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Gaining Arm Use In Stroke Recovery

Posted Feb 12 2013 1:51am

How to gain function faster after a stroke

 Bill had a massive stroke thirty+ years ago and has not had the use of his right arm for the same amount of time. When he came to me his brain had NO awareness of the arm, shoulder or much of his entire right side. He could not tell the difference between his shoulder, humerus, lower arm, wrist, hand or fingers. The entire arm was bent rigid across his chest with his hand in a fist. It was so contracted it was a real problem to pry his fingers apart enough to cut his nails. His stated goal when he started seeing me several years ago was to be able to shake my hand someday. Last week he achieved his goal – we shook hands. It was an emotional moment for us both; for me to finally have validation that my approach works; for Bill to achieve his goal that he half-believed was only a dream.

It would be an understatement to say that Bill presented massive challenges to restore functionality on his right side. For 25 years his brain functioned with no knowledge that his right side even existed, at least not the part of his brain that executes movements. He could visually see his right side but there was no connection with his vision to the part of his brain that senses how to move. Bill is a big guy, about 6′ 3″ and 250 pounds and I am a mere 98 pounds! He is so strong that I literally could not lift his contracted right leg when he lay on the table. The muscles in his belly were so strong I could sit on it and nothing would move, he couldn’t even feel the pressure of my weight.

My approach to regain functionality is to move the structure as it is designed, however how do you move bones when the muscles have them frozen and entrapped in an incredibly tight muscle straitjacket? The only part of him that moved was the left side, so that is what I moved to give his brain messages that compelled him to feel his right side. Every time I moved any part of his left side to the right he went into horrific spasms that made his left and right side incredibly rigid. I needed to decrease the spasms so I worked out an approach to twist and counter twist. For instance if I was taking his left arm to the right I rotated the lower arm one way and the upper arm in the opposite direction. The real slog was when I would roll him on a side and try to bring the upper body back to create a twist in the torso. Whew, try doing that with 250 pounds of contracted muscles!

I have simplified the process but using this philosophy it took about two years to eliminate the spasms. As we progressed other changes occurred like his memory improved, he started to actually think rather than his mind be a big blank. He recovered some rudimentary math skills and his repertoire of conversation and words vastly expanded.

Finally the right side was becoming released enough that I could start moving him in ways to show his left side his right side existed. This was confusing and difficult at first. Our brain is like a very detailed, dense roadmap of connections and when it is working optimally it takes the shortest, most direct route to achieve a movement. To optimize the speed and ease of the movement we decrease effort. The effort variable can be explained as using just the amount of muscular effort needed to achieve the movement. Let’s add a few more variables:

- Habits

- Consciousness

- Awareness

Habits are patterns of movement that our brain has pre-memorized so we don’t have to consciously recreate the movement over and over. For instance to lift a glass of water is a habit, your brain calculates how much effort must occur based on the weight of the glass of water, how high you are lifting it, the angle of the lift and so on and you don’t have to consciously know about it. The movement of lifting a glass of water requires million, if not billions of bits of information processing through your senses. Your consciousness can only handle anywhere from 16-40 bits of information so without habits you wouldn’t be doing much! Habits are great – until they aren’t. Habits can be your worst enemy if they are counter-productive to the movement you want to do. The symptoms are stiffness, discomfort, more effort, soreness, pain and more. Why do we make counter-productive habits? Your brain does not judge whether a repeated movement sequence is good or bad, it simply habituates what you repeat. How can you create bad habits? Lack of awareness of how it feels to do a movement. If you have already established less than optimal habits a stroke will amplify and compound them to be even worse because connections in the brain roadmap suddenly go nowhere – much like the bridge to nowhere in Alaska. Your brain doesn’t like dangling connections so it looks at whatever is around to connect with. Bill showed oddball connections by contracting everything on the left when I moved any part of his right side, even turning his head to the right contracted his left foot!

Consciousness is what we think controls our body and thinking. Here is how our brain really works: millions perhaps billions of bits of information are processed by our senses in any given moment. About 16-40 bits of information is passed on to our consciousness. The quality of the information that is passed is wholly dependent on our awareness, which is our only way to connect with our senses. If we are disconnected with what we feel then the information we get is pretty disconnected too leading to emotional, intellectual and spiritual confusion and less organized movement.

Awareness is the state of being in the present moment and allowing you to sense and feel all that is around you and within you. Try lifting a glass of water feeling just how much effort is needed. The only way to achieve this is to feel what muscles to release. The rule is if you can feel it you are over-using it or do not need it. Do the movement over and over until you are pretty close to feeling nothing yet the glass lifts without effort. Try it with your eyes closed and notice what you feel, hear, smell, touch. Notice how the air feels as your breathe and how much effort you use to breathe. Do you contract your belly muscles to breathe? If so try to breathe without contracting them. Notice how your mind feels now.

Given the complexity of the roadmap and the fact that Bill’s had a bunch of oddball connections; he had developed habits of moving as if only his left side existed; he thought if he only gave a movement more effort it would get easier; he had little awareness of what it felt like to move and in some sense probably really hated his body; and he thought his consciousness controlled everything he did –  completely opposite to what was needed to re-learn how to move optimally.

As he has transitioned to functioning with awareness, releasing muscles and feeling how to move, his progress has speeded up exponentially. He happily complains about how tired he is and how his brain seems to be buzzing with electricity all the time – especially his left side, which is where the stroke occurred. Bill’s story is a testament to our brain and its ability to recover from grave injury and illustrate such extraordinary plasticity to function even better with appropriate guidance. It has been an amazing journey for Bill and I, he learning to trust himself to surrender to his brain’s capacity to function without his consciousness trying to control his world and for me – the same. We sense and feel our world and how we function in it first, then we rationalize and organize the information we receive in better ways.

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