Breaking News! Jodanna’s stubborn right arm is starting to show a little life!
In this video, you can see that she is holding up her arm, ever so slightly.
The physical therapists are not willing to provide a prognosis. They won’t commit to expectations at this point. However, there is some encouraging news. The PTs are starting to see muscle tone where it was previously lost, and she has made some physical progress.
The physical therapists are working on “eccentric control” of her bicep and tricep. That’s the beginning of rehabilitating Jodanna’s right arm.
Muscle contractions occur every time we move. The muscle must contract in order to move the bone to which it is attached or to provide resistance against a force.
A muscle may contract in one of two ways: Isometric Muscle Contractions or Isotonic Muscle Contractions. Isometric contractions occur when the muscle contracts but there is no movement. For example, when one pushes against a heavy object or holds a “wall sit” position.
Muscle contractions which result in movement are known as “isotonic” contractions. There are two types of isotonic muscle contraction – concentric and eccentric. Concentric muscle contractions are the most common form of contraction. These occur when the muscle shortens in length in order to make the bone move. These contractions occur when the body is working against gravity. For example, envision a bicep “curl” exercise. When the arm is bent from the straightened position, the Biceps Brachii muscle is working concentrically. The muscle is shortening to move the bones of the forearm and decrease the angle at the elbow.
With Jodanna, the physical therapists are concentrating on eccentric contractions. Eccentric contractions are the opposite of concentric contractions. The muscle contracts but increases in length. This type of contraction occurs usually in the direction of gravity, to control a movement. Envision the same biceps curl exercise example from above, but this time, the focus is that the arm slowly straightens from the bent position. The Biceps Brachii muscle contracts eccentrically to control the downward movement and increase the angle at the joint.
So yes, Jodanna can hold her arm up a little. That’s the beginning of eccentric contractions. That’s huge. Even better, when she was on the treadmill today, her right hand was holding on.
Of recent concern, however, Jodanna needs to wear her wrist brace at night, otherwise, her hand might freeze into a fist position.
Spasticity is like a “wicked charley horse.” Brain injury from stroke sometimes causes muscles to involuntarily contract (shorten or flex) when one tries to move an arm or a leg. As Jodanna’s brain works to move her arm, Jo is increasingly vulnerable to the effects of spasticity.
Spasticity creates stiffness and tightness. When a muscle can’t complete its full range of motion, the tendons and soft tissue surrounding it can become tight. This makes stretching the muscle much more difficult. If left untreated, the muscle can freeze permanently into an abnormal and often painful position.
Spasticity in the arm can cause a tight fist, bent elbow and arm pressed against the chest. This can seriously interfere with a stroke survivor’s ability to perform daily activities such as bathing, dressing, and eating.
How is it treated?
Healthcare providers consider the severity of spasticity, overall health and other factors to prescribe an appropriate treatment plan. In Jodanna’s case, they are using physical exercise and stretching.
Stretching helps maintain full range of motion and prevent permanent muscle shortening. They are also using a wrist brace. The wrist brace holds the muscles in Jo’s wrist and hand in a normal position to keep the muscles from contracting.
Jodanna is good about wearing her brace. She understands that if her arm “wakes up,” that’s a big deal for her independence and future quality of life. The sling you see her wearing in the video below is to keep her shoulder in place and prevent subluxation of her shoulder joint.
In other news, her speech is becoming more conversational, and her walking continues to improve. In this video, Jodanna is practicing lifting her right leg as if to get in and out of car.
As always, Jodanna’s intrepid spirit keeps her moving forward.
Slow and steady, as she goes.