Showing posts with label ▷ 2013 Jun 22. Show all posts
Showing posts with label ▷ 2013 Jun 22. Show all posts

Saturday, June 22, 2013

Walking a.k.a. Ambulation


Walking From Wikipedia, the free encyclopedia.


Computer simulation of a human walk cycle.
In this model the head keeps the same level at all times,
whereas the hip follows a sine curve.
Walking (also known as ambulation) is one of the main gaits of locomotion among legged animals, and is typically slower than running and other gaits. Walking is defined by an 'inverted pendulum' gait in which the body vaults over the stiff limb or limbs with each step. This applies regardless of the number of limbs - even arthropods with six, eight or more limbs.

The word walk is descended from the Old English wealcan "to roll". In humans and other bipeds, walking is generally distinguished from running in that only one foot at a time leaves contact with the ground and there is a period of double-support. In contrast, running begins when both feet are off the ground with each step.

This distinction has the status of a formal requirement in competitive walking events. For quadrupedal species, there are numerous gaits which may be termed walking or running, and distinctions based upon the presence or absence of a suspended phase or the number of feet in contact any time do not yield mechanically correct classification. The most effective method to distinguish walking from running is to measure the height of a person's center of mass using motion capture or a force plate at midstance.

During walking, the center of mass reaches a maximum height at midstance while during running, it is at a minimum. Definitions based on the percent of the stride during which a foot is in contact with the ground (averaged across all feet) of greater than 50% contact corresponds well with identification of 'inverted pendulum' mechanics and are indicative of walking for animals with any number of limbs, although this definition is incomplete. Running humans and animals may have contact periods greater than 50% of a gait cycle when rounding corners, running uphill or carrying loads.

Although walking speeds can vary greatly depending on factors such as height, weight, age, terrain, surface, load, culture, effort, and fitness, the average human walking speed is about 5.0 kilometres per hour (km/h), or about 3.1 miles per hour (mph). Specific studies have found pedestrian walking speeds ranging from 4.51 kilometres per hour (2.80 mph) to 4.75 kilometres per hour (2.95 mph) for older individuals and from 5.32 kilometres per hour (3.31 mph) to 5.43 kilometres per hour (3.37 mph) for younger individuals; a brisk walking speed can be around 6.5 kilometres per hour (4.0 mph).

Champion racewalkers can average more than 14 kilometres per hour (8.7 mph) over a distance of 20 kilometres (12 mi). An average human child achieves independent walking ability around 11 months old.

A Pedestrian Is A Person Traveling On Foot.

Health Benefits of Walking

Sustained walking sessions for a minimum period of thirty to sixty minutes a day, five days a week, with the correct walking posture, reduce health risks and have various overall health benefits, such as reducing the chances of cancer, type 2 diabetes, heart disease, anxiety and depression. Life expectancy is also increased even for individuals suffering from obesity or high blood pressure. Walking also increases bone health, especially strengthening the hip bone, and lowering the more harmful low-density lipoprotein (LDL) cholesterol, and raises the more useful good high-density lipoprotein (HDL) cholesterol.

Studies have found that walking may also help prevent dementia and Alzheimer's.

The CDC's fact sheet on the Relationship of Walking to Mortality Among U.S. Adults with Diabetes states that those with diabetes who walked for 2 or more hours a week lowered their mortality rate from all causes by 39%. "Walking lengthened the life of people with diabetes regardless of age, sex, race, body mass index, length of time since diagnosis, and presence of complications or functional limitations."

Paleoanthropology and Ambulation

Judging from footprints discovered on a former shore in Kenya, it is thought possible that ancestors of modern humans were walking in ways very similar to the present activity as many as 1.5 million years ago.

Evolutionary Origin of Walking

It is theorized that "walking" among tetrapods originated underwater with air-breathing fish that could "walk" underwater, giving rise to the plethora of land-dwelling life that walk on four or two limbs. While terrestrial tetrapods are theorized to have a single origin, arthropods and their relatives are thought to have independently evolved walking several times, specifically in insects, myriapods, chelicerates, tardigrades, onychophorans, and crustaceans.

Variants of Walking

Nordic Walkers

While not strictly bipedal, several primarily bipedal human gaits (where the long bones of the arms support at most a small fraction of the body's weight) are generally regarded as variants of walking. These include:
  • Hand walking; an unusual form of locomotion, in which the walker moves primarily using their hands.
  • Walking on crutches (with a variety of possible gaits);
  • Walking with one or two walking stick(s) or trekking poles (reducing the load on one or both legs, or supplementing the body's normal balancing mechanisms by also pushing against the ground through at least one arm that holds a long object);
  • Walking while holding on to a walker, a framework to aid with balance; and
  • Scrambling, using the arms (and hands or some other extension to the arms) not just as a backup to normal balance, but, as when walking on talus, to achieve states of balance that would be impossible or unstable when supported solely by the legs.
  • Nordic walking, walking with ski poles in both hands.

Biomechanics

Simple Walk-Cycle

Human walking is accomplished with a strategy called the double pendulum. During forward motion, the leg that leaves the ground swings forward from the hip. This sweep is the first pendulum. Then the leg strikes the ground with the heel and rolls through to the toe in a motion described as an inverted pendulum. The motion of the two legs is coordinated so that one foot or the other is always in contact with the ground. The process of walking recovers approximately sixty per cent of the energy used due to pendulum dynamics and ground reaction force.

Walking differs from a running gait in a number of ways. The most obvious is that during walking one leg always stays on the ground while the other is swinging. In running there is typically a ballistic phase where the runner is airborne with both feet in the air (for bipedals).

Another difference concerns the movement of the center of mass of the body. In walking the body "vaults" over the leg on the ground, raising the center of mass to its highest point as the leg passes the vertical, and dropping it to the lowest as the legs are spread apart. Essentially kinetic energy of forward motion is constantly being traded for a rise in potential energy. This is reversed in running where the center of mass is at its lowest as the leg is vertical. This is because the impact of landing from the ballistic phase is absorbed by bending the leg and consequently storing energy in muscles and tendons. In running there is a conversion between kinetic, potential, and elastic energy.

There is an absolute limit on an individual's speed of walking (without special techniques such as those employed in speed walking) due to the upwards acceleration of the center of mass during a stride - if it's greater than the acceleration due to gravity the person will become airborne as they vault over the leg on the ground. Typically however, animals switch to a run at a lower speed than this due to energy efficiencies.

As a Leisure Activity

Walking in Shilda

Many people walk as a hobby, and in the post-industrial
age it is often enjoyed as one of the best forms of exercise.
Fitness walkers and others may use a pedometer to count their steps. The types of walking include bushwalking, racewalking, weight-walking, hillwalking, volksmarching, Nordic walking and hiking on long-distance paths.

Sometimes people prefer to walk indoors using a treadmill. In some countries walking as a hobby is known as hiking (the typical North American term), rambling (a somewhat dated British expression, but remaining in use because it is enshrined in the title of the important Ramblers), or tramping. Hiking is a subtype of walking, generally used to mean walking in nature areas on specially designated routes or trails, as opposed to in urban environments; however, hiking can also refer to any long-distance walk. More obscure terms for walking include "to go by Marrow-bone stage", "to take one's daily constitutional", "to ride Shanks' pony", "to ride Shanks' mare", or "to go by Walker's bus".

Among search and rescue responders, those responders who walk (rather than ride, drive, fly, climb, or sit in a communications trailer) often are known as "ground pounders".

The Walking the Way to Health Initiative is the largest volunteer led walking scheme in the United Kingdom. Volunteers are trained to lead free Health Walks from community venues such as libraries and GP surgeries. The scheme has trained over 35,000 volunteers and have over 500 schemes operating across the UK, with thousands of people walking every week.

Professionals working to increase the number of people walking more usually come from six sectors: health, transport, environment, schools, sport and recreation, and urban design. A new organization called Walk England launched a web site on 18 June 2008 to provide these professionals with evidence, advice and examples of success stories of how to encourage communities to walk more. The site has a social networking aspect to allow professionals and the public to ask questions, discuss, post news and events and communicate with others in their area about walking, as well as a "walk now" option to find out what walks are available in each region.

The world's largest-registration walking event is the International Four Days Marches Nijmegen. The annual Labor Day walk on Mackinac Bridge draws over sixty thousand participants. The Chesapeake Bay Bridge walk annually draws over fifty thousand participants. Walks are often organized as charity events with walkers seeking sponsors to raise money for a specific cause. Charity walks range in length from two mile (3 km) or five km walks to as far as fifty miles (eighty km). The MS Challenge Walk is an example of a fifty mile walk which raises money to fight multiple sclerosis. The Oxfam Trailwalker is a one hundred km event.

As Transportation

Walking is the most basic and common mode of transportation and is recommended for a healthy lifestyle, and has numerous environmental benefits. However people are walking less in the UK; a Department of Transport report found that between 1995/97 and 2005 the average number of walk trips per person fell by 16%, from 292 to 245 per year. Many professionals in local authorities and the NHS are employed to halt this decline by ensuring that the built environment allows people to walk and that there are walking opportunities available to them.

When distances are too great to be convenient, walking can be combined with other modes of transportation, such as cycling, public transport, car sharing, carpooling, hitchhiking, or driving a car.

Walkability

There has been a recent focus among urban planners in some communities to create pedestrian-friendly areas and roads, allowing commuting, shopping and recreation to be done on foot. The concept of walkability has arisen as a measure of the degree to which an area is friendly to walking. Some communities are at least partially car-free, making them particularly supportive of walking and other modes of transportation. In the United States, the active living network is an example of a concerted effort to develop communities more friendly to walking and other physical activities.

Walking is also considered to be a clear example of a sustainable mode of transport, especially suited for urban use and/or relatively shorter distances. Non-motorised transport modes such as walking, but also cycling, small-wheeled transport (skates, skateboards, push scooters and hand carts) or wheelchair travel are often key elements of successfully encouraging clean urban transport. A large variety of case studies and good practices (from European cities and some worldwide examples) that promote and stimulate walking as a means of transportation in cities can be found at Eltis, Europe's portal for local transport.

The development of specific rights of way with appropriate infrastructure can promote increased participation and enjoyment of walking. Examples of types of investment include pedestrian malls, and foreshoreways such as oceanways and riverwalks.

In Robotics

The first successful attempts at walking robots tended to have six legs. The number of legs was reduced as microprocessor technology advanced, and there are now a number of robots that can walk on two legs. One for example, is ASIMO. Although robots have taken great strides in advancement, they still don't walk nearly as well as human beings as they often need to keep their knees bent permanently in order to improve stability.

In 2009, Japanese roboticist Tomotaka Takahashi developed a robot that can jump three inches off the ground. The robot, named Ropid, is capable of getting up, walking, running, and jumping.

See the article:
       Walking From Wikipedia, the free encyclopedia.





An Introduction to Walking

Uploaded on Oct 10, 2011 

Walking is a low-impact exercise accessible to just about everybody. It's safe, simple, and doesn't cost anything.George Halvorson, Chairman & CEO of Kaiser Permanente, explains the numerous health benefits of a regular walking regime: reduced risk of coronary heart disease, stroke, diabetes, and other chronic diseases. Physical activity need not be strenuous for an individual to reap significant health benefits; just 30 minutes a day (or two 15 minute sessions) of brisk walking will do the trick.

Get more information at: http://www.everybodywalk.org

Standard YouTube License @ EveryBodyWalk's channel






Walking After a Stroke

Uploaded on Feb 7, 2011 

When Daniela had a stroke at the age of 18, walking again became a major step in her rehabilitation. Hear her inspirational story of recovery. Plus, therapists explain how important it is to get patients with brain injuries to take those crucial first steps, how the desire to walk again can be a great motivator, and how even the smallest steps can mean big improvements. Listen in as Daniela attempts to regain something most of us take for granted.

Get more information at: http://www.everybodywalk.org

Standard YouTube License @ EveryBodyWalk's channel





After a Stroke: Alison's Story

Uploaded on Feb 9, 2012

Stroke is the leading cause of adult disability in the United States and Europe and is the No. 2 cause of death worldwide. Alison Bonds Shapiro suffered two debilitating and nearly-fatal strokes in her fifties. This video tells her story of recovery and how she reclaimed the ability to walk.

Get more information at: http://www.everybodywalk.org

Standard YouTube License @ EveryBodyWalk's channel





New Technology Improves Mobility of Stroke Survivors

Uploaded on Jul 21, 2009

In this video, Karen Nolan, PhD, a research scientist from Kessler Foundation Research Center, demonstrates new devices available to improve walking in individuals whose mobility has been impaired by acquired brain injury. Dr. Nolan's studies show that by applying technological advances, braces can be enhanced to not only improve walking, but help individuals with such disabilities as stroke or traumatic brain injury be more active and independent in their community.

Standard YouTube License @ Kessler Foundation






Device Helps Stroke Victims Walk Golden Gate

Published on May 10, 2013

A new wearable walking device is letting stroke victims regain their mobility. It's called Kickstart and three early adopters used it to walk across the Golden Gate Bridge on Thursday. (May 10)

Standard YouTube License @ AssociatedPress






Walk Across Kansas Hopes to Raise Awareness & Money for Stroke Research

Published on May 15, 2013

Physical Therapist Sandra Billinger, Ph.D., whose research focuses on the benefits of exercise after strokes. (She walked 570 miles across the entire state of Kansas last month in support of research to study the impact of physical activity in the recovery of strokes and brain trauma).


Standard YouTube License @ KUHospital






Stroke Survivor Walks Her First 4K Walk

Published on Apr 9, 2013

Sabine Becker, was born with no arms, due to the drug Thalidomide. She accomplishes all daily chores with her feet.

10 months ago she had a major stroke, which paralyzed her left side completely. Now she is fundraising for her first 4K walk. All benefits go to "canine companions for Independence",  an organization training service dogs for people with disabilities at no cost to the recipient.

Standard YouTube License @ Sabine Becker







Dawn... Stroke Survivor - Walking Again

Uploaded on Nov 3, 2011

Standard YouTube License @ Trevor Wicken





2012 Stroke Walk

Published on Oct 13, 2012

SSTattler: This a sample - most cities have the same equivalent - Everybody Walk! 

A collection of photographs from The American Stroke Foundation's 10th Annual Stroke Walk that was held at Theis Park in Kansas City, MO on Saturday, Sept. 8th, 2012. A big thanks to our sponsors, volunteers, and participants who helped make this such a successful event! We look forward to seeing all of you next year!

Standard YouTube License @ AmericanStroke1997

Saturday Comics



For Better and For Worse
Lynn Johnston - 2008-06-05

"...summer job at a veterinary clinic"
Dilbert
Scott Adams - 2013-06-19

"... two ways to fail."

Garfield
Jim Davis - 2013-06-21

"wire cutters... I need wire cutters!"

Betty
Delainey & Rasmussen - 2013-06-21

"I think my eyebrows are..."






  
*For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well 
 the author Lynn Johnston).
** I tried to get low or free price at the people http://www.UniversalUclick.com/ for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using GoComics.com and Dilbert.com.
*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.

Eclectic Stuff & Articles

Definition: Eclectic(noun) a person who derives ideas, style, or taste from a broad and diverse range of sources.













Awesome Treatment: Walking

Jeff  Porter
Stroke of Faith
Tuesday, August 14, 2012

Walking is one of the best "medicines" anyone can take. It can be habit-forming - for the good. Walking - and other exercise - can help prevent strokes and a myriad of other health problems.

Not long ago, the U.S. Centers for Disease Control and Prevention released some survey information about walking activities. More people are walking, but not yet enough, says a MedPage Today article:

Still, walking is a "wonder drug" that can prevent a variety of maladies from diabetes to cancer, CDC director Tom Frieden, MD, MPH, said during a phone call with reporters.
"I would say there's no single drug that can do anything like what regular physical activity does," Frieden said.
The data come from the CDC's 2005 and 2010 National Health Interview Surveys, and Frieden said the increase in walking prevalence was seen across almost all demographic groups.

Yet only 48% of Americans are meeting 2008 guidelines that recommend at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking, per week, and a third of Americans said they don't get any physical activity at all.

(Photo from CDC)

See the original article:
      Awesome Treatment: Walking
      from Stroke of Faith

Challenge 3: Personal Landmarks

Grace Carpenter
My Happy Stroke
Monday, April 8, 2013

There's a water tower in my town that looks like the pantheon. It's on top of one of the highest hills in the town, and it's about a half mile from my house. I hadn't walked to the water tower since the stroke.

When my kids were little and I couldn't stand one more trip to the playground, I would trudge up the hill with the kids in the double stroller and go to this small circular park. It has great views of Boston. It also has crabapple trees, which are just right for little kids to climb on, and the grass has tons of dandelions to pick. My kids were also intrigued by the series of manholes in one area of the grass, and we would hop from one manhole cover to the next.

Last Sunday I asked the kids if they were interested in walking up to the water tower. My son--who's acting more like a teenager every day--had other plans: hanging out with his friends, playing Mindcraft, and going to the hardware store with his dad. My daughter--who sometimes begs me to go on a walk--of course had no interest in walking that particular day.

So I walked up there by myself. Afterward I was pretty exhausted. According to my pedometer, I took about 2800 steps. I've been on longer walks, but not by much.

Maybe I can bring grandchildren there one day.

2 comments:

Marcelle Greene April 11, 2013 said... Sounds like a great place to go. Most of my walking takes place in stores. I wonder how many steps I took recently at Home Depot looking for 2-1/4" wood screws.

Rebecca Dutton April 11, 2013 said... It looks like a great place to see the city on a sunny day. 2800 steps - wahoo! I love it when my pedometer gives me credit for my hard work.

See the original article:
      Challenge 3: Personal Landmarks
      from My Happy Stroke

What Task-Specific Stroke Recovery Really Does

Peter G Levine
The Stroke Revovery Blog
Saturday, December 3, 2011

Find out what they want.

"Task specificity" and "task-specific training" are buzzwords in stroke-specific neurorehabilitation research. The foundation of recovery from stroke is rewiring of the cortex "around" the area of infarct. And the best way for anyone to rewire their brain is to focus.

As completely as possible, the focus should be on a specific task. Most therapists will tell you that they do task-specific training.

PTs and OTs have every right to claim that what they work on is task-specific. ADLs ("activities of daily living"; the focus of much of OT) transfers, walking, etc. are inherently task-specific. But working on recovery using the "task-specific" approach can be magnified if you focus on tasks that are vital to the survivor.

You might ask, "What is more vital than ADLs, standing, walking and transferring?"

The answer is, "Ask the survivor."

The more focus, the more rewiring. Let's consider someone who has not had a stroke: Jim. Let's say Jim decides to take French because he is required to take a foreign language for school. Now consider Tina. She is an American who grew up in Texas but is now living in France.

Which of the two will get the most robust brain rewiring dedicated to learning French? Tina, quite a bit; Jim, not so much. Tina will naturally bring quite a bit more focus to the task. So there will be quite a bit more rewiring.

Now let's consider relearning walking after stroke. Walking means much more than simply getting from place to place. The ability to walk can impact the ability to be independent, the ability to earn a living, friendships, self-esteem and much more.

Walking, especially in a clinical setting, may or may not be tied to what really matters to the stroke survivor. I worked with one stroke survivor who told me, "I can't continue to walk funny. It's bad for business."

He was a surveyor. When he went on construction sites the other workers didn't believe he could do the job. And they believed this because, although his speech and cognition were perfect, his movements were typically hemiparetic. In this case, the motivation is not walking, it's really the ability to make a living.

Another stroke survivor told me, "I can't cope with this constant fear of falling." The motivation here is not walking, but fear. I know stroke survivors who have lost friendships because of their stroke. "As soon as I had my stroke, the boys stopped coming around."

Another survivor told me, "The fact that I've lost the use of my hand keeps me from doing things with my friends." The motivation here is friendship. Other stroke survivors hate being dependent on their families.

Fear, friendship, career, independence. All of these are powerful motivators.
In some ways it's easier for occupational therapists. They ask, "What is it that you have to do? What is it that you love to do?"

The answers will be as varied as stroke survivors. One might say painting is the most important thing. Another might say golf. Another might say child care.

For OTs, "task specificity" can be just about anything. An OT can work on hand grasp/release. Putting grasp/release within the context of a highly valued task is relatively easy. And putting it within the context of a valued task will drive more cortical plasticity (thus more recovery) much more than stacking cones or playing with a pegboard.

Support Motivation
So how can PTs and PTAs promote the same sort of focus to walking as an OT promotes in a vital task done with the upper extremities? The first thing to do is to listen. "Patient education" time can be used as "therapist education" time. What did the stroke survivor do before his stroke? What did he do for a living? Did he ever play any sports or instruments? What were his hobbies?

Revealing the activities that patients most want to recover reveals what drives them. And what drives them drives their nervous system toward recovery.

But there is a gorilla in the room. What if their motivator is beyond their present capacity? Walking a golf course may be the ambition. But even nine holes of a par 3 is a couple of miles. So what is the first step in recovering enough robust walking to take the survivor miles?

First, the ambition must be revealed. Once walking a golf course is established as the goal, the goal is always kept in mind. An essential aspect of task-specific training is keeping the task in sight.

For instance, even if the painter can't yet paint, a paint brush and paints are kept as reminders of the task to be accomplished. But how do you keep a golf course in line of sight?

Keeping the task front and center is a matter of allowing the vista of a golf course to form within the walls of a therapy gym. The survivor may never make it to the golf course but the love of the game will have him walking further than he might have.

Research has revealed better tools than ever to help survivors along their journey. From partial weight-supported intensive treadmill training, tools to recover walking after stroke increase in numbers and in their evidence. But don't let survivors forget what most motivates them. The most powerful tools live inside the survivor.

6 comments:

oc1dean December 3, 2011 said... Sorry Peter, but I'll have to disagree with you on this one. Task-specific training is just taking the easy way out because if you can't walk properly you're not going to get better by practicing bad walking. The surveyor wants to dorsiflex properly and also not have his lower leg swing out due to spasticity. In order to correct these problems very specific muscles need to be worked on. Therapists should be able to assess what needs to be corrected by using:
    1. Computerized gait analysis or 
    2. compare to EMG profiles during normal human walking, available since 1986, or 
    3. motion-sensing technology, or 
    4. Epants can monitor your joints, or 
    5. the ForceShoe with identification of gait events using an instrumented sock.

Any of these should be able to identify specific muscles to work on. Spasticity may prevent success but that becomes a separate issue. By focusing on task-specific actions everyone is taking the easy way out and not expending any brainpower on how to recover the more complex problems. In my case I have to consider that my pre-motor cortex is mostly gone so the planning of complex muscle movement like 
walking needs to be recreated.   -- Dean

 Peter G Levine December 3, 2011 said... Thanks Dean and you're right. I plan to have a full and open response in a blog entry soon. This is an issue that has come up in seminars recently and I'd like to address it fully. Thanks again....

 Mike December 5, 2011 said... During my first 2 weeks at the rehab, most of my affected side was not moving, my vision was bad and there was no prorioception. My therapists could not do much.But those less severely affected were able to get more recovery.I was satisfied to gain something from the ADLs,PT.After I was discharged,I recovered more on my own since I was more confident with the transers, swallowing, and simple activities.Task specific approach is suitable when the survivor is more confident which I don't have during the first few months at the rehab.

 Elizabeth, John and Jack December 22, 2011said... This was exactly what my theapists did, but they did break it down to the muscle groups that needed to work well for me to care for my son. He was 30lbs at the time and my left side was so weak...I wanted to be able to pick him up more than anything. Walking came fairly easily but my shoulder and arm required much more work.

 Amy May 2, 2012 said... I completely agree Dean, you need the foundation first.

Peter G Levine September 8, 2012 said... Please note I dealt with this issue in the entry here: http://recoverfromstroke.blogspot.com/2012/06/demanding-repetition.html

See the original article:
      What Task-Specific Stroke Recovery Really Does
      from The Stroke Recovery Blog

Sunday Stroke Survival ~ Walking Post Stroke

Jo Murphey
The Murphey Saga
Saturday, June 15, 2013

Happy Father's Day to all you fathers out there and Mom's playing both parts.

Today a video with a twist. At least my take on it...

I want you to notice and keep in mind a few things while watching this video so you might have to watch it twice.
  • Walking post stroke is like this cat wearing shoes.
  • The everyday non survivors is depicted by the Yorkie whizzing by the camera. He's busy going about his life with momentary pauses while he checks on the welfare of the cat.
  • Of all the videos I watched about walking, this one best exemplifies what walking is like post stroke to me.
  • The cat's movements take on an almost fluid motion when he reaches the door. It is the same for recovering stroke survivors...with practice our movements become more fluid as our brains rewire and it can takes years.


Standard YouTube License @ n777k

Unless you are recovering from a stroke or recovered from a stroke, you don't understand the thought that goes into each step you take. While you may get a chuckle or two from the video, you feel for the cat attempting to walk. There are other diseases that can relate but here I'm talking about stroke recovery.

When people zip by me in their normal everyday hustle, I want to shout, "Hey, I'm walking here!" In my best Bronx, NY accent. Both in jubilation and in irritation.

When old friends see me now with pity in their eyes, my response, "At least I'm upright on three legs. That's better than I was a year ago on wheels and a walker."

When my DH (darling hubby) utters the same phrase for the umpteenth time of, "Take your time. We're in no hurry." I want to yell back, "I'm at top speed. I'm not going any faster." No, I don't say it, but I'm thinking it very loudly.

When people watch me walk my mind yells back at them, "Give me a break! I've only been walking a year."

I have to squeeze my butt muscle to engage my hamstring to lift my leg and bend the knee to take a step. Then in reverse, I have to relax the gluteal muscle slowly to disengage my hamstring, straightening the leg, after the step so my foot doesn't fall straight down to the floor with a thud.  That's a focused effort with each and every  step I take with my right leg.

Similar to the engage brain before speaking, I have to engage my brain before taking a step. Yes, there is a pause between my steps with my right leg if I have to measure things like rugs, level transitions, and steps up and down because that's a skilled motion.

I don't need a balancing tool (cane) to walk on even surfaces. Yes,while on level surfaces such as linoleum or hard wood floors, I can manage a fairly normal gait with feet extending past the midline in secession, but it still takes concentration. Eventually, the neural connections in my brain will rewire and the steps will become automatic again. I walk with a cane for additional balance and it's not the cute little walk that Charlie Chaplain did. I know quite a few of you are scratching your head going, "Who?" So I'll leave you with this...

Standard YouTube License @ bloguresti

Nothing is impossible with determination.

3 comments:

Pk Hrezo June 16, 2013 said... Wow. I never realized how much thought goes into every movement afterward. Amazing. And YOU are amazing for keeping at it and staying strong. That cat vid is too funny--my kids got a big kick out of it. Gives a really great perspective of what it must be like.

J.L. Murphey June 16, 2013 said... PK, yep I keep at it. Having a stroke makes you appreciate how your kids learn to move, and then hurrying around trying to catch up.

Zan Marie June 18, 2013 said... Go, Jo, Go! I think you're amazing to be able to think and analyze each step the rest of us take for granted.

See the original article:
       Sunday Stroke Survival ~ Walking Post Stroke
       from The Murphy Saga

Post-Stroke Walking Program Improves Stroke Survivors’ Lives

Dean Reinke
Deans' Stroke Musing
Friday, March 8, 2013

But what about the dangers of falling and death?

Regular, brisk walking after having a stroke could help boost your physical fitness, mobility and quality of life, according to research in the American Heart Association journal Stroke.

“Walking is a great way to get active after a stroke,” said Carron Gordon, Ph.D., lead author of the study and a lecturer in the physical therapy department at University of the West Indies in Jamaica. “It’s familiar, inexpensive, and it’s something people could very easily get into.”

Researchers divided 128 adult stroke survivors into a group that performed brisk outdoor walking three times a week for three months and a group that had therapeutic massage and no supervised exercise.

Compared to the massage group, the walking group:
  • Reported a 16.7 percent improvement in quality of life based on physical health.
  • Walked 17.6 percent farther in a six-minute endurance test.
  • Had a 1.5 percent lower resting heart rate (the massage group’s resting heart rate was 6.7 percent higher).

After a stroke, many people lack energy and are afraid of falling while walking — withdrawing from meaningful activities like going to church, buying groceries and visiting friends and family, Gordon said.

Previous research has shown that improving physical activity without putting too much stress on your body can help achieve a higher quality of life after a stroke. But those studies evaluated treadmill walking and cycling.

The new study shows you can walk without exercise equipment at any convenient place in the community, Gordon said.

Study participants were from three Jamaican hospitals, had either an ischemic or hemorrhagic stroke six to 24 months before the study and could walk independently with or without a cane. The average age of the 70 women and 58 men was 64.

Before and after the study, researchers interviewed participants and measured their fitness and quality of life. They also monitored heart rate and blood pressure before and after each walking session.

Walking group participants were supervised by instructors during their walk. Eventually, friends or family members could walk along instead, until the participants were comfortable walking alone, Gordon said.

Although most study participants were blacks living in Jamaica, similar results can be expected in any ethnic or cultural group, Gordon said. However, the results can’t be extended to patients with more severe effects or those unable to walk independently.

“Walking can help control blood pressure, reduce lipid or fat levels and help with weight control — all cardiovascular risk factors,” Gordon said. “So doctors should encourage it for patients who have had a stroke.”

The American Heart Association recommends at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or some combination of both) for most people. For stroke survivors, the association recommends aerobic exercise three to seven days a week, for 20 to 60 minutes, depending on fitness level.

1 comment:

Elizabeth, John and Jack March 10, 2013 said... I agree. This was consistent with my experience. I did a lot of walking, since I couldn't drive...and my son's stroller doubled as a "walker"/something I could hold onto. All the walking was really therapeutic.

See the original article:
      Post-Stroke Walking Program Improves Stroke Survivors’ Lives
      from Deans' Stroke Musing ?query=walking  (There are much more than +200 articles in 
                                                                                                                                 DSMusing; I gave up at finding +200!)
      from Deans' Stroke Musing

Some Fears Still Hanging Around-But Getting on With the Daily Chore of Living

Andrea
A Year of Living In My Head
Tuesday, June 18, 2013

On Wednesday I will accept a position on the board of a museum.  One year ago this would have been a pie-in-the-sky concept, since I was immersed in "what-if's" and healing.  What if I rev myself up into another stroke.  What if I have another stroke.  What if I cannot grasp detailed concepts. What if I forget stuff.  What if I fall asleep. I don't have as many of those anymore, or if I do I see other people my age without strokes in their past and realize, "Holy Crap, their memory is shot and they fall asleep too!".

My part-time job of last summer helped me back into the pacing of work.  I took the winter off to focus on family and farm (which was good because two teenagers just about aged me 22 years in seven months).

I am gearing up for going back to work and getting a divorce. All which I was doing pre-stroke - but rapidly ceased at my forced life hiatus.

 I have learned when to take a step back.  An adrenaline junkie, I love revving up under pressure to accomplish things.  I know when my physiology is amping up and I intentionally divert that energy to a different place.  That feeling of being keyed up now is a warning sign to me.  That is where the fear comes in... that if I live my life the way I did, that automatically I will wander down the same path and have another stroke.  There is no logic to the situation when I am thinking like this, just an irrational fear.  Almost like a baseball player and their superstitious repetitive movements to bring them luck - I cannot overcome these fears except with time.

Example: During my three-day stroke, I was in a big box store and the neon lights in the back of the store made me feel unbalanced, nauseous and tippy.  So, if I feel like that in a store,(which I still do sometimes) I try to overcome the fear that starts welling up and wait it out.  I remember: I do not have the same circumstances of health that I did with the stroke. Just because I am feeling light-headed does not mean a stroke is imminent. I do have some perception differences post-stroke and tumor, and this may be one of them.   I have found the passing of time is the only thing that truly heals this fear. no doctor has been able to explain this.

The job was the same thing.  When I would get very tired and have more pronounced head fog and slurred speech, I would worry.  As my stamina increased, that diminished.  So as I worked, my fear quieted. The goal here is to make it quieter, less urgent,  and then send it away.

It is all a learning process, which is ideal for me.  It is good to learn that life is finite, and appreciate it for what it does bring, not fight against what it does not. This may all common sense to you, but I used to have the illusion I controlled my life a bit more than I do.



1 comment:

Barb PolanJune 18, 2013 said... "I used to have the illusion I controlled my life a bit more than I do." Bingo!

See the original article:
      Some Fears Still Hanging Around-But Getting 
                on With the Daily Chore of Living
      from A Year of Living In My Head

And Now I am a Criminal !

Diane
The Pink House On The Corner
Sunday, June 16, 2013

So we went to see the Pain Management doctor last week. Well, not the doctor--we never see the doctor--we pay $35.00 which is the co-pay for a doctor/specialist, but we always see the Physician's Assistant instead. I tell you, Pain Management is a racket.

Anyway, we are waiting for the PA to come in and it seems to be taking longer than usual for her to show up. Finally, she comes in and I can tell something is wrong. Because usually she is a pretty cheerful gal. That day, she has this look on her face which was anything but pleasant.

Then she says, "We have a problem with Robert's urine screen. And the doctor is VERY UPSET!"

OK, about then, I am just pretty shocked.

And she goes on, "There is no Fentanyl in his urine screen." Then she sort of glares at me....

And I'm thinking, huh? And then, I think, oh Ha ha! because I'm thinking she said "Phenergan" which is another drug Bob was taking at one time, but I took him off it. The reason I took him off of it is because I had read somewhere that Phenergan can cause/contribute to cervical dystonia. And I thought maybe being off that drug would help his neck. It didn't, but, by the same token, I didn't see any difference between Bob on Phenergan than Bob off Phenergan, so I figured why take a drug that's not doing anything?

So, I start to tell her this, I say, "That's because I took him off--" and she interrupts me.

"YOU CAN'T DO THAT!!! NOT WITHOUT MY PERMISSION!!"

And now, I am totally confused. Because Phenergan was prescribed for nausea and why do I need her permission? It's not that big of a deal, as far as drugs go.

And I can't think of what to say, but it occurs to me suddenly we may be talking about two different drugs, so I say, "We are talking about Phenergan?"

She says, "No! I am talking about FENTANYL. THERE IS NO FENTANYL IN HIS URINE! And, not only that, the screen shows TRAMADOL!  And we HAVE NOT prescribed TRAMADOL!"

Now the way she said TRAMADOL, she might as well had said CRACK COCAINE. Because that's the way she made it sound.

I say, "Tramadol was prescribed by his primary care doctor for lung pleurisy."

She says, "What about the Fentanyl? Why isn't there Fentanyl in his urine? What are you doing with his patches?"

I just stare stupidly at her, I don't even know what to say, because this is really weird. I mean, Bob has two Fentanyl patches and I change them out every 72 hours. I do this religiously. I even have "patch" marked on my calendar for the days I need to change them. Because without his Fentanyl patches, Bob would be screaming in pain. And this woman is treating me as if she thinks I am some kind of freaking drug dealer, stealing Bob's patches and selling them on the street! GA!

I finally mumble something about putting them on him every 72 hours. Then I say, "You can check him! He has them on! I'll show them to you!" Because now I am really scared that Bob is not going to get his monthly prescriptions for pain. So I pull Bob's shirt up and show her the pain patches.

Then she gives me the third degree. Asking how/when/where I put them on. Asking if any had fallen off or not stuck properly. Asking is I accidently missed a dose. And I tell you, I felt like a criminal by the time we left that office. But we got his prescriptions. We were warned there would be another drug screening in the near future.

As I rolled Bob out of that office, he looked at me and said, "Weird."

It was weird. I have no clue why the stuff didn't show up in the drug screen. Of course, the first thing I did when we got home was google "Fentanyl drug screen" and the first things I found were some forums with junkies asking if Fentanyl would show up on their parole drug screen. To which, some people answered that Fentanyl requires a special type of drug screen test. Then I found some other forums for pain management patients and, you know, a couple of people wrote that the same darn thing happened to them. i.e. Fentanyl did not show up on the drug screenings....

So then I called the company which makes the drug and asked if they knew why it wouldn't show up on a drug screen or if there was a special drug screen for it. They couldn't answer my question. They had no clue.

Then I thought long and hard about it, and realized that that drug screen was the first one we had done using urine from Bob's condom cath bag and I wonder if that made a difference. That, and the fact, that the PA had told me to "bring some urine" with us, i.e. not empty the cath bag before we left the house. And I did that. In fact, I brought in urine that was over a day old and I had stored it in the fridge over night. And I wonder if that made a difference....

So I am armed with questions for the next Pain Management appointment. Such as, did the lab run the right test? Did the condom/cath bag i.e. latex/silicone skew the results? And does Fentanyl have a shelf life?

4 comments:

DebbieL June 16, 2013 said... Wow! What in the world is wrong with these people? Well, you know how I feel about this kind of stuff. Hang in there, girl! From the other "criminal" -- Debbie

J.L. Murphey June 17, 2013 said... Diane, First of all, You are not a criminal!

Pain management doctors are under such state and federal scrutiny as of the first of the year and a long laundry list of new verification procedures.

The PA in this case was a piss ant qualification.Confusion with drug names is common specialist versus layman. The refrigeration probably kept his urine fresher. I know when we do a 24-hr urine screen for Mr. T, we always refrigerate it.

The lab is probably at fault. You are within your rights to have another lab screen for results.

Is there a lubricant on Bob's condom? That could have an effect. I don't know about latex and silicone. Next time ask for an in and out cath to get the freshest possible urine. That's what they sometimes have to do with Mr. T because of ongoing prostrate problems.

Fentanyl does have a shelf life. Check the box. I hate patches that's why I opted for injectable drugs. Patches are notorious for not making good contact with the skin and an iffy absorption rate depending on the skin condition.

I remember once I lost Mr. T's morphine RX. I searched the house top to bottom and couldn't find it. That is a highly controlled substance. I called the doctor in a panic because Mr. T only had two injections left in the vial. While they were writing out a new RX, I found the original under the couch when it had fallen out of my purse with the grandkids rousing about. I ran to the pharmacy to get it filled because I was down to one dose. I went through the same rigamarole that you did with the doctor's office.

But hey, stuff happens.

Anonymous June 18, 2013 said... Please don't beat yourself over the head and flog yourself for a possible bad test and a lousy attitude from the PA. You KNOW you were doing everything properly, and Bob hasn't been in any severe pain, so the patches are working as prescribed. They should be asking questions, but in a civil manner and questions that would conclude why the test results were what they were. It always seems the medical profession is first to jump on the patient rather than the lab or other "professionals" (used lightly).

You're doing a great job in caring for Bob, so don't let some baboons indicate otherwise.

Lots of hugs and prayers for both of you. Dan

Barb Polan June 18, 2013 said... That the PA is still alive shows how gracious you are when under attack. Nice job!

See the original article:
      And Now I am a Criminal!
      from The Pink House On The Corner

Nilofer Merchant: Got a meeting? Take a walk!

Published on Apr 29, 2013

TED Talks - Nilofer Merchant suggests a small idea that just might have a big impact on your life and health: Next time you have a one-on-one meeting, make it into a "walking meeting" -- and let ideas flow while you walk and talk.
SSTattler: Hey lets have SSTattler meeting walk!
Willumpie Steve Jobs was also known to take business meetings outside. The most notorious deals where actually made walking.
Forth Meta Chairs were designed with the consideration of the human body.To say we sit because we're evolved to do so is saying that the human body was designed with the consideration of chairs. Conserving energy isn't necessarily good; people with sedentary jobs live shorter than people who move around/standmore 
superhamzah85 When we don't have to move, we sit. It's our default resting state. I'm not saying we evolved the ability to sit. I'm not saying it's good or bad either. Just explaining why we sit. Similarly, we've evolved to seek out high sugar and high fat foods, this doesn't justify a modern diet of sugar and fat, merely explaining why the problem exists. It's not a modern development, it's an ancient acquired trait that is no longer a benefit. 
rstevewarmorycom Runners have a shorter life expectancy, as do professional athletes. Below that, there is not a significant distinction between the longevity of the sedentary and that of the energetic, as long as they both remain active and involved at their own levels. Doctors had to give up telling people they'd live longer when it wasn't found to be true, so now they dodge the question by claiming it increases the "quality" of life, even though many regard exercise as a profound decrease in quality of life. 
and many comments Nilofer Merchant: Got a meeting? Take a walk in YouTube.

Standard YouTube License @ TEDtalksDirector

23 And 1/2 Hours: What Is the Single Best Thing We Can Do for Our Health?

Uploaded on Dec 2, 2011

First on SSTattler: 
      February 11, 2012 - Saturdays News - What Is The Single Best Thing We Can Do For Our Health.

Follow Dr. Mike for new videos! http://twitter.com/docmikeevans.  My new website is up and running, I'm curating resources and information for a range of common conditions, http://www.myfavouritemedicine.com

A Doctor-Professor answers the old question "What is the single best thing we can do for our health" in a completely new way. Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.

Some comments:
Bobby Clerici What a jewel this is, and my comment is not critical toward this presentation. Are we really so far gone that our big health and wellness revelation is...EXERCISE = GOOD? Well, DUH!...lol  Great video, and I hope it gets in the hands of those who are on the modern fad fitness treadmill to nowhere. Yes, most folks are looking for just the right pill, potion, exotic herb or magic that will transform their fat, elephantine physiques and rotten health. NOPE! Eat clean and exercise...simple as that!
13tmj absolutely inspiring. thank you. I loved all the references back to the studies done. I loved the way it has been presented with the sketches and the white board. this needs to be shown to as many people as possible. I am going to make it my priority to be active 30 mins a day. I will sit down and make a plan to make this happen, better than any pill and it is free. thank you again. 
and many comments 23 And 1/2 Hours: What Is the Single Best Thing We Can Do for Our Health? in YouTube.


Standard YouTube License @ DocMikeEvans

Forwarded Without Comment...

Jackie Poff
Stroke Survivors Tattler


Forwarded without comment... 

none necessary!









The Landfill Harmonic Orchestra

Published on Dec 13, 2012
Monty Becker
Stroke Survivors Tattler




Beautiful music in the landfill !!

RMR: Rick and Olympic Swimmers

Published on Mar 21, 2012

Rick visits Victoria, BC to train with members of Canada's Olympic swim team.


Standard YouTube License @ The Rick Mercer Report

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