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.