Several important factors underscore the potential value of exercise training and physical activity in stroke survivors. Studies have demonstrated the trainability of stroke survivors and documented beneficial physiological, psychological, sensorimotor, strength, endurance and functional effects of various types of exercises. Unfortunately, stroke remains a leading cause of long-term disability. Consequently, stroke survivors are often deconditioned and predisposed to a sedentary lifestyle that limits performance of activities of daily living.

Appropriate exercise does not only help you in the post stroke period, but can also cut stroke risk as a preventive method. Researchers found that as exercise levels increased, stroke risk decreased even after controlling for diet, smoking, high blood pressure, and other risks. Those who exercised the most had half the risk of ischemic stroke (the kind caused by a blockage of an artery to the brain) as the least active.

Walking, bending and stretching are forms of exercise that can help strengthen your body and keep it flexible. A simple activity like sweeping the floor can be undertaken every day. In these two editions of newsletter, we will give you some tips to get you started. We will introduce you to two exercise programs in the following paragraphs. Firstly what we will present is for the person whose physical abilities have been mildly affected by the stroke. In the next issue we are going to talk about exercises for those with greater limitations. The exercises may be performed alone if you are able to do so safely. However, for many stroke survivors, it is advisable to have someone standing beside while an exercise session is in progress.

Exercise 1: To strengthen the muscles which stabilize the shoulder

Lie on your back with your arms resting at your sides. Keeping your elbow straight, lift your affected arm to shoulder level with your hand pointing to the ceiling, then raise your hand toward the ceiling, lifting your shoulder blade from the floor.There is a variation to strengthen the muscles which straighten the elbow: stay in the same position and put a rolled towel under the affected elbow.

Bend the elbow and move your hand up toward your shoulder while always keeping your elbow resting on the towel. Hold for a few seconds, and then straighten your elbow and hold. Slowly repeat the reaching motion several times, remember to lower your arm to rest by your side.

Exercise 2: To improve hip control in preparation for walking activities:

Lie on your back, start with your unaffected leg flat on the floor and your affected leg bent. Lift your affected foot and cross your affected leg over the other leg, lift the affected foot and uncross, then resume the cross motion. Please repeat the crossing and un-crossing motion several times.

Exercise 3: To enhance hip and knee control

Start with your knees bent, feet resting on the floor. Slowly slide the heel of your affected leg down so that the leg straightens. Slowly bring the heel of your affected leg along the floor, returning to the starting position. Keep your heel in contact with the floor throughout the exercise. Taking off the shoes during this exercise is recommended as your foot will slide more smoothly.

Fatigue while exercising is to be expected. You will have good and bad days like everyone else. Certainly these programs can be modified to accommodate for fatigue or other conditions. However, it may be necessary to tolerate some discomfort to make progress.

Published in May 2008 by Viking, honored as New York Times Bestseller, "My stroke of insight" described a brain scientist's personal journey during the aftermath of a stroke. Jill Bolte Taylor, was a 37-year-old Harvard-trained and published brain scientist when a blood vessel exploded in her brain. Through the eyes of a curious neuroanatomist, she watched her mind completely deteriorate whereby she could not walk, talk, read, write, or recall any of her life. Because of her understanding of how the brain works, her respect for the cells composing her human form, and an amazing mother, Jill could completely recover her mind, brain and body.

What is even more interesting than her explanations of the science of stroke is her description of the unique functions of the left and right halves of the brain and how her left-brain insult led to a spiritual awakening. As what is noted on her website: "In the absence of her left brain's neural circuitry, her consciousness shifted into present moment thinking whereby she experienced herself ‘at one with the universe.

One of the readers said that Taylor's book has accomplished quite a few important things in a fairly short space. It tells a fascinating story that begins with how she orchestrated her rescue that morning even as "my earthly body dissolved and I melted into the universe," and proceeds through brain surgery and eight years of slow recovery of her left-brain functions (for instance, she had to learn to read all over again, beginning with the preschool-level "The Puppy Who Wanted a Boy"); it bursts with hope for everyone who is brain-injured (not just stroke patients but accident victims as well); and it gives medical practitioners clear, no-nonsense information about the shortcomings of conventional treatment and attitudes toward the brain-injured: "I needed people to come close and not be afraid of me".

What ever your situation is, you owe it to yourself to watch this 18-minute long video and let her inspire you personally, just enter this address in your internet explorer: Jill Bolte Taylor's Powerful stroke of insight; or you can purchase the book directly on Amazon. What is more, a discussion forum has been set up on mystrokeofinsight.com.

In February we talked about aphasia, a loss of the ability to produce and/or comprehend language due to injury to brain areas specialized in these functions. In 1989, two scientists showed in their survey that stroke with aphasia have a greater negative impact on the patient’s spouse than stroke without aphasia does. This was explained by the fact that aphasic partners had more difficulty communicating about details concerned with role adjustments.

Already in 1987, two Canadian Scientists, Friedland and McColl studied patients during the first two years after a stroke and identified four aspects of social support which could provide positive and useful help. These were:

1. satisfaction with social support
2. satisfaction with social support
3. the single most significant relationship in the individual's life
4. close friends and family
5. the community

It is suggested that other approaches to helping the stroke patients could be developed. One way of looking at an aphasic sufferer's difficult situation is to use the psychological model, Personal Construct Theory (PCT). This method, developed by Kelly in 1955, is a way of describing how we understand ourselves and other people. That is, in Kelly's terms, the way in which an individual understands the reality of his world, based upon the past he learnt and the future he estimates. PCT can offer a theoretical perspective on the individual's situation which can enhance our understanding and thus empower us therapeutically.

Used in therapy, it is helpful to view adapting to a stroke as a process of transition, a change of patient's initial role (spouse, parents etc). That is, the individual comes to understand and make sense of the situation by moving through phases of researching and understanding.

Personal Construct Theory was devised primarily for people with intact language systems – even there was no such mention in Kelly's original work about this application. However, in case of acquired brain damage, a "grid technique" is widely used today, which is originally from Kelly's sub-theory: the Role Construct Repertory Test. It aims to elicit constructs from a person by asking them to consider groups of role titles which have been selected from their social context. The role titles are written along the top, and the bipolar constructs are written down the side. Each role title is considered in relation to each pair of constructs.

An example of the procedure would be that three elements are considered:

• Self before illness
• Self now
• Self I would like to be

And put the following words below in the grid:

• very good - very bad
• can move - can't move
• happy - sad
• angry - not angry
• Calm - more excitable

In a case, Mr. X talks about his distress at his changed ability in talking: "I know I talk slower than what I could do before the stroke, but, it was a shock, because round here people talk quick and I talked quicker than them and I miss the words out, the little words and that. I think it was a shock."

Note the use of the contrast between before his stroke and afterwards, the pain caused by the loss of his abilities of speech is clear.

Along with PCT, while talking to a stroke survivor with communication disabilities, try to grab adjectives with which he/she describes him/herself, and compare those to the language he/she used before the stroke. Help them with the right and appropriate strategy and give them a positive strength. Personal characterization can also offer a basic starting point.

The application of PCT to our understanding of the reactions to stroke and acquired communication problems can offer theoretical insights which make it easier to understand the meaning of the problem to the individual. It offers a structure to the recovery process.

In the end, here are several communication tips for daily life:

• Personalize the conversation, including using the person's name to get attention, making eye contact or a gentle touch
• Use short, simple sentences and speak clearly and slowly.
• Repeat sentences exactly, if the person does not seem to understand a word, try substituting it with another one.
• Be specific
• Offer simple choices such as "Yes" or "No".