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Interview with Alan McComb 2010

Alan McCombe and family

Alan McComb is a 43 year old student at Liverpool Hope University. In 2002, whilst playing cricket, he suffered a major stroke which left him both visually impaired and with memory difficulties. In 2008, having combated incredible odds, Alan began study at Liverpool Hope University to study History. Here is his truly inspirational story, one that says if you want something bad enough there’s always a way to get it.

Memories of the incident

On 21st May 2002, I was playing a Lancashire Cricket Cup Match for my club, Prescot and Odyssey CC, at Netherfield CC, Kendal. When rain interrupted the game, both teams helped wheel covers onto the wicket to protect it from the rain and so prevent a possible abandonment. 

Whilst pushing the first set of covers up a steep bank from the clubhouse to the wicket, I felt dizzy but didn’t think much of it.  It was when pushing the second set of covers that I suddenly collapsed climbing the steep bank.  As I fell, a strange sensation came over me of hearing a loud noise in my head as my team mates tried to assist and comfort me. 

An ambulance arrived, but by this point I was incoherent and dazed. 

During the journey to hospital, I was apparently conscious and then violently sick. The friend who accompanied me believes that I was able to see during the journey, however all I can remember is collapsing on the cricket ground ... my last memory for the next three and a half weeks. 

Admission to Hospital

I was admitted to Westmoorland Cottage Hospital on 21st May without a diagnosis and a brain scan failed to confirm a stroke although results indicated a possible brain haemorrhage had occurred.  As family members visited me, I was apparently able to converse though have no recollection of this. I was placed in a bed opposite the nurse’s station for “close observation” – although the curtains being drawn all the way around the bed - and it was then that, by chance, a nurse saw I was having a seizure. I was immediately sedated, ventilated and transferred to Lancaster Royal Infirmary to undergo a more detailed scan which finally indicated a haemorrhage and bilateral stroke. 

Intensive Care

I spent the next week in Intensive Care, fully ventilated and recovering from pneumonia.  After 1-2 weeks in Lancaster doctors diagnosed that the cause of my stroke was an irregular heart rate which had caused blood to pool in the heart, causing  a clot to form, which had then become dislodged due to the exertion on the cricket pitch.  The clot entered the blood stream and travelled to the brain, thereby cutting off its oxygen supply.  The doctors then decided to remove ventilation after recovering from pneumonia after which I was transferred  to a general ward.  I spent the next 4 to 6 weeks slowly recovering, sleeping almost 24 hrs a day.  When conscious I slowly regained basic bodily functions such as independently holding my head up, standing before finally progressing to walking with a zimmer frame, becoming continent, feeding myself, communicating by speech (though very slurred) and generally becoming more communicative, pleasant  and less aggressive.  My only vision was a distinction between light and dark.  My eyes were monitored for any change in my level of vision but this, unfortunately, didn’t happen and doctors informed my family that there would be no change because progress would have had to occur within 6 weeks.  Therefore, we were to assume that I would be blind.  I received Warfarin to prevent another clot forming, Sotolol to regulate my heart and  blood pressure and cholesterol reducing medication.

Heart attack or Heart attacks?

Two to three weeks after being admitted to Lancaster Royal Infirmary, I suffered a heart attack and a scan detected old scarring to the heart indicating a previous heart attack.  A particular friend told my family that he recalls my telling him when we were both 19 that I had suffered severe chest pain and was admitted to Walton Hospital Liverpool.  The Walton doctors diagnosed an earlier heart attack but I did not believe them.  I never conveyed this incident to my family because I had not given any credence to the diagnosis. I was discharged with no follow-up arrangements.  Doctors in Lancaster suggest that it was from the age of 19 that my heart rate became irregular.  It seems as though I was at risk of stroke from my first heart attack, to the actual day of my stroke at 34.  Doctors suggested that over the years between the heart attack and stroke I had learned to live with palpitations.  After my heart attack in Lancaster, I was treated with occupational rehab with some physiotherapy, but referral for blind rehabilitation with LVSB was delayed until a transfer to Liverpool could be secured.

Persuading two medical fields to sing from the same hymn sheet

Transfer to Broadgreen hospital in Liverpool eventually took place in July 02, with the delay caused because doctors thought my condition too unstable. It transpired that beds were unavailable in Liverpool anyway and the diagnosis was unclear as I came under the medical umbrella of  blindness and brain injury. Although there is good medical care for individual brain injury or blindness, problems have been encountered, through my experience, when two different medical fields are as part of a single diagnosis.  These two areas of medicine seem to prefer their own individual interpretation of results rather than consulting each other to form one medical opinion, with due regard to both areas of expertise.    

On leaving Lancaster doctors diagnosed a bilateral stroke affecting all vision, balance and  short term memory.

In Liverpool at last

Transfer  to Broadgreen Hospital Liverpool occurred on  3rd July 02  and I was discharged in December 02 and it felt good to be in my home town, even though I was to spend the next six months in a hospital bed. 

The treatment at Broadgreen was exceptional, under the care of stroke consultant Dr Jack who prescribed physiotherapy twice a week using wobble boards etc. to help me regain my balance which improved my walking which was, up until then unstable. 

However, most of my spare time at Broadgreen was spent on my bed with little stimulation, I was kept occupied by family and friends who took me out for home visits as much as possible. 

Although my lack of vision continued, I did begin to notice some strange things regarding my memory.  I could not remember the plan of the home I had shared with my partner, Angela, for around three years, but my long term memory seemed to be intact as I could recall the plans and routes of my parents’ home.  I also had difficulties remembering localised routes in my neighbourhood such as the way to the newsagents and, more importantly, the pub.

At Christopher Grange, Liverpool

Frank Ainsbury, Liverpool Voluntary Society for the Blind
I would like to take a moment to explain how my blind and brain injured  rehabilitation came about.  Just before discharge from Broadgreen there were no plans to treat all the symptoms of my diagnosis.  A clear medical pathway to ensure blind rehabilitation is established for sight loss.  However there was nothing which could simultaneously treat blindness with acquired brain injury. Unsure of how to proceed, and quite by chance, my wife, Angela, spoke to a friend about my medical problems. And this particular friend knew Frank Ainsbury and his area of medical interest. 

Frank is a blind Rehabilitation officer working for LVSB with an interest in acquired brain injury.  Through this contact Frank made arrangements to meet my wife and I  in Broadgreen shortly before my discharge. From the first contact with Frank my family and I were given hope that I would possibly have some form of improved vision. 

Frank had found me spending most of my time at Broadgreen lying on my hospital bed.  He therefore tailored a plan which took into account the problems of the two medical fields of brain injury and blindness and began my visual rehabilitation by taking me for short walks in the hospital and encouraging me to look at isolated items to try and see if there was an improvement in my vision after observing them for a length of time. 

For example I saw various items, but the first one I recognised was a window in a door in the Physiotherapy department as I was practicing on a Wobble board to improve my balance. Amazingly the longer my bouts of observation lasted the more items I could identify. 

An analogy of my sight would be as though a sighted person is looking through a straw.  The straw would mimic the loss of field of vision and highlight the small amount of central vision.  However, the central vision would be similar to looking through a magnifying glass without focus. My best vision is from a distance of around 8-12yards.  The closer objects are, the more they tend to melt into a multi-coloured blur. 

However, beyond the immediate melee some objects, especially small items, are easier to identify within the narrow field.  My sight becomes clearer after observing items of interest for around 5-10 minutes and with encouragement from Frank, the longer I observed individual objects the more I could identify.  We then moved onto locating shapes of light and colour.  An amazing moment occurred when Frank pointed out the location of a clock in the ward and asked me to try and tell the time from my optimum distance.  I was looking at it for over 5 minutes and was then able to tell him the correct time.

When he told me that I had been successful, I didn’t believe it and had to double check by pressing my talking watch. This crucial moment was the turning point in the whole rehab process as it was the first time that I believed in myself along with Frank and the rehab programme. It was from this point that I could (with great difficulty) actually identify something through my vision.  This was a time of elation - being able to defy the doctors prognosis - even if it was only in a small way – gave me great satisfaction and hope for the future. 

It was at this point that Frank introduced a psychotherapy CD he had developed to aid my belief system and this enabled me to better understand what my brain was interpreting through my eyes was actually true. 

A description of my Vision

During the first 6 months of attending Christopher Grange the focus of the rehab was to accomplish basic domestic skills to enable home independence and the skills learned were in the fields of cookery, English, and mobility.

At this time Frank continued with my sight development using enlarged high visibility playing cards.  For example he would place these cards on the floor and ask me to locate and identify them.  Frank worked closely on my vision and set tasks to encourage what use I had.  However, I found that having limited vision frustrating. 

At this time my vision was a blurred combination of multi-colours, but Frank’s brain- injury-sight-therapy over time seemed to enable me to interpret the combinations of blurred colour into some form of recognisable image.  It seemed as though I was given a code to help better understand the distorted image within my vision.

The progression of my sight developing seemed at the time painfully slow.  However, on reflection it was rapid, given the enormity of the situation.  The complexity of my new vision led to confusing situations.  The central vision is better able to identify small items from a distance of around 8-12 yards.  This can cause embarrassment as I can identify small items from my optimum distance.  However, I cannot distinguish items from in front of my face such as a computer screen or keyboard and I became convinced  that people were thinking that I was a fraud, as the revelation of some useful middle distance vision would cast doubts on the claim of being blind. 

As time went on I was able not to feel guilty as I soon realised that there was an incredibly broad spectrum of visual impairment.

Further Blind rehabilitation with Christopher Grange

It became evident that in order for me to progress that I would need to be discharged home and start at Christopher Grange Blind Rehabilitation centre Liverpool.  Once there, I had to demonstrate my ability to mentally map the general routes within the centre. This led onto the introduction of the ‘hoople’ a tool for use in aiding travel.  This device allows a blind person to safely become mobile and requires little training whilst giving a blind person enough confidence to travel indoors with adequate protection. 

Whilst the “long cane” offers more protection on mobility it also requires more detailed training.  The “hoople” was to give me immediate mobility around the centre to help with cognition and orientation. I moved on to simple cooking.  A tray had to be used to keep all equipment together and to cut out the time it took to locate them before and after use.  This procedure combated my short term memory.  For example, after using items of kitchen equipment, I could not recall the place where I had just left them.  The introduction of the tray gave a central focus for all the equipment.  This also became a useful organisation technique to adapt and use in other areas.
The care plan initially provided around 40 Hours of care a week.  The family’s perseverance in their battle with the hospital and social services enabled me to progress down the road that was rehabilitation and independence. These hours were used to complement the rehab from LVSB, and Christopher Grange. 

Skills learned through these institutions were reinforced at home by the home care support team.  Several support workers were used to assist and encourage me to become more independent.  To begin with I spent many hours of the week mapping basic routes around the home.   The same route had to be repeated countless times as repetition was the best method to combat my short term memory.  The repetition although boring was effective and eventually allowed me to remember more complex ideas and thoughts. 

Christopher Grange Blind Rehabilitation Centre

I would like to talk to you about Liverpool’s best kept secret. 

That is the Christopher Grange Blind Rehabilitation Centre, which  is situated in Knotty Ash Liverpool. The Youens Way centre has touched the lives of many of the visual impaired people who have passed through its doors since the early 1970s.  From this time it has positively affected the lives of many visually impaired students who, with the help of the Grange,  have managed to come to terms with sight loss and acquire the skills to manage the daily challenges of life with sight impairment.  It approaches the many difficulties of visual impairment with    a friendly welcome which immediately sets the new student at ease. The rehabilitation process is discussed and the clients individual needs and problems are addressed and accounted for in a unique rehabilitation programme.  Those lucky enough to attend are given the three fundamentals of blind rehabilitation.  These are mobility training, communications with  daily living skills and counselling.  They understand that we are all individuals and  tailor your rehab programme to meet your specific requirements.  At the same time they will inform you that you will have to acquire core rehab skills to achieve your aims. 

For example before you are allowed onto a computer you will have to learn to touch type.  Learning to touch type will allow speedy progression into learning computing skills without being hindered by basic typing errors.  Whilst you are progressing through your rehab programme you will be assisted by Christopher Grange volunteers.  These people’s are a brilliant source of help, friendship and experience.  The vast majority of which are former students.  They are therefore aware of the difficulties new students are going through.  They understand that coming to terms with sight impairment can be traumatic and that being able to talk to people who have travelled along a similar road is of great comfort.

The volunteers are also fantastic examples of what can be achieved by blind people and this mentoring provides new students with the confidence to persevere with rehabilitation to help achieve their personal goals.       

Computers

Around this time at the Grange I was introduced to computers and became aware that I had to acquire some understanding of  them in order to progress in education.  I was introduced to a screen reader called Supa Nova.  However around this time I was also made aware of an alternative screen reader called Guide which was much simpler to use and I was enticed by the simplified interface which quickly helped me achieve E-mails and surf the internet. 

However, it was only in retrospect that I was simply learning to use one individual screen-reader.  If I wanted to progress in education I would have to start understanding computers. Therefore I would have to be familiar with a screen reader such as Supa Nova which allows you to follow the windows interface.  This technology is recognisable internationally both in business and education.  Guide also restricts the computer user allowing him/her to carry out their computing tasks only on a guide machine.  that said Guide gives you the confidence as it allows you to achieve E-mails, write documents and use the internet rapidly. 

However, blind computer users would argue that all that guide is doing is to supply an easy way to achieve these important  functions, but once the user has mastered these basics, he/she is restricted to guide.  The computer user is then solely reliant on the guide inter-face and cannot interact with Windows to perform more complex computing.  

Getting to the Heart of the matter

A few months after my discharge from Broadgreen I underwent a cardioversion to regulate my heart.  This was successful and I was able to continue regularly using the gym.  I was able to safely reach a decent level of fitness which had a positive knock-on effect to my general well being and the rehab programme. My activities in the gym seem to have replaced my interest in active sport. 

Fine tuning visual aids

My vision continued to improve and this led me to see an Ophthalmologist in February 03, who prescribed a pair of glasses which fine-tuned my central vision. The glasses made a difference as I was able to focus on things more quickly and gave definition to objects.

Further rehab

Mapping of the home widened to the lesser used areas and I began doing more adventurous cooking.  In Christopher Grange I moved on to further living skills which focused on my main two areas of rehab that was mobility and cooking.  These included using specialist equipment such as talking kitchen scales, and a talking microwave.  I was also given the long cane to use at home during the Christmas break. 

I am eternally grateful for the vision that I have, although it can be frustrating in some ways, being able to see small items from my optimum distance is brilliant and at the same time infuriating. Although I have useful central vision it is only functional from 8-12 yards away, the distance in between is too unfocused for useful sight.    However, I still cannot use it effectively to simply walk from one side of a room to the other.  My small amount of vision gives me great elation because with help from Frank Ainsbury, LVSB, Christopher Grange, support workers and my family I have managed to defy those doctors who told me and my family that I would never see again.  Mobility was combined with vision therapy by encouraging me to identify landmarks.  This led to orientation around the Grange which then progressed to acquiring the skills needed to safely use the long cane.

Neurological assessment

As my rehabilitation memory and cognition had improved it was suggested a neurological assessment was needed.

In February 04 I was examined by a neurologist who had a special interest and understanding of acquired brain injury with visual impairment. This assessment was used partly to ascertain the probabilities of entering further and higher education.

The assessment was positive and showed that I could understand new concepts and had a much improved memory recall than I had had say one year previously. It also enabled me to implement newly learned memory recall strategies to help me to better understand, store and recall information for use in education.  This assessment gave me the confidence to proceed down an educational route without embarrassment, which my memory problem could cause me.

Visual filters

Spring 04 Frank managed to set up a meeting with David Harris, an expert with visual filters, to try out an idea Frank had had for a few years.  Basically, the theory goes, this was to use visual filters to enhance my vision.  The filters would encourage the brain to create a ‘neural pathway’ ( or an alternative route) for the brain to transmit   its information to the eyes. This is the same process that is used on dyslexics i.e. using visual filters to better interpret information to the eyes.  This meeting proved to be successful as the improved vision was beyond every ones expectation.  The visual filters further improved my vision compared with using regular glasses.  The main improvement was sharper definition and depth perception.  Unfortunately future treatment had to stop because funding for further research was unable to be secured.

Return to Education

My return to education in 2005 was littered with challengers that had to be overcome in order to achieve my ultimate goal of full time employment.  The lessons learned in Christopher Grange and the use of memory strategies from the Neurologist helped me overcome many of the problems that I encountered. 

I completed a Pre-Access and Access Course, starting without qualifications.  I received fantastic disabled support from Hugh Baird College, Bootle which was second to none. This enabled me to continually improve along the path of education. 

Recently I have successfully completed my first year in Liverpool Hope University. I would like to thank Sheila Watts and her support team at Hope and, also, Chris, Helen  and Laura for their great learning support. As I write I am looking forward to the challenges of the next years of my degree in History.      

Securing an extensive care plan

I was discharged home from Broadgreen with a good care package that was hard fought for through the determination of my family and bed blocking at Broadgreen until acceptable arrangements were in place at home.  My family managed to “persuade” the medical and social service teams to implement this extensive care plan before discharge.  With consultancy from Frank and LVSB, Christopher Grange, friends, family and social services the care arrangements had foreseen all potential problem areas and facilitated the extensive rehabilitation programme.

Thanks to…

I would like to take the opportunity to thank Christopher Grange, LVSB or Liverpool Voluntary Service for the Blind, Liverpool Social Services and Broadgreen Hospital for the care and care arrangements they set in place which facilitated my rehabilitation.  It is  rare to hear of extensive care plans being implemented.  They therefore should be congratulated for the part they played in my rehabilitation.  A special thank you to Angela, my family, Frank Ainsbury, the volunteers, staff and students  at Christopher Grange, my blind computer guru John Poole,  all the staff that I know at Hugh Baird College and Hope University, a special thank you to the long suffering Chris High who has endured my educational and non-educational memory losses as well as editing this piece of work.  All the organisations previously mentioned for the help, expertise and friendship they have extended to me over the years.  Without my support network I would be unable to progress as far as I have with my rehabilitation. Thank you.           

For more information: www.christopher.grange.co.uk

 

 

  
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If you would like to comment on this interview with Alan McComb in March 2010, please feel free to contact me - GUESTBOOK

“Writing gets me away for a while' from this world and into one where I, alone, can make or
break the rules as I see fit.” - Chris High 2003.
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