Many people with a Neurological disorder or Chronic health condition, find that they can no longer do all the activities in a day that they wish.  When working with clients we get them to appreciate that they need to pace their activities (Something that over my rehab period I have also had to do). 

What is Pacing?
“a way of increasing your activity level without stirring up your fatigue/pain or other symptoms such as dizziness too much”

Aim: to maintain an even level of activity throughout the day instead of doing as much as possible in the morning and then resting all afternoon.
When we don't do this we can get in to a cycle which is unproductive which we call the BOOM/BUST cycle. 

Setting goals can be one of the best ways to drive your performance and rehab forward. 
Here is a great little booklet we put together to help you out. 
DOWNLOAD - HNR goal setting ebook. 

It is also important that the hand is mobilised gently and regularly, either by yourself or by a support person or therapist.  Your therapist will be able  to provide you education on how to do this, and you can look at the resources here. ​

Exercises to be performed by you.
Right arm 
Left arm 

Exercises to be performed support person.
Right arm 
Left arm 

Positioning post stroke is extremely important as it allows for muscles and joints to remain in there correct positions which helps with returning function and reducing impairments of joint changes and pain. 
The New Zealand Stroke foundation has some excellent resources for positioning post stroke 

Find these here 
For left hemiplegia 
For right hemiplegia 

We have recently been discussing the importance of good sleep but for the many that can be difficult, for many different reasons. It may be that you have a neurological condition that impacts on your sleep, it maybe that you have developed insomnia over your life, like me you may have an interrupted sleep pattern due to small children or animals, it maybe that you feel you just don’t need that much sleep.
 
Well prioritising getting a good nights sleep can be one of the best things you can do for your health, in this post we are going to discuss the ways you can set your self up for a good nights sleep.
 
Regularity – going to bed and waking up at the same time each day helps set your Circadian Rhythm (your body clock) to be working well and gives you the best chance to fall asleep well.  Research shows adults need between 7-9 hours sleep so ideally getting into bed to give yourself an 8- 8.5  hour sleep opportunity is important.
 
Embrace darkness – Not only is it important to have a dark bedroom by using eye masks or black out curtains in the bedroom. It is also important to watch your light exposure before bedtime.  Cut the artificial lights down at night time, this will help allow melatonin levels to rise. Limit screens as the blue light from phones have been shown to disrupt your dream (REM) sleep when used as little as an hour before bed and this disruption has been shown to last for days afterwards.
 
Body temperature – To fall asleep we need to have our core body temperature fall, keeping your bedroom around 18 degrees allows for this. Use appropriate bedding and sleepware can help too. Having a warm shower or bath before bed assists with this process and helps you fall asleep faster. However having cold hands and feel can stop your core body temperature dropping so using socks or something like a wheat bag can help warm them up to drop your core temperature.
  
Watch what your drink  - Both caffeine and alcohol will affect your overall quality of sleep, and have been shown to affect sleep in small doses even if you not aware of it. Caffeine, found in coffee, tea and soft drinks has a half life of 6 hours and a quarter life of 12 hours. Recommendations for sleep is to drink caffeine no later than midday.
 
Even one glass of alcohol has been shown to disrupt dream sleep and the by products of the body processing alcohol are still present 8-9 hours after that drink. Alcohol affects the quality of sleep.
 
Drinking too much fluid close to bed time can also increase nocturia (night time toileting) and can cause you to wake from sleep.  Fluid intake and hydration is also important as dehydration also irritates the bladder and causes more toileting.
 
Watch when you are eating – avoid eating three hours before bedtime as this can cause ongoing issues with reflux, and your body is undergoing digestion process so can not repair until this is finished.
  
Bedtime routine – Having a consistent bedtime routine signals to your body that you are ready for sleep. 
 
Some ideas for a bed time routine are

• Shower or bath before bed
• Hot drink such as camomile tea
• Read a book
• Wash your face
• Meditation/prayer/mindfulness/deep breathing
• Turn off screens so you have an hour free screen time before bed this helps reduce the blue light that can affect your sleep.

 
Manage stress – The build up of stress chemicals such as the hormone cortisol can impact of getting and staying asleep. Understanding stress triggers and dealing with these can support good sleep. Meditation before bed has been shown to help people get a better nights sleep. An hour before bed taking some time to document any thoughts or stressors can also help. If you wake in the middle of the night, you can go and quietly write down any of the things that are keeping you awake. Can’t get out of bed, try deep breathing into your stomach in through your nose and out through your mouth or trick your brain to stop going through all those thoughts imagine your self taking a gentle walk in your favourite spot, or if you can try to walk yourself through a guided meditation, ideally avoiding the use of your phone.
  
Keep the bedroom for sleep - The brain can be extremely associative it is recommended that if you are having difficulty with sleep that you use  bedroom for only Sleep and sex. This is some of the reason why you can fall asleep on the sofa then try to go to bed you won’t be able to go to sleep. It is also why if you find yourself awake in bed for longer than 20 minutes it is recommended if safe that you get out of bed and do something quite until you feel sleepy and return to bed.  Some people finding reading before bed can help and as long as this does not disrupt your sleep then this can be a good way to switch the brain off.
  
A word about rest and naps
 
We will cover fatigue management more at a later stage but if you find that you are needing to nap during the day and this is regular and dose not interfere with your night sleep then it it good to continue.  Naps can affect a hormone call adensosisne which is needed to build up to help us sleep, when we nap we release some of the adenosine and that can impact out night sleep. If you have had a bad nights sleep it is better to wake up at the same time and then try to go to bed when sleepy in the evening to help with maintaining a good sleep pattern.  If you do nap try not to nap too late in the afternoon before 3 pm is ideal.

                                                    Happy sleeping 

      1. Click on the App store icon on your phone or tablet

       2. In the search bar enter ZOOM, select the one below

      3. Click GET and wait
      4. Then Click INSTALL
      5. You may need to enter your Apple ID and password so have this ready
      6. Then click OPEN

     2.  In the search bar type ZOOM
     3. Select the below Zoom app, and click INSTALL

     4. Then click the GET button
    5. You may need to use your google account ID so have this ready to use. (This is               most commonly a gmail account eg: joebloggs@gmail.com)