Eye Exercises for Visual Field Loss

Often a stroke survivor, or survivor of traumatic brain injury, has a loss of visual field perception, often termed Hemianopsia.  They may be unable to see to one side, or they may have blind spaces in their visual field.  Many eye doctors still believe that this visual field neglect never improves after a stroke. However, in my experience, exercises that promote eye, neck and inner ear coordination do in fact help reduce the visual deficit.

Below are some exercises that I frequently use with patients in the clinic.

EXERCISES FOR VESTIBULAR-OCULAR-COLIC COORDINATION

Exercises should be completed at least 3x/day for a minimum of 10 days. It is important to have adequate water/hydration before and after each exercise set.

The GOAL OF THESE Exercises is to maintain your visual focus on the target, despite either the target or the head moving. Exercises should first be done SITTING. After all exercises are easy to complete in sitting – be sure to do the full 10 days – then you can progress to doing them in STANDING.

 Briefly close the eyes and rest between each Exercise Set. If they cause extreme dizziness (greater than 5/10 intensity) then a reassessment should be done. All exercises are initially done for 10 days with only horizontal or vertical movements. Diagonal patterns should not be added until the other directions are easy and cause no dizziness.

* IF the stroke survivor cannot hold the card(s), then another person can hold the card(s)*

EXERCISE ONE – STATIONARY HEAD / MOVING TARGET

Hold a playing card or small object arms length from your eyes, nose height. Keeping your head completely stationary, move the card/object slowly from Right -> Midline -> Left -> Midline -> Right (repeat 3x) .

While the card/object is moving keep your eyes focused on it , but your head still.

After a brief rest, keep your head completely stationary, move the card/object slowly

Up -> Midline -> Down – Midline (repeat 3 x)

 

EXERCISE TWO – STATIONARY TARGET / MOVING HEAD

Hold a playing card or small object arms length from your eyes, nose height. Keeping the card/object completely stationary, move your head slowly from Right -> Midline -> Left -> Midline -> Right (repeat 3x) .

While your head is moving keep your eyes focused on the card/object.

After a brief rest, Keep the target completely stationary, move your head slowly Up -> Midline -> Down – Midline (repeat 3 x)

 

EXERCISE THREE – TWO STATIONARY TARGETS / STATIONARY HEAD

Hold a playing card or small object in each hand, arms length, nose height with approx. 3 feet spread between hands. Keeping your head still, rapidly look from left to right focusing on the card/object on one side then the other (10x each side)

 

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ReLearning to Walk After A Stroke

I recently presented at a Stroke Symposium for the Pacific Stroke Association and several members of the audience asked me to post my slides.  They are posted here for educational purposes only. Not all of the slides are self-explanatory, so if you have questions please feel free to contact me.

Just a reminder:  IF you are holding onto anything with your hands, or if a therapist is holding onto you during your “balance exercises”  you are NOT working on balance.  One must not have contact with anything when learning to balance on their own, therefore it is very important that you practice only in safe confine with another person guarding for safety. I recommend standing with your back very near but not touching a corner, then placing a walker or chair or person in front of you for safety. 

ReLearning to Walk 09.17

Cross-Brain Exercises

I was giving a talk over the weekend to a group of stroke survivors when a woman in the audience reminded me to talk about “cross-brain exercises.”  She had used these types of exercises to help her own post-stroke recovery.

There are lots of websites, You Tube videos, and books about exercises that encourage the two halves of your brain to communicate with each other. This is especially important when one half has been injured!   Historically, these exercises have been used for children to aid in neuromuscular development, but they are great for any brain ~ young, old, or injured.

Just a few ideas:

1. Reach for bean bags, balls, stuffed animals, or other objects across midline, then throw them at a target. You can use your sound or affected hand to do this exercise.  You can also use your feet to kick rather than throw across midline.

2. Draw large Figure Eights (the infinity sign or an 8 turned on its side) on paper or in the air with a finger. While drawing the Figure Eight follow the path closely with your eyes, but do not allow your head to move.  Then try it again, keeping your eyes quiet while allowing your head to move as you follow the Figure Eight.

3. Strength and coordination training of the sound hand or leg has been shown to be beneficial for affected / weak side. Practice lifting a weight with one hand and then placing it on the opposite side of the body without switching hands. Or lift a weight on your ankle and cross your leg over to the other side.

4. Touch the opposite elbow and to knee. You can begin by touching your elbow the the strong side to the knee of your weak side, and then vice versa.

5. Cross one foot over while sitting, then alternate.  To make this more difficult, cross one foot over the other while standing against the wall, or if you are doing really well over the other while walking sideways.

6. Windmills-Stand with feet spread apart and arms extended out to the sides. Bend over at waist and tap right hand to left foot or knee. Stand back up and then bend and tap left hand to right foot or knee.

Those are a few ideas.  You can also do cognitive exercises such as:

  1. Working puzzles.  Start with a 32 piece puzzle and work your way up to a 500 piece puzzle as you get better at it.
  2. Work on “hidden word puzzles”
  3. Play card games

The basic idea is to use your brain daily. If movement is limited, do the best you can to cross body, cross brain. Be creative!!

Human Standing

I see so many clients post-stroke who have poor standing balance yet have already begun to “walk”. They don’t actually walk, they “hobble”. Thing is that I have also noticed a lot of people who have never had a stroke also “hobble”, due to back pain.

I think that we have been ignoring the amazing features of the human brain and physiology that allow us to walk upright on two very small bases of support.  It is really kind of crazy that two little feet can keep us upright!  Well, we have more going for us than our feet…

Balance and upright posture is controlled by sensory interactions within our brains.  We do not “think” about balance, we simply balance. This requires that our brain be able to continuously compare input from our EYES, our INNER EAR, and SENSORY RECEPTORS in our MUSCLES.  After a stroke…or even an injury to the back… this sensory comparison is all out of whack! It is imperative to recalibrate the brain and the sensory signals it is utilizing.

A simple daily exercise will make a huge difference:

Stand against a wall with your heels touching the baseboard, hips touching the wall, shoulders touching the wall, head touching the wall.  Close your eyes.  Hold this position for 2 minutes with your eyes closed!  It will feel strange. Perhaps difficult and occasionally it may not seem possible. Stick with it.  After 2 minutes, open your eyes and then slowly turn your head to the left and then to the right, three times. Returning the head to midline each time.

Do this exercise 3 times per day every day for 2 weeks.

Once this is easy, the do the same exercise while standing in the corner of the kitchen. You will no longer be touching the wall, but instead free-standing as if you were against a wall.

*Always have supervision when doing any kind of balance training* Never try the exercise alone the first time*

May is “Stroke Awareness Month”

When I was actively lecturing on the warning signs of stroke and the need for immediate medical attention, I would get letters from people.  Lots of letters.  Letters that said thank you for teaching the warning signs of stroke.  It is so important to know when to call 911 – because everyday heroes are the ones that can change the outcome for a person having a stroke.

An excerpt from my book “Highs, Lows, and Plateaus: a path to recovery from stroke”

“It is very important for everyone to recognize the signs of stroke, because stroke strikes anywhere, anytime, across age, ethnicity, and socio-economic groups. I have never known anyone who planned on having a stroke. But, I know a lot of people who survived with minimal deficit because someone else recognized the signs and sought help. Unfortunately, in my field of work, I also know a lot of people whose symptoms of stroke went unrecognized. Remember, according to our national statistics, fewer that 7 percent of stroke victims get to the hospital in time for emergency intervention.

The odd thing about a stroke is that the person having a stroke often does not fully realize that anything is wrong. When asked if they are o.k. the person having the stroke quite often says they are fine or makes up a reason to explain their behavior. Remember, it is the brain that is under attack – and this is the same brain that is supposed to be identifying that something is wrong! A brain under attack is going to have to rely on someone else to identify the problem and seek help.”

stickguysmall

Acceptance: a quote from “Highs, Lows, and Plateaus: a path to recovery from stroke”

The physical recovery from stroke is only part of the story. There must also be an emotional recovery: for all of the survivors of stroke – not only the one whose brain was injured. … I have found that those who survive a traumatic event, such as a stroke, must go through a grieving process that is sometimes very similar to dealing with the death or loss of a loved one. This grieving process includes: Denial, Anger, Bargaining, Depression, and Acceptance.

In my opinion, it is important to grieve the loss of life, as you once knew it. The stroke took away a lot, but you survived. It is o.k. to experience the process of grieving and to acknowledge that Acceptance is part of healing. To me, acceptance doesn’t mean giving up. It means being at peace with where you are at the time, while striving to be where you want to be. With the acceptance that life has changed, you will thrive. You will continue the journey through the highs, lows, and plateaus until life again is joyful and meaningful.

A lovely woman, C.M., once told me that her stroke had allowed her to have two lives: the one before her stroke and the one after. She said that she thought the one after her stroke was better because it was more loving, more accepting, and slower. She felt that in the second life she had been encouraged – not criticized; applauded for her accomplishments – not put-down for her failures. She accepted herself and she accepted her challenges. Because of that, she just kept trying to get a little bit better each year. And she did – just keep getting better, accomplishing more, and changing the lives of those around her. The stroke had not robbed her of life. It had given her a different one.

Highs, Lows and Plateaus upcoming VIDEOS

I have heard from a lot of people now that they would love to see some videos to accompany the Stages of Recovery that I talk about in my book.  These stages were defined by a Swedish Physical Therapist, Signe Brunnstrom (1966, 1970), who described the process of recovery following stroke-induced hemiplegia. The Brunnstrom Approach, emphasizes the importance of encouraging movement within the synergistic pattern of movement that evolves post-stroke. As the stroke survivor improves, the exercises change.

I have spent quite a bit of time working out a series of exercises to help progress clients through the Stages of Recovery.  Keep a look out for upcoming videos and feel free to share them!

In the past, I have been stymied at Stage 5 and not sure how to help promote individual movement of the fingers.  Recently, I have had the opportunity to demo the Music Glove by Flint Rehabilitation and am very excited about the potential to rediscover finger movement: https://www.flintrehabilitation.com

Look forward to more to come.  DOWNLOAD SLIDES 03-15