The Flexion Synergy Can Be Good

In Stage 1 the arm is totally limp.  Stage 2 is exciting because stroke survivors see small limb movements.  In Stage 2 I could fling my hand onto my thigh, but my hand slid off.  When I was able-bodied I thought keeping my hand on my lap was effortless, but it requires shoulder and elbow strength.  Stage 3 is bad because an abnormal synergy produces only one movement pattern which dictates the one place you can put your hand.  

The photo shows the stab-yourself-in-the-stomach version of the flexion synergy.  There are many versions so your movement pattern may look different.  The flexion synergy is also bad because to move one joint you have move the whole arm whether you want to or not.  This is exhausting.  When Stage 3 becomes full blown the hand is fisted and the arm is close to the body.

I made Stage 3 functional with the help of an electrical stimulation device called NeuroMove which has a biofeedback component and a spring-loaded hand splint called SaeboFlex.  They helped me retrain my brain to open my hand a few inches so it can receive an object from my sound hand.  Hand-to-hand transfers let my affected hand hold an object close to my body so my sound hand can manipulate the object.  Hand-to-hand transfers made me independent in over 30 bimanual tasks like taking the cap off a deoderant bottle.

Stage 4 brings shoulder, elbow, and forearm motions that move the hand farther away from the body.  Keeping a hand open while reaching for an object is a skill able-bodied people use thousands of times.  My emerging Stage 4 skills are: 1) keeping my hand open when I reach at waist height while standing and 2) partially rotating my forearm to orient my hand to the different positions objects require.  My hand is still synergy bound so I cannot open my hand unless I also move my shoulder.

Stage 5 means you can move one joint without moving all the other joints in a limb.  I was stunned to learn my hand is useful without achieving Stage 5.  As an OT I knew stroke survivors walk using the extension synergy in the leg, but I was taught the flexion synergy in the arm is bad.  I had to have a stroke to see the flexion synergy in the arm in a more positive light.  homeafterstroke.blogspot.com

Friends/Family Who Volunteer for Big Tasks

I am stunned by friends and family who volunteer to help me with big tasks.  After my stroke I had to move out of my house that had one bathroom on the 2nd floor and a washer and dryer in the basement.  A friend told me I could stay with her while I was looking for a one-story home.  When I was ready to move, my brothers 800 miles away called to tell me they were coming to pack up my house.  Two friends 1,000 miles away called to tell me they were coming to unpack my belongings.  Before I moved into my new home a friend told me she was going to take me to the grocery store so I could buy food to fill my empty kitchen.  I used to think people offering to help with a big task without being asked was something that only happened in movies.

Currently, a friend knows I hope to move to an independent living facility in Michigan to be closer to my brother.  While we were at a restaurant, she offered to drive me 800 miles and drop me off in Kalamazoo before she goes to see a friend who lives 90 miles away.  

This support gives me a big boost in confidance which helps me turn their efforts into a good outcome.  One of the ways I repay kind people is to work hard to succeed.  homeafterstroke.blogspot.com 

Motion Capture for Stroke Survivors

As a stroke survivor and an OT who specialized in stroke rehab, I am not impressed with most motion capture systems for stroke survivors.  First, these systems create the impression that you need a computer to see and analyze movement.  But analysts who watch ice skaking and diving demonstrate how accurate the human eye is when you know where to look.  Slow motion replays have proven that experts can detect if a skater's foot did not land correctly after a quadruple jump or divers bent their hips slightly just before they entered the water.  Second, most of these systems focus only on shoulder and elbow movements while the hand maintains a static grasp on a handle.  Hello - all the arm does is deliver the hand to the target.

The one system that impresses me is Amadeo.  It monitors each individual finger plus the thumb as the hand opens and closes.  It provides biofeedback to help clients learn what their muscles are doing before they see visible motion.  It can provide EMG stimulation if a client's muscles need assistance.  The forearm can be placed in different positions to help the hand adjust to different positions that objects assume in the real world.  It can be used in exercise mode or with video games.  You can see a demonstration of Amadeo at youtube.com/watch?v=GM9HjI2OIrA.            Of course, roll-out of this system is constrained by how many rehab centers can afford it.  homeafterstroke.blogspot.com