Device helps recover hand movement after stroke

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BY ANNA WILSON
BLUE RIDGE HEALTHCARE

MORGANTON - In the summer of 2006, Melissa Poarch had a cold. On day, she blew her nose too hard, causing an aneurysm.

On that day, June 21, 2006, her life changed forever. This 21-year-old was a senior at Appalachian State University, worked full-time and was the mother of a 1-year-old boy. After June 21, she was a mother who couldn’t talk to her child, much less lift him.

The stroke damaged the portions of Poarch’s brain that control her right side and her speech. Today, almost a year after her stroke, wears an ankle and foot brace and walks with a slight limp. When she’s not moving, you’d never know this pretty woman with bright blue eyes and deep dimples has any physical problems.

If the stroke had occurred 10 or even five years ago, Poarch would be receiving therapy, but not like what she’s receiving today from her occupational therapist at Blue Ridge HealthCare.

Tabitha Yates, OTR/L, recently completed training in using SaeboFlex and SaeboStretch, devices invented in 2002 by two occupational therapists wanting to improve a stroke patient’s ability to unclench their fists and grasp objects.

“Before this device, there wasn’t much we could do to help with the hand,” Yates said.

On therapy day, Poarch, now 22, travels from her home in Lenoir to Morganton for at least three hours of intense therapy - physical, speech and occupational - at Blue Ridge HealthCare.

“Try to open your hand,” Yates says.

“I can’t,” Poarch tells her after a few minutes of trying.

“Just try.”

Poarch ends up pulling her arm up and in. She’s unable to open her hand on her own.

One of the most limiting factors to regaining hand function following a stroke, besides the severity of the stroke, is the shortening of soft tissue - the skin, tendons and muscles. Poarch’s stroke has caused her right hand to draw up into a fist - a common occurrence among the neurologically impaired. If allowed to remain that way and the tissues are not stretched, she will be unable to use her hand and arm at all.

The SaeboStretch can be worn all the time and keeps fingers elongated and in proper position. The inventors felt that some splints caused joint damage and did not promote movement.

The SaeboFlex device, worn only during therapy sessions, supports the weakened wrist, hand and fingers while positioning them in preparation to function. The device attaches to the forearm, hand and fingers, and has no electrical parts. The user is able to grasp an object by voluntarily flexing the fingers. The spring system assists in re-opening the hand.

At least 15 minutes of Poarch’s Saebo therapy are taken up by Yates carefully unclenching Poarch’s fingers and placing them in the robotic-hand looking device. Yates works up a sweat and Poarch is silently suffering. She says it hurts to have those involuntarily clenched fingers pried open.

“Try to relax,” Yates tells Poarch.

“I am,” she replies.

“You’re very tight today,” Yates says. “Have you been wearing the Stretch at home?”

“Yes,” Poarch says forcefully. “The rain.” She reminds Yates.

In the days leading up to Poarch’s therapy, the weather has not been cooperating. It’s been cold and raining. “Weather has a direct effect on a lot of people in therapy,” Yates said. “I’m pulling against something that doesn’t really want to move.

“That’s part of what the device is made for,” Yates added. “It’s to strengthen the bond between the brain and the body, to get your body used to listening to the brain say relax. A lot of times learning to let go is what’s causing the problem. If you don’t have the strength to straighten your fingers, this helps. It strengthens the mind and body.”

Once Poarch’s hand is strapped in correctly, Yates begins to manually straighten Poarch’s fingers. She readjusts springs, wires and fastenings. Then Poarch begins a series of exercises where she grasps a foam ball, turns and lets it drop into a basket.

“Saebo is made for the hand because the fingers are the hardest part to get to open after a stroke,” Yates said.

With Yates constantly telling her to relax, Poarch really concentrates on flexing her fingers on the ball enough to pick it up.

“She’s extra tight today,” Yates said, while checking the springs and the fastenings for chafing. “You can see that when she lifts her hand to grasp the ball, she’s already pulling into the fist. So she has to let herself relax.”

At first, Poarch uses her left hand to hold up her right arm like it’s too heavy even though the device is lightweight. She positions her right hand over the ball and resists the urge to use her left hand to press down on the ball. She must relax and open her fingers first, then concentrate to get them to close and grasp the ball. She works even harder to relax her elbow and shoulder and get the fingers to open again, releasing the ball.

After she’s warmed up, she can lift her hand on her own. The motion is a bit jerky, but she’s doing it on her own.

“It’s amazing how her body responds,” Yates said. “It’s a very robotic movement, but it’s more than she can do on her own.”

Today, Poarch tires quickly. She’s already had an hour of physical therapy, where she’s climbed stairs, stepped over curbs and walked over uneven ground, and an hour of speech therapy.

“She really has to concentrate, and she’s kaput when she’s finished,” Yates said. “But it works. Her arm is not as tight when she finishes.”

Yates takes off the device and Poarch can move her fingers a little. They are not clenched in a fist.

“In some ways she’s most definitely getting better,” Yates said. “But part of it is mostly the retraining of her muscles and mind.”

Frustration can hinder Poarch’s therapy, but as Yates said, “She’s young and she’s very motivated by her son. He’s the love of her life.”

Poarch’s goals are to finish college, learn to drive using adaptive devices and being a good mother to her now 2-year-old son. The therapists at Blue Ridge HealthCare are helping her achieve those goals.

“I know it’s frustrating when your hand doesn’t do what you’re telling it to do,” Yates said. “It’s the same way with her speech. She understands everything you tell her, but her words don’t come out the way she wants. When she gets mad, it’s because we don’t understand what she’s trying to tell us.”

“It’s getting better,” Poarch said, the longest sentence she’s said since the session began an hour ago.

“Her speech is getting better,” Yates said. “And her body’s response is getting better. It just takes a long time and hard work. We’ll get there eventually.”

Not every stroke patient is a candidate to use Saebo. You must have some shoulder and elbow movement along with some flexibility in your fingers. At almost $1,700, the cost may be prohibitive as well unless paid for by insurance. Yates, as a trained clinician, can schedule an evaluation. For more information on Saebo, visit the web site www.saebo.com or for specific questions about the therapy, contact Yates at 580-6808.

ANNA WILSON is a writer and graphic artist in Blue Ridge HealthCare’s Marketing and Public Relations Department.

The second largest employer in Burke County, Blue Ridge HealthCare serves a four-county area and includes Grace and Valdese hospitals, Blue Ridge Home HealthCare, Grace Heights and College Pines Health & Rehabilitation Centers, Grace Ridge Retirement Community, Phifer Wellness Center and a number of physician practices.