Bathing When I Travel

I am traveling at the end of April.  I have not used this shower stool for 4 years so I practiced using it home before I left.  Rehearsal always gives me confidence. 

Caution.  This stool may not be safe if you need assistance to stand up or sit down or are heavy.

It is not safe for me to stand in the shower.  When I travel I use a folding shower chair.  This adaptive device allows me to visit with family and friends and present at conferences.  I bought the stool at a local medical supply house. Before I bought it I wanted to see if I could open it myself and sit on it to feel how sturdy it is.    It is too big for anything but the widest luggage so a luggage saleswoman suggested I transport it in a nylon garment bag.

When I travel I cannot count on towel racks being close to the shower.  Before I get in the shower I check to see if the toilet is close to the shower.  If it is far away I drag a chair from the bedroom and place it close to the shower.  Then I open a towel and put it on the closed toilet seat or chair.  This gives me a clean place to sit after I get out of the shower.  I also put a folded towel on the closed toilet lid or a chair so I can dry myself.  After I am dressed I take the stool out of the bathtub.  I fold the stool and place it on the towel covered toilet seat and use the ends of the towel to wipe off the water.  homeafterstroke.blogspot.com

Carts Keep Me and My Stuff Safe

A cart saves me from making numerous turns when I bring home groceries. Food that goes in the refrigerator is scattered in several shopping bags.  I collect cold items on my cart, push the cart to the refrigerator, and stand in front of the open refrigerator - no turning and walking back to collect the next item and then turning to face the refrigerator again.  Turning increases the chance of a fall because it is more difficult than walking in a straight line.

Here I am 3 months after my stroke taking a meal to the table.  When 

I got tired of eating frozen dinners heated in the microwave I started cooking.  Initially I cooked one food, ate it out of the pot, and then cooked the next food.  The day I put three kinds of cooked food on a plate was a triumph.  Now I cook regularly and the cart keeps me from burning my hand while transporting hot food. 

A three-tiered cart allows me to sort my dirty laundry by color while sitting instead of repeatedly leaning over and standing up.  This cart also helps me safely transport dirty clothes to my 1st floor laundry room. 

P.S.  I am sitting on a folding metal chair that is stored behind an open door.  homeafterstroke.blogspot.com 

Walking in Snow with a Cane

Warning: I do NOT use my cane to walk through snow.  I wait until a neighbor I pay shovels my walkway and digs out my car.  I must be able to see the ground to tell if there is an icy patch that could make the spikes of my Briggs Ice Cane/Crutch Attachment slip.  Checking the ground for ice slows me down, but it gets me to my car safely so I can drive.

The photo shows the attachment in the up position to keep it out of my way.  I bought it at a medical supply store near my home.  The advantage of buying it in a store instead of on-line was the saleswoman got out a screwdriver and fastened the device to my cane.  














To lower the prongs, I place the cane in my affected hand and my sound hand pushes the device down until I hear it snap into position.

The device makes my cane slightly heavier which slows me down which is not as bad thing.

I use a different cane during warm weather rather than take this device off and try to put it back in the same place each winter.  homeafterstroke.blogspot.com

Teach Us to Turn in the Kitchen

Having PTs walk me in straight lines in the PT gym and walk around the block after I went home did not prepare me for the problem solving I need do while walking.  In the hospital I was in a wheelchair, but after I got home I had to teach myself to safely turn 180 degrees while standing with the support of a cane to shut the bathroom door and turn again to flush the toilet.  

Here is another example.  The photo shows the turns I take to prepare a glass of iced tea and a bowl of cereal with a sliced banana for breakfast.  Turning away from a counter is a fall hazard because it is done by stepping backwards.  I have impaired balance so my inner ear does not tell me how far away from vertical I have stepped.  After I fell and broke my forearm while turning I got scared.  Now I use itsy bitsy baby steps to backup and turn before taking normal size steps in the new forward direction.

Research on this topic is emerging.  Chen trained stroke survivors on a straight OR a turning-based treadmill (1). Subjects walked on a round treadmill that turned underneath them as they walked in one place while holding onto parallel bars.  Subjects who learned to to accommodate the constant change created by the round treadmill were significantly better at turning while walking on level ground.  Not being able to sahomeafterstroke.blogspot.comfely turn while being distracted by a purposeful activity has serious implications. 

1. Chen, I, Yang, Y, Chan, R, Wang, R. Turning-based treadmill training improves turning
    performance and gait symmetry after stroke. Neurorehabilitation and Neural Repair. 2014;28
    (1):45-55.

The Gift That Keeps on Giving

In the hospital my PT had me reach down with my sound hand to pick up cones sitting on a stool and stand up to place the cones on a shelf at head height.  I saw the value of this exercise when I started to wobble less as I reached down to pull up my pants at the toilet. I could not go home if I needed 24 hour assistance for toileting.  When Michelle did not have me squat in the morning,
I asked to do it in the afternoon.  After I went home activity analysis helped me identify how squatting keeps me safe during dozens of tasks.  Activity analysis is the gift that keeps on giving because it tells me WHY I WORKED SO HARD.

   I bend my knees and hips when I reach down to:
* Pull up my underwear and pants after toileting
* Pick up my cane after it has fallen on the floor for the thousandth time
* Get clothing out of the bottom drawer of the dresser
* Get shoes from the floor of the closet
* Get a milk carton sitting on the bottom shelf of the refrigerator
* Get a box of cereal from the bottom shelf of a kitchen cabinet
* Get a heavy pot from the bottom shelf of a kitchen cabinet
* Get a box of dishwasher detergent from under the sink
* Take a heavy book from bottom shelf of book case
* Plug a cord into a low electrical outlet 
* Pull clothes out of the dryer
* Use a garden hose to fill a watering can that is sitting on the ground
* Empty a waste basket
* Pickup a bag of garbage to take it to the outdoor garbage can
* Pick up purchases sitting on the floor of my car

P.S. Reaching down by bending at the waist with straight legs is hard on my arthritic low back.
homeafterstroke.blogspot.com

Walking in the Dark

I need light to see if I am standing upright because a stroke stole my ability to feel where vertical is.  Unfortunately, my electricity goes out one or two times a year so I have learned to be afraid of the dark.  Instead of moving to a long-term care facility I put flashlights every place I sit (couch, computer, kitchen table).  My leg brace allows me to carry a flashlight in my sound so I can walk to a phone to report the outage.  However, when I get up to go to the bathroom in the middle of the night I am barefoot.  I need a quadcane in my sound hand instead of a flashlight.  A friend showed me her Energizer Folding Lantern.  It has a large handle so I can carry my quadcane and the lantern in my sound hand.  Thanks to a silvery lining this lantern is bright enough to light the few feet I need to walk to my on-suite bathroom.  

This lantern opens like a clam shell when I need to replace the batteries.  I need a big screwdriver to remove 2 screws (see small white circles) to open the battery compartment.  Searching for a screwdriver is maddening so I bought a screwdriver just for the lantern.

I keep the lantern, screwdriver, and replacement batteries next to my bed on an 8 inch wide rolling cart I found at Target.  It is the Household Essentials 3 shelf utility cart.  Before I get into bed, I place the cart where I can pull it close to me without getting up.  The lantern is on the middle shelf so I can turn it on while lying in bed.  In the dark I slide my fingers along the edge of the shelf until I feel the lantern handle.  This tells me where the on-switch is.   homeafterstroke.blogspot.com

Walking in a Barren Environment

Walking in wide, empty spaces did not prepare me for tasks that force me to stop concentrating fiercely on my hemiplegic leg while I am walking.  In-patient PTs walked me in gyms with equipment and people sitting around the periphery.  When two clients who are walking approach each other the PTs look at each other and decide who will stand still while the other person moves first.  Home health PTs walked me around the block in the middle of the day when nobody was outside.  PTs work in a barren environment that does not make them aware of cognitive demands.

Stroke survivors need to walk sideways between tables at a restaurant and go down stairs that have a railing only on their affected side.  At a store - walk in circles around racks of clothing and stop for people who are not watching where they are going.  At a hair salon - sit down in the chair without tripping over the big metal footrest.  Using a public toilet - turn around to sit on the toilet regardless of which side the grab bar is on.   Clients and family members need to understand that walking requires problem solving as well as physical mobility.  

Football coaches do more than have players throw and catch footballs and do foot agility drills.  Football players eventually have to stop concentrating on their body and start thinking about their opponents' strategy as they move.  Athletes and musicians have rehearsals to make the transition from practice to function.  Why are stroke survivors not getting the same kind of help?  homeafterstroke.blogspot.com

Arm and Leg Synergies are Different and the Same

The affected arm is dominated by the flexion synergy while the affected leg is dominated by the extension synergy. This means muscles that straighten the knee and point the toes are strong while muscles that bend the hip, knee, and ankle are weak.  I also cannot move a single joint. 

To point my toes I have to straighten my whole leg (photo on left).  To bend my ankle I have to bend my hip and knee (photo on right).  All this unwanted movement is exhausting.

 Problem: My weak hip and knee flexors do not always lift my leg high enough to clear my toes as I take a step.  The extension synergy forces my toes to point.  The photo on the left shows me stubbing my toes.                                                                                                                                                      Solution: I faithfully wear my leg brace because it lifts my toes up which prevents falls.  

Problem: The extension synergy makes my affected knee snap into a fully straightened position every time I take a step.  This abnormal movement will eventually damage my knee.  Muscles on the back of my thigh (see pink line) are too weak to stop my knee from snapping into this dangerous position.

Solution: My leg brace keeps my knee slightly bent (see green line) when I take a step.  I faithfully wear my leg brace because I do not want to have knee surgery.  homeafterstroke.blogspot.com

The Final Shoe Solution

Being forced to stay home during the covid-19 pandemic helped me remember why I work so hard to solve problems caused by my leg brace and shoes.  I would be severely depressed if I had lacked the confidence to walk safely in the community during the 16 years since my stroke.

Neither the white duct tape in the photo or double-sided tape have glue strong enough to stop my leg brace from pushing the shoe insert out of place.  When the shoe insert slides to one side my foot tilts so most of my weight is on the outside edge of my hemiplegic foot (ankle inversion).  Walking on a foot that is not flat is unsafe and tiring.  I am currently using T-Rex Ferousiously Strong double-sided mounting tape to see if it keeps the shoe insert in the center of the shoe.

Long socks that reach the knee prevent skin chafing as the brace rubs the top of the calf.  However, the only knee-high socks made for women are brightly colored socks used during soccer.
I cut the top off a man's white tube sock so it covers the top my calf.  I have washed them many times.  They fray eventually but hold together for a long time.  I am happy that what people see is black socks with black shoes and beige socks with beige shoes.


My THICK leg brace creates a leg-length discrepancy by making my hemiplegic leg longer than my sound leg.  Wearing 2 socks on my sound foot makes my sound leg a little longer.  The 2nd sock also keeps my foot from sliding inside the extra wide shoes
I need to accomodate my brace.  Having my sound foot slide inside my shoe makes walking tiring and puts strain on my hip and knee.  I wish I had known about this 2 sock solution before my sound knee needed joint replacement surgery.


The long sock I pull over the short ankle sock gets stretched out which makes it easier to don.  I bought permanent ink pens to mark the stretched sock in each pair.  A black pen works for white and beige socks.  The silver pen I use on black socks fades in the wash so I have to repeatedly mark them.

If you read this entire post you may understand why I do not think this is my last post about my shoes.   homeafterstroke.blogspot.com

On-line Grocery Shopping

Janet is a dear friend who can speak truth with kindness.  She gently talked me into paying a grocery store employee to shop for me during the winter.  Thanks to Janet, I did not become hysterical about being stuck in my house with no grocercies because of a blizzard.  When weather reports became dire, I ordered groceries on-line and picked them up before the snow storm hit.  This photo shows I was right to worry.

The designated parking spaces I have to use for on-line grocery shopping are too narrow for me to put a shopping cart next to my car to unload groceries.  So I put groceries in my trunk.  I am glad I put boxes and a cooler in my trunk before my 1st attempt.  I do not want to use my cane to fish around for cans and round produce that could roll to the back of my trunk.  homeafterstroke.blogspot.com

Painful Lesson About Falls

Linda wrote a post in Leading a Healthy Life about dislocating her hip when she bent at the waist instead of bending her knees while reaching down to pick up something.  She screamed when her hip slipped out of its socket, when family members helped her sit on a chair, when the EMTs moved her to a transport chair, when they carried her up the basement stairs, when they put her in the ambulance, etc.  I also take chances when I reach down to pick up an object.  Even though I know better, it is frustrating to not be able to move the way I used to as an able-bodied person. 

I am grateful that Linda shared her painful experience.  Her description was so vivid it has changed my behavior.  For example, I put heavy bags on the top step (red circle) so I can I load them first into a rolling cart inside my front door.  I do not want them to crush fragile products like bread.  When I leaned way down to grab lighter bags on a lower step I thought "don't do this."  Now I use a safer strategy.  I expend the energy to walk down to a lower step (green circle) before I lift the lighter bags up to the top step.    

A few days later I felt my heels come off the floor while I was struggling to maintain my balance as I squatted to pick up an object under a chair.  Again I thought "don't do this."  I moved the chair.  In the coming weeks I will look for instances when I put my body in a precarious position.  Linda, thank you for reminding me to be careful.  homeafterstroke.blogspot.com

Staying in My Home is Not Easy

The independent living facility I hope to go to has a heated underground garage.  Until I move, I need 5 snow strategies because I have to park my car on the street.  When snow is forecast my 1st strategy is to go grocery shopping.  When we get a dusting of snow I use my 2nd strategy.  I use a child-size shovel to push snow onto my lawn.  I sprinkle Ice Melt on my walkway and in front of my car.  The big container is heavy so I use a funnel to pour Ice Melt into a small container sitting in my bathroom sink.  My sound hand lifts the big container.  My affected forearm under the big container controls the degree of tilt.  

New Jersey often gets above freezing after a snow storm.  When the weather forecast says this will happen I use my 3rd strategy.  I wait a few days for the sun to free my snow-covered car.  However, the street has a low spot that captures water as the sun melts the snow.  I need a 4th strategy to cross this small pond.  I place a thick rubber matt over the water so I can to get to my car safely.  

When the weather forecast says New Jersey will stay below freezing after a snow storm I use my 5th strategy.  I pay two teenage boys to clean my car, walkway, and snow that the snowplow has pushed against the side of my car.  They also shovel snow in front of and behind my car so I have a clean parking space.  Old people in my neighborhood are nasty when someone takes the parking space in front of their house.  homeafterstroke.blogspot.com

Feeling Embarrassed is a Luxury I Cannot Afford

At a patio dinner party I was the only person who wanted watermelon for dessert.  That meant I got the round end of the watermelon that rocked every time I touched it with a spoon.  Eating it was a slow process because the best I could do was get a thin slice each time.  My hostess tried to help me because she was so uncomfortable with my awkward attempts.  This is the first time my friend has seen what happens the first time I try a new task.  She does not know my performance will improve because I often discover solutions that make my 2nd attempt go better.  She does not know I can count on getting faster and smoother with repetition.  I refused to let her help me because I will never know if I can do a new task if I do not try.

A few minutes later another friend at the dinner party asked me if I get embarrased.  I told her my plate is often too full to feel embarrased.  For example, able-bodied people stand up without any conscious awareness of what their body is doing.  When I stand up I have to make sure my center of gravity is over my feet before I straighten my legs.  If I lean too far backwards I fall back onto the couch or chair I was sitting on.  If I lean too far forwards I fall on the floor.  My stroke often forces me to concentrate so hard that I do not have the mental energy to worry about what other people are thinking.  homeafterastroke.blogspot.com

What Therapists Do Not Know About Falling

I recently heard a doctor on TV say elderly people should not look down when they walk.  He said using vision to prevent falls weakens the balance system.  Yet stroke survivors look down because even tiny obstacles can be dangerous.  Here is an example.  I had a terrible fall while walking on a slate walkway.  I fell after I stubbed my toe on the edge of a tile that was tilted up about an inch. Thank God I did not fall forward and smack my forehead on the slate sidewalk.  I instinctively dropped my cane and threw my sound arm forward to try to catch myself.  This sudden arm movement rotated my body slightly to the right so I fell on the grass.  I hit the ground so hard I had dirt and pieces of grass caught under my glasses after my face hit the lawn.

Therapists may not know how violently stroke survivors can fall.  Human subjects committees would not allow researchers to put test subjects on a tilt plate that can cause a sudden fall without first putting test subjects in a safety harness.  PTs have to be conservative when they walk stroke survivors because they cannot have anyone fall on their watch.  homeafterastroke.blogspot.com

Sitting In the Dark

I live alone so when the electricity goes out 2 to 3 times a year I have to handle it.  My stroke took away my ability to know where vertical is unless I can see my surroundings.  So I put flashlights in every room.  My plan worked until last night when the house went completely black while I was watching TV at 10 p.m.  I reached down for the flashlight on the floor next to my couch.  I started to freak out when I could not find it.  The electricity has gone off for hours in the past and sitting on my short couch until sunrise would be awful.  I finally found the flashlight, but after the lights came back on I moved it to the tray on my couch that holds my remote control devices.  

Thank God I have another flashlight on the counter directly behind the place I sit at my kitchen table and a flashlight on the floor right next my computer desk.   homeafterstroke.blogspot.com

I Need to Walk on More than Linoleum

I am glad I had PT after I came home from my knee replacement surgery for what used to be my sound leg.  The first time I walked across carpeting with a cane instead of a walker I was wobbly.  The carpeting felt uneven after waking on linoleum at the hospital and in-patient rehab.  I was glad I had a home health PT to steady me when I panicked.  Half of fall prevention is reducing fear that makes me stiffen up.

The first time I walked outside I was startled by a car that came around the corner quickly.  I did not know the hospital environment had allowed me to develop the bad habit of staring at the ground when I walked.  Again I was glad to have a PT by my side when I froze.  This upsetting experience made me realize I was staring at the floor inside my home as well.  So I began practicing walking while looking up in this less challenging indoor environment.  Walking on linoleum in wide spaces while PTs decide who goes 1st when two clients cross paths does not help stroke survivors learn to divide their attention between environmental challenges and controlling their body. 
homeafterstroke.blogspot.com