At Bethesda, I met my first person who had had a recent stroke. You would think that, having theoretically learned about strokes during my course, I would have met a person with signs of a stroke sooner (not only after my graduation).
She was a lovely elderly lady – let’s call her Ms X – who was absolutely determined to be independent. Her symptoms were entirely motor, with hemiplegia on the left side. Four weeks on, she had already learned how to walk again, and I was allowed to work with the occupational therapy assistant (OTA) as she helped Ms X walk across the room and back. A lot of the focus was on reminding her to shift from side to side as she walked. I thought a good idea for increasing standing tolerance and practicing weight shifting would be to bring in a radio onto the ward so that the people there could dance, or at least sway from side to side, with help from a healthcare assistant, family member, OT, PT or even just a walking frame. It would have certainly made the ward a little more fun and engaging!
Another suggestion I had that the OTA actually used was to test just how much sensation Ms X had in her affected side. She insisted she could feel everything, she just couldn’t move her hand that much; the OTA was a little skeptical. So I said that Ms X should close her eyes and the OTA should stroke different materials across her palm or put different objects in it to see if Ms X could identify them. She got everything but one material wrong – she thought my leather glove was the same as one of the hospital gloves. I have to admit that I was quite pleased with myself about this idea, as it showed the OTA that Ms X was more intact than originally thought.
Ms X was constantly stroking her affected hand and repositioning it. I actually noticed the same behaviour in some of the other patients on the ward who’d had a stroke. She described how her hand was always stretched out and relaxed while she slept, but as soon as she woke up, the tone would start to increase, hence why she continuously tried to stretch her fingers out. She said it got tiring after a while having to pay so much attention to her hand. I thought a resting splint would help for a few hours during the day so that Ms X could relax, so I asked the OT about it. She informed me that a splint would only stimulate the palm and increase the tone, something that’s intrigued me for a while.
I asked the Twittersphere earlier about it, and @kirstyes kindly explained to me that splinting could in fact increase tone in some people, and that encouraging normal bilateral movement and positioning was more important in the earlier stages. This is definitely something I should investigate further, and I’ve done a preliminary search on the topic in the AMED database. I guess I have some reading for a few days!
I met another woman, and I actually visited her home on my first day volunteering, who’d also had a stroke at a similar time. She didn’t seem as determined, and she wouldn’t let anyone touch her arm, saying it hurt too much. When the OTA tried to stretch the arm, this woman could be heard across the wards. She insisted that she wanted to be independent, but her actions did not appear to match her words. Compared to Ms X, she seemed to need a lot more psychological support on top of the standard rehabilitation. I’m very glad I was able to meet two very different women in terms of their experience with stroke.
I’m also very grateful to have finally had the chance to go on a home visit! I even think I made a contribution, discussing different bathroom and kitchen modifications with the OTA, and pointing out certain practical considerations that she didn’t think of, like the turning circle in the bathroom.
Overall, I thank Bethesda for allowing me the opportunity to apply the theory I learned in university to real situations. (This also applies to my chance to work with the babies in the inpatient ward – absolutely loved it!) I also thank @kirstyes for passing on her experience to me.