In the field of stroke rehabilitation, hemianopsia is considered one of the neglected impairments. These are impairments of the senses that probably affect up to 60% of stroke patients (1). These neglected impairments have not received systematic attention by neurologists or rehabilitation therapists. Both the practice and research of stroke rehabilitation have focused on and have tried to correct motor and speech deficits. In recent years there has been some interest in the rehabilitation of vision. But very little, if anything, has been done for thousands of people who, after a stroke, are unable to smell, taste, hear, or have feelings on areas of their skin.
I too had one of those "neglected impairments", and I did not know that I had it. The three neurologists I saw after the stroke did not bother to check for anything other than possible motor defects.
Then, once my vision improved and I became able to drive, I went to visit my step-daughter who is a naturopath and lives in Walla Walla, Washington. She set up a consultation with a colleague of hers, Dr. Dale Elmenhurst, a chiropractor practicing functional neurology (2).
What is functional neurology? It is a treatment modality based on principles of brain plasticity. It offers therapies that enhance the performance of areas of the brain that have been affected by stroke or other injuries. Click here to read more about functional neurology.
Dr. Elmenhurst did a thorough exam. He assessed sensory deficits in addition to the motor and visual ones. And from his assessment it became obvious that I had a problem with my sense of smell. I could barely smell anything through my left nostril. To test my olfactory sense he used several little bottles emitting different smells, aromas that were unfamiliar to me. He had me close my eyes and the left nostril and tested from how far I could smell each smell through my right nostril. I could smell them from a considerable distance. Then he had me close the right nostril and test the left one. He nearly had to put the bottle inside my left nostril for me to smell anything. He then tested my merory of the smells, and the right nostril could remember the order the smells were presented to me. The left one was a dud.
I had mentioned to the neurologists I had consulted that after the stroke I had lost my appetite. I had told them that I had to remind myself to eat and the food tasted dull. It was not a topic that they paid any attention to. The discovery that my sense of smell was impaired and the exercises that Dr. Elmenhurst suggested have helped improve my appetite and restore the pleasure of eating.
My smelling exercises involved smelling herbs and spices through my left nostril with my eyes closed. I discovered that I could not tell oregano from mint in my garden, if I tasted them or smelled them with my eyes closed. I had to hold the spices I was smelling, cinnamon and cumin, so close to my nose that I was constantly sneezing. But after many repetitions my sense of smell started improving. Now, after all this practice, I can close my eyes and tell oregano, dill, mint, verbena, thyme and basil apart. My left nostril is not as adept as the right one in smelling, but it is getting better.
From working on improving my vision and my smell I learned this: there is a very simple principle that should guide one's efforts to rehabilitate one's brain after a stroke. It is one of the central tenets of functional neurology articulated by Dr. Datis Kharrazian in his very interesting book "Why isn't my brain working?"(Elephant Press, 2013).
Brain rehabilitation can be simplified by saying "whatever you can't do is your rehabilitation program"... Start very slowly with functions that are difficult but do not cause you to crash, and work you way up.
I have found that this strategy has three parts:
First one has to figure out what is not working.
Second one has to find out what to do to improve it.
Third one has to get oneself to do it.
If you are lucky to find professionals who can assess the problem and prescibe exercises, then the whole process is more or less easy.
In the absence of experts who can test and find out what is not working, the first part requires that one pay meticulous attention to one's behavior in order to find out where the deficits are. Then to find out what to do about them there is the Internet which is a bottomless source of information. Lastly, one has to discipline oneself and make oneself perform tedious and repetitious exercises and tasks over and over again. This requires considerable focus and persistence. But the efforts pay off in terms of regaining function.
So now I can see better, I can read real fast and I can drive. I can smell better and food tastes quite good. After several months of fixing this and that I am taking a break from all exercises and improvements. I feel that I have rehabilitation fatigue. What is left to work on is my memory that was also affected by the stroke. I will write about that in my next post.
Sources and resources
1. Click here for an interesting review of rehabilitation research.
2. Click here for a link to Dr. Elmenhurst's website.
