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.