Our First Date: Don't Fall Me Down

Bruce and I had an educational first date. I needed to visit the Social Security Office to get a new card. As a recipient of Social Security disability benefits, Bruce was a frequent visitor to the Social Security office. He excitedly had offered to show me where the office was. We each traveled to the nearby intersection on our usual bus, arriving at the same time, he from the north and I from the south. Then the real adventure began.

Maintaining balance requires the normal functioning of many parts of the brain which can be affected by stroke A person's confidence in performing activities without falling could be as important as the real balance ability in situations of daily living.

I had never walked with Bruce before this date. With or without the rain of that morning, this was to be a learning experience for me. I began to step up onto the median to enter a parking lot and cut across to the sidewalk we needed. He stopped behind me.

"I can't do that. It will fall me down," Bruce said as he turned to walk towards the driveway.

To maintain our balance we need a normal inner ear, the nerves traveling from the ear to the brain, and a normal control center, which is mainly situated in the part of the brain called the cerebellum, situated at the base of the brain. Many other parts of the brain however, are also needed to enable us to stand steadily on two feet. The cerebellum is sometimes affected by stroke.

I have to admit that I had no idea why Bruce could not walk across the median. I had seen him climb the stairs into the bus every time he boarded. I had witnessed him step down with the support of the handrails but he could step down. It wasn't until I began to pay attention that I discovered how he almost completely supported himself with handrails when he stepped up or down. We went around the median and traveled through the empty parking lot. We would not both fit, side by side, down the sidewalk.

Stroke survivors are instructed during rehabilitative therapy to go up the stairs by stepping on the "good" or "strong" leg, then to step onto the stair with the weaker leg. The opposite is exercised when descending the stair. The stroke survivor steps down first with the weaker leg then uses the stronger leg to step onto the stair. Support must be available for balance and for stability.

Our walk was about one half of a block and we stepped up on curbs more than once. I had yet to learn just how difficult that was for him. When we reached the office it was closed. Bruce knew a couple of the people waiting outside and they struck up a conversation. Just about the time that the security officer was opening the door, Bruce turned with a panicky look on his face.

"I'm sorry. I have to sit down. NOW."

He began to walk away and I stood there watching, wondering what I could or should do next. He looked back and assured me he would be alright.

"Go inside. Get your number. I'll be okay. I just need to sit down."

Standing balance deficits are common in individuals after stroke. A history of stroke increases risk of falls even years after stroke, and subsequent fear of falling causes individuals to reduce their activities.

When I'd gotten my number I went back outside. I found Bruce sitting on a curb in the nearly empty parking lot beside the building. He was basically hidden from public view. His face was very stressed but his eyes softened when he looked up at me.

"I am sorry. I don't want to fall down," he said. "I had to sit."

"I see that. Are you better now?"

"A little," he said. "I'm O.K. I need to get up so we can go inside."

Since stroke can result in decreased leg strength, poor balance and mobility, there is an increased risk of falling - and a fear of falling - among people who have had a stroke.

The fear itself is strongly related to and is considered to be a cause of falling.

I stood for a moment to see what he wanted to do next. I watched as he began to maneuver his body so he could stand. There was nothing around him to lend support except me. He refused my offer. Little did I know the wisdom of that refusal. Bruce weighed a little over 270 pounds at that time. I weighed more than 100 pounds less than him. It was not safe for me to help and he knew it.

"No," he said, "It will fall me down. You might fall me down."

He needed stability and strength that would not waiver. He would obviously need a sturdy, heavy object to pull himself up.

As I continue to research the effects of stroke and what I can expect to encounter, I find little practical advice. Medical journals abound with information that would probably help me understand. Unfortunately, I don't posses the proper language skills.

In researching for this article I found this "enlightening" piece of information at PubMed.gov: "Stroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling. Patients who have had a stroke are under the risk of a wide range of secondary complications ..." (Imagine how frustrating information presented in these terms must be for the lay person.)

Bruce moved towards an SUV parked about four spots away. He had to move to the right, which is the weaker side or paralyzed side of his body. His right side does not respond quickly, easily or smoothly to any internal command. He was concentrating very hard to get the needed response from his limbs.

When certain brain cells are not able to function due to stroke, the parts of the body controlled by those brain cells are unable to function. If the stroke occurs in the left hemisphere or left side of the brain, the right side of the body will be affected. For 95 percent of people, the left hemisphere controls the speech and language centers. Those affected may experience right-sided paralysis or weakness.

Besides dealing with the physical struggle to maneuver, Bruce was dealing with the fact that he was in the presence of a woman he wanted to impress. Yet, here he was, sitting in the rain, unprotected from the elements, and struggling to push himself along a concrete riser with only one leg, one arm and one hand. He gritted his teeth, stared at the ground and kept moving. "Something" told me to remain silent and not to hover. I remained close by and moved slowly along with him until he reached the SUV. With great difficulty he twisted his torso to place his left hand on the front bumper. It took another five minutes before he was standing.

It is necessary that a stroked individual maintain a very high level of stubbornness / determination / persistence, although it will most likely be interpreted by most people as selfish stubbornness. "Stroked" is used rather than "stroke victim" because a stroke is not a state of health affairs, but rather, a millisecond experience that once it occurs, it can never be fully eradicated. This is due to the fact that the cells of the brain, unlike all other kinds of cells in the body, do not regenerate.

The first hour of our first date had successfully introduced me to the most important and life-sustaining characteristic of Bruce's spirit. He is incredibly stubborn, doggedly determined and persistent to the point of obsession. If I had ever given a thought to being his rescuer or liberator, it was dashed against that concrete curb in the Social Security parking lot.