An Education

12 12 2010

I am in the midst of a relatively unique learning experience. When we learn to walk as infants, we don’t have the capacity to understand how the process occurs.  Reflecting on it later in life is not helpful because we can’t remember the time when we started walking.  Even therapists and scholars who study neurology and anatomy and understand the physiology involved do not get to personally experience the learning.  Despite the bad fortune that landed me in this position, I now have the good fortune of experiencing the learning involved in making a body walk.

When my spinal cord was first injured, my brain sent signals to my muscles telling them to move but received no response because the signal was disrupted at my injury site.  Eventually, my brain decided sending signals was futile so it stopped doing so. This is called “learned non-use”. My spinal cord repaired itself to a certain degree, but, because my brain was no longer sending signals, my muscles still did not activate.

Now that I know these muscles are capable of receiving information from my brain, I’m trying hard to transmit messages.  This is where the learning process becomes interesting.  It seems that each movement requires a separate command from my brain.  To take a step with my left leg, I have to think about activating my hip flexor, then my quad to bend my hip. I have to think about pulling my leg through the stride and then raising my knee, but not too high. I have to concentrate on contracting my quad to extend my leg while moving my body forward and placing my foot on the ground with my heel first.

If I forget to specifically think about one of these movements, it doesn’t occur.  At least that used to be the case.  Some of these movements have started to become automatic.   I’m not sure at what point it occurred and do not understand quite how. In fact, I’m not terribly aware of which movements are automatic and which are not; somewhere along the way I just stopped thinking about some of them.  I discover what is not automatic when I try to talk at the same time as I walk.  With the distraction, certain movements become lazy or cease until I concentrate on them again.  The more I practice, the more automatic or natural the movements become.

I realize as I’m writing this that others can experience this type of learning when they try a new activity that requires undeveloped physical skill and capacity. New skiers, in particular, come to mind. Do you remember what it was like learning to turn, balance and control speed while traveling down a hill on two narrow skis?  How it took your entire concentration to lean the right amount, in the right direction, at the right time?  Even then, you needed to develop stronger muscles to become proficient.   If you can’t remember a similar experience, give it a try.  It’s quite exciting.


Return of the Heel Strike

17 11 2010

I’ve had a couple of new physical breakthroughs.  First, I got my heel strike back.  “What’s that?” you may ask.  Well, when we take a step we typically land with our heel first then continue through the step and finally push off with our toes.  My left leg has been stubborn due to spasticity and inflexibility brought on by years in a chair.  When I took a step, my left calf would spasm causing my toes to point so my foot would strike the floor with my toes landing first.  Not good for momentum or balance.

Last week at physiotherapy I was able to concentrate on landing my step heel first and make it happen. They were kind of wonky, over-exaggerated looking steps. I was concentrating hard and using all of my effort so my leg lifted higher than expected and I was almost marching. I was able to work out most of the kinks this week as I settled into the technique and better understand how much effort to expend. So now my foot moves smoothly through a relatively normal looking stride.

I’m actually not sure what the reason for the improvement is yet because my physio and I have been trying many things at the same time.  For those interested, here are the things that altered:

1. Reduction in spasms/spasticity. I cut back on the drug I use to relax spastic muscles (baclofen) after learning from folks on the SCI web forum that it weakens muscles.  This provided increased strength in my legs, particularly my hipflexor which is key to pulling my leg straight through a stride.  Oddly enough, for people with paralysis who don’t or won’t progress due to the nature of their injury, baclofen is an incredible drug to help settle spasm and tightness.  For those who need more strength and move more, it just inhibits muscle function.  Ultimately my spasms have decreased anyway due to more walking & exercise, stretching my calf muscles/tendons, and using muscle stimulation to activate dorsiflexion in my foot.  Yesterday, for the first time, my calf was actually relaxed while I walked.  This was so enjoyable and made walking a piece of cake – at least while using a walker.

2. Gait training. After posting a video of me walking on the SCI web forum I received tips on how my gait was hampered: swinging my leg to the side so my foot would clear, foot inversion etc.  My physio and I applied the tips on proper mechanics.

3. Extensive exercise.  I committed myself to working out really hard to improve as much and as fast as possible. I’m up to 3 days spinning a week.  It is incredible exercise for the arms, but, more importantly it is great for my core stomach and back muscles which I use when I walk.  I notice my pants are tighter so I suspect (or at least hope) this is because I’m bulking up with muscle. I also continue with physio twice a week and beyond that perform specific exercises targeting my quad, hip flexor, hamstring and glute.

4. Recovery. The signal from my brain is reaching the correct muscles.  I’m not sure if this is new or if my muscles are now strong enough to perform what my brain is asking of them.

My second new breakthrough is achieving a better sense of balance.  In my last post I wrote about walking independently and how difficult that is without balance.  I continued working on this at physio and it seems that I’m regaining my sense of balance.  My brain forgets in between each stroll how to balance, so the first steps of each session are off kilter. Finally, my brain says, “oh, I recognise this orientation. It’s not right. I’ll send a signal to the appropriate muscle to correct it.”  Then I’m good to go.  With each walk, balance kicks in a little quicker.  The most challenging part remains the strength of my muscles (or the ability of nerve signals to reach those muscles) because having a sense of when you’re leaning too far or falling and actually being able to do something about it are two very different accomplishments.

The coolest thing about this process now is seeing steady, often exponential, progress.  The one thing that remains constant: quarter squats are the bane of my existence!

Dancing with Myself

25 10 2010

I feel young again!  I was just standing at my desk doing some quarter squats when some fun music came on and I started dancing.  Whew, what a work out – but so much fun!  It’s a great way to get in those pesky squats, shift weight from side to side, rotate the body and practice balance.  I love it.  I think it’s going to become a part of my home workout routine. Anything that helps with the monotony of exercise is welcomed.

On that note, I’m hoping to borrow my sister’s Wii.  I think that trying to play some of the sports while standing will force me to use my quads and core muscles for balance – hopefully keeping my mind off of the actual work.

I’ve also started a spinning class once a week using an arm cycle. It’s been two weeks and, so far, I just love it.  It’s great cardio and strength training for arms AND core muscles.  My stomach is developing a six-pack.  Maybe more importantly, it’s fun and social which makes me want to keep going.

My left hip flexor continues to be the weakest link in the walking muscle chain.  It’s firing more consistently now, though nothing compared to that of an able bodied person.  I’ve come up with a new exercise that is starting to show some small results.  I’ll provide more on that later.

Finally, the newest element in my physio regime is walking unassisted.  This gets left to the end of the session because, when I’m done, I’m spent. My balance is terrible.  If I touch something with my right hand, I have no problem balancing. Even if I’m using the tip of my pinky finger, I’m cool.  Then I’m left only addressing muscle function issues.  Take away that aid and I have a difficult time.  I do it, but it looks hilarious. I rival John Cleese for the silliest walk.   I’ve gotten a little better each time as I become more familiar with the balance mechanics required to get my left leg through its uneven stride.  I tire quickly because when my balance waivers, my quads and core muscles engage and use all of my energy to stop me from falling.  As I get better with balance, that saved energy will go into walking further. I plan to record it so I can keep track of what I’m doing wrong and any improvements made.  I’ll post in the video section.

Until next time…


22 10 2010

I realized that I write only when I’m happy with the progress I’m making.  I think this is misleading to readers.  There are times when I get frustrated, plateau or regress, get too busy to workout, or just don’t feel like it.  It usually doesn’t occur to me to write at these times or, if I do consider it, I can’t be bothered.   This post is my admission that every day is not as rosy as the best moments I describe and my disclosure that this blog will most likely not present a balanced view of my progress. Not fair, I guess, but I’m just not committed enough to documenting everything; at least I’m committed to the actual work.

La Dolce Vita

27 09 2010

Time flies. I’ve had three weeks away in Europe and have been back at work for a month since my last post. Here’s the progress report:

The first bit of news happened accidentally.  My hotel in Barcelona turned out to be inaccessible: there was a flight of stairs before the elevator much longer (10 steps) than anything I had attempted before.  Instead of lugging everything around Barcelona looking for a new hotel, I gave it a try.  I was successful and it was easier than I anticipated.  Despite the photo, I did use a spotter.

I upped the ante on the first day of sightseeing.   I climbed the steps of a double-decker sightseeing bus and walked to my seat.  I’m not going to lie.  It was tough.  The stairs were steep with a left turn three steps in.  The walk down was the hardest part though.  I had to rush because the bus did not stop long and I descended backwards which meant I had to put faith in my unstable left leg to support me on the steep drop.  All turned out well, however, and I was able to enjoy beautiful architecture while basking in the sun.

After the double-decker bus, other tour buses were easily conquered.  They were more of a Grey Hound-type with a giant first step and then four or five regular sized steps.  For the larger cities, I booked cars to make life easier.

Back on the ship, I practiced climbing flights of steps (see video) and walking through hallways though I did not do either as often as I should.  I didn’t take my muscle stimulator either.

So now, back into the swing of real life, I continue to work away at physio.  I’m concentrating on my left quad. Quarter squats are my least favourite exercise, but they have the biggest results.  I’m not sure if it’s observable yet, but I have a real sense of control when I walk now – which is an awesome feeling.  Previously, I could step on my left leg, even stand on it isolated, but it was just kind of there holding me, not propelling me.  Now it is an agile and active participant. I do an activity at physio where I stand and my therapist pushes me in various directions.  It’s a balance exercise and, with the development in my left leg, I have no trouble keeping myself upright while he tries knocking me over.  Progress!

I tweaked a muscle in my back this past week and it was painful so I haven’t been exercising much. Wow, how quickly my body revolts against me. I already feel my quads have weakened.  The good news is I’m starting to feel better so squats here I come!

Amazing Machines

14 07 2010

A couple of images of the EMS unit I’m using.

Mind games

11 07 2010

Ok, I’m going crazy.  I have to play music or turn the tv on to distract myself because, with silence, my mind is spinning out of control.  I can’t believe I’m going to be walking again!  The realization is sinking in and shaking my core.  I want it here already if only to settle my mind.

Exceeding my expectations in the last couple of weeks (see my previous post about the rapid development of my weak left side) has thrown me for a loop. I’m now almost where I expected my end point to be and I’m just getting started.

I have tried so hard to keep my expectations realistic – to what I believed was possible. Only now possibility has shifted.  I have to redefine my goals and expectations, but I don’t know what they should be.  I’m afraid to set them too high or admit to myself that walking is a real possibility, because failure (I know, it’s not failure – but it is, you know?) would hurt so much.

Some people love the mystery and freedom of not knowing the future.  I want to join them and live in the moment and enjoy myself, but my mind is not letting me.  Being this excited is intense.

Right now I’m transferring that energy into exercise. But I’ve now done two workouts today and I know my muscles will resent it tomorrow and, still, I’m stuck with all of this anxious energy. Although I usually find writing to be therapeutic, writing this is feeding my disquiet.  I need to meditate…or something.