Derek has shown improvement in stopping the irritating clonus he had been experiencing in his right leg. This means he can now sit and settle into different positions more easily and not be disturbed.
Derek has shown improvement in stopping the irritating clonus he had been experiencing in his right leg (clonus is repetitive, involuntary, jerky muscle contractions due to a hyper-reaction when a muscle is stretched or a limb is loaded with weight). This means he can now sit and settle into different positions more easily and not be disturbed as regularly by his ‘sewing machine leg’. Derek continues to have difficulty actually feeling his right hand and foot, and so finding any specific movement is very challenging. Nevertheless he is delighted with the change in his ‘jigging leg’, which he found to be very upsetting and embarrassing, so it’s a big relief to him and his levels of frustration.
In order for us to be able create good quality movements, our brains need to be aware of and able to feel the body part we want to move. If a body part hasn’t been moved for a while, the brain tends to ‘forget’ it is there and so is less likely to move it automatically. If Derek could consistently feel his hand and foot, he would be more likely to move them in the future. This would also help him to create a more balanced and stable trunk, and so give him more chance of achieving his tooth-brushing goal.
Giving lots of sensory stimulation to Derek’s right foot has helped his brain re learn how to pay attention to his foot, and to become more aware of where it is in relation to the rest of his leg and body. I have been ‘hands on’ moving individual toes, muscles and bones to help his brain to ‘remap’ his foot, and different textures to bombard the sensory receptors on his skin.
Derek’s foot can settle on the floor better, which means he can adopt a more active sitting position with his right leg helping him to balance. This has allowed him to achieve a more symmetrical standing posture, and start to put more weight through his right leg.
We completed similar work with Derek’s right hand, resting it on a bench to support the weight of the limb. Derek was encouraged to look at his hand while I worked on it, as this would help his brain to link the sensations he was beginning to feel with the part of his hand they were coming from. Derek’s wife was very involved in this part of the session, watching and learning what I was doing so that she could continue this important work with Derek for short periods each day, and improve the chances of regaining the sensation in his hand. We worked here with caution as intense hand therapy can sometimes be very tiring and we didn’t want to make Derek feel weary or tired as he had the rest of his day to manage after his physiotherapy session. Having short breaks and changing the tasks during the session enabled us to review his cognitive energy levels and make sure he was doing okay.
By the end of the session Derek felt he was more aware of his right hand and foot and more in contact with the surfaces that they were touching and interacting with. He felt that he was steadier when he moved from sitting, up into standing, and that he was more confident to load his right leg again. This had a great result at the beginning of his walking when he set off from sitting – he was steadier, stronger, and more upright in his posture, as he crossed the room with his stick. He was also aware that he was less heavy on his stick too, which was an exciting moment for him and his wife to experience, compared to how heavy he had felt he had had to be previously. Derek felt safer and more balanced!