hospital vampires

Hospital vampires, beware of them, they do exist
I wrote this when I was still in the hospital. Practically every morning when I was in the hospital between 7 am. and 7:30 am one comes in the room saying I'm from the lab and need some blood work done. It seemed that every other day the vampire came for me. The one this morning was very polite, asking which arm I wanted to offer him. His prehensile fingers expertly put a tourniquet on the arm and cleaned the selected spot with an alcohol swab. He even thanked me for good gusher he selected. After he was done he thoughtfully put a cotton swab over the puncture and taped it down. I personally think this was more for hiding his victims from the other vampire residents than for his concern for me bloodying the sheets.
You can tell when the place is infested when the tourniquets are strewn around the room., They look like 1 inch wide flat rubber bands, blue. When I first got to my room there were two tourniquets draped over the bed rails and one on the door knob, I should have screamed bloody murder and requested another room but I was naive about the safety of hospitals.
No wonder I was exhausted all the time and could fall asleep in the 10 minutes
between therapy appointments. And there weren't any young women to distract him, just us middle-aged and old codgers.
Beware

demylination and stroke rehab

After nearly three years I finally decided to see another neurologist at a different clinic. It was quite interesting that there was no real interest in the MRI I brought along so I made the assumption that he was not interested in determining a diagnosis of my deficits.I was asking some difficult questions of him that he had no idea on. The first was whether I could go insane because neuroplasticity had taken over my cognitive functions in order to relocate my motor functions. He said it wasn't possible because the routing of nerves from the motor functions would no longer function because those nerves would have demylinated from lack of use. (What a load of bull - there are enough instances of recovery years later to disprove this.) I asked him if this was the same problem that MS patients have. I think he was just blowing smoke to try to bamboozle me with big words. He did suggest that maybe I wanted to try the RIC (Rehabilitation Institute of Chicago). That won't be occurring because Chicago is an 8 hour drive for me, so I will continue on the do-it-yourself plan. I have been unable to find any research that shows this to be the case.

And the questions I asked will be nothing compared to a high-powered Type A baby boomer.

Motor memory and stroke rehab

I have been reading books on the brain . The latest one was A User's Guide to the Brain by Ratey, John J. In it was a discussion on motor memory which led to my thinking that maybe it is possible to reverse engineer this so the memories of movements can be laid down as actual movement control in whatever new location is possible. I used to be a computer programmer, at times when we lost the programming source code we would take the load module and disassemble it back to actual coding statements. Similar to reverse engineering an iPhone to see how it works. Why couldn't we try the same thing with motor memories or whatever lost functions there are.
Talk about pie-in-the-sky ideas, I think too much about all things stroke related.

Alzheimers and stroke

The following is a series of comments on a stroke forum where survivors worry about getting alzheimers. In a class I took the instructor stated that 40% of Azheimers diagnosises were wrong, mainly because general practitioners don't have the knowledge or ability to correctly diagnose it.
And sometimes brains from other sisters who appeared mentally intact when alive show extensive evidence of the disease.Findings from Nun Study Show Contradictions of Alzheimer's Disease
 I take this as hopeful so even if you have extensive Alzheimers you can still be mentally sharp. Which is quite a relief for me considering this article.
Research illuminates link between Alzheimer's and stroke
For years, neuroscientists have known that the risk of Alzheimer’s disease is nearly doubled among people who have had a stroke.
Research illuminates link between Alzheimer's and stroke


This particular article now speculates that what was normally considered to be a sign of Alzheimers -namely tangles and sticky plaques may actually be a sign of the fight against it. Which means to me that the nun study I quoted was probably not accurate New Science Sheds Light on the Cause of Alzheimer’s Disease
And AARP has better information than any of our stroke associations.

And then there is B vitamins - B vitamins may slow brain shrinkage
Although when I told this to a nurse, she said overdosing on B vitamins is not good.
I may have to figure out how to add to my brain reserve.The brain's reserve cells can be activated after stroke


You know the drill, don't listen to anything I have to say, ask your medical staff for information on this subject. If you are really lucky they won't say
'I know nuthin'

dead brain recovery options

Since I have huge amounts of dead brain these are the therapies I am using to try to get them moved to another location. This is not actually recovering the dead brain, it is trying to move the functions that area of brain controlled to another place. This is probably the hardest thing to do, especially with no research guidance or medical support on how to do this. So this is just my opinion only, try your doctors to see if they have anything better and then reply here.

mental imagery:
Andrea Zimmermann-Schlatter*1,2, Corina Schuster2,3, Milo A Puhan4,
Ewa Siekierka5 and Johann Steurer4
http://www.jneuroengrehab.com/content/pdf/1743-0003-5-8.pdf
Using Motor Imagery in the Rehabilitation of Hemiparesis ,
Mental imagery for promoting relearning for people after stroke: A randomized controlled trial1 , *1 .
Archives of Physical Medicine and Rehabilitation , Volume 85 , Issue 9 , Pages 1403 - 1408

Mirror-box therapy: Rehabilitation of hemiparesis after stroke with a mirror
Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn DME, Ramachandran V
The Lancet - Vol. 353, Issue 9169, 12 June 1999, Pages 2035-2036

Passive movement: http://www.ncbi.nlm.nih.gov/pubmed/15003755
The effects of repetitive proprioceptive stimulation on corticomotor representation in intact and hemiplegic individuals.

Thermal therapy: http://stroke.ahajournals.org/cgi/content/full/strokeaha;36/12/2665
researchers found that cycles of heat and cold significantly enhanced the
sensory and motor function in the arms and hands of stroke survivors after a few weeks of therapy.
Music therapy: I am way too late for this to help but this should be part of every survivors' therapy in the hospital.
http://www.msnbc.msn.com/id/35502970/ns/technology_and_science-science/
http://www.epsychology.us/rhythm-of-life-music-shows-potential-in-stroke-rehabilitation/
https://web.archive.org/web/20090726073749/http://hubpages.com/hub/Music-Therapy-Healing including Kenny Rogers
I don't think I could have handled Kenny in the hospital.
Lucid dreaming: This one is just my completely off-the-wall idea. Why waste the time spent sleeping. Of course I have no proof/research that supports this. I try to dream using my pre-stroke abilities.
Do not take any of this as medical advice

Penumbra identification and recovery for stroke rehab

This study on the penumbra kind of reflects on what I consider to be necessary.
http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00444.x/full
 Mainly that the penumbra be identified so therapies can be directed for that damage
as compared to dead brain damage which should have completely different therapies.
Reading this is obviously not for laypersons, it may as well be written in Sanskrit.
 I did ask the question on PhysioBob if the therapists there had different protocols for penumbra recovery vs. dead brain recovery, but no one answered. I hope that was just because they don't answer survivors rather than they didn't understand the question.
At least it does prove that PET scans can visualize the penumbra.

Cane exercise for stroke rehab

This is not medical advice, just something I do.
Found a couple of exercises to use with my cane.
For flexability in the shoulder and ROM(range of motion) I started by using the pulley over the door, but that was only available in one place and it was extremely hard to get my hand open enough to grab the handle. So I tried something different, Putting the grip handle of my cane in my affected hand, I grabbed the lower part of the cane with the unaffected
hand and used that to push my affected arm up. First straight in front of me , then to the side and eventually to the rear. I would try to get my affected hand to the level of my head, After a while I could get it well above my head. Next step was to move the arm around in a semicircle around my body as it was up in the air. I first had to use the unaffected arm to push the affected arm around but was able to get the affected arm moving by itself. A recent addition is to put the grip of the cane in my affected hand and push the left arm straight out to the side and then place the tip of the cane on my hip. I then try to move my arm behind my back, this stretches my spastic pecs out and forces my biceps to quiet down.I know this has helped both my arm swing and relaxing my biceps. This de-weighting of the arm has led to other similar advances.
For working on my triceps I used my cane also. First sit down on a chair and place your cane in front of you, affected hand on the grip, tip on the ground, starting out you can use your unaffected hand to fully extend your affected arm. As you get better at this you will be able to use your affected arm only to extend your arm and then pull it back. I started out by doing 50 reps of these nightly, ended up doing them also when waiting at a bus stop bench, or when sitting in a waiting room. For working on your shoulder muscles when your arm is extended straight in front of you,move your arm to the right and left, seeing how far down you can go. This I use to mimic moving the steering wheel on a car.
By using the cane in these manners I am carrying around my exercise equipment all day long.
Remember you didn't hear this from me, ask your therapist first

Neuroaid and stroke rehab

I was answering a question on the MedHelp forum that was posted by a Neuroaid representative. My answers were as follows.
This was an interesting blog posting on the ancient chinese medicine.
http://skeptigirl.wordpress.com/2009/02/12/cam-taking-advantage-of-stroke-patients/
It confirms my thoughts on magical stroke recovery.
Here is a clinical trial but I couldn't read it.
http://www.clinicalconnection.com/exp/ExpandedPatientViewStudy189961.aspx

They replied back listing this research as proof.
http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=000155220
I read this and pointed out that this sentence in the report showed that there was no scientific benefit.
The impact of Neuroaid treatment cannot be differentiated
from the contribution of natural recovery, medication and physiotherapy effects. However, all cases reported
improvements.

And the next day I went back and the complete posting was gone. I think I haven't been banned from the site yet due to stepping on toes. Oh well, I may have to use another alias, Zorro here I come.

24 hour-a-day stroke rehab therapy

My therapy seems to continue 24 hours a day.  There is nothing here that is clinically proven but I believe that even minimal tries every day will eventually produce neuroplastic change.
This knowledge came from reading lots of books, mostly Stronger After Stroke by Peter Levine. Everything I do has to be looked at in terms if it will help my recovery. I'm left side affected with at least half of my motor cortex dead and all of my pre-motor cortex dead, no real damage to my sensory cortex. This diagnosis did not come from my doctor since he never even showed me my MRI, I figured this out myself by joining a research study that did an fMRI scan on my brain. My sensory cortex supposedly was not affected but is less than before so I am assuming that it was routed thru the motor cortex across the central sulcus to get to the correct nerve endings. And since the motor cortex is mostly dead I have to find a new pathway to those nerves. This is rather depressing that I have to do all this self-diagnosis myself.
Since I am 4 years out I am way past the normal spontaneous recovery of the penumbra of the stroke. This means that all the work I am doing is to neuroplastically move control of dead areas to another location in the brain. The concept I am working on is to at least get some movement by passively moving body parts that don't work. Passive movement does have some research backing it up. http://www.ncbi.nlm.nih.gov/pubmed/15003755

Normal day, going to work.
Breakfast is pretty much a one-handed affair. I don't have finger extension yet to be able to hold my bowl of cereal with my left hand.  I can't keep my arm on the table due to spasticity constantly pulling it off, My OT tried to use opening the refrigerator door with my left hand as a therapy goal but since the fingers still haven't opened that one is still a failure. Zipping up a coat is still a challenge with the limited pinch grasp I have. I walk 2 blocks to the bus stop with my cane. I use a cane to get to work because the Messenger bag I carry pulls me off balance. At the corner waiting for the bus I lift my left foot up to the top of an 18 inch high rock. this mimics the stair stepping my PT always had me doing.After that I stand on my right leg and pull my left leg back until it rests on my left toes, this is trying to get my hamstring to fire. Then comes standing on my left leg and stepping back and forth with the right leg, good for all the little muscles that fire in your legs to keep you balanced, if necessary I use the cane in my right hand for balance. This came from a Tai Chi class I took. I add using my cane for PROM movements of my shoulder. On the bus ride itself I have to decide if I should work on keeping my arm straight, trying to stop the spasticity in my bicep, or flex my fingers open and closed with my good hand.
At work, I use my good hand to guide me bad hand with a single finger pointing down to type. Sitting in my work chair I pull my left leg under me, trying to fire my hamstring muscles.I try to dangle my arm over the side of the chair to let it know that it can relax and hang straight. Washing my hands at the sink I have to open and close the single lever faucet with my bad arm/hand. Then I go to the stairwell and do a set of 50 toe raises.
Waiting at the bus stop at night I raise and lower my lower arm 50 times. Next is knee bends on the left side, just going down enough to unlock the knee and then straightening it out again. On the way home I stop at one of our apple trees in our yard and put the affected hand around a limb that is at shoulder height, push and pull with the biceps/triceps. Sitting on a couch reading requires either sitting on my flattened hand or keeping the whole arm straight next to my leg.
While sitting I rotate my arm outward from my leg, even if it is only 3 inches at a time.
Eating at the table I just put my left hand flat on the table next to my plate, just trying to keep it in one place is a workout quieting down my spastic pectoralis and bicep muscles. I sneezed once at the table and swept all my dishes to the floor, so now I grab my affected hand as soon I notice a sneeze coming. In the shower at night I put my affected hand directly under the shower head trying to stimulate the sensations. This idea came from Sensory Re-education of the Hand After Stroke by Yekeutiel, Margaret. I also have a small fingernail brush that I use on my affected hand. The other trial I work on is hot and cold water on the hand from http://myweb.ncku.edu.tw/~fzshaw/ ASA.pdf
Researchers found that cycles of heat and cold significantly enhanced the
sensory and motor function in the arms and hands of stroke survivors after a few weeks of therapy.
At night I have to decide if I want to sleep on my back which requires putting my affected fist under my butt, or sleep on my side with my affected hand flattened out under my pillow.
Other therapies during a regular day. Riding in a car means either flexing my fingers of my affected hand or straightening my left arm and just holding it straight.
Every time I stop walking I have to consciously tell my left arm to relax and hang straight by my side. This is rather embarassing for a guy walking around to have his bent arm constantly banging into his crotch. As much as possible I try to come up with exercises that engage my triceps to keep my arm straight. I also work on exercising my biceps because exercising spastic muscles does not increase spasticity as your therapist probably told you.
None of this is intended to be medical advice, Just my opinion that if you are going to recover you need to consider it a constant job, either with exercises or mental imagery of those exercises.
My suggestion is that you take whatever movement you do have and work at the outer limits of that movement.
What I have to do is think every single moment of the day if there is some movement I should practise or should I be thinking about that movement. What this means is that I have to do everything the hard way to get to recovery rather than compensatory movements.
This book, The survivors club : the secrets and science that could save your life / Ben Sherwood, was interesting in that it broke down survivors of disasters into 3 groups. 10% would actively become leaders, 80% would follow the leaders, 10% would do nothing. I try to apply this to my stroke survivorship and am working on being in the top 10%.
In further posts I will detail the work I do for rehab.

No rest for the wicked.

21 days of canoeing therapy

In 2009 this was my 'vacation'.A 21 day canoe trip on the Eagle, Bell and Porcupine rivers in the Yukon and Alaska with Wilderness Inquiry. I wouldn't call it a vacation because we paddled every day and I was quite fatigued every day. I ended up being the only disabled person on the trip. Some learnings taken from the trip:
1. The 3-legged folding camp stool was an absolute necessity, Crazy creek chairs are not feasible yet because of the problem of getting up off the ground. This way I could have a lap to set the food bowls and actually eat since my left hand is not usable yet for holding a bowl or plate without spilling.
2. I left my AFO(Ankle Foot Orthotic) packed away for the whole trip. After 10 days I could tell that I was getting a heel strike with my left foot, which the AFO prevents me from doing. Walking over extremely rough ground strengthened my ankle muscles but I could tell I was close to the edge of getting an ankle sprain which really slowed down my walking.
3.By the time the end of the trip came I was able to lift my left foot over the gunwale of the canoe without having someone else lift it out for me.
4. kneeling while in tent. This was pretty much a no-no for any of the rockier sites because I still only have a three-point stance, The left arm and hand still collapse too easily.
5. Moving around in the tent. It was a good thing we had 4-person tents, as I was getting ready for bed I would take up 2/3rds to 3/4ths of the tent as I flailed around getting the sleeping pad and bag ready.
6.Sleeping bag. I have a right hand zipper which you would think would be good since my right arm /hand is still quire useable. Good thing it only got cold on two of the nights. I was able this year to get the sleeping bag zipped all the way up but not able to cinch the drawstring. So I draped my pile jacket over my shoulders. The second night I knew it was going to be cold so I just wore the jacket to bed.
7.Kneeling to paddle in boat. Because these were Pak-Boats they had aluminum tube frames that made it difficult to get my feet into the correct position. In two hours my knees and ankles would be dying. A lot of this was because I couldn't adjust my position after I got in because I couldn't get my left arm/hand down on the gunwale to push myself into a slightly different position.
8. Paddling on the left side. The first day I used the velcro hand wrap to attach my left hand to the paddle shaft. This only worked somewhat well. This was because the lower hand on the paddle shaft slides along it until the paddle is planted in the water. The rest of the trip I didn't use the velcro thing. I could manage about 5-6 paddle strokes before I had to put the paddle shaft on the gunwale and pull the shaft out so the hand was lower down on the shaft. I probably only paddled on the left side maybe 10% of the time due to this problem. Paddling on this side required a lot of concentration and looking at the hand to make sure it was still positioned correcly. Which didn't allow me to look at the scenery.
9. Paddling on the right side. I never tried velcroing my left hand to the t-grip because I observed how my right hand worked by clasping and upclasping the grip on every stroke. I ended up prying my hand open enough to force the T-grip in and curled the thumb around the end. I could paddle anywhere from 3-70 strokes before having to reposition the hand again. The paddle stroke still left a lot to be desired, I was never able to get the full extension on the left arm to get a vertical shaft but it was better than last year where the left hand didn't get off the chest. This year it was at least 10-12 inches out from the chest. Paddling on this side was much better, mainly because I could do it without full concentration, allowing me to see the scenery and talk to other paddlers.
10. Some of our participants calculated that we would need to do around 500,000 canoe strokes. We did around 600 miles, averaging about 30 miles per day in 7-8 hours.
11.finger intrinsics
First some definitions. Intrinsic muscles are those completely contained within the hand/wrist unit. The extrinsic muscles are contained in the forearm and connected to the hand by tendons and provide
most of the power and range of motion of the joints of the hand.
Intrinsics stabilize the hand in fine motor tasks.
I have been working a lot on passively flexing and unflexing my fingers which are the extrinsic muscles, flexors and extensors but have not been working on the intrinsics mainly because I think I need to get the extrinsics working first and I don't know how to start engaging them.
On my canoe trip on the day I ripped the skin off my left palm we were paddling downstream with an upstream wind of 20-30 mph and I was paddling as best as I could on the right side with my left hand gripping the t-grip. My extension of my left arm was pretty poor, only able to get it out maybe 10-12 inches from my chest. We beat against the wind for a couple of hours until we were all forced ashore. After some consultations it was decided to set up camp, sleep and start paddling again in the evening when the wind usually dies down. So we slept from 5-10 pm and started again at midnight paddling until 3 am(24 hour daylight is wonderful at this latitude) I didn't sleep too well because the left hand was aching a lot. I think what occurred is that I totally overworked my finger flexors and the intrinsic muscles in the hand started firing to try to help hold the paddle. This was a wonderful occurence to find out about since it may lead me to a way to get the intrinsics firing again.
12. Tiredness or being knackered as our English friends say. During the rest stops/lunch breaks I could easily fall asleep. This is somewhat of a conundrum since according to my latest physical I have a resting heart rate of 53, which at my age of 53 puts me in the athlete category. If I am an athlete, why am I so tired all the time?
13. Setting up tents was a problem because the tents had sleeves for the poles, not conducive to one-handed help.
On the river we saw black bears, fox, moose, bald eagles, sandhill cranes.
We paddled past the 25,000 acre Porcupine River forest fire, saw some complete trees go up in flames.

Analysis to riding a two-wheeled bike

This is one of my goals. In order to accomplish this there are numerous items to work on. I have to do a lot of analysis to determine what individual pieces I need to work on. This is completely different than how I started on a trike, I just got on and started pedalling.
My balance is pretty good, I can ride my tricycle for hours with no problems, I can stand on a bosu ball for 15 minutes at a time.
1. The up and down motion of the left leg is in a straight plane on my trike, much better than when I first started riding when the knee would swing out quite a bit.
2. Getting the left foot flat when pedaling. Spasticity in my leg causes my toe to point downward when pedalling. The toe occasionally scapes the ground. So far it has not caught anything, but this needs to be corrected prior to the two wheel test. I use the pool at the 'Y' for some of this. standing on the lowest step with my right foot on it. I put my left leg/foot go thru a pedalling motion, also useful for mimicing the walking motion. At the 'Y' I also use the exercise bikes because it is much easier to concentrate on good pedalling form when you do not have to balance the bike. The toe clip is essential to keeping my foot on the pedal.
3. Getting the left foot onto the pedal. This is only possible right now on my trike when I am completely stopped. My hamstring doesn't have enough power to counteract the spasticity extension of the lower leg. Some exercise to counter this; Stand in the pool and lift the left leg to the surface facing the wall so the foot can't swing out. Lying on a mat face down and lifting my left foot up so it forms a 90 degree angle to my body. Sitting in my chair at work and pulling my left leg underneath me.
4.Signalling turns with my left arm. I am passing on this because I know I do not have enough brainpower to tackle this. Also I will only be starting out on paved dedicated bike trails.
5. holding the left arm straight to be able to put weight thru the arm to the handlebars. I do have a city bike so my riding posture is fairly upright but I used to ride with the dropped handlebars all the time and was very comfortable doing that.
I can't use the flat hands and straight arm against the wall because I can't get anywhere close to a flat hand. So I use a shoulder height branch from our apple tree to lean into and push away from.
6. grasping and releasing the left hand from the handlebars. On my trike this is not really a problem. Once I get it clamped on it will stay there. But for a bike I will need to be able to release it. Or I might have to ride the bike into the ground if I fall or try to stop suddenly. I extensively work on passively flexxing/unflexing those fingers. But I plan on wearing my SaeboFlex, it will at least allow me to let go of the handlebars. I will look stupid but that comes with the territory.
7. braking with the left hand. I don't plan on using this because I will be on a flat dedicated bike path. Maybe if I am lucky the Saebo will allow my hand to open enough to reach the brake lever.
8. Getting my left hand onto the handlebar. This will probably have to be done while stopped. I barely can control my whole arm while standing still.
Left foot toe clips. I have this on my trike and will have to install one on my bike. Without this I doubt I could keep my foot on the pedal for any length of time.
This ought to be interesting since the first time I rode a three-wheeler I crashed on a perfectly straight/level path. Obviously this will be a goal for next summer, I can work on the pieces this winter.
This pretty much is not how therapists are taught to work with stroke survivors, they are taught to work on complete functional movements. But since I am nowhere close to the movement needed I decided that the only way to recover was to break down the movements into doable small pieces and then eventually put them together. Since this is not one of the ADLs I shouldn't even attempt this.

You know the routine, Do not take any of this as medical advice.
2 updates, read these before trying this.
http://oc1dean.blogspot.com/2011/07/testing-bicycle-riding.html

http://oc1dean.blogspot.com/2011/08/epic-failure-at-bike-stroke-therapy.html

Failing at the corpse pose in yoga

The corpse pose, or Savasana in Sanskrit, is the most restful pose in yoga. It's the final pose used in most yoga classes, but can also be done on its own to facilitate meditation or relaxation. You lie on your back, legs slightly spread, arms slightly spread out.
This is supposed to be the easiest pose in all of yoga and I can't do it because my bicep and pectoral muscles are spastically contracting and pulling my arm up onto my lap. This also means that when I try to sleep on my back I have to tuck my hand under my butt to try to get the whole arm to relax. I tried an air splint but by morning I had always bent my arm forcing the air out.

3 reasons I survived

I think there were 3 reasons I survived my event.
1. I was in fantastic physical shape. I had just completed a 6 day whitewater canoeing trip in Canada, 23 miles falling 1100 feet, only 5 portages. One of those being 1.5 miles long. On the Dog River Ontario by Wawa. Here are some pictures, I am in the red canoe, red helmet. Dog River album

This is Denison Falls 120 ft. 1.5 mile portage A favorite place to paint by Bill Mason

2. My brain reserve was pretty substantial.
http://www.physorg.com/news154620279.html

3. I received the clot busting drug tPA within 1 hour. Even so the dead area was substantial. I was listed in critical condition the first day. 3 years later my parents finally told me that when they left the hospital that first night they were positive that I wouldn't survive the night. Of course I had no idea I was that bad. And my doctors never told me anything. My cascade of neuronal death had to be substantial.

Left hand stroke therapy

Getting something into my left hand is an interesting exercise in patience. While my hand is not curled into a fist the fingers are not hanging loose. Anything larger than a bottle of soda is impossible to grasp. The top also needs to be sealed, an unopened can or bottle is only possible because I need to be able to tilt it on its side prior to forcing my fingers open. Open glasses will not work because I can't hold it upright and pry my left hand fingers open at the same time. Soft sided styrofoam or cardboard cups are also out. My basic therapy for this is passively flexing my fingers open and closed with my right hand. I used to have a plastic hand splint for nighttime use to keep my fingers straight and splayed but after three years of continous use the plastic rotted.

obstacles to my stroke recovery - spasticity

Sometimes this is called tone, which sounds so benign.
I consider spasticity the largest reason I am having a hard time recovering. My bicep is firing most of the time so instead of my arm hanging straight by my side it is slightly bent. This causes my hand to bang into my crotch when I walk. Sometimes known as the 'dead brain look' Freehand reaching for something is almost impossible because my biceps tenses up preventing me from reaching forward. I'm not sure I have enough brain power to handle two things at once. Telling one set of muscles to relax while telling the opposing pair to extend. If I didn't have to control spasticity first I know I would be able to neuroplastcally move the actual movement to another location in my brain. I am not paralyzed enough to easily recover. If you really want to get irritated google William M. Landau and see what he thinks about the usefulness of spasticity.

Stroke rehab for sensory input

My sensory cortex supposedly was not affected but is less than before so I am assuming that it was routed thru the motor cortex across the central sulcus to get to the correct nerve endings. And since the motor cortex is mostly dead I have to find a new pathway to those nerves. This is rather depressing that I have to do all this self-diagnosis myself. I take a fingernail brush and run it across my left hand. In the shower I hold my left hand under the shower spray. I haven't yet gotten to the thermal stimulation yet, that is dunking your hand in ice water alternating with warm/hot water.

A hot/cold session consisted of two alternating cycles performed five days a week for six weeks. The sessions lasted between 20 minutes and 30 minutes. Thermal packs were wrapped in towels, and applied to the patient's hand and wrist. The hot pack was 167 degrees Fahrenheit, while the cold pack was just below 32 degrees Fahrenheit.

A lot of these ideas came from Sensory re-education of the hand after stroke by Yekeutiel, Margaret.

Stroke rehab and life in the slow lane

This falls into one of our requirements in order to recover. I think this was best put in one of the survivor books I read. The survivor was spending 5+ minutes trying to turn off a light switch when her husband walked by and thinking he was helping turned it off for her. She was not happy as it was one of her rehabilitation goals. I try to use the same idea when using the lever faucets at work, I could get it done in 1 second with my right hand but it takes 5-15 seconds with my left hand/arm. I think I will be in the slow lane for years to come.  
It also means having to accept that I walk slower without my AFO and cane, but you have to take these small steps to get better.

stroke rehabilitation and drop foot

This is an extremely common result of a stroke. The patient can't lift their foot
during walking to clear the ground. The problem is that dorsiflexion is not occurring. The standard response seems to be get them a AFO to lock the foot at 90 degrees. I didn't see any attempt to determine why the dorsiflexion was not occurring.
I can see numerous different reasons and I am not medically trained.
1. The motor cortex area that controlled the Tibialis anterior muscle was damaged and in the penumbra.
2. The motor cortex area that controlled the Tibialis anterior muscle is dead.
3. The pre-motor cortex was in the penumbra.
4. The pre-motor cortex is dead.
5. The executive control was in the penumbra.
6. The executive control area is dead.
I don't know my math very well but I think this leads to 6! 6 factoral or 6* 5* 4 * 3 * 2 * 1 = 720 possible variations as to the cause of dropfoot.
Correction: I asked a PhD friend about this and his reply was;

On your combinatorics question - the 6! = 720 combinations would refer to a situation in which all six items are distinct from each other and for which the order matters. I don't believe that is the case here. It seems to me that you are describing three possible areas for controlling dorsiflexion (motor cortex, pre-motor cortex and executive control) that are always there, and the failure of dorsiflexion happens if at least one of these areas is damaged/dead. So if I call those areas M, P and E and if they are either alright (Y) or damaged (N), then normal control happens for one configuration only:

M P E

Y Y Y

In the second row, there are seven other combinations:

Y Y N Y N Y N Y Y

Y N N N Y N N N Y

N N N

In other words, three areas with are either Y/N leads to 2^3 = 8 total combinations, of which only one is all Y, and the other 7 refer to a dysfunction. Then I would say there are 7 different variations as to the cause of dropfoot.

And we have a one-size-fits-all AFO for this.
The standard seems to be a rigid plastic AFO, sometimes with a built-in hinge.
I received one of these for two reasons, allowing my toes to clear the floor and stop the eversion of my foot.
Currently have quit using the AFO from 1 year ago. The use of it was preventing me from getting a decent heel strike and was not allowing me to build up any muscle strength in my ankle muscles.
I think that there should be a protocol for each underlying diagnosis. In my case I can dosiflex in any position but doing it while walking does not work very well. My diagnosis is that since my pre-motor cortex is dead it was not coordinating the firing of all the muscles of walking. Do not take any of this as medical advice.
Peter Levine has a good description of what you are missing by using an AFO to compensate.
http://recoverfromstroke.blogspot.com/2010/11/make-them-walk-funny-and-look-lousy-in.html

Stroke research questions

I started compiling a simple list of questions that I think stroke researchers need to address regarding stroke rehabilitation. I consider them to be easy questions with difficult answers. Without these answers we are just stumbling in the dark.

1. What is the correlation between cognitive ability before the stroke and complete recovery from the stroke deficits?
2. What amount of cognitive ability is needed after the stroke to get to complete recovery?
3. Can neurons in the brain control two different processes at the same time? ie. Can the area for toe control also be used for finger control?
4. If the previous question is false then how is it decided which functions of the brain are thrown out to neuroplastically recover damaged functions? This assumes that 100% of the brain is in use and the 10% use of the brain is a myth.
5. How many persons go insane while recovering from a stroke? This is a serious question.
6. How does brain reserve get built up again?
7. Why has no one folowed up on Brunstroms six stages of recovery to map exactly what needs to be done to get from stage to stage?
8. How much sensation is needed to fully recover motor ability?
10. What needs to be done to bring back proprioception?
11. Which therapy is best for getting a new area to start performing functions from a dead area? Passive movement, mirror-box therapy, or mental imagery?
12. How many passive movements are required to start neuroplasticity?
13. Does the laying down of new functions facilitate related functions nearby? If shoulder muscle control relocates, does that make it easier for arm and hand control to relocate nearby?
14. What is the order that recovery should work on? Should complete leg work be done before working on arm/hand issues? Or can therapy be interspersed?
15. Has the spasticity issue finally been resolved? Should spasticity be treated? From 2004-5 there were a number of researchers stating we should not treat spasticity, it was a normal protection effect of the stroke.
16. Do new neurons grow into the dead area? Where does neurogenesis lay down the new neurons?
17. Would cell homing be useful as a pointer for stem cells?
18. Which technolgy has been proven to be better, c3A peptides or NOGO receptors?
19. In 20 years when the boomers are fully into having strokes, what will you tell them about complete recovery from a stroke? They will not accept 'I don't know' for an answer.
20. How many years after a stroke is the tumor necrosis factor (TNF) is still around in the brain? In regards to the use of etanercept.
21. Is anyone researching white matter recovery vs. gray matter?

I eventually will keep going on these questions. As a lark I once said I could come up with 1000, with a little help that wouldn't be hard. Someday I will figure out how to get these to NINDS.

Negative reinforcement as stroke rehabilitation

Negative Reinforcement - Does it Work?
In 2008 I took a week long canoe trip to the BWCA with Wilderness Inquiry trying to get in thousands of canoe strokes to recover that part. Since we moved everyday we had to go over 6-8 portages each day. I was not wearing my AFO because I kneel when I canoe so I was going over the rough portages with no brace on(which my PT scolded me about later) Because I was not able to clear the foot completely my foot would bang into rocks and tree roots hundreds of times each day. This turned out to be extremely painful since I had an ingrown big toenail on my affected foot.
My learning on this was that negative reinforcement was not enough to learn to lift my foot properly.
I also remember talking to and slapping my hand to get it to work, but that didn't work either. I guess the brain in my hand muscles does not understand English.
Don't try this at home.