After a Stroke, A Case Study of Hilary

This article refers to the lesson that can be heard here: Balance

“Ha! I’m not dead.”

That was Hilary Mark’s reaction on waking up in ITU after a cerebral haemorrhage. For Hilary, an NHS physician and educator, the day had started quietly with a routine mammogram on her way to work. Then the headache began. Nothing to worry about, she thought, as headaches were not unusual for her.

But this one was different, growing steadily worse until, at a meeting with her medical director that afternoon, she began to feel queasy and suffered severe vertigo which forced her to lie on the floor, totally helpless, the pixels on the left side of her body ‘going offline’. Calmly, she told her boss she was having a stroke and asked him to call the resuscitation team. Hilary ran a teaching programme involving simulated scenarios, including cerebral haemorrhage, so she wasn’t fazed by the situation, not even when being carried to the Emergency department down an old stairwell, the only part of the hospital without a lift! Her main concern was for the resuscitation nurse, to whom Hilary apologized for vomiting over her.

From then on, everything went blank until she woke up in intensive care where she stayed for a weekend before being transferred to a general ward for the next few weeks, followed by 3 months in the rehab unit. The stroke had left her with double vision, vertigo, weakness along the right side of her body and numbness on the whole of her right side. Though unable to vocalise or even swallow, she was fully aware of her situation and able to understand everyone. There was no definite prognosis, just comments such as, “you will find meaningful work,” and equally vague intimations that she would be ‘stable’ when discharged.

But then going home seemed a long way off. Because she found swallowing difficult, Hilary had to be fed through a tube, supervised by a dietician, and received blood pressure management for the acute reaction of her body to the bleed. She also needed speech therapy, a programme of physiotherapy, skills training around daily living activities, psychological support through peer group activities, and specific rehab directed to her own condition. “The neuro rehab unit was fantastic but like being at boarding school. I’d always wanted to live in Bloomsbury and enjoyed some of my time there, as I was taken out in a wheelchair to the surrounding squares, visiting the British Museum and Foundling Museum and enjoying the long, hot summer.” Once home, Hilary joined the ‘Different Strokes’ group in Haringey where she still goes for Chi Kung sessions. It was here she found out about the Feldenkrais method from group co-ordinator John Murray.

“As a rheumatologist I had heard of Feldenkrais but conflated it with the Alexander technique as a resource facility for people recovering from injuries or pain.” John talked favourably about his experience, crediting Feldenkrais for helping him regain movement in his arm and shoulder, and as a result, I was invited to hold a class for the group.

Convinced that neuroplasticity is key to recovery, Hilary was keen to explore new ways to generate it. After one of the first times that she and I worked together, she said: “Alex encouraged me to stand behind my wheelchair, cross my legs, then sense how my weight was distributed. It was a revelation! Using this technique, I could fool my brain into thinking the weak side was strong and I felt able to stand straighter, although still holding on to my wheelchair for balance. I already attended the gym to improve strength and endurance, but balance needs a different approach.”

Impressed by this innovative method and already feeling the benefit, Hilary joined a U3A group that I run and followed that course of gentle floor exercise. I encouraged her to continue to experiment, discovering ways of getting off the chair to the floor, of turning over on the floor and getting back up from the floor. In each case, Hilary needed to gauge how heavy her head was and how far she could lean before feeling unstable.

I also do individual lessons of Functional Integration, which I think has helped Hilary’s neck. This hands-on aspect of Feldenkrais really chimed with Hilary, which she felt was somewhat lacking in other work she had experienced. And Hilary is also learning from the Feldenkrais Guild audio files, many of which she can do whilst sitting down.

“Overall, I think it is a very reflective experience,” say Hilary, “more movement through awareness than the other way around. Feldenkrais has certainly given me a focus, a natural way of exercising at my own pace. I actually feel my muscles changing and the weight distribution technique is really useful. Being able to sense how it feels for you is absolutely unique to my recovery, while repetition at one’s pace fits in with current theories on stroke rehabilitation.”

Hilary exercises four or five times a week and is determined to get even fitter! Not only has she become more independent since doing Feldenkrais, but is now actively supporting other stroke recoverers.

A major element of the Feldenkrais method is self-reflection which enables clients to become aware of muscle use and to master their movements. In looking at the whole person, Feldenkrais is aligned to neuroplasticity, reflecting our new understanding of how the brain works. The muscles are either more switched on or weaker in certain areas, or the client’s sensations may be impaired after stroke. Is the client paying attention to the whole of their body? Are they fixated on listening to or sensing only one part of their body while ignoring other parts? By asking these questions the client learns to inhibit and select areas of the body that need attention.
 
Feldenkrais classes elicited Hilary’s curiosity through challenging exercises she’d never previously explored. Curiosity is one of the key features of neuroplasticity. Curiosity is important for our brains because it encourages our brains to seek out new connections, like a dog sniffing the air. Curiosity provides vital motivation for the brain to change and recover. We all need curiosity to explore new movements.
 
Since using the Feldenkrais method, Hilary has seen significant improvements, such as better balance, more awareness, less muscle tension and increased mobility, particularly in her feet. “The Feldenkrais method has, in practical terms, helped me to turn over in bed, get down on the floor safely and get up again holding my wheelchair,” says Hilary. She is more aware of her posture now, and is generally more adventurous and curious about pushing the boundaries.
 
“It’s not a quick fix; I have been working with Alex for at least 4 years as part of my self-designed stroke rehabilitation. It has also made me curious about other aspects of anatomy; for instance, what happens in connective tissue, a subject covered through an online Feldenkrais ‘summit’ I attended last year,” she said. “Feldenkrais has definitely become one of my favourite habits!”