Stroke Recovery. Are You Up for the Challenge?

Keeping it challenging...

Whatever is practiced, it must be challenging. In research, an 80-percent threshold is generally used. For instance, if a stroke survivor can successfully turn the pages in a magazine 80 percent of the time, the challenge can be increased by turning the pages of a newspaper. Since turning pages of newspaper requires increased excursion of the shoulder and elbow, the increased AROM will "trickle down" to easier tasks such as turning pages in books and magazines, card flipping and laundry folding.

What is usually done

Compensation (learning to "get by" with the "good" side). As "Dean's" puts it: Compensation being doing whatever is necessary to accomplish a goal. Recovery is using the muscles as intended to accomplish the same goal. Insurance wants you to use compensation whenever possible because it is faster and cheaper. 

Faster and cheaper

Faster and cheaper is good because its faster and cheaper. You could go to a State University. Or you could get a degree from a degree mill. You could make a a salad, but you could get the same amount of calories from a pop tart. But even as fast and cheap as they are, you'll still feel gypped.

AFO: You can check out anytime you like, but can you ever leave?

I often get questions about ankle foot orthoses (AFOs), and how to get out of them. I'm not a big fan of AFOs because they encourage a sort of "learned nonuse." It's actually more like "learned disuse." (Learned disuse: You're not learning to not use the body part, but you learning to use body part incorrectly.) And keep in mind, every movement you make changes the way your brain is wired. So it's very easy to get used to an AFO. Let's put it this way:

It's easy to walk into an AFO. It's hard to walk out.

In any case, I get a lot of e-mails about this subject. Here's an example:

 

I wear a big brace on my right leg. I am paralyzed on the right side. I walk with a one-point cane. I walk with an open hinge (articulating) AFO.

 

They opened the hinges on my old brace several years ago. I walk around my apartment with the old one. But when I go out I use the bigger brace which isn't open at hinges.

 

I read on Deans' Stroke Musings that you recommend the Air Cast. Which one for stroke survivor do you like? They have a lot of different ones on their website. 

Here's my answer:

First of all, the disclaimer:

(Warning: ENDING THE USE OF AN AFO CAN LEAD TO FALLS AND INJURIES.

Never discontinue the use of an orthotic without first consulting the appropriate health care provider. Then call your doctor. Then have your doc talk to any other providers as needed. Then discuss it some more. Thank you.)

Wear a brace on the ankle that satisfies two things:

1. Keeps you safe

2. Challenges* you

*Challenge: Walking naturally challenges you to lift your foot. If you can lift your foot up and down to stay safe (not trip) then you might consider questioning an orthotic that helps lift the foot. 

Gradation would usually be something like this:

1. Rigid AFO

2. Articulating AFO (where the ankle joint moves just a little bit)

3. A stirrup (stabilizes both sides the ankle but allows the ankle to move up and down freely)

4. A high top shoe (like a basketball shoe)

5. Nothing

There are a wide variety of other options between a rigid AFO and barefoot. Here are some. Some help bring the ankle up during gait, others support the ankle. The stirrup is usually associated with one particular company: AirCast.

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Know a good doc or therapist?

I get this all the time:

"How does one go about looking for a neurologist or physiatrist or therapist who is familiar with the practices outlined in your book?"

You'll notice a link on the right column. Or you can click here. Either way, if you live in the USA,  you'll find resources to help find aggressive healthcare providers for your recovery team.

Then  next questions is "Where do I find an OT or PT or speech therapist who knows?" You find a resource for that too.

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