The subluxed shoulder is a common problem post stroke and often treated only with a sling, that really does not offer much support. I think we need to change the way we treat the subluxed shoulder. Historically, weight bearing through the paretic arm has mostly resulted in a painful shoulder. Often the paretic hand is bound / tied to the handle bar of machine that does reciprocal pedaling/rowing/etc. This is really not good for the subluxed shoulder. Every revolution of the handle bar is essentially pulling the arm out of the shoulder joint again.
In my book “Highs, Lows, and Plateaus: a path to recovery from stroke” I talk about the stages of recovery following a stroke. Not everyone goes through these precise stages but it provides a framework. Early on the arm is often flaccid and the shoulder joint becomes subluxed, i.e. the upper arm bone literally slips out of the shoulder socket. A few DO and DO NOT lessons that I have learned:
- Use a sling to keep the arm safe when walking
- Electrical stimulation to the muscles of the shoulder joint is helpful when used daily on a set protocol.
- All exercises for the arm should be done while lying on your back. This provides stability to the shoulder blade and also allows the upper arm to gently glide back into the joint.
- The first exercise is to bring the weak arm gently over head (with help from your strong arm) so that with your hands together, both arms are vertical to the body (90 flexion) and the elbows are straight. Then make TINY little circles with the hands allowing a gentle motion of the shoulder joint. This allows the joint to gently settle into the socket and stimulate the sensory receptors that then excite the muscles around the joint.
- DO NOT Use any type of reciprocal exercise machine for the weak arm!
- DO NOT Put weight through the weak arm – not until the shoulder joint is no longer subluxed out of the socket
- DO NOT Overstretch the arm by having any motion that brings the arm overhead or out to the side. If an overhead motion is made, then the shoulder blade MUST also be rotated to prevent the arm bone from pinching into the front of the shoulder socket
As you do the first exercise the muscles around the shoulder joint will begin to activate again. As the subluxation resolves, the exercises are advanced.
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.
2014 was a good year… now cheers to 2015!
I wanted to highlight a few successes that some of my clients had in 2014:
K. received a new dynamic ankle brace and is now walking more than ever. He reports that he can feel the muscles in his weak leg getting stronger, and he can walk over uneven ground, up /down stairs easily and finally can say that he enjoys walking again.
C. is using her fingers again! Not quite two years post stroke and she is able to use her hand to help her with all kinds of daily activities. She has returned to work full-time and has also gotten back in the routine of being “mom” in her family now. It was hard having her daughter and husband take care of the baby, but she is back. This year, is dedicated to fine motor control in those fingers!
E. became independent in transferring into the shower, is driving his own van, and is learning to walk again. Not bad for someone who is not even three years post injury to his cervical spinal cord. No need for an electric chair because he can push himself in his new lightweight chair and feels he is getting stronger (below the level of lesion) every day.
S. returned to work full time, is using her right hand for typing and is talking up a storm! She and her family have fought hard. Still a ways to go until this young woman feels satisfied with her recovery, but I have no doubt she will get there.
M. barely survived his stroke, but he is getting better every day. He can stand independently, transfer for showers and walk short distances. Mostly delayed now by distorted vision that makes it hard to move, but he is having a surgical procedure this week that hopes to improve his vision.
Just a few successes. Would love to hear from others about the Highs, Lows, and Plateaus of recovery.
Cheers to 2015!
This morning, my daughter asked me why animals begin walking shortly after they are born but it takes years for a baby to walk? The answer is not as simple as four versus two legs. If it were, then babies would begin crawling shortly after birth! Is it about size? That cannot be right since baby elephants, giraffes, and horses are far larger. Is it about survival? Perhaps. Is it about the complexity of the human nervous system? Most likely. The desire to walk it tantamount in recovery from injury! It is the driving force for much of physical rehabilitation. This complexity of the human nervous system also gives rise to the potential for neuroplasticity.
What are your thoughts on this topic? Would love to hear from you?
It seems that each week, I hear from someone who has been told by their doctor “not to expect any further recovery.” Most recently, I heard this from a young man who had an incomplete Spinal Cord Injury only a few months ago! Such a statement by a doctor is utter non-sense, so I ask myself “Why would someone say that?”. What I have decided is that health care professionals play it safe by not promoting any form of expectation from their patients. If someone is told they will never do anything again, and then they accomplish something they are pleasantly pleased… in fact, they feel that they have beat the odds.
I think we need to let people expect more. We need to instill hope through information and education and resources. No false promises, but rather the opportunity to believe in the power of neurorecovery and the strength and resilience of the human spirit.
Well two months after meeting that young man, he has already made tremendous gains and yet the words of his doctor still haunt him. It will take a long time to diffuse the negativity of comments that are destructive to the potential of hope, handwork and neuroplasticity.
I have been working in NeuroRehab for over 25 years now. Some days are sad days. My daughter says that I am a “Healer”. She says it is o.k. to feel sad sometimes. Helping people along the path of recovery can sometimes be emotionally draining, and I want to cry by the end of the day. Other times it can be so amazingly rewarding that I want to cry, not from sadness but from joy! I have learned to appreciate each day. To notice the little things. To try and be kind to everyone regardless of their race, ethnicity, religion, or socio-economic level. We are all just people. Doesn’t matter how impressive of a life one lives, if it can all be reduced to a common denominator by stroke!