Rehab after stroke

A personal story about rediscovering my left arm and hand

Some background

Eight weeks ago (24 September) I had a stroke.

  • I’m making a good recovery (probably helped by being relatively young, I’m 44).

Neural connections, muscles, body maps, and space

Small bits of spontaneous recovery started for me within 24 hours, with fractions of isolated movements returning to my shoulder and upper arm. This could happen at any time, often over night. For example, one night in hospital I felt my left bicep randomly start to fire and twitch: a good sign, my brain was beginning to re-establish a connection to the muscle. Most of the time, once there I kept this new neural connection. Occasionally, I lost it (and the associated movement) and had to get it back again later.

It’s like my brain has cut off my arm, detaching it like I used to do with the limbs of an action man doll

My shoulder and gravity

My recovery follows the classic pattern for an upper limb after stroke: movement comes back from the trunk towards the hand. That is, I regain the ability to move muscles around the shoulder before those in the upper arm, which comes before my lower arm, and moving my fingers comes last.

Where has my left shoulder blade gone? See the difference between the lower edge of my right shoulder blade and my left

My arm

Rehabilitating my arm is relatively uncomplicated too. Over the weeks, I gradually and naturally relearn how to do the various movements, and only one issue requires more focused rehab. My left tricep (or my mental connection to it) is particularly weak — more so it seems than some of my other arm muscles — and this goes along with my bicep rarely extending to its full length, so consequently the bicep muscle shortens, making it a double effort to fully straighten my left arm. For weeks I cannot put any weight through my arm without my elbow flaring out. Again though, the physio is not too concerned, and he gives me some exercises.

I can’t straighten my left arm as much as my right arm. (NB my knees are on the floor: my left arm is not strong enough for me to do a push up yet.)

Adding in weight

I gradually progress from not being able to move my arm, to being able to lift my whole arm, or just my forearm, or just my wrist. I then progress to being able to hold my arm up against gravity in an elevated position for a couple of seconds, or to doing five and later ten repetitions of an exercise. After about six weeks I progress from there to being able to lift a small weight — a child’s wooden brick first and then on to lifting a kilogram, which is exhausting, and I need to go for a lie-down afterwards.

Check me out: I can lift 1000 000 mg with my left tricep!

The more I recover, the more I discover that I can’t yet do

At first, the issue with my affected arm feels relatively simple — there’s just one thing I can’t do: move my arm. As my rehab progresses, I discover more and more things that I can’t do with my arm in the way that I used to: moving it like this or rotating it like that, and this experience is repeated and multiplied for each individual part of the limb (lower arm/wrist/hand/ finger/knuckle).

My hand

The hardest aspect of my physical rehab is my hand. This is normal for stroke survivors: it’s the most complicated part of the upper limb, with an amazing number of bones and soft tissue connections and a correspondingly amazing range of subtle and complex movement possibilities.

A screenshot from one of our Elsevier digital products (by the wonderful 3D4M team), showing some of the anatomy of the hand. To get and idea of the amazing tech, watch this video

Moving a finger

I’m having a physio session. I look at my left hand and try to move a finger. I can’t. It’s like I don’t know how to any more. I stare at it again, and nothing happens. To get some idea of this, try to move one of your toes individually without moving any of the others (in bare feet). Most people find this incredibly hard and find it requires a lot of concentration.

Mirror box therapy

I use a mirror box to help me with this mental exercise. I put my left hand behind a mirror and my right hand in front. I move my right hand and look at its reflection in the mirror.

A photo of me using a mirror box

Small steps on my journey

I like to get a sense of me making progress in my recovery, and to help with that I keep a record of my physical rehab and of activities I can do again in everyday life. As my physical recovery has progressed, I have enjoyed a series of firsts, and in particular I enjoyed:

  • the first time walking to the toilet by myself
  • the first time I flushed the toilet with my left hand (both when I used a handle to do so and when I used a button)
  • the first time getting in/out of the bath by myself
  • the first time I had a shower by myself
  • the first time I went for a walk out the house by myself
  • the first time I could carry a tray
  • the first time I could move and fill the kettle with my left hand
  • the first time I opened a bottle of wine using both hands on a winged corkscrew
  • the first time I made a hot drink in the morning and took it to Rebecca in bed
  • the first time I could use our stove-top coffee pot, screwing it open and closed
  • the first time we had sex again
  • the first time holding a breadloaf in place as I cut it
  • turning on/off a light switch
  • pulling a light cord on/off
  • opening/shutting a door with the handle
  • the first time I chopped wood for kindling (even though I used the axe for this task one-handed with my right hand, it still felt like a step back towards normality)
  • the first time I stacked logs
  • the first time I could scratch an itch on my right arm with my left hand
  • the first time I could do up the zip on my coat using my left hand
  • the first time I tied my shoelace
  • the first time I tied a double knot in my shoelace
  • the first time reading a bedtime story with our two girls again
  • the first time I used an exercise bike
  • the first time I rode on a real bike again
  • the first time I peeled and chopped cooking apples
  • the first time I took a drink with my left hand (albeit with my right hand in a supporting role, which I still have to do)
  • the first time carrying a bag in my left hand and not dropping it
  • the first time being out by myself and getting taxi
  • the first time going out to someone else’s house for a meal
  • the first time going into a shop
  • the first time going into a shop by myself
  • the first time I didn’t go to bed at the same time as my girls but stayed up ‘late’ with Rebecca and watched a tv show
  • my first time doing a chi gung form
  • the first time I could hang from a bar and lift my feet off the ground (for 3 seconds)
  • opening a tin of sardines (a two-handed job that I did for the first time this morning).

“it’s like you can only do it when you decide to do it.”

This is spot on. When I focus, I can get often get my arm/hand/fingers to do what I want. When I don’t, or when I stop, I can lose that control. I often drop things as they slip out of my hand. (As Rebecca points out this is partly a reflection of the fact that I’m doing more with my left hand. She’s right. But it’s still frustrating.) Things are harder when I’m tired, when I’m more likely to lose my concentration.

  • holding a book up to read with my left hand
  • shuffling a pack of cards
  • chopping wood using an axe with two hands
  • carving a spoon
  • going for a run
  • driving a car
  • swimming
  • kayaking

Senior Director @ElsevierConnect doing product strategy implementation & performance. Mainly writing about getting from A to B, & digital stuff. Personal acc’t.