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

Electrical Stimulation with NeuroMove

My hand was completely flaccid for three month after my stroke.  I did not get motion back until I started using an electrical stimulation device called NeuroMove.  Electrical stimulation strengthens muscles, but NeuroMove also has a biofeedback component.  I was able to watch a line on a monitor creep higher and higher as I thought about moving my hand.  That immediate feedback kept me focused and working hard even when I did not see movement.  When my muscle activity finally increased above the threshold line, I got a few seconds of stimulation and was rewarded with a visible hand motion.  NeuroMove would not help me until I made a sincere attempt to recruit the muscles that open my hand.  Equally important, NeuroMove would not repeat the stimulation until I completely relaxed the muscles I just used.  This added feature is important because stroke survivors have trouble both recruiting and relaxing muscles.

I tried other electrical stimulation devices that stimulated my muscles at pre-set intervals or when I pushed a button.  I could not coordinate my efforts with those devices.  In the beginning it took me 20 seconds to figure out how to recruit a muscle and up to 60 seconds to make that muscle relax.  Devices without a biofeedback component zapped me whether I was ready or not.  It was like dancing with a really bad partner who kept jerking me around the dance floor.  NeuroMove patiently waited for me.

Neuroplasticity helps stroke survivors grow new connections in the brain, but that does not mean we can find them. The biofeedback component of NeuroMove helped me find connections
I did not know I had.  NeuroMove stimulated my muscles AND helped me retrain my brain.
homeafterstroke.blogspot.com

What I Learned About Splints as a Stroke Survivor

When spasticity from a stroke holds muscles in one position, muscle become short which restricts motion.  Lannin (1) concluded "splinting has little or no effect on the loss of range of motion"

(p. 113).  However, Lannin told therapists to stop 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 did passive stretching and active hand exercises, but stopped wearing my resting splint at night.  After a month of not wearing a 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.  Closing my hand all day makes my thumb tight by bedtime so my splint has not eliminated spasticity.  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 that is hard to see holds down the little finger.  The cover zips off so it can be washed.  homeafterstroke.blogspot.com

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