I have been there

A stroke patient offers help to others


A stroke usually comes without warning. Mine did. For the following days or perhaps weeks we slowly adapt to a previously unthinkable situation. Our bodies have divided into two parts: one functions much as it used to, and the other has become numb and partially immoveable except by gravity. (We quickly learn that gravity is not necessarily on our side when limbs hit hard objects.)

As we finally focus our minds on the damage to our bodies it sometimes shows small signs of adjustment. This is no more than a tremor but has within it just the possibility of things moving in the right direction. That, at least, is on the plus side. It was for me. The variation in human reactions to rehabilitation becomes acute as the early weeks wear on. Much as I became preoccupied with my own feverish desire to get back to normality, it was evident from others in the ward that reactions were as varied as the strokes themselves. And much the most puzzling factor for the layman is the differing levels of immobility.

Immobility has to be the keyword. Whilst in normal living we constantly seek opportunities for immobility because of tiredness or even sheer laziness, the imposed variety makes it vastly different. The choice has not been ours.

Early on in our post-stroke state physiotherapists appear before us, unfailingly optimistic in manner (which is not always appreciated by the doubters and moody ones amongst us) and smoothly resistant to suggestions that 'my world has come to an end'. I'm sure every stroke patient adopts a love-hate relationship with physios at the beginning. They have some similarity with redcoats at Butlins, jollying us along when we feel murderous and somehow surviving when tempers really explode.

Always remember that physios help you regardless of your mental state, which is rarely positive until the initial shock dissolves. Should your mental stamina then steadily rise above your physical condition - and remain so - you have gained a powerhouse of optimism and determination, offering something way beyond normal belief. Turn the other way and you lose heart. There are few things as tragic in stroke therapy as the patient defeated mentally, and thereby physically as well.

After a month or so, a touch of perspective glimmers in our minds indicating progress as we measure up to the schedule prescribed for us. That indicates what we may achieve in the short term. Long term is a whole new ball game. Prediction may be sweet to the ear of a desperate stroke patient (assuming that he or she hears what they want), but reality cannot be anticipated. The challenge that lies ahead needs to dominate thought and fuel ambition. We face a crucial period in rehabilitation. This can be met if we discipline our minds to do so. Always remember that physiotherapists share this challenge with every patient. These professionals spend countless hours programming our brains to reactivate clumsy limbs and restore destroyed senses of balance. There is no other path but we tread it in partnership with physios encouraging us every inch of the way.

We soon become aware of other patients in the Neurogym, and are attracted at first to those who have obviously recovered from the initial trauma of a stroke and are standing and perhaps taking a few steps under the watchful eye of a physio. From our viewpoint this experience reawakens distinct possibilities for our recovery and is going to dig deep into the mind. The temptation now is to evade the initial stages and commence the exercises where they seem more interesting and related to that wonderful mobility we once had. 'Wonderful mobility?'. Yes, we walked without a thought for the bodily actions required. Now....can we expect ever to do it again?

Beware this pitfall inducing the state of mind that leads ever downwards to black despair. Moving upwards is tougher than sliding down so always look up to the light. Nothing is impossible if you submit to that simple truth. What follows is true and gives a warning of the tragic outcome of rejecting expert advice. I witnessed the extreme case of a patient discharging himself from hospital because he dismissed as unimportant the knowledge and experience of physiotherapists. He would get himself back to normality and mobility his own way without all the boring exercises.

A year later he returned to the hospital in desperation. I saw this unfortunate man demonstrate his new method of walking. It was crab-like, a monstrous distortion of the body's natural ease of movement in walking. He wondered if the physios could undo the damage he had inflicted upon his body. The answer was sadly no, the damage irreversible.

A neighbour of mine tells me of her younger sister back in Ireland years ago dragging her bad leg after a stroke which forced dislocation of a hip. Those were the days when skilled help was not available. One can only imagine the pain and distress for stroke patients left to manage without assistance or a single word of advice.

Today we benefit from research and the development in recent years of a course of treatment which manipulates and exercises the body muscles in such a way as to progress consistently towards the best possible result for our condition. The intensity of strokes is slightly different in every case. Therefore treatment is related exactly to our physical needs. Understandable then is the insistent questions from patients: 'How long am I to be stuck here doing exercises?', 'When will I walk again?'. There are countless variations on this theme. The answer largely depends on the patient and the attitude taken towards recuperation.

If I'd known early on that it would require 18 months of intensive exercising for me to walk slowly with a stick, I would have screamed the place down and sulked for days. My present accomplishment, such as it is, would have never taken place. Do not assume that my experience will be your experience. I saw patients admitted after me walk slowly but confidently out of the hospital long before my departure. Every case is individual and largely follows the dictates of the mind.

Go for it! After you have absorbed the shock a stroke presents a challenge like nothing else. Expertise is ready to admit you to a comprehensive programme of physiotherapy. Obviously the extent of it varies according to the area in which you live. Whatever, grasp it with a firm anticipation of new life. It is coming for me, and is ready for you.

Basil Ramsey