PATIENT DIARIES
Overcoming spasticity can take hard work, years of therapy
It was Father’s Day, back in June 1998, when the life of David Andrews was abruptly turned upside down. The Vancouver engineer had just returned home after a long walk with his wife Merylin. He was chasing his dog, who was poking around some garbage bins, when he started to feel unusually out of breath.
“I sat on the bottom of the stairs and bent down to tie my shoelace,” Andrews remembers. “Next t hing I knew I was lying on the ground and, it seems, lost consciousness.”
Then in his early fifties, Andrews was experiencing a severe stroke. His wife, being a nurse, recognized his symptoms and immediately called an ambulance. He recalls waking up in the recovery ward in hospital with slurred speech, unable to move his limbs on the left side. Andrews, who used to love to play squash and swim, spent months in a rehabilitation centre before he could even sit up on his own and take a few tentative steps.
Today, after nearly two decades of therapies and medications, the 72-year-old has seen a slow but steady improvement in his health. He can now speak clearly, go to work by taxi and even ride a recumbent three- wheel bicycle. Still, with many of the muscles on the left side of his body contracting involuntarily, every step remains a challenge. It is hard to control his foot movements, and he walks with an awkward gait.
“When you take a step you are never quite sure what is going to happen,” says Andrews, noting spasticity has caused extreme tightness in his ankle, leaving him without the foot control needed to walk properly. “Any time you do a movement it takes quite a lot of brain effort to figure out what is going to happen next. You are always a bit out of balance, and the last thing you want to do is fall.”
Spasticity develops as a result of an injury to the central nervous system. This disruption makes it harder for your brain and spinal cord to regulate the movement of muscles. The signals that instruct your muscles when to contract and relax no longer work properly. Spasticity is a common aftereffect of stroke, and while therapies are available, many sufferers assume it to be an untreatable condition.
Andrews is one of hundreds of people being treat- ed for spasticity at the GF Strong Rehabilitation Centre in Vancouver. The condition can develop after a stroke, as is the case with Andrews, and is often seen in patients with spinal cord or brain injuries. People living with cerebral palsy and multiple sclerosis are also at risk. Dr. Heather Finlayson is a physiatrist ( specialist in physical medicine and rehabilitation) at the centre who counts Andrews among her patients. In her work, she has seen just how profound the impact of spasticity can be.
“Spasticity can lead to very severe disabilities for some people,” Finlayson explains. “If they can no longer use their arms properly, for example, they may not be able to work in a job that requires the use of that limb, from typing to heavy labour. It can affect someone for day- to- day things like getting dressed. It can affect a mother who wants to lift, and carry her baby.”
Finlayson, along with a team of specialists, works to help patients regain lost mobility and limit the effects of spasticity. There is a broad range of treatments available, depending on the individual’s specific condition and their personal goals. Andrews has seen his condition improve with the support of physiotherapy, occupational therapy, a leg brace, injectable neurotoxins and oral medications. He has also taken part in trials to test new technologies.
“David has come an incredible distance, but it has been a long journey, and required a tremendous amount of work on his part,” says Finlayson. “It is never an overnight fix. A person cannot just take a pill and be better the next day. It is very much a process that happens over months to years.”
Andrews has come to accept that, even with his extensive efforts, he may never regain full control of the left side of his body, but he is happy with the progress he has made so far. His wife is a great support. She helps him get dressed every day, and does all the driving. He is grateful for the help of his family and therapists, who have made a difficult journey more manageable.
“I am exceedingly lucky to have a wife who has taken such good care of me, and family close by who look after me a lot. Without that, life would be very, very tough.” Talk to your doctor for more information on the management of spasticity, and available treatment options.