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Home , Athetosis, Stroke recovery

MARCH 2014 Recovery Tips www.stroke-rehab.com

MOVEMENT DISORDERS ATTRIBUTED TO STROKE

Have you noticed that you flailing, violent movements of —called the flapping have a twitch or after the limbs tremor (hands may look like a having your stroke or maybe bird flapping its wings) and is jerky, writhing, or involuntary Tremor—involuntary, quivering characterized by failure to movements? Sometimes move- movement (often in the hands) sustain a muscle contraction ment disorders can occur after with lapses in muscle tone stroke. These disorders are —sudden, involun- more frequently noticed with tary jerking of a muscle —slow movement that occur in the basal with increased tone and tremor ganglia or but can —sustained muscle occur from strokes in other are- contractions causing twisting If you are experiencing abnor- as of the brain as well. These and abnormal postures mal movement after stroke, visit with your neurologist to disorders can appear right Athetosis—slow, writhing away or even several years see if you are a candidate for movements usually of the medication. There are various after stroke. Some of the hands and feet movement disorders that can medications that may help occur after stroke : Psuedoathetosis: - abnormal, decrease unwanted movement writhing movements usually of depending on the location of Hemichorea—unilateral, rapid the fingers caused by lack of the stroke and the movements involuntary movements of position sense (patient doesn’t occurring. bending/straightening or rota- know what position his limbs tion Reference: Handley, et. al. are in due to loss of proprio- Age Ageing. 2009;38(3):260- —involuntary ception) 266 .

SHORT TERM MEMORY DEFICITS After stroke, one may ex- Keep a consistent daily Working crossword puzzles Inside this issue: perience short memory schedule (e.g. meals, exer- deficits. There are many cise, naps, shower at a regu- Playing memory games such techniques that can be larly scheduled time) as memory match with cards. Movement Disorders Attribut- 1 used to compensate for ed to Stroke decreased memory. Some Use memory strategies such Using opportunities in every- of these include as imagery, chunking, mne- day life to work on memory Short Term Memory Deficits 1 monics, associations, etc. recall. Make a memory journal to keep track of information/ Activities to improve short Work on memory recall ac- Central Pain Syndrome 2 daily activities. You can term memory include: tivities directly related to refer to journal as needed their job/work. Caregivers Corner—What’s 2 to help with memory. Trying to learn a new musi- for Dinner? cal instrument or hobby. Functional use of memory Timers/cell phone remind- and problem solving in eve- Dealing with Stubborn Hand 3 ers/day planners can be Make sure you get enough ryday life is most beneficial. Edema helpful with activities such sleep and exercise. as cooking, getting to ap- pointments, taking meds Stay involved in social activi- etc. ties/opportunities to com- municate with others.

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CENTRAL PAIN SYNDROME Central Pain Syndrome (CPS) is a condition bed covers to keep pressure off of the skin. The that can result from a stroke or other neuro- pain can appear immediately after having a logical conditions. It has been identified by stroke or have a delayed onset of months or other names including: even years after a stroke.

* Central Post Stroke Syndrome Treatment Options * Posterior Thalamic Syndrome Treatment for post stroke pain may include the * Dejerine-Roussy Syndrome following: * Post Stroke Pain * Thalamic Pain Syndrome Medications - , , * Retrolenticular Syndrome and less commonly narcotic painkillers. * Thalamic Hyperesthetic Anesthesia Intravenous Lignocaine Infusions

CPS effects approximately 8% of all stroke TENS - Transcutaneous Electrical Nerve Stimula- patients according to a 1996 article from the tion Journal of , , and Psy- chiatry. Surgery including Deep Brain Stimulation or Motor Cortex Stimulation Symptoms CPS pain is often relentless and can effect Unfortunately, treating CPS can be difficult and small areas of the body such as the hands and may require changing meds several times to feet or large portions of the body. The pain is find something that works. Meds may have to often moderate to severe and has been de- be started at lower dosages, taken long term, scribed by various stroke patients as burning, and gradually increased in dosage to prevent pins and needles, aching, sharp pains, a wet adverse side effects. Many times, medication sensation, throbbing, or as if a probe has will only take the edge off the pain but not been applied to a raw nerve such as in a den- eliminate it. Physicians are often unfamiliar with tal procedure. CPS pain is commonly charac- CPS so it is important to seek the advice of a terized by hypersensitivity to touch and tem- physician with experience in neurological and perature. Many who experience Central Pain post stroke pain. Syndrome may wear light clothing or avoid

CAREGIVER CORNER: WHAT’S FOR DINNER?

Okay, so here is one of my are in charge of meal hospital so you may want to go pet peeves: the spouse of planning and preparation, through any materials sent my stroke or heart attack it is important to buy and home to see if a specific diet patient continues to prepare prepare heart healthy was recommended. If not, you greasy, fatty foods or ar- foods. can always schedule for you tery clogging desserts for and your loved one to meet the patient. If you truly Healthy food intake can with a dietician. For some want to help prevent future help control blood pres- good tips on eating healthy heart attacks and strokes sure, help prevent future after stroke, you can read this then you should stop prepar- strokes and heart attacks, article from the Cleveland Clin- ing unhealthy meals and and decrease excess body ic: encourage a healthy diet for fat. Reducing excess your loved one. I’m not say- weight can also improve http://my.clevelandclinic.org/ ing that you can control one’s mobility and ability disorders/stroke/ what someone else puts into to get around. In order to hic_eating_well_after_a_stroke their mouth, but many times determine the right diet/ .aspx family members are respon- food intake for your loved sible for grocery shopping one, it is advisable to meet and preparing meals for a with a registered dietician. stroke patient and can influ- Often stroke patients will ence their diet. When you meet with a dietician in the Page 3

DEALING WITH STUBBORN HAND EDEMA

Sometimes after stroke, one may develop nique to be helpful with patients that have edema in the affected hand. Therapists will particularly stubborn hand edema. often use techniques to help with edema including compression gloves or sleeves, Sometimes, edema is more widespread than manual edema mobilization (a type of gen- just the hand and one may notice it in the tle manual therapy that helps the flow of legs or feet as well. It is important to consult fluid), positioning of the arm, and elevating with a MD regarding edema especially when the hand particularly above the heart when present in more than just the affected hand. sleeping. A patient may need tests and treatment to rule out other problems or may need meds to Stroke Rehab: A Guide for One solution that your therapist may not treat the edema. Also, if using compression have tried is called a chip bag. A chip bag gloves or sleeves, be aware that there can Patients and their can be made by taking a small piece of be contraindications and precautions espe- Caregivers stockinette tubing, placing foam such as cially for those that have volume overload, packing peanuts inside the stockinette, and CHF or these type of disorders so always Exercise photos included then sewing the ends. The chip bag is then check with your MD first to make sure com- placed under the edema glove on the dor- pression devices are okay or indicated for Visit http://www.stroke- sum of the hand. The chip bag will help you. decrease the edema. I have found this tech- rehab.com/stroke-rehab-e- book.html