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.