So, what a fabulous event last night! Chris thought last night was fantastic and expressed “I am very grateful.” Max and Beau expressed that it was “unbelievable.” It was so nice to see them smile. Everyone that was there last night was amazed by the incredible turnout. Good thing the Fire Marshall wasn’t invited. Whether you were able to attend, or not, THANK YOU ALL! Your incredible kindness and generosity will absolutely help assist this wonderful family through their toughest challenge.
Jodanna was in good spirits and worked very hard in her various therapies today. Chris reports that she is adamant about coming home on Friday, August 5th, despite the therapeutic team’s recommendation to stay for another week. We all want her home, but sincerely hope we can convince her to stay.
The quality and intensity of Jo’s rehabilitation is crucial to her recovery. Jodanna is very busy everyday. The following is a list of the types of therapy that Jodanna experiences everyday at SRI.
Passive Range of Motion – This refers to an external force moving a body part rather than it moving on its own volition. Examples include a patient taking her strong arm and moving the weak or paralyzed arm, as Jodanna does, or a therapist moving an affected limb. Passive range of motion is important to maintain flexible joints and prevent “joint contracture,” a profound stiffening of the joints. Joint contracture occurs when there are structural changes to the soft tissue such as tightening or shortening of muscles and tendons that restrict movement. It is important to perform passive range of motion even if a person has experienced total paralysis because a contracture can predispose one to skin breakdown, tissue irritation, pain, decreased blood flow, and prevent one from moving a limb if muscle function does return. Joint contractures also interfere with activities of daily living such as trying to wash under one’s arm, donning clothing over a contracted elbow or knee, or cleaning the fingernails of a contracted hand.
Active Assistive Range of Motion (AAROM) – This type of range of motion occurs when a weak limb is assisted through movement. The weak limb is helping but cannot perform all of the work on its own. For example when Jodanna partially lifts her arm and a therapist assists her in lifting the arm further (or she uses her strong arm as an assist). Active assistive range of motion is helpful in strengthening a limb that does not yet have full range of motion.
Active Range of Motion (AROM) – This occurs when Jo can move a body part on her own without assistance. Many stroke patients with movement on the weak side may not be strong enough to add resistance exercises yet, but can perform an active range of exercises. AROM helps promote joint flexibility, strengthening, and increased muscular endurance.
Strengthening or Resistance Training – Stroke rehab exercises often consist of strengthening activities that involve moving a body part against resistance. This type of exercise will gradually and progressively overload the muscles so that they will get stronger. There are many types of strengthening exercise equipment, including dumbbells, tubing, putty, and exercise machines.
Stretching Exercises – Muscles often become tight or lose tone after a stroke. Stretching on a regular basis helps prevent joint contracture and muscle shortening. Sometimes manual stretching is not enough and a patient may need a splint to help stretch tight joint and muscles.
Weight Bearing Exercises – These stroke rehab exercises can be some of the most important exercises for the survivor. Weight bearing can help reduce excessive tone (hypertonicity) brought on by the stroke. In Jodanna’s case, weight bearing can help reduce excessive tone caused by Jo’s reliance on her strong left side, as well as strengthen weak muscles on her right side. Weight bearing also helps prevent bone loss. If a stroke victim tends to put all of their weight on the strong leg, then the weak leg will begin to experience decreases in bone density. This bone loss can lead to “brittle bones” which also puts a person at higher risk for fractures. Weight bearing is very important for Jo’s arms and legs.
Scapula Mobilization – The muscles that attach to the scapula (or shoulder blade) are often affected after a stroke. These muscles may become weak or have increased tone. If the scapula cannot move properly, one cannot lift their arm overhead. Scapular mobilization exercises help move or mobilize the scapula in order to maintain or improve shoulder range of motion and prevent pain.
Balance Exercises – Stroke victims often have poor balance. If balance is affected, one of the first things a patient must learn in stroke rehab is the ability to maintain their balance in sitting. Sitting balance exercises focus on strengthening the core or trunk musculature. Standing balance exercises will help Jo improve her ability to stand in place as well as walk or perform activities without loss of balance.
Gross Motor Skills – Coordination exercises for gross motor skills emphasize fine tuning large muscle movements such as walking, throwing, and moving the limbs in a coordinated manner.
Fine Motor Skills – Hand dexterity is important for picking up objects, feeding oneself, buttoning clothes, writing and many other activities. Fine motor exercises will help Jo improve her use of her hands for manipulating small objects.
Constraint Induced Movement Therapy (CI Therapy) – Sometimes referred to as forced use therapy by some, this stroke rehab technique involves limiting the movement of the strong side and “forcing” the weaker side to attempt activities.
Improving Sensation (Sensory Re-education) – Following stroke, one may have decreased sensation, numbness, or tingling. This can be especially difficult if sensation is impaired in the hands. Forms of sensation that can be impaired are detection of heat/cold, pain, light and deep touch. Stroke patients may also be unable to discriminate where they are being touched, for instance, a touch on the elbow may feel as if it occurred on the upper arm. Decreased sensation can greatly impair the use of hands, causing one to drop objects, have difficulty with fine motor tasks, and be at risk for burning oneself. Sensory re-education involves retraining the sensory system in the attempt to improve sensation and hand function.
Brain Exercises (Cognitive Exercises) – The speech therapist will help Jodanna with exercises to improve cognition. These may involve exercises to improve memory, problem solving, reasoning, following directions, initiation of activity, and comprehension. The occupational therapist may also work on cognitive activities with a patient to help with daily tasks such as paying bills, cooking, and work activities.
Speech Exercises – Exercises to improve speech aim at improving articulation due to weak mouth and tongue musculature and improving a one’s inability to recall or understand words. Jodanna is affected by expressive aphasia, she is heavily engaged in speech therapy.
Hoping we can convince her to stay…