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I know why my arm nd hand don't work



hello All,

I'm a 38 year old woman who is a stroke survivor. last year at the end of April I had a pretty large right midle cerebral artery stroke. I'm also a vascular(stroke) and endovascuarneurosurgeon. Since my stroke I've one a lot of thinking about neurological defecits and recovery. I initially had a very severe left sided hemiparesis that involved my face,arm, hand and leg. My core strength and trunk muscles on the left were also affected. Initially I could neither sit up nor hold my head up. I'm happy to report that I have regained a lot of my former strength but I'm not finished as I still use an AFO and a cane to walk and I do not have use of my left arm and hand yet. I'm writing because I had a revelation today :o). I know now why my arm and hand are lagging so far behind my leg. I still have great difficulty bending my knee when I walk and lifting my toe(ankledorsiflexion)but I can walk 25 inutes on a treafmill and my speed has also been improving I can even walk without my brace and cane for short distances. so, the leg... coming along nicely.... the hand an arm...? not so much. well I figured out why. I simply havent tried as hard with my arm and hand as I have with my leg. When I first stroked I fell inmy bedroom and lay there for about 7 hours. I was nable to sit up and when I got out of bed my left leg collapsed underneath me and I hit the deck where I remained unbtil my husband came home that evening.When I got into rehab, about 1 week after the stroke I still had fantastic wakness of my trunk and leg as well a my arm. A week or 5 days after I got to rehab however my therapis t asked me if I was ready to try walking. I eagerly said"Oh yeah, of course." My first walks required a minimum of three and sometimes 4 people to assist me. One person followed behind me with my wheelchair in case I got too tiredand neded to sit. A second blocked my left knee, keeing it from buckling again once my weight was on it. A third therapist used to slide my left foot forward for me because I wasn't able to do it on my own. I walked like that with a team crowded around me and my first after strokes walks I was a max assist 3-4 person walker. but I still got up and tried and 'walked' everyday. My point is I wan't really able to walk but the drive to stay out of a wheelchair was so great I got up everyday and tried. I must have walked like that everyday for a month before my brain figured out how to bring my left leg forward. Once it figured that out my therapist no longer had to push my left leg forward for me and eventually I was abe to straighten my leg with enough force tht it didn't buckle either so I needed one less person to walk me eventually I became a 'contact guard' patient and could walk with one person who stayed nearby in case I lost balance. By that time i was able to keep my left leg straight, even under the weight of my body, and i was able to slide my left leg forward onmy own. Point is, even though I coudn't walk initially I kept tryng and eventually I was able to walk. Well my brain must have received1000 requests to move my left leg forward before it figured it out. The 'requests' came from me trying to do this thing that I couldn't at the time do. After all those requests, my brain figured out a way to move my left leg and it did Since then I've taken easily 1 million steps. that's a lot of'requests' being sent to my brain and my gait, though still impaired is a lot better tan it used to be and I've got video to prove it to myself {Whenever I get discouraged I look back to those old videos :o0 So I asked myself honestly. why isn't my arm/hand back.? Iv been going to OT and doing my excercises adnd weight bearing reigiously. So what gives? Then I thought about it in simple numbers it took lots and lots of'requests' to move my leg before my brain figured out how.In a single day I ask my brain to normalize my gait with evey step and I take hundreds of steps per day There isn't one movement or action that I ask of my arm with that kind of frequency. And that I believe that is why my arm and hand aren't back. I haven't been sending enough 'requests' to my brain. Recently I've been trying to do more things with my left arm andhand lik open my office door.Everytime I try I get frustrated and give up and use my right hand:o|. because of my spasticity I am not able to extend my arm or open my hand so I hven't been able to open the door. I stopped and thought about the numbers... truth is I know I haven't tried a thoudand times or even a few hundred times so of course my brain hasn't gotten the message, not enough 'requests' being sent. I'm a neuroscientists and I know that neuroplasticity ( the ability of a brain to rewire itself ybypassing damaged ares is real but it doesn't jus happen because we want it to. we've got to send 'requests'. And I mean LOTS of requests. I must have taken'maybe 1000 steps before my brain found a new pathway to enable me to bring my left leg forward.There isn't 1 thing that I've tried to do with my left arm 1000 times and that. I believe is why it isn't back yet. I've just got to stomach the frustration and deal with it & keep trying. My first steps after the stroke weren't pretty but they were and are so cherished by me. I simply kept trying to do something I could not do and my brain eventually figured it out. So Im going to just keep tryng to do things with my arm that I cannot yet do until it figures it out and I know it will because I'm not giving up on my arm or my hand. I'm not giving up on me. I wrote this similar content to aother survivor here and then got up from my desk to go to the bathroom. I tried again to open my office door and although my hand didn't open I got my arm extended away from my body just enough to get my fist on the lever which I then pushed down and then I pulled my door open with my left fist.:o) I walked to the bathroom with a HUGE grin:o) because Im practicing what I preach and it's working so keep using the parts that don't work. because that's how you will get them to work. If your early walking was as difficult and impaired as mine you'll only have to look back to your own experience and think about it how many steps did you take or try to take befor you were ale to ambulate at your current level and then ask yoursef; have you tried to do anything with your affected aram or hand with that high a frequency..?Ifyou're like me, probably not. Avoiding the wheelchair was a huge incentive and eventhough those early steps were with tons ogf assistanc I kept trying to move my leg fomyself and when I couldn't they'd push it forward so I firmly believe its in the effort of simply trying I couldn't move my leg at first but I kept trying (ie sending requsts to my brain...). My attemps to move my leg are what enabled my brain to find a new way to move my leg :o) Hang in there survivors.Im not stopping unti I post a picture of me with both hands in the air, palms open ready to high five all you other fighters :o) we survived ! so now lets persist and persevere and high five each other at the end of this long road. As always all my bes wishes, hopes and prayers for your full recovery d patience in the meantime :o)




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