“Walking is man’s best medicine.” – Hippocrates
It’s the most frustrating piece of advice that anyone who has had a stroke can receive. Throughout this process, I’ve researched, read, observed and trialed dozens and dozens of techniques and interventions to help Dad in his recovery. The one underlying theme that every study, every professional and every technique I’ve used has unequivocally suggested:
The return of function in the affected limbs take an immense amount of effort, movement and repetition.
Yup. It’s that vague. This is what discourages stroke survivors. If they’re anything like my Dad they need specific examples, dosed exercise and constant reminders. What this means for caregivers, family, friends and rehab professionals is that making a stroke survivor USE the affected side AS OFTEN AS POSSIBLE is the key to their recovery.
Turn this open-ended and meaningless suggestion into something tangible. Any attempt at movement will lead to at least some improvement – there is no magic exercise. Any and all exercises will help! Need some examples? No problem –
- Holding your phone in your affected side
- Straightening and bending the affected leg
- Shrugging the affected shoulder up and down
- Bending and straightening the affected arm
- Opening and closing the affected hand
- Squeezing the shoulder blades back and together
- Sit down and stand up multiple times in a row
- Squeeze a pillow between the knees
- Tap the toes on the affected foot
Now here’s where some people give up. They can’t do any of those movements and the task seems impossible. What then? When I brought Dad home from rehab he could do NONE of those things (and still can’t do most of them). If you, or your loved one, is in this boat don’t lose hope! Even ATTEMPTED movements (mental imagery, small twitches, the act of just trying with no success) count as moving. If you TRY to move the hand 10,000 times – research is saying that it’s beneficial and that your brain is rewiring to make it so (this is based on the idea of Neuroplasticity – something I’ll detail in another blog post).
So if recovery is as “simple” as “move more,” then why don’t more stroke survivors get meaningful function back? In my opinion there are three main limiting factors. While I’m sure there are others, these are the ones I’ve observed (in no particular order):
First, the current rehabilitative healthcare system does not focus on recovery of the affect limb(s). Much of what Dad was taught in the beginning of his rehab process was to “compensate” and use the good side for tasks. What that meant was that his neglect of the affected side only got worse and worse. My attempts at getting him to focus on the affected side were limited (as I could only be around him for 5-6 hours a day) as I imagine all care givers are. But then what can you do to overcome this? Try talking with your physical therapist, occupational therapist, and speech therapist. Let them know that using the affected side is the goal and they should work with you. If they don’t – that’s a HUGE red flag that you’re at the wrong facility and you need to seek out new rehab professionals (something that is often only an option once you get to outpatient rehabilitation).
The second is factor is the emotional state that goes along with stroke recovery – the frustration, exhaustion and subsequent depression that come from trying to do something hundreds of times without instantly measurable success. This is magnified even more with stroke survivors as often there is a change in personality due to the brain damage/trauma. What you’re trying to accomplish is to teach the remaining healthy cells in the brain to learn how to move your body FROM SCRATCH. The original cells that moved that limb are dead. Gone. Checked out. Not coming back. There are so many reasons why this is so difficult a task (I’ll detail this later too) so please don’t get angry at yourself (or your loved one) when it takes a lot of time and progress seems very, very slow. You are effectively starting with the motor control of an infant and having to learn the way they learn. Unfortunately it is much harder for you because your brain isn’t in a developing stage, you’re much bigger and have more motions to coordinate, falling/failure is far scarier now and mentally you know you that you used to be able to do this. Don’t let yourself get caught looking back or getting angry with yourself. You’re doing something truly difficult and amazingly impressive all at the same time! Stay positive!
The final obstacle is a combination of memory and motivation. In my Dad’s case, the stroke caused him to lose the ability to sequence, recall, problem solve and manage time. He no longer thinks the way he did before his stroke. Where he used to live life by a schedule, he can now sit for hours and hours without moving or even thinking to move. He doesn’t see cause and effect the same. He’s pathologically afraid of falling and failure. In these cases the demand on the caregiver and loved ones is immense! Make lists, gently push and challenge, set schedules and try to facilitate independence by encouraging intrinsic effort on the part of the stroke survivor. Use positive reinforcement and allow them to direct some of the tasks (don’t be surprised when they choose the ones they are good at). Make them see that the harder and more frustrating the task (moving the hand, moving the foot – basically the things that they can’t yet do), the greater the potential future benefit. And remember – It does get easier (for both of you).