The Shadows of 'Trusting' Rehabilitation: The 'Mold' Called Recovery

To trust is

a wonderful thing

But

in the setting of stroke rehabilitation

brought about by that trust

in the repeated reality

feeling a sense of helplessness

is something that happens

Such memories

I have written down

Movements that grow similar—the 'mold' of the recovery phase

About two years ago

For a time, I

worked at a private rehabilitation facility

providing rehabilitation services.

While there,

I was assigned to a woman with hemiplegia following a stroke.

She was relatively young.

The paralysis was on her left side.

She walked on her own using a cane.

When I first saw how she walked,

I thought,

'Oh... not again...'

She put most of her weight on her right leg, which was not paralyzed,

and kept her left leg stiff and rigid,

swinging it forward in a wide arc.

Because my ankle does not flex

I am wearing a brace

My left arm is bent tightly, with my hand positioned in front of my chest

The clients are

of various ages

and the areas of the brain where the onset occurred

should be different for everyone

yet their ways of walking are all

similar

The paralyzed leg

feels stiff

feels heavy

The paralyzed arm

is bent tightly

and even when trying to straighten it, it does not easily extend

My fingers will no longer straighten

That arm

is useless

it is just there...

In theory

the way one walks upon discharge

depending on the location and size of the brain injury

should be different

for everyone

However

the clients I meet at that facility

who are at the level of

'being able to walk alone with a cane'

Everyone walks in a similar way

The hospitals they were admitted to were all different

In other words, in any recovery ward

When they are discharged

Everyone walks in a similar way

And, for the most part, everyone

Also says things

That are similar

...

You get better as you walk

You don't get better if you walk alone

If you walk where there is a physical therapist

Someday, I will get better

...

The symptoms are similar, too

My body hurts

My paralyzed limbs feel stiff

I cannot sleep well at night

My body is stiffest when I wake up in the morning

...

And then, I

'This is what a stroke is like'

with that

single phrase

I am 'convinced'

...

If there is pain

painkillers

If you cannot sleep

sleeping pills
(though the brain waves are different from natural sleep...)

If your body becomes stiff
get a massage or apply heat

To prevent your arm from getting any stiffer
move it daily with your other arm

"Because it's a stroke

　symptoms appear

　and you deal with them using medication or something else"

This pattern...

But already

her fingers

will not extend...

The cage of 'common sense' in recovery—the repetition of symptoms

They tell me all sorts of things about what the rehabilitation during hospitalization was like.

They teach me many things.

At first, they started training with a large brace,

and gradually that brace became smaller,

and now it has become this brace.

I was measuring my walking speed regularly

and I could feel myself getting faster

which made me happy

Fortunately, for my rehabilitation

I was able to be seen by a great doctor

Most people have stories like that

She

has also experienced

Botox injections

My ankles had become too stiff and pointed downward

so even when I stood up, my heels wouldn't touch the ground

Injection into the calf

"Medicine that softens the muscles"

is what she said, but

it only reduces muscle function for two or three months

"The cause of the stiffness"

if that doesn't change

it will return to how it was

She, too, has ended up stiff again

When you were discharged, what kind of guidance were you given?

When I asked that,

"The fact that my leg, which wouldn't move, started moving is thanks to rehabilitation.

If I stop rehabilitation, it immediately gets worse and worse.

Just as Shigeo Nagashima said,

If you take even one day off, it gets worse.

So, please do your best and walk."

Discharge instructions were

just

'Please walk'

And what's more, stories like this

are not rare

...

Talk of 'tools'

like canes and braces

Talk of 'numerical values'

such as strength, walking speed,

distance walked, and time

The job title of the rehabilitation staff
and the hospital's reputation

Talk about 'evaluation'

Talk about painkillers, sleeping pills, and other

'medication'

Talk about long-term care insurance services and other

'systems'

Such

'external'

matters

are discussed often

The body is afraid—the 'misunderstanding' led by the numbers

Such people

Rehabilitation like mine

Cannot be accepted

In particular, I am not doing anything difficult

I am not talking about difficult brain science, like judging based on the lesion

I am not talking about philosophical questions like, 'What is the meaning of you getting this illness?'

The reason you cannot understand is

This kind of approach

"It's fine to just stand there,
but don't move from that spot."

I instruct.

While observing the balance of their entire body,

I gradually guide their weight onto their left foot.

Then, at a certain point,

they change their standing posture on their own.

Their body moves of its own accord.

Because,

it is a movement they have never done before.

Even though it is a movement

that is absolutely essential for standing and walking,

when they try to do it,

The body feels 'scared'
(not the person's own emotions)

When I correct the posture and have them do it again

They change their posture on their own again

This is pointless...

'Oh, this is the practice for putting weight on my left leg, right?'

she says,

interpreting it in her own way, on her own terms

'I practiced a lot while I was hospitalized!

Using a device that measures

how much weight is on the left and right feet,

I kept getting better and better as I practiced!'

she says happily, demonstrating the movement from that time

A movement of twisting the waist sharply to the left

A movement that results in "what looks like" weight being placed on the left foot

That is not the movement

I am looking for

In the first place, such a movement

When standing

When walking

I would never do

Practicing a movement

I would never do

And rejoicing that

The numbers have improved

Such hospital rehabilitation

comes to mind

Effort that betrays—a risk that should have been predictable

Because my left ankle is stiff,

the brace has also become one with metal supports.

"Since you're such a hard worker at rehab,

the doctor made it metal so that

the brace would be harder to break."

I really couldn't

respond to that statement.

I was

nearly speechless.

...

Even so, this woman's

increase in muscle tension (spasticity) due to paralysis is

intense...

Unfortunately,

I don't have the brain imaging data.

If I could see that,
the reason would be easier to understand, but

I will try to think about it

based on her body's reactions.

The 'nerve pathways that suppress muscle tension'

might be
affected.
(such as the medullary reticulospinal tract)

If that is the case,

Rehabilitation during hospitalization

must be done quite carefully.

Effort-based rehabilitation,

like that which causes the right-side limbs to tense up,

strenuous rehabilitation,

rehabilitation that pushes you to try hard,

will

steadily and cruelly

make these left-side limbs stiff.

Especially the arm,

because it is suspended in the air,

is

prone to that influence...

I cannot judge accurately—the 'thinking' that has been rehabilitated

The hospital where she was hospitalized

was the hospital where I once worked

'I used to work there'

I didn't say anything like that

I didn't want to be thought of as a
colleague
of the rehabilitation staff at that hospital now

However, she

wanted to know

the hospital where I worked

She probably wanted to judge my rehabilitation skills
based on the hospital where I gained my experience

It was, for her,

a 'baffling' rehabilitation

Because I was doing it, you see

There were parts that improved, but

I didn't think it was thanks to

my rehabilitation

Because I walked a lot
just as the rehabilitation therapist instructed
while I was hospitalized

I got better

That is what she believed

While she was hospitalized

The one who had her doing

rehabilitation that simply forced her to work hard

was the person in charge of rehabilitation
in the recovery ward of that hospital

Even now
one of the officers of this prefecture's Physical Therapy Association

The person who once

from the hospital

"He kicked me out"

He was a physical therapist named T.

The 'trust' of experience and status—the authority of T

T loved evidence.

Though he misunderstood

the meaning of evidence.

He often read overseas research papers.

And then, looking at the photos in them,

he would imitate them in practice.

Using a ball. Once I saw the image

the next day, I was using nothing but balls.

"Recently, in an American paper,

it was reported to be effective," I said.

I would tell the patients.

"It's not well-known in Japan yet,

but it's famous in America."

I liked

this line of reasoning.

If you actually read the paper,

"This effect was observed in this type of person"

it was clearly

The 'conditions' are written down

The patient that T is dealing with

was not

'this type'

'I am, for the record, the chief.'
'I am, for the record, the manager in charge.'
'I have quite a lot of years of experience, you know.'

to the patient

hesitantly

'Always'

would say

When I was off duty

they would limit
the staff who would do the rehabilitation in my place

They made sure that staff who do rehabilitation like me
would not be assigned

But even that has its limits

I and my colleagues

Sometimes I do rehabilitation in place of T

When I had someone else do my rehabilitation instead of Dr. T the other day,
it was great.

I never knew there was that kind of rehabilitation.

As expected, Dr. T's subordinates are excellent!

I suppose he must have hated
being told that by patients.

Hearing such things in the rehabilitation room,

my colleagues and I

would laugh,

softly, so as not to be noticed.

Remembering it now,

I feel a sense of nostalgia,

everyone.

I suppose he must have hated being told that by patients.

Hearing such things in the rehabilitation room,

my colleagues and I

They quit and left

Now

everyone

is scattered

I wonder if they are doing well...

Taking off borrowed glasses—the path to returning to one's own body

Back then

"Rehabilitation for the patient"

using those words as a shield

we criticized each other's rehabilitation

And

we

lost

Some of our colleagues

adapted their approach to rehabilitation

to fit the organization

Those who could not adapt,

including myself,

left

the hospital

...

The period during which you can receive rehabilitation after hospitalization

is likely becoming shorter

The rehabilitation provided

rather than the patient's own true recovery

within a limited timeframe

so that they can be discharged to their home

acquiring the necessary abilities

is prioritized

While it remains true that

rehabilitation during hospitalization

is important

after discharge

in the course of daily life

rehabilitation

is becoming increasingly important

I suppose it is becoming that way, isn't it?

Ah

Already

it has become so, hasn't it?

Former patients

their own bodies

and their hearts

not through borrowed glasses from the outside

but rather

knowing what is truly necessary

to know

I truly wish I could help you

feel

your own body and mind

I thought

that I would like to

do so

I thought

Conclusion: What Shifts, What Remains

Yesterday was the House of Representatives election, wasn't it?

Even on a day with disaster-level heavy snowfall

you do it, don't you

that kind of thing

is what it is, though

the problem is...

just kidding

thank you for staying with me

up to this point

May today

be for you

a good day

Unsplashphoto by austin austin