In Balance

After I had been going to therapy for a couple of weeks, I started to see many of the same faces of people I had worked with when I had been an inpatient a year earlier. They seemed genuinely impressed by the progress I had made in twelve months. And while it often did not feel all that substantial to me on a day-to-day basis, I had obviously made strides.

For instance, I had moved around the hospital in a wheelchair a year ago. I had practiced walking only under controlled conditions. Now I was safely walking the halls. My vision had been so bad that I could scarcely write and edit for more than a half hour at a time. Now I could produce a 2,000 word blog post in 24 hours. I had barely been able to move my left arm a year before. Now I was opening jars, guiding my dog’s leash, and using both arms during workouts. I had worked hard to get to this point, and I was around medical professionals who knew it.

One day I saw the DME representative who had procured my foot orthotic. I reintroduced myself since she hadn’t seen me in a year. I told her that the adhesive on the strap that held the device on my leg was wearing out. She said that she would replace the straps when I came back later that week. She also had begun working with a new orthotic that she wanted me to try out. They happened to have one in the therapy gym, so she brought it over for me to try walking in.

The first thing I noticed was that it was bulky. This turned me off because I did not want something that wasn’t going to fit in my shoe. The first orthotic I had tried required that I wear shoes that were a size bigger. The therapist had suggested that I simply wear two socks on my right foot. This struck me as unduly cumbersome. The orthotic I now wore took up so little space in my shoe that all it required was that I remove the sole insert. Having a more streamlined insert was progression toward the point where I might not require a brace at all. This felt like a step backward.

The representative pointed out that this model was hinged at the ankle to allow more natural movement. And although it surrounded more of the foot, it would still fit inside my shoe. This one was a half-size larger than I needed, but she was able to easily get it inside my shoe. I walked in a circle around the room, and although I wasn’t used to the feeling of a brace that completely covered the sole of my foot, walking was effortless because my toes no longer dragged the floor. It felt wonderful that my ankle bent every time I stepped as well. It helped to absorb much of the shock when my foot struck the ground.

After I completed my circuit, the representative asked, “Well, what did you think?”

“It felt different, but I could definitely tell it was helping.”

“Do you think it’s something you would wear?”

“Probably? I wouldn’t want to wear something that bulky forever. Is it something I could eventually not have to use?”

“If your ankle moves every time you take a step, your brain might adapt to start doing it on its own.”

“Okay I’m interested. Worst case scenario: I wear it for a year, then decide to go back to the old brace.”

That weekend I met my friend John for lunch. I had known him since my days living on the Gulf Coast. Now we were both living in the Twin Cities – one in Minneapolis, the other in Saint Paul. We would try to get together about once a month to eat. Since he liked his food extremely spicy, we went to Harry Singh’s Original Caribbean Restaurant.

My Independent Living worker is also from Trinidad, the same as the eponymous restaurant owner Harry Singh. In fact he and Harry are distant relatives, so I had him drive me there for one of our weekly meetings. As soon as we got there, he and Harry began catching up on what was going on in their community. When John arrived, we both ordered the jerk chicken.

It had been several months since we last saw each other. John told me that my speech had improved even more since then. Volume control had been a problem for me in the past. Now I was able to speak as loudly or softly as I needed. I was no longer losing breath in the middle of sentences, either. I was proud to simply be sitting there having a normal conversation. The food and the company were excellent. I stopped being self-conscious about my speech after a while. Soon I was just having lunch with one of my favorite people in one of my favorite restaurants. It was a wonderfully ordinary day.

When I arrived home, it was time to walk Mary. I took her outside and led her through the yard. It was so easy to clean up behind her that I could scarcely believe that it had once seemed so menacing. Walking and bending down on the grass were just routine parts of my day.

Mary vomited in my apartment that night. Since it is not the responsibility of the assisted living staff to clean up after pets, I had to clean it up myself. The first thing I did was put down a towel to soak up the moisture. After letting it sit for ten minutes, I used the towel to scoop up as much of the now-dried food as I could. A few pieces remained, so I swept them into a dust pan, holding the broom with only one hand. Once the contents were in the garbage, I spayed bleach cleanser in the spot then wiped it with a paper towel. I was astonished at how easy it was becoming to keep a clean house.

A few days later, I was at Caribou Coffee. I needed to use the restroom, but I found that toilet stopped up. I had to use it so bad that there was no time to go out and tell a barista. Instead I grabbed the plunger and unclogged the drain. Sure it wasn’t my job, but it was satisfying being able to do the job with only one hand.

The next day was my laundry day. The assisted living staff came up to take my laundry down to the basement. Normally they would fold it and put it away for me, but I just had them to fold it. It took a lot of careful repositioning my feet, but over the course of thirty minutes I was able to put all of my laundry away without falling. These accomplishments would have once seemed trivial, but after needing other people to do such for me, doing them myself felt truly liberating.

At the end of September my physical therapist at Courage Kenny announced that we would be performing my one month evaluation. I was not feeling fully alert and stable that day, so I asked her if I could warm up on the stationary bike to wake myself up. She said that would be fine.

The stationary bike had a swivel seat on it. Ordinarily the therapist would turn the seat to the side, I would sit down, and she would swing it back around so that I was facing forward. Then she would help me slide my feet into the pedal straps. Today I was barely awake, so I didn’t think to wait for her to turn the chair to the side. I slid onto the seat then put my feet onto the pedals. Then all of a sudden I realized what I had done. I couldn’t believe how I had done the whole thing so independently. It usually required a great deal of concentration just to make sure I didn’t fall.

 

After ten minutes, I was all warmed up. Now we moved to the testing phase. Having performed all these tests before, I was not too anxious. Whatever score I attained would be higher than the 41 point balance score I had earned at the beginning of September. So that would give me an idea of how many points I would need to gain in October in order to get me to 45 points. After that I could spend the rest of the year working out in the gym and living a more normal life.

We started by doing Sit-to-Stand. The goal was to sit in a chair, rock forward, and stand up without using my arms. This was a little difficult, because I still used my left arm to help me stand in daily life. But after a couple of tries, I was on my feet. The next test was spinning around in a circle, then doing it again in the opposite direction. I knew this was timed, so I did it as quickly as I could without compromising my balance.

After these tests, we went through the whole battery. I had to try to stand with my feet together while looking over each shoulder. Stand with my eyes closed. Stand with one foot forward; now switch. See how long I could stand on each foot. The tests were not exhausting, but I was eager for them to come to an end. As before the stroke, I had a tendency to rush through tests, because I was in a hurry to see the outcome. I had to keep reminding myself that I could screw up my score by rushing.

What I remember most is that the therapist seemed to take an eternity tabulating my score. After a few seconds I became impatient. Had I completely screwed up the test? Maybe I rushed too much after all. Oh well, it would give me something to shoot for in October. As long as I gained a single point, it would only be three points shy of 45. I could make up three points by working harder at home, therapy, and the gym.

Finally she finished. “You scored 45.”

“Four whole points? That was my goal for two months!”

“Well we’d like to see you add three more.”

Seven points in two months seemed pretty aggressive. But this was the best physical rehabilitation program in the state. If anyone should know what to expect, they should. I had to ask, “Does that mean that I’ll no longer be a fall risk?”

“You’ll no longer be a serious fall risk once you get above 45.”

My new goal became 46. Once I achieved that, the sky would be the limit. Better balance would lead to more intense workouts which in turn would improve my balance.

I went home that day and redoubled my efforts. That included stretching, using my home e-stim unit, and exercising. I tried to keep doing more around the house. When I took Mary out, I would try to keep her in the backyard at least thirty minutes. My life was increasingly one of action as opposed to simply looking toward the future.

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