Welcome to the third part of my small blog on coping, surviving and living after having a stroke – I hope this will be helpful and beneficial to all.

 Lynda Wheeler is a neurophysiotherapist working at Synergistics Wellness Centre.                 

  Balance – Excel – Harmonize Phone 5723031 for more information.

 LIVING                                               .3.

How a stroke affects a person will, in part, be determined by which area of the brain has had the loss of blood flow from a blood clot or bleed into the brain tissue.

It can affect the person’s speech, movement, balance and thought processes.  The severity of effects on all or one of these areas will determine the presentation of the stroke.  This is the outer layer of the presentation.  Under this will be the other medical conditions a person is contending with, such as heart disease or diabetes.  Governing all of the outer layers and underlying conditions are a person’s thought processes and personality.  If a person’s thought processes have been preserved, these can be a great determiner of progress.

A doctor who had spent much of her life studying stroke, awoke one morning and self diagnosed she was having a stroke.  In her writings afterwards she records this moment as “really interesting” as she could study her chosen topic “up close and personal”, using the experience to inform her future research.  She saw the situation as a “cup half full” moment, made a good recovery and did indeed use the experience to an advantage for all stroke survivors. 

I will outline the physiotherapy rehabilitations of one of my clients to give some ideas for work to do for you or for a family member if they present in a similar fashion.

PW presented some 18 months after her stroke.  She had had some patchy rehabilitation in hospital and in her rest home.  She had wished to return to her own home, which she had achieved, with good family support and social services care.  However, she was unable to stand or transfer independently and despite some active movement present in both her right arm and leg, she was not walking.

PW had a habit of pushing hard with her left (unaffected) side over to the right (stroke affected side), feeling that she was falling to her left.

This presentation is known as “Pusher Syndrome”.  This occurs when a person’s three “plumb” lines have been severely affected by the stroke.  In our adult lives we have our strong midline plumb line to allow us to know where our centre of balance is.  Then, we have our left and right “plumb” lines to allow us to balance on our right or left leg (such as when we walk).  If the stroke distorts these lines then a person finds it very difficult to stand and balance, so cannot take advantage of the movement available on the stroke affected side.

The first line of therapy was two fold.  One was to begin to gradually improve her cardiovascular fitness and general background muscle activity.  A person who has not stood up for any length of time (except for the occasional transfer) will have difficulty using her antigravity muscles, such as our long back muscles, to work to support a body in standing.  Our heart and lungs also become sluggish if we rarely stand up.  When a person such as this is first stood up for a long period of time (5 to 10 minutes) it is equivalent to a short run and so they tire very quickly, could feel light-headed or indeed faint!

Within a therapy session at my centre, the therapist can use a specialised bike and standing frame to increase the length of time a person can tolerate standing and challenge their heart rate for a sustained period of time.

At home, work can be done with a person sitting their body forward, away from the backrest, so making some of the long back muscles work.

Raising your arm (or arms) above your head will increase your heart rate.  Fast movements (air punching) or weights (lifting milk bottles filled with water or baked bean cans) above your head can all help in this aim of general cardiovascular fitness.

 The therapist can then use each session to direct a person to relearn to balance over the non-affected left leg.  This becomes the new point of reference for movement.  Then retraining the mid-line plumb line and stroke affected side can be undertaken.

PW was assisted into standing, from a raised plinth with some assistance of the therapist. She was instructed to keep her hip close to the chair placed on her left and to self correct as she felt herself swaying off to the right and back.

On her second session she was much quicker at finding her balance point on the left and able to stay standing for a longer period of time.

I will continue to chart her progress to keep giving tips for those of you who are at home looking for ways to increase your standing and walking abilities.