One day I was wandering around Facebook when I came across a post by one of my patients, Adriana Jiménez. In this post, Adriana showed an accessory where skaters train their own technique. A kind of very slippery carpet that allows the gesture of skating on the same site.
“Do you know what similarity there is between skaters who train board technique? What about people who use a cane after a stroke? The cane as the table are supports to improve the technique in our case of walking, in order to avoid STROKE patterns such as the walking of the reaper, likewise the cane gives us security and stability in our rehabilitation process, I know it is a I challenge leaving the cane, it happens to me, but the cane is a great support in the rehabilitation process ”.
I had the pleasure of getting to meet Adriana during the months we worked together and knew that her brain is structured like a competitive athlete. I refer to the propensity to perfect the technical gesture and the habit of daily work to achieve a result even in time. However, this post pleasantly surprised me.
I am used to having to go against the grain with the cane.
It is common for recovery professionals to invite the patient to leave the cane as soon as possible to demonstrate that they have achieved greater autonomy. The patient himself often identifies the cane as a sign of disability and getting rid of it has a more moral than technical meaning. As a professional, obviously I also want my patients to be autonomous and to abandon the cane, but I want this to happen in the face of an improvement in the quality of the walk. Why do I often have to ask that the cane be taken back even by patients who have already left it? Because even due to the abandonment of the cane, these same patients were forced to implement motor rewards to find a new balance, compensating that if, on the one hand, they were effective, they sacrificed part of the quality of the step. When I start treatment with a patient, even years after his stroke to influence quality recovery, I have to build his pathological pattern and to do so I need him to feel safe during the day, while trying to correct every little movement that will lead you to a better technique. Without a cane, the patient’s problem will be managing balance, while I need their attention to be directed to technique management. I know exactly the comments of those who superficially criticize the choice of the cane, considering it even harmful because it makes the patient lazy and invites him to carry too much on the healthy side, escaping from the plexic side. Let us immediately clarify that I agree that the cane is a comfort that invites the patient to escape the burden on the side of hemiparesis, but I am even more aware that the whole nature of neurocognitive work is aimed at offering the patient again the perception of the plexic side, consciousness and new cognitive tools for movement management. So, compared to a motor rehabilitation aimed only at the physical part of the body, it is true that leaving the cane to the patient means offering an alibi so that it does not load on the plagical side, but facing a neurocognitive rehabilitation aimed at the recovery of the quality of the step, the cane is nothing more than a subsidy that temporarily wants to offer the patient the serenity necessary to focus all their attention on recovering the skills that will allow them to remove the cane without sacrificing the technique of a quality path.
THE USE OF THE CANE IN THE NEUROCOGNITIVE REHABILITATION PROCESS
“I remember my first day of training at the skate club with which I trained for 10 years, I trained on the grass and not on the rink, the coach was measuring my level on the skates, for some it might be strange, because when you register in any sport you would like to take action, from that moment I realized that there is a big difference between someone who does something to do it and someone who does it with quality, it took me many years to be one of the best speed skaters in Colombia, no It was the most powerful, but if it was one of those with the best technique, how did I do it ?, I had special training sessions to improve technique, and I did it not only on skates, there was also on a board, it was hours of training for achieve the best starting technique, on the straight and on arrival. Why do I tell you this? Sometimes they insist that it is time to leave the cane, when I started Neurocognitive Therapy with Valerio Sarmati and the Stroke Therapy Revolution team, they made the recommendation to continue working with the cane, I I did not see any problem, because I consider that I still require it, not only because I still do not feel so safe to walk without it on the street, the recommendation was to use it also in the apartment, while I improve the march, to be honest, I never imagined That this process would be so slow, but there are things that take time, and more in the case of people who have had a cerebrovascular accident (CVA), our brain by not receiving blood flow, brain cells died, which caused the temporary damage, but this is not the end, since thanks to brain neuroplasticity we can create new neural connections, reorganizing our structure, functions and connections, the neuroplasticity allows us to adapt after brain damage and thus learn motor programs, behavioral strategies that make recovery possible, this is one of the reasons why I accept the suggestion to continue using the cane, at this moment I am retraining the walk, it is important do it well and the cane is an external element that more than a hindrance or an enemy in our rehabilitation, it is an element of support to improve, give us stability and allow us to correct certain aspects of the gait of a person who has had a cerebrovascular accident (CVA), In my case, I can focus on flexing my knee and not walking as a block as I did before starting treatment. I don’t know if you remember what it was like when you started driving the car, everything was so mechanical, in my case I had to pay attention to everything, stepping on the clutch or clutch, putting the gear, accelerating, everything was step by step so that the car Come on, at first it was not so easy, but then later with the practice of insurance it was easier, you even drove with one hand, the same thing happens when you train your gait, think about the weight unloading, flexing the knee and hip, in My personal experience, the cane has become a great support while my brain does the motor engram, so that it then performs it automatically, and we must teach the brain well, and in this case the cane is an ally. ”
What is more important: quality or speed?
“I remember the day my older sister said to me: Adry, what is the use of walking beautifully, if you don’t do it fast?” She also told me: “don’t let the perfect be the enemy of the good”, was an expression that resonated in my head and made me remember my days as a skater, because the first thing I did as a speed skater was to learn the technique and then I gained speed and power, and yet I trained technique while doing strength and endurance, I went from doing 300mts in 33 seconds on skates to do them to do them in 20 minutes in a conscious march, at this moment for me it is much more important to work on the technique, then speed and strength will come. Sometimes I understand my relatives when they make the suggestion to leave the cane, but for me it is important to continue using it, because with it I can better perceive the mistakes I make, and thus focus on those aspects that I need to correct to carry out a quality march ”
BENEFITS OF USING THE CANE
1.It gives you security.
2.You can pay more attention to your progress.
3.You can correct those aspects that are not favorable in your progress
4.You can gain independence by being able to move safely.
MYTHS ABOUT THE USE OF THE CANE
1.Only the elderly use a cane and I am young.
2.If you get used to using the cane, you will never let go.
3.The cane is for the sick (I don’t need it).
4.I already walk and using a cane means that I have not progressed.
5.I draw attention to using the cane (people look at me).
6.I can acquire poor body posture.
“In conclusion, when we are more aware of the mistakes we make walking, we will be able to focus our attention on those that we must recover and the use of the cane will be of great support to be aware of how we walk.”