The following is an except from a presentation I gave at the Inaugural Interdisciplinary Symposium on Quantitative Research in Music and Medicine. Ogden, Utah. June 3, 2011. The presentation will be published in its entirety in the 2011 Proceedings of the Interdisciplinary Society for Quantitative Measurement in Music and Medicine. Precise publication information will follow when it becomes available. Many thanks to the conference board for allowing publication of this material in my blog.
My first post-stroke memories begin around four days after the event. Subjectively, my thinking seemed dazed, but relatively normal. I just felt very tired. It was not until I tried to act in the world—perform simple addition or subtraction, read, tell time, speak, or tried to do just about anything—that the fractures in my mind became apparent. So too with my body. At rest, it felt normal, completely pain free. Until I tried to act, I had no idea I could not chew and swallow normally, walk, or move my left arm and fingers. Indeed, I had no left side sensation whatsoever.
On the fifth day after the stroke, I found I could move my left wrist. Earlier in the day, a neurologist had asked if the stroke had affected my music cognition. I had no idea. I had not thought about music at all; mostly my mind was silent. The neurologist sang some pitch intervals and I identified them without difficulty. How about rhythm, he wondered. I tapped a clave pattern with my right hand, also with no apparent problem.
Alone again, with my left arm lying on the bed, I moved the wrist to tap a beat with my left hand fingers . . . 1, 2, 3, 4. Movement was slow, and difficult to maintain, but a far as I could tell, the tempo was even. Next, I tried to alternate left and right hands. That was not successful, initially at least. Right-side activity overwhelmed and masked the weak directions my damaged brain was sending to my left wrist, which abruptly stopped moving. Not until I focused nearly all my attention on moving the left wrist could I sustain the two sides together. Even so, I succeeded only for a few repetitions.
Because I had no sensation in my hand, it was necessary to watch the wrist move or to tap hard enough to hear my fingers make contact with the bed. Both were difficult. I tied tapping my left leg, but could not feel the contact. Next, I lifted my left arm over and tried tapping on the right side of my body. That was no better. The confusion resulting from registering right-side sensation when I moved my left hand made the task conceptually impossible.
Even so, I found the movement challenges highly engaging. Next, I tried a similar tapping exercise with my left foot, which I could now slowly rock back and forth. As with my hands, initially my left leg stopped moving when I attempted to alternate movements between both legs. Drum set-style, over the next few days and weeks I developed bilateral tapping exercises, organized both horizontally and vertically, for example:
1. Left hand—right hand—left hand—right foot.
2. Right hand—right foot—right hand—left foot.
3. Right hand—left foot—right foot—left hand.
4. Et cetera.
These exercises weren’t about developing quickness or fluidity of movement (that would only come months later), but about finding left-side muscles from different vantage points (or approaches) and with bilateral integration. There were distinct levels of difficulty. Crossing from left to right was far more difficult than alternating left hand with left foot. Crossing laterally and alternating hands and feet (see #3 above) was most difficult of all.
To keep me on task, I eventually attempted to maintain a steady rhythm. I continue to perform these exercises on a daily basis; they remain challenging. Concentrating locally (that is, entering deeply and solely into the experience of each particular movement event, rather than maintaining a broad overview perspective from which I sought to retain full-body awareness) made the task of moving from one limb to the next both more difficult and more productive. Such was the case for two reasons. First, paying close attention to each individual movement helped me understand the physical and mental mechanics of achieving the desired movement. Second, losing left-side focus resulted in left-side “invisibility.” It required considerable mental effort to rediscover the missing limb. I found that by having to search anew time and again, I began to learn where to look.
In the weeks that followed, my therapists gave me a variety of left-hand tasks. At first I picked up wooden blocks; later, I tried to stack them. Some two weeks after the stroke, and about a week after being relocated to Boston’s Spaulding Rehabilitation Hospital, I decided it was time to relearn to eat with my left hand. That first meal took almost an hour to consume and I looked like I had been in food fight, but my tray was cleared and a fair amount of the food had made it into my mouth. I was accomplishing tasks, but the work lacked a methodology upon which to scaffold undertakings from simple to difficult.
After all, imagine the muscle control involved in the “simple” act of picking up a block or getting food from plate to fork to mouth. The arm and hand must move through three-dimensional space; muscle groups must interact and work together. And with almost no sensation, I had to rely almost exclusively on visual cues. I cooperated with my therapists, but on my own I decided to break movement down to the basics, to create simple graduated exercises.
There is a piano in the common room of Spaulding’s stroke ward. At night, when the room was free, I went in to “play.” With my right arm I held my left hand over the keyboard and pushed down the keys one finger after another. Seconds would pass as I tried to locate neighboring digits, then move them forcefully enough into the keys so as to activate the hammers. When I learned to hold my left hand in place without assistance, I tied adding my right hand so as to play in octaves. The attempt was premature, however. When I used my right hand, I lost track of my left, which would simply fall to my side.
Some five weeks after the stroke, I was allowed to go home. We didn’t then own a piano, so I returned to the bilateral rhythmic exercises I had begun while still in intensive care. My goal was to play a drum. It was nearly 6 months before I could hold sticks and hit what I was aiming for. I began with slow motion, maintaining a grip as I turned my wrist to bring the tip of the stick up and down, up and down. I quickly realized left-side pathways were fused together; my left leg moved reflexively in response to my brain’s muddled left-arm directions. As my left wrist turned, my left foot twisted with toes clenched inward. Nerves along my left side tingled, sometimes burned like a vicious case of hives. While these effects have gradually lessened over time, they have yet to disappear.