Day 29 - Dancing Santas and Dorsiflexion

I am going to begin this entry with a quote:

"I will persist until I succeed. Always will I take another step. If that is of no avail I will take another, and yet another. In truth, one step at a time is not too difficult.... I know that small attempts, repeated, will complete any undertaking." Og Mandino


In those few words is the essence of my cleo. Today she took a huge stride forward, during her physiotherapy session. She walked a few steps without support. Now those steps were not perfect by any means, and the effort that it took was enormous, but, even though there was always the chance she might lose her balance, she actually did it, without help.

I cannot say how overjoyed I was for her.

Prior to this James had found a way to create a spontaneous movement in the muscles of her left foot too, which hitherto had refused to co-operate. Laying on her back, James had asked her to lift her left knee towards chest, thereby lifting her left foot off the bed. At the moment that the foot lifted it twitched. This had not happened before, so this too is an improvement.

James got pretty excited at this, and tried to encourage movement at the ankle. There are four types of movement that happen at the ankle joint.

• plantarflexion: push the foot downwards against resistance
• dorsiflexion: pull the foot upwards towards you against resistance
• eversion: pushing against resistance outwards
• inversion: push against a resistance inwards

The movement which cleo sems to have right now is dorsiflexion. However, this means that the brain is starting to "fire" (in medical terms to recruit ) a muscle group. This is a learning process. The damage that may have been caused by the stroke creates a "loss" of this naturally learned activity, and the aim of physiotherapy in this instance is to allow the patient to re-learn that lost faculty.

All this is good news, and while it is a small advance it also represents a major leap in the right direction because it indicates that the ability to recruit those muscles is still there.

Also during the physio James wanted cleo to do some standing and balance exercise. She stood, and was pretty stable too, but after a short while she gets a woble in her leg, and this is because she does not shift the weight correctly from one foot to the other, and while james was explaining this, she was copying him, which resulted in her sort of dancing on the spot as she wiggled her hips from one side to the other. Remember those dancing santa toys that were all the rage a few years ago? Well, that's cleo, a dancing santa with feet firmly planted, and wiggly knees and hips.

Cause and effect...

There is a man on the same ward as cleo who seems to wander round the place on the middle of the night. He is quite old, and tends to lose his trousers while on walkabout!

For the last couple of nights he has wandered into the room where cleo is, and the staff just don't seem to know he is up and wandering about. He is probably harmless, but I am mindful of the fact that cleo cannot get out of bed that easily without help.

I did say that I would mention her concerns to the Sister, but cleo asked me to wait till tomorrow, to which I agreed, but if it happens again I am going to say something.

The doctors have prescribed iron tablets for cleo , saying that her iron levels are low, which of course can lead to many problems including anaemia. We don't believe this is from before, but having had a month eating their vegetarian dishes, which are (mostly) particularly unappetising it seems that the iron supplement is needed. Now, taking ferrous sulphate is all well and good, but it can create constipation. When the doctor spoke to her today, she mentioned this and he said "Well we can give you something for that".

Seems to me that what they should be giving cleo is a balanced diet, not iron tablets, and then a laxative to counteract the effects. They are dealing with the effect, and not the cause.