- Paul Fink
My journey from wheelchair to walking
I was very active life before my stroke. Growing up, my two older brothers (Steven and Ronnie) were always playing sport mainly basketball, footy, cricket and I love running. I was not injury-prone but I was accustomed to injuries and physio treatments. One broken wrist, lots of rolled ankles, knee strains, hamstrings and calves were problematic, popping fingers, etc. But aside my injuries, I was very healthy and fit 90% of the time - in fact - I am alive now because my lifestyle choices before my stroke.
After I woke up the coma at the Alfred Hospital, I was not able to lift my right leg. Granted, my memory was a mess, but I remember when it happened. It was about a week after I woke from my coma - and once I was out of ICU - that I started to notice some muscle activation and movement in my paralysed leg. My wife was there and I recall that she was very happy. She instantly called the nurse and insisted the rehab doctor come and review me for rehab asap. A few days later I was moved to Caulfield (rehab) Hospital as I was not getting much therapy in the acute hospital.
At Caulfield Hospital, I was very busy with sleeping, resting, getting dressed and socialising, but also I was busy maximising my time for therapy - including Physio.
I recall one conversation with a nurse (Debbie), and I said [paraphrasing] 'you reckon possible to walk on the future?' She replied 'I worked at the hospital over 20 years, and she said ...most definitely'. It was a tiny glimpse of hope with my recovery and I was very happy with the response. After that, I was more motivated and happy. Body language and the tiny improvements are crucially important on health-workers, especially with motivation - in my opinion.
Physio was second-nature to me because my exercise background. In fact, my first visit at home - aside spending time with my son and my family - I was exercising with my brother-in-law (Jared) also. My thought process was little bit of more exercise - can't hurt.
In the hospital, I was very conscious of positive feelings and I avoided negative thoughts. I listened to uplifting music - especially motivational music - because music releases dopamine and endorphins in the brain, that gives a person a superior and happiness state of mind. I am still listened to music during exercise.
I received a portable DVD player in my hospital room, and similarly to music - I chose to watch inspirational movies (eg. Rocky, Cinderella Man and more classics). After watching Miracle - particularly this scene/phrases coined by the late coach Herb Brooks, “The Legs Feed the Wolf”. He was used to inspire the players of the gold medal winning 1980 US Olympic Hockey Team to focus intently on their leg strength, endurance, repetition and persistence. This quote was stuck in my head - some reason - and I silently repeating the quote in the hospital gym with my exercises.
I was wheelchair-bound at four months after my stroke. My Physios were Cath Brooks (no relation to Herb Brooks haha - I think!!!) and Fiona Bahr. They were outstanding. They taught me to walk, how to climb stairs, how to swim, use an exercise bike, strengthen my legs, and lots of repetition exercises. Also I volunteered to participate in a intensive physio six weeks trial (Ballistic Strength Training in Stroke) - additional to the normal physio exercise sessions as well. Basically I got a big boost of extra therapy by being involved in quite a few research projects along the way, and I highly recommend it to anyone recovering from a stroke or brain injury.
The process of returning to walk started as soon as I arrived at rehab. It was was very challenging. My strength and balance was very poor and I needed lots of help with any exercises in the early stages. Also, my speech and comprehension was inadequate, therefore I was very difficult to communicated [to the therapists].
My Physios immediately gave me exercises to do which eventually progressed me to walking on my own. This involved walking in the rails, balance work, using different types of gait aides, strength training and endurance training. Safe to say, I enjoyed my sessions. It was hard work... but was familiar to me because of my strong exercise background. I also didn't feel I need to think as much (relative to speech and OT) - and I saw tangible progression almost every day.
I started walking independently after four months - with an ankle foot orthosis (AFO) and a walking stick. The orthotist, Tim, was amazing. He made a custom-made AFO for me, and three years on, he helped me to run with the special ankle brace... (I will write a blog about my knees and running in the future) but I digress...
I remember the hospital beds and every patient had a colour-coded chart. In the beginning, my chart was red (= I needed hands on assistance with walking). Bit by bit, I was improving and my physios decided to change my chart to yellow (= supervision walking but not holding on) after two/three weeks. Eventually, I graduated to green (= independent with a walking stick).
I remember this conversation with my therapists... I was happy with my improvements, but frustrated with the word 'independent'. What happened was, I was almost ready to go to hospital gym but I can't tie my shoes-laces, so I said 'I am not independent' because the physios or my wife were helping my shoes. Very soon, I consulted my OT (Bianca) about options for shoelaces with one hand and she said it is possible, and - eventually - with lots of practice and repetition - we found a way, and I use this method every day. I was so excited try to walk in my spare time, and I roped in with my wife, family and friends to help me do laps in the ward.
Get rid of the wheelchair was a monumental milestone on my recovery. I was walking taller - literally - and I was overjoyed. On weekends - I was busy doing laps at the 'breezeway'. [The breezeway is concrete long corridor in Caulfield Hospital, roughly 100 meters in length]. Technically, I was not allowed (I think) ventured out the breezeway (sorry Nurses and physios), but I was backed my instincts. I am normally a conservative man, but I have a daring aspect side of my personality also and I was very confident that my walks were safe. I was backed my instincts and I walked up and back, roughly half an hour, lots of times.... I liked my walks in the hospital.
Eventually, I was discharged from hospital (Aug 2014) and coming home was very nice and liberating, especially reconnected with my son and my wife. My transition to inpatient from outpatient was relatively easy because I attended the handover meeting with David Harrower (my outpatient physio).
David visited my home and he gave lots of at-home exercises and also, I attended my Alfred Health Community Rehabilitation Centre [outpatient therapy at Caulfield Hospital] three times a week. Luckily, Caulfield Hospital is not far from my house (only 10 minutes to drive) and my wife and my parents chauffeured to me for my sessions. I was well looked after.
My rapport with David was excellent because we shared common interests (Melbourne footy club, cricket, etc) and I was improving rapidly. We worked 'together' at 10 months . Six minutes tests, treadmill, Pilates, weights, balance exercises, attempting to walking on grass and sand, practice the tram stops, and of course, a lot of repetition, sweat and productive hard work. I was in my element... and luckily, my competitive juices are still there. I know strokes are not competitions, but I like challenges with myself - and end-goal always is get better faster.
One month after starting outpatient therapy, David decided to remove the AFO. I was hesitant initially because my right leg was still very unstable. AFO's are very useful for stability because of very unlikely to roll an ankle, therefore ditching the AFO was a big milestone with my mobility. David was trying to less dependent on the AFO because of the long-term benefits. I like the analogy is 'one step back... but two steps forward'. Means = I was walking slowly and more chance of rolling and falling, but strengthening my legs muscles.
After my stroke anniversary - 31 January 2015 - I was still very motivated and improving. I was exercising at the rehab gym mostly but, three months after, I abandoned my walking stick. My balance improved and, after that, I was started to walk outside. Sometimes walking around the block or walking on the Carnegie streets with David, other times walking with Anthony (my OT) and sometimes my wife and Oscar. Also, David decided to go to Duncan MacKinnon track (at Murrumbeena), for interval training because the rehab gym was too small. I loved my sessions at the track... the fresh air, sweating and challenging myself and I developed more confidence and trust with my legs.
Similar time, my wife and I decided to go to Queensland for one week without my son. It was very relaxing holiday including lots of walks (good therapy!!). I realised also, my body is better at warmer climates. My wife said, my thermal regulations centres of the brain help was affected by my stroke. Basically I am more colder in general... possibly one or two degrees lower than before my stroke, and I am more productive with therapy at the warmer climates. Winter at Melbourne is very cold and my legs normally more stiffer. Having more time, and feeling generally looser in my body allowed me to push myself more and become more confident in my own ability. But, saying that, love Melbourne...
After the holiday, I was discussing with David and I set a goal to walk 5 kilometres as part of the Melbourne Marathon festival. He supported my goal, but I was improving rapidly and I decided to try 10 kilometres - not five. This was a very lofty goal, but I completed the walk... (I will write a other blog post about this soon because it was a big milestone and achievement).
In August 2015, I finished with outpatient therapy because David said I was 'autopilot'. I was satisfied with David's conclusion because I was still exercising constantly and making gains without his help. I was still using David at-home exercises, lots of Pilates exercises, walking and swimming. It was nice to graduated from the physio gym, back to a local gym like I used to go to. I still keep in touch with David and keep him updated on my progress.
So, thanks to all my Physios and health professionals for helping me - Cath Brooks, Fiona Bahr, Genivieve Tole, Bianca Summers, Anthony To, David Harrower, Carol Pham, Tracey Wagstaff, Tim Burke... and lot of Physio uni students also. And as always my wife who always says she's just my wife but I am lucky that she's a physio and there to offer guidance too.
*** You may notice that one videos I am wearing an arm sling. This was necessary in the early days to support the shoulder. As all my muscles on the right side were paralysed, the sling helped to prevent gravity from pulling the shoulder downwards, causing pain and potential subluxation.
