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.

Get a Grip

One thing that continues to blow my mind is how the stroke affected every part of my left-hand side — my toes, my intestines, my ear canal, even my eyeball.

My left eyeball now gets irritated easily. When I first tried to soothe it with eye drops, the drop plopped in one side of my eye and rolled out the other. I had no blink reflex because I couldn't feel the drop hitting my eye. It kept happening, so I started calling my Visine, "Eye Drop Outs." I had to learn to blink right away to "catch" the drop in my eye. Once I could feel dampness on my lids, I knew the drop had reached its target.

I remembered this lesson during my first efforts to pick up exercise balls with my fingers. The balls kept popping out of my hand. I was applying more pressure than necessary because I couldn't feel the ball against my fingertips. I had to learn to moderate my grip pressure.

I was explaining this to a friend who suffers from neuropathy. She said, "I know exactly what you mean! I was trying to pick up a bobby pin and I couldn't do it, because I couldn't feel it!" 

Wow. That was awesome not only to have my realization affirmed — that a sense of touch is important to grip — but to be reminded that if this stroke hadn't gotten me, some other thing probably would have. There is just a whole smorgasbord of difficulties out there to suffer from.

Over time, as I've practiced moving the exercise balls, I've begun to feel them. I had the clear sensation last week of the rough texture of the balls brushing my fingertips as I released them.

Next post: a formula for reawakening nerves.

Oh, What a Feeling!

My loss of sensation was as concerning as my loss of movement. In the hospital, family members would touch my fingers or toes and ask, "Can you feel this?"

"No."

Not only did I lose sensation in my lower limbs, I could not place them in space. With my eyes closed, I could not tell if my arm rested by my side or in your hands. My perimeter had become fuzzy.

As feeling began to return in those early weeks, I qualified it: There was vibration and pressure, but not touch – no sense of skin against skin or the texture of bed sheets.

Temperature returned during a rehab shower – strange signals from my left leg. My right leg felt hot water. So, this is what hot feels like, I told myself. To this day my left side feels heat more keenly than my right. Hot is insistent.

A different sensation emerged one day as my occupational therapist worked with my arm. Her hands were cold. And so this is what cold feels like, I instructed myself. Cold is subtle – it reveals itself from a distance.

Without looking, I still cannot tell if my fingers are open or curled – grasping an object or empty. To test my sense of touch, I ask my husband to brush a cotton swab beneath my fingertips. With eyes closed, I try to tell which finger he's touching. For the first time last week, (15 months post-stroke), I was finally able to identify each finger correctly.

Who knew that having my husband tickle me with a Q-Tip could be so exciting?