On my way to Madrid!

It’s already autumn and the course in Madrid is almost there! It is time to orientate to “London” language and get used to Spanish culture and schedules. Long days coming in Madrid next week! I have read only two articles and still few to come. The issue is very interesting in the course; Functional recovery of the upper limb and hand.

The course is organized by Ibita the International Bobath Instructors Training Association. The course instructor is Mary Lynch-Ellerington and she is assisted by Miguel Benito Garcia, basic course instructor. The course is in rehabilitation center Centro Lescer, in Madrid.

More info http://www.centrolescer.org/

We have four articles to read before the course. The first article I’ve read was about the recovery of the upper limb and hand from the stroke survivors perspective. It was qualitative study, which was made in Australia to survivors (19) and their spouses (9). This study gives very valuable information for us, therapists, about stroke survivors thoughts and their personal experiences.

It is known that upper limb recovery after stroke is very poor with only 50% of stroke survivors regain some functional use of the arm compared with 82% who could expect to walk independently again. The time spend with the upper limb rehabilitation is minimal and the lack of spontaneous use of the arm in function is regrettable. Although stroke recovery services have been traditionally based on the belief that recovery is gained from three to twelve months, there has shown improvement beyond that period.

There has been shown that upper limb training programmes involving intensive and repetitive task related practices improve recovery. Anyway, recovery in hospitals is mainly teaching only how to walk before you get back home. It is also financial question, but this diminishes the recovery training of upper limb. One participant said in the interview: “It would almost be easier if the arms came back. You could sit in a wheelchair, at least you could do something. When the leg comes back the only thing you learn to do is walk. But the number of things you can do with an arm…”

The results of this study, some kind of survivors processes how to manage and survive:

“Keeping the door open”, “Even years later things are still changing as long as you haven’t accepted this is all over”. Survivors don’t want time limits for recovery or that someone says what is possible or not.

“Hanging in there”, “You have to take responsibility for yourself, you have got to work at it. Don’t ever give up.” Personal commitment is required and not to give up.

“Drawing on support”, ..The courage the physiotherapist gave me is what I needed. That he had faith in me.” The participants believed that the support from others (spouses, friends, therapists etc.) was remarkable for them to achieve a good recovery of their arm.

“Getting going and keeping going with exercise”, “If you sit in a chair and do nothing you definetily won’t improve.” Exercise was seen as the means to physical recovery. Participants emphasized that it was important to start soon after onset, practicing regularly, intensively, appropriately and continually, using the arm in every day tasks.

Today I had a short discussion with my ”stroke survivor” about the topic and he agreed the results. It is far more interesting to do and work with your both hands than learn how to walk again. He has ”survived” pretty well in 1,5 years since his stroke. He can walk with small stick or even without any aid and in the last half of the year he has learned to use his more affected arm in grasping and reaching on his shoulder level. He said the arm was forgotten in the early stages in recovery, but gladly his wife had an instinct how “to keep the door open”. She helped to stimulate the sensory from the fingers and the arm and held the possibility to regain the good recovery of the arm. He also thinks this is a journey and a lifetime project, not just a one year sprint!

So, keep on going and don't forget the arm, even in the early stages!

Sincerely yours,

TAB

Reference: R.N.Barker & S.G.Brauer, 2009 Disability and Rehabilitation; Upper limb recovery after stroke: stroke survivors perspective