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Posts Tagged ‘spinal cord injuries’

Five days after carpel tunnel surgery I have:

Walked along the waterfront using a gutter frame, twice

Transferred independently from the bed to to wheelchair and back

Transferred independently from the wheelchair to the gutter frame and back

Transferred from the chair to the floor for a bit of crawling

Stood up from the wheelchair to stand up at the bathroom vanity

Emptied the leg bag myself

Done standing exercise ….

Plus all the other things that anybody can do after carpel tunnel surgery:

Used a fork and spoon easily

Tied my shoelaces

Taken off my socks and shoes

Placed the Odstock electrodes after having retrieved them from their ziplock and zipped bag, then remove them and put them away

Squeezed and pinched my fingers and thumbs

Made a fist … And heaps of other things like cleaning my teeth, wiping my face, combing my hair, putting on moisturiser

Every day everything is stronger, but there are a few goals that will be a little way off, like being able to put my all weight down through my hands on to the crutch handles – that will likely be the final challenge!

Whew! So far, so much better than I had expected!

My surgeon didn’t refer me to a hand physiotherapist or give me exercise to do after the surgery so I found some good web sites to help me.

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OR: FINALLY, A MEDICAL EXPLANATION HOW THIS INCOMPLETE PARAPLAEGIC’S WALKING CONTINUES TO IMPROVE

I came across an article from the University of Washington that blew my mind. I am excited, delighted and vindicated.

Some highlights:

Spasm caused by spinal cord injury can prevent voluntary movement of weak muscles. Sounds pretty simple. Except it’s not. Spasm can be complex and the cause, other than the obvious one that it is caused by sci,can be difficult to identify. Pain that is not felt can cause spam, so pain killers can help reduce spasm. Stretching can help reduce spasm. Weight-bearing and walking can reduce spasm. Good postural alignment whether sitting or standing can replasma spasm.

I’ve already learnt this through experimention. I take a cocktail of prescription drugs from muscle relaxants, to pain killers, to anti-epileptics, to a neural enhancer. I exercise five days a week at the gym under the supervision of a personal trainer who creatively extends my range of movement and improves mobility through gentle exercises that target weak muscles, and finds ways of reconnecting neural pathways. I stretch at regular intervals during the day.

Here’s the eye-opener though.Spastic muscles not only inhibit weak voluntary opposing muscles, they also take up residence in synapses and axons and make them unavailable to voluntary muscles! So get rid of the spasm, and nerves can reconnect to voluntary muscles! That goes a long way to explaining rapid improvement in my walking over the last two years – since my spasm was finally under control.

It still doesn’t explain why muscles that had no movement, have gradually become enervated, suggesting that the central nervous system can repair itself!

So never, never, never give up!

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Spinal cord injuries (sci) are complex. No two injuries present in the same way. However, it can be helpful to compare symptoms and to try treatments that others have found useful. I believe that exercise and stretching are critical to successfully managing the nasty symptoms that I experience – pain and spasm. The older my injury (it’s been over eighteen years since I damaged my cord at T7/T8) the more fervent my belief in the power of exercise becomes.

And here’s why.

List of recommended Surgery:

Lengthen my Archilles tendon
Insert baclofen pump in my spine
Treat trigger thumb
Treat carpel tunnel syndrome

Actual treatment:
Instead of surgically lengthening my archilles tendon the surgeon injected botox into the gastroc and soleus muscles (muscles that make up the back of the calf). He did this four times over a year, providing a window during which time I could intensively stretch, exercise and stimulate these muscles, with the help of a physio, personal trainer and osteopath. These muscles had progressively shortened because of spasm and tone, and I could no longer put my heel on the ground – not good for the small amount of walking I can do and would quickly reduce my mobility. That was about two years ago and as long as I continue to stretch these muscles every day I’ll be fine. I also walk on a “stone board” every day to continue to stimulate the sensory nerves in my foot. Exercise 1, Surgery 0 (The surgery and after care in hospital would have cost ACC $70,000)

Instead of inserting a baclofen pump in my spine the same surgeon changed and added to my medication to manage spasm, and injected botox into my left quad, right hamstring, and both adductors. The injections in my hamstring and adductors were one offs, I have had three injections into my left quad and no more are planned. My spasticity is complex and extensive, but the botox and on-going medication allow me to stretch and exercise so that spastic muscles no longer pull my body out of alignment and mask and prevent any voluntary movement I have. I now walk using an Odstock rather than a dictus (a brace to lift my foot into a flexed positiuon). I walk for an hour on a treadmill every day, exercise at the gym to improve my posture and alignment, and frequently stretch shortened muscles every day. I religiously exercise and stretch every day. Exercise 2, Surgery 0

The surgeon in both these cases works in the Burwood spinal unit and I have found that people who work here take an holistic view to treatment and surgery is considered one of many tools. Not so other surgeons …

Instead of surgically lengthening the tendon in my thumb I independently embarked upon a programme of intense stretching and massaging my thumb. A physio later endorsed this. The trigger thumb was probably caused by my using crutches. Surgery would have meant that I would have lost my mobility for months, and that I would have needed help with personal care. This particular surgeon was adament that surgery was the only treatment if I wanted to straighten my thumb. Turns out he was wrong. (I subsequently spoke to two men whose surgery was unsuccessful and were having to have it repeated, one for the second time.) Exercise 3, Surgery -2

The same surgeon has recommended surgery for carpel tunnel in both my wrists. He says that without surgery the nerves to my hands and fingers will die. However, surgery will for months prevent me using crutches and I will require 24 hour care including someone doing all my personal care for me. Not if I can help it! An osteopath has given me exercises and stretches to help release constriction of nerves through the carpel tunnel; I have found web sites that show how to do other exercises; I have a dynaflex to exercise my wrists; the Odstock I use reduces the pressure I put through my wrists onto the crutches.

So, hopefully, Exercise 4, Surgery 0

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Warning: this post may be seen as lecturing …

Furniture, furnishings, possibly art or decorative pieces usually provide focal points in living rooms. Not so in our home! Sure we have couches and a coffee table, paintings on the walls, piano, side tables and nic nacs, but in our living room everything is pushed back to the walls to make space for me on the floor and to use the toys and tools that I use to help me stay mobile. House and Garden we are not!

Living On The Floor

In some ways the juxtaposition of piano and Swiss balls is quite charming, and the space cleared in the centre, an invitation to use it … I haven’t used the comfy couch for over a year. Instead, I use the floor to sit, lie, sprawl, wriggle, stretch and exercise as I read, watch TV or use the i-pad. (I’m spread out lying on my stomach as I write this on the i-pad. This position helps stretch my hip flexors and flexes my lumbar spine.)

LIVING ON THE FLOOR

If everyone used the floor instead of furniture, not only would they save lots of money not buying chairs and couches, but they’d be a lot healthier! Young people think that they’ll never get old and stiff and older people think they’ll never get stiff. Sitting on the floor stretches and strengthens muscle groups that don’t get used when you sit in/on a chair.  Everything you can do in a chair you can do on the floor – read a book, use your I pad, watch TV, or chat to someone – plus you get the benefits of sitting on the floor:

Stretching your adductors:

Sitting on the floor reading while stretching adductors

When you’re on the floor you can read or watch TV while you sit on your heels stretching your quads, then lean back and stretch your hip flexors. You can sit upright with your legs straight out in front of you to stretch your hamstrings. (I can only do this while holding onto some webbing or theraband):

Sitting upright with legs straight out, while watching TV

Not only does sitting on the floor improve flexibility, but sitting on a hard surface puts pressure on muscles that are in contact with the floor, causing them to eventually relax. This is similar to when massage therapists stimulate the golgi tendon organs through deep tissue massage, causing the muscles to relax. Living on the floor is comfortable and good for you!

There is no reason why you should be stiff when you’re old. YOU HAVE BEEN WARNED!

I began to stretch because if I don’t, tension, tone and spasm increases in my muscles – despite the diversity and quantity of muscle relaxants I consume. The more I stretch, the better I feel, and the better I walk. I have a low boredom threshold so I’ve nagged my physio and personal trainer for equipment and techniques that allow me to multitask while I stretch. No problem in either case – the physio is sympathetic to my needs, and the personal trainer is a proponent of living on the floor. In fact he introduced me to the concept.

I also need to recruit weak muscles and try and redress gross muscle imbalance. I can do some exercises in the gym in a social environment, but some exercises are repetitive and can be done at home. I could put all my equipment in a spare room, but it’s much nicer and more likely to happen if I can do the exercises in a shared living space, another benefit of living on the floor.

I can exercise on the floor while chatting to others

The whole family can play on the wii, but the balance board gives me fantastic feedback – I have no sensation or propriception so I’ve no idea whether I’m leaning to the side … And the walking frame gives me something solid to grab if I start to fall.

Playing on the wii

I can use the Obie foam roller to massage my hamstrings, calves, glutes, lumbar spine and thoracic spine. I can use it to exercise my obliques:

Using the Obie foam roller and non-slip mat while chatting and watching TV

I can use the Swiss balls for active sitting, for activating hamstrings, and for strengthening my left glutes and around my left knee:

Using the small swiss ball

These toys and tools are great for me, but even without them, just getting down and living on the floor has been a great move. As an aside, I’ve noticed that it’s younger people that take most easily to this idea. Little kids will do it naturally but it seems the older we get, and the more affluent we become,the more out of touch with our bodies we become.

Think about this: more than half the world’s population live on the floor. That includes the elderly, who in our society creak and groan as they get up out of a chair.  Yet you don’t have to be stiff when you get old … and you don’t have to have problems with mobility to live on the floor!

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Ok, hand controls are not, strictly speaking, around home. But they are probably the single most important item that enables me to be mobile and independent. I don’t know how I would live without my hand controls. Seriously, I don’t know how I would live without them.

Hand controls are fitted to my car and enable me to accelerate and brake without using pedals. Ever wondered how people with limited or no leg function can drive? Lots of people assume we can’t. An automatic vehicle takes care of not being able to use a clutch, and hand controls let us control the speed of a car.

Last week I drove solo to Auckland for the weekend. Just me (and my hand controls) and my music … and a new tic … This time the spasm caused my right hip to flex, taking my right leg into the air and me with it, then down to the ground. No problem when I was driving, but as soon as I stood up and took a step … woohoo, I was on the ground. Crutches couldn’t save me, nothing could. I had to stretch the hip flexors before I could walk, but I had to walk somewhere so I could stretch my hip flexors. Something of a conundrum. This new tic trick was also, for a fleeting microsecond, an excruciatingly sharp pain.It started to get me down until I heard Nina Simone sing “Ain’t Got No” :

Ain’t got no home, ain’t got no shoes
Ain’t got no money, ain’t got no class
Ain’t got no skirts, ain’t got no sweater
Ain’t got no perfume, ain’t got no beer
Ain’t got no man

Ain’t got no mother, ain’t got no culture
Ain’t got no friends, ain’t got no schooling
Ain’t got no love, ain’t got no name
Ain’t got no ticket, ain’t got no token
Ain’t got no God

What about God?
Why am I alive anyway?
Yeah, what about God?
Nobody can take away

I got my hair, I got my head
I got my brains, I got my ears
I got my eyes, I got my nose
I got my mouth, I got my smile
I got my tongue, I got my chin
I got my neck, I got my boobs

I got my heart, I got my soul
I got my back, I got my sex
I got my arms, I got my hands
I got my fingers, Got my legs
I got my feet, I got my toes
I got my liver, Got my blood

I’ve got life , I’ve got my freedom
I’ve got the life

And I’m gonna keep it
I’ve got the life
And nobody’s gonna take it away
I’ve got the life

That thought got me a long way. I was still smiling as my new tic sent me sprawling in the middle of the lobby of the hotel where everyone who works there knows my husband by name!

I have a confession to make. The next day I was determined to get on top of this spasm, so I went to walk along St Helier’s Bay. I was approached by a middle aged man who was very pleasant and interesting and we chatted for a while. He suggested he pray with me. I’ve strong views against this, but for some reason I felt comfortable accepting this. I would even go so far as to say I felt humbled when he commanded the pain in my leg to go. I’m not sure what happened … maybe it was coincidence, maybe it was all in my mind. It’s easy to be cynical, it’s harder to take a leap of faith. All I know is that I’ve not experienced the pain or that spasm since.

This doesn’t mean that I’ve changed my views about people who want to pray over me. But somewhere out there is a man with whom I felt comfortable chatting and who, for a few minutes, I trusted to pray with. And that really bad pain has gone.

And I had to drive to Auckland to meet him! And to drive to Auckland I needed my completely indispensable hand controls!

By the way. I could live in Auckland. It’s warm there – I can go outside knowing I’ll be warm in just a t-shirt and shorts. I can live with the traffic, the high house prices – I like being warm. I like being warm.

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