Rehab From Rehab

I'm learning to walk all over again — again. This time, my privately hired therapist and I have the same goal: to get me walking normally.

My therapist at the insurance-provided rehab hospital where I spent 21 days in the weeks after my stroke had a different goal: to get me functional. That meant walking however I could manage it. It didn't matter that I was locking my knee; didn't matter that I contorted my torso; didn't matter that I balanced all my weight on one strong hip. Didn't matter. What mattered was getting me functional enough to send home.

Today it matters. I don't want to erode the cartilage in my knee, or develop spinal and hip problems. As I work to undo the bad habits formed over the past three years, I think about the whole post-stroke rehab industry and wonder what could be done to improve it? Why didn't someone take the time to help me recover my muscle function correctly from the beginning? Was I incapable? Would that have taken too long and cost too much? Isn't cutting corners going to cost my insurance company more later — when improper function leads to knee surgery? When drugs used to control spasticity cause complicating side effects?

One way to improve stroke recovery is to avoid permanent brain damage in the first place … climb on the Dean bandwagon and demand a stop to the neuronal cascade of death. But how do we help those for whom that’s too late? How do we align the goals of rehabilitation providers with rehabilitation patients? Because yes, after 21 days of insurance-covered room and board at rehab, I wanted nothing more than to go home — except to someday again be normal.

On My Nerves

As a stroke survivor I have heard that to regain muscle control, I have to forge neural pathways between an undamaged part of my brain and the nerves that network through my muscles.

One tool I've used to facilitate innervation (nerve growth) is Neuromuscular Electrical Stimulation. In addition to receiving electrical stimulation as a regular part of physical therapy three times per week, I purchased a small NMES unit to use at home while doing hand exercises. Initially my arm and fingers moved only when triggered by the unit, which works by sticking electrodes to the skin and sending electrical pulses through the muscles. Basically, the stimulator does the job of nerves until they can do it for themselves — sort of like jumpstarting a car.

Additional methods of stimulation include massage, heat and exercise.  I use them all.

Stimulation triggers blood flow into the targeted area, causing oxygenation of the nerves. Nerves require oxygen in order to transmit impulses. Nerves transmitting impulses is how we move our muscles. Moving our muscles causes more blood to flood into them, starting the cycle again.

STIMULATION + OXYGENATION = INNERVATION

When we don't use our muscles, blood passes by on the circulation super highway without being detoured to nerves in nooks and crannies. No oxygen = no impulses = no movement; unused muscle tissue can atrophy and develop adhesions (tissue fibers that stick together because they're not lubricated).

When I follow the formula and innervation begins, I feel tingling, pain and/or twitching. Once I perceive these feelings, I know I have a connection to my brain, that my nerves are awake and ready for instruction. Then comes the hard work of strengthening and coordinating my muscles.

Thanks to Dr. Arbi Derian for explaining this to me and helping me to achieve it.