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.   

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.

The Task at Hand

I've been told that recovering use of the hand after stroke is "tricky." When I question occupational therapists that I like and trust about my prognosis, their faces become shielded and their speech careful. Almost two years into recovery, I appreciate why predictions in a case like mine are unwise. So much depends on my willingness to perform hours and hours of boring, demoralizing exercises.

The 4 1/2-minute film below shows me performing my current hour-long exercise routine. I've edited the long pauses required to unclench my fingers after each effort to use them. The routine is a variation of grasping and releasing POOF balls, which I've done almost every day for the past 20 months. If you find the film tedious, then it's a good representation of what it feels like to rehabilitate my hand. Progress is agonizingly slow.

But I am making progress. I think back to three months post-stroke when, summoning all my concentration, I could just twitch my middle finger. Still I want more.

I've been reluctant to write about rehabilitating my hand. Writing brings clarity and I haven't wanted to look too closely at the hope and dogged determination that keeps me going. I fear not recovering my hand. I fear being foolish for continuing to try past the point of progress. That point hasn't come yet, but as I approach my two-year anniversary, I feel an urgency to push myself to the next level of achievement.

Breaking Barriers

In "Getting Better vs. Getting It Done," I wrote about the struggle to use my affected hand in performing daily activities. A comment on the post prompted me to ask "Why don't I use my left hand?"

1. I’m afraid of breaking something. With my unreliable grip, I once dropped a glass bottle of sparkling juice. Which leads me to…

2. I don't want to cleanup a mess. I tried holding the cap of the laundry detergent in my left hand while pouring the liquid with my right; the cap tipped, spilling detergent between the washer and dryer. Which leads me to…

3. I’m tired. Using my affected hand requires more concentration. If I'm tired, I'm less likely to push myself. And I'm more likely to be tired if I’ve had incidences like #2.

4. I'm in a hurry. Using my left hand slows me down, especially if it results in incidences like #2, which can follow #1 and are more likely to happen if #3.

5. I don’t want to hurt myself. My finger sensitivity is still minimal, so I don't reach into dishwater to grab a knife, or try to pick up the lid of a pot on the stove. I’ve been doing simple ironing, but I practice first with a cool iron. This only works because I'm not #4. I might have all my Christmas napkins put away by Labor Day.

6. Inability. There are things I can't do yet – like open my fingers when my arm is stretched above my head.

7. Habit. After 23 months, I'm on autopilot with my right hand and assume #6.

Now that I know why I don't use my left hand, I can develop strategies to break these barriers to progress. Awareness of a problem is the first step toward its solution.

Top 10 Challenges

Time for those year-end Top 10 lists!
This is the Top 10 Challenges for the One-Handed.

This list could have been a Top 100. I've confined it to things I do on a regular basis. If something obvious isn't here, it's probably because I avoid it — i.e. zippers and buttons.

10. Getting the last bite of food onto a fork.

9. Taking a greeting card out of an envelope.

8. Putting a greeting card into an envelope.

7. Signing a credit card receipt – a short one that curls.

6. Opening that waxy plastic bag inside a cereal box.

5. Preparing a toilet seat cover.

4. Texting while driving*

3. Donning shoes while my dog confuses them for chew toys.

2. Removing fingernail polish.

1. Pinching one nostril closed while snorting allergy medication from a long-nozzle, pump-action bottle.

*Calm down – I’m kidding.

Getting Better vs. Getting It Done

I manage three household tasks: Washing and putting away dishes, washing and folding laundry, shopping and putting away groceries. I do these things one-handed, which means I get things done only slightly faster than Congress. Imagine moving wet laundry from washer to dryer with one hand; moving dishes from rack to cupboards with one hand; carrying grocery bags from car to house one bag at a time.

The BIGGER problem is that I should be using my injured hand to assist with these tasks because that is the only way to retrain it. I can't expect that just because I improve at my formal hand exercises, I'll be able to grasp a T-shirt and fold it, or drop silverware into the correct slot in a drawer. I am going to have to practice these things repeatedly. However, when I attempt to do these things with my affected hand I often get so frustrated I default to using the good hand so I can get the job done.

It reminds me of my working days as a manager trying to implement an improved business process at the same time that daily business needed attending to. How can a business slow down productivity now for the sake of developing a system that allows it to become more efficient later?

Of course the Big Boss always wants both: Do it now and do it better. And in this case, I am the Big Boss. Sigh. Too bad I can't just fire myself and bring in somebody younger.