[Note: Simulations are an important part of the Health for America at MedStar Health fellowship . Given the many dimensions of stroke, the 2016-17 fellows participated in a range of stroke simulations. Below, Michael reflects on his experience. You can read other fellows' perspectives here and here. ]
Throughout our exploration phase, we heard a lot about hemiparesis, which is unilateral weakness or paralysis faced by many after a stroke. But what would life with hemiparesis actually be like?
During the HFA fellows’ short-term stroke simulation, I set out to understand. I simulated hemiparesis by adding additional weight to my left extremities. In addition, I utilized a cane for the duration of the simulation. Although I didn’t need to use the cane due to physical impairments, I did so to understand how having to lug a cane around all day affects one’s abilities to perform activities of daily living.
Then, during my long-term simulation, I made a concerted effort to eat foods low in sodium and cholesterol, simulating the challenge of adjusting to new dietary recommendations related to primary or secondary stroke prevention. In addition, I measured my blood pressure twice daily. Two weeks of this low-sodium and low-cholesterol diet proved extremely difficult, particularly because my previous diet had been high in both macronutrients.
Looking back on my simulation experience, several moments of frustration stand out. In one such instance, I was staring at a menu at Olive Garden, realizing there was hardly anything my diet allowed me to eat. Even more frustrating was the realization that anything I COULD eat would leave me feeling hungry or simply wouldn’t be anything I’d be very excited to eat in the first place (yes, I get excited about food). Several other notable moments of frustration occurred while attempting to perform activities of daily living using only one hand. Getting coffee, typing, putting on a backpack, or using a mobile device can all be extremely challenging with only one functional hand available.
But as challenging as these simulated disabilities were, I’m still thinking about the immense difficulty I faced in successfully carrying out a low-sodium and low-cholesterol diet. As a former powerlifter, who on occasion had to rapidly cut weight to compete within a targeted weight class, dieting is not a new practice to me. However, the idea of adhering to a new diet with a long-term goal like lowering my cholesterol or my blood pressure proved to be unexpectedly challenging (even for a couple weeks). Even more challenging and unexpected was that nearly all of my favorite foods contain either high levels of sodium OR high levels of cholesterol. This highlighted the constant balancing act that stroke survivors or at-risk populations face: I could eat unsalted red meat or eggs and get away with not consuming a high amount of sodium, but I’d have to limit the amount I could eat in order to ensure I didn’t consume too much cholesterol.
Ultimately, as I went through the simulation, it became increasingly clear that it was nearly impossible to comprehensively simulate what a stroke survivor actually experiences. This isn’t just because it’s difficult to simulate the major impairments associated with stroke. It’s because the disabilities caused by stroke vary widely, and the psychological effects these disabilities have on stroke survivors vary to an even greater degree. It will be important for our team to consider this fact when using the simulation experience as a point of reference for thoughts and ideas during our ideation phase.
With this in mind, several useful ideas were brought up through the simulation experience. Sodium content proved extremely difficult to gauge in precooked, unpackaged food items. The ability to easily measure sodium (or other macronutrients) within unpackaged food would be very helpful in nutrition tracking. Several solutions currently exist for this purpose, like this salt intake measurement device, but are not widely used.
Additionally, any device that would increase stroke survivors’ independence with activities of daily living would likely be welcomed. Many of the most challenging moments within my simulation occurred due to not being able to effectively carry out a task that needed to be accomplished. This would surely be even more frustrating if I were truly disabled due to a stroke.
Finally, an overarching thought that stemmed from the simulation experience is the potential for a positive feedback loop to lead to the further degradation or lack of recovery of a stroke victim. Since survivors are often left cognitively and physically impaired after their stroke, if they don’t have a strong support network, their disabilities may prevent them from taking advantage of existing solutions. In turn, this could lead to more disabilities or the stagnation of the recovery process, thus making their return to relative independence increasingly less likely.