Increasing Movement

Jo's physiotherapy session was interesting today. Rather than repeat the previous two weeks they decided to get Jo to transfer onto the bed to study her transfers and review the exercises Jo could conduct there.

To their obvious astonishment Jo was able to transfer herself from the wheelchair to the bed with a little effort. Once on the bed she demonstrated that she was able to raise her left leg at the knee with even more power than before. Not only that but Jo was able to move her left leg from left to right with little effort. This was something she had struggled and failed to do three months ago.

Jo was also able to raise herself up from a sitting position and get herself to a position sitting on the edge of the bed. This took the most effort and Jo was visibly tired afterward but it certainly seems that she is making progress.

Worried about Warfarin

I am increasingly concerned about Jo being on Warfarin. She did not suffer an ischaemic stroke but did suffer a brain haemorrhage in 2000, which Warfarin is a risk factor for. As she has one untreated aneurysm that risk factor is doubled.

She has been experiencing; hot flushes, shortness of breath, drowsiness and coughing. The first two are signs of low blood pressure and the second two of increased intercranial pressure. She is also experiencing difficulties keeping her left foot from leaning over to the left, a symptom we have seen before but which had abated post-cranioplasty, which is also the case for the drowsiness and coughing.

After speaking with the Neurological Consultant he agrees and Jo has stopped taking Warfarin.

The whole nine yards

Jo repeated her achievement of last week, that of walking the nine yards from her chair in the front room to the front door today. Last week took there attempts as Jo had to keep stopping for a rest as the pain from her left foot was so intense.

The physiotherapists say this pain is the foot waking up and trying to walk. Certainly Jo described the pain as intense pins and needles. We have all experienced that when a limb "goes to sleep." Is this the pain of increasing spasticity as described in Brunnstrom’s seven stages of rehabilitation?

In any event Jo managed the feat in just two stages today. The pain is still there and so intense she is literally crying in pain, but she seemed to overcome that quicker this week than last. Hopefully next week she can walk the whole nine yards in one go.

Jo walks to the front door

Jo had her first physiotherapy session for two weeks today. Using the the new gutter frame, specially adapted for her height and with support and guidance from the two physiotherapists, Jo was able to walk from her chair in the front room to the front door, a distance of some nine yards. Although it was painful, as the muscle spasticity has increased in line with Brunnstrom's seven phases of rehabilitation, Jo was jubilant about this achievement, as am I.

Pictures on the wall

We went to A&E today as Jo had some spontaneous bruising on her right arm and a swollen and painful index finger, possibly warning signs that she was taking too much warfarin. Her INR came back as 2.4, possibly a tad too high and the doctor advised Jo to stop taking aspirin.

Whilst wheeling Jo along the corridor to A&E I drew her attention to the pictures of the old fishing village on the wall to the left of us. I had often done this last year, when Jo was in the neurological ward, in an attempt to ascertain how her hemispatial neglect was faring. Initially she would keep her head turned stubbornly to the right and ask "What pictures?". Later on, and with some effort, Jo would turn her head to the left but fail to comment on the pictures.

Today she did not even turn her head to the left but commented that they were lovely pictures. When I pointed out that she could not see them last year she admitted that in the later stages she could see them but could not discern what the pictures were of as they were just a blur. The fact she did not have to turn her head demonstrates that objects on her left are not only perceivable by her, they are visible in her peripheral space.

A frustrating week

It's been a frustrating week as the physiotherapy sessions, which were already cut down from two to one as one of the physiotherapists was on holiday, were further reduced to nothing when the other physiotherapist fell ill. I've been away all week working and so have not been able to fill the gap. All this just makes Jo more despondent, which is the last thing she needs.

Once again I find myself frustrated at the state of private health care in the UK, which largely consists of vanity treatments because of the monolithic presence of the NHS, which is great at critical care but parlous at providing chronic care. With no real funding base beyond vanity treatments, private health care is in no position to fill the gap.

It is an extremely frustrating position to be in. Jo has the will and she is getting better but the availability of help is extremely limited unless you have the personal wealth to fund it which, unfortunately, I don't.

First steps without a frame

Jo took her first steps without a frame today as they have taken the gutter frame away to have it modified for her height. With one physiotherapist holding her hand and the other guiding her foot, as she still has no sideways control, Jo managed two steps.