The Subluxed Shoulder – stage one

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:

DO

  • 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

  • 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.

 

 

 

Advertisements

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!!

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

Focus should be on “partially complete” versus “incomplete”

Rehab gyms across the country, such as SciFit and ProjectWalk are changing the scope of recovery following spinal cord injury and stroke. Rather than focusing on the deficits and problems left by the injury, their focus is on the potential for neuroplasticity and learning within the human central nervous system. Movement recovery depends on a demand for use. Rehab professionals should embrace a change from speaking of the negative “incomplete” and focusing on the positive “partially complete”. This is the only way we can change the dialogue around recovery.

I would love to hear from survivors who have continued to improve and reach their goals despite a negative prediction set by many health care providers.

Humanity

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?