Fatigue is a Deal Breaker

The fatigue I felt for the first year after my stroke was unlike anything I had ever experienced.  

I repeatedly felt a crushing fatigue that I could not push through.  When I did not rest, I could barely hold my head up after dinner.  Using a timer to force myself to rest was annoying because it would go off at the worst time.  Watching TV turned me into a zombie who could not stop clicking the remote because nothing good was on at the moment.  I tried reading and going on the Internet, but I got so absorbed in these activities that sitting for long periods made me tired.  I found two strategies that work for me. 

(1) Brief rests before the fatigue overwhelms me.  Lying on top of the bedspread with a towel under my shoes does not feel like I am going back to bed.  I lie down for fifteen minutes without having to get undressed.  (2)  Energy conservation.  For example, I divided doing dishes into 3 steps.  

Step 1: Empty dishwasher - rest 5 minutes.  Step 2: Take clean dishes to the appropriate cabinet with a cart.  I did not have to repeatedlty carry heavy stacks of dishes from the dishwasher to each cabinet - rest 5 minutes.  Step 3: Load dishwasher.  I have a double sink so I use one sink as a staging area to hold dirty dishes until I need to wash them.    

GOOD NEWS: My crushing fatigue faded after the first year!    homeafterstroke.blogspot.com

The Only Magic Bullet I Have Found

Sometimes stroke survivors tune people out, but not necessarily for the reason you think.  When I am struggling with a task, I start talking to myself.  For example, when I heard my toe scuffing the floor because I did not lift my leg high enough in the 1st year I silently said "knee up, knee up."  If someone was talking to me at that moment I did not hear what that person said.  I cannot listen to other people when I am talking to myself.  If you want me to process new information or I want to participate in a discussion, I need to sit down.
 
Avoiding multitasking is a magic bullet because it has an immediate effect.  By not dividing my attention, I  focus all my energy on the part of my brain I need to use right now.  When I take a hot dish out of the the oven I stop talking to guests.  I need to monitor my hemiplegic hand to make sure it maintains a firm grip on the 400 degree handle.  When I drive during rush hour I turn off the radio.  I need to respond quickly to aggressive, unpredictable, impatient drivers.

I am not saying stroke survivors can never multitask.  However, it can take many repetitions before a task becomes so automatic that I can simultaneously pay attention to a second task. 
homeafterstroke.blogspot.com

Constraint Therapy is Good and Bad

Constraint therapy involves 1 or more hours of therapy per week that focuses exclusively on the hemiplegic hand.  Clients also have to wear a mitt on the sound hand for 3+ hours at home each day to force the hemiplegic hand to work.  Constraint therapy is good because it challenged long held beliefs that clients cannot recover function years after a stroke.

Constraint therapy is bad because it is appropriate for a limited pool of clients.  1) Stroke survivors must already be able to straighten their fingers 10 degrees and their wrist 20 degrees.  2) It can be a problem for women who's husbands are not willing to do chores at home while wives constrain their sound hand all day.

Current research offers an alternative.  Clients can use their sound hand to guide the affected hand while making lunch, eating, and cleaning up (1).  Stroke survivors who were helped to use their hemiplegic hand during for 90 or 180 minutes improved as much as subjects who received constraint therapy for the same amount of time (2).  homeafterstroke.blogspot.com   

1. Hayner K, Gibson G, Giles G. Comparison of constraint-induced therapy and bilateral treatment
    of equal intensity in people with chronic upper-extremity dysfunction after cardiovascular    
    accident.  American Journal of Occupational Therapy. 2010;64(4):528-539.
2.  Sterr A, Oneill D, Dean P, Herron K.  CI therapy is beneficial to patients with chronic low-
     functioning hemiparesis after stroke. Front. Neurol. 2014;5:

Kinesio Taping Reviewed

A subluxed shoulder is painful because the upper arm (humerus) has slipped out of the shoulder socket.  It felt like someone had punched my shoulder very hard.  Subluxation is rated by how many fingers you can fit in the space created by this abnormal shoulder separation.  I had a one finger subluxation so the hospital staff put a small lap tray that slid over one armrest of my wheelchair.  I made sure the staff put the tray on every day because I knew nerve damage can occur if nerves in the shoulder are stretched too much. 

The lap tray could not support my shoulder when I walked and did exercises while sitting on a mat table.  My shoulder ached constantly during these times until my OT bound it up with Kinesio tape. This wide tape provides support but is stretchy enough to allow movement.  I wore the tape 24 hours a day - even in the shower.  It eventually came loose and had to be replaced every third day.

Hanger and associates found stroke survivors who had their shoulder Kinesio taped had less shoulder pain (1).  The improvement got very close to statistical significance (p = 0.11) because some people were helped while others were not.  Kinesio tape was the only thing that made that my constant shoulder pain go away.  homeafterstroke.blogspot.com

1.  Hanger H, Whitewood P, Brown G, Ball M, Harper J, Cox R, Sainsbury R. A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clinical Rehabilitation. 2000;14(4):370-380.