More thoughts on traveling to a place like Oaxaca Mexico

   First, assume the world is NOT accessible. Most curbs do not have curb cuts and in many cases the curb is followed by a fairly deep dish. It is possible to travel with the aid of an able bodied person capable of getting a chair over obstacles. There include bumping over curb cuts and up and down the few steps which often separate businesses from the sidewalk. DO NOT TRY THIS IN AN ELECTRIC CHAIR.
   The sidewalks are also relatively rough and not uncommonly blocked with a post positioned in a way which is impossible to pass on either side, a building protruding into the sidewalk which is too narrow to pass or ditches and cuts through the sidewalk.
    I can with a fairly large and experienced able bodied party and have not hurted for able bodied help. I have been told that it is possible to hire a pusher for not too much money. I have not tried this and would assume that the pusher would have at best minimal English.

     Taxis are possible and inexpensive and represent a reasonable way to get around. We would use them more if we did not enjoy walking and if I did not have skilled and willing assistants.

More lessons from travel

    We are spending almost three weeks in Oaxaca Mexico learning among other things about international travel. As I said in the previous post, the ADA does not apply down here.Almost every building has several steps to get in. The picture below illustrates a local restaurant.

One interesting observation has to do with transfer boards. When I was first injured I was taught to transfer, that is get from a chair or bed to a wheelchair or back, using a board connecting the two locations. Since then I learned how to transfer without a board with one exception - getting in and out of cars. The distances are long and there is frequently a difference in height. On other trips we have rented a car and took a board. The board could remain in the rental car until we left. This time we took a long board anticipating its use. However we did not rent a car - depending on taxis and hiring a driver. The problem is that if you use a board on a taxi trip to downtown, then you need to carry the board all day. I rapidly decided that I was really good enough to get in a car without any aid.
     The taxis in the city are subcompacts with the seats at about the same height as the wheelchair. One day we hired an SUV where the seats are about  a foot and a half above the height of the chair and where was no way that I could get in without some assistance. Even getting out was a real challenge.
      Yesterday we went to Monte Alban, a pre Columbian Zapotec site about 20 km out of town. Normally I woiuld not even try to go to a site at the top of a mountain with many hills. Monte Alban has made an effort to make the site wheelchair accessible. An elevator takes you up about 10 meters to  a plane covering most of the lower levels of the site. I was able to roll around the lower levels of the site - clearly the steep Zapotec  steps were out of the question.Also like all of the museums we have encountered so far, admission for the disabled is free.
     Of course sometimes you get what you pay for. One museum on Oaxaca is in an old convent with all the exhibits on the second floor and no elevator. The steps look like this.

Needless to say I sat on the lower floor while others went up.

Where the ADA does not apply

   For the the first time since my accident my wife and I went abroad to a third world country. We are in Oaxaca Mexico for almost 3 weeks. Oaxaca is a city we have traveled to before. We remember the city as relatively flat with a lot going on and want to use the trip as a test case for further travel we may consider abroad. It was very clear that many of the easy assumptions you could make in the US since the passage of the Americans with Disabilities act would not work. The question is how bad  could life get..
   The first issue we ran into was in the airport when the wheelchair barely was able to squeeze through the door of the bathroom. Of course the idea of a stall wide enough to accommodate a wheelchair is out of the question but the is a nicety not a necessity. The rest of the loo was at least functional. 
     The sidewalks are also interesting. While a number of intersections in the city center have curb cuts, eight blocks away where we are staying there are none and even many of the existing curb cuts are so deep it is difficult to get a wheelchair either up or down. Where we are staying there is no way for me to move more than a block or two without an assistant to help get the chair onto and off of curbs. Many buildings have a few steps to get in and few if any have ramps.
       We took a cab to town (forcing me to try for the first time getting in and out of a car without using a transfer board) This worked well but once disgorged there were sidewalks blocked with parked motorcycles, ladders and even carts as well as the curbs to climb and descend.
         At the restaurant where we had lunch, the  loo was down a flight of stairs and up two. I did not even look at it for size.
      My wife and I did explore about a mile through the city center. We found a great church with a ramp tp get in (not ADA shallow but usable especially with a companion to help.
    In the next week we have a series of trips to outlying districts scheduled and will really see what is and is not possible.

The Troubles with Braces

The braces I have been using are RGO braces which mean that they not only brace the legs but the hips. Once standing you can lock the braces by tilting the hips forward and unlock the braces by moving them to an unlocked mode and moving the hips forward again. There is a lot of hardware above the hips doing a fair number of complex things. The thing I have discovered over the past month or two is that none of it is reliable.
    The first problem I ran into (ignoring a lot of adjustment when I first got the unit) was when I went to sit down at Pushing Boundaries. The action was not gentle but neither was it that violent. There was a crack on my right leg and I found that the two screws holding the metal support to the plastic molded to my leg had pulled out - one leaving a smooth hole and the other cracking the plastic. The braces went back to the orthotist who, fortunately, had gotten the mold used to make the plastic piece from the factory. She was able to rebuild the plastic pieces holding my lower lag with thicker and sturdier plastic.
    The next week I went back to Pushing Boundaries. Jerry, the therapist who was there when the braces first broke was more careful. We inspected the braces carefully and he took care that the Velcro straps holding the braces to the leg were especially tight. This was a mistake as the thin wire loop holding the Velcro pulled out forcing us to hunt down an pliers and rebend it back into shape. We then began walking around Pushing Boundaries. After a walk around the place we went to sit down Again there was a crack in the right leg as I sat and again the screws had pulled out of the right side. This time the heads had sheared off and the thicker plastic was undamaged. The braces went back to the orthotist to replace the screws and the wires all over with thicker and heavier buckles.
    Then the braces came back there was a small issue with some of the Velcro being so long the end was under the leg making it difficult to undo. Next we took the braces back east on a Thanksgiving trip to my sister's. I was able to put them on and walk for my sister. I found that the place we were staying in had a long, straight hall - perfect for practicing walking. I walked up and down the hall for a couple of days in succession until I heard a strange sound from the left side of the brace. At first I could not see the issue. Later I realized that the upper left brace was sitting a couple of millimeters off the back brace. It turns out the screws holding that piece had become stripped. So, the braces went into their bag for the rest of the trip. In addition we decided not to take the braces on the three week trip to Mexico we had planned to take later. It was back to the orthotist to replace the two small screws with three larger ones on each side.
    After we got the braces back we started practicing around the house. After a couple of days There was a noise in the right back that after much inspection was due to the fact that a screw which was part of a critical joint had largely unscrewed. Later we would discover that there is a set screw which is supposed to prevent the piece from moving and it had grown loose. I was able to fix the joint myself and my therapist tightened the set screw.
    A day or so later my therapist and I were practicing getting up using hand crutches. For a number of repeats it was working well until I got up and the braces did not lock. With assistance I sat down and we tried it again. This time I was sure that I had made the move properly and was stable but again the braces did not lock. By now the therapist and I were sure something was wrong. With some help I got down and took off the braces. We decided to go through and try to understand the locking mechanism. It was not hard to find the problem - one one side there was a spring loaded peg. On the other an empty hole. My therapist scoured the floor and found the peg, the spring and the screw which is supposed to hold the peg in. Lacking a small enough screwdriver and deciding that it was important that the unit get a thorough inspection, we taped the parts in and sent the unit back one more time to the orthotist.

Hand Crutches

As I have become better using a walker, my therapist has begun to teach me how to use hand crutches. Using hand crutches is significantly scarier than using a walker because you are way less stable. In addition, as the video shows, getting up using hand crutches can be scary especially at first. To get up using hand crutches you need to push yourself to a vertical position and then, quickly moving the crutches, catch yourself before you fall over. 

Initially I had a lot of problems getting to a standing position using a walker and I felt and probably still feel that in the long-term the best solution is to learn to use hand crutches. As I learned better technique with the walker and specifically have improved my ability to stand up from a seated position I see hand crutches as probably inevitable but less urgent. It is certainly true that there is less equipment involved with hand crutches and that the equipment takes up less space and is more portable. Now that I am at home and using a walker there my therapist has been concentrating almost exclusively on the use of hand crutches, a skill that I am still developing.

The video below shows something like my third attempt to walk using hand crutches. It is not very pretty but then I never imagined that whatever I got to would be elegant. I'm assuming that over time my technique will improve and specifically that I will become more stable. I have been discovering that there are things that are difficult to do with a walker. Some of these such as walking down a slope (the walker feels like it may have a tendency to roll away from you) or walking on an uneven surface may well prove easier when using hand crutches.

The Shower

For the past six months I have been taking showers in a rolling bathroom chair. While the chair has small wheels which, unlike my manual wheelchair, makes it impossible for me to simply sit in the chair and push in the wheels, the bathroom is a small room. Rather than pushing the chair, I have arrayed a collection of handles on the walls of the room. Using my hands and , when the reach is to long, a stick with a hook on the end, I have been able to get myself anywhere I need to go. When I am ready to leave the bathroom, I simply transfer into my regular chair and roll off.

   The one place I could not get was into the shower. We had a walk-in shower installed, However, a two inch lip on the edge prevented me from getting the chair into the shower without help. This is important because showering is one of the few things I am incapable of doing by myself. When my wife and a friend went camping for several days leaving me by myself, the only thing given up was the ability to take a shower. Recently we had the  man who installed the man who installed the shower look at the issue of removing enough of the lip for the chair to get into the shower. He came up with a plan to cut off the back of the lip and to replace it with a gentle tiled slope. S The implementation had some problems. The cement under the slope took a long time to dry and was still wet by the time we tested. The tiles were designed as wall tiles and some of them broke and came up as the chair rolled over them.

of them broke and came up as the chair rolled over them.
 We have arranged for the tiles to be replaced the next time we're on vacation. However, the arrangement is usable enough to try. This morning, for the first time, I was able to roll the wheelchair into the shower, shower and roll the wheelchair out without any assistance at all. With this accomplishment if Verna wants to go on a long vacation, say a week or more, she is free to take off and I am confident that I can take care of myself during this period. No matter how much I might miss her.

  The one place I could not get was into the shower. We had a walk-in shower installed, However, a two inch lip on the edge prevented me from getting the chair into the shower without help. This is important because showering is one of the few things I am incapable of doing by myself. When my wife and a friend went camping for several days leaving me by myself, the only thing given up was the ability to take a shower. Recently we had the  man who installed the man who installed the shower look at the issue of removing enough of the lip for the chair to get into the shower. He came up with a plan to cut off the back of the lip and to replace it with a gentle tiled slope. S The implementation had some problems. The cement under the slope took a long time to dry and was still wet by the time we tested. The tiles were designed as wall tiles and some of them broke and came up as the chair rolled over them.

The Ins and Outs of Braces

After walking around much the rehab clinic with my physical therapist walking behind holding a gait belt in case I lost my rather precarious balance, I was allowed to take the braces home. Not the walker which meant I was allowed to practice putting on the braces and  standing up followed by sitting back down but not moving around.

 There are three pieces - a back support shown above as the large curved piece and below shown from the back showing the assembly linking the legs . There are also two leg supports. These consist of a plastic piece molded to the foot and the leg below the knee, a small insert the fits over the leg just below the knee velcroing into place and a metal rod coming up the side of the leg and locking into the hip assembly.

In the picture below I have put the brace on my left leg and am in the process of putting it on the right. I have not yet fit the leg into the hip assembly.

 Here the assembly is together except for the shoes which go over the feet. An important piece is an
wedge in the shoe which raises the heel and throws my weight more forward onto the arms

 Getting into the shoes.

 In the last picture I have used the bars on our stair case to pull myself to a vertical position. Eventually the idea is to push up from a walker. Walkers are quite light and not too stable when pulled on. In addition the physical therapist felt (properly) that I was not ready to handle a walker without adult supervision. When I am standing in this position the braces lock at the hips allowing me to move the legs but forcing them to move in sync.

Curiously while I have no problems moving my legs in the parallel bars or the walker, I am unable to move when standing at the stairs. The problem seems to be that I cannot use my arms to unweight one leg allowing me to move it. 

Crowds

One thing I have not allowed myself to do since my accident is to get into large crowds. I have been to the movies and to the opera but not to sporting events or street fairs. Last weekend I was offered a pair of tickets to a Husky (UW) football game. Clearly it was time to deal with crowds,
The first issue is parking. Being handicapped allows you to get a good choice of parking but no parking is really close to the stadium. The closest lot is a couple of blocks away. We decided to arrive early and to park by the hospital which has tons of handicapped parking and a lot we have used in the past where the rout was well known. While expensive parking was not a real challenge. The crowds were serious but not terrible and it proved easy to move with the crowd into the stadium. The field is below street level with the main walkway about two fifths up the stands. Handicapped seating was on a wide platform at the main level with wheelchair spaces and folding chairs for companions. About 2/3 of the handicapped spaces were filled with folks in wheelchairs. We were originally seated at the end of the field but once the stadium filled were allowed to move to about the 30 yard line.
It was a great game - the teams were evenly matched, the lead changed hands several times and at no time was the difference between the score more than ten points. In the three minutes Cal got the ball. They were 8 points behind and thus needed a touchdown and a two point conversion to tie the game . With under a minute to go they got to the five yard line first and goal. For four plays the Huskies managed to hold and ended up winning the game in the last seconds.
Getting out of the stadium proved to be a much greater challenge than getting in. Even after waiting for over 20 minutes before trying to exit, there were huge crowds. We struggle to move  into a lane where we had a curb cut to get onto and then out of the street. The biggest barrier was a sidewalk on the way to the hospital jammed with people waiting to board buses. I rolled half on the sidewalk, half over the flowers in the garden, all the time asking folks to get out of the way. One time I accidentally rolled over a man's foot. At one time we took a path through the garden believing it would lead to the hospital without forcing us to go up stairs. I could see that there were no stairs heading up. What I did not see until we got to the top was the stairs heading down that everyone else took, The door to the hospital was locked and we ended up heading back to the crowds on the sidewalk.  Eventually we got to the hospital and our car and decided that we can handle crowds.

Walking with Braces

For the past four sessions I have been working with my orthotist and my physical therapist to get the braces to work properly. For the first time today the orthotist did not show up. I was allowed to put the braces on by myself, a difficult but doable operation. One serious issue is that once I am in the braces, the wheelchair I use is slightly too narrow to allow my legs to sit comfortably. Fitting the leg and hip components together required some delicate timing and positioning since once the legs are tight it is difficult to fit the bars into the hips. Eventually we had the whole package together.
Standing required me to straighten my leg, lock the knees leaving my legs sticking straight out, move a lock on the hips to the locked position, place my feet firmly on the ground, raise myself to a standing position and finally lean back to lock the hips. We immediately discovered that the lock on the left hip refused to move into a locked position. What followed was a frantic search for a screwdriver to smooth the aluminum slide followed by a file for the same purpose. After about 30 minutes we were ready to give up when we found that a lot of force could move the slide far enough. (The brace goes back for further work).

 At last we were ready to go. In the previous session I had started to use a walker within the confines of the parallel bars. Now the therapist was ready to allow me to leave the parallel bars and (with a spotter) wander around the room. I was able to go back and forth a number of times. By the end of the session I was sweating  but did not feel I would be unable to get around the house - especially after I had more practice. I was in some danger of toppling over backwards and it is something I will need to work on. The other thing to watch is that once my leg is unweighted, it is easy to take took long a step and get off balance.
  It is still hard to tell what walking will mean to me. What is very clear it  that I will have to make a serious effort to use this capability and to hone it. There is no question that getting around with braces is going to be harder than getting around with a wheelchair but it is an effort I want and need to make,

Braces

After it was decided in May that I would be fitted for braces it has been an entire summer of waiting. I had a session with my physical therapist and my orthotist both of whom agreed that the best choice was a Reciprocating Gait Orthotic or RGO. The RGO provides support not only for the legs but also has a piece on the back with a large bar which causes one leg to move forward when the other is moving back. My orthotist has been working with me in physical therapy to fit the device to my body.

They spent the first session looking at the leg braces and, after I stood for a while deciding to shorten the legs. Today the legs fit better and we spent a lot of time standing trying to find a perfect balance point. A major issue is that I have some contractures from a year in the chair which make it difficult to fully straighten my knees and legs. I have started more aggressively trying to stretch but full flexibility will take a long time.
The braces lock at the knees and at the hips. The first thing discovered is that the locks at the knees tended to catch on my chair making it difficult to keep the knees locked when I am trying to get up. When I sat down the next issue emerged - namely that the hips refused to unlock. The orthotist, about my size, will try wearing the braces and debugging the issue.
After an afternoon of adjustment, my physical therapist decided that after two sessions I should try walking. I have seen videos of several people with spinal cord injuries walking with rgos. I was impressed with the difficulty people had walking. I was surprised at how large a step I could take - too large to maintain balance easily. After that I walked the length of the parallel bars about four times. Navigating the parallel bars is easy. What things feel like when I am onl in a walker or hand crutches is a harder question.

Me and Barry Bonds

   As I am building new muscle in many places, especially areas of my legs which have not worked in close to a year, my wife suggested that I consider testosterone supplements. It worked for Barry Bonds and Sammy Soso. She also pointed out an article in the New England Journal of Medicine showing that testosterone (in massive doses) combined with exercise was twice as effective as exercise (or testosterone ) alone. Armed with this information I went to my rehabilitation doctor who refereed me to a an endocrinologist , Dr Susan Ott, at the University of Washington. (The name sounds familiar and I believe she was in my high school class.) I called her clinic and was informed that she saw patients only one day per week and was booked up for almost a year. This did not sound very hopeful.
I next went to my primary care provider who works in a large clinic figuring he could either write the prescription himself or refer me to an endocrinologist who can do the deed. He measured my testosterone levels which fell in the low-normal range and  after a little prodding referred to one of the clinic's endocrinologists.
I walked in and explained that I wanted testosterone to allow me to build muscle and aid my recovery. His first response was "So you are asking me to prescribe performance enhancing drugs."
"Exactly"
He admitted that he had never done anything quite like this. I pulled up the article referenced above which I had just been reading on my smart phone. After commenting that the doses were pretty massive, he wrote a prescription for a standard dose of testosterone and arranged to see me in about a month. I had my first shot yesterday so it will be a while before I see what the effects azre.

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.

My Vertical Life

I have spent the past ten months sitting. The sitting involves sitting in a wheelchair or sometimes in other places but for all of that time I have either been in a lying or a sitting position. As discussion turns to braces and to the possibility that I might get around on my legs, the first question is what happens to me when I stand up. It turns out, for reasons which will be clear in a paragraph or two, that this can be a real issue.

It turns out that there is a device which allows a paralyzed person to remain and even to work in a standing position. This device is called a standing frame and is shown in the picture. Basically the device stabilizes your knees within some C shaped cushions and then pushes on your butt to raise you to a standing position. There is a work surface where your arms are enabling you to work while standing.

My physical therapist was interested in putting me in one of these devices to make sure that nothing bad happened when I stood up. This is not a trivial concern. The other patient that she put in this device, a twenty-one-year-old with a higher level of injury, saw his blood pressure drop down to 60/40. This blood pressure could be considered quite dangerous and in many people would cause them to pass out. It turns out that the patient did relatively well, perhaps because his blood pressure has been running low since the accident.

My blood pressure runs a lot higher. In fact my blood pressure tends to run too high and I take drugs to decrease. In addition, because the level of my injury is lower, a significantly smaller portion of my body is abnormal and therefore the expected effects on blood pressure are smaller. In fact, when I was put into the standing frame my blood pressure did not significantly change.

It turns out that using a standing frame can be a good thing for someone with a spinal cord injury. Merely placing weight on the bones will diminish calcium loss, a common problem spinal injury since the legs are not bearing weight. There are also supposed to be good effects on the bowel and other parts of the body although I find it difficult to explain exactly why these should be seen.

After trying it in physical therapy, I decided it was appropriate to get a standing frame and start using it on a regular basis. I bought one that has the ability to wheel it around using your hands giving you mobility in the standing position.

A Weekend on the Water

For a long time we have been wondering about my use of a canoe or a kayak. My arms are plenty strong but I am uncertain about the strength of my trunk and how much of that strength would be required to move a kayak. We have also been very concerned about the problem of how to get into the boat. I thought long and hard about the issue of kayak versus canoe. Kayaks are stable, put your body close to the water rather than on a seat. Kayaks offer the disadvantage of, for most designs, having a relatively small hole to get your legs into complicating the problem of getting into the boat. Normally you would sit on the seats of a canoe which would be extremely awkward. If you could sit on some cushions in the bottom of the canoe, the problem of getting into the boat would be considerably simpler.

This weekend we went camping with some friends at a house on the waterfront on Whidbey

Island. In addition to many other amenities, the house had a couple of kayaks. One was a conventional single person kayak with a relatively small hole. The other was a two-person kayak designed to be sat upon. This design so many of the issues of getting into the boat. with seven able-bodied people it was easy enough to roll the wheelchair down to the beach and have a few people left me into the kayak. After that with some more help the kayak was pulled into the water and launched. it was not an elegant solution and not necessarily one that would be easy to repeat but it worked.

Once in the water I discovered that paddling a kayak was very easy. In fact, I made the mistake of insisting that my wife stay in the back of the boat to enable her to steer if I had a hard time paddling. This was a mistake because Verna is not very good at steering boats, she almost never rode in the stern before my accident. and throughout our trip she continually complained about an inability to steer, forcing me to do much of the steering from the front.

One problem that we discovered with this sit up on kayak is that while the craft is self bailing it is also very wet. The good news is that all of the cold water tended to fall on my legs and specifically the parts of my legs that are not sensitive to cold (or anything else). The bad news is it meant that I was losing a lot of heat without necessarily feeling. The other good news is that it was a sunny day and for Seattle relatively warm. One thing that I learned is that hypothermia is a problem and that the self bailing sit on kayak is probably not the best solution.

Kayaking was extremely successful and I am now in the process of looking for more reproducible ways to get into a canoe or a kayak without having a lot of people to help.

The W Word

The W word is walk. Lying in a hospital bed looking at my useless, motionless and senseless legs I wondered whether it was possible to even contemplate the idea that I might walk in some way shape or form. I was told that most of the change in the status of a spinal cord injury happened in the first three months. In the first three months there were few changes in the status of my legs. At the end of that time I basically had decided that I would never regain any functionality in my legs and that I would never walk again.

Walk became the W word, the word that you dared not utter or even contemplate. There was a doctor on the ward whose gait was clearly abnormal. I asked him why and he told me that he too had a spinal cord injury, very severe, and had been confined to a wheelchair. Eventually he regained sufficient function to walk. It was not a normal walk and it may well have involved a great deal of effort and pain. He asked me whether it was a good idea to tell the patients that he had similar injuries. I considered the question carefully and I never gave him an answer. I knew that most of the people on that ward would never recover significant function. The odds were against them and also against me. Is it a good idea to hold out the possibility of recovery knowing how long the odds are. I never gave him an answer and to this day I cannot say what a good answer is.

For a long time walk remained a word that I did not consider. Three or four months ago, as I have outlined in other entries, I began to regained some function. My legs are still very weak and most of the movement that I have is really not muscles in the leg but in the abdomen. I have no feeling and no movement below the level of the knee. However my therapist believes that there is sufficient movement to try to teach me, using a large number of braces, crutches and other aides to be able to walk on my own.

She said that she has over a period of ten years taught seven people with similar injuries to mine how to walk under these conditions. Only one is still walking. The others all decided that walking with my level of injury is a huge amount of work compared to the ease of getting around in a wheelchair. I know that there will be a lot of work, probably a lot of pain, and in the end getting around in a wheelchair will be easier in the short term and maybe the long term. This does not mean that I will not give walking all that I have.

Next week I will be measured for braces. Tomorrow I will go into a group called Pushing Boundaries to start an exercise program. I will say more about Pushing Boundaries in a later post. I have no idea what the therapy and training with braces will involve. I do not even know how long it will take to build the braces and when I can start. The only thing I do know is that walk is now a word that I'm willing to utter and willing to attempt.

A Bicycle for Brother Steven - Plan B (4 of ?)

The first model of the bicycle that I built works very well in the sense that I was able to pedal the machine using only the power of my legs. One significant problem with the first design is that the issues were bolted directly to the pedals. Aside from the fact that in the early designs issues tended to slip, the major issue is that it required me to get my feet into the shoes while they were bolted to a set of pedals which could move. Another issue is that the pedals are relatively far down and difficult to reach.

I decided that a proper solution would be to first put on a pair of shoes and that somehow attach the shoes to the pedals. My first thought was that by cycles had clip on shoes that would clip on a special set of pedals. I went to a bicycle store and asked to see these clip ons. What I soon discovered is that it took a huge amount of force to get the shoe onto the pedal. It was very clear that it would take an even greater amount of force to get the shoe off. As I sat in the bicycle store waiting for someone to help me with shoes I was suddenly struck with the fact that I was looking at the wrong solution to my problem. The forces that I can generate with my legs are very weak. Bicyclists are interested in a strong attachment for a strong leg that will keep the leg attached firmly even when strong forces are applied. It suddenly occurred to me that the correct solution was a weak attachment which was easy to make and easy to break.

Two solutions came immediately to mind: Velcro and magnets. Both solutions are way cheaper that whatever I could get at the bicycle store. I laid my hands on some industrial Velcro and a couple of large magnets. For either solution I needed a flat plate on the bottom of the shoe. I grabbed a tube of Shoe Goo and glued a metal plate on the sole of a new pair of shoes. Again the shoes were chosen to Velcro closed making it easy to get them on and off of my feet.

I took the pedals that came with the child's bicycle crank and bolted a fairly thick metal plate to the top with other plates making up the bottom. The idea was that if Velcro work properly it would simply be necessary to glue Velcro onto the plate and attached the shoes in that manner. If Velcro proved unsatisfactory, the plate would provide an excellent service with a magnet to stick to.

It turns out that the Velcro is a good strength for holding my feet onto the pedals. The only real problem is that it is still difficult to place my feet properly on a bicycle where the pedals can move – especially when the device that I have built to keep my leg from flopping to the side tends to cause the pedal to flip over. The next picture shows my current solution with the pedals being held up right and somewhat stationary using a couple of bungee cords. With this arrangement I can with some difficulty get on and off the bicycle without requesting any able-bodied help.

The Floor

Since my accident I have only been on the floor four times and each of those involved a spill caused by a bad transfer. In other words, every time I have been on the floor it was an unindented accident and my only real wish was to get back into my chair as quickly as possible.

For a long time I have thought that it might be nice to be able to get onto the floor and back into the chair - especially when there is work that is best accomplished from the floor.

The first problem in this is getting around once you are on the floor. It did not take me long to decide that a mechanics creeper was the best solution to this problem. After that there was the issue of how to get to the floor and to return the chair. In my exercise class one of the things that I did was to lift weights with a grip similar to that used in a pull up. I had no problem lifting 40 pounds but when I attempted to lift fifty I found that I was pulled up out of my chair because my body weight less than the weight that I was trying to lift. This suggested to me that I could use the same maneuver, a pull up, to get up out of the chair and to return to the chair from the floor . I would, of course, require some help positioning the chair after I did the pull up.

because we already had a Hoyer lift, it was an easy matter to fashion a pull up bar from a piece of pipe, some insulating foam for padding, and a couple of carbiners. The picture shows me on the mechanics creeper immediately after I have done a pull up to get off of my chair and then lowered myself onto the creeper. While I was doing this, my wife remove the chair and pushed the creeper in its place.

Having done this once I came to the conclusion that the Hoyer lift was a bad plan for getting out of the chair. Even though the wheels on the Hoyer will lock, the device tends to slip when you do a pull up. My conclusion is that the next generation will involve a bar are in a doorway which will be unable to slip. The other conclusion is that we did not have to change the height of the bar at any point during the process of getting onto the floor or back into the chair. This suggests that a single fixed bar, or rather a single fixed set of holders for a bar which can be removed, is all that is needed to facilitate smoothly getting onto and off of the floor. While the mechanics creeper is not as nice as the wheelchair for getting around, it is unlikely that most jobs will involve more than moving to the job, performing the work and moving back to the chair.

Inaccessible

The place where I work has a conference room which is used for seminars and conferences. The room has a set of three wide steps at the back, the usual way to get in , and a hall with a ramp providing access to the main floor. It is very common to have coffee and pastries or for longer meetings, breakfast and lunches. The food is placed on a table approximately as wide as the upper step (reachable from another room at the back). This means the only way to get at the contents of the table is to go down to the second step, a place reachable neither from the back of the room nor the bottom. One picture is worth a thousand words here.

I complained to management and they say the situation will soon be corrected

A Bicycle for Brother Steven (3 of ?)

Success -

Until a few weeks ago I was unable to use the bicycle effectively. While I was able to move the flywheel, I lacked the strength to go over the top and make a complete cycle. After major efforts finding the right position of the bicycle, the right position of my legs (slouching to bring in more abdominal muscles) and the right way to start, a few pushes on the left, weaker, leg I finally got the bicycle to move under my own power.

The advantage of a bicycle over the earlier motor driven device is that I know that the effort comes from me whereas with any kind of a motor it is very hard to separate what your legs are doing from what is contributed by the motor.

Also, unlike the pool which has limited hours and represents a major expedition, cycling may be started at any time with limited effort and may be performed while watching television, thus combining entertainment and exercise.

Skipper Bob

I went sailing today for the first time since my injury. There is an organization in Seattle, footloose sailing Association which was founded to take people with handicaps sailing. They have about a half dozen boats on one of the marinas on lake Washington. Every other Saturday during the summer they take people with disabilities sailing. I have not been in a sailboat or any other kind of small craft since my injury and I was very concerned about how I would get into the boat and what would happen once I got.

We went down there and were met by a nice group of people and assigned to a boat captained by a man named Bob. Bob is one of the founding members of the organization and has been in a wheelchair for twenty-six years. He was injured diving into the Yakima River and, since his friends did not notice that he was injured and in trouble after the dive, he is very lucky to be alive. It just happened that a fisherman downstream saw him struggling and pulled him out of the river with a broken neck.

Bob has a low cervical injury and what that means is that he has some, but not complete use of his arms. Of course, he has no use of his legs. In practice this means that he can grip things with several fingers but does not have complete use of his hands. His arms themselves are relatively strong.

Bob is the captain of the boat. The boat is a standard sailboat with almost no special provisions for handicapped people. There is an interesting arrangement on the mainsail, one that I had not seen before, where the sail is zipped into a linear bag against the mast that is constructed by building a zipper into the cloth of the sale itself. As the halyard is raised the sale unzips itself and becomes a standard mainsail. As the halyard is lowered, there is a small bag moves down the zipper stopping the sale in and zipping the bags closed. The jib has a standard arrangement where it is stowed I by rolling around the fore stay. As a result of these two arrangements there is a lot less work in raising and lowering the sails and no work is required to stow them.

Getting onto the boat is a challenge. The boats rail is at least 10 inches lower than the height of my chair, a considerable distance. Bob is of course used to making the transfer from his chair but I am not. I request that a few pillows be placed on the rail raising its height and adding padding against any mistakes I might make. It turns out that getting down is fairly easy but I will later require help to get back up into my chair. I never did see how Bob manages to accomplish this task.

We had seven people in the boat, to able-bodied assistants from the club, skipper Bob, a woman and her very severely disabled daughter. I believe that the daughter must have had a developmental disability because she never spoke on the entire trip. We fired up the motor and motored into the lake. Once outside the breakwater we turned into the wind and raised the sails. I have located myself on one side of the stern with skipper Bob on the other. after we were underway I took over sailing and sailed the boat most of the way across the lake. I had little trouble handling the boat except that the tiller was loose and fairly heavy and required me to lean too far forward in order to effectively run it so after a while I gave that task to Verna who was sitting further forward and had better leverage on the tiller.

On the way back Bob ran the boat for a while. When he adjusted the lines, for example pulling in the jib, he would fall in the line and then hold it in his teeth well he reached out to pull in some more. He was very efficient at this process and had no problems controlling the line.

Bob has been sailing this boat for over twenty years. He can get around the boat easily, I am not quite certain how he manages it. Which is arm weakness I would certainly have a great deal of difficulty getting around. He is able to get down to the cabin and sleep there, a task that I certainly could not accomplish.

Back at the dock I was faced with the problem of crossing from one side of the cockpit to the other. After considering several options, I ended up reaching up and pulling myself up on the boom and then swinging across. On the way out I was able to get onto a pillow on the rail but after contemplating the distance I would have to rise to get into the wheelchair I ended up asking for assistance from a couple of able-bodied men who were able to easily raise me onto my chair.

We will return to footloose sailing hopefully on a sunnier day.

Carrying Things

One thing you rapidly discover is how difficult it is to carry things in a wheelchair. Both hands are required to push the chair. Attempting to push with one hand moves the chair in a circle and pushing with something in your hand is virtually impossible. Most things you wish to carry eventually get places in your lap. This is a barely adequate solution. Frequently, things will fall off and in the worst case break.

I have come up with a number of solutions. On the back of my chair I carry a back back strapped to the arms. While this is not very convenient to get at, it is a good place to put things which will be carried for hours, days or weeks.

Under the seat I have another pouch, perhaps more difficult to get at but fairly large and well protected. I use this for carrying things I want to be with me for a long time as well as things I need to carry during long, uneven rolls when the odds of falling off my lap are high.

One useful thing that I made is a simple tray bolted between two pieces of plastic pipe that fit well over the arms of the chair. This gives me significant space to carry fairly large items in a space significantly larger, flatter and more stable that a lap. I can, for example, clear a table dishes by stacking then on the tray.

A Bicycle for Brother Steven–Part 2(of ?)

well I will describe the attempt to convert a standard exercise bike into something that can be used by someone with a spinal cord injury. Today I will discover some of the things that I discovered in this attempt and how I attempted to solve these problems.

In the last post I described how I built a system to keep my feet on the bicycle and keep my legs from flopping to the side. with that system in place I rapidly discovered a large number of other problems. The first problem was that my legs could not really handle the distance they had to move to push the pedals. After considering a number of solutions, I talked to a friend of mine who happens to be a pretty good amateur bicycle mechanic. We decided, and is later proved to be the case that the bearings for all bicycles are the same size. This meant that we could choose pedals from a different bicycle and put them on this machine expecting them to fit. We went down to the local goodwill and for a couple of dollars picked up a child's bicycle. As we expected, the pedals fit perfectly and significantly shorten the distance that my legs needed to travel in order to push them.

The next problem that we discovered was that the device was smart enough to have a ratchet allowing the pedals to slip whenever they were moving in the wrong direction. The problem with this is that we were hoping to use the momentum of the flywheel could carry the pedals along those portions of the cycle where I was too weak to push. If the pedals were allowed to slip backwards, this would not work properly. My friend pointed out that the device that was slipping also came in a nonslip version and volunteered to come back in a couple of days with a suitable, non-slipping gear.

Once these two modifications were in place, I discovered the next problem in my theory that I would be able to push a bicycle which could be pushed with the pinky finger. The problem is that legs have a significant amount of weight and as a cycle is pedaled, this weight moves up and down. In theory, the weight of the leg moving up in the weight of the leg moving down will balance each other. Reality is not right so simple and in various portions of the cycle significant weight will have to be lifted.

once the device was assembled and tested, I discovered that it tended to move to a neutral position where the pedals were horizontal and one leg was forward and one back. with the strength that I have I was able to rock the pedals back and forth but not move over the top to the other neutral position. Rocking the pedals back and forth took significant effort and the exercise involved could be considered a victory although it is not like the same thing as being able to move the bicycle. I have been considering a number of schemes to balance the weight of the legs and decrease the effort in moving the cycle to something that I can manage it this time but I have not come up with a plan which works to my satisfaction.

A Bicycle for Brother Steven–Part I (of ?)

In the last post I described in devices for performing exercise using electrical stimulation. I also described reasons why such devices might not be the right choice if you were capable of performing exercise with you muscles without external aid. I considered the idea of a bicycle with little or no resistance. Most exercise bikes have a fair amount of resistance built into the basic design. While I was shopping at Costco I ran across a bicycle where the pedals drove a large metal flywheel. What was interesting about the design was that if the resistance on the wheel were removed, the device would be very easy to pedal. Looking at that stationary bicycle got me to wondering whether it was possible to put together a bicycle that I could pedal.

There are a large number of problems in this design. First, my legs are extremely weak and can generate relatively small forces. Second, I have very little control over the placement of my feet and without significant effort they will simply slip off the pedals. Third, my feet tend to flop to the side and some kind of mechanical device must be used to keep them center over the pedals.

As we tested various stationary bicycles I developed what I call the pinky test. The rule is simple if you cannot push the pedals with your pinky finger then there is too much resistance for me to use the bicycle. Most bicycles that we tested failed the pinky test. The design that seem to work the best was the one that I saw at Costco, the pedals driving a flywheel with any resistance placed on the outside of the wheel. These devices are fairly expensive, around three hundred dollars which is a lot to spend on something that you have no idea whether or not is going to work. One day someone posted an ad on craigslist for a bicycle of this design with a much smaller flywheel than most of the devices we have been looking at. They wanted twenty dollars for it and I bought it immediately.

Now that I had a bicycle, see the picture above, I had to solve all of the other problems listed above and any new problems that I would find. There were plenty of problems to find and I will describe them later.

The first problem was how to attach my feet to the pedals. We decided that the easiest way to do this was to buy a shoe and a bolt the shoe to the pedals. If you would keep my feet solidly in place and as long as it was easy to get in and fasten, we chose one that fastened with Velcro, it would keep the feet in place and not make getting on and off too difficult.

The next problem was how to keep my legs from flopping to the side. Copying a design I saw on an FES machine we attached a bar to the pedal that came up to a curved piece of plastic having a band that wrapped around my leg. Designing such a system to be rigid but not too rigid and strong enough to hold the leg in place was a major challenge and after several designs I am still not sure that what I have is working properly.

Swimming III

I discovered relatively recently that I could swim and get assistance from my legs when I was stroking on my back. This worked well except that most of the work was being done by my arms. My legs were assisting with a fairly reflex action as the entire body contracted stimulated by a strong action of my arms.

My physical therapist recommended that I try the side stroke. The idea was to get my legs to go back behind my spine which is a necessary movement as I contemplate the idea of walking. In the pool I found out that I was completely unable to do the side stroke. First, I could not remember quite what my arms were supposed to do. Usually most of the work in the side stroke is done by the legs and the arms actually follow. In my current state, while I can move my legs, I do not have a lot of control. It is extremely difficult to have a movement which starts in the legs and carries the arms along.

I began to try something simpler. I attempted a flutter kick. In the flutter kick the legs move in opposite directions. For me, this is an extremely difficult thing to do. It took a lot of practice to move my legs in opposite directions. As you will see in the video below, I am twisting my hips a lot in order to assist my legs in moving.

Up until now whenever I swim, my legs are following the movements of my arms and most of the work is done my my arms. I have begun attempting to swim with my legs only and my arms doing relatively little work. It is actually easier to swim using the flutter kick in this matter. When my legs are coordinated using a front kick they really want the action of the arms to start the entire movement.

My swimming using the flutter kick is extremely slow but eventually I am able to get from one end of the pool to the other using my legs with my hands doing fairly little at my side. The video below illustrates swimming with the flutter kick. Clearly there is a long way to go but it is the first time since my accident that I have been able to move a significant distance using only the power of my legs.

Swimming II

While Wayne and his wife went on a vacation in Thailand, I considered the issue of swimming again. I rapidly discovered that almost all of the public pools in the Seattle area had made provision for people in wheelchairs. A trip to the Bellevue aquatic center led to the discovery that not only do they have wheelchairs and hydraulic chairs for lowering people into the pool but in their warm pool they even have a ramp that allows a wheelchair to simply be rolled into the pool.

One major issue was that when I went swimming with Wayne I was capable of changing in the men's locker room with Wayne to assist me. If I went swimming with my wife that possibility would not be available to me. Fortunately, the Bellevue aquatic center has considered this issue and has family changing rooms which are private and allow a disabled person and their assistant to change in a small room which even has a private shower. Another accommodation that Bellevue makes is that the the assistant of a handicapped person does not have to pay for use of the pool.

With this knowledge I tried swimming at the Bellevue aquatic center with my wife. By now it had been at least a month and a half since I had been swimming and I had significant improvement in the function of my legs. I was surprised to find that when I swam on my back my legs would naturally kick with the same rhythm as my arms. By concentrating on the movement of my legs I was able to get a significant kick from my legs to assist the movement of my arms. After we discovered that my legs were helping me to swim we gave the legs some assistance by putting on fins, forcing them to do more work but allowing them to help more.

The video below shows me swimming while using a frog kick.

Swimming Part I

My friend, Wayne was until he recently retired,a special education teacher in the Seattle school district. One of the things he did was to take his students swimming. He went to the West Seattle YMCA which had facilities for dealing with people with disabilities. One of his students was in a wheelchair. I believe, but I am not sure, that he might have had spina bifida or some other view birth defect. When he heard of my injury, Wayne offered to take me swimming.

Swimming presents some interesting difficulties. My wheelchair cannot really get wet. I was uncertain how to get in and out of the pool. I was also uncertain that I would be able to swim once I got into the pool. It turns out that the YMCA, and later I would discover most other pools in the region, have answers to most of these problems. They have loaner wheelchairs, much cheaper and less sophisticated than mine, which may be taken into the showers. They have a hydraulic lift, water is a good hydraulic fluid, which is a chair which may be raised or lowered into the pool. They offer a number of flotation devices to guarantee that once in the water you won't sink.

There is also an issue about getting dressed. Is very difficult to take your pants on and off when you are sitting in a wheelchair. Normally when I am getting dressed I lie in bed and as I raise my pants I roll back and forth. This takes the weight or the one side allowing me to pull the pants up or, when getting undressed, push the pants down. In a wheelchair, I can raise my body by pushing up with both arms. However, when I'm using both arms to raise I have no arms to do with my pants. So when I am getting dressed for swimming I need the assistance of an able-bodied person to deal with my pants while I am raising my body to take my weight off of them. Fortunately, Wayne was used to playing this role.

We got a loaner chair, I rolled into the shower and washed off and then rolled to the pool and transferred to the chair. I was then lowered into the water and put on floats around my waist and both feet. I rapidly discovered that I was unable to swim on my stomach because it was difficult to raise my head and breathe. However, swimming on my back presented no difficulties. I was able to easily swim laps using my arms in a coordinated stroke and allowing my legs to float behind.

Swimming laps was easily the hardest exercise I was capable of doing since my accident. Wayne and I swum a number of laps. Everything went well until it was time for me to leave the pool. I easily got into the chair and was raised out of the pool. From there I needed to transfer back into the loaner wheelchair. Getting into the chair had been very easy and I assumed that getting out would be the same. Unfortunately, I did not count on the fact that the chair was still extremely wet from being in the pool. When I gave a vigorous push with my arm to propel myself into the loaner chair, my arms slipped and I found myself in a crumpled heap on the floor.

Fortunately, Wayne and a lifeguard were standing right next to me. I had never instructed people in the use of the fireman's carry which is the way I was taught to be picked up off of the floor but there is a first time for everything. With two strong men helping me getting back into the chair was a very simple process.

I went swimming with Wayne several more times in West Seattle. The only real problem was that West Seattle is a long ways from my house and most of the time was spent getting to and from the pool. I began to think about other pools which might work equally well.

More Movement

it was several weeks since I discovered the ability to move my left leg toward the center. For that period it seemed that the one muscle on the left leg was the only one in which I had any movement. Suddenly I found a number is muscles had movements which started off as almost imaginary and gradually gained reality at least under the zero gravity conditions of the hot tub.
   I discovered the ability to  move my right leg both in (toward the center) and out. I discovered that the left leg had some ability to move out as well as in.  By holding my knees in a manner where the leg could swing freely, I found I could swing my feet out and, more recently I discovered the ability to swing the feet in as well. 

So far almost all of this movement is in the zero gravity environment of the hot tub or a pool. The movements have little power and, with a few exceptions such as the inward movement of the left leg, little ability to work in a full gravity environment. Still each day, all of the movements get a little stronger and more effective. It is way too early to tell where all of this will lead.

I know that I am very, very lucky. Few people with spinal cord injury have significant recovery of function. I am working hard ot see what I can do with this opportunity.

Movement

I was sitting in the hot time in February when I noticed something very interesting. I imagine that it was possible to move my left leg just a little bit to the left. The movement might have been a millimeter, certainly no more, and was only possible in the zero gravity environment provided by the hot tub. However, when you have a spinal cord injury and have had no movement in your legs since the accident any movement is a very big deal.

For some time since the accident I had been gaining feeling in my left thigh. Most of the feelings were feelings of pain but feeling is feeling and might be a sign of something going on. I have since regained some feeling in my right thigh as well, less painful than that of the last but still painful.

Movement is something else and indicates the possibility that my legs might become something more than useless appendages. Over the next several weeks the movement in my left leg grew from a millimeter or so to several inches. As the muscle became stronger I was even able to move the leg outside of the hot tub as long as there was no weight on the parts being  moved.

What would Jake Sully Drive

At one point during the discussion of my therapy my doctors raise the issue of driving a car with hand controls. I would, of course, need to use a car with hand controls because my feet are no longer functional. Their jaws dropped when that when I said that I had already driven a car with hand controls and thus knew what was involved.

The story goes back to six months before my accident when I tore my Achilles tendon playing racquetball. I felt as if somebody had hit me in the back of my leg. It would later turn out that this is the most common description of somebody who has had their Achilles tendon rupture. It took about a week including several calls to my doctor my wife and another nurse practitioner before finally my wife correctly diagnosed the problem as a torn Achilles tendon. None of the providers seem to believe that I was able to hobble around while my Achilles tendon was completely broken.

I walked into the office of the orthopedic surgeon and announced that I probably had a torn Achilles tendon. I told my story. His response was to turn to the resident and say "this is exactly what the presentation of  torn Achilles tendon is like."

After the surgery I was in a cast and on crutches for a couple months. Because the surgery was on my right foot I was unable to drive during this period. This was a large handicap but I could count on the services of my wife to get me where I needed to go. Unfortunately, several weeks after I was put in the cast Verna was offered a job in Richland on the other side of the Cascades. My initial response was "no you can't go, you're my transportation".

Then I got to thinking… "Suppose I was paraplegic. Suppose I flew into a new city. I would, of course, want to rent a car and someone would be able to rent something that I could drive. My line was "What would Jake Sully drive?

Jake Sully is the protagonist in the movie Avatar and is a paraplegic.

So I called up Enterprise Rent a Car and asked whether it was possible to rent a car with hand controls.Their response was "When you need it?". Several days later I showed up and they gave me keys to a car with and controls. I had, of course,no idea or rather very little idea of how to drive a car with an controls, I drove VERY CAREFULLY around the parking lot about four times before I felt confident enough to VERY SLOWLY get out on the street and drive home by the least used route.

So what are hand controls? Hand controls consist of a bar which is mechanically hookedto the brake and gas pedals of the car. Moving the bar down mechanically pushes the gas pedal. Moving the bar away from you, toward the front of the car causes the brake pedal to be pushed. The connection to the brake pedal is shown below.

 

So learning to drive with hand controls consists of doing with one hand no exactly what you would with 1 footIt takes a little practice, but within a day or twoYou are not even thinking about what you were doing.

Freedom at last

Of all of the adaptations that I have made over the past six months, the one that has made the greatest difference in my life was obtaining a car with hand controls that I could drive and which gave me the ability to transport myself without assistance. After looking at a large number of cars, see a previous post, we ended up settling on the Nissan Cube.

We chose the cube for several reasons,first, it was less ugly than the Toyota Scion, the other car that we seriously considered. The seats are low enough to allow transfers to be made easily and yet the doors are high enough so that the wheelchair may be passed into the car. There is enough room in the back to allow the wheelchair could be stored while at the same time carrying four passengers.

In this pictureI have just used a board to transfer from my wheelchair to drivers seat. The next staff in using the car is to disassemble the wheelchair And play the place the pieces where they can readily be used to reassemble the chair when I get where I'm going.

This shows the removal of the seat cushion.

Here I am removing a wheel

Because the frame is too heavy for me to lift off the ground I clip a strap with a ratchet to the front allowing me to hoist the frame in several steps

H

Finally placing it in the passenger seat

and driving off