Almost two months ago, a close family member suffered a devastating
stroke. It was a Sunday night, and he and his wife were planning to
watch The Amazing Race – or whatever reality show is on that night. (To protect their privacy, I'm going to call them George and
Gracie.)
George was the type of guy who was always busy, always working on
something. He seemed to be in great health, other than an injured
shoulder, and he hadn't complained about not feeling well that day. Gracie
had gone to take a shower before the show started. When she came out,
she saw George slumped over on the bed, and it seemed he had vomited.
She was worried he was sick, but she thought he was being overly
dramatic about it. She quickly realized it was far more than an upset
stomach and called 911. George was transported to the local hospital,
then immediately transferred to the huge regional hospital with better
facilities for treating stroke patients.
I don't know nor
understand all the specifics of the stroke. George wasn't even 50 at the
time of the stroke. It was determined that nothing he did caused the
stroke nor could have prevented it, because he was diagnosed with a very
rare condition called Moyamoya that caused his carotids to become
completely blocked. George's stroke was in his right hemisphere, and
there was evidence of 4 or 5 previous strokes that no one was aware of
until then. He was completely paralyzed on his left side. The left side
of his throat was also paralyzed, making speech very difficult. He also
couldn't swallow, so he couldn't eat or drink anything. It was obvious
in the first few days of his recovery that his intelligence was
completely intact. He could write out notes that asked intelligent
questions or made snarky little jokes - just like he always did. It was
obvious George was still "in there", but he was "trapped" by his body
that just couldn't respond the way it used to.
George was at the
regional hospital for about five days for medical treatment, then he was
transferred to one of their intensive rehab facilities. My family and I
have visited with George and Gracie at least once a week since the day
after the stroke. Each time we saw him, George had made progress. He was
working hard in physical, occupational, and
speech therapy. Gracie,
who stayed with him every day and night while he was hospitalized and
in rehab, said he'd work hard for the therapist but didn't like to do
his exercises on his own. Who could blame him, because a lot of the
things I saw him doing looked boring. But therapy lasted only a short
while each day, and progress was going to require him working on his
own.
I care about George and Gracie, and I wanted to help them in
anyway I could. We live about 1.5 hours away from them, so I couldn't
just pop over and help out every day. We aren't rich, so I couldn't
finance 24-hour in-home care for him. Then I started thinking about how
the iPad has impacted the lives of disabled people and wondered if
anyone had used it in
stroke recovery. I found several news stories about how
Florida Hospital Oceanside
had been successfully using iPads with an aphasic stroke patient.
Unfortunately, that application allowed the patient to touch an icon and
a synthesized voice would communicate simple messages. That's not what
George needed, so I started searching the internet and the
Apple App Store for more ideas.
I found another story on
MSNBC about two Australian neuroscientists,
Stuart Smith and Penelope McNulty of Neuroscience Research Australia,
who had been using iPad, Kinect, and Wii games to make physical
exercises less boring for stroke patients. Smith found that Fruit Ninja
on the iPad was especially useful for improving fine motor control in
patients. Searching the App Store turned up several applications that
were developed for aphasic patients so they could tap an icon to have a
voice speak for them. Best of all, I found an app that had videos
demonstrating all the mouth and tongue exercises that would help improve
George's throat paralysis, swallowing (so he could have his beloved
coffee again!), and speech.
Unfortunately, George and Gracie
didn't already own an iPad and now wasn't a good time for them to make
such an expensive purchase. Butch and I talked about it, and we decided
we'd
buy an iPad for them as our best way of helping them.
We got an iPad 2 at the local
Apple store. I didn't want to initialize the iPad on my iTunes account; it needed to be associated with Gracie's
existing iTunes account so they could get updates for the apps I
planned to add and to add new apps later. We had the Apple associate
initialize the iPad for us. I was able to set it up completely without
ever connecting it to a computer - at least not until I had access to Gracie's computer. And by the way, when I did connect it to Gracie's computer, it connected and synced with no problems. All the apps I had purchased on
the iPad 2 were transferred to the computer without a hitch.
George had made a great deal
of progress, but he was still physically recovering, so I thought a
sturdy case to protect the iPad from spills and drops was necessary. I
searched around on Amazon and found the GumDrop Drop Tech Series Case for iPad 2. I liked this case because it completely covered the iPad 2.
The buttons were encased but easily usable, and all the ports had
attached covers over them. There was even a replaceable screen cover.
Only the camera lens was left uncovered by this case. The case has a
deep "tire tread" pattern that improves your hold, and it's thick and
padded enough that it should protect against shock and bumps. This case
is heavy, but I like it a lot. I used it for a couple of days on the new
iPad as I was loading it up with the apps. The case does add weight and
size to the iPad, but it's not uncomfortable to hold.
Because
of his paralyzed left arm, I realized that George would need to use the
iPad while it was in a stand. The GumDrop case is so thick, I didn't
have a stand that would work well with it. I remembered that I had a ThaiPad from Levenger.
This padded pyramid-shaped pillow supports books, tablets, and ebook
readers. I thought it would work well for George, because it would be
soft enough that he could put it on his lap or even on his chest as he
lay in bed. I tried it with the GumDrop-encased iPad and found it worked
well.
Gracie trusted me enough to tell me her iTunes password,
so I bought an iTunes card for her account and got busy loading up apps
directly onto the iPad 2 from the iTunes app store. Of course, I added Fruit Ninja HD. I also added Angry Birds HD; I thought it might be a fun way to work on fine motor control and reasoning skills, too. I thought CHALK_BOARD,
a simple drawing program, would be handy for George to write a note if
no paper was near, and they could always play simple paper-based games
like Hangman or Tic-tac-toe. I added Montessori Crosswords, a spelling game for children,
because it reminded me of a letter arranging activity the therapist had
George doing. Hopefully these games would prove more interesting than
actually pushing letter tiles around on a tabletop, and George would be
able to work on his fine motor control without being bored.
I was most excited about a series of Lingraphica apps from The Aphasia Company. The SmallTalk Aphasia – Male
app has a simple vocabulary of phrases, spoken in a normal male voice -
useful when George needed something but couldn't make himself
understood. (It's also available with a female voice.) SmallTalk Letters, Numbers, Colors
has a series of videos showing the mouth and tongue movements needed to
say the 26 letters of the English alphabet, colors, and numbers 1-20.
You are shown a tile with the letter, number, or color displayed; tap it
to see a video of a woman slowly pronouncing the word. The SmallTalk Oral Motor Exercises
app has 53 videos demonstrating cheek, tongue, palate, lip, and jaw
exercises designed to strengthen oral musculature. All these SmallTalk
apps are iPhone apps, meaning they run in the small window on the iPad.
However, the videos are easy to see in the small window and remain clear
enough to easily use even when screen-doubled.
We gave the iPad to George and Gracie
at the end of August, about 1 month after his stroke. At that point,
George had made quite a bit of progress, but he still wasn't allowed any
food or drink by mouth because of his throat paralysis. His speech was
still difficult to understand, and you could see the effort he had to
put into talking.
I spent some time showing George how to use his
apps on the iPad, and he immediately started trying the oral exercises.
Gracie was excited to see that application; she said the exercises
demonstrated in the app were exactly like the ones used by the speech
therapist. They had been given a printed list of these exercises, but it
was hard for George to remember how to do all of them. After a while,
Gracie and I started going over these and other apps, and I was giving
her a general lesson on how to use and maintain the iPad 2. George, who
often seemed to quickly lose interest in things when we had visited
previously, actually tried to get himself out of his wheelchair and onto
the bed so he could see what we were doing. I'm sure he wanted to see
what we were doing with the iPad, because he picked up his ThaiPad stand
before he started trying to get on the bed.
In the following
week, Gracie said that George loved using the iPad and was working much
harder at his oral exercises. By the end of the week, he passed his
swallowing test and was allowed to have food by mouth for the first time
since August 7th. I'm not saying that one week of the iPad improved him
so much that he passed the test, but I am saying that he didn't balk so
much at doing his oral exercises. Gracie said they took the iPad to one
of his speech therapy appointments and showed his therapist the apps.
Gracie said the therapist liked the apps and said they were exactly the
exercises George needed to do.
They've had the iPad about a month
now. George was released to go home early in September, and he's
continuing physical, occupational, and speech therapies at home. He's
continuing to use the iPad to do his oral exercises. He also plays his
games, and he's started to go check the scores at ESPN and use the Rush Time Machine app
(the Canadian rock group) that I put on there because he loves Rush
music more than anything. Gracie feels all his time on the iPad would be
better spent doing his therapy apps, but I think he's using his mind
and his motor control to do these other activities. Movement and control
has started to return to his left hand and arm, and his speech is
improving daily. Turns out Gracie loves the iPad 2, also. I think they
both get some exercise racing to grab the iPad before the other person
can get it.
As a note, I only had a short time to show
Gracie how to use the iPad in general and how to do general maintenance
functions. The next weekend, I asked her if she wanted me to show her
how to do anything we had talked about or anything new she'd thought of.
She looked at me like I'd lost my mind and said she didn't need any
refreshers. The iPad 2 is so intuitive, she only needed a couple of
minutes of instruction and she was off and running.
For his 50th
birthday last week, George received a Wii Fit Board. We've heard about
how the Wii helped senior citizens maintain and improve their physical
abilities. Hopefully the Wii Fit works as well for stroke patients and
will help George continue to improve his strength and balance as the
iPad has helped with fine motor control and speech. Apple haters can
scoff all they like, but I think Steve Jobs hit the nail on the head
when he said the iPad is magical. At least it's helping George work some
recovery magic.
Note: Brain picture is from PubMed Health. Product pictures are from their respective vendors.
