Sunday, May 13, 2018

Sunday Stroke Survival: Caring for a Spastic Hand

Now,  I'll admit that my spasticity is severe. Most stroke survivors do not have spasticity as bad as mine. But for those who do, this post is may help you.

Even with my severe spasticity, the therapist , with electro-dry needling and working her hinny off, can stretch my fingers out to almost full extension (straight) and my wrist to almost neutral position (straight). The electro-dry needling is my word for it. I imagine there is a technical word for it. I just can't remember the term right now. A battery operated device causes the muscles to contract and relax through a sequence electrical shocks. The electrodes are attached to the various acupuncture needles inserted into my muscles. It basically saves the therapist time, and wear and tear on herself. It can tire the muscles in ten minutes versus an hour of manipulation by hand.

At times, the spasticity in my hand is so bad my nails will bite into my palm enough to draw blood. As I said my spasticity is severe and most severe spastic sessions can last hours (think spasticity on overdrive). Yes, it's very painful. I've described it here and other places as a cramp on top of a Charlie horse.

Grossness Alert, but it's honest

The normal shedding of skin cells pile up in the palm, creases in the wrist, the crease in the elbow, and between the fingers. As you can imagine this with normal sweating...the smell of this dead skin is awful. The old saying of it will gag a maggot fits perfectly to this. While many therapist will say that ice reduces spasticity, but remember I'm the Queen of Abby Normal. It takes moist heat and a lot of it. I've got a 40-gallon water heater and when I bathe, it takes every drop of it to reduce the spasticity enough to relax the muscles enough for me to marginally wash these places. Most times, it's by brute force shoving the washcloth in there. At times, I've even resorted  to a Scotch-Brite green scrubber part that the sponge has worn off to exfoliate my hand. Yes, I'm sold on Scotch-Brite as I said in an earlier post. A simple washcloth just doesn't do the job. The worn out green part is thin enough that it will fit wear a loofah will not. Even with all of that, there's still dead skin left in the nooks and crannies. I know because I can feel the slimy mess when I dry off. My spastic, inverted foot isn't as bad because the skin is exposed for the most part.

All this slimy goo building up on my arm, besides the smell, can cause skin break down if not removed. Most days, I can manipulate my fingers by myself, but with my wrist in a fixed 90 degree flexed state makes it impossible to cut my nails as I once did. So what do I do? I pick at them. Yes, they aren't pretty, but most of the time they are curled into my palm anyhow. My nails, from constantly being in a warm, moist environment, are now thin and soft. For this, I'm thankful. Madge, from Palmolive dish detergent fame, be hanged. Notice she only puts the finger nails into the Palmolive to soften them before a manicure. Yes, I know. I'm aging myself referencing a 1960-70s ad. By hey, I'm an older person. Get over it. It's hard to imagine that with all that goo constantly in my hand I still have dry skin to boot, but I do.

Now my hand isn't always spastic in a fist closed fashion. Since the fingers will move, sometimes I become spastic in a witch's craw. Every joint hyper extends in the opposite of normal. Yes, I had the ability to do this before my strokes at will. Every couple of months, the hand will relax as pictured like this morning. Although the spasticity will persist in the wrist, the fingers are pliable and I can voluntarily move them a little. Oh happy hours~ because at the most that's how long it will last. It's a mini spa day at the Murphey Saga house. I'll break out my soft loofah and being careful not to touch the center of my palm, I'll scrub everywhere else. Touching the center of the palm reflex will cause the hand to close into a fist. I am also careful not too extend my wrist too much because this will cause the spasticity to return. It will be awkward trying to get at places but it sure beats a closed fist. I'll immerse the hand in warm water to rinse the dead skin and sweat away. Oh heaven! The hand is actually clean!

Next, after drying the hand, I'll apply lotion. I'll put a big dab on the back of my affected hand and up my arm so I can go to it easier than trying to squeeze it out of the bottle every time I need some more. I know time is limited before the spasticity curls the hand shut again. As I apply the lotion, I'm using a massaging action. At the base of the fingers where they connects to the hand, the tendons are usually tight like piano wires. I'll massage these first and make my way up each finger with a kneading motion, it's a reflexology massage stretching them out one by one. I hit all the trigger points pictured. I save the center palm and the crease of the wrist for last. I know the reflexes and spasticity will return with the manipulation of these areas so I work quickly until I can no longer access the area. But, it's heavenly while it lasts.

I have mentioned several fields of study in this blog. I'm an expert of none of them. I do watch, read, question, and learn what works and what doesn't as it pertains to me. I've been in occupational and physical therapies for over half my life with this or that ailment, or it seems like it. I've never stopped and added up all the hours. There's also a limit to what I can do for myself with one functioning hand. I'll do what I can and ask others for help if needed. The other more questionable practices like acupuncture, massage therapy and reflexology have is garnered knowledge from licensed, holistic healing persons over the years. I say whatever works, do it. It really can't hurt. Even my PT follows my suggestions because it alleviates my pain and helps with my range of motion while she works. Now that's team work.

Nothing is impossible.


  1. I never thought about not being able to scrub in certain parts.

    1. When you are standing in the shower all parts are accessible. But seated on a shower chair and with on hand doing all the work, many places are hard to reach.

  2. Jo, I don't know if this would make a difference for you or not, but it does for me. About a year and a half after my stroke, my brother (a physical therapist) was visiting me. He played with my hand some, enough to see my spasticity, and recommended a splint for the hand that would keep my thumb straight (at the time it was wrapped tight in the middle of my fingers). I found one on Amazon, he approved it, and I've been wearing it daily ever since. He said that keeping the thumb straight, not getting it clenched in my hand, is key. This is the one I have:

    It is for either hand, and has a (removeable) aluminum stay that keeps the thumb straight. Mine was about $20.00, and now, 3 years later, my thumb isn't much better but isn't any worse. And although I still have spasticity (which has gotten worse), I can clean my hand with a washcloth every day. No more smell!

    1. Denise I have a cock-up splint for my thumb. The problem is the wrist. I can remove my thumb to outside of the fingers.


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