Mum’s had a couple of bad falls recently, the worst of which was on Friday last week. It seems she’s been falling asleep constantly: a phenomenon they’re putting down to tiredness and possible sleep apneoa rather than something a little more exotic like narcolepsy. (Although between you and me, that fact sheet kind of sounds like her; she’s even been known to fall asleep in the middle of physiotherapy).
On Friday, she apparently fell asleep on the toilet, promptly falling off and having to be rushed to emergency for scans to see if she’d broken a bone. Although she says she feels as though she’s broken her bottom, so far she appears shaken, sore but otherwise uninjured.
Mum’s other falls and mishaps have been due to a condition called denial or Anosognosia; a symptom associated with a right hemisphere stroke. Anosognosia is a condition where a person who suffers a certain disability is seeming unaware of it.
Right hemisphere stroke patients may deny that they have had a stroke. They may appear to be unaware of their hemiplegia (left-side weakness or paralysis) or other cognitive issues. It is not uncommon for right hemisphere patients such as Mum to declare they are perfectly capable of walking, driving and returning to work immediately despite all evidence to the contrary. In Mum’s case, her anosognosia has frequently expressed as forgetting that she can’t walk or even insisting that she can walk but the doctor/nurse/physiotherapist won’t let her.
When Mum first had her stroke she’d perpetually try to get out of bed, insisting not only that she could walk perfectly well but that she had walked frequently since the stroke. Although this has obviously improved a great deal, she’ll still insist she can walk if only “they” would let her and makes grand plans for things like cooking for a dinner party, driving to the shops or other activities well out of her grasp for the present moment. The source of the problem is physical, not emotional; it seems as though patients are physically unable to recognize their limitation as a result of the damage to the brain from the stroke.
In the last few weeks, Mum has had a fall trying to walk back from the bathroom by herself (“I really believed I could walk,” were her exact words) and has bogged her (short-term trial) wheelchair (that needed to be returned that day!) trying to wheel herself around – despite only having a single functional hand. While the last one has an amusement factor because she then extricated herself by ringing the facility and telling them to come and help her, it nearly ended in tragedy because, as she told me later, she was convinced she could unbog herself by standing up and yanking the wheelchair out of the mud.
This combination of impulsiveness, left-side neglect, paralysis and anosognosia is the reason why Mum needs assistance 24/7 and why right-hemisphere stroke patients cannot be left alone. Driving a wheelchair off the path is one thing: breaking a hip while trying to walk is another.
It’s just another wonderful part of the new normal we’re all adapting to.
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