency room I was able to talk and sign my name so I was left alone and fell asleep.  When I woke up I called to find out if I could have something to eat because I did not have breakfast.  A staff member did a neuro check and looked concerned when I could not squeeze her hand with my right hand.            A neurologist was not on duty so it took a while before someone ordered brain scans.

Abedi's suggestion that hospitals should use artificial intelligence to improve diagnosis of these strokes (1) really makes me angry.  Facilities do not need to buy expensive computer programs to diagnose a stroke in posterior blood vessels.  Health care professionals need to forget the old F.A.S.T. warning signs and learn the new B.E.F.A.S.T.  The B. and E. are signs of a posterior stroke like a brainstem stroke caused by damage to the vertebral artery. 

B = Balance.  SUDDEN loss of balance/dizziness/coordination is not caused by an ear infection.  

E = Eyes.  SUDDEN difficulty seeing out of one or both eyes (e.g. blurred or double vision). 

F = Face.  Weakness of one side of the face that produces an uneven smile; facial numbness.

A = Arm.  Weakness of one arm (e.g. unable to raise both arms evenly).

S = Speech.  Slurred speech; trouble understanding speech, difficulty repeating simple phrases

T = Time lost = brain lost.  Call 911 immediately.

1.  Abedi A, et al. Using artificial intelligence for improving diagnosis in emergency departments: a practical framework.  August 25, 2020. 

September 3, 2020

Cheap Equipment That Reduces Frustration

A cheap seam ripper I bought at a sewing goods store got rid of a ton of frustration.  I open seals around the top of bottles by slipping the point of the seam ripper under the edge and ripping upwards or downwards.  Then I pull off the seal by grabbing the cut edge with my sound hand while I squeeze the bottle between my thighs.  Sometimes I grab the cut edge with my teeth as my sound hand holds the bottle.  No more trying to slice with the tip of a knife which shreds rather that cuts.  

I use the tip of the seam ripper to rip open the foil at the top of a pill bottle and dig out the cotton ball that fill half of the bottle.  Preventing decades of frustration is not a small thing - so much energy saved for better things.