Bend it like Billy: Yoga

If I turn into a Yoga Bore, feel free to shoot me, says Billy Mann. In the meantime ...

To the innocent bystander, the transition from tai chi to yoga must seem like swapping a boiled egg for a poached one. Yes, the two disciplines do have similarities, not least in this case because again we are in the capable hands of Anne and Nora at Headway East London. The key differences between the two (tai chi and yoga, not Anne and Nora) are movement and breathing. Breathing is much more of a BIG DEAL in yoga, and the movement is more structured than in tai chi, aimed often at specific parts of the body. Moreover, whereas you can adapt tai chi exercises into something you can do easily at, say, the bus stop, or in the kitchen while waiting for the kettle to boil, yoga demands more focus, a focus that leads you to "feel" the movements and stretches. 

We started the programme seated, which is a gentle way to introduce the movements. The Cat-Cow is a movement that stretches the back and neck by first rounding the shoulders forward then reversing the movement back while tilting the pelvis, arching the back, extending the chin and chest into what is hopefully a sort of elegant s-shape. Not sure I quite hit the mark on that one. The word elegant did not spring to mind. We went on to do some moves where we sit, hands together, elbows pointing right and left, in a sort of praying pose. Then we breathe in, extend our praying hands skyward as if reaching for heaven, then hold, breathe out, breathe in, extend hands towards the outer reaches of the universe, and hold, breathe out, breathe in, and slowly move your arms back to planet earth in a forward stretch that again arches the back, sticking out your chin and staring meaningfully at that spot on the wall. You then bring your arms first down to the side of your chair, then gather up your hands into your lap in what is supposed to look like a dignified, enigmatic yoga-type pose. I was convinced that I looked the part, but that could have been delusion kicking in.

If this is as far as I ever get in yoga, I shall be quite happy. The Cat-Cow thing could, in my view, be done easily while sat on the toilet. Who knows, we could have discovered a revolutionary aid to comfortable defecation? Send me the cheque. Anyway, I have already been able to build it into my daily routine to the extent that I can sit, stock still, in a straight, aligned and yogistically perfect way (or so I imagine) watching Midsomer Murders and not feel like a dickhead. It helps having a wife who is a Yoga Bore. 

So, well done Yoga. Well done Anne for making it so easy for someone who probably would have previously shot anyone who dared to suggest my life might be improved by this Total Hippy Nonsense. I was wrong, you were all right, and I surrender. Defeat, bring it on xx

Out on a Limb

Nora began the second Tai-Chi class at Headway East London by saying that this week there would be less talking and more action. I'm not sure ACTION was the best word for the level of tai-chi we are at, but you can see where she's coming from.

We revisited the moves we had been introduced to in the first session, but Nora added some seemingly small additions. This, I have come to realise, is very much the tai-chi way, to build very slowly but deliberately. The ball thing is still an enigma wrapped in a mystery for me, but by 'shrinking the size of the ball' to something like the proportions of a tennis ball, I think I might have found a way forward. I even found myself cautiously handling an imaginary sphere during the ad break in Midsomer Murders. Thank goodness I was safely hidden indoors because I must have looked like a right weirdo.

The weight-shifting from one foot to the other in the standing position also progressed to include lifting the heel of the resting foot. This tests the strength and balance in both legs and increases your awareness of any limitations. Nora described this action as floating, but for me it was more of a spring in the step. 

These additions to what we had already learned further established the idea that practising ta-chi is for life and not just for the duration of a short programme. For me it has multiple advantages. Unless I can make exercise a routine and a habit, it is something that becomes all to easy to neglect. In this sense, tai chi  is a good fit because already I actually ENJOY doing the moves. This might have something to do with their simplicity, but who cares? Simple is OK by me. And if I enjoy doing something (writing and drawing, too), I am more likely to continue. As that man says in the film Casablanca, this could be the start of a beautiful friendship.

The slow movement

Today at Headway East London I joined a six-week introductory programme in Tai Chi, run by physio Nora with assistance from Anne. I had some limited prior experience of Tai Chi and had found some of the very slow, low resistance movements, as opposed to the high energy combat stuff, useful in everyday life. The basic moves are relaxing and offer an opportunity to focus and think about nothing in particular. 

We practised some centering and balancing positions before moving on to that thing they do with the imaginary ball, which I had never previously been able to get the hang of. I am not quite sure I got it this time, either. Maybe I was allowing my "monkey mind", or whatever it is called, to boss my head around too much. But I did manage eventually  to get some sort of meaningful movement to work for me by rotating my hands, so that rather than holding the imaginary ball with both hands parallel and facing one another, I held  it in a position in a way that looked like a polite handclap poised and waiting for the moment of contact. That is about the best description I can come up with, I'm afraid.

The other tip I have taken and exploited from Lesson 1 is the balance and centring movement in which you stand, feet hip-width apart, and very slowly and almost imperceptibly shift your weight from one leg to the other, attempting all the time to 'root' your feet in the ground. This movement is very relaxing and almost hypnotic/narcotic in how it forces you to surrender control of your body. It progresses to a tiny lift of the feet on to your toes with each movement. This offers up the kind of dancing motion I have been searching for and is one movement I will be using a lot. It has also helped in developing a method of walking (without stick) in a gentle sway, which I hope will come to relieve some of the pressure my current robotic style of walking inevitably places on my hips and knees. 

Things for me to work on are deep breathing (in and out through nostrils) all the way down to the abdominal core. I can do this in isolation and feel the benefits, but doing it while in movement is, for me, a different matter. I shall keep going with that and report back. 

As Nora told us early on in the session, you are a beginner in Tai Chi for at least 10 years. 

I'm in no hurry.

Memory: the elephant in the room

When he noticed that song lyrics seemed immune from memory loss following brain injury, Billy Mann got to wondering what it is exactly that stimulates our ability to recall and recollect

There are advantages to having a brain injury. At social and formal gatherings you are allowed to forget things. You can walk into a room, be introduced to half a dozen people and instantly forget their names. Then, when you bump into one of them later, they forgive you when you whimper, pathetically, “I’m sorry, but I’ve forgotten your name.”

Memory problems are very common among people with brain injuries. One day a week, I attend Headway East London in Hackney. Some of my fellow members there cannot remember my name from one moment to the next. One of them, Sharon, who I have now been happily greeting each week for around two years, stares at me, her face screwed up in quizzical concentration. 

“It begins with a B...” she says. 

“Yes,” I answer, and wait a few beats. 

“Bobby?" 

"No. Billy." 

That we have arrived at B in two years is, I like to think, some kind of minor miracle.

Another member I see regularly is Stuart, who also suffers from acute memory problems. Stuart and I have a part-share in a backstory. We are both a similar age and we both lived in Liverpool during the late 1980s. Like Sharon, Stuart greets me each week with a confused and inscrutable look. He will then take a guess at my identity. 

"Scouser?"

What both Sharon and Stuart share, other than their difficulties with short-term memory, is a love of music. In Sharon's case, this comes down to a girlish infatuation with The Osmonds, an American family group popular in the 1970s. They were five brothers — Alan, Wayne, Merrill, Jay and Donny. Other Osmonds (Mormons, big family, etc) also enjoyed some commercial success on the 1970s music scene, notably Marie with a memorable song, Paper Roses, and Little Jimmy Osmond with a cheeky number titled Long Haired Lover from Liverpool. The Osmond Brothers themselves had many hit records, but the one that comes to mind right now is 1974’s Love Me for a Reason. It comes to mind because with those five words Sharon's memory is thrown on to some kind of neurological dancefloor and the words come flooding back: 

Don't love me for fun, girl

Let me be the one, girl

Love me for a reason

Let the reason be love

In 1995 the boyband Boyzone attempted their own version of the song, but as Sharon is quick to remark, it was nothing on the Osmonds’ rendition. She might have put it less politely.

The routine with Stuart is similar. In his case we have an ongoing exchange relating to music from 1970s-80s Liverpool (Stuart was a performing musician in the city then). Our first meeting point each week normally involves an exchange of lyrics from a band associated with Liverpool called The Scaffold, a trio that actually started in the heady days of the 1960s and enjoyed notable success during that swinging decade. They were a performing ratatouille of comedy, poetry and music featuring Mike McGear (real name Peter Michael McCartney and brother of Paul McCartney), Roger McGough (he’s that Poetry Please guy off the radio) and madcap funnyman John Gorman. Each week Stuart will smile brightly in my direction and say “Thank you very much for the Aintree Iron” (a line from the Scaffold song Thank U Very Much), to which I will reply “Did you get your medicinal compound, Stuart?” (from the Scaffold song Lily The Pink). Stuart catches on to this game without hesitation and answers with another lyrical reference to Lily The Pink. 

“Yes, most efficacious in every way.”

Clearly both Sharon and Stuart have a thing about song lyrics that makes words stick in their heads. It is a joy to witness, and obviously a potential open door for therapists. But part of me wonders what other memory triggers are sitting hidden in damaged brains everywhere. Could I, for example, attempt a not-so controlled experiment in which I appear casually to mention the character Boss Hogg from the 1980s US TV show The Dukes of Hazzard while actually fishing for a bit of anecdotal evidence on the importance of popular culture in understanding a badly misfiring memory.

Memory is a strange fruit. It is part of that thing we would like to call our soul, but we know little about it. At best I am prepared to stick my neck out and say that memory is the slippery customer that skates the thin ice that separates the neuro from the psycho. There is also something about memory that repels fiddling. Mess around with it and you risk the wrath of the gods, etc.

Which draws me back to where I started. There is another advantage to having a brain injury. I call it the Automatic Exit Strategy (AES). When you are at a social or formal gathering and starting to glaze over with boredom right in front of someone, you can just say, “Sorry, I have to go now” and they won't turn to the person next to them and say, “How rude was that?” I have an agreed version of this with my wife. I say, “I’ll just go and sit down and shut up, shall I?” to which she replies, “Yes, please.” 

OK, then, that's my cue to leave the table. Bye for now. And don’t go trying to tinker with any of those memories while I’m gone.

Sharon is not her real name.

Club 300 Closes: but did it work?

A project to test the theory that 300 repetitions results in improved performance has come to an end. And the results are in. By Billy Mann

The Occupational Therapy project at Headway East London I posted about a while back has now finished. To recap, Club 300 as we cheekily called it, brought together four members of Headway East London, each of whom wanted to gain some improvement in the execution of an everyday task. Two members wanted to improve their handwriting, another wanted to cut up food on a plate more confidently, and I tasked myself with the mission impossible of walking without a stick while holding a cup of water in my weaker left hand. 

If you want detailed information on the results of this exercise, the OT in charge was Natasha Lockyer. I cannot discuss how others performed, but to finish the analysis, the tests we performed at the start were repeated at the end and the change recorded. At the start, I had walked a given distance (not sure what it was) holding a cup in my left hand filled to near the top with water in 46 seconds, and I spilled around 10ml in the process. At the end, I walked the same distance in 18 seconds and spilled no water. Get me, eh? Top of the world, Ma.

In my daily executions of these 300 steps, I determined to make the task more difficult as my performance improved. This, I am afraid to say, has fallen by the wayside in favour of basking in the success of spilling no water. Still, I do continue to perform the routine every day (or thereabouts) and continue to notice a difference. I shall report on my progress as and when something of interest happens, and I will ask Natasha if a re-run of the test in, say, 6 months is possible. Only then will I be able to declare Club 300 a giant leap for mankind.

One Small Step: Learning to carry a cup

Learning to carry a cup in my left hand, while walking. It's not as easy as you think, says Billy Mann

This is the third week of an Upper Limb OT project I am following devised by Natasha Lockyer at Headway East London. The idea is based on research that has indicated that 300 is a magic number of repetitions post brain injury to deliver meaningful brain change. So, if you perform a given routine activity at 300 repetitions daily, in this case for 6 weeks, lasting improvement in the execution of that task will result.
This sounded plausible to me, so I said I would give it a crack. We have called the group Club 300 for a bit of a laugh. One member of the group is practising cutting food (ie, Theraputty) to develop the fine motoring of her right hand. Two others are working on handwriting. My task is to walk 300 steps daily with no walking stick and a cup of water in my left hand. This is a sort of continuation of therapy I was introduced to at a 3-week intensive Upper Limb clinic I attended at London’s National Hospital for Neurology and Neurosurgery earlier this year.I think it is probably a statement of the bleeding obvious that this regime got off to a stuttering start. Having made some initial measurements as a benchmark against which progress can later be recorded, I set about repeatedly walking back and forth with a cup of water in my left hand. The movements, as Headway East London staffer Anne noted, were comically robotic. I managed to tip water all over myself on several occasions and came away from the session with a very wet pair of quite expensive shoes. Slowly, however, and with Anne’s help, I started to improve. The main problem for me was one of focus. My concentration flitted from the cup of water to the uneven paving in front of me. With practice, and via a not entirely unexpected echo of the ‘cognitive distraction’ I have described before, I found the best results (ie, not much water spilled) by fixing my attention on a distant object (in this case, a wall) and humming a tune while walking. 
As they say in court reports, the case continues. Watch this space.

Talk The Talk: 'Finding words' after brain injury

'Finding words' after brain injury. The process of discovery can be both bewildering and endlessly challenging, says Billy Mann

I read a report recently with the headline Comedians’ ‘gift of the gab’ linked to differences in brain activity and it occurred to me that as I have recovered from the effects of a stroke more than two years ago I have become more articulate. I have no idea whether the two are causally related. In fact, I have no idea whether I have actually become more articulate (my wife is doubtful), and I am not sure how this could ever be measured. All I know is that the words seem to flow more easily, if that is a definition of articulacy. I cannot be certain how easily they flowed before my brain injury, but I do recall incidents in which I felt “tongue-tied” or “lost for words”. Now instead I sometimes feel verbally incontinent. The experience of not finding the right word at the right time is not unusual. Who has not emerged from a stalled conversation and not reflected later that “I wish I had said that…” Not now. Not for me, anyway. In fact, I suspect sometimes that my brain injury has left me with a special variant type of Tourette’s in which I can’t stop saying what I think.