I need an expert on stroke patients

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   Dori
3 Posts

Posted - 10/10/2006 :  15:47:35  Show Profile  Reply with Quote
Hi! This is probably a different sort of request from the kind you normally get here. I am a children's book author and I have a picture book coming out next year entitled, My Grandpa Had a Stroke. I received the cover art from my publisher and the art itself looks very nice, but I'm concerned that it's incorrect.
The grandfather in the story cannot move his left arm at all. My illustrator drew the left arm lying relaxed in the grandfather's lap. A lot of my information comes from my father's experience with stroke -- his arm is currently very tight, bent at the elbow, the fingers sit at odd angles etc. But I know experience varies from one patient to the next. And I don't remember if my dad's arm was so contorted right after the stroke or if it got that way over the last 7 years. This book doesn't need to mirror my father's experience, but it does need to be correct (or at least not incorrect). I don't want to ask the publisher to have the illustrator redo unless it truly is incorrect, but I don't know whether it is or not...
If you know what a stroke patient's arm should look like about three months after a stroke (given he never regained use of that arm in those three months), please look at the cover art I've posted on my livejournal account at: http://dorihbutler.livejournal.com/ and let me know whether it looks okay or not.
Thanks!
Ask a PT
156 Posts

Posted - 10/10/2006 :  18:15:59  Show Profile  Reply with Quote
Dori,
I love the art work and your story potential. I share a similiar expereince as my grandfather also suffered a stroke, but I was already grown and aware of what a stroke was, especially since I was a PT. However, my nephews and nieces were young and did not understand what happened to great grandpa. They didn't understand why he was now bedridden and sleeping in a hospital bed in the living room, why he was no longer walking and why he was now using a commode. In fact the kids, initially were scared of him but overtime got over their fear and realized that this was the same man that they had known. As far as what happened to my gradfather he suffered a mild/mod stroke but it did not really affect any one side. He mostly experienced paresis and weakness in his lower extremities and did work with a PT at home for awhile and performed exercises with family members on a consistent basis. However, he just did not get any stronger and he continued to weaken to the point of where he could no longer walk and required assistance for most aspects of life. Since his legs were weak and he was immobile/bedridden, he did eventually develop contractures (when the muscles and structures around a joint become tight and stuck in a bent position and will not straighten)at both of his ankles, knees and hips. His overall condition continued to deteriorate and along with his other underlying medical conditions he did end up passing away. From my experience, I think your book would be a great resource to help children understand what a stroke is and its impact on that individual and his/her family.
Now getting back to your artwork.
You mentioned "what I've said in the text is: Grandpa couldn't move his left arm (nor does he feel the doctor tickling his left foot) at the beginning. He slept a lot for the first three days. Then he had to relearn where center was when he first sat up. He spent about a week in the hospital, then moved to a rehabilitation center, where he learned to sit straight, stand up and even walk a little. I don't actually say how long he's in the rehabilitation center, but it's implied that it's several months. This art work is illustration a scene at the very end of the book (so several months after the stroke)...and he still can't move his arm at all at this point. Given that information, is the above art correct in your opinion?"
I believe it is an accurate representation of what an arm would look like for someone who is experiencing hemiplegia given your description and story line. In my earlier years I worked in a rehab and nursing home settings where I have worked with many individuals who suffered a stroke which resulted in hemiplegia or hemiparesis. Despite many months of rehab, some individuals were never able to regain any function of their extremities. Many of these individuals continued to have flaccid extremities on the affected side but did not necessarily display a flexion synergy or contracture at their upper extremity. The increase tone which results in the contracture is generally determined by where in the brain the stroke occured, how severe of damage has occured and the interventions performed. Great story and do let us know when your book comes out!
Ask a PT
156 Posts

Posted - 10/10/2006 :  18:17:36  Show Profile  Reply with Quote
Hi Dori,
I just read a comment from your blog.
"I think the arm in the cover image looks too normal. People I've known who've had strokes resulting in paralysis either have the contorted arm you mentioned, or it kind of hangs there and the person lists to the side.
The other thing I've noticed is that the affected hand often is closed, like in a fist, often very tightly. Sometimes you'll see that person holding onto a wad of gauze or a rubber ball. The point is that person can't let go."
Jennifer is somewhat right. A person does have a tendency to lean to one side but you mentioned in your book that they had worked on balance and sitting so if he regained his sitting balance then this picture is accurate. Also for someone who has a flaccid arm from hemiplegia, it would most likely be in an arm rest which attaches to the side of the wheelchair and is inclined upwards with a place where the hand can be spread out and rest. The "holding onto a gauze or a rubber ball" is for someone that has increase tone or spasticity, as this is not your case with grandpa given the description of the type of stroke that you provided in your story.

MadCityPT
4 Posts

Posted - 10/11/2006 :  20:31:07  Show Profile  Reply with Quote
I agree with both of the above opinions. The affected side arm and hand would most likely be either elbow bent with a closed fist, or set in a arm rest to secure the flaccid arm. You would be appropriate to show either scenario. I hope this helps. The book sounds great!
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Dori
3 Posts

Posted - 10/11/2006 :  20:56:39  Show Profile  Reply with Quote
Thank you for taking a look and providing input. I was hoping you all would tell me it's okay...I know my editor would be very unhappy about having to ask the illustrator to redo. But *I* would be very unhappy with a book that wasn't accurate.

grpt
15 Posts

Posted - 10/18/2006 :  11:57:34  Show Profile  Reply with Quote
The illustration looks fine given the description and comments provided. I do see patients who have had strokes occasionally, and some of them do have arm rests and trays as accesories to their wheelchair. Click on this link and you can see some examples. Sounds like a great book.
http://www.1800wheelchair.com/asp/view-category-products.asp?category_id=619

rygarm
1 Posts

Posted - 02/13/2007 :  15:23:02  Show Profile  Reply with Quote
After looking at the illustration, I feel that if the arm were flaccid, it would be propped on an arm rest attached to the wheelchair and the had would be spread out with the digits extended. I do feel that by looking at the image initially, the left hand is just resting on his lap. Just a slight change in the image may help make his deficits more "real".

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Previous CPT Forum Members Profile Send Private Message Find Members Posts Add to Buddy List Senior Member Joined: Jun 24 2008 Status: Offline Points: 131	Post Options Post Reply Quote Previous CPT Forum Report Post Thanks(0) Quote Reply Topic: I need an expert on stroke patients Posted: Jul 08 2008 at 12:48am
	Dori 3 Posts Posted - 10/10/2006 : 15:47:35 Show Profile Reply with Quote Hi! This is probably a different sort of request from the kind you normally get here. I am a children's book author and I have a picture book coming out next year entitled, My Grandpa Had a Stroke. I received the cover art from my publisher and the art itself looks very nice, but I'm concerned that it's incorrect. The grandfather in the story cannot move his left arm at all. My illustrator drew the left arm lying relaxed in the grandfather's lap. A lot of my information comes from my father's experience with stroke -- his arm is currently very tight, bent at the elbow, the fingers sit at odd angles etc. But I know experience varies from one patient to the next. And I don't remember if my dad's arm was so contorted right after the stroke or if it got that way over the last 7 years. This book doesn't need to mirror my father's experience, but it does need to be correct (or at least not incorrect). I don't want to ask the publisher to have the illustrator redo unless it truly is incorrect, but I don't know whether it is or not... If you know what a stroke patient's arm should look like about three months after a stroke (given he never regained use of that arm in those three months), please look at the cover art I've posted on my livejournal account at: http://dorihbutler.livejournal.com/ and let me know whether it looks okay or not. Thanks! Ask a PT 156 Posts Posted - 10/10/2006 : 18:15:59 Show Profile Reply with Quote Dori, I love the art work and your story potential. I share a similiar expereince as my grandfather also suffered a stroke, but I was already grown and aware of what a stroke was, especially since I was a PT. However, my nephews and nieces were young and did not understand what happened to great grandpa. They didn't understand why he was now bedridden and sleeping in a hospital bed in the living room, why he was no longer walking and why he was now using a commode. In fact the kids, initially were scared of him but overtime got over their fear and realized that this was the same man that they had known. As far as what happened to my gradfather he suffered a mild/mod stroke but it did not really affect any one side. He mostly experienced paresis and weakness in his lower extremities and did work with a PT at home for awhile and performed exercises with family members on a consistent basis. However, he just did not get any stronger and he continued to weaken to the point of where he could no longer walk and required assistance for most aspects of life. Since his legs were weak and he was immobile/bedridden, he did eventually develop contractures (when the muscles and structures around a joint become tight and stuck in a bent position and will not straighten)at both of his ankles, knees and hips. His overall condition continued to deteriorate and along with his other underlying medical conditions he did end up passing away. From my experience, I think your book would be a great resource to help children understand what a stroke is and its impact on that individual and his/her family. Now getting back to your artwork. You mentioned "what I've said in the text is: Grandpa couldn't move his left arm (nor does he feel the doctor tickling his left foot) at the beginning. He slept a lot for the first three days. Then he had to relearn where center was when he first sat up. He spent about a week in the hospital, then moved to a rehabilitation center, where he learned to sit straight, stand up and even walk a little. I don't actually say how long he's in the rehabilitation center, but it's implied that it's several months. This art work is illustration a scene at the very end of the book (so several months after the stroke)...and he still can't move his arm at all at this point. Given that information, is the above art correct in your opinion?" I believe it is an accurate representation of what an arm would look like for someone who is experiencing hemiplegia given your description and story line. In my earlier years I worked in a rehab and nursing home settings where I have worked with many individuals who suffered a stroke which resulted in hemiplegia or hemiparesis. Despite many months of rehab, some individuals were never able to regain any function of their extremities. Many of these individuals continued to have flaccid extremities on the affected side but did not necessarily display a flexion synergy or contracture at their upper extremity. The increase tone which results in the contracture is generally determined by where in the brain the stroke occured, how severe of damage has occured and the interventions performed. Great story and do let us know when your book comes out! Ask a PT 156 Posts Posted - 10/10/2006 : 18:17:36 Show Profile Reply with Quote Hi Dori, I just read a comment from your blog. "I think the arm in the cover image looks too normal. People I've known who've had strokes resulting in paralysis either have the contorted arm you mentioned, or it kind of hangs there and the person lists to the side. The other thing I've noticed is that the affected hand often is closed, like in a fist, often very tightly. Sometimes you'll see that person holding onto a wad of gauze or a rubber ball. The point is that person can't let go." Jennifer is somewhat right. A person does have a tendency to lean to one side but you mentioned in your book that they had worked on balance and sitting so if he regained his sitting balance then this picture is accurate. Also for someone who has a flaccid arm from hemiplegia, it would most likely be in an arm rest which attaches to the side of the wheelchair and is inclined upwards with a place where the hand can be spread out and rest. The "holding onto a gauze or a rubber ball" is for someone that has increase tone or spasticity, as this is not your case with grandpa given the description of the type of stroke that you provided in your story. MadCityPT 4 Posts Posted - 10/11/2006 : 20:31:07 Show Profile Reply with Quote I agree with both of the above opinions. The affected side arm and hand would most likely be either elbow bent with a closed fist, or set in a arm rest to secure the flaccid arm. You would be appropriate to show either scenario. I hope this helps. The book sounds great! Go to Top of Page Dori 3 Posts Posted - 10/11/2006 : 20:56:39 Show Profile Reply with Quote Thank you for taking a look and providing input. I was hoping you all would tell me it's okay...I know my editor would be very unhappy about having to ask the illustrator to redo. But I would be very unhappy with a book that wasn't accurate. grpt 15 Posts Posted - 10/18/2006 : 11:57:34 Show Profile Reply with Quote The illustration looks fine given the description and comments provided. I do see patients who have had strokes occasionally, and some of them do have arm rests and trays as accesories to their wheelchair. Click on this link and you can see some examples. Sounds like a great book. http://www.1800wheelchair.com/asp/view-category-products.asp?category_id=619 rygarm 1 Posts Posted - 02/13/2007 : 15:23:02 Show Profile Reply with Quote After looking at the illustration, I feel that if the arm were flaccid, it would be propped on an arm rest attached to the wheelchair and the had would be spread out with the digits extended. I do feel that by looking at the image initially, the left hand is just resting on his lap. Just a slight change in the image may help make his deficits more "real".

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