Putting It All Together

Last summer I “tried my hand” at rowing a boat. My husband Ian and I were staying with family at the Hood Canal in Washington State. I picked my way carefully over the pebbled beach and climbed into the rowboat while Ian held it steady. He rowed away from shore and handed me the oars – one at a time, of course, because I had to position my affected hand on the left oar.

I tried to row the boat. The left oar flailed.

First uncoordinated attempt: note different oar positions.

I needed to help my affected side through a few strokes so it could get the feel of the circular motion. I gave the right oar to Ian and placed my right hand over my left, guiding myself through the motions -- dipping and pulling, pushing and leaning.

When that felt comfortable, I traded oars with Ian. Now I observed my right side doing the same motions. I felt how the oar pushed on my thumb as I reached forward, and pulled on my index joint as I leaned backward. When I had that sensation locked in my mind, I took both oars.

My healthy side made longer, stronger strokes, my husband pointed out. I eased up on the strong side, allowing my affected side to set the pace, consciously synchronizing my movements.

Row, row, rowing the boat!

Next thing I knew, I was rowing the boat gently down the lake – for about 10 strokes, then my affected hand tired and wouldn’t hold the oar anymore.

I repeated the exercise a couple times over the next few days. By day three I had muscle memory and was able to start off with coordinated strokes. It felt so good to exercise my body this way!

Dear Santa: a rowing machine might be a great therapy tool for me to build strength and re-coordinate muscles.

Reflections

"Pay no attention to that man behind the curtain." -Wizard of Oz

I concealed my affected hand behind a mirror while I watched the reflections of my healthy hand open and close. This tricked my brain: As I watched the reflection of my healthy hand, I had the sensation that my affected hand mimicked the movement! But I couldn’t resist peaking behind the mirror, where I saw the reality of my curled limp hand. For me, that shattered any benefit of mirror therapy.   

What I find more useful is to study my healthy side for clues on how to use my challenged side. When working with SaeboFlex to grasp balls, I sometimes notice my movement feels unnatural. I am approaching the ball in a way that makes it easier to grasp given my disability. I stop and study how my healthy side would do it.  I observe the angle I reach from, the position of my hand, then try to mimic that with my affected side – because my objective isn’t to pick up a therapy ball – but to move my affected side as normally as possible. 

I learned from Eric that symmetry is important. He sees a heavy crease in the skin on my affected side, while the healthy side has a fine line. He sees the ridge of a curving tendon on my affected shin, while its mate runs straight. He shows me a mound and hollow in my affected calf compared with the smooth curve of the healthy muscle on the other side. He tells me to imagine my skin like a sausage casing and to spread the meat evenly inside it.

My body is a roadmap showing me where it needs work: level the shoulders, flatten the torso, balance the hips. Today my mirror therapy encourages me to look at both sides.   

Mind Over Muscle

Pre-stroke I worked out listening to my iPod, thoughts meandering over yesterday, today and tomorrow.  Post-stroke my mind needs to engage as much as my muscles.  First, I relax the spastic muscles in the area I want to exercise; second, I link my brain to the muscles I want to work (harder with some than others); third, I put my core muscles in proper position. Now I exercise, holding all of the above in mind as I repeat the motions.

I liken it to golf and all I had to keep in mind simultaneously to hit the ball on the sweet spot: Keep that elbow straight, rotate those hips, keep that head down – oh yeah, and try to relax! I sucked at golf.

I’m working harder at rehabilitation than I ever did at golf.  The most mentally challenging aspect for me is correcting bad habits – not just those acquired through adaptive functioning – but those that pre-exist the stroke.

Instead of keeping my feet parallel and engaging my core muscles, I turn out one foot for stability. Eric calls it my kickstand and says a lot of people do this, which contributes to the prevalence of lower back pain. I do it when I’m standing at the kitchen counter, in line at the post office, lifting weights. 

The other bad habit many of us have is to use our joints for stability instead of our muscles. It’s easier to lock our knees than to use our leg and core muscles. I use my hip like a linchpin, taking all the weight on it and cocking it as needed to move me. No wonder it hurts. 

For healthy recovery, I need to stop relying on my joints and make better use of my muscles.