With reference to the putty, dynamic and passive splints, electrical stimulation, and recent mirror therapy, that request seemed to embody the theme of the last couple weeks especially, and in general since inpatient days: focus on the hands. -S
I suppose evolution did not "plan" it this way, but I am in a position now to reflect on how utterly dependent we all are on our hands when it comes to interacting with our physical environment. Of course, it seems totally strange to imagine a situation where our hands play not a primary but a secondary role in daily activities, like the core does with the act of standing, where you might say the legs perform the primary function. I suppose it’s stunning how a human’s infinite creativity and ingenuity are, in the end, largely articulated by a set of ten dexterous digits.
Right now I’m about 1 for 10. Though the top knuckle barely bends, I can move my right thumb in and out, left and right. The other nine are not yet so advanced. On the right side my intrinsic muscles (within the hand) respond: one group to spread the fingers wide (interossei) and another to straighten the fingers (lumbricals). The extrinsic (in the forearm, with tendons to control the digits) do respond to bend the fingers (flexors) but not at all to bring the fingers back toward my elbow (extensors). That is, I can do the squeeze in a handshake (lumbricals, flexors) but not the open-hand motion of a high five (extensors).
The left side, (on) the other hand, still has very little innervation. Despite receiving a commensurate amount of attention in hand therapy, the only activity is a faint quiver in the thumb.
This doesn’t mean that my left hand is useless, however. Going back to the tendons that convey extrinsic muscle contractions to the hand, moving my wrist up or down will shorten or lengthen the finger tendons such that the fingers can be flexed or extended without the need for the finger muscles; this is the tenodesis we have mentioned before. It does not allow me to swing a hammer (I’ve tried), but for picking up the contact solution bottle or passing the pepper, it is functional. Sorting pills or picking up a sheet of paper, however, is much harder because, though it does not require strength, those items do not easily rest inside a passive hand.
As for the right side, without finger extensors I typically have to reach for objects from the other side and pull toward me, using tenodesis to open my hand and actual muscle firing to close it. This works in open spaces, but makes reaching for a bottle in a backpack especially hard, or getting a Fastrak from the glove-box almost impossible because I cannot get under or behind it.
An added excitement is spasticity. For whatever reason, when I lean forward in my chair onto my thighs, my hands always spasm. That lean is typically to pick something up, which means my body could not have worse timing for tightening up. I wait for the reflex to calm down, because retrieving a book with a clenched fist doesn’t work.
Now let me step back. I do not share these troubles from frustration, but rather to illustrate by means of a “picture’s negative” what beautiful function a working hand has. Writing and home-row typing are in some ways the epitome of that dexterity: every muscle group is used, and with precision. Dictating to type is an amazing asset to those with impairment, but my spoken typing speed does not match my prior typing speed. Additionally, if you have dictated extensively, you know it is just not the same as composing through the fingers.
In a sense, my hands are a defining feature of my loss of comfort and security about what lies ahead. I was not one to plan my life’s path, but rather I made decisions based on maximizing possible futures, on giving myself more options down the road.
With studying and becoming more educated, I could apply myself to broader intellectual pursuits.
With increased fitness and athleticism, I aimed to reach the highest point I could in a single discipline, and still be able to climb on weekends or backpack in the summer.
By practicing awareness, I sought to better understand the events and people around me.
Now, most of those qualities remain, and that is in no way lost on me. I am conscious of how fortunate I am in so many ways. However, those qualities are, at least for the time being, constrained in part by my physical self. I have an uncertainty that comes with being bound in by something so fundamentally me as my own body. This will not stand in the way of my contributing to the world–making the proverbial ‘difference’–but my constant awareness of it is the source of my determination to recover.