So, how is our friend Jodanna doing?
She goes to at least one of her therapy sessions five days a week. Jodanna is making steady and gradual progress across the board. Her speech is becoming more fluid. At times, she has difficulty making herself understood when she can’t find the words, but she is usually able to get her message across.
Jo’s right arm is still not responding. The physical therapists are not alarmed by this. They indicate that the arm usually does not “wake up” until four to six months post-stroke. So, those of us (like me) that get anxious over these things need to remember to be patient. Jo has a good two years of recovery before her. This will be a long haul. She is working hard and up to the task.
In the meantime, the therapists use an EMS device on her arm, and Chris also applies it at home. EMS stands for Electrical Muscle Stimulation. These devices are predominately used to prevent, or reduce, muscle atrophy. Atrophy is the weakening and loss of muscle tone, which is usually experienced after surgeries or injuries. EMS has been proven to be an effective means of preventing muscle atrophy. EMS also helps by increasing blood flow to muscles, increasing range of motion, increasing muscle strength, as well as enhancing muscle endurance. EMS has pain management attributes in helping muscle related pain, such as a spastic muscle, sore muscles, or tight muscles. With the assistance of the EMS device, Jodanna’s muscles in her right arm respond. They still work. She is not paralyzed, however, there is no current connection between her right arm and the brain. Patience Grasshopper.
Her walking is improving. You can’t keep this feisty one down. She’s been cleared to walk within her house unassisted. She uses a cane to help her. Sometimes, she can walk short distances without the cane. Here is a picture of Jo walking down to Sopa Thai for lunch with friends.
The doctors and therapists are now working on her gait. They want to improve her proprioception.
What is proprioception?
Everyone learns in school about the five senses: vision (sight), audition (sound), olfaction (smell), taction (touch), and gustation (taste). These senses are responsible for our interaction with the external world. Additionally, we have several senses that are responsible for our internal functioning. One of the most important internal senses is called proprioception, or position sense. Proprioception affects our lives every moment of every day, and allows us to accomplish complex tasks that would otherwise be impossible. The sense is so fundamental to our functioning that we take its existence for granted.
Proprioception allows humans to control their limbs without directly looking at them. Take, for example, the complex task of driving. We are able to keep our eyes on the road and simultaneously adjust our arms and hands on the steering wheel, and apply the appropriate amount of pressure to the pedals to maintain speed. Talented drivers can also change the radio station, eat small meals, talk on the phone, reach for something in the rear seat, or any host of other ill-advised tasks while maintaining eye contact with the road ahead. If humans had to observe their limbs to successfully accomplish tasks, we would have to look down at our feet every time we wanted to change from gas to brake, or stare at our arms if we wanted to make a right turn. The distraction would make driving nearly impossible.
Human beings do not have a single organ for proprioception. Instead, the sense is processed by the entire nervous system as a whole. Inside every muscle and joint lie tiny meters called muscle spindles and Golgi tendons that constantly measure the amount of tension and degree of contraction. This information travels up a discreet highway in the spinal cord called the spinocerebellar tract, and makes its way to the cerebellum. The cerebellum accepts information from every muscle and joint in the body, and calculates where the limbs must be in space. The system is not perfect, but gives a rough estimate to allow for basic task completion. We can use our vision to confirm limb position for more technically demanding tasks.
Like most physiological processes, proprioception can be improved with challenging practice, and can also be impaired by disease or disuse. A concert pianist can play incredibly complex music with their eyes closed because they have trained the proprioceptive sense of their fingers to be precise enough for the task. If that same concert pianist tried to play a piece they have never seen before, they would have to look at their hands to master a complicated section.
By contrast, patients who suffer from stroke often have difficulty with balance and coordination during their recovery. Proprioception is also impaired by diseases or injuries affecting the musculoskeletal system, like an ankle sprain or diabetic neuropathy. Patients suffering from these types of conditions are predisposed to falls and repeat injuries, which compounds problems. For this reason, physical therapists can work with patients on proprioceptive training to help gain a stronger position sense.
Training usually consists of working on uneven or irregular surfaces, and balancing on affected joints with a blindfold to remove visual confirmation. In Jo’s case, they are trying to achieve using the right leg without locking the knee for each step. This is really scary for her, as she doesn’t trust her leg yet. Although these exercises are demanding, patients can usually see functional benefits within a fairly short time.
The family is settling into their “new normal” for now. Everyday life has its ups and downs. Discouraging and encouraging moments are experienced daily. Chris is planning to take time off work and stay home through the holidays, and return to work in January. Max is down at UC San Diego, and Beau is back at Nevada Union. Both boys are working hard and doing fine.
For the past year, the Bishops have been planning to spend Christmas in Hawaii. They can’t wait to go.