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30
Oct

Canes

Did you ever see the show House?  Well my friend Vicki, she’s an occupational therapist, said she has some therapist friends that won’t watch that show because House uses his cane on the wrong side.  I think that’s funny.  I saw this commercial recently for some cane and the commercial showed a guy using the cane on the wrong side.  If you’re trying to sell a product, use it correctly in the commercial.  I used a cane for a while after my stroke – and hated every second of it.  For long-term users of assistive devices you just have to embrace it and learn not to hate it.  Luckily, I don’t have to use a cane anymore.

Here’s how to use a cane correctly……

You hold the cane on the OPPOSITE side of the weaker side.  In my case, my right side is all goofy so I held my cane with my LEFT hand.  The purpose of a cane is to increase your base of support which improves your balance so that you don’t fall.  So at the same time you take a step forward with the BAD leg, the cane, held with the opposite hand, should be advanced forward simultaneously.  When I walked with a cane, I would move the cane forward with my left hand AT THE SAME TIME as when I took a step forward with my right leg.

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29
Oct

Sitting Down

A lot of things that I write about are much easier said than done.  In my post, Center of Gravity, I explain the best way to stand up from a seated position.  In Transfers, I explain how to move to a different place.  These are all of the techniques I learned in PT school.  Well, it would be nice if your body cooperated with all this stuff.  For example, in this post I’m going to say at one point “reach your arms back and feel for the chair.”  You might not be able to do that.  After a stroke one elbow might be constantly bent making reaching behind you impossible.  This is one reason that it’s imperative to let your therapist know if something isn’t working for you.  A lot of things annoy me, but one of my biggest annoyances is when someone says something and just expects me to be able to do it.  Ummm, I have brain damage.  So now I will explain how a PT is taught to teach someone to safely sit down.  First, you’re standing – obviously.  You should feel the chair/couch/seat on the back of your knees before you do anything.  So, now you’re standing and feel the chair on the back of your knees.  Ok now bend over a little bit and reach behind you to grab onto the arms of the chair, if the chair has arms.  Then sit down.  NO PLOPPING.  Plopping down is a very bad thing and any therapist working with you on sitting down will say “no plopping.”  When you sit down it should be a slow and controlled thing, no plopping down just because you know there’s a seat behind you to catch you.

24
Oct

Hospitals

I was in the hospital for a month.  Now, when I was in the hospital I didn’t understand what was going on.  I didn’t understand what had happened to me, I didn’t understand my disabilities, anything.  I really didn’t, I just knew I was in hell.  I have what’s called an intention tremor.  That means that at the end of a purposeful movement I shake – a lot.  For example, if I try to pick up a glass of water with my right hand, I start shaking wildly and the water goes everywhere.  If I carry a liquid with my right hand it has to be covered.  Both sides of my body are affected, but my left side much less so.  When I was in the hospital, my left side was pretty bad, it’s not anymore. Everyday in the hospital, I chose my menu for the next day. Everyday, like I had for the first 29 years of my life, I chose cereal for breakfast.  I should not have had that option.  A 30-year old who had just had a massive, bilateral cerebellar stroke which resulted in a severe intention tremor should not have been given the option to order cereal for breakfast.  And don’t get me started on soda.  Soda should not be in a hospital.  We need a lot more individualization in hospitals.  It might take a little more time to create customized menus but I think the hospital staff can spend that time.  Some of those patients are in absolute, extreme hell and the details will make a difference.  I understand that I was an extreme case but people with extreme cases need it the most.  Some of my hospital staff was absolutely wonderful.  Rhonda, if you ever read this, thank you for everything. Most sucked.  🙂  I shouldn’t be able to say ‘most.’

22
Oct

Bilateral Training

Read this.  I don’t know a lot about bilateral training.  Bilateral = both sides.  I guess I did it in my practice without really knowing it with gait training.  Gait training means practice/teaching walking.  I don’t know a lot about it but I do know this.  For the first year after my stroke, I really had to force myself to use my right side.  I read a little bit about bilateral training so when I would use my right hand/arm, I would use my left side simultaneously.  It helped.  I don’t do that anymore, I don’t have to force myself to use my right side anymore, it just looks funny.

18
Oct

Strokes and Young People

I’m way young to have had this happen.  I’ve heard that A LOT.  That’s like an automatic response from people who first meet me.  I think they just don’t know what else to say so they say “oh my God you’re so young.”  Yeah, I am but I’m not the youngest person to ever have a stroke.  I met a guy who has had 3 strokes starting at the age of ten.  I know of a little girl who had a stroke in utero.  At least I finished my education and started a career before getting sick, these people didn’t really have a chance before their lives were turned upside down.  I think that part of the reason that it took so long to diagnose me was because no one thought it could be a stroke.  That’s no excuse, they should’ve given me an MRI long before they did but that’s part of the reason.  Strokes in young people happen and are on the rise.  This research says that there are more strokes in young people because of increasing rates of obesity, diabetes, and high cholesterol.  I didn’t have any of these, sometimes s*** just happens.  😦  One doctor told my family “sometimes 30 year-olds just have strokes.”  Umm, ok.  I live in a city with the best doctors in the world – that’s not a good explanation.  I have a patent foramen ovale(hole in the heart) but the most current research says this doesn’t increase stroke risk when it was long thought that it did.  There is more research coming out soon on this subject, so we’ll see.

16
Oct

FES

FES stands for a bunch of things. When I googled ‘FES,’ a whole bunch of things came up. Well, in the therapy world FES stands for functional electrical stimulation. I never had any e-stim after my stroke. It wouldn’t have helped me, I had/have no strength issues. But electrical stimulation can do a lot. I learned about FES during my unit on strokes. E-stim can build strength in a muscle/activate a muscle when it can’t be done adequately voluntarily. FES is cool. Here’s an example, we did this in school. Imagine someone with foot drop. Foot drop happens when your shin muscle doesn’t work right and your foot isn’t lifted adequately when walking and drags on the floor. This is common after a stroke. With an FES machine, you put a sensor on the bottom of your heel and an electrode pad on your shin muscle(tibialis anterior). So when that foot is stepped down upon, the sensor turns off the stimulation.  At all other times the muscle is stimulated and the foot lifts so that it doesn’t drag. You can use FES in other ways too.

14
Oct

Imaging

I had A LOT of imaging when this happened and for about a year after.  Imaging is the term used for all the internal pictures they do.  So, an x-ray, MRI, CT scan – all that stuff is collectively called imaging.  I’ve learned a few things since my stroke.  A CT scan is like a plain film(x-ray) but it takes cross-sectional images, so the doctors can look at ‘slices’ of the body.  Plain film is what x-rays are called.  Like a plain film meaning it makes it much easier to see “hard” structures in the body, mainly bones.  Problems with organs show up on a CT scan as well as tumors, etc.  A CT scan is the first thing I had to try to figure out why I collapsed.  The doctors said it looked fine.  I learned a few months later at a support group for stroke survivors that an ischemic stroke(stroke caused by a blood clot) WILL NOT show up on a CT scan in the first few hours.  For that, you need an MRI.  An MRI takes pictures of the ‘soft tissues’ of the body.  It took them about 30 hours to give me an MRI.  Why?  I’ll never know.  They messed up.  I understand that when a 30-year old woman presents to the hospital the last thing anyone would think of would be a stroke but clearly there was something wrong with my brain.  And every time I had a follow-up appointment I would have a CT scan.  Not sure about this either.  I know MRIs are way more expensive but if you have a young woman who had an ischemic stroke wouldn’t the doctors have wanted to see an MRI?  I don’t know, I’m not an all-knowing doctor.  Imaging

13
Oct

Do you know what I’ve done for you?

If you have a brain injured friend or a loved one with some other disability don’t say this.  DON’T say to that person “do you know what I’ve done for you?”  or “remember what so and so has done for you.”  This person is probably acutely aware of everything that everyone has done for them and most likely that person has an ENORMOUS amount of guilt about it.  No need to remind them.

12
Oct

Homunculus

These are pictures of a homunculus.  It took me a while to really understand this concept in PT school.  I don’t know why, it seems so easy to understand now.  A homunculus is a representation of what area/how much of the brain control what area of the body.  See how the hands are really big?  Well, a lot of the brain is devoted to the hands, that’s why they’re so sensitive and we do all of our feeling things with our hands.  The lips and tongue are big – taste and speech take a lot of brain cells.  The knees – not so big.  They are involved in walking, running, standing, etc but not much else.  You can’t put something on your knee and tell what it is with closed eyes.  You can do that with your hands.  After a stroke, the homunculus is going to look a lot different.  It might be lopsided or not have certain parts on it at all.  Your doctor SHOULD be able to tell you what your homunculus looks like.  Should being the optimal word.  The goal is to make your homunculus to look like this again.

9
Oct

Hemmorhage

The first stroke I had was really 2 strokes.  The blood clot split, formed into 2 clots and affected both sides of my brain.  This might not have happened if they diagnosed me before 36 hours went by!  Anyway, about a week later, I had a really bad headache.  So they took a CT scan of my head and found ‘new blood’ in my brain.  My family was given some doctorly reason for why this happened but at no time, at no time, did anyone say that I had had another stroke.  I did.  Make no mistake, anytime there is a ‘bleed in the brain,’ that’s a stroke.  I don’t know how much further brain damage this second stroke caused and I’ll never know.  I’ve been told the tremor on my right hand got much worse after the ‘bleed.’  The only thing I can do now is live with my disabilities and try to get rid of them.  At least I have that option.  You can recover from a stroke.  Some people have disabilities that won’t go away ever.

8
Oct

Insurance

I used to not pay attention at all to what insurance policies I had.  I pretty much just signed up for anything that came across my desk at work.  I was 30 years old when this happened, that’s plenty old enough to think about insurance.  But I had no kids and was unmarried, I think those things kinda make you think about insurance policies more.  I’m assuming there are other young adults out there like me, that don’t think about insurance.  Well, all I can say is THANK GOD I signed up for my work’s long-term disability plan and was paying into it.  Thank God, without it I would have been really, really, really, really, really screwed.  At the age of 29,  I couldn’t have told you beyond medical what insurance I had.  It’s kind of embarrassing to say that but it’s true.  At the age of 30 everything changed and I became disabled.  Pay attention to insurance.

7
Oct

Transfers

I got a whole lot of good feedback about my post entitled ‘Center of Gravity.’  In that post, I explained how to easily stand up.  Well, this time I’ll explain an easy way to transfer.  A transfer just means moving from one place to another.  For example, moving from the couch to a wheelchair, that’s a transfer.  The same principle applies here, move your center of gravity and it will be easier to move around.  Let’s use the example of the couch to wheelchair transfer.  Position the wheelchair as close as possible to the couch.  First, scoot to the edge of the couch.  Now, while still seated, lean the upper body forward.  This should sound familiar if you read that other post.  Pull your feet back as far as you can.  So now you should be bent forward sitting on the edge of the couch with your feet pulled back.  Now, lift up your butt and swing it to the wheelchair.  It should be really easy to lift up your butt in this position.  If it’s not, you did it wrong.  🙂  Just kidding, sometimes you will still need help moving but doing this should make it much easier.

5
Oct

Stretching

After a stroke, your muscles will most likely move synergistically.  You’ll have synergistic movement.  Synergistic movement means multiple muscles will move at the same time.  Sometimes, this is a normal thing.  Not after a stroke.  When something happens to the brain, you’ll most likely experience a flexion synergy on the damaged side of the body.  In a flexion synergy, everything kind of curls up.   Extension synergies can occur too, but flexion synergies are much more common.  In an extension synergy, everything straightens.  I had a flexion synergy on the right side of my body.  I really, really noticed it when I would try to walk.   I hated it.  I would attempt to walk and my upper body got all involved.  The upper body should be involved a little bit but not this much.  My shoulder came up, my elbow bent, my wrist curled.  I hated A LOT of stuff, but I really hated that.  It doesn’t happen at all anymore.  My point in talking about this is to tell you that you have to stretch, and stretch frequently.  If you have a synergy, certain muscles are going to be frequently contracted and shortened.  They have to be stretched out.  If you don’t keep your muscles stretched and at a normal length, bad things will happen.  Here are some videos that demonstrate some stretches well.  At ALL times, you should have good posture, your back should be straight.  Remember when you were little doing a hamstring stretch and you were told to try to touch your toes?  NOOOOOOOOOOOOO!  Shoulder and shoulder  All of these shoulder exercises can be done laying down.  Proper hamstring stretch, calf muscle, bicep muscle

3
Oct

S to Z Ratios

I do something in speech therapy called S to Z ratios.  I was told it really works the diaphragm.  If you know anything about me or have been reading this blog, you’ll know I’m all about the diaphragm!  🙂  This is what I do….I take a big breath from the diaphragm(the chest stays still!) then using the exhale from the diaphragm, make an ‘S’ sound for as long as possible.  I then do the same thing with a ‘Z’ sound with the goal being to hold the ‘Z’ sound for as long as the ‘S’ sound.  It’s harder to make a ‘Z’ sound.