Hands are the chief organs for physically manipulating the environment, and each hand is dominantly controlled by the opposing brain hemisphere. After a stroke with partially damaged brain, grasping a block, gripping a glass, pinching to pick up a small ball or simply opening hands … These tasks may suddenly seem to be too difficult to reach. Indeed, impaired hand function is one of the most frequently persisting consequences of stroke.

The essential of the hand movements is controlled by specific part in our brain (within the motor cortex), and accomplished by two sets of muscles and tendons.

After a stroke, if the controlling brain area is damaged, it will also result in the shortening of soft tissue, skin, tendons and muscles. These will further become one of the most limiting factors to regaining hand function later. If the tissues are not stretched, it will result in spasticity which will further limit use of hand and arm and diminish the recovery potential.

The loss of hand functions results from the combination of two factors : a loss of brain activity due to the stroke and the physical changes in muscle and tendons that occur as a consequence. The less active the motor cortex and the more severe the spasticity , the less one can use his/her hand muscles.
Both problems need to be addressed as part of rehabilitation: stimulating the building of new circuits of information in the brain and releasing the spasticity in the hands, to allow these circuits of information to activate the hands.

Therefore the rehabilitation can indeed be adapted in each patient to the extent to which he suffers from each cause.

Usual interventions include muscle vibration and electrical nerve stimulation in the limbs enhance the motor cortical output to target muscles; mental practice (patient’s concentrating on moving the muscle). NeuroAid, which supports neurological functions, can also help patients to regain hand function more rapidly. With time, the cells in that part of the brain affected by the stroke progressively become more easily activated. The changes in the strength of the connections between the brain and muscles lead to improvements in the ability to use the muscles.

Further intervention are under exploratory development, for example a team of Canadian doctors has developed a test to evaluate hand muscle control: tapping a single keyboard key with the index finger; picking up pegs, one at a time and placing them into holes on a pegboard; and pushing with index finger against a metal bar that measures force. Performance on this test was linked to the ease with which brain cells that control muscle functions can be activated; how active the brain cells are at the time of testing; and the strength of the neural connections between the brain and the muscle. Such test supports then the development of new clinical treatment strategies which will better match each patient situation at the different stages of the recovery process. This may open in the future a route way for more effective individualized optimized treatment protocol for stroke survivors based by adjusting the treatment to the individual’s exact situation and recovery dynamics.

There are specific books or tools such, which may help you find out the exercise which are most suited to your situation – by researching on the internet we came across several books written by stroke survivors who are more than happy to share their experiences. To benefit from these ex stroke patients’ genius creations, you can visit Amazon.

I thought we could use this newsletter to share which books you found to be most useful for your recovery, do write us a short email on which was your favourite book during your recovery journey and why it helped you . We will publish the list of the best ranking books in the upcoming newsletter.

Sources:
Medical News Today
Blue Bridge Healthcare, USA

Self-advocacy is a key of being a “Stroke Survivor”. After a stroke, there is rarely any complete “going back”. Recovery is a lifelong journey. While the road to recovery almost always takes more time and efforts than anticipated, there are things one can do to make the journey easier to travel.

The definition of advocacy is “active support”, especially the act of pleading or arguing for something. In this case it is for the patient himself, for his own well-being. To be a self-advocate is definitely to be a supporter, believer, encourager, and activist of and for oneself. Patients should state their needs in a clear, specific and firm ways, and don’t be afraid to ask for help.

Suffering a stroke is often an overpowering experience, which takes from survivors a sense of control, both over their physical and mental health and well being. Self-advocacy is important, because it is a way of empowering oneself; that allows patients to personally take responsibility in making the most of their recovery from stroke. Patients have to identify and explain what they want and need, which can directly impact their own quality of life.

First step, you may ask yourself or ask your dear one what you/he can do to prevent another stroke. Take the steps necessary as prescribed by the doctor. This includes things such as monitoring blood pressure, finding out cholesterol numbers and working to control them, quitting smoking.

As one advocates oneself, education is critical. Gather information to help understand what has happened and what to do next. Learn about stroke, the disabilities, and what treatment options are available. Books, pamphlets and fact sheets are quite good resources for getting this information. Watching informational videos, CD-ROMs or DVDs are excellent methods too if patients and family want to know more. You can surely find these resources on some online bookstores like Amazon. Meanwhile, browsing the web or having a friend or family member to do it for you stays the easiest way, as many sites give quite good and useful information, like www.strokeassociation.org, or www.mystroke.org. Besides this, attending a workshop, seminar or talk allows the family to get directly in contact with experts; otherwise you can talk to a social worker, case manager or community resource specialist.

It is vital to seek out and listen to those individuals who are familiar with or specialized in stroke rehabilitation. This includes not only the healthcare team but also other stroke survivors and their family. Ask questions, stay positive, and stay in the course!

Sources:
National Stroke Association

Although strokes normally affect older people, up to a quarter of all strokes actually occur in people of working age – a time when careers and families are being established. Depending on the severity of the stroke, not all stroke survivors are able to return to full-time employment. There can be many reasons for this:

• Forced to retire by employer
• Unable to meet expectations
• Unable to drive or use public transport
• Fear of losing benefits
• Not fit enough to work
• No longer able to do previous job, face demotion

However, for most of the younger stroke survivors their main objective is getting back to work – not only for financial reasons but also to help to rebuild their confidence, regain their independence and even enhance their recovery. Yet not all of those stroke survivors are able to make the return. Among the ones that don’t make it back to work, many might have been able to re insert themselves, if they had been given better support and followed an adequate rehabilitation program.

Rehabilitation helps
Depending largely on the level of the impediments at the acute phase, a stroke can often lead to long disability periods for the stroke survivors, making the possibility of returning to work fade away. Yet, for many, taking the right action can make all the difference. Long term support and appropriate rehabilitation tailored to the needs of the patient, is crucial for stroke survivors aiming to return to work. The patient’s firm will to return to work, can also serve as the motivational factor needed to initiate an intensive rehabilitation process. Physiotherapy, speech and language therapy, and psychological support all work help achieve faster and more complete recovery.

Continuing disability and the patients’ ability or not, to independently care for him or herself, is obviously an important determinant of whether it is possible to get back to work. Following and intensive and well tailored rehabilitation program will minimize the likelihood of needing to cope with such a situation. On the other hand, depression is one of the major causes of work failure, and has a significant impact of its own, on work status after a stroke. However – as discussed last month – depression is a separate illness that can be treated successfully if appropriately approached.

Make your employer prepared
The attitude and willingness to help shown by the employer is of major importance and can have direct impact on whether or not a stroke survivor returns to work. It is thus very important to contact the employer as soon as possible following the stroke, to agree on reasonable and necessary adoptions to the working arrangements and conditions to make the return to work as smooth as possible. Too many stroke survivors who go back to work leave soon afterwards because their employers have not made the necessary adaptations, making it impossible for them to fit in and perform at their capacity. There are several measures that you might ask the employers to take so as to help you continue your work:

• Allowing a phased return to work
• Changing working hours
• Part-time work
• Redeployment
• Job sharing
• Providing help with transport to and from work
• Arranging home working

Adaptations to a job or work environment must also be backed with appropriate training and guidance. For example, if a new tool is provided, the stroke survivor will need to receive training on how to use it.

Finally, negative employers – unwilling to make the necessary adoptions – exist, but mustn’t stop the patient. The sufferer should allow him or herself some time and look for new opportunities with employers that understand their situation and show the required flexibility. To consider a career change could also be an option, not forgetting that there is always life after work.

Sources:
Web MD Stroke News
Stroke Organization UK

What follows is a short list of critical tips, to start your rehabilitation on the right foot.

1. MAKE ARRANGEMENTS BEFORE YOU LEAVE THE HOSPITAL. Don’t forget to ask your doctor before leaving, to arrange a home visit by an occupational therapist (OT), who is trained to help you manage daily activities and regain your independence. This person will check your home and may suggest simple changes to make everyday living easier, and they also will arrange for changes to be finished before you return home.

2. ACCOMMODATE YOUR HOUSE TO YOUR RECOVERY. Forty percent of stroke survivors suffer serious falls within a year after their strokes. That’s why the OT will suggest you to move extra furniture out of the way either to corners or another room, to move electrical cords out of pathway, to remove loose carpets and runners in hallways and stairwells or to fasten them with non-skid tape to improve traction. Low pile carpeting is better than a thick one because it makes wheelchair or walker movement easier. Try stair glides, stair lifts and platform lifts if you need to use the stairs many times during the day.

3. ACCOMMODATE YOUR BATHROOM. The bathroom usually poses challenges. To make bathing both simple and safe, use sturdy hand rails, grab bars in the tub or shower, non-slip flooring strips installed inside and outside. Don’t hesitate to use them to stabilize and balance yourself. The bathing supplies should be easy to reach and use.

4. ACCOMMODATE YOUR BEDROOM. The bedroom is a place where you should feel safe and comfortable. To make your private world safer, make sure that all the utilities are easy to be reached, like the telephone, the light switch and other personal items. Use a nightlight and clear a path for easy access to the toilet at night. At last, since some accidents are unavoidable, consider placing disposable “blue pads” underneath your sheets, which prevent bed staining, with cloth on one side and waterproof material on the other.

5. GET 100% INVOLVED IN YOUR RECOVERY. After a stroke, home treatment will be an important part of your rehabilitation. You may need assistive devices to help you to eat, to get dressed, to walk, or you may feel like letting a caregiver take charge; however, for a successful recovery, you have to be as involved as possible. The more you can participate, the better. After a stroke, a combination of physical, speech, and occupational therapies can help you manage the basics of daily living.

6. SLOW DOWN AND PLAN YOUR RECOVERY. It is important that you slow down, take time, plan a task and break down tasks into a series of simple steps. Day after day, you will find these little steps add up to a large progress. Furthermore, a regular exercise program for stroke survivors is recommended, including 20 to 60 minutes of aerobic exercise three to seven days a week, a strength training with resistance or light weights two to three times per week and other stretching and flexibility exercises, as well as trainings in balance and coordination.

7. TRY TO ADD FUN TO YOUR RECOVERY. Not only can regular physical exercise improve the quality of life for stroke survivors by increasing their strength and mobility, it can also reduce their risk for a repeat stroke and a heart attack. If you want to have some fun while practicing, try this video game especially designed for home stroke therapy.

8. DO NOT BE AFRAID TO FACE YOUR RECOVERY. A stroke is always stressful for the family therefore; the caregiver needs as much support as possible from others. It would be better if the family members and the caregiver work together in order to ease the stress on everyone. When everything is being prepared, you are still asking yourself thousands of questions, you may be afraid of facing your disabilities. No worry, considering new resources, equipment and therapies which are available each year, just take advantage of them to improve your quality of life. Continue to set new goals for your stroke recovery, and tomorrow will always be a better day!

Source:
National Stroke Association NSA
Stroke Recovery Association NSW
WebMD – Stroke guide
American Heart Association
Youtube

New research, published in the peer-reviewed medical journal “Brain”, suggests that listening to music could help stroke patients to recover from brain damages after having suffered from a stroke. The study carried out in Finland, randomly allocated patients into three groups, and the patients in one of them were instructed to listen to their favorite music at least one hour a day and keep a diary of how much they listened. Following the study the researchers concluded “that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood”.

It is time to pick up your old favorite CD, be it jazz, classical or pop, and start recovering… it can’t be more relaxing and comfortable than this!

Read more at MedicalNewsToday.com

For many stroke survivors, being able to drive is a big step, and a big achievement. It does support a fuller independence. A stroke can affect many of the skills necessary for independent driving. A number of stroke survivors will return to independent driving.

The first objective in evaluating the possibility of independent driving is to ensure safety. Safety is always an issue as soon as someone gets behind the wheel. It’s even more important after a stroke. Injury to the brain can result in deficits in strength, coordination, vision, perception, and cognition – all these will impact the stroke survivor’s safety in driving.

Adaptive aids, such as steering wheel pegs and accelerator extensions, can certainly be incorporated to help compensate for some of the motor deficits. A spinner knob can be attached to the steering wheel to allow controlled steering with the use of one hand. A left gas pedal may be used if you are unable to use your right foot to gas or brake. All these aids will require training to ensure safety with a new adapted driving method.

Before one returns to driving it is advisable to have an Occupational Therapist perform an evaluation of one s driving ability. This can include an assessment of vision, muscle and grip strength test, brake reaction time, and perceptual and cognitive abilities. Driving skills can be tested in a simulator or behind-the-wheel with an instructor. In some case the therapist will recommend additional driver training such as visual scanning and tracking, reaction time, spatial perception, execution of complex actions. Your doctor can guide you on training and evaluation options.

Please note that driving against your doctor’s advice can be dangerous and may be illegal. Some stroke survivors will unfortunately have to cut off or give up driving. They can still keep their independence with some planning ahead to go to the places they want to and meet the persons they want to. They should consider riding with family and friends, taxis, public transportation or even to walking. They also often have access to transportation services offered by senior centers and local service groups.

Sources
MediFocus Guide from Medifocus.com
www.nhtsa.dot.gov
www.driver-ed.org