Writing Aids I Cannot Live Without

The long boring weekends in the rehab hospital drove me crazy.  When my recreational therapist gave me an opportunity to practice writing with my sound, non-dominant left hand I jumped at her offer.  My friend Arlene did not volunteer to write checks to pay my bills for the rest of her life.  Kathy helped by bringing me clear Dycem and crossword puzzles she had enlarged on a Xerox machine to make the spaces bigger.  Clear Dycem is thin and slightly sticky so it holds the paper still as I write.  Solving crossword puzzles was more fun than writing letters of the alphabet over and over like I did as a young child in school.

When I got home I found clear Dycem at www.pattersonmedical.com but was shocked at the price.   However, I splurge on a small roll of clear Dycem which costs $55 + shipping and handling because it is a writing aid I cannot live without.  I have pieces of it every where I sit down to take phone messages, pay bills, do crossword puzzles, write reminders on Post-It Notes, etc.  I make it last longer by washing it.  A small roll (8 inches x 2 yards) lasts almost two years. 

I also splurge on gel pens that cost $15 a box.  Gel pens are more forgiving that ball point pens that must be held at a precise angle to make the ink flow.  homeafterstroke.blogspot.com 

Nails Do Not Stop Growing After a Stroke

         CAUTION: CLIPPING NAILS REQUIRES GOOD SENSATION AND COORDINATION

I live alone so I have to cut my nails.  I cut the nails on my sound hand by using an adapted nail clipper.  The end of the large nail clipper has a square handle which is comfortable for my palm to press on.  The long handle also gives me good leverage when I push down.      I returned the small nail clipper.  The V-shaped end dug into my palm when I pushed down.  The short handle meant I had to press hard to get enough force to cut my nail.

The large nail clipper has emery boards held by pegs that are tightened by hand.  I use these emery boards to remove sharp points at the corners of my nails. This is safer than trying to get the clipper into these tight spaces.  The clipper came with four emery boards, but replacing them is a challenge.  All the stores near my home sell only wide, thick boards (see pink board) that do not fit in the clipper.  The Internet sells long emery boards except for this link.

My sound hand uses a regular nail clipper to cut nails on my affected hand.  Spasticity in my affected hand makes my fingers curl.  To straighten them, I prop them one-at-a-time on a the edge of an opened drawer.  The open drawer allows my sound hand to get low enough to get a good cutting angle.  I put a piece of non-slip shelf liner under the finger to keep it from slipping, but the shelf liner got in the way when I photographed my hand.


Bottom Line: I cringed when I learned the large nail clipper costs $37.50, but nails do not stop growing so I do not have a choice.  homeafterstroke.blogspot.com

Another Thing I Did Not Know About Stroke

When I was an OT who specialized in stroke rehab I did not know the temperature of my hemiplegic foot could vary widely.  Two studies found a stroke survivor's hemiplegic leg may have atrophy of the superficial femoral artery which reduces blood flow (1, 2).  This may explain why my hemiplegic foot feels ice cold by bedtime in the winter.  However, poor leg circulation does not explain why my hemiplegic foot is hot and red by bedtime in the summer, even though I have air conditioning.  Sometimes my brain interprets this high heat as pain so then I walk barefoot after dinner with my quad cane.  The quad cane has four feet that force me to walk slowly which is irritating.  A stroke taught me things I did not learn from an advanced certification course or treating stroke survivors.  homeafterstroke.blogspot.com

1. Durant MJ, et al. Superficial femoral artery atrophy and reduced lower limb blood flow in
    subacute stroke survivors. Stroke. 2020(Feb);51:ATP484.
2. Ivey FM, et al.  Impaired leg vasodilatory function after stroke.  Stroke. 2010(Oct);41:2913-2917.

I Cannot Use Salt to Make Food Tasty

I had a 2nd stroke two years after my 1st stroke so I got serious about lowering my blood pressure with a low salt diet.  Low salt food tastes terrible so I jacked up the flavor with onions and garlic.  Peeling garlic is a challenge.  I use the smooth side of meat pounder to smash the garlic open so I can remove the peel with my sound hand.  Then I chop the garlic with a large kitchen knife. Rocking the knife over the garlic creates a mix of small and medium size pieces.  I place a food scraper in my affected hand so my sound hand can scoop up chopped food and dump it in a mixing bowl or pot.  Notice that the fingertips of my affected hand are not touching each other or the food scraper.

But sometimes I want small uniform pieces of garlic that are evenly distributed in a dish.  I spice up turkey burgers by stirring crushed garlic into an egg before adding it to the raw meat so I will not bite into a big hunk of garlic.  However, a garlic crusher takes lots of hand strength to squeeze the two arms of the crusher together.

I rest the bottom arm of the crusher on my cart as I grasp it with my sound hand.  Leaning on the top arm lets me press down with my whole arm.  I catch pieces of flying garlic with a piece of saran wrap.  To get garlic clinging to the crusher into a bowl or pan, I place the crusher in my affected hand so my sound hand can use a knife to scrape off the garlic.  homeafterstroke.blogspot.com

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

Stroke Survivors Need to Talk

Research with over 1,000 stroke survivors in the UK found that one in five choose to keep their fears to themselves (1).  Major fears included having another stroke, never getting better, and being sent to a long-term care facility.  Reasons for remaining silent included not wanting to worry others and not wanting to sound stupid.

I rarely discuss my stroke issues with family or friends for two reasons.  First, the challenges a stroke creates never ends.  I do not want to see able-bodied peoples' reaction to a litany of complaints that never end.  Second, after trying to explain a few problems to able-bodied people
I found they do not understand the emotional and physical toll a stroke creates.  In contrast, a stroke survivor recently thanked me for a presentation I gave.  I showed him a simple way to hold a toothbrush still while appying toothpaste with his sound hand.  He thanked me enthusiastically because he knew how irritating it would be to clean up sticky toothpaste when a toothbrush falls over every day until he dies.  He gets me and I get him.  Thank God reading stroke survivors blogs showed me that we can get better after rehab ends and my concerns are not stupid.  homeafterstroke.blogspot.com

1.  https://thiis.co.uk/research-reveals-the-often-silent-fears-and-concerns-putting-stroke-survivors-recoveries-at-risk/

Adaptive Garderning After a Stroke

Anti-depressants do not just come in a pill.  I am glad I found a way to garden after my stroke because it makes me happy.  I get to enjoy beautiful flowers every time I come home.  However, each year I forget the tricks I discovered so I took photos and described the steps.

At first I pulled plants out of their containers one-handed.  The moist dirt balls broke apart.  I learned to let the plants dry out a little.  The photo shows a child size spade I slide down the sides of each container to loosen the roots.  


I use a big plastic pot that is lighter than clay.  After I partially fill the pot, I put a ring on top of the dirt.  I made this ring out of a disposable plastic cutting board.  The ring keeps plants away from the rim and gives me something to lean the 1st row of plants against.  A small cup helps me fill the narrow space between the ring and the edge of the pot.  I make sure the plants are touching each other so they grow into a thick ball that prevents water evaporation.  I drop fistfuls of dirt in the small spaces between the plants.  Then I pull out the ring.

I use my hemiplegic (paralyzed) hand to hold the watering can still so it will not tip over as I fill it with the hose.  I use the garden hose to wash off the dirt I have spilled on my concrete patio. 

I lower the pot onto a bench and carefully slide it next to the chair I sit in to watch the sunset and drink a cup of coffee.                                                                                                                        P.S. Rebecca you only need four 4-packs.  homeafterstroke.blogspot.com

Do Not Go Gently Into That Good Night

An OT told me about a client in a nursing home who wanted to get off the toilet line.  The toilet line is for people who have to wait for two aides to transfer them on and off the toilet.  The client wanted to get off the toilet line so badly it took her only 2 months to learn how to use her artificial leg again so she could walk into the bathroom.  This story confirms my worst fears about nursing homes.        I can hear the staff telling this woman she would feel much safer in a wheelchair.  Her story reminded me of Dylan Thomas's poem.

Do not go gently into that good night
Old age should burn and rave at close of day
Rage, rage against the dying of the light

My rage was triggered recently when someone tried to take away my independence.  Women at my breakfast club give small gifts for Christmas.  To make it easier to take the gifts home, I put them in the bag that came with one of the gifts.  The photo shows the hook on the Christmas ornament that kept getting caught on the handle of the bag.  As I was struggling I saw a hand reach across the table.  The hand disappeared when the rage I felt showed on my face.  I should have said "I'm not a young child playing with a sharp knife" so say "may I help you?' homeafterstroke.blogspot.com

Cooking is Therapy for My Hand

Cooking is therapy for the hand because many tasks have to be done with both hands.
Below are a few examples of kitchen tasks that force me to use my hemiplegic hand.

The photo shows me holding a Cuisinart container with my hemiplegic hand while my sound hand scrapes out the food that always sticks to the side of the container. 

Two more examples - One hand holds a pot still while the other hand stirs the food.  One hand opens the refrigerator door and the other hand takes food off a shelf.

A stroke taught me a palmar grasp is useful.  In the photo the ends of my fingers are not touching the object or each other.  Why wait until tip pinch emerges when a palmar grasp lets
able-bodied adults to do ADLs that have to be done thousands
of times?



I am not the only one who thinks cooking is therapy for the hand.  OTs at Samuel Merritt University had stroke survivors prepare lunch and clean up (1).  The group that was helped to use both hands during cooking used their hemiplegic hand more often at home than the group who received constraint-induced therapy.  Transferring skills to a new setting is more likely to happen when the practice task closely resembles the target task.    homeafterstroke.blogspot.com

1.  Hayner, K., Gibson, G., & Giles, G. (2010).  Comparison of constraint-induced movement
     therapy and bilateral treatment of equal intensity in people with chronic upper-extremity
     dysfunction after cerebrovascular accident.  American Journal of Occupational Therapy, 64(4),
     528-539.

Dysarthria is More Than Slurred Speech

I had a stroke in the pons which contains the bridge to the cerebellum which controls coordination.  Poor coordination of my lips, cheeks, and tongue made my speech severely slurred (dysarthria).  The good news is that I never lost the ability to understand what people were saying.  The bad news is that people could not understand me. 

Not being able to control my breathing made speaking difficult.  To speak you have to let your breath out slowly.  At first I would exhale explosively in one big gasp.  I had to take extra breaths to finish even one sentence.            I gradually regained the ability to say more before running out of breath.  It is still tiring to speak in a group because I have to take deep breaths to be heard.  Thankfully people never have trouble understanding me on the telephone.  I speak into an ear bud so I never have to raise my voice which requires more air.

My dysarthria has never fully disappeared.  When I am tired my speech is still somewhat slurred.  homeafterstroke.blogspot.com