The huge bucket of ice water sits across from me, filled to the brim. It’s my first of three weeks at the Taub Clinic at the University of Alabama at Birmingham, and I have no idea what I’ve gotten myself into. My occupational therapist for the next few weeks returns with what appears to be a hand splint and a big smile. “Today we’re going to start by trialing a new strategy for weight bearing with that left arm,” she tells me. “We’re going to do an ice bath.”
Ok, so that explains the mysterious bucket of ice and water in here. But what was an ice bath and how on earth was it going to help me?
Since my stroke, I’d been very fortunate in the sense that my body seemed to react well to whatever therapeutic intervention we tried: osteopathic manipulation to correct the rotated vertebrae in my neck (which is still a work in progress), or even Botox injections for the tone in my neck, arm, and leg that prevented normal muscle movements and caused my hand to flex and contract instead of open. I could send the message a million times from my brain to my hand, telling it to open, but my hand had a mind of its own. Open, I’d think, and instead it immediately does the opposite, tightening into a fist. Muscle tone, and the inability to effectively control the actions that I wanted performed was my biggest challenge. And this is why Botox was so important for me to get every couple of months. The Botox injection temporarily paralyzed the troublesome muscles, like my ankle, bicep, and finger flexors, so that I would be able to focus on strengthening them. The only problem for me with the Botox is that it wears off after a couple of months and I have to go back for more. I started getting injections six months after I had a stroke, and found it extremely helpful, giving me extra time to focus on my rehab exercises without the intervention of unwanted muscle contractions. But after two months, I found that the botox would wear off and my arm would get tight again. I wanted to correct this situation but wasn’t sure how.
Which brings me back to the ice bath. That first week in Alabama, my occupational therapist told me that weight bearing was the most important exercise I could do to rehabilitate my arm. I had a slight shoulder subluxation, which meant that the head of my humerus did not sit correctly in its position in the shoulder. Therefore my shoulder joint was slightly dislocated. All of that being said, I was anxious to try any method that might help mitigate the negative effects of muscle tone, fix my shoulder position, and strengthen my arm.
My occupational therapist told me that she wanted me to submerge my hand in the ice water up to my wrist five times in five second intervals. I did, and the intense cold of the water burned. We then dried off my hand and stretched my fingers, placing my hand into the weight bearing splint. My hand went in easily, without its usual problems causing it to tighten up unexpectedly. With my hand easily secured in the splint, I did weight bearing exercises to practice putting weight through my left hand. It was severely out of practice. After lots of weight bearing exercises, I took my hand out of the splint and was surprised to see how loose my fingers were. My occupational therapist said that the ice bath temporarily paralyzes the finger flexors, removing the tone from the equation so that I would have a window of about 30 minutes or so to focus on finger activation while everything was nice and loose. And now that I know the secret to success that is an ice bath and weight bearing, I can’t go a day without doing it. If I don’t get anything else done, weight-bearing is the one thing I absolutely must do. And it has made all the difference in mitigating my tone.
Apart from weight-bearing, my three-week stint in Alabama also opened my eyes to the importance of using my affected side and attempting to incorporate it into daily activities. I had gotten by basically by just using my right hand for everything. I figured that because my left arm and hand was paralyzed, I might as well learn how to do everything with my other hand. But when I got to Alabama, this was not the case. I was told I could only use my affected side to complete tasks while I was there. Use it or lose it, my therapist told me. It only takes a few days for the brain to rewire positively or negatively, and what had happened for me was that my brain decided that I didn’t need to acknowledge my left side since it wasn’t participating in any activities. But in order to positively rewire my brain, I needed to make an effort to incorporate my left hand into every activity I did, even if it couldn’t actually help. Eventually, if I kept at it, there was the potential that my brain would rewire to acknowledge my left side. and so I began to at the very least attempt to use my left side in tasks like opening and closing doors, zipping jackets, and tying my shoes.
In my next post I’ll share more about my experience at Taub with rewiring my brain, and how this simple mindset shift from ignoring my left side to actively engaging it, has made all the difference in my recovery.
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