[Beware The Rubber Band Of Recovery Language
Eliora Shopbell
But you also have to be aware of muscle fatigue. The smaller the muscle, the quicker the fatigue. The further away from the body, the slower the recovery. For example, this is why hand function often takes longer to improve than arm function.
Pressing on piano keys is a great way to develop finger strength, dexterity, and hand-eye coordination. When you perform an activity that is familiar, the brain may activate the muscle movement easier and quicker.
These fine motor skills are essential for improving handwriting after stroke. Playing the piano is a fun and engaging activity that makes it easy to perform the repetitions necessary to promote neuroplasticity.
Central agraphia is generally treated by working with a speech-language pathologist. These therapists are highly trained in helping stroke patients relearn how to write words after stroke.
Copy and recall treatment involves repeatedly copying and re-writing to ensure that the individual can spell the targeted words. The more the patient writes the word, the more successfully itsspelling is retained.
If incorrect, the speech-language pathologist will write it down for the patient, and then have the patient write it down multiple times. The letters will be re-scrambled until the patient can independently write the word correctly.
If you struggle with agraphia after stroke, make sure you get an accurate diagnosis from your Speech-Language Pathologist. A correct diagnosis will help you practice the most relevant exercises to improve writing after stroke.
My name is Monica Davis but the person who is using the FitMi is my husband, Jerry. I first came across FitMi on Facebook. I pondered it for nearly a year. In that time, he had PT, OT and Speech therapy, as well as vision therapy.
The progression of disability during the acute phase of Guillain-Barr Syndrome can vary from a few days to four weeks, and, infrequently, six weeks. Then a low stable level of impairment (paralysis, weakness, etc.) continues for a variable length of time, days to weeks, and, less often, months or longer.
When the patient has recovered from acute life-threatening complications such as breathing difficulty and infections, and muscle strength has stabilized and perhaps even begun to return, treatment in an acute care hospital is usually no longer required. However, many patients will still require rehabilitative care including intensive physical and occupational therapy.
The rehabilitation process itself does not improve nerve regeneration. Rather, the major goal of rehabilitation is to assist the patient in optimal use of muscles as their nerve supply returns, and to adapt to a lifestyle within their functional limitations. In addition to helping the patient regain use of muscles, the rehabilitation center treats any remaining medical complications. These can include control of high blood pressure, antibiotics for infections, treatment or prevention of blood clots, etc.
Strength usually returns in a descending pattern, so that arm and hand strength usually returns towards normal before leg strength. Often, right-handed persons note more rapid return of strength to the left side and vice versa. As arm strength returns, the patient is again able to perform some restricted things that used to be taken for granted, such as brushing their teeth, feeding, grooming and dressing themselves, cutting meat and so forth. As ability to perform activities of daily living improves, the success can be emotionally gratifying.
Occupational Therapy: An occupational therapist instructs the patient in exercises to strengthen the upper limbs (shoulders, arms, hands and fingers) and help prepare them for return to their occupation. Usually arm strength and use returns before hand and finger dexterity. Help is given to re-learn activities previously taken for granted such as holding a pencil, using an eating utensil, etc. Muscle testing may be performed, and exercises designed to strengthen the weaker muscles. Repetitive squeezing of a rubber ball or putty can strengthen the hand grip while spreading two fingers apart against a rubber band placed across the fingers can be used to increase finger strength.
Tests may be utilized to determine the status of hand sensation. For example, the patient may be instructed to look away or close their eyes while articles of varied consistency and shape are placed into their hand are placed into their hand, such as a marble, key, eraser, pen, closed safety pin, and the like. The ability of the patient, without looking, to discern the presence of these objects and identify what they are indicates that their sensory nerves can perform fine touch discrimination. In another test, the patient inserts their hand, with eyes closed, into a bowl of sand or rice containing such items as chalk, keys, eraser, etc. The ability of the patient to locate these, and, upon removing them, identify their particular shape and consistency provides an index of return of finger sensation. Some patients may experience persistent difficulties in using their hands and fingers to perform such activities as using a zipper, buttoning a shirt, writing, using utensils and handling coins. Methods are available to compensate for these problems. For example, to circumvent difficulty in buttoning clothes, a button-hook device may be utilized. Velcro straps or zippers with large pull handles may sometimes be practical alternatives to buttons. Because of the potential for fatigue, severely affected patients are taught energy conservation techniques that include using shortcuts to maximize hand and arm use. Splints may be used to position the wrist in a slightly bent position, and to support the thumb, to optimize hand use.
Physical Therapy: The physical therapist emphasizes strength and function of the lower limbs, and ultimately teaches the patient to walk as independently as possible. A variety of methods are used to accomplish these goals. Initially, the patient, fitted with a life jacket (personal flotation device), may be lowered into a pool, and assisted into a suitable depth of water so they can walk on the bottom of the pool with partial weight bearing, the life jacket and water providing buoyancy to enable this. Immersion in a therapeutic pool may also relieve muscle pain. As strength returns, exercises are performed on mats to help strengthen various muscle groups against gravity and resistance. For example, the patient may be placed on a mat on his back, with the knees raised on a triangular foam support; progressively increasing weights are placed on the ankle and the patient is directed to slowly and repeatedly straighten and lower the leg. This exercise can help the patient increase thigh muscle endurance. Slowly raising and slowly lowering the leg affords greater use of muscles and facilitates better development of thigh muscle strength, rather than allowing the lower leg to fall with gravity. Other exercises are used to strengthen the hip musculature, such as lifting the upper leg with the patient on their side and maintaining it in an upward position against gravity.
As nerve innervation returns, other exercises can be used to maintain muscle strength. A stationary rehabilitation exercise bicycle may be used to apply an adjustable force to the leg as it pedals the bike, thus providing progressive resistive exercise to improve strength and endurance.
As leg strength improves sufficiently for the patient to bear weight and begin walking, assistive devices provide added support and balance. The patient may be placed between two railings, called parallel bars, positioned at about waist level. These provide the patient with maximal support while walking, by their holding the bars with both hands. Their upper body can support some of their weight, that their legs no longer have to support. As balance improves, a wheeled walker may be used. The patient rolls or slides the walker forward to provide support as they walk. As balance improves further a standard, non-wheeled walker can be used with the patient lifting the walker forward and placing it down ahead repeatedly as they walk. The next progression may then be to the use of forearm crutches or directly to the use of underarm crutches and then canes. A quad cane, with four small feet close together, provides a fair amount of stability. If the patient has enough balance and strength, a straight cane may be sufficient. Eventually, if possible, independent walking without an assistive device is accomplished. During the rehabilitation process emphasis is placed on proper body mechanics, avoidance of substitution of stronger muscles for weaker ones, prevention of muscle strain and fatigue, and safety.
As the patient progresses through the rehabilitation program, it may be appropriate to plan for multiple long-range problems. These problems include learning to drive and using convenient parking, re-employment, learning to pace activities, sexual activity, limitations of the wheelchair-bound patient and so forth. A social worker may assist in handling many of these problems. The majority of patients who were in a rehabilitation center may be placed on an out-patient therapy program when sufficient strength has returned. At home, living on a floor that has a bathroom and bed may be temporarily helpful until the patient is able to climb stairs. As sufficient strength returns, driver retraining may be appropriate, especially if the patient had been hospitalized and not driving for a long time. Driver retraining, and adaptation of an automobile for hand controls, is available through some rehabilitation and hospital centers.
The frustration of physical exhaustion, or shortness of breath associated with prolonged walking, may be reduced in the recovering patient by parking near a building entrance in a handicapped parking space. A special parking placard or license plate is available in some states.
As the patient approaches the end of in-hospital rehabilitation, it is usually appropriate to plan for return to their employment or reemployment. This is hopefully a cooperative effort between patient, social worker, current employer and, if available, a state bureau of vocational rehabilitation. A potential barrier to returning to work, as well as resumption of a normal overall lifestyle, is the onset, following a certain amount of activity, of muscle aches, physical exhaustion, and abnormal sensations, such as tingling and pain. These problems may be circumvented by returning to work part-time initially, and if possible, timing activity with intermittent periods of rest. Many patients learn by trial and error how much activity they can tolerate.
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