If you would like to contribute something to this blog, I’d be delighted to hear from you – you can be anyone at all, but contributions are particularly welcome from stroke survivors, if you care for someone who has had a stroke or if you are a professional working in the field of stroke care and rehabilitation. You can contribute by sending your words, audio or pictures to deesidepress@btconnect.com
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This week I am reading Twilight of Democracy by Anne Apelbaum
Man Dog Stroke 
I have just finished reading ‘Man, Dog, Stroke’. It was sad, funny and informative and it made me want to have a rant!. I have been a neurological physiotherapist for 30 years and got my first Senior post on the stoke unit at Barnes Hospital in Manchester in 1985. Every single comment that you make in your book Eric, rings true.
Why is it that we can’t provide the right care for people after they have had a stroke? It’s not rocket science, it’s common sense. People need to have the right input in the right environment as soon as possible after they have had a stroke. They need to feel normal and not feel like they have crossed over into ‘patient world’ where you are no longer treated as an individual.
Sometimes I get so disheartened. The stroke unit I worked on for almost 15 years in the NHS was not perfect but there were a lot of positives. We didnt use hoists, people were moved a lot more, they experienced standing often and we didnt hurt our backs. It wasn’t about physically lifting someone but helping them use their weaker side.
If everyone looked a bit fed up we would go and high jack the blue ambulance and go for a pub lunch, and lots of other things. The grounds were lovely, we had a pond, Canadian geese, cherry trees and a huge Physio and OT department. It was closed down in order to pay for some debt. On the Friday we were having discussions about turning into a centre of excellence and on the Monday we were told it was closing down. We were all given a framed photograph of the building and then moved to the main hospital in the city with a temporary prefab Physio department which is still there today well over 10 years later!
Going back to some of the comments you made in your book, you are absolutely right why would you encase a leg in a plastic splint and put a sling on someones arm? How can you learn to use a limb which is wrapped up and not used? Isn’t that the time when you need to remind the brain how to use your limbs again? In my opinion they are a quick fix which has a detrimental effect on your long term potential. If you don’t use it you lose it. A big frustration for me is the lack of sensory input to the hand early on as everything is geared to walking and getting home. However being more connected to your hand and arm helps your balance and walking.
A stroke unit (not sure thats the best name ro use) should provide a quiet pleasant environment, a good diet, skilled therapists and people who understand what you are going through who can help answer questions. Surely this is not that difficult to achieve.
Regular Physio from therapists who know how to get the sense and movement back for someone after stroke is essential. This is not that complicated if there is a skilled team who give intensive treatment in the early stages after stroke. It would save a huge amount of money later on if more money was put into the early stages of rehabilitation.
I have also been teaching the Bobath concept to physiotherapists and occupational therapists for the past 15 years. This is a hands on approach to rehabilitation which works to strengthen the connections to the affected side and minimise the necessity for compensatory movements. It helps people to move as a whole rather than through one side. Fundamental to the Bobath concept is teaching people to be able to balance better after their stroke. This is one of the key factors in helping people to gain control of any increased tone in their affected arm. If you put a plastic splint on someone’s foot they can not move their ankle, they can’t feel the contact of their foot to the floor or adapt to it in order to balance properly. This means you start to stiffen your arms to try and balance. The increased tone in the arm is often secondary to poor balance. Getting the foot adaptable and moving over so you can experience the sensory information as you do is is absolutely essential. You can’t do this if you are hoisted for too long or encase the foot in a plastic splint. This basic but fundamental understanding of the importance of being exposed to movement and feeling movement im controlled situations seems to be being lost.
I have been in private practice for 10 years now.I moved from the NHS because I wanted to be in control of the amount of time i spent with the people who come to see me. So I could work to really see what was possible, to explore the true potential for recovery. Why is there such a barrier between NHS as independent practice?
Anyway, I think I had better stop writing this blog as I should be preparing a course I am teaching next week! I am really glad I read your book as it has given me second wind to keep plugging away at working towards improving in some small way what is available after stroke.
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