That pesky right handed thing

When brain injury disables your subdominant side, you have a decision to make. Allow you dominant side to dominate, or buy in to bilateralism? By Billy Mann

This post coincides roughly with the follow-up consultancy appointment at Dr N Ward's Upper Limb clinic at NHNN in Queen Square. In the time since finishing the 3-week intensive Upper Limb Bootcamp in January I have noticed that one problem with turning routines into habits is that the process is made easier if they can be absorbed into existing procedures. I can add shoulder-blade strengthening exercises to my existing gym routine. Ditto ball bouncing while walking. But other routines, especially the ones that targeted the use of my left hand such as carrying water glasses, eating and typing are hindered by the fact that I am right handed and my dominant side naturally will always prevail over the subdominant left side. This means that special measures need to operate if I am to cultivate a more balanced use of both limbs. I have to choose deliberately to drink one cup of tea per day left-handed, or to set aside time for typing exercises. This makes habit forming a lot more difficult and noticeable improvements a lot slower. 

Still, as I discovered just this morning while emptying the dishwasher with my left hand only, just after repositioning the kettle to preclude the overuse of my right hand, it is worth the effort. I only have to look at my improved typing (both hands and many fingers now) to know that. Another thing I have just noticed is that I can make progress in tea drinking by grasping the cup with my left hand rather than trying to fine motor it using two fingers and the handle, upon which my hand begins to shake, with potentially dire consequences.

It's the psychology, stupid

A revealing moment on the treadmill forced Billy Mann to ask whether real progress in post-stroke rehabilitation can ever be felt while you are actually in the process of doing it?

When I pitched up at the NHNN rehab unit back in January of this year for an Upper Limb Bootcamp, I was quickly placed in the charge of the archetypal therapy tag-team of physio and OT. When I had been there two years earlier immediately following my stroke and emergency surgery, a psychologist and a social worker were also part of the squad. This time, the absence of a social worker was not a surprise, but I did think a psychologist's input might be useful. I guessed that in the consultancy process it was decided that I had little need in that respect, which was reassuring. But since motivation forms such a key part of rehabilitation, psychology surely has a role here. 

It is only now, after some time to reflect, that I believe that one of the strengths of the intensive programme is that the psychology is embedded in the experience of the process. It's, like, existential, innit? Is that laughter I can hear? have I strayed too far into the land of Pretension? Let me outline an example and you can decide. 

On one day, Jo, the physiotherapist in charge of my treatment, was off sick and my session was taken by another physio, Fran, who started by asking me whether or not I could run. I answered quickly: "No." Fran then asked me if I had ever tried. "No, but ..."  I then told her of the time a bus driver failed to stop when I had signalled but was then halted by a nearby set of traffic lights. My anger at the driver's conduct impelled me to pursue the bus in order to offer the driver a piece of my mind. So, I tried to "run" after the bus, but my left leg would not co-operate and I was left stranded and very frustrated on the pavement, waving my walking stick and shouting "tosser". 

Fran laughed politely, but of course she now knew that I had the "desire" or the motivation to run, which from a therapy point of view could prove valuable. She then invited me to step on to the treadmill and started me walking at a slow pace, increasing it gently until I had found the momentum of a brisk walk. She started to crank the speed up, to a point at which she was barking at me "run, run run." I frantically tried to obey, flapping my left leg around. All the time Fran was standing casually to one side of the machine, with her left elbow hovering over the red "emergency stop" button. She eventually slowed the machine to a fast walking pace, which was both more comfortable and I suspect more therapeutically useful. 

As soon as I left the session, I sent an SMS text to my wife boasting "I have just been running."