Episode 005 -- Prevent Shoulder Subluxation



Welcome to Week 5 of the Strokecast. What do you think so far? Let me know in the comments below, or email me at Bill@strokecast.com

You may have noticed the "Bill Suggests" menu at the top of the page. That's a collection of books and tools related to stroke recovery or public speaking that I find useful. They are also affiliate links. That means that if you click on them Amazon will send me a portion of the sales for the next 24 hours. It doesn't change your pricing or impact you in anyway. If you see a link to a product on Amazon on this site, you can assume it's an affiliate link.

In Episode 004 last week, I talked about my experience on the JoCo cruise with a focus on disabilities. I actually travelled with my friend Jon Clarke this year and we recorded an episode of his podcast over the course of several days. In it, he tries to figure out just what this whole cruise thing is. You can hear this discussion here, or subscribe to Caffeinated Comics in your favorite podcast app.

Shoulder Subluxation

The shoulder is a mess of a joint. When hemiparesis sets in, as happened after my stroke, it means the arm (and leg) on that side of the body stop working. Since the shoulder is such a complicated amalgam of muscle, bone, tendon, and ligament, it has to work right to stay together. Subluxation is basically what happens when the shoulder starts to pull itself apart.

When this happens, it's difficult to exercise, it's difficult to get the rest of the arm back on line, and it can hurt.

There are two main ways to prevent shoulder subluxation and to minimize it -- support and exercise.

[Bill wearing the GivMohr sling Bill wearing the GivMohr sling


Support is about minimizing gravity's insidious effects. It can include:

Ultimately the way to address it for most folks is exercise. It's why I do things like:

  • Shoulder shrugs
  • Shoulder rolls
  • Shoulder blade pinches
  • Cross body reaching
  • ...and more

Long term, strength is key. To get the strength,

  1. Get the exercise
  2. Get the fuel
  3. Get the support
  4. Get the rest

Hack of the week

"]Cane in a mop holder Mermaid cane in a mop holder 

Mop Holders are great tools for holding my cane. I have about 6 of them stuck up around my apartment in the living room, the bedroom, the bathroom, and near the dining table. I can easily clip my cane to the wall so no one trips on it, and I can still grab it easily and quickly when I want it. I also lose it less often since I know where to look.

Where do we go from here?

  • Do you have a story you'd like to share on Strokecast? Email me at Bill@strokecast.com.
  • How do you deal with sublux? Let us know in the comments below.
  • If you enjoy Strokecast, please subscribe to the show in your favorite Podcast app.
  • If you use a cane, check out the mop holders you can mount around your home or office.
  • Don't get best...get better.


Here is the latest episode of The Strokecast


Episode 053 -- Don't Change Your Caffeine and The Power of Rituals


2-Minute Tip: Don't Change Your Caffeine Consumption


It can be tempting the morning of a big speech to load up on coffee and enjoy that miraculous substance. If that's part of your standard morning ritual, that's fine. Go for it. 


But don't suddenly double or triple your standard consumption. I get that you may feel tired or nervous, but excess coffee will not help. Instead, you will just ramp up the anxiety even further or cause other last minute biological challenges.


You are much better off getting a good night sleep the night before and giving your body what it has come to expect in the morning.


Post Tip Discussion: The Power of Rituals


Rituals, like the crowning of a new king in the Black Panther movie are powerful things. Whether they are religious, civic, personal, cultural, or familial, the bond a community together. They become ingrained from an early age and follow us throughout our lives. disregarding a community's rituals is a great way to get banned from the community and marked as an outsider.


It's important for speakers to understand or at least respect the rituals of the communities they speak to. As I discussed in Episode 035, persuasion depends on engaging the audience with Pathos, Ethos, and Logos. Rituals play into the Pathos side of that triangle.


Ignoring, disregarding, or mocking a community's rituals makes it harder to persuade them, as you burn up Pathos and throw away good will. Do so at your own risk.


Call To Action:


  • Think about the rituals in your life, your family, and your organization. How can you leverage them to build deeper bonds?
  • Consider what rituals you can introduce to your team meetings that will help center everyone and help them be more present.
  • Before your next big talk, maintain your standard caffeine consumption.
  • Don't get best...get better.

Check out this episode!


Episode 004 -- JoCo Cruise


Strokecast is available on more platforms including:

I've begun compiling a list of Stroke support Facebook groups here.

Have you read the Stroke Smart magazine put out by the National Stroke association? You can sign up for a subscription here.

Let's Talk about Cruising


[caption id="attachment_87" align="alignleft" width="300"]Deck 10 of the ms Oosterdam in port at Cabo San Lucas. I did a full round of PT and OT exercises at the rail of the ms Oosterdam overlooking Cabo San Lucas.[/caption]

Last month I joined the 8th Annual JoCo Cruise. It was my 6th time with the group and my first as a traveler with disabilities.

It's a full boat charter of Holland America's ms Oosterdam. 1500 folks joined us for this week-long nerd summer camp. I always have a great time and recommend it to anyone interested in geeky pursuits, board gaming, science fiction, fantasy, writing, podcasting, and great music. The community, while not perfect, is fantastic.

I also found it to be quite accessible. While the buffet proved challenging, the staff was incredibly helpful. My accessible cabin was comfortable and the roll in shower meant I didn't have to step over a tub wall.

It was also the first time I've been in a pool since my stroke. It was interesting learning more about buoyancy and my affected limbs. It gave me a chance to actually JUMP on my weak leg.

[caption id="attachment_88" align="aligncenter" width="300"]Sunburn line from GivMohr sling This is my sunburn on the first day I burned. The burn line is from my GivMohr sling. I was wearing SPF 70 at the time.[/caption][caption id="attachment_91" align="aligncenter" width="300"]ms Oosterdam Cabin 1011 shower There is a cord near the shower head. As a warning, don't mistake it for a clothes line that failed to retract. It's actually an emergency cord that calls the stateroom attendant to your shower in case you have an emergency. I don't recommend tugging on it to retract it.[/caption][caption id="attachment_90" align="aligncenter" width="300"]ms Oosterdam Cabin 1011 beds The beds are slightly smaller than twin size, but they are reasonably comfortable. I did have to request a special extension cord for my CPAP machine.[/caption][caption id="attachment_92" align="aligncenter" width="300"]ms Oosterdam Cabin 1011 living space There is actually a decent amount of space in the small, inexpensive cabin. The couch also turns into a couch to accommodate a third person. That might be a bit too cramped, though.[/caption]


[caption id="attachment_86" align="aligncenter" width="300"]Seating reserved for persons with disabilities The theater on the ship had a full row of accessible seating on the same level of the doors. It was convenient and the view was still pretty good.[/caption]


Hack of the Week

Carry a bag.

I often carry a nylon tote bag like these Chicobags (affiliate link). Carrying stuff is difficult in general. One hand doesn't work yet and one carries the cane or holds the handrail on the stair.

I use it for my coffee thermos, phone, tablet, paper notebook, getting the mail, or whatever other random carrying I need to do.

It's a simple thing, but sometimes the simplest things are the most helpful.

Where do we go from here?

  1. What are your thoughts on cruising, conventions, and other nerdy activities. Share them in the comments below.
  2. Please leave a rating or review for Strokecast in the Apple Podcasts store.
  3. Want to learn more about the JoCo Cruise or book for next year? Visit Strokecast.com/joco
  4. Subscribe to the National Stroke Association's Stroke Smart magazine here.
  5. Check out the assortment of Facebook stroke support groups here.
  6. Don't get best…get better

Here is the latest episode of The Strokecast


Episode 052 -- Avoid Dairy and The 7 Deadly Sins of PowerPoint


2-Minute Tip: Avoid Dairy Before Speaking


I love a big bowl of sugary cereal or a nice cheesy pizza. I used to drink mochas like water before I decided to switch to Americanos for weight loss (by the way, switching from mochas to Americanos will NOT make 30 pounds just fall off). So I like my milky, cheesy goodness.


But not right before speaking.


Dairy consumption promotes phlegm production. Excess phlegm means that when speaking you have to clear your throat more off, deal with being a little more stuffed up, and generally have to work harder to push your words out cleanly.


So save that beloved dairy consumption for after your talk.


Post Tip Discussion -- The 7 Deadly Sins of PowerPoint


Over the previous few episodes, I've talked about the 7 Deadly Sins of Public Speaking. They are:


  1. Droning on
  2. Going overtime
  3. Starting late
  4. Failing to rehearse
  5. Ignoring the audience
  6. Getting dragged off topic
  7. Using inappropriate language


This week, let's get a little more specific and talk about the 7 Deadly Sins of PowerPoint.


A lot of folks will complain that PowerPoint is the root of everything that is wrong with presentations and meetings today. They're wrong. The problem is people using PowerPoint badly or lazily. As a speaker, you can be much more effective with PowerPoint if you simply don't commit the 7 Deadly Sins of PowerPoint:


  1. Eye charts
  2. Excessive animations
  3. Transcripts
  4. Low quality images
  5. Not knowing the content
  6. Not knowing the software
  7. Typos


Call To Action


  1. Are there more deadly sins of PowerPoint? Let us know in the comments below.
  2. Check out the Strokecast where a Gen X stroke survivor explores rehab recovery, the frontiers of neuroscience, and one-handed banana peeling.
  3. Avoid dairy before your next talk.
  4. Don't get best…get better.

Check out this episode!


Episode 003 -- Tone 101


While I'm typically an Android guy, I must say I have been impressed by the quality of the service I've gotten from the Apple Podcasts team. They've been responsive and helpful whenever I've had to work with them. And now, they are even faster. Generally it takes up to 2 weeks to get a new podcast in the Apple Podcasts store. It took them just 6 hours to add Strokecast.

Please leave a rating and/or review for the Strokecast here.

Being in the Apple Podcasts store means you can easily subscribe from an iPhone or iPad and never miss an episode. It also means that most other popular podcast apps for the Android or Samsung phone platforms also know about the Strokecast. You can subscribe in pretty much whatever app you use to listen to podcasts.

Strokecast is also on Spotify. If you use Spotify on your mobile device, just search for Strokecast and it will pop right up.

Tone and Spasticity

 Infomercials and popular media talk about how the latest diet or the newest bow-nordi-master machine will help you build muscle and get toned. Tone in muscles is actually a bad thing in the PT/OT world.

A muscle with tone is basically flexed all the time. It's contracted and in a state of tension. When my fingers curl up in a tight ball and won't release, it's because I have too much muscle tone. It my arm gets toned, that mean the muscles tighten and it curls up, useless. Tone in my legs will prevent me from bending or unbending my hip, knee, or ankle. Or cause my toes to curl up in my shoe. A muscle with tone is useless.
One goal of the exercises I do with PT is to prevent tone from setting in. Working on range of motion, joint flexibility, and muscle strengthening prevents tone.

What most people think of as tone is probably definition. They want to see the muscles. We often make our muscles visible be flexing them. Tone is when your muscles essentially flex themselves and then stay that way, even when you want them to stop. Imagine flexing your bicep and then keeping it flexed all day as you go about your business.

That's why you don't want tone in your muscles.

Hand splint for finger toneTreatment

There are a number of ways to address tone. Some popular ones include:

  • Movement therapy
  • Stretching
  • Tiring it out
  • Massage
  • Relaxation/mindfulness
  • Accupuncture

There are also medicinal solutions.

Baclofen is a pill that can reduce tone. It can affect the whole body, though, and one of the main side affects is fatigue. Since many stroke survivors are already dealing with fatigue, this can be a challenge. Of course, not everyone experiences the side affects, and it can be a great solution.

MedtrBaclofen pump imageonic also makes a Baclofen pump. A surgeon implants it in the abdomen and runs a tube into the spine so the pump continually deploys small amounts of Baclofen into the spinal fluid. It can be a little more targeted than the pill, and because the dosage is much lower it has few side affects. The dosage is lower because unlike a pill, it doesn't have to make its way through the digestive system into the circulatory system, and then into the nervous system. On the other hand...surgery.

Botox is also an effective treatment. 

Based on Botulinum Toxin, Botox is used to treat both wrinkles and tone. The director uses electrodes to monitor the firing of nerves in a muscle, and then injects Botox directly into the toned muscle to put many of the nerves to sleep for a few months. This relaxes the toned muscles and gives the other muscles a chance to recover.

Hack of the Week

It took me a while to figure out how to take my shirt off, and not just because people scream when I do. It simply wasn't a skill we needed to focus on the hospital. Here is my current process.

  1. Reach straight back over my head with my good hand -- follow the path of an imaginary Mohawk.
  2. Grab the back of my shirt collar.
  3. Pull that over my head.
  4. Take my right sleeve in mouth and pull the sleeve off my right arm.
  5. Grab the left sleeve with my right hand to remove that.

This process also works with jackets and hoodies. It works best with long sleeves, but my short-sleeved t-shirts work out okay, too. I just skip the sleeve biting there.

Where do we go from here?

  • Do you have any tips or stories you'd like to share on a future episode? Email me at Bill@strokecast.com. I'd love to hear from stroke survivors, caretakers, medical professionals, and more.
  • Share your thoughts on Episode 3 in the comments below.
  • On the Apple platform , please leave a rating or review.
  • Share this episode with anyone who might be interested.
  • Don't get best...get better.

Here is the latest episode of The Strokecast