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

When I Cannot Finish What I Started

If I were still married, asking my husband to fix me breakfast would have been a disaster.  Harley got up at 6 a.m. every day we were married.  His routine was to go to a convenience store like 7-11 to get a cup of coffee and sweet roll and come home to putter in the garage.  On Sundays I slept in and he went to a flea market.  If he made breakfast for me after my stroke, one of us would have had to change life-long habits.  Repeated frustration can turn into resentment.

It does not matter if I can get out a box of cereal, a bowl, and a spoon.  My hemiplegic hand has to reach out to grab the handle of the milk container to stop it from moving when my sound hand pulls off the cap.  Even if my husband opened the container the 1st time, prying the cap off one-handed could make the container tip over.

 If I cannot open the milk container I cannot finish what I started

Caregiver Disconnect

Forty caregivers of stroke survivors reported they often felt abandoned (1).  This may sound surprising unless you know therapists usually do not talk to caregivers.  Lutz found that "during rehabilitation many of these caregivers still hoped and expected that the stroke survivor would return to pre-stroke function (p. 8)."  Caregivers reported not knowing how to help when their loved one went home.  One caregiver said when her husband struggled with a task she helped by doing it for him.  This solution produces muscle weakness and mental decline which increases the caregiver's burden.

As an OT I was oblious to the stress that caregivers experience.  They have to: 1) take on their partner's chores, 2) be a therapist, and 3) be a case manager.  A wife may take out the garbage and change the batteries in smoke detectors.  A husband may clean toilets, do laundry, and cook.  When caregivers are therapists, they may help with self-care like bathing, set up home exercises, and deal with a stroke survivor's bad moods.  When caregivers are case managers, they schedule doctor and therapy appointments, arrange transportation, deal with insurance companies, and make multiple trips to the drug store to pick-up medication.  Many caregivers do this without professional psychological support or respite care.  Now I see that caregivers are angels.   homeafterstroke.blogspot.com

(1).  Lutz B et al. Improving stroke caregiver readiness for transition from inpatient rehabilitation
        to home. The Gerontologist. 2016; Vol 00:No.00,1-10. doi10.1093/geront/gnw135.

Another Cheap Solution

Here is another example of how stroke survivors can use cheap every day items to solve problens instead of ordering equipment from an expensive medical catalogue. I love my kitchen garbage can except for 1 thing.   As it gets full, the weight of the garbage pulls the liner down.  The notch (see arrow) does not keep the liner in place.  Garbage can get caught between the liner and the can - yuk. 

Recently I saw 2 metal clips resting on my counter that I forgot to put away.  I thought the clips might hold the liner in place.  Voila - the tiny black clips next to the hinge do the job.  I am so happy.  Serendipity saved me again.  Having a master's degree in OT is not enough.

I had to do in-store shopping to find a kitchen garbage can I can use.  I discovered I cannot use a garbage can that opens by stepping on a pedal.  This mechanism requires me to slowly step on the pedal so the lid does not fly open.  My balance is not good enough to do this.  I learned garbage cans with openings in the lid that swing open when touched are small so the edges can get spattered with food - another yuk.

A model made by Hefty has a lid that hangs over the side (see arrows).  I lift the lid with the back of my hemiplegic fist so my sound hand is free to dump the garbage.  homeafterstroke.blogspot.com

Reading One-Handed

After my stroke I still enjoy reading, but holding a book one-handed is tiring and frustrating.
I am glad I found a book holder that works for every size book.  The clear plastic page holders (see black arrow) move in and out so they adjust to thin and thick books.

The easel arm is also adjustable.  I release the lock (white arrow) and tilt the book holder so it is more horizontal or more vertical.  This gives me a good reading angle regardless of the size of the book or the resting surface I am using.

I found this Actto book holder at amazon.

homeafterstroke.blogspot.com

Working Smarter Instead of Harder

I get reader's fatigue when they read my long procedural posts like Bathing Can Be Exhausting,
I Am the Queen of Velcro, Applying Make-up One-handed, and Things You Don't Learn in Driving Rehab.  However, modifying even 1 or 2 steps makes life easier which reduces frustration.  The good news is repetition turns long adapted procedures into a routine I do not have to think about.  Repetition is a gift that keeps on giving.    homeafterstroke.blogspot.com

Eyedrops After Cataract Surgery

People who do not have someone to put drops in their eyes four times a day need help.  Task modification helped me succeed after my recent cataract surgery.  It is easy to drop a tiny 5 ml bottle.  It is also difficult to squeeze the stiff sides of a tiny bottle.  I am glad I found the Autosqueeze Eye Drop Bottle.  The big wings are easy to hold and require only a gentle squeeze.

Before I lie down on my bed I gather two bottles of eye drops and a Kleenex tissue.  I put a pillow on my chest (not stomach) and put my sound elbow on the pillow.  This support makes my hand remain steady instead of bobbing around as I hold the bottle in the air.  To stop myself from blinking I distract myself by looking through the opening formed by my thumb and index finger instead of the bottle.  I try to get the drop in the inner corner of my eye.

When I put the cap back on I need to stop my hand from bobbing up and down and accidentally touching the tip of the bottle.  I keep my hand still by pressing my elbow firmly against the pillow.  homeafterstroke.blogspot.com

Pain Scales

My knee surgery has been delayed.  I used some of my time to document pain levels.  Dividing pain into mild, moderate, and severe is not enough to identify 10 different levels.  Noting whether pain was intermittent or constant was helpful.  It helped to document when pain disrupted my Activities of Daily Living (ADLs) and how much pain reliever I took.  At 6-10, emotional distress added further refinement.  Here are the 10 levels of pain I have experienced over a lifetime.

1.  Have to think to recall if I had Mild  Intermittent pain during the day.
2 . Spontaneously aware of Mild  Intermittent pain throughout the day.
3.  Mild  Constant pain.  650 mg Tylenol at bedtime.  Must do some ADL tasks differently
     (e.g. walk down stairs backwards).
4.  Moderate  Intermittent pain.  Added 650 mg Tylenol in a.m. because I ache before I get up.
5.  Moderate  Constant pain makes me achy and exhausted by the end of the day.
     Worried about what 9 months of Tylenol is doing to my liver.
6.  I cannot tolerate Constant  Moderate pain much longer.  Irritable!! 
     Need 2 attempts to do some ADL tasks (e.g. stand up).
7.  Severe pain makes me afraid I cannot finish a task (e.g. thought about leaving loaded cart in

     the grocery store and going home).

8.  Severe pain makes me say "Ow that hurts" but I am able to remain still.
9.  Severe pain makes me Yell "OW" and I jerk involuntarily.
10. Excruciating pain: Not able to make any sound because I cannot exhale or inhale.
        homeafterstroke.blogspot.com

Handicapped Bathrooms Are Badly Designed

Handicapped bathrooms in hotels I have stayed at since my stroke are poorly designed.  

The most common error is placing the towel rack on a wall ten feet away from the tub.  It may be dangerous for a companion to turn his or her back on a disabled person and walk across the room to retrieve a towel.  I solve this problem by dragging the luggage rack into the bathroom.  I place my towel and bathrobe on the rack where I can reach them while sitting on my folding shower stool.  In a regular room I place my towel and robe on the lid of the toilet seat which is often super close to the tub. In a handicpped bethroom the toilet is far from the tub to make room for a wheelchair.

I ran into two unique problems at one hotel.
1) The shower curtain was so short and hung on a rod that was so far away from the edge of the tub I could see a speckled beige bathroom tile floor when I looked down.  A wet floor is a Fall Hazard.  Before I got in the tub I put a bath towel on the floor to soak up the water that fell through this gap as I showered.  A cheap solution is to purchase longer shower curtains that can be tucked inside the bathtub.

2) When I detached the shower hose to use in sitting, I had to turn off the water while soaping up because letting the nozzle hang free let it point outwards to spray water on the floor (photo on left).  A wet floor is a Fall Hazard.  

These negative experiences taught me to stop asking for a handicapped bathroom when I travel.  homeafterstroke.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