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Revisiting a stroke through the lens of neurophysio

Potentially the biggest driving factor in my deciding to retrain as a physiotherapist was the fact that that my granddad had a dense and permanently debilitating stroke when I was a young child. The memory of the immediate aftermath of this event, the things I remember about his rehabilitation, and his changing level of function and quality of life over the decades since have compelled me to want to understand more about neurological physiotherapy and stroke. I was asked in one of my university interviews, “why physiotherapy? Why don’t you want to be a different member of the multi-disciplinary team involved in your granddad’s care?”. All I can say is that it was the physiotherapy exercises I remember him doing when I was a child, and that have been imprinted on my mind. As I’ve grown older and more aware of my own body as it changes, I’ve come to appreciate how important it has been for my granddad – now in his 80s – to have had the function and independence to live at home all these years post-stroke. For me, physio has played a big role in that from what I can tell, at least equal to the input from other health care professionals.

 

Neurophysiotherapy

By Dr. Johannes Sobotta [Public domain], via Wikimedia Commons
By Dr. Johannes Sobotta [Public domain], via Wikimedia Commons

In the first year of my physiotherapy degree, we focussed on musculoskeletal assessment and management of the upper and lower limb. Diving back into the course after a lengthy summer holiday, we looked at spinal assessment and management. Currently, we are in the midst of neurological assessment and management, and have covered stroke in some detail so far.

I find neuroanatomy and neuorophysiotherapy fascinating, although complex. If I thought the language of medicine was difficult before this neuro module, I find it exasperating now! There is a logic to the (often Latin-derived) terminology I find myself having to use, and my comprehension does come after a moments effort. But I still find myself having that blind millisecond of panic upon having to describe the function of reticulospinal or spinocerebellar tracts, or having to remember the difference between oligodendrocytes and astrocytes. How I have grounded myself in this new lexicon is to think about my granddad’s condition, now and historically, to use this language to understand what happened, how it happened, and how he would have been treated. As my granddad lost his speech almost entirely during his stroke, I’m using the words of this discipline to make his stroke make sense to me all these years on.

 

A New Understanding of Stroke.

I now appreciate that he had a cerebrovascular incident in the left-hemisphere of his brain leading to severe hemiplegia on the contralateral side. Why does that clinical language help me? Because these words now mean something to me, precisely, and I can use them to address the questions the child-me never articulated. Why can’t he speak? Because the speech and language centre of the brain is in the opposite hemisphere to a person’s dominant side. In this case, it was the left hand side where the interruption of blood to the brain occurred, which is why it is so difficult to understand him, and so frustrating for him to be understood. Why does granddad’s hand and foot look like that? Why can’t he walk? Because the injury to his brain affected descending motor pathways, disrupting his ability to initiate and control voluntary movements, and the lack of muscle-pump action in his inactive limbs has lead to chronic oedema. I am empathising with his condition in a way that I couldn’t when I was young, and I am reexamining my understanding of his situation when, as an adult, it had become so familiar as to become almost invisible.

I don’t know how others on my course are getting their heads around this challenging module. I’m certainly not saying you need a close relative to be able to ‘get it’, but it’s certainly been the most personally moving few weeks of the degree so far. I wonder if neurophysio is a field I will go into or whether it will be something else entirely that becomes my passion. What I love about physiotherapy is that we are always dealing with realities rather than abstracts, with real people rather than hypotheticals, and everything can be related to our own bodies. We’re amazing creatures, and even when things go badly wrong, our capacity to adapt is incredible. So when I say my granddad can’t really speak, or walk much more than a short distance shuffle, I am missing out that while he can’t tell a joke very well he has a wicked sense of humour, and that he can perfectly crack an egg into a frying pan with one hand, or that he still loves to grow things. If as a physio I can help at least one person like my granddad in the way that he was helped, then I think I will have done something real and something good.

 

Featured image: Brain by Dierk Schaefer. [CC BY 2.0]

Category: Physio Student JourneyPhysiotherapy

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Article by: Vee Uye

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