Ramblings on healthcare, medical education, and life with a spinal cord injury
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A dip in the pool…

I’m still damp.  Not sopping wet, mind you, but just a nice damp.  I got in the pool late this afternoon during a session with a physical therapist I know who lives close by and is helping me out.  It was the second time we got in the pool, the last being about a month ago, and I was excited at the prospect.  The last time we got in the pool, I was able to put weight into my left leg and stand on it.  I was also able to take a few steps, although the therapist had to brace my right knee since the quadriceps and hamstrings weren’t kicking in to help straighten it.  This time went even better.

I should preface this by also adding that this past Monday at Mount Sinai, I tried something new I’ve been wanting to for a while.  We started the session by getting into the standing frame, which I’d been wanting to do the past few sessions.  A standing frame is a device that basically helps you stand without the risk of falling and hurting yourself.  First, you sit on a big padded seat, which is connected to the backrest by a hinge.  This allows the two to open up relative to each other.  There is also a big padded block that gets adjusted so it is tight (not too tight!) against the knees.  What this does, effectively, is lock your knees in place so they can’t move at all.  Additionally, the feet go into contoured footrests that prevent them from sliding.

Then a hydraulic handle is pumped, and it lifts the seat upward while opening up the angle with the backrest.  The net effect is that the device literally stands the user upright.  There is also a pad about chest-height that keeps the torso from flopping over forwards.  This is especially necessary for those individuals that have compromised trunk strength and cannot keep their upper body upright on their own, due to things like, oh, I don’t know, high-level spinal cord injury.  But I don’t know anyone like that.  ;)

Some images will probably help clarify it, so I swiped these from a vendor’s site to show the sitting and standing orientation:

My therapist adjusted it so I was almost upright, but allowed some room to attempt to contract my muscles a bit.  I was able to start getting some good contractions out of my quads.  Additionally, I was able to move my pelvis forward (which is quite important for walking) and get my butt off the padding on the frame a bit.  This was even new to her since I began working with her, which was only roughly a month ago.  I was feeling particularly energized and strong, and mentioned to her that I wanted to try getting on the parallel bars sometime soon.  No more than a few seconds later, we had both agreed to forgo the standing frame and head over to the bars.

I’d already done a fair amount of standing in the kitchen of my apartment, but in that position my arms were in front of my body and it is nearly impossible to get my body fully straight.  And I did manage to stand on a walker one day in therapy, but that’s a challenge in and of itself.  Since I have to pull on the walker a bit for support while getting upright, it takes balancing and assistance from two people to help me stand up and keep my knees supported so they don’t buckle under me.  But I do enjoy both.

I wheeled into the bars, we adjusted them for my height, and my therapist and a helper got ready.  I managed to pull myself upright fairly easily, and I was surprised at the ease with which I was standing.  On the first attempt, Melissa (my therapist) was blocking both of my knees with her legs since we didn’t know whether or not my muscles would cooperate.  I stood up for a minute or two (maybe longer, I wasn’t paying close attention), then sat down to rest.  On the second try, Melissa was able to move her leg completely off my left knee as the muscles were contracting enough for me to put my body weight into the leg without it buckling. I stood up six or seven times, each for several minutes, and at a few points even took my left hand off the bar for five to ten seconds.

I cannot begin to express how it felt to be upright, on parallel bars, standing with minimal assistance.  It was at this point that I also realized how much work the muscles in my right leg were doing.  When I spoke to Melissa about it after, she expressed surprise at how much less support she had to provide to the right knee than expected.  I’ve been worried about the right quadriceps for a while, and over the past couple weeks I’ve started to notice that I’m able to contract them a bit.  Nowhere near as much as the left leg, and nowhere near normal, but still, after many months of waiting, the muscles are starting to contract and my worry is starting to subside.

It was while I was standing that I realized I really, truly believe I will walk again.  It’s not just a maybe or a hopefully, I can do this.  Doctors have told me it’s possible, as have therapists and people around me, and although I always wanted to believe it, a part of me always held on to the “what if I don’t?” idea.  But while I was up on those parallel bars, shifting weight back and forth between both legs, and feeling the muscles firing to help me stand, it really hit me.  I can do this.  It’s not going to be easy, and it’s going to take a long time, but I can do this.  And it felt amazing.

Back to today.  We got to the YMCA and as we got ready to get into the pool, the lifeguard realized that the chairlift wasn’t working.  I had never noticed these things before the membership coordinator at the YMCA pointed it out to me when I was first signing up, but they help people get in and out of the pool who are unable to use the steps or ladder.  It’s a seat attached to a lift, so I can just transfer from my wheelchair into the seat, then the lifeguard flips a lever and the seat rotates over the pool and slowly lowers me in.  The inverse makes getting out a snap.  But today, it wouldn’t be so easy.

Getting in wouldn’t be the problem.  I can certainly just flop over into the pool easily.  Or propel my wheelchair forward REALLY fast, then lock the brakes up right in front of the pool so I fly out.  (No, that’s not what I did :) ).  Getting out would be much harder, though.  Rather than give up, the lifeguard felt they could get me out without too much trouble.  With two big lifeguards and a therapist who’s strong herself, I figured it wouldn’t be too big a deal, so I transferred from the seat to the floor and then slid into the pool.  No harm, no foul.

Right away, I put my arms on the edge of the pool and stood up almost effortlessly.  The last time we were in the pool, I was able to stand up, but it certainly took some work.  I was surprised at the ease with which I got up this time.  The legs spasmed a bit, as they always do when I stand up, but after putting some weight into them they calmed down and started to listen to me.  The right needed to be blocked from buckling, but I did start to get weight into it and it started to contract.

After standing numerous times, it was time to take some steps.  With my left hand on the edge of the pool and my right arm firmly on my therapist’s shoulders, I pulled myself upright and steadied my body.  With my weight in the left leg, I lifted the right leg a bit and swung it forward from the hip flexors.  Wow, that didn’t work that well the last time. I still needed help blocking the knee on the right leg, but I was able to get weight into it and rotate my pelvis a bit while I swung the left leg forward to take a step.  I was able to take three steps with each leg before needing to rest, but the steps were a lot more solid than the previous time and they looked a lot more like normal steps.  Granted I couldn’t do that even in the pool without the support, especially on the right leg, but it’s progress.  It’s significant progress, seeing as it’s barely been three months since I first wiggled that toe.

Sometimes I surprise myself.  I’ve never been a fan of patience.  When there is something I really want to learn or do, I put all my effort into getting there.  And often, it consumes a good chunk of my life.  But this process has taught me patience.  Yes, I want to walk and stand right now.  But I’m ok with how much time this is going to take.  As I continue to make progress in slow, steady bits, I’m happy.  It may take me two or three years before I can walk on my own, and it may take another year after that before I can completely ditch the wheelchair.  But as long as I’m moving forward toward that goal, I am completely fine with that.

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