I Am Angry

An article in Stroke magazine made me angry.  The authors said they could predict independent walking three months after a stroke based on early status after the stroke (1).  These predictors included younger age, good leg strength, good sitting, continence, no cognitive impairment, no neglect, and independence in activities of daily living. 

What made me angry is that the authors recommended these data be used to decide who should get rehab and who should go straight to residential care (1).  Data that describe groups of people cannot accurately predict which group a specific individual will end up in.  For example, data that says a chemotherapy treatment is 80% effective does not tell you if a client if will be in the 80% that will be cured or in the 20% that will die.  

There is no such thing as a perfect prediction because unaccounted for variables can change an outcome.  For example, years ago I went to the nursing floor and found two nurses transferring my client from a wheelchair to the bed.  When I asked why I could transfer him with minimum assistance but he needed two nurses to do it he said "therapists make you do things for yourself and nurses do things for you".  He did not show the least bit of embarassment when he said this.    I wondered which rationale he applied to his wife.  

To withhold care because of early status is *****!   It it fairer and more accurate to make decisions based on the amount, speed, and consistency of improvement.  homeafterstroke.blogspot.com

1. Preston E, Ada L, Stanton R, Mahendran N, Dean C.  Prediction of independent walking in people who are nonambulatory early after stroke: A systematic review.  Stroke. 2021 July. doi: 10.1161/STROKEAHA.120.03245.

Handicapped Parking

Handicapped parking is more than being close to the door of a store.  The wider handicapped space is very helpful.  It is difficult to load purchases in the car because a regular parking space leaves very little room to open the car door.  Able-bodied people solve this problem by leaving their shopping cart at the back of their vehicle and walking the bags to the open car door.  I have poor balance so walking with a bag in my sound hand instead of a cane is a fall hazard for me.  The wider space lets me pull the cart up to my open car door to unload my bags.

A regular size parking space is difficult for another reason.  It is hard to get in and out of a car when I can open my car door only two feet.  This small opening makes it hard for me to maneuver a heavy leg brace that will not let me point my toes.  A wide handicapped parking space is especially important for someone in a wheelchair.  They need the car door to open widely so they can slide from their wheelchair onto the car seat.  homeafterstroke.blogspot.com