Recovery - proximal vs.distal

[oc1dean]

Some of my medical providers told me that my arm recovery would come first closest to my core,proximal, and last to come back would be furthest away from my core, distal, i.e. my fingers.  Does anyone know if this is true? I saw this in another posting again today.  Since recovery takes place in the brain it doesn't make any sense that it would take place proiximal to distal.
Any thoughts or actual research on this.
Dean

[som9]

Hi Sue,
I followed your method( thx for the precious info)  of using FES and have got some fingers slightly moving; I have some questions.
I am at 6 months post stroke. I got a hemorrhagic stroke back in August 2010; my left side affected.
As I am using FES to exercise grasp/release ( actually the e-stim "releases" for me, I notice my little/ring/middle fingers having voluntary movement (extending movement), but still not the thumb and index yet.
  .  How long did it take you to get all fingers ( especiallly the important thumb)back after starting using FES?
. when you exercise with FES, did you try grasp/release with some small objects or you just relaxed and let the FES run and move the fingers all by itself.
. I got my thumb wiggling (voluntarily) for 3 months but no progress beyond that yet. Did you experience similar thing?If so, how long did the thumb get to the point of opening ( and help release an object from a grip?)
. How did you deal with tone/spasticity? by using medication or just stretching/splinting?
I have used baccclofen and dantrolene but no effct so far.

thx,
binh

[som9]

Just a quick note to say hi!
Hi Sue,
I followed your method( thx for the precious info)  of using FES and have got some fingers slightly moving; I have some questions.
I am at 6 months post stroke. I got a hemorrhagic stroke back in August 2010; my left side affected.
As I am using FES to exercise grasp/release ( actually the e-stim "releases" for me, I notice my little/ring/middle fingers having voluntary movement (extending movement), but still not the thumb and index yet.
  .  How long did it take you to get all fingers ( especiallly the important thumb)back after starting using FES?
. when you exercise with FES, did you try grasp/release with some small objects or you just relaxed and let the FES run and move the fingers all by itself.
. I got my thumb wiggling (voluntarily) for 3 months but no progress beyond that yet. Did you experience similar thing?If so, how long did the thumb get to the point of opening ( and help release an object from a grip?)
. How did you deal with tone/spasticity? by using medication or just stretching/splinting?
I have used baccclofen and dantrolene but no effct so far.

thx,
binh

[oc1dean]

My therapists also did not recommend exercising spastic muscles but that is an incorrect assumption now. here is an article on it about CP which i think also applies to stroke spasticity.
http***www.aaippt.org/STRENGTHTRAINING.html
This book also reports on the controversy.
http***books.google.com/books?id=BJcL3enz3xMC&pg=PA107&lpg=PA107&dq=strength+training+spasticity&source=web&ots=lBsggzEKoY&sig=wPcjRkk-mJUZBGHgPYNzMZKP6xI&hl=en&sa=X&oi=book_result&resnum=6&ct=result
Anyway, now I try to exercise every muscle on my affected side even if the form doesn't look good.
Well, years to go before I can rest
Dean

[sue_in_oz]

Hi again

I'm glad you found something that works for you :)  

I don't do too much work of my finger flexors - mainly functional stuff not strengthening as I am paranoid that the spasticity will win again LOL.

Oz is a shortening of/ nickname for Australia ;)  Also a bit of a play on (the maigcal kingdom of) Oz from Wizard of Oz ;)

HTH

Sue

[oc1dean]

Sue, Yes, thanks. i am trying to stretch my fingers 50 times for each finger daily along with mental visualization which feels like maybe my fingers are starting to twitch.
Something new I found that I am usually just putting on while at work. I have a SaeboFlex but that takes me 15-20 minutes to get on so i don't use it on a daily basis.
Found a new item I have started using to open my spastic fingers Theraband makes progressive hand trainer sheets with prepunched holes for your fingers. You put the sheet into an embroidery hoop, the one that comes with the kit doesn't work, so buy a 7 or 9 inch embroidery hoop.  None of the individual sheets were strong enough to keep my fingers open, so I used  all six that came in the red refill pack and put them into one hoop. Once I get the flexors tired out I work on various finger movements. A lot cheaper than the SaeboFlex  and probably just as good, except for maybe needing to anchor your thumb on the ring. It also allows you to work on finger intrinsics.
Can i ask what oz is about?
Dean

[sue_in_oz]

Bump - Dean did you see this?

KR

Sue

[sue_in_oz]

Hi Dean,

Sorry for the delay.  My 8yo son has been unwell :( but is all OK now :)

As promised, here is the wrist & finger work that I have been doing & continue to do.  Hope it may be of some assistance to you.

Wrist
· Stretching wrist in extended position, as I had lost passive range
· FES on wrist for extension (also did some finger extension at same time due to electrode positioning).  
           o        20 mins a day, working up to 40 mins
           o        whilst FES was on practiced active movement in time with the pulses (but not for whole time, too tiring)
· When some movement gained, 3 x set of 10 active wrist extensions/day
· When that became relatively easy, I added resistance by using a 0.5 kg wrist weight across my hand, working my way gradually up to 1.5 kg today
· I continue to stretch my wrist in extension and flexion for ~10 mins each every day (I do this every morning while still snoozing in bed, lying on my side with my hand arm resting on the bed, a really good excuse to have a bit longer in bed LOL!

Fingers
· Taking what I had done for my wrist I adapted it for my fingers.
· Lots of stretching of fingers.
· 3x set of 10 finger extension/day, once some movement was possible.
· This never became very easy, there always seemed to be a barrier to straightening my fingers, so I thought that be incorporating some resistance I may get the strength to overcome this barrier, so I googled finger weights and I found some!  http://www.fingerweight.com/ but I bought mine through ebay.
· Starting with the lowest weight for several weeks, I did the 3 sets of 10 extensions a day.  The difference for me was almost immediate :)  I could very soon move my fingers a lot more easily to the point of straightening.
· Every couple of weeks I increased the weight (following in part the instructions that came with the weights
· Today I have beautifully straight fingers that I am very proud of and that release objects when I want LOL

[oc1dean]

Can you provide more details on wrist/finger work, I had been using some instruction by Madfit from another forum. These are some on the exercises I do to keep my shoulder loose and get some movement after unweighting the arm.
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. So I tried something different, Putting the grip handleof 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. 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 muscleswhen your arm is extended straight in front of you,move your arm to the right and left, seeing how far down you can go.  By using the cane in these manners I am carrying around my exercise equipment all day long.  
The other shoulder work I did was lying in bed and just holding my affected arm straight up with my good arm. I would let go with the good armand see if I could keep it upright. When i could do that I start moving it around in tiny circles advancing to larger and lower circles. Eventually after about three months I could lift my arm flat off the bed from any direction to overhead.  So for me the shoulder and arm are working somewhat but te fingers are recalcitrant.

[sue_in_oz]

I was also told this.  Not sure how true it is, maybe it is matter of control or something else.

As far as my arm is concerned, I am opposite.  I was unable to work on my upper arm for 8 months due to a spastic shoulder, so I worked on my wrist and hand instead.  I've had a great deal of success with them.  Since botox & nerve blocks for my shoulder in August I am now also doing a lot of work on my upper arm, as well as continuing on my wrist & fingers.

So - YMMV.

Happy to provide details on wrist/finger work :)

HTH

Sue