Look Out Sarah Conner

Pushing Boundaries has a machine which moves your legs as they would if you were walking. For me this machine can do some important things in terms of stretching contracted from long disuse and even longer sitting. It can also train the muscles in some of the movements they will need to use as I attempt to relearn some form of walking.
I have seen this machine used with people with cervical injuries who are struggling to recover use of their arms and have no hope of effective use of their legs and wonder why it is being used. Even for me, I wonder about the motions of my knee and foot. I currently have almost no ability to move my  knee on my own.
You start by putting on a harness which attaches around your chest and under the groin. You will hang in the harness while the straps are attached to the thighs, calves and feet. It took about 20 minutes to find the propper adjustments of a large collection of straps and braces. Presumably the next time I use the device all of these measurements will simply be dialed in.

Once all the straps are in place, the machine begins to move your legs, slowly at first and then in larger motions. Once the motion is going and well tolerated you are lowered onto the treadmill. You are now walking or more properly the machine is walking for you. I remember a comment from one of the spinal cord injury forums not about this device but about an exoskeleton which would allow you to walk independently using their motors. One person commented "I don't want to walk around looking like I am stalking Sarah Connor".

After 15 minutes of "walking" they tested the strength of my legs. With the right I was able to generate about 20 NM and about a third of that with the left flexor. Extension ( moving the leg down) was much weaker. When I asked what these numbers meant, Erin hemmed and hawed and eventually said that the company says you need about 40 NM to walk. I could say on the right that the glass is either half full or half empty.

Casting for Braces

The first step in making braces is to make a cast of the legs and hips allowing a manufacturer to make pieces that fit your body well. My orthotist did the casting in two steps. First in the facilities of her office she cast my legs.

She sheaths the legs in cloth tubes and lays a piece of surgical tubing on top. Later she will use the tubing as a path to cut the cast off the leg. The she takes rolls of plaster impregnated cloth, dumps it in a bucket to get it soaked and wraps them around the leg in the same manner as a classic cast is made (In modern times fiberglass which is lighter and probably stronger would be used for a cast designed to remain for more than a few minutes.) After the cast dries, she takes a cast saw and cuts along the line if the surgical tubing. Using a special spreader tool she spreads the crack and removes the cast.

For the casting of the hips, she wanted a lower mat so I could sit with my knees on the floor and my body bent over the mat. We went to the school of orthotics at the university. I was placed in a position on the mat and my entire trunk was placed in a couple of layers of cloth tubing. After that layers of plaster were put on my back (not wrapped around the body. In the end the cloth tubing was cut off.

I have no idea how long the braces will take to make, what they will look like when they are done or, most important, what it will feel like to walk. I am very interested in how much work it will take to walk (everyone says a lot) and how difficult it will be to balance - I suppose there is little to do but wait patiently,

Before You Can Walk

I did two things at Pushing Boundaries that I have not been able to do after my accident. The first was to get onto and more importantly to get off of the floor. The second was to crawl across the room.

The seat on a wheelchair is about 20 inches off of the floor. This distance can be very daunting when you consider trying to get out of the chair and onto the floor or, more importantly, if you were to find yourself on the floor consider how to get back into the chair. I have done this a couple of times by positioning a bar that I can use to do a pull up which raises my body to about the right height. At Pushing Boundaries my instructor had me get on the floor merely by putting my feet on the floor and then attempting to lower myself from the wheelchair. The results were not pretty and would probably consist be considered to be a fall. Once on the floor, actually on a gym mat, I crawled the length of the room but I will talk more about that in a second. After crawling I was faced with the problem of how to get back into the chair. The instructor suggested placing one hand on the chair and another on one of the metal arms and trying to push myself up onto the seat. This did not look like it was going to work very well. Looking around I found a heavy, padded bench a little bit lower than the wheelchair. I have the instructor move the bench so that the wheelchair and the bench for a 90° angle allowing me to place myself in the corner and have solid support for each and to raise my body to the height of the chair. It was actually very easy.

The next issue was crawling. It may be the only time outside of the pool that I can move with the assistance of my legs. The idea is to get up in my hands and knees and then move by unweighting one leg and moving it forward, the repositioning the arms and repeating. Sort of like what a baby does but way harder. The main issue is that the legs and hips are not terribly stable. It takes a lot of work on the part of the arms just to maintain balance. In moving the leg forward, it it important to work against the natural tendency for both legs to move toward the center. For a stable platform, the trick is to keep the knees far enough apart to form a stable platform. Every few feet it was too much work and I had to collapse to one side and rest. I fount that it was less work to lean on my elbows rather than keep my arms fully extended. It took about 30 minutes to crawl about 40 feet down the mat and get back to the chair with many rests in between.

Braces

I used braces for the first time a few days ago. I had met with my orthotist earlier and we agreed to meet with my physical therapist to try some loaner braces. We met later with the physical therapist in the gym at Harborview hospital. There are two kinds of braces that we were considering. KAFO which stands for knee ankle foot straps onto your leg whereas RGO is more rigid and includes a strap on your back. The orthotist brought a loaner pair of KAFO braces. The only RGO brace that she brought was designed for a small child. We strapped on the braces and move to a set of parallel bars.

The braces have two modes, in one mode they knee swings freely allowing you to sit in a wheelchair, in the other mode the knees are locked and rigid. To stand up you need to put your legs straight out, lock the knees and then somehow get to a standing position with your body over your feet. The parallel bars help a lot but it is still not very easy.

As you can see there are tricks to standing up. Once standing the trick is to position your body over the legs which requires a lot of difficult movement in a back with a lot of hardware.

In the end both the orthotist and the physical therapist thought in view of my back I would be better off with the more rigid RGO braces (the kind I didn't try). It will take a couple of weeks to meet the orthotist for casting and a few weeks more to make the brace.