Does It Add Up?

Barb Polan
Barb's Recovery

October 24 / 2013

Nota Bene: I do not have any kind of medical qualifications. I am simply a disabled stroke survivor.

To other stroke survivors and PT’s: I have a problem with numbers …

All of us know that it takes AT LEAST tens of thousands of reps to make a new neural connection. Yet we, stroke survivors, continue to get, upon discharge (from inpatient and outpatient rehab), pages of instructions about daily exercises we should do, with 3 sets of 12 reps being the standard instructions.

Survivors think that THAT’S our work; if we “work really hard,” we conscientiously do the exercises twice, maybe three times, a day.

And you know what? The number of exercises we do from those pages – even doubled or tripled - is nowhere approaching the number we need to be able to actually make the connection we need. It hardly even contributes to the total. We may as well not do them. Heresy! Yes, I know, but the truth as I see it.

Again, I am not trained medically, so please listen to your own medical team, not to me. I don’t say that to cover my ass, but because I might be wrong.

PT’s, the next time you complain about survivors not doing their exercises as the reason they’re not progressing, it’s an effing LIE, and you know it. All it does is evoke guilt about not “working hard” enough.

Please tell them instead, that the number of reps is “enormous,” (or “far too many,” or “until it works,”) and what they should be doing are activities that result in far more reps (“massed practice,” as Peter Levine calls it); try walking, using stationary exercise equipment, etc. THOSE numbers add up.

What we need are reps that add up quickly. If we are doing only dozens of reps at a time, it will take us much more calendar time (I’m talking about YEARS, not weeks or months) than it should. Those are years in our lives that we’re often missing out on our lives. Of course, that’s a-whole-nother topic - what we do with our lives between the stroke and the resumption of our abilities.

Want to know what those exercises on paper do well? They let the survivor know whether he/she can do an exercise now that was not possible before. And, if you can actually do them already, many can help strengthen your muscles that have already atrophied.

But the injustice is that the exercises and instructions console survivors that they are working as hard as they possibly can. WHEN THEY ARE NOT.

Although neurologists, physiatrists and therapists tend to not admit it (maybe they don’t want to discourage their patients, or maybe they just don’t want it to be true because it discourages THEM), “working hard” is getting those reps as close to tens of thousands as quickly (in calendar time) as you can.

If only someone had told me that shortly after I had the stroke, I think these 4 years could have been more fruitful.

Not that I’m angry about it or anything.

Now that I finally know that it takes AT LEAST tens of thousands, I am spending 2 hours every day doing mirror therapy opening a clenching my hand. I’m up to 35,000 reps now, and I’m still logging the number of reps because 35,000 are apparently not enough for me to successfully open and close my hand, and I'm curious how many it will actually take.

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Does It Add Up?

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Barb's Recovery