Opening Hands

(An introductory post to go with this essay.)

Sometimes the hand is left in a fist. Not only do u have to start all over again, but u have to start with an adult body. Both my hands have been fisted. I type this with 1 finger on the hand that was lesser. I knew if I could get 1, I'd get the other. It's coming along, but it doesn't type. Although they both open n close n there is finger individuation, there is more to do. It's already been many yrs. What I describe here can span a few months or a few yrs, it depends on the condition n how fast your body wants to work. I wish mine was over night, but rly it's yrs.

Someone who has been thru it can explain it. We haven't ever had 1 have we? So yes, this is different. 

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"Digits should move together. Don't worry about finger individuation yet. First get movement established" http://thoughtfulveg.blogspot.com/2014/11/neurons-that-fire-together-wire-together.html

If your hand is fisted, hold a rolled wash cloth. This will give your hand some separating space. The fingers won't be against the palm of the hand. It reduces and may even stop sweating of the hand. It gets the hand used to being open a bit.

A regular to thin wash cloth should do well for holding. The thicker luxury ones may roll too wide to hold.

Throughout the day, squeeze the cloth. You will make your fist tight. It will be in tightening your hand that you make it looser. Squeezing tighter will be isometric exercise.

Eventually you graduate and move up to stress balls, the kind you squeeze in your hand. I used a cheap foam one. Some companies will put their logo on them and give them away. You can find plain ones at stores. These are the cheap foam ones. They do go up in price as you find the gel ones used in hand therapy.
 

I actually found a picture of the one tied to my wheelchair. A nurse bought this with her other shopping at Wal-Mart. She thought of my fisted hand. She put a hole in it, and threaded gift-wrapping ribbon through it. She used the ribbon to tie it to my wheel chair.
 

 
When you squeeze your stress ball, your fingers stay together. You are not individuating them, yet. Finger individuation doesn't come right now. It is the next step.

From the squeeze ball, and even before you are done with it, you can start doing hand therapy exercises. Don't worry if you can't hold your hand wide open. That is what you are striving for. Just do as much as you can right now.

*I use the videos for their information, not their company.

You Are In Crisis And You Are In The Middle

There is little for the middle class in an emergency. You make too much to qualify for government assistance. You are not rich, either. What do you do when a medical emergency strikes? It happened to me. Luckily, I've worked in a program eligibility and I have economics background.

"Quality rehabilitation is in short supply at a few major centres, and in the US, those lucky enough to gain entry have their length of stay curtailed by reimbursement criteria that limit the amount and duration of care. Instead, patients are subjected to what is called ‘medical necessity’ or the improvement standard, where ongoing rehabilitative care ceases to be provided if improvement is not demonstrated in a timly fashion." https://aeon.co/essays/thousands-of-patients-diagnosed-as-vegetative-are-actually-aware?utm_source=Aeon+Newsletter&utm_campaign=f3c11e932f-Daily_Newsletter_10_May_20165_10_2016&utm_medium=email&utm_term=0_411a82e59d-f3c11e932f-68910097

I initially kept my work insurance under COBRA, and used the SSDI to pay the premium. COBRA is national. https://www.dol.gov/ebsa/faqs/faq-consumer-cobra.HTML For the monthly payment you will need the whole SSDI/SSI check. Insurance is pretty steep. Any extra money can pay bills, rent, or other needed cost. Most bills are headed for collections now as the last payment was missed due to the incident. Pick what you need first and pay on that. Don't worry about bad credit as you are now in crisis mode. "Crisis" will be your answer if questioned later. There is no argument.

The person in need may have to live with a friend, loved one, or family member, if he or she is not hospitalized. "Caregiving" may be reimbursable. This will be important, some mileage will be reimbursed by Social Security. Get that pre-approved and in writing. The person would have to have Social Security.

The work insurance will pay more on surgeries and will probably offer needed therapy longer than the government minimum that is given in government insurance. Keep this work insurance as long as possible. This therapy after surgery is needed and is crucial for "come back." I could only keep my insurance a few months after my surgery. New rules would make it longer now.

...In the middle
But me and Cinderella
We put it all together
We can drive it home
With one headlight

Turn Off the Light

I have one way to start using that bad hand,  http://braininjuryknow.blogspot.com/2016/03/using-that-hand-again.html Piano wasn't for me, though. I wanted to turn my light off when I left my bedroom. My good arm is the left. The light switch is the right.

No need to restrain the good hand. Either retrain the bad, or turn around to use the good. I use a wheel chair. The light wasn't worth the trouble of turning the chair. So I put my bad arm up n let gravity take over. It wasn't pretty, but it got the job done. It looks better now. I have control over that bad arm. The point is that I was using it.

So what if it didn't look good? It felt good.

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Choose an activity. This one chose me. You may have to restrain your good hand. Don't do anything fancy. Wear an oven mitt on your good hand.

Maybe you make your bed every day. Do the pillow with your bad hand. Either keep that mitt nearby, or concentrate on only using that hand. You can finish up the way you were doing, but you gave yourself some practical therapy. Formally, the therapy is called Occupational Therapy. Some figure it only to focus on the hands. It includes the use of equipment, also, in order to get a job done.

Stretches...from Baseball

After moving that arm again, I could really use some stretches! I thought back to when I was 15. I was in softball back then. We did stretches that were specifically for the arm.

I looked at this video. These stretches can also be arm exercises after a stroke or other brain injury. 
 

I'm already familiar with the first ones. That last one he called YTWL is new to me. I tried it and liked it.

Now it's time to stretch!

Using That Hand Again

* Don't expect movement to be as good as before. If it is, then great. This is just concerned with being able to use the hand not used.

This girl is using her bad hand to play piano,
 

The technique is called  Constraint-Induced Movement Therapy. "Constraint-induced movement therapy (CI or CIMT) is a form of rehabilitation therapy that improves upper extremity function in stroke and other central nervous system damage victims by increasing the use of their affected upper limb^." [Now it looks to me, that this therapy can roughly be done at home. Wear an oven mitt on the good hand. The idea is to restrain it and force yourself to use the bad hand. You "constrain" your good hand, and by doing so, you are "induced" to "move" your bad one. The focus is on moving your bad hand and not playing beautifully. Doing it at home is no replacement for the real thing, but you sometimes have to make do. Besides piano playing, other activities are used in the therapy. I just happened to find a piano video.]

Practicing playing scales builds finger strength and your agility on the keyboard. Your music will sound better. I could say something about the presentation of this next video. It has good theory, but where are this man's shoes?

The C Major scale is used in this video lesson. That is what the above therapy video is using, although it is broken to the first few notes. Stick to something simple when retraining your bad hand.

The very first song I played after a stroke was "Mary Had a Little Lamb." I used my left hand. This song is based on the C Major scale.

Don't go out and buy an expensive piano. There's no need for a professional keyboard. Get an inexpensive child's toy at a discount store. I'm no virtuoso. I just needed something to practice on. I got a toy. Children of friends and family can use it and stay out of trouble when visiting.
 

As you listen, pieces will have scales in the song. It's good to know your scales for these:

*A larger keyboard such as a piano will exercise the shoulder. It may take some time to switch.

Streetsmart In A Wheelchair

I learned how to drive an electric wheelchair in Northridge, CA. Northridge is in L.A. County. L.A. as in L.A. A while back (1994) there was a bad earthquake. Sometimes it's called The Northridge Earthquake. I went there years after the quake to a care home. Destruction was gone, but people remained.
 

One point stressed at that home was to know your care, because a stranger might be doing it tomorrow. 

As care was done, it was common to be routinely quizzed:

• What medications do you take?
• How much?
• When? 
• Do you require a special diet?
• Electric wheelchairs are to be plugged in every night. (This rule probably comes from having no power for days after the earthquake. It probably isn't good for battery life. Check your manual before doing this.)
• Always carry a duffle bag or backpack with a change of clothes, a diaper (if needed), and a feeding for g-tubes (two cans of formula in my case).

*This particular care home was for quadriplegic persons. All persons residing there needed diapers and g-tube feedings.

updated video on 6/25/2018
 

No Dreams

"I don't dream since the brain injury."

I used to think that, but then a daughter told me I was making noises in my sleep. She said I was barking!

Could it be true? I had Post-Traumatic Dog Syndrome?

I really was probably dreaming about a dog.

You can tell if you are dreaming with this trick. It's not 100%, but it can give you an idea. While you are asleep, someone needs to look at you. They shouldn't stare. I can't sleep if someone is staring at me.

If they can tell your eyeballs are moving under your eyelids, then there is a good chance you are dreaming. REM or rapid eye movement is the stage of sleep in which we dream. This isn't fool-proof, and the other person might not be able to tell.

You really are dreaming. You just don't remember any of it. Memory issues can be a problem of brain injury. If you don't have memory issues or a brain injury, you are NOT dreaming, and it bothers you, seek further advice. Remembering your dreams ranks pretty low on a list of needs. I just went without. Some people go without dreams their entire life and do just fine. To me, remembering your dreams is a luxury.