The Dog Days of Summer

26 09 2011

I find myself at a crucial and exciting recovery point: on the verge of being a walker.  One with some limitations, sure, but walking none the less. I’d been making great strides, but found my ability to progress limited by my job.  Exercising at the end of the work day, my best energy was already tapped out.  To increase the quality of my workouts, I decided to use my holidays (4 weeks in August) and apply myself entirely to walking to push through to the next phase.

I set up a fairly intense schedule with physiotherapy every morning followed by independent exercise in the afternoon.  It turned out the schedule was a little too rigorous and I developed mild bursitis in my hip midway through week two.  I had to take things easy for over a week before I could resume at a more moderate pace.  This is frustrating because I’m experiencing results and can even see the end result not too far out of reach – which is ridiculous motivation to get there – but I have to pace myself to avoid injury.

I’ve been researching more about exercise and motor recovery and found a great article.  One of its key points is that different types of training – to build muscle strength and endurance – are great workouts and obviously good for anybody, however, where neurological impairment (SCI) affects walking, the greatest recovery of walking occurs in individuals who repeat walking patterns.  This repetition either allows the brain to overcome “learned non-use” (see other post for explanation) by relearning how to activate muscles used in the walking sequence, or it creates peripheral neuro-pathways to do this.   So, to summarize, cross training is beneficial, but the real neurological/motor progress will occur by walking, walking and more walking.

This discovery has changed some of my habits. I have walkers at home and work, which I’ve been capable of using for quite some time, but haven’t used extensively because it’s much slower to walk than wheel.  Knowing that repetition is the key to recovery, instead of waiting to use the walker until I’ve built enough strength and speed to make it efficient, I’m now trying to accept this slower speed as my new pace and walk more.    I’m having more success with this at work then at home.

I continue to work with two physiotherapists, Janice and Malcolm, who complement one another well.  With Malcolm I’m working primarily on balance and proprioception.  “Proprioception is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement.” (Wikipedia)  In pursuit of achieving better proprioception, I do a lot of unaided walking with the addition that now I’m not to look at my feet.  The reason for this is that when I use my eyes, the visual feedback I receive establishes the moment-to-moment information of balance – so I’m not required to feel for balance with my body.  To feel proprioception at work yourself, try balancing on one foot with your eyes open, using visual clues to keep your balance.  Then close your eyes and keep balanced.  Much harder, yes? You’re now using feedback from your body’s proprioceptors to keep balanced.

In the beginning my proprioception was terrible and I stole too many glances at my feet. Malcolm threatened corporeal punishment, but, when I objected, we settled on a quick “hey” when I slip up.  I’ve started to overcome this bad habit and my brain is now better able to tell where and how my left foot moves without seeing it.  I still have much work to do on balance, which seems to improve only with practice.

Walking unaided is challenging, but it pays off when I use an aid.  I’m just so much more comfortable and confident – which brings me to my work with Janice.  We’ve been working on walking with a cane. In the limited amount of time we’ve had the opportunity to focus on this, my abilities and confidence have increased significantly.  See the video of my first August rehab walk.  We’re also working on the quality of my steps, certain basic skills that I’ve forgotten (like how to turn properly and remembering to shift weight from one leg to the other when standing still – yes, I forgot about that) and climbing and descending stairs.  I seem to be conquering everything we set out to do.  Next we’ll be working on strategies to achieve speed.

To conclude this update on my August rehab, I believe I have reached a new stage.  It’s a transition level; strength, endurance, balance and speed all need improvement, but the foundations necessary to become a full time walker are there.  The exciting news is that there is so much more improvement yet to come.

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