I was just taking my dog for a walk and this older gentleman says to me “you’re walking like Walter Brennan, what happened?” I had no idea who Walter Brennan was or what that meant. But when I got home I googled him and found out he’s some old actor who walked with a limp. That’s really rude. Now, this guy was saying it with a huge smile on his face and thought he was being friendly. To him he just saw a healthy looking young woman who was walking funny. But I’m hypersensitive to this stuff and he shouldn’t have said that.
I was in occupational therapy the other day and there was this girl in there that I’ve gotten to know. She’s a year and some months out. She always asks me about my walking. I walk really well, she does not. However, she uses her hands A LOT better than I can even now. So to her, everything is about walking. To me, everything has been about using my hands. Whatever you can’t do, or do well, is going to seem like the bigger, more horrible issue. It’ll get a lot better, especially for us youngsters.
Bell’s Palsy occurs when one side of the face is paralyzed. Strokes will often cause one side of the face to have a palsy. A droopy face. Every therapist has heard this – that Bell’s Palsy can be caused by sleeping next to an open window. They said this to us in PT school. Uhhh, really? I don’t know if it was said jokingly or if the professor was serious, I can’t remember, I was probably half asleep. Anyway, if your face droops on one side, it’ll get better. The facial muscles are the exact same as any other muscle in the body. Eventually they will work better because the brain will work better and make better connections with those muscles, or make new connections. You have to make this happen, it won’t just happen spontaneously. Well, it might happen spontaneously, if it does you’re very lucky. But in order to help make it happen, do these exercises. At the beginning of this video there is a warning about something called synkinesis. This can happen with facial palsies when the nerves get confused and something happens when it’s not supposed to happen, such as closing of the eyes when the mouth muscles are used. The warning on the video says this is a permanent condition – no it’s not. No condition resulting from damage to the nervous system is permanent. You certainly don’t want synkinesis though.
I’m not going to pretend that I understood the importance of this when I was a physical therapist. I’m still a physical therapist, but when I was working as one – you know what I mean. No I didn’t really and truly get this until I had a stroke and had to do it myself. To recover a movement after a stroke, you have to do it A LOT. Repetition is the number one, most important concept in stroke recovery. To recover a movement, you have to do it over and over and over and over – and over. I used to think when I was a physical therapist – because a clinical instructor of mine said it to me when I was a student and it stuck – that why would you make someone do something in the clinic when they come to PT when you’ve given it to them for homework and they can just do it at home? Because people don’t do what they should do at home – for the most part. That’s been my experience anyway, the majority of my patients did not do what I told them to do at home. AND because like I said before, it takes doing something over and over and over and over – possibly millions of times. How do you think Nolan Ryan got so good? He pitched everyday over and over and over and over. Now in orthopedics you can overuse a muscle, that’s usually how you get tendonitis. But I wouldn’t worry about that when recovering from a stroke. There are some movements I can’t even do right now, let alone overdo.
I was at the gym earlier and I got into a conversation with a guy. Now, generally I try my best to avoid talking to strangers but it’s gonna happen. Every time I talk to someone new I tell my story and explain why I talk weird. So I told my story and the guy goes “You had a stroke? You don’t look like it. What’s wrong with you now?” HAHAHAHAHA! What’s wrong with me? That’s a loaded question dude.
I’m pretty smart. One of the biggest things that annoyed me, and still annoys me to this day – you know what, A LOT of stuff has annoyed me. A LOT. I mean I had a stroke at age 30, that’s pretty annoying. But this has been one of the biggest annoyances. I lost nothing cognitively. I was not affected cognitively whatsoever. But a lot of people treated me like I was. I can certainly understand being treated that way the first few months because my brain was recently massively injured – that’s gonna cause some immediate cognitive issues. But after a few months, my cognition was fine. I still said and did weird shit, couldn’t help it, but I wasn’t stupid – I was injured. Don’t treat someone like they are any less intelligent, they’re not. You have absolutely NO idea what’s going on in their head.
About a year and a half after my stroke a light bulb switched on in my head and I realized that my life, if that’s what you could call it, f’ing sucked. It was at this point that I realized I needed to re-enter life. Up until then I was just kind of existing. The biggest thing I did was end my mentally abusive relationship. I would rather live alone and disabled than in the situation in which I was living. Before I got sick, I was in a bad relationship. After I got sick, things got worse. I didn’t realize that they were worse for a long time – a year and a half. And things sure didn’t seem bad to outsiders, but behind closed doors things were bad. I’ve been told that outsiders thought we were a perfect couple. NOOOOOOOOO! So I left. For a long time I thought I had to stay, I thought well this is my life now, fate sealed. Don’t ever think that, fate is never sealed. And there were some things said to me that SHOULD NOT have been said. About a year after my stroke I called a “friend” because I needed to talk about the misery that was my existence on this planet and he said to me “remember everything ___ has done for you.” BELIEVE ME, I was WELL aware of what had been done for me. That person is no longer my friend. Don’t say something like that. Don’t. All of my sadness regarding my former relationship has turned into anger. I said this to my therapist and she said “that’s great!” I was like “how the hell is it a good thing that I have a ton of anger now?” She said “because that means you’re moving on, that all that energy has shifted.” Damn. She’s good.
I am an adult who had something incredibly huge, severe, and life-changing happen. I don’t think some people in my life get that. This has been absolutely devastating. Because of this happening to me, there needs to be a lot of changes in my life and the way I’m dealt with by others. If you have a loved one that gets sick, they’re probably going to tell you all kinds of things like “I don’t like that” or “don’t touch me there.” FOR THE LOVE OF GOD, respect their wishes. You should be respectful of someone’s wishes like that anyway, even if your loved one is perfectly healthy. But after something like this, it should go without saying. For some people in my life it did not go without saying. It didn’t go with saying for some people.
Barb just got Botox injected into her forearm and it worked! In her latest blog post she said that she can open her hand fully. That’s awesome, Botox won’t always have an effect. So, you’ve heard of Botox. It’s the stuff that women get injected into their foreheads and around their eyes so they don’t have wrinkles. Well, Botox paralyzes muscles so along with losing wrinkles you might lose facial expressions. But I guess it’s more important to some people to not be wrinkly than to emote. But it can be really useful for stroke survivors. Botox can be injected into spastic muscles to relax them so that the opposite muscle can work better. So if your biceps are spastic, you can get them injected with Botox and hopefully the triceps will work better to overcome the spasticity in the biceps and straighten the arm. I think it’s pretty important for me to write about this because I have a friend who cannot open her hand and Botox has never been mentioned to her. Maybe there’s a reason for this, I don’t know, I don’t know what all her hand can and can’t do. I have no spasticity, none of my muscles are overworking – they just act insanely weird – so I’m writing about something I just know about, have never had it myself.
Dean gave me this idea. HEY THANKS DEAN!!!!!!!!! A tendon is the piece of tissue at the end of a muscle that connects that muscle to a bone. You have frequently heard of the achilles tendon, right? That’s what is connecting the calf muscles to the heel bone. In the hand there are all kinds of weird tendons. I think they’re weird anyway, the hand is really confusing. Vicki you know WAY more about this than me so if you’d like to tell me I’m wrong or add anything, go right ahead. 🙂 Often after a stroke, the hand will be all curled up and it might not open very easily. Along with working all the muscles of the hand, you need to work the tendons too and there are specific ways to do this. Here are tendon glides. Here’s a bunch of hand exercises.
I was complimented on my posture yesterday so I thought I’d write about it. It’s a natural thing for me to have great posture and never slouch but it’s not at all natural for most people. If you fix your posture, you’ll fix a lot of things. Here’s how I used to teach patients about posture. Soooo, start with sitting down. Don’t worry about your spine yet, just sit there. Now, slouch as much as you can. Yes, I’m telling you to slouch. From that slouched position straighten your spine as much as you can. Overcorrect your posture so that you look really awkwardly straight. Then go between these 2 positions a few times. The point of this is to know what it feels like at both extremes, neither of these positions are natural or correct. Ok, finish on that weird, overcorrected, straight spine position. From this position, relax a little bit and decrease the straightness by about 10%. This is where your posture should most likely be. If you find yourself slouching throughout the day, overcorrect yourself then decrease that by 10% and you’ll have good posture. 🙂
I had never heard of this and didn’t know what the hell it was until I took a course taught by Peter G. Levine. BDNF stands for brain-derived neurotrophic factor. That’s a really long name for a protein. BDNF is a protein that is produced by the brain. It helps neurogenesis – it makes new brain cells. New brain cells = neuroplasticity. Neuroplasticity is the rewiring of the brain. BDNF has been referred to as Miracle-Gro for the brain. So we want it. Stroke survivors want a lot of it. Exercise stimulates its secretion. So the moral of the story is…..workout……a lot. Here, read this.
I was in occupational therapy today and there was this girl in there. My OT made her do her entire hour of exercises standing up. Why did she do that? Because this girl has a hard time being on her feet. She tires easily and has poor balance. OK, so here’s how to more easily stand up. But once you’re up, then that’s a whole different ballpark. You may have trouble standing, you may get really tired, you may have terrible balance, you may fall. These things happen. Once you’re in a standing position, there’s a lot of things you can do to work on remaining standing. My OT kept making this patient do weight shifts. Weight shifts are just what they sound like. You shift your weight from leg to leg. The leg that isn’t working remains on the ground BUT you should be able to easily lift the unweighted leg – it should have no weight on it. It’s not balancing on one leg, it’s simply shifting your weight. Now, you may feel like you have to hold onto something when standing. Like if you’re standing at the kitchen sink you may feel like you have to hold onto the counter. That’s OK, but try to decrease the amount of weight you’re putting through your hands, decrease the number of fingers used to steady yourself until you’re only using 1 finger and eventually no fingers – you’re standing on your own. NO leaning, your spine should remain straight and you should be standing up tall. Also, no resting your hips on the counter. If you do that, you’re negating the whole exercise. Here’s some exercises. This site is meant for cartoonists, but it’s a good explanation of weight shifts.
My last post was about the hip abductors and Dean requested that my next post be about the hip adductors. Done! The hip adductors are what people call the groin muscles. So if your leg is out to the side, it’s the hip adductors that bring it back. Usually these muscles are going to be a lot stronger than the hip abductors. My best friend rides horses, has all her life and has like no hip abductor strength. Her hip adductors – super strong. She’s spent her entire life building up those muscles by squeezing a horse. The muscles on the inside of her thigh have been in constant use for like 25 years. So generally there’s an imbalance there. But after a stroke EVERYTHING needs to get stronger. Here’s hip adductor exercises. Here’s more.
Guess what, this is an orthopedic post……