In previous posts I have stated how many problems I have been having with my braces. one of the suggestions I read was to take the braces to a local expert and asked for advice. I did call the company and after a few conversations they proposed that I come over at a time when they had a national expert on RGO braces to look at the situation and make suggestions.
Two weeks ago I did that. I brought the braces over and their expert, who is well known to my orthotist and has lectured in her classes, took a good look. After a couple of hours of having him look and having me walk back and forth in the parallel bars, he came up with a long list of changes he wanted in the braces. he felt that the hips were too loose, that the feet were at the wrong angle, that some of the attachments were of an incorrect length, that some of the attachments were put on correctly which might account for some mechanical weakness that we had been having and that I should be able to balance in the braces without using crutches as long as I am not moving. This is something that I clearly cannot do at the present time.
There was also a long discussion about alternate knees. There are two options: a purely mechanical system and an electromechanical system. The purely mechanical system uses a rod to lock the knee whenever the foot is resting on the ground and to release it when the foot is raised. The electromechanical system uses a sensor and what sounds like a motor but might actually be a brake to accomplish much the same thing. I plan to come back and try one or both of these systems if it is at all possible. Problems with the knees being locked at all times are a major subset of the difficulties that I have with my current braces and I am eager to explore alternatives although I am not sure quite what they will mean in terms of my gait or anything else that I might do.
I have sent the braces back to the manufacturer to have some of the changes made and plan to hire the local company to make other changes as much as possible. This means that I will spend several weeks to a month without the braces and plan to find other ways to exercise. I am hoping that what I get eventually will significantly improve my ability to walk.
Saturday, March 17, 2012
Locked in the Van
a very curious thing happened to me a couple of weeks ago. I had coffee with a friend who has a high cervical injury and is in a motorized chair. Recently she acquired a van which allowed her to driver herself. We agreed to meet for coffee. When she got there she discovered that she was locked into the van with no way to get out.
Let me start by explaining how people spinal cord injuries drive. There are three options for ways to drive depending on the level of injury and the amount of work you are willing to do. for people with low levels of injury and good arm function, one option is to use a fairly ordinary car and after transferring from the wheelchair to the car disassemble the wheelchair and place it in the passenger seat. This is the option that I choose. When there is an able-bodied passenger the wheelchair may simply be placed in the back especially if the car is chosen with a large enough back to easily do this.
A second option is to choose a van with a ramp or a wheelchair lift. The ramp or lift requires a much larger parking space than is required for a car or even for the first option. If the person can easily transfer from the wheelchair into a seat it is possible to set up the van so that he can roll in up the ramp, part the wheelchair next to the driver seat and transfer from the chair into the seat. He can then drive the van from the drivers seat using hand controls similar to the first option.
For people who have difficulty transferring because of arm weakness and this will include most people were using motorized wheelchairs a third option is to drive from the wheelchair itself. In almost all cases this involves a motorized chair. There is no chair in the driver seat and once the chair is rolled up the ramp it is rolled into a special clamp in the driver seat and locked in place. The car may then be driven using hand controls with the person sitting in the wheelchair. When the person wants to leave the van he pushes a button unlocks the lock holding the wheelchair in place and allows him to roll backwards out of the clamp and then out of the van.
Now we go back to our story. The clamp is electromechanical and the release mechanism might fail. This is exactly what happened to my friend. The release mechanism failed to work and she was stuck with no way to get out of her car. I saw her drive up and rolled up into the van so that I could watch her get out and thus pretty much saw the whole thing. The idea of being stuck in your car with no way to get out is, as you can imagine, very unpleasant. Eventually she was able to call the company that had installed the mechanism. Luckily, someone answered and was able to give her help. He explained that if the mechanism failed there was a lever that you could pull to release the chair. Unfortunately the lever is very deeply under a large electrical wheelchair. It is impossible to imagine someone with limited arm function being able to reach that far and engage the lever. Fortunately, I was there and was able to take the call. I drove my chair out of the van and around to the driver's side. My friend never opens the driver side door. She gets in to the ramp that comes out the side of the van. She had to move the car to create enough room for me to come around to the driver side and feel around for the box locking the chair. Eventually by feel rather than sight I was able to find lever and pull it unlocking the chair.
I found the entire incident very disturbing. Even knowing how to release the chair there is no way that my friend could have done so without external help. We considered several arrangement the most promising of which is to tie the release lever to the driver side door so that opening the door would release the wheelchair. The mechanics of this arrangement are not simple because the chair would have to drive over whatever attachment was made. I am very concerned about the idea that someone could be locked in their car with no way to release themselves.
I discussed this with a friend of mine at pushing boundaries who told me a story about a man who drove into a similar van which was parked in his garage with the ramp already down. After he had driven in causing his wheelchair to lock in the car, he discovered that the battery was dead and the car would not start and, of course, the unlocking mechanism would not work. Fortunately, he was able to use his cell phone to call AAA and they were able to get into the garage and recharge the battery. If he had been unable to use his phone or summon help in other ways he might well have died of hypothermia before he was able to get out.
Let me start by explaining how people spinal cord injuries drive. There are three options for ways to drive depending on the level of injury and the amount of work you are willing to do. for people with low levels of injury and good arm function, one option is to use a fairly ordinary car and after transferring from the wheelchair to the car disassemble the wheelchair and place it in the passenger seat. This is the option that I choose. When there is an able-bodied passenger the wheelchair may simply be placed in the back especially if the car is chosen with a large enough back to easily do this.
A second option is to choose a van with a ramp or a wheelchair lift. The ramp or lift requires a much larger parking space than is required for a car or even for the first option. If the person can easily transfer from the wheelchair into a seat it is possible to set up the van so that he can roll in up the ramp, part the wheelchair next to the driver seat and transfer from the chair into the seat. He can then drive the van from the drivers seat using hand controls similar to the first option.
For people who have difficulty transferring because of arm weakness and this will include most people were using motorized wheelchairs a third option is to drive from the wheelchair itself. In almost all cases this involves a motorized chair. There is no chair in the driver seat and once the chair is rolled up the ramp it is rolled into a special clamp in the driver seat and locked in place. The car may then be driven using hand controls with the person sitting in the wheelchair. When the person wants to leave the van he pushes a button unlocks the lock holding the wheelchair in place and allows him to roll backwards out of the clamp and then out of the van.
Now we go back to our story. The clamp is electromechanical and the release mechanism might fail. This is exactly what happened to my friend. The release mechanism failed to work and she was stuck with no way to get out of her car. I saw her drive up and rolled up into the van so that I could watch her get out and thus pretty much saw the whole thing. The idea of being stuck in your car with no way to get out is, as you can imagine, very unpleasant. Eventually she was able to call the company that had installed the mechanism. Luckily, someone answered and was able to give her help. He explained that if the mechanism failed there was a lever that you could pull to release the chair. Unfortunately the lever is very deeply under a large electrical wheelchair. It is impossible to imagine someone with limited arm function being able to reach that far and engage the lever. Fortunately, I was there and was able to take the call. I drove my chair out of the van and around to the driver's side. My friend never opens the driver side door. She gets in to the ramp that comes out the side of the van. She had to move the car to create enough room for me to come around to the driver side and feel around for the box locking the chair. Eventually by feel rather than sight I was able to find lever and pull it unlocking the chair.
I found the entire incident very disturbing. Even knowing how to release the chair there is no way that my friend could have done so without external help. We considered several arrangement the most promising of which is to tie the release lever to the driver side door so that opening the door would release the wheelchair. The mechanics of this arrangement are not simple because the chair would have to drive over whatever attachment was made. I am very concerned about the idea that someone could be locked in their car with no way to release themselves.
I discussed this with a friend of mine at pushing boundaries who told me a story about a man who drove into a similar van which was parked in his garage with the ramp already down. After he had driven in causing his wheelchair to lock in the car, he discovered that the battery was dead and the car would not start and, of course, the unlocking mechanism would not work. Fortunately, he was able to use his cell phone to call AAA and they were able to get into the garage and recharge the battery. If he had been unable to use his phone or summon help in other ways he might well have died of hypothermia before he was able to get out.
Tuesday, February 14, 2012
Walking at Work
After using braces in therapy for several months I finally summoned the courage to take them in to work. I wrote the manager of our physical plant and had him meet me in the garage and walk with me to my office. There are a number of possible barriers. First there is a door between the parking area and the elevators. The door opens on a card swipe and then is fairly heavy - requiring first a swipe from a walker - not really difficult but time consuming. Then you need to put away the wallet and open the door so it will not relock. Then the door needs to remain propped open until you can get it wide enough to get the walker through, then you have to move the walker through the door without being knocked over or jammed in the door. Getting out is another issue but I will deal with that later. Next there are the elevators. There are three elevators. Pushing the button is not difficult but after that you have no idea which door is going to open. Once a door opens you need to be able to get into the door before it closes. If you are moving slowly in a walker, this can be a big problem especially since once you are in front of the door you are too far from the button to push it again.
After getting help with the door and the elevator I arrived at my desk. I had them lower the office chair to allow enough space for the cushion I brought. Office chairs are not nearly soft enough for the easily damaged skin of people with spinal cord injuries. The next issue is that the chair can both rotate and move. This can be a bad thing if you need to back up to a chair and getting down is essentially a controlled fall. It turns out that a great solution is to place the chair tight in the corner on my cubicle where is is effectively constrained from moving back in two directions. Once the chair is braced it turns out the ability to rotate and roll is an advantage since I cannot move the chair with my legs but can easily pull it with my arms into a good position while occasionally raising my legs if they are dragging.
Later in the day when I had to use the bathroom I needed to get back in a wheelchair. The maneuvers in the bathroom are way too complex for braces. I had left a wheelchair in the garage and needed to get it. I then remembered that one of the elevators is configured for freight and has a separate button. That made the issue of the elevator simple. Push the button, move right next to the door and when it opens push enough of the walker inside to insure the door will not try to close. After that there is plenty of time to get in. Once the uncertainty about which door is to open is resolved, elevators are not an issue. It turns out that the building manager called an elevator maintenance person to slow down the door close time. I suspect he left the close time longer on the freight elevator but I no longer needed it.
So having solved the elevator problem I found myself in the basement on the wrong side of the door to the parking area. The way the door works to get out, there is a motion sensor which unlocks the door. Of course, the sensor is not timed for someone in a walker so by the time you get to the door even if it has sensed you, the door has been unlocked and then relocked. That is OK, if the sensor fails there is a button on the wall to open the door. Of course, the button is on the hinge side rather than the knob side. So if you push the button you need to walk completely to the other side of the door and try to open it before the mechanism times out. My real hope was that someone would show up and I could ask for help. After about five minutes I gave up and called the building supervisor to ask for help. Of course, there is no cell service in the basement so it was back to my desk. When I got back I simply asked for the chair to be brought up.
When I left I simply got in the chair and went down to the garage. After getting into my car I left the chair in the garage hoping it would not roll away from a position designed so I could drive up and use it.
They have promised me a button to open the door to the garage. That was, of course, a few months ago but the were also trying to get a button to the door to the street. In ,my chair the door to the street is a bigger issue since it is heavier and the place to swipe your card is much farther from the door. There is no way I am likely to go out on the street in my walker - everything is way too far to walk - so The street door is a lower priority. besides I have managed it in my wheelchair, usually on the second try, so it is possible they can accelerate a solution to the parking garage.
Well I feel like I should add to the Google bomb causing a Google search for Santorum to go to here.
After getting help with the door and the elevator I arrived at my desk. I had them lower the office chair to allow enough space for the cushion I brought. Office chairs are not nearly soft enough for the easily damaged skin of people with spinal cord injuries. The next issue is that the chair can both rotate and move. This can be a bad thing if you need to back up to a chair and getting down is essentially a controlled fall. It turns out that a great solution is to place the chair tight in the corner on my cubicle where is is effectively constrained from moving back in two directions. Once the chair is braced it turns out the ability to rotate and roll is an advantage since I cannot move the chair with my legs but can easily pull it with my arms into a good position while occasionally raising my legs if they are dragging.
Later in the day when I had to use the bathroom I needed to get back in a wheelchair. The maneuvers in the bathroom are way too complex for braces. I had left a wheelchair in the garage and needed to get it. I then remembered that one of the elevators is configured for freight and has a separate button. That made the issue of the elevator simple. Push the button, move right next to the door and when it opens push enough of the walker inside to insure the door will not try to close. After that there is plenty of time to get in. Once the uncertainty about which door is to open is resolved, elevators are not an issue. It turns out that the building manager called an elevator maintenance person to slow down the door close time. I suspect he left the close time longer on the freight elevator but I no longer needed it.
So having solved the elevator problem I found myself in the basement on the wrong side of the door to the parking area. The way the door works to get out, there is a motion sensor which unlocks the door. Of course, the sensor is not timed for someone in a walker so by the time you get to the door even if it has sensed you, the door has been unlocked and then relocked. That is OK, if the sensor fails there is a button on the wall to open the door. Of course, the button is on the hinge side rather than the knob side. So if you push the button you need to walk completely to the other side of the door and try to open it before the mechanism times out. My real hope was that someone would show up and I could ask for help. After about five minutes I gave up and called the building supervisor to ask for help. Of course, there is no cell service in the basement so it was back to my desk. When I got back I simply asked for the chair to be brought up.
When I left I simply got in the chair and went down to the garage. After getting into my car I left the chair in the garage hoping it would not roll away from a position designed so I could drive up and use it.
They have promised me a button to open the door to the garage. That was, of course, a few months ago but the were also trying to get a button to the door to the street. In ,my chair the door to the street is a bigger issue since it is heavier and the place to swipe your card is much farther from the door. There is no way I am likely to go out on the street in my walker - everything is way too far to walk - so The street door is a lower priority. besides I have managed it in my wheelchair, usually on the second try, so it is possible they can accelerate a solution to the parking garage.
Well I feel like I should add to the Google bomb causing a Google search for Santorum to go to here.
Saturday, February 11, 2012
Segways
Last weekend I took my first ride on a Segway. I have been wondering for some time whether a paraplegic in braced with little or no movement in the lower part of his body could ride a Segway and, more importantly, how he might arrange to easily get off and on. I answered one of those questions. If I can get up I can ride the device.
I found someone in town who rents Segways and is a genuine expert. Then I invited a fairly tall and string friend to help he get on and we went out to his place. I received a long lecture on Segways and how it was necessary to turn on before stepping onto the device and if you push or pull the wrong way the device will scoot off - not really good. We ended up blocking the device with 4 2x4s. Them two men picked me up and my feet immediately swung under the Segway. From then it was back to the drawing board.
The eventual solution involved a shop table which could be raised hydraulically and my pushing myself up rather than being lifted. Once on the device I was able to easily ride it - In the older models you make the unit go forward by leaning and turn by twisting a know in the left of a control bar. This makes the required control of leaning much less precise since you are only controlling a single direction. Newer models use lean for both go and turn.
The older models also have a single rigid shaft. This is really needed since i need a place to hold on and help balance. One issue is that the bar is apparently quite fragile and made of "unobtainium" . There are commercial approaches to reinforcing the bar although I suspect I am better off looking for a solution that meets my needs and maybe even takes some weight off the bar placing it in other sturdier places.
I am now looking for places to buy a Segway and good solutions to getting on it.
My friend posted a video here.
I found someone in town who rents Segways and is a genuine expert. Then I invited a fairly tall and string friend to help he get on and we went out to his place. I received a long lecture on Segways and how it was necessary to turn on before stepping onto the device and if you push or pull the wrong way the device will scoot off - not really good. We ended up blocking the device with 4 2x4s. Them two men picked me up and my feet immediately swung under the Segway. From then it was back to the drawing board.
The eventual solution involved a shop table which could be raised hydraulically and my pushing myself up rather than being lifted. Once on the device I was able to easily ride it - In the older models you make the unit go forward by leaning and turn by twisting a know in the left of a control bar. This makes the required control of leaning much less precise since you are only controlling a single direction. Newer models use lean for both go and turn.
The older models also have a single rigid shaft. This is really needed since i need a place to hold on and help balance. One issue is that the bar is apparently quite fragile and made of "unobtainium" . There are commercial approaches to reinforcing the bar although I suspect I am better off looking for a solution that meets my needs and maybe even takes some weight off the bar placing it in other sturdier places.
I am now looking for places to buy a Segway and good solutions to getting on it.
My friend posted a video here.
Wednesday, January 11, 2012
Stairs
a day or so ago I was at Pushing Boundaries practicing with my braces. I was talking with my trainer about stairs and whether it was possible to use stairs with the braces. He mentioned that they had some stairs and back that I could test. He has both 3 inch stairs and 6 inch stairs. 6 inches is basically this has standard height for a set of stairs. 3 inches is ridiculously low. However, 3 inches and is a height that I have handled in the past and might reasonably expect to handle. I decided to give them a try.
The stairs were narrow and handrails on both sides which gave you maximum advantage because you could push all of the very solid surface in order to get whatever leverage was needed by the arms. Once again, these conditions are fairly unrealistic because the stairs are narrower than anyone would ever reasonably make them . Is also the case that you use the rails I had to leave my crutches behind and, of course, the moment I got the top I would find that I need my right choose again.
Getting up was not terribly difficult as you can see. Getting down was another story entirely and barely worked. After thinking about this for a while I realized that what was happening was this: When going up you unweight one foot, swing it up to the higher stair and transfer weight to the higher foot. Then you raise the lower foot and move it up. All well and good and the fact that your weight is on a higher foot helps in raising the lower. Down is different. You unweight a foot and move it to the lower stair. When you put your weight on the lower foot, there is a significant force down on the upper foot. This force makes it difficult, near impossible to raise the higher trailing foot.
I need to review videos of how people in braces descend stairs. I recall a strange gait where both feet swing as a unit and what I felt may explain why.
The stairs were narrow and handrails on both sides which gave you maximum advantage because you could push all of the very solid surface in order to get whatever leverage was needed by the arms. Once again, these conditions are fairly unrealistic because the stairs are narrower than anyone would ever reasonably make them . Is also the case that you use the rails I had to leave my crutches behind and, of course, the moment I got the top I would find that I need my right choose again.
I need to review videos of how people in braces descend stairs. I recall a strange gait where both feet swing as a unit and what I felt may explain why.
Wednesday, December 28, 2011
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.
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.
Thursday, December 22, 2011
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.
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.
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