Professional Statement Paper: “My Stroke of Insight” by Jill Bolte Taylor

Lifestyle & Disability Assignment

Professional Statement Paper:

 “My Stroke of Insight” by Jill Bolte Taylor

Katherine van den Heuvel

University of Maryland Baltimore

October 29, 2012

The book My Stroke of Insight by Dr. Jill Bolte Taylor¹ is a very accessible source for the general public to gain a better understanding of stroke.  In her book, Dr. Taylor outlines her work as a neuroanatomist prior to her stroke, the basics of anatomy and brain function, how her symptoms presented during her stroke, and the aftermath.  She goes on to elaborate about what approaches worked best for her own treatment, and spends some time talking about her choice to use more of the right side of her brain.  Dr. Taylor writes about her mother’s involvement in re-teaching her as if she was a young child, and highlights the warning signs of a stroke. 

Because she had a very specific and rare type of stroke, there is some risk that her portrayal of her own disability with stroke will be inappropriately generalized by the public. What Dr. Taylor experienced was a left hemisphere hemorrhage from a previously undiagnosed arteriovenous malformation (AVM).   According to the National Institute of Neurological Disorders and Stroke, AVM’s are the cause of only two to four percent of hemorrhagic strokes.² Dr. Taylor does an excellent job of presenting her disability and those involved with her treatment in a very fair and nonjudgmental way.  While Dr. Taylor’s autobiographical story is an accurate case study, there exists a definite risk of misconception by the general public that all persons with stroke may experience a similar level and type of disability. 

While her book does not dwell on the differences between left and right brain stroke, Dr. Taylor describes the differences between right and left-brain hemisphere functions with her discussion of brain anatomy and function.  As a future physical therapist, I can keep in mind the possible ramifications for a person who suffers a stroke in a particular hemisphere. Dr. Taylor experienced a deficit on her left cerebrum, including language, memory, and hearing. She highlights the blissful feeling she experienced when the analytical chatter of her left-brain was shut off.  She felt very expansive and connected to everything, describing the experience as finding Nirvana.  In contrast, patients who experience a right side stroke may become more detail oriented and more reliant on clear and rational verbal communication.  In that case, it may be important to reconnect them with the value of creativity and connection between people and things.  This is supported by a description of hemispheric lateralization of function in the book Basic Clinical Neuroanatomy. ³ According to that text, the left-brain is strong in analytical thinking, rationalizing, calculation, and verbalizing, while the right hemisphere is better at emotion, nonverbal thinking, artistic skills, and spatial perception.

Another way that Dr. Taylor’s book will have an impact on me as a Physical Therapist is through her captivating descriptions.  She writes vividly about her memories of how she felt and what she thought during all aspects of her treatment, explaining that although she was “mentally disabled,” she was not unconscious.  Her perception of people and their energy (and her desire for calm, quiet, and positive energy) is a great insight into the mind of a patient who may be unable to express their feelings and needs.  When she was awake in the first few days following her stroke, she felt pain in her body, lights were too bright, sounds were too loud, and the world was moving too quickly.  She discusses her need for sleep and how her skills became better integrated after periods of rest.  According to a study on fatigue levels in patients with stroke and end-stage heart failure published in 2008, the Fatigue Assessment Scale is a good way to measure fatigue after a stroke.⁴ They show the scale to have good face validity, test-retest reliability, and high construct validity.   Although Dr. Taylor did not have continuing motor deficits or qualify for Physical Therapy, professionals in any discipline can apply her descriptions and tips for treatment. 

One thing that I will choose to educate my patients and their families about is the recovery process.  This book demonstrates the importance of patience, not only of the therapist, but also of the patients for themselves.  Each task and concept that Dr. Taylor learned took a lot of time and effort.  I can expect my patients to need a lot of time to work on new things, and a lot of rest.  According to Taylor, she finally regained an understanding of mathematics four years after her stroke.  She did not consider herself to be fully revered until eight years had passed.  According to the National Stroke Association, progress is possible even twenty years after a stroke. ⁵

Another thing presented in the book that I feel is important for me to teach my patients and their families is the importance of breaking a task into smaller components.  Dr. Taylor provides example after example of how learning part of a task at a time helped her to achieve the whole skill, from learning to sit up in bed to completing a jigsaw puzzle and sorting laundry.  In the text Motor Control: Translating Research into Clinical Practice, this is also called “task analysis.” ^6(p.36) The idea is to not only break down components of the skill or movement, but also to be able to put them into the correct sequence.  Dr. Taylor could not afford to be disappointed by the failure to succeed with an entire skill all at once, and neither can my potential future patients.  While I know that a positive attitude is helpful, Dr. Taylor brings out the importance of celebrating each mini success along the way.

In my professional opinion, this book is a very valuable resource for the general public.  It is extremely accessible to the layperson with its two early chapters on anatomy with simple hand drawn pictures, basic description of stroke types, and overview of left and right brain function.  There may be some risk of misconception by the general public that what Dr. Taylor experienced with her left brain stroke is something experienced by all patients who have a stroke.  I would still recommend this book to the general public for stroke awareness and warning signs and to healthcare professionals for treatment of patients.  This book did not change my viewpoint on patients with stroke, but rather reinforced and enhanced my pre-professional learning.  

Reference List

1. Taylor JB. My Stroke of Insight. New York: Plume; 2009.

2. National Institute of Neurological Disorders and Stroke.
NINDS Arteriovenous Malformation Information Page. Available at: http://www.ninds.nih.gov/disorders/avms/avms.htm. Accessed October, 2012.

3. Young PA, Young PH. The cerebral cortex: Hemispheric lateralization of function. In: Basic Clinical Neuroanatomy. Baltimore, MD: Williams and Wilkins; 1997:195.

4. Smith ORF. Comparison of fatigue levels in patients with stroke and patients with end-stage heart failure: application of the Fatigue Assessment Scale. J Am Geriatr Soc. 2008;56:1915.

5. National Stroke Association. After Stroke. Available at: http://www.stroke.org/site/PageServer?pagename=afterstroke. Accessed October, 2012.

6. Shumway-Cook A, Woollacott M. Motor learning and recovery of function: Whole versus part training. In: Motor Control: Translating Research into Clinical Practice. 4th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2012:36.