Author Archives: bokjae

About bokjae

A retiree and full-time home care-giver to my wife a stroke survivor. A graduate in Electrical & Electronics Engineering, working as Project Manager; and was in Senior Management (Executive Director) with a local Telecommunications Company for 22 years till retirement. Upon retirement I was attached to a Church serving as full-time lay leader, lay counsellor as well as in social or community work such as old folks home, drug rehab, orphanage.

Latest Study on Stroke Prevention

Just an update on the latest development in stroke prevention done by a research team at John Hopkins Hospital and lead by Sylvain Dore. The research classified as alternative medicine uses Ginko on rats and noticed the preventive attributes before a stroke as well a therapeutic potential for after stroke situations.

For more details on this study click on link below :-

Ginkgo has been used as a medicine for centuries and remains a very popular herbal medicine. Some findings suggest it can improve cognitive function and decrease development of Alzheimer’s disease symptoms. It is generally considered safe.

Coping With Behaviroal Change for Caregivers

Based on the number of visitors reading my Post on Behavioral Changes it seems to me that this is one area where people are keen to know more. I can understand that because I fumbled through the process all because I did not fully understand what I was contending with.

It was quite natural to treat your spouse after a stroke and had been discharged from the hospital just like before! She looked physically fine except for the spasticity on the affected limbs. However slowly it dawned on me that a stroke survivor is different from a physically impaired person in the sense that a stroke survivor suffers from brain damage!

Any damage to the brain however small still causes a lot of dysfunction in terms of the thinking process, processing words and understanding. Initially my wife told me things that she didn’t mean to say! For example she wanted bread but what came out from her mouth was noodles! When I brought her noodles she said she told me to get bread! I was flabbergasted by such things and initially get rather stressed out because of the frequent out-burst of anger from her apart from doing double work.

I did not understand this aspect of brain damaged and we had quite a few tiffs in the initial stage. As I read more and understood what was happening, I began to have compassion and understand her frustrations too! She could not help it either! The caregiver, as the person with a good brain intact is expected to empathize with the stroke survivor and with understanding comes the ability to handle and brush-off ‘unfair accusations’ and not allowing yourself to get angry, thus making caregiving less stressful and more meaningful.

I hope that sharing our experience in this area of ‘Behavioral Change’ can help other family members and caregivers to sail through the recovery process with less stress and better understanding, hence compassion for the stroke survivor. As you see the slow improvements, that is the reward for all caregivers and make all the aches and pains worthwhile.

In the days ahead, I will put up posts on this issue with personal experience and less of a technical treatise on the subject and hope that others who are going through similar experience can benefit from the sharing. Please leave your comments, positive or otherwise, so that we can learn together and enjoy mutual benefits. Thank-you!

Motor Imagery Therapy That Stroke Survivors Do

Hi! haven’t been posting for a month! My apologies for the long delay partly due to computer problems and busy with other things! This is a continuation of my earlier post Bilateral Isokinematic Therapy (BIT) and today I would like to introduce the use of Motor Imagery in stroke-rehab.

Motor imagery (MI) is the mental representation of movement without any body movement. Abundant evidence on the positive effects of motor imagery practice on motor performance and learning in athletes, people who are healthy, and people with neurological conditions (eg, stroke, spinal cord injury, Parkinson disease) has been published.

An advantage of MI is that patients can practice it independently during the regeneration phase between two physical therapy sessions. MI can also be practiced in all stages of stroke recovery. In an early stage of recovery, MI allows patients to mentally practice a task which they cannot yet carry out physically due to motor impairment. However, it has not been determined yet, when it is best to start with MI.

The Video Links given below are the routine MI and BIT exercises that Rock goes through daily! The use of the mirror is to create the artificial impression to her brain that her affected hand is moving in tandem with her good hand! In a way this is also considered Bilateral Isokinematic in a sense. There are in total 8 Videos of different exercises involved and you may watch each specific exercise to get a better understanding of how it is done. These Videos were recorded at the University Hospital Stroke Rehab Clinic with the kind permission of Puan Noorieni the Chief Physiotherapist there. Hope these Videos are helpful to other caregivers who want to use them at home but you need to purchase or make those accessories yourself. Thank-you.

Exercises that Rock did since 2005 … 3 times a day with each exercise lasting an hour or more.

  1. Motor Imagery – Wrist Rotation Exercise.
  2. Motor Imagery – Wrist Up-down Exercise.
  3. Motor Imagery – Wrist Open-close Exercise.
  4. Weight Bearing Exercise.
  5. Bilateral Isokinematic – Elbow Exercise.
  6. Bilateral Isokinematic – Fingers Exercise.
  7. Bilateral Isokinematic – Wrist Up-down Exercise.
  8. Bilateral Isokinematic Relaxation Procedures.

Bilateral Isokinematic Training in Action

Hello everyone! It has been quite sometime since my last post on Bilateral Isokinematic Training (BIT) and today, I would like to share a Video Clip on the Initial Relaxation Exercises before commencement of the actual BIT Exercises. Just a bit of background introduction to the main Actresses shown here. They are my wife rock, the stroke survivor and Puan Norani the Senior Occupational Therapist at the University Hospital in Petaling Jaya, Selangor. The video was shot in her Clinic and I have to say Puan Norani is a very experienced, well-trained OT with many years of experience in this field and she is gentle and patient

Like all Physiotherapy and OT Exercises, bringing the person into a state of relaxation is very important for effective therapy. Proper movement of the other parts of the hand in this case are related to the state of relaxation. Never, never start the exercises when the person is not relaxed because then it will be the Spasticity that is causing the movements and not the proper linkages, muscles of the hand.

As her caregiver, I am learning the whole exercise process and the various routines so that at home I can repeat the exercises properly and for at least three times a day. Each exercise routine lasts about 30 minutes and allow time for the person to rest. The Relaxation Exercises are repeated for each and every routine. Patience, gentle coaxing, verbal affirmations are the right approach for caregivers who assist stroke survivors going through the exercises.

I had shared quite a bit of information on stroke, you can view my articles at the
stroke archive by click on the link.

BIT (Bilateral Isokinematic Training)

BIT stands for Bilateral Isokinematic Training and my wife (who is a stroke sufferer) is currently undergoing this training by a trained Occupational Therapist. I did some personal research into this so call ‘New Technology’ or should I say ‘New Approach’ to treat people with unilateral (one side) damaged to the brain due to stroke or accidents etc.

Many studies and research are being done now to study the effects of this form of treatment and honestly, it is so technical that it is difficult for me to explain this in layman terms! I am sure you have noticed how babies when they kick, they often use both legs! This is what the doctors call our human inherent natural body Symmetrical Motion with respect to the mid-sagittal plane! Such studies comes under Neuro-Physiology.

In simple terms, BIT is being introduced into Stroke Recovery Programmes for upper body limbs training and there are contradicting research results from the medical practitioners. Some said BIT do not contribute significant improvements as compared to Unilateral training and others strongly recorded significant improvements! I went through the research papers and the test results are dependent on selected patient samples, extent of damaged, age factor etc. All I can say is that there are more proponents who observed positive improvements than negative ones.

In my wife’s case, she is on this program for about 2 months now and we noticed a marked improvement Continue reading

Stroke & Diet – Part 4 (End).

Good nutrition is the goal, but food is not just about nutrition. It is about emotions, culture and being social. What and how we eat is so personal that changing eating habits can be difficult. The best advice for stroke survivors is the same as for everyone!

Eat low-fat diet with a variety of grains, vegetables and fruits along with some high-protein foods like meat or dairy products and balance how many calories of intake with exercises.

Deciding to change is the first step and remind yourself that changes don’t have to take place over-night. Start with easy ones then one by one add more kinds of vegetables, reduce portion sizes.

Bladder problems are another issue. Quite often, fear of having to go to the bathroom frequently or loss of bladder control causes a person to limit fluids. This can cause other problems such as dehydration, dry mouth, difficulty swallowing, loss of appetite and constipation.

Depression can affect people’s appetite in different ways. Many people turn to certain foods for comfort when they are depressed. These may be old favourites from childhood – scoop of ice-cream, mashed potatoes etc. The danger is overdosing it and increase intake of sugars, fats and other unhealthy elements. There are some who lose their appetite when they are depressed. Eating with others can help you and the person in your care stay connected. Remember that staying physically active can help decrease the symptoms of depression.

Bowel management often involves preventing constipation. Fiber counts…add up! Fibers are found in cereals, grains, nuts, seeds, vegetables and fruits. A diet rich in fiber (about 25 to 30 grams each day) along with adequate fluid intake and physical activity can help promote good bowel function. Fiber also provides a sense of fullness, which helps in managing how much one eats.

This will be the concluding Part of Stroke & Diet and hope that you find these Four Parts useful or helpful, especially if you have a family member or friend who is a stroke survivor. What was written under Stroke & Diet in these four Part mini-Series are collections from various sources and it is difficult to give any references to them. I suppose with the Internet checking for further reading to these is not such a difficult task anymore. Thank-you for your patience!

Stroke & Diet Part 1 ~ Stroke & Diet – Part 2  ~ Stroke & Diet – Part 3

What is a Stroke? ~ Facts of Stroke & The Warning Signs. ~ Stroke Risk Factors. ~ Understanding Spasticity Eating & The Stroke Survivor ~
The Job No One Asks For Caregivers Month ~ Botox & Spasticity ~ The ABC’s of Caregiving Behavioural Changes ~ There is Hope ~ Improving Awareness ~ Fall Prevention for Stroke Survivors ~ Sleep Disorders.

Stroke & Diet – Part 3

Firstly my apologies for missing-in-action for sometime. We were relocating and it was a terribly busy few weeks for us. Anyway this is Part 3 on Stroke & Diet and sharing on a very important part of a stroke survivor’s diet and it is none other than Fruits.

Personally I feel that it is equally important to address the issue of Antioxidants in relation to a healthy diet be it for stroke survivors or ordinary folks. Sufficient quantity of fiber and antioxidants in our diet are the building blocks for good health.
Antioxidants are disease-fighting compounds that prevent and repair damage caused by oxidation from environment pollutants, chemical toxins, tobacco smoke, lifestyle abuse and poor diet choices. Unchecked oxidation can lead to cancer, heart disease, Alzheimer’s diseases and Parkinson’s diseases.

From the Book “The Antioxidant Miracle” by Lester Packer Ph.D., Lipoic Acid, Pycnogenol, Vitamins E and C will help you to prevent oxidation. One source for these antioxidant content can be found in fruits. A five to ten servings of fruits daily should supply you with sufficient antioxidants. One serving is about the size of your fist. Locally in South-East Asia we have the following fruits that are rich in antioxidants.


Red-fleshed Guava contain high quantity of the antioxidant Lycopene, more than strawberries, spinach and broccoli. Lycopene may lower the risk of cancer such as prostate, ovarian, cervical, oral, pharyngeal, esophagus, stomach, colorectal, lung and pancreatic cancer. One pink-flesh Guava contains 37 calories and is a good source of fiber and Beta-Carotene another antioxidant. Helps to lower cholesterol as well as blood pressure too. Continue reading

Stroke & Diet – Part 2

My earlier post Stroke & Diet Pt. 1 was sharing on what a healthy diet is suppose to do and that is about effective control of Blood Pressure, Sugar Levels and Cholesterol levels. In Part Two, let us be more specific and explore some appropriate food that will help keep these levels in check. Here are some helpful guidelines.

Recommended Food:

  • Choose lean meats, fish and poultry and bake, broil or grill whenever possible. Add beans, peas, lentils, nuts and seeds to it.
  • For Calcium supply, include 3 cups of low-fat or fat-free milk, yogurt or low-fat cheeses for good bone health. For those who cannot consume milk use calcium fortified foods and beverages to fill the gap.
  • Limit your fat, sugar and salt for these extras can add-up. Check food labels and look for low in saturated and trans fats. Sugars often only provide added calories with little added nutritional value so reduce your intake and if possible avoid it. Choose and prepare food with little salt or sodium.
  • Eat any type of fish with edible bones, such as canned salmon or sardines. Fish contains Omega 3 Fatty Acids which helps to reduce risks for Arrythmia or sudden death, blood clots and Atherosclerosis, reduce Triglycerides levels and lower Blood Pressure.
  • Choose dark-green vegetables like kale, broccoli, turnip greens and mustard greens. The calcium in these veggies is better absorbed than the calcium found in spinach, rhubarb, beet greens and almonds.
  • Calcium-fortified tofu, soymilk, orange juice, breads and cereals are excellent staples. Tofu, soy, walnuts and flaxseed oil are the plant sources of Omega 3 Fatty Acids.
  • Vitamin D also plays an important role by helping in with calcium absorption. Exposure to the sun is another way where our bodies produces Vitamin D say 15 – 20 minutes exposure. Be careful with supplementation because Vitamin D is stored in the body and can be toxic in relatively low amounts (>2,000 i.u./day).

Watch out for my next post on Stroke & Diet Part 3, which will cover Recommended Fruits which are beneficial for stroke survivors!


Stroke & Diet Part 1 ~ Stroke & Diet Part 3

What is a Stroke? ~ Facts of Stroke & The Warning Signs. ~ Stroke Risk Factors. ~ Understanding Spasticity Eating & The Stroke Survivor ~
The Job No One Asks For Caregivers Month ~ Botox & Spasticity ~ The ABC’s of Caregiving Behavioural Changes ~ There is Hope ~ Improving Awareness
Fall Prevention for Stroke Survivors ~ Sleep Disorders.

Stroke & Diet Part 1

A good friend suggested to me to share on Diet for stroke survivors a week or two ago. It was a great suggestion, for stroke survivors to prevent a recurrence, he or she need to have a healthy diet to bring down Blood Pressure, Cholesterol and Sugar Levels which in the first place, because of a poor diet, that one gets all these to unhealthy levels which lead to a stroke. Diet is never a stand alone thing but must be balanced with adequate exercises. Diet and Exercise is a rather broad subject and to cover as many aspects of these two requires a very lengthy post. Perhaps it will be easier reading if I break it down to several posts with this for introduction.

Poor diet and lack of exercise contribute to stroke and other cardiovascular diseases in the following ways:

  • Diet affects Dietary Cholesterol, which has a major impact on Atherosclerosis. High Cholesterol dramatically increases the risk of all cardiovascular diseases, including Ischemic Stroke.
  • Diet affects blood pressure.
  • Diet impacts diabetes which dramatically increases the risk of stroke and cardiovascular disease.
  • Diet contributes to overweight and obesity which in turn increases the risk of diabetes and cardiovascular disease.

The diet of a stroke survivor necessarily take into consideration the following:-

Control Cholesterol:

Cholesterol is present in the cell wall of every cell in animal and human bodies. The amount of cholesterol determines how permeable (leaky) the cell is. Cholesterol is so important to our basic biology that our bodies manufacture all the cholesterol they need from saturated fat. Dietary Cholesterol is extra.

Cholesterol manufacture is under genetic control and it is possible that diet and exercise won’t be enough to lower the level. The use of cholesterol lowering medication may be called for. Older cholesterol drugs work to block absorption of dietary cholesterol. A new type of drug addresses the manufacture of cholesterol in the liver.

Tropical oils (palm and coconut) and partially hydrogenated oils contribute to cholesterol levels. Hydrogenated oil is vegetable oil with hydrogen whipped into it, generally to increased shelf life. Nutritionists now label these oils as “trans-fat.” It is suspected that trans-fats also contribute to atherosclerosis a disease in which cholesterol deposits form on the walls of arteries, narrowing them.

Control Blood Pressure :-

Diet affects blood pressure because it affects weight, sodium and atherosclerosis. Atherosclerosis increases blood pressure by narrowing arteries from the inside. Sodium causes water retention because our kidneys need water to maintain a proper electrolyte balance. This retained water puts pressure on the blood vessels and keeps them from relaxing, thereby increasing blood pressure.

One good diet formulated by nutritionists is the DASH Diet (Dietary Approach To Stop Hypertension) which is low in saturated fat, cholesterol, and total fat. It emphasizes fruits, vegetables and low-fat dairy foods and includes whole-grain products, fish, poultry and nuts. It is reduced in red meat, sweets and sugar-containing beverages, as well as rich in magnesium, potassium and calcium, protein and fiber. Research has reported reductions in blood pressure in as little as two weeks after beginning the DASH diet.

Haemorrhagic Stroke & PPA

Received an email from a friend highlighting the connection between Haemorrhagic Stroke and PPA (Phenylpropanolamine). PPA is an ingredient used in many over-the-counter (OTC) and prescription cough and cold medications as a decongestant and in OTC weight loss products.

I did a search on this and confirmed that this is true. A Research Team at Yale University did a project called Haemorragic Stroke Project and the findings were given in a Report on May 10th 2000. For those who want to know more please go to the following site :-

The implications are serious in this findings. Many people buy OTC medicine for common cough and cold and for some weight-loss prescriptions without realizing the danger if such prescriptions or drugs contain PPA. Even for first time users taking drugs that contain PPA stand the risk of a Haemorragic Stroke. Perhaps this explains why young and healthy people died suddenly of a Stroke although they never possessed any symptoms or tell-tale signs like High Blood Pressure, Diabetes etc.

The next time you run to your local drug store for some cold medicine please check that it does not contain PPA! In the US, the FDA has stopped drug companies from using PPA in their prescriptions.

What is a Stroke?
Facts of Stroke & The Warning Signs.
Stroke Risk Factors.
Understanding Spasticity
Eating & The Stroke Survivor
The Job No One Asks For
Caregivers Month
Botox & Spasticity
The ABC’s of Caregiving
Behavioural Changes
There is Hope
Improving Awareness
Fall Prevention for Stroke Survivors
Sleep Disorders.

Sleep Disorder

Lately heard from a friend about her mom being observed for sleep patterns which are necessary for the doctors to determine how her sleep pattern affects her recovery process after an operation. The Idaho Neurological Centre did a survey on Sleep Disorder and Stroke Risk discovered the following :-

Out of 15 stroke survivors observed, all show some form of sleep disorder.

Obstructive sleep apnea, which causes a person to stop breathing temporarily and happen repeatedly was more common among stroke survivors than others.

Stroke survivors has stage one sleep (lightest sleep) and snored more loudly than others.

Between 31% to 70% occurs during sleep.

However after saying all these, Continue reading

Fall Prevention for Stroke Survivors

As high as 40% of stroke survivors have serious falls attributed to Balance Problems. Rock fell from the stairs twice and thank God she did not incurred serious injuries except for some vicious looking bruises and having aches and pain for a week.

People with balance problems often benefit from physical therapy. Your first step is to get a therapy prescription from your physician. According to physical therapist Sapan Palkhiwala your body uses a combination of three systems to stay balanced.

1. Vision:
This is self explanatory.

2. Vestibular:
The vestibular system helps by monitoring changes in your head movements with respect to the pull of gravity. It includes two parts: the central system (housed in your brain) and the peripheral system (in your inner ear). These systems are connected by the vestibular nerve. Strokes are more likely to affect the central system. If the vestibular system is injured by stroke, you may experience dizziness and imbalance

3. Somatosensory:
With the somatosensory system, your body uses information it receives from the pressure of your feet on the floor, and your ankle positioning, to help balance your body.

Sapan says a majority of stroke survivors have balance problems because one side is stronger than the other. He encourages survivors to build up their affected side by using it in daily activities, such as reaching for a glass of water.

Caregiver can bring a chair into a corner of a room. While the survivor stands in the corner, he or she can hold on to the back of the chair and practice moving shoulders and hips together from side to side and then forward to backward. This exercise also forces the survivor to use and strengthen his affected side.

If a stroke affects your vision, you can learn to compensate. If you have a visual field cut so that you cannot see anything out of the left side of both eyes, you can practice scanning the room with the right side of your eye while turning your head.

With the help of a therapist, survivors can also practice balancing on shifting surfaces like foam, grass, sand or seat cushions. Since your feet are not on a flat surface, you can’t use your feet to reference yourself. You are forced to use vision to balance yourself, thus strengthening this system.

Some Recommended Steps For Preventing Falls : Continue reading

Improving Awareness

A Blessed New Year to all of you! Yes this is my first post in 2008 and my good friend Vivienne has done a very thought provoking post today to help kick-off the New Year with helpful, thought provoking self-questioning. I have to say it is a good way to start afresh in 2008. It is indeed appropriate to address the issue of “awareness".

Stroke survivors, are not aware of their affected side after a stroke and I am sure many of you have noticed that how they bumped into door jams, turning forgetting to take the affected hand along…….. Every caregiver and family members and yes including visiting relatives and friends can help the survivor be more aware of their affected side. Here are three helpful suggestions to improve awareness in stroke survivors: Continue reading

There is Hope

Christmas is coming soon and what is more appropriate than to do a post giving HOPE to stroke survivors! Basically a Stroke causes brain damaged or more accurately brain cells damaged. Contemporary Medical Science says that there is no way to recover that part of the brain that is damaged. The only hope for recovery is through the process of Physotherapy to train the good part of the brain to take over the function handled by the damaged part.

Research done at MIT by Elli Nedivi assistant professor of Neurobiology shows that the adult brain cells do grow contradicting what used to believe otherwise. In 3D time lapse images, the brain cells pushed out tentative tendrils that grows round neighbouring cells. What it means is that one day it is possible to grow new cells to replace cells damaged by stroke. (See the photo)

Although this is new and the growth detected were of a small scale but the fact that it grows is the amazing thing said Nedivi. Lets pray and hope that as research progresses it won’t be too far a distant future to see big strides in this area and one day stroke survivor can re-grow the damaged part of the brain!

Behavioral Changes

I would like to share about personality changes that can happen to stroke survivors. Personality or behavioral changes are rather difficult for family members and caregivers to understand and get accustomed to. Suddenly that person seems different, for example from a caring nature to apathy!

Apart from depression, which is quite normal for stroke survivors to experience, there are other emotional deficiencies such as frustration out bursts or short temper due to difficulty of speech, memory loss, forgetfulness, and lack of clarity in thoughts. These are all rather frustrating and debilitating to the stroke survivor. Short-term memory loss seems to be associated with people with left-brain stroke. Problem solving ability is sometimes affected and this may give rise to deficiencies in their awareness and ability to do things. They think that they can do things but they really can’t! This was the reason Rock rolled down the stairs twice! She tried to do things independently, but she was not ready for that, but she could not understand that.

Another common problem stroke survivors experience is the lack of Continue reading