Google As a Medical Diagnostic Tool

Bill Yates
Brain Posts

20th October 2010

My Google Reader accidentally picked up an intriguing abstract that examined a research study of resources that medical students use in solving diagnostic cases.  The abstract was picked up because it contained the word “exercise” that is one of my PubMed filter queries.  Although we often think that most diagnostic decision-making occurs from learned information stored in physician’s brains, information resources can be very helpful.  What information resources are medical students using to help them with the diagnostic process?

Graber and colleagues asked this question and designed a learning experiment.  One hundred and seventeen medical students were presented a challenging case and asked to provide their top three diagnoses as well as listing all the resources they used and the helpfulness of each resource.  This experiment occurred as part of a examination of the web-based decision support system known as Isabel.  The top six most used resources (and the percent of medical students who used the resource in the experiment) were:

• Medical books (73%)
• Google (70%)
• Other students (69%)
• Journals (49%)
• Residents and attending (29%)
• Isabel (28%)

Google to Apply Expertise to Health and Aging Project

Dean Reinke
Deans’ Stroke Musing

Monday, September 23, 2013

I have to figure out how to contact them to see if they might take on some of the functions one would expect a stroke association to do - Google to Apply Expertise to Health and Aging Project.

Google has already had an immeasurable effect on our home lives and work, with its big data work and technological development. Their products may have an indirect effect on the health and well-being of the working population, but now the company is planning a new venture that will tackle health-related issues directly.

A new company founded by Google, called Calico, will investigate new health technologies and approach the issue of aging, and it's been driven by one of Google's founders own health problems.

Larry Page has spoken publically about how much health and aging affect family life - and it's the drive from senior levels of the organisation which has brought their new venture to life.

Google Inc., operator of the world’s most-popular search engine, is investing in a new company focused on health and well-being. 

The business, called Calico, will address the challenge of aging and related diseases, Google said in a blog posting. The venture will be led by Arthur Levinson, chairman of Roche Holding AG Genentech unit and a former Google director. 

The focus on health, which Google Chief Executive Officer Larry Page acknowledged was a “lot different from what Google does today,” comes as the co-founder himself battles with personal ailments. Earlier this year, he disclosed he was diagnosed with left vocal-cord paralysis, a condition that restricts vocal-cord movement, and is also experiencing impairment on the right side. 

“Illness and aging affect all our families,” Page said in the posting. “With some longer term, moonshot thinking around health care and biotechnology, I believe we can improve millions of lives.” 

Google is stepping up investments in areas outside its core online-advertising and consumer-services business. The search provider has already put money into health-related companies through its venture arm, called Google Ventures, among other sectors. The Mountain View, California-based company has also worked on longer-term bets through a research unit that’s unveiled plans for computerized eyeglasses and driverless cars.

See the original article:

Google to Apply Expertise to Health and Aging Project

in

Deans' Stroke Musing

Typing Practice

Pamela Hsieh
Rehab Revolution

22 April 2010

For those of you like me who struggle with returning to two-handed typing, a good idea apart from simply typing with both hands whenever you use the computer is to find a good program for the computer made for training people to type in general. I use a program called aTypeTrainer4Mac, which is obviously only for Mac users, but a quick Google search on typing programs will yield plenty of results. I just tested myself on my typing speed, which single-handedly without looking is apparently 77 wpm (words per minute), and bimanually is 24 wpm with looking. Quite a significant difference! I'll have to retest myself in a week or so and track improvements.

I believe with aTypeTrainer4Mac you can set "level" priorities to emphasize your quality and quantity, and you may also copy texts or just type the random series of letters they choose for you. Another nice feature is that it automatically records logs of your sessions.

Mine for today looks like this:

Round & CPM/WPM
  1. 103/20
  2. 116/23
  3. 109/21
  4. 108/21
  5. 122/22
  6. 133/26
  7. 96/19
  8. 109/21
  9. 120/24
10. 129/25

So, a little all over the place. But the nice thing about the randomly generated letters/characters is that they tend to alternate hands, something I've been told is neurologically stimulating (bilateral alternation).

Going to do this once a day for a week to see if it yields results. I'll keep you posted. Good luck to you, too!

To our healing,
Pamela

See the original article:

Typing Practice

in

Rehab Revolution

Surgery - Gall bladder

Andrea
A Year of Living In My Head

Wednesday, August 7, 2013

I need my gall bladder removed.  Since the stroke I have dozens of little stones that have formed in it, and cannot be on any statins because they give me an attack.  (Doctor point of contention "There are no studies that show statins cause gall stones").  Well, doctors. When you put me on statins they give me an attack. When I don't take statins, the attacks stop unless I do something like, say, for instance, eat a brownie. A big one. Or down something cooked with lots of dairy.

Since I am "getting" the importance of being on a statin as a preventative, it is better for me to do this surgery when I am still relatively young with minimal health issues at this point.  (Do I really get to say that with a stroke and deadish head tumor floating around in my head -- I am saying it anyway). The stones may have been caused by my sudden diet change or weight loss (35 pounds over a year, no more any fried foods or burgers...75% less meat consumption) and in some ways it does not matter. A gall bladder attack is something I am getting very tired of.  Hours on the bathroom floor worshipping the white ceramic toilet.  Absolutely hands-down an unthrilling stomach venture.  And they always happen at night, so it pretty much wipes out the next day.

My Mom's Day present from the kids this year.

Unrelated milestone I passed... the two year mark since the stroke.  It is true, the first year was the sketchiest.  I went to the hospital for more weird episodic head stuff than I have in the last 9 months.  It seems like things have stabilized. For my age and demographic, three years is the mark of going back down to only having a 3%  risk of recurrent stroke (10 times greater than the non-stroked general population), rather than 30%.  I should search Deans blog for more current research than 20+ year old stuff out of England but I liked what this one said.  I am a person that likes to know things, but truly the data on strokes is heavy, depressing, and hopeless sounding.  I went to a very dark place post-stroke because of how it was presented (and having many in the health care industry visibly give up on preventative health care for me) like I had one foot in the grave. Technically, we all are going to the same place, so that is a ridiculous attitude to have.  I am glad (?) maybe not the right word, to know what my body has a propensity for so I can manage my life better.  And, I get to say that, because, really, what choice do I have?

See the original article:

Surgery - Gall bladder

in

A Year of Living In My Head

Kinesio Taping Reviewed

Rebecca Dutton
Home After a Stroke

January 4, 2015

A subluxed shoulder is painful because the upper arm (humerus) has slipped out of the shoulder socket.  Subluxation is rated by how many fingers you can fit in the space created by this abnormal shoulder separation.  I had a one finger subluxation so the hospital staff put a small lap tray that slid over one armrest of my wheelchair.  I made sure the staff put the tray on every day because I knew nerve damage can occur if nerves in the shoulder are stretched too much.

The lap tray could not support my shoulder when I walked and did exercises while sitting on a mat table.  My shoulder ached constantly during these times until my OT bound it up with Kinesio tape. This wide tape provides support but is stretchy enough to allow movement.  I wore the tape 24 hours a day - even in the shower.  It eventually came lose and had to be replaced every third day.

Hanger and associates found stroke survivors who had their hemiplegic shoulder Kinesio taped had less shoulder pain (1).  The improvement got very close to statistical significance (p = 0.11 instead of the required 0.10) because some people were helped while others were not.  I am glad Kinesio tape worked for me because having a subluxed shoulder felt like someone had punched my arm very hard. The only thing that made that constant ache go away was Kinesio tape.

1.  Hanger H, Whitewood P, Brown G, Ball M, Harper J, Cox R, Sainsbury R. A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clinical Rehabilitation. 2000;14(4):370-380.

See the original article:

Kinesio Taping Reviewed

in

Home After a Stroke

Gluteus Maximus

Amy Shissler
My Cerebellar Stroke Recovery

January 1, 2015

Happy New year.  Since 2014 has been called “the year of the rear,” I thought this was appropriate.  I think I’ve written about something like this before but here goes again….Yesterday I had a yoga lesson and was in the cobra position that looks like this(this is called a prone press up in the physical therapy world)….

http://sharingdisana.com/2013/03/01/7-pose-terbaik-yoga-yang-memperkecil-perut/(this site is in a different language and I have no idea what language it is)

So I was in the position and noticed that my butt was clenched.  So I internally rotated my hips.  Ok, here’s what that means and why I did that.  Part of the job of the gluteus maximus, the main butt muscle, is to externally(laterally) rotate the hips.  That means rotating your thigh outward which will point your toes outward.

http://www.mendmeshop.co.uk/muscle/groin-anatomy.php

If you do the opposite, the muscle will be shut off.  If a muscle can’t do all of its actions, it does none of its actions.  So internal(medial) rotation of the hips shuts off the gluteus maximus and since I purposely did the opposite action of what the gluteus maximus is supposed to do, my butt unclenched.  Muscles are very passive aggressive that way.

See the original article:

Gluteus Maximus

in

My Cerebellar Stroke Recovery

New Years Resolutions

Sas Freeman

January 5, 2015

We find ourselves a couple of days into a new year, Christmas already a distant past and people talking of new year’s resolutions, some feeling guilty for over indulging over the festive period.

It is a time when people everywhere ask what New Year’s resolutions each of us have made and either we have made the same old ones promised each January 1st forgotten by about the 5th, or we have to suddenly try and pluck an idea from thin air as the only way, to move the conversation onto something else.

As stroke survivors why don’t we instead, decide to reflect on everything we have achieved in the past year, on each small achievement and create a list of our recovery progress.

Keep this list somewhere so we can often glance at it and at times we forget our achievements take it out again, so we can begin the year in a personal positive frame of mind.

Achievement Box

Then this year, start a progress or achievement box by wrapping a shoebox in a pretty paper and fix the lid so that it cannot be opened. If you are not able to manage yourself ask someone else to do it for you. In the top cut out a tiny opening to allow little pieces of paper to be posted inside.

Call it your ‘goals reached’ or ‘achievement box’, whatever means something to you. Every time you achieve a task you are aiming towards this year, write it on a slip of paper and posts it into your pretty goals box. For example if you manage to make a drink on your own for the first time without help, simply write ‘made first drink’, if you like you can even date it. Do this throughout the whole year.

On New Year ’s Day 2016 have a glass of your favourite drink open your personal achievement box and celebrate YOU – your achievements through this year.

Happy Healthy 2015 fellow survivors

See the original article:

New Years Resolutions

in

Sas Freeman

How Therapists and Caregivers Become Experts in Aphasia and Dysarthria Therapy

Mark Ittleman
Teaching of Talking

Jan 8th / 2015

“And then I watched her perform the speech and language stimulation and it looked like I was doing it, and noticing she had a certain confidence and was doing really good work!   Then I realized it wasn’t me, it was the person I mentored.”
-Ittleman 2005-

The other day I was working with a caregiver whose son had been in a motor vehicle accident.  He was left with an apraxia, dysarthria, and an expressive aphasia.  For the layperson or student, he had difficulty articulating accurately, even with intensive articulation stimulation.  The words he was having difficulty with had to be broken down into individual syllables, and articulator placement stimulation had to be done before the actual attempt at speaking.

When I was a speech pathology student it was always a cardinal rule that placement of the articulators was a prerequisite prior to verbal production of the target sound or the phoneme.  Correct articulation of a sound is often rather simple to stimulate with many clients if they have a good “eye” and “ear,” but with this young man the speech model a.k.a. therapist had to break a complex word down into syllables and assure the sounds within those syllables were said accurately.   Even though this young adult had a moderate to severe apraxia, he was stimulable to produce words accurately if the correct principles of articulation therapy were followed.

But that’s not the point of this article.  This young man also had a severe expressive aphasia and receptive language component.  That means he had severe trouble finding the words he wanted to express in addition to severe difficulty comprehending spoken language when it was directed to him in rapid succession; typical of the way normal speakers communicate with machine gun-like speech rate.

#strokerecovery tweetchats 4pm London Time 13th January 2015 – Here’s why…

Kate Allatt
Stroke Recovery Tips

January 2, 2015

Stroke is global healthcare problem. In developed countries, it is the third or fourth most common cause of death.  However as 80% or more people now survive the initial stroke, the largest effect of stroke is through the long-term residual difficulties, daily living activity limitations and reduced social participation/interactivity.  Stroke is the main cause of adult disability.  Physical and emotional  impairments from stroke affect the whole family, not just the person with stroke.

Most stroke survivors and their families want get on with the rest of their lives after stroke —in other words their goal is #strokerecovery. This doesn’t not mean the stroke survivor or family will fully recover like they were pre-stroke. Rather, our #strokerecovery tweetchat aims to practically advise, help and inspire people to make progress in the daily living activities, socially and professionally.   This includes motor, communicative, cognitive and emotional recovery. In other words, it is possible for  stroke survivors and their families can live satisfying lives with impairments.

What is #strokerecovery ?

#strokerecovery is a vibrant community of people interested in exploring stroke recovery in for themselves and in stroke recovery. Sharing, learning & improving from each other.

Our first chat is held on 13th January 2015 at 4pm London time.

Why #strokerecovery ?

"Instant Gratification and How It May Hurt You” OR"It Works Great (and That's the Problem)"

Peter G. Levine
Stronger After Stroke

Monday, December 29, 2014

You want to eliminate drop foot?
Use an AFO, done!

You want the elbow to straighten?
Tap the triceps, done!

You want the hand to stay open?
Put a splint on, done!

You want to improve balance?
Give 'em a walker, done!

You want to have them talk better?
Give them a language aid, done!

You them to swallow better?
Feed them thickened liquids, done!

In every case, and many more, short-term "instant gratification" often gets in the way of a more complete recovery.

Why and How?

Weekly Columnists

Sunday Stroke Survival: Search Engines

Jo Murphey
The Murphey Saga

Sunday, January 4, 2015

But how can I find it?

Your brain is the vault of all knowledge. Everything you've experienced, seen, done, read, smelled, and touched is in there somewhere. Similar to computers, the brain has both Random Access Memory and long term data storage. So what can be done when the brain is damaged by a stroke or other mechanism of injury to the brain? How do you recall or search for data that you know is in there?

For the computer, there are all sorts of search engines from the low end like Google to the high end like Knowledge Vault or Knowledge Graph. Each has similar features but the high end is what you want for the ultimate data searches. All you need to do is plug into the internet.

Would it be so easy for the brain to do the same thing. Unfortunately, there is no such thing. People use many different things to jog their memory. In therapy, it's repetition to maybe wake up pathways in the brain to circumnavigate the damaged areas. Forgetful people leave Post-It notes for themselves or tie a string to their finger. That's all well and good, if it works for you, but that's the problem. What if it doesn't? What do you do then?

My youngest daughter is a TBI (traumatic brain injury) survivor. Similar to me with my stroke, we have no short term memory but have to store all things that we want to remember in long term storage. We also are aphasic which means we have issues with recalling data. Things like words get lost in the shuffle. We can substitute words (although they are not always right) and describe what word we are looking for in detail and let someone else tell us the word (guess, like the game 20 questions), or recall it later and often much later. You can imagine how frustrating this can be.

Jackie The Jester: A New Store That Sells Husbands

Jackie Poff
Stroke Survivors Tattler

A store that sells new husbands has opened in Melbourne, where a woman may go to choose a husband. Among the instructions at the entrance is a description of how the store operates:

• You may visit this store ONLY ONCE! There are six floors and the value of the products increase as the shopper ascends the flights. The shopper may choose any item from a particular floor, or may choose to go up to the next floor, but you cannot go back down except to exit the building!
• So, a woman goes to the Husband Store to find a husband. On the first floor the sign on the door reads:
• Floor 1 - These men Have Jobs. She is intrigued, but continues to the second floor, where the sign reads:
• Floor 2 - These men Have Jobs and Love Kids. 'That's nice,' she thinks, 'but I want more.' So she continues upward. The third floor sign reads:
• Floor 3 - These men Have Jobs, Love Kids, and are Extremely Good Looking. 'Wow,' she thinks, but feels compelled to keep going. She goes to the fourth floor and the sign reads:
• Floor 4 - These men Have Jobs, Love Kids, are Drop-dead Good Looking and Help With Housework. 'Oh, mercy me!' she exclaims, 'I can hardly stand it!' Still, she goes to the fifth floor and the sign reads:
• Floor 5 - These men Have Jobs, Love Kids, are Drop-dead Gorgeous, Help with Housework, and Have a Strong Romantic Streak. She is so tempted to stay, but she goes to the sixth floor, where the sign reads:
• Floor 6 - You are visitor 31,456,012 to this floor. There are no men on this floor. This floor exists solely as proof that women are impossible to please. Thank you for shopping at the Husband Store.

PLEASE NOTE:

• To avoid gender bias charges, the store's owner opened a new Wives Store just across the street.
• The first floor has wives that love sex.
• The second floor has wives that love sex, have money and like beer.
• The third, fourth, fifth and sixth floors have never been visited. 

TED Talks - Jeremy Howard: The Wonderful and Terrifying Implications of Computers That Can Learn

Published on Dec 16, 2014

SSTattler: Brilliant lecture... !!

What happens when we teach a computer how to learn? Technologist Jeremy Howard shares some surprising new developments in the fast-moving field of deep learning, a technique that can give computers the ability to learn Chinese, or to recognize objects in photos, or to help think through a medical diagnosis. (One deep learning tool, after watching hours of YouTube, taught itself the concept of “cats.”) Get caught up on a field that will change the way the computers around you behave… sooner than you probably think.


Standard YouTube License @ TED

Rick Mercer Report: Rick and Face-First Rappelling

Published on Oct 8, 2014

Rick visits Drummond, New Brunswick to descend into the Grand Falls Gorge.



Standard YouTube License @ Rick Mercer Report

Laid-Back Administration: With Google Search

Dr. Beagle C. Cranium
Stroke Survivors Tattler

Three Tricks

Just For You!

  
1 - Use the brief  Google Search Synopsis... and they will search on the whole Stroke Survivors Tattler and display with the maximum 32 articles. Most of the time, it is enough.
2 - Use the Google Advanced Search on Stroke Survivors Tattler.  They have 16 parameters and lots variation of punctuation, symbols, operators, knowledge graph, spelling check,... etc. if you want to. There is no limit of the number of articles displayed.
3 - The Weekly Index for Stroke Survivors Tattler. There is 3+ years of SSTattler list from recent week(s) to September/2011.

Daily Comics

For Better and For Worse
Lynn Johnston

Canada Family Events

Dilbert
Scott Adams

Dilbert Office Events

Edmonton Journal
Malcolm Mayes

Politics Views from Canada

Doonesbury
Garry Trudeau

Politics Views from USA

  

** 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, 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, Dilbert.com and EdmontonJournal.com.

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Saturday News

Contents of This Week Saturday News:

• Headline - Physiotherapist / Physical Therapy
• Eclectic - Many articles from many Guest Bloggers about Stroke
• Pilot Study of Split Belt Treadmill Based Gait Rehabilitation System for Symmetric Stroke Gait
• Life as Rehab
• Therapy 1
• Community Ambulation Falls Thru the Cracks
• Wii Fit: Fun Therapy
• Physical Therapy - Again
• Mixing It Up
• Experience
• Unbrace Yourself
• Goodbye, Urvashi
• Dangerous Phrases
• Elliptical Timeline
• In The Swim
• The Rest of the Story…
• PEI Stroke Care Model "Caregiver Handbook"
• Time to Reflect
• A Caregiver's Christmas
• Mentoring: Speech Therapy for Aphasia/Developmental Language Delay
• Top Ten Brain Posts 2014: 1-5
• Weekly Columnists
• Sunday Stroke Survival: I Got One, But Not the Other
• Jackie The Jester: Okoboji Museum
• TED Talks - Michael Rubinstein: See Invisible Motion, Hear Silent Sounds. Cool? Creepy? We Can't Decide.
• Rick Mercer Report: Rick and Jann Arden on Tour
• Laid-Back Administration: No Posts This Week
• Daily Comics: FB Or FW, Dilbert, Mayes, Doonesbury

Definition: Physiotherapy / Physical Therapy

Physical Therapy From Wikipedia, the free encyclopedia

Physical Therapy / Physiotherapy
Military physical therapists working with patients on balance problems,
orthopedic / musculoskeletal injuries, amputee, compression wrapping
to control edema, and during evaluation/assessment of strength,
flexibility, and joint range of motion, massages, etc.

Physical therapy or physiotherapy (sometimes abbreviated to PT) is the health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention. It is carried out by physical therapists (known as physiotherapists in most countries) and physical therapist assistants (known as physical rehabilitation therapists or physiotherapy assistants in some countries). In addition to clinical practice, other activities encompassed in the physical therapy profession include research, education, consultation, and administration. Definitions and licensing requirements in the United States vary among jurisdictions, as each state has enacted its own physical therapy practice act defining the profession within its jurisdiction, but the American Physical Therapy Association (APTA) has also drafted a model definition in order to limit this variation, and the APTA is also responsible for accrediting physical therapy education curricula throughout the United States of America. In many settings, physical therapy services may be provided alongside, or in conjunction with, other medical or rehabilitation services, including occupational therapy.

Overview

Physical therapy involves the interaction between therapist(s), patients or clients, other health care professionals, families, care givers, and communities in a process where movement potential is assessed and diagnosed and goals are agreed upon. Physical therapy is performed by a therapist and sometimes services are provided by a physical therapist assistant (PTA) acting under their direction. Physical therapists and occupational therapists often work together in conjunction to provide treatment for patients. In some cases, physical rehabilitation technicians may provide physiotherapy services.

Video: Physiotherapy / Physical Therapy

SSTattler: Below is a sample of the first year, approximate, of a stroke (by YouTube).  Much more available on YouTube / Vimeo / ...

I Wanna Be a Physiotherapist

Published on May 13, 2014

Jesse goes behind the scenes with Renee to find out what a day in the life of a Physiotherapist is all about. Want to see more career videos from Student Edge?

Click here: http://s-edg.com/careervideos

Standard YouTube License @ Student Edge

Eclectic Stuff

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

Pilot Study of Split Belt Treadmill Based Gait Rehabilitation System for Symmetric Stroke Gait

Dean Reinke
Deans' Stroke Musing

Thursday, January 17, 2013

When I was still getting physical therapy 4 years ago my PT told me about a colleague of hers that was doing a trial of this technology. Who is going to compare this to the displayed foot placements on the treadmill? or the auditory cueing one?

Pilot Study of Split Belt Treadmill Based Gait Rehabilitation System for Symmetric Stroke Gait

Abstract

A split belt treadmill for gait rehabilitation was developed to improve the symmetry of the stance phase time of patients with stroke. The system, which increases the stance phase time of the affected leg and then realizes a well-balanced gait, is divided into two components. First, the stance phases of the sound and affected legs were measured and presented visually in real time to the patient and physical therapist as biofeedback. Second, using stance phase biofeedback, the physical therapist sets two different velocities of treadmill belts for sound and affected legs. In an experiment, 11 patients with chronic stroke participated in a short-term intervention trial (20 gait cycles) of the developed treadmill system. Three of the five subjects who had lost balance between the stance phase of the sound leg and that of the affected one improved their gait balance in the intervention trial. In addition, one subject kept the well-balanced gait after the intervention.

Full text available at the link.

See the original article:

Pilot Study of Split Belt Treadmill Based Gait Rehabilitation System for Symmetric Stroke Gait

in

Deans' Stroke Musing

Life as Rehab

Robin
Rocky Mountain Stroke Survivor

June 24, 2013

My perfect day: Having slept in as late as I wanted, I woke up in my beautiful and peaceful bedroom to the feel of a light breeze coming through the open window.  I close the window and curtain before the heat of the day and pad into the kitchen where my husband has breakfast waiting for me.  Everyone smiles at me and I at them as I walk into the room.  The kids are already diapered/pottied and dressed for the day.  They are each settled into an age appropriate, interesting, and educational activity.  My husband is wiping down the completely clear table after their breakfast (did I mention they were already fed too?) and as soon as I finish my breakfast, my dish is whisked into the dishwasher in order to not dirty the freshly scrubbed sink. Supper is already in the crock pot and my husband announces that he has a picnic lunch already packed so the kids and I can go on a little jaunt while he finishes up a project in the back yard.  I put on the clothes that were laid out for me and away we go.  When we get home an hour or so later, my husband has gotten an amazing amount of work done around the house and yard; he takes over the kids while I take a 2-3 hour nap.  I wake up refreshed.  We spend a little time together as a family before supper and everyone stows themselves neatly in bed nice and early.

My real day: Our daughter, age 1, has a fever and wakes me up with her piteous cries at 4am.  I kick my husband until he wakes up enough to understand that I need him to fetch the infant ibuprofen from the bathroom.  By the time he comes back, I’ve fallen asleep in an uncomfortable position holding my daughter.  As soon as he wakes me up and hands me the syringe of medicine, he’s konked out (in an uncomfortable position).  I dose the baby and spend the rest of the night in that weird sort-of sleep that only parents of sick kids and political prisoners understand…you’re exhausted so you fall asleep instantly but the instant you fall asleep, you are awoken by kicks and screams.

Therapy 1

Steven H. Cornelius
Music and Stroke

February 7, 2012

When released from intensive care, I was moved Mass General’s neurology ward. Things were coming along nicely. Already I could raise my left shoulder, slowly bend my elbow, and even move my thumb.

That day, a physical therapy intern came in to see me. After few niceties, she put a comb on the bed table, and then asked me to comb my hair. If I could have spoken more than a couple words at a time, I would have tried to explain why hers was a stupid request. (Nearly 30 years of college “professing” makes ideal teaching moments hard to pass up.) But alas, I could manage neither the words nor organize the concepts.

So being a good sport (and appreciating her attention), I gave it a try. After some struggle, I captured the comb between palm and thumb. With much shoulder raising, head lowering, and eventually some elbow bending, I eventually got comb to head, which knocked the comb out of my hand.

So I tried again, and again, and for what seemed like an eternity, as she looked on encouragingly. I could go through the gory details of the repeated attempts, but not much changed.

So, the teaching moments…

Community Ambulation Falls Thru the Cracks

Rebecca Dutton
Home After a Stroke

August 16, 2014

Walking in PT gyms and on a deserted sidewalk did not prepare me for walking in community settings, like maneuvering around carts and people in a grocery store, squeezing past closely placed chairs and tables in a restaurant, and dealing with children in a shopping mall who do not look where they are going.  PTs do not know walking requires divided attention because they walk clients in wide empty spaces that provide no cognitive challenges.  Equally unfortunate, OTs who are trained to assess and treat cognitive issues do not assess community ambulation because walking is PTs domain.  So community ambulation falls through the cracks.  Stroke survivors are left to figure out how to walk safely in the community.

A recent study addresses the unpredictability of walking in the community.  Inness learned what stroke survivors did when they were not told they were about to experience a fall hazard (1).  Stroke survivors were asked to stand with each foot on one of two force plates.  At an unexpected time the two force plates were tipped forward and subjects had to recover their balance by stepping forward onto a third force plate.  Clinical tests like walking speed and the Berg Balance Test did not have a significant correlation with the unexpected stepping test results.  Subjects who did poorly or did well on the unexpected stepping test had a similar range of Berg Balance scores (25-55 and 20-56).  The Berg Test does not measure real world balance because clients can concentrate fiercely on their own body and get to decide when they want to initiate movement.

Bottom Line: Being afraid to walk in crowded environments is a major barrier to participating in valued community activities.  Limiting gait training to walking in the home contributes to social isolation and depression.

1. Inness E, Mansfield A, Lakhani B, Bayley M, McIlroy W. Impaired reactive stepping among patients ready for discharge from inpatient stroke rehabilitation. 

See the original article:

Community Ambulation Falls Thru the Cracks

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Home After a Stroke

Wii Fit: Fun Therapy

Jeff Porter
Stroke of Faith

Tuesday, July 01, 2008

While I don't need a Wii Fit for physical therapy, I'd love to try one out just for the sheer fun of it. It sounds like a way to help some recovering stroke survivors. This one is from The Plain Dealer, in Cleveland, Ohio.

From the article in The Plain Dealer in Cleveland:

▶︎ Physical therapy is best served with a little camaraderie and light conversation, but therapist Nancy Ditzel also dished out some fun to recovering stroke patient Marilyn Smigelski recently.

▶︎ The LakeEast Hospital therapist put Smigelski to work on the latest Nintendo Wii video system game, called Fit. While the American Physical Therapy Association magazine recently reported widespread use among members of Wii games that simulate sports like tennis and bowling, the Lake hospital system is the first locally to use the Fit game in physical therapy.

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Wii Fit: Fun Therapy

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Stroke of Faith

Physical Therapy - Again

Andrea
A Year of Living In My Head

Sunday, April 14, 2013

Went to a new physical therapist yesterday.  As part of my wrapping up medical things while they are fully paid for before the divorce... I went to this PT for getting my lesser muscles back online.  I notice my muscle mass is decidedly different on the left side of my body. After the ever-fun assessment it was decided, yes, my left leg and torso have lost strength.  He gives me such simple exercises.  Ridiculously easy and slow and they don't take much time.  And, after, I feel like I have run a marathon and swam the English channel AND climbed Mt. Rainier.  My body has been slacking big time.  (Really, I wonder why.)  Once I get over the shock that I have no strength (what is getting me up in the morning? because it is obviously not muscles) I do my exercises and freak out my body.  Connections. All about those connections. Thank god I am such a stubborn person.

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Physical Therapy - Again

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A Year of Living In My Head

Mixing It Up

Pamela Hsieh
Rehab Revolution

20 May 2010

A key strategy to ward off that dreaded plateau -- that point of flatlining improvement everyone hates -- is to vary your routine.

Variety?! But my routine knows not that word! In fact, that is exactly the opposite of routine!

Not if you don't let it. What I do is have my physical therapist write me a new full-body program every eight times I've gone through one. Now, this tip is clearly aimed at people farther along in their rehab, where independent and/or more advanced techniques are part of their daily gig (because earlier on, your rehab is more or less guided completely by your therapists).

If you keep your body guessing, you'll keep it on track rather than getting bored with the same-old, same-old.

An easy way to implement a regular mix-up? On a drizzly day you feel too sluggish to hit the gym yet feel guilty for playing hooky (um, like today, for me), stay in and pop in an exercise video or DVD. I've got them all: yoga, dance, capoeira, Bosu Ball, Bender Ball, pilates. (Apparently, there's a whole rehab aspect to pilates that I've never officially tried with a practitioner before, but I'll definitely get more information on that for you.)

Experience

Amy Shissler
My Cerebellar Stroke Recovery

October 18, 2014

The first couple of years that I was a practicing physical therapist, I was scared of everything.  It’s really scary when someone that’s already in a lot of pain and coming to you for help tells you that the exercises that you asked them to do caused more pain.  That’s a scary thing.  That’s when confidence and experience become critical.  Now, I only have 4 years of work experience so I don’t want to give the wrong impression but that being said, I kinda know a lot and I was really good at what I did.  I only have 4 years of work experience but I have personal experience now that most health care practitioners with decades of work experience don’t and never will have.  It took a few years after getting a lot of good results with people to have the confidence to say to someone “I know it hurts a little more or in a different spot, that’s ok.  Keep doing the exercises and I promise you’ll feel better.”  That wasn’t always the case of course but I knew what to do and how to deal with it after a while.

When I got sick, and when I was doing inpatient rehab, I could have done a whole heck of a lot more than I was asked to do.  But I’m sure my therapists were absolutely terrified of me.  First of all, I was the youngest person in the stroke unit so that alone probably scared them.  I was bald, I had an enormous scar on the back of my head, I was shaking uncontrollably due to my tremors and ataxia, I could barely speak.  I looked like absolute, utter hell.  So I’m sure they were scared shitless and were terrified to ask me to do any real exercise. It’s not their fault, it’s what they were taught and how they’re told to treat.  In therapy I was tired as hell because I wasn’t allowed to sleep when I needed to be asleep.  I was scheduled to go therapy based on THEIR schedule, not mine.  I wasn’t AT ALL getting what I needed.

Unbrace Yourself

Marcelle Greene
Up Stroke

Wednesday, October 5, 2011











I left rehab with an Ankle-Foot Orthosis (left) to support my ankle and keep my foot from dragging. I hated it. I hated having to wear long socks in hot weather. I hated having to put on a brace and shoes in the morning just to walk to the kitchen for a cup of coffee. I hated wearing shoes that were two sizes too big so they could fit the brace.

I googled alternatives and found the Freedom Soft Footdrop Brace (center). I discussed it with my since-dismissed physical therapist who said it wouldn’t give me enough support. I ordered it anyway (July 2010, $120). By allowing more ankle flexibility, my muscles strengthened.

When I started with Arbi (Feb. 2011), he said, "Marcelle, why are you wearing shoes that are too big for you? No wonder you walk funny." He directed me to a  sports brace (right). It was only $20 and I could wear it with my regular shoe size!

The first few days wearing that brace my foot felt like it was going to roll over and break off at the ankle. I questioned Arbi – but he was firm and so was the brace. Within weeks, my ankle strengthened and, in July 2011, I stopped using a brace. Period.

I read in a fellow survivor’s blog that she had become dependent on her AFO because it had prevented her muscles from developing. I don't know if what I did would work for everybody. But I am glad I ignored the skepticism of my first PT and trusted Arbi enough to follow his advice. Half the battle is knowing who to listen to and when to listen to yourself.

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Unbrace Yourself

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Up Stroke

Goodbye, Urvashi

Grace Carpenter
My Happy Stroke

Monday, August 23, 2010

Torturer. Slave-driver. These are some of names I call my physical therapist, Urvashi. But actually, she's been great. She works me hard but always makes me laugh.

So I'm a little sad that Thursday I finished with PT.  I'm also worried: I still have a lop-sided gait; a ten-minute walk exhausts me; and my knee is very, very wobbly. But Urvashi says that I'm much stronger, and I can do most of the exercises by myself. She also said that my gait will improve as my sensation returns, and maybe I will need more PT down the road.

I will miss her.

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Goodbye, Urvashi

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My Happy Stroke