Developing a PT Program

[betheny]

I'm disgusted, I had a perfectly nice post for this. Now it's in the wrong spot. For intros, please see the Project Walk topic by Chris. Someone had better take this ball from me, I can't type and listen to my kid at the same time. Betheny

[update]
Developing a PT Program

Or as my son says, a PT Club. We could all try our hardest and provide online support and knowledge base, report what seems to be working, and encourage each other. T-Bone is right, a boot camp would be so great. Some things to consider- what resources do you each have? E.g. access to trainers, PT friends, equipment that should be tried out and evaluated, routines to suggest...I haven't seen my new gym yet, it opens on the 1st. It has a pool, weight machines & weights, regular cardio stuff. I don't know yet what I'll be able to use. I also get 24 visits w/ a personal trainer. Sadly enough, my husband reports that the trainer is weird looking. But I digress...:) My last bout of PT involved a stationary bike (w/ one foot ace-bandaged to the pedal), a little rowing machine (should have been more, it works everything), a lot of Thera-ball balancing, stair climbing.
I'll be offline for a week or so. I hope to come back and find that the guys of carecure have banded together and devised a solution to our problems. Between all of us SCI people, we must have seen every type of PT imaginable. If we can just remember it-Betheny Aargh...I was trying to move this topic, and got distracted. Look under Developing a PT program on Cure. Moderator, can we move this post?

[This message was edited by Steven Edwards on Dec 26, 2002 at 03:41 PM.]

[betheny]

For bumping the thread on recovery programs. I knew I had seen it somewhere. One thought I've had-for aerobic conditioning, swimming works well for me. I use a snorkel and scuba mask in the lap pool. I still flounder, but think it will get better as my trunk strength improves. You could add scuba fins if you can kick that hard. I've got one hand clawed up and need to devise a mitten type thing. It's hard getting in and out of the pool, but like everything else that's hard, it's therapeutic. After swimming that's it for the day for me. Lucky to make it back to the car. Betheny

[dogger]

Betheny , unless someone has a better suggestion [ that is cost effective ] , i think an elleptical trainer is a must .strangely , with this machine i don't need a harness as i find it easier to use than walking though my endurance isn't very long on it . as i have stated on other threads , i think aiming for and achieving a correct gait is very important .
pool therapy is very good for both conditioning and walking [ i haven't done any of this since rehab due to an absence of pools out here ]. a suggestion for your hand , in Australia you can buy small flipper like things that fit on your hand that are used for bodysurfing .
i ride a pushbike as well , i am not sure whether this has any benefits over the trainer apart from being a boredom reliever , because i get outside and have a look around while exercising . [ though it is a bit frustrating having falls off it ] .
i don't do any upper body weight training etc . i feel i get enough of this in a normal days work , doing such things as putting out up to a ton of stockfeed every few days .
looking forward to other ideas and information
dogger

every day i wake up is a good one .

[betheny]

Dogger-Can you find me a link for the fin things? And is a pushbike a handbike? Do you belong to a gym out there? Do you walk with crutches? Long pre-SCI we had 50 acres and 4 horses, I didn't have to do upper body work. Tossing sacks of feed is a workout! Procrastinated the trip to Kansas until tomorrow. Beth

[dogger]

Betheny , a pushbike is one of the names Aussies use for a normal bicycle [ others include , treadly or deadly treadly and ''sit down walking machine '' ] . i don't belong to a gym , they are thinner on the ground than pools here , about as rare as rocking horse sh*t . not sure whether the closest one is 70 miles away or maybe 200 miles away .
i only use crutches [ canadians ] if i am going to be on my feet for long periods or if the terrain is very uneven . i feel they cause bad shoulder posture .
regarding the fins , i will find out more about them and let you know , i can send you a pair when i track them down .

thank you
dogger

every day i wake up is a good one .

[betheny]

Does anyone here use AFO's? Has anyone ever heard whether we should be working out with or without them? Dogger, you must have good balance. I have Brown-Secaud and am very weak on my right side. I've never met another "walking quad" to compare notes.

One of the posts on Chris' thread said that the workouts should be process oriented, rather than goal oriented. Meaning you don't just do it because you plan to walk like a human, I think. So what in the process would motivate you to do it? My thoughts:

Better circulation
Easing of "evacuation"
Increased overall strength
Knowing you gave it your best shot

Anyone else?

The first thing to do, for me anyway, is to make sure I am well nourished and hydrated. This sounds simple but I'm terrible at it. That will be my goal this week. Still excited-Betheny

[etexley]

Where does one draw the line between "therapy" and "exercise?"

The first step is achieving a HEALTHY exercise program.

So, I was always told..."Cardiovascular exercise, 3 times a week, 20 minutes"

I agree...for cardiovascular, swimming is the best (if not the only) workout where I can REALLY get my heartrate up. Try getting in and out of a pool at a corner. Put your arms on either corner of the 90 degree for leverage and boost yourself out. If you're a quad, you'll need triceps and wrist extensors. In time you'll find that getting back into a wheelchair is tougher than getting into and out of a pool.

I can't even get the kind of workout in my racing wheelchair that I can get in a pool! My ARMS tire too darn fast. Maybe I'm just not in shape. But when I would run before I got hurt, my body would SWET! I don't get that now.

Recently, I did a study on skin color change (actually the blood filtered through the skin) with cardiovascular exercise. As hemoglobin molecules pick up oxygen in the aveoli of the lungs, the reflection spectrum of the blood changes. I used a simple digital camera to take pictures of the back of people's hands. I got a statistically sigificant correlation between hue and heart rate.

Now Im getting curious what the relative degree of change for me is, vs. an able bodied person for the same increase in heart rate.

[duramater]

Betheny,

Hand fins are available in the U.S. If your town or county or high schools have swim teams the people involved in those will be able to tell you where to buy them. Around here they are standard equipment for training swimmers young and old. Like dogger said they are flat little paddle like flippers that strap to ones wrist and hand. Use, two and you will get the most balanced stroke possible. Good Luck to you. If you cant find them they sell them at my pool for like 20 bucks but they overcharge everything so you never know. You may even try sporting goods outlets on-line.

Happy Swimming!

Mary

...and she lived happily ever after...

[duramater]

Eric,

Well you have me stumped, the neurologist I saw told me not to go to the gym and pool close by where I have unlimited access to machines, weights and a therapeutic pool-- I have a trainer who is one of the best looking men I have ever seen in my life...serious eye candy....and he knows virtually everything! She told me to go to PT far away with no pool, and scarce appointments lasting 30 minutes and I think I have to pay to park. It seemed as though they want me to train on a treadmill, stretch and swim in a warm pool. Oh but the swimming was another referral far away. Somehow I think my own plan may be more therapeutic after all. Seriously I would consider any added fitness as therapeutic because its beneficial to all other systems of the body.

...and she lived happily ever after...

[Rick1]

Hydro-Tone: http://hydro-tone.com/hydrotone.html

Zoomers: http://www.zoomers.net/products.htm

[etexley]

How comfortable are you with being in the water? Take a friend with you. sit down on the edge of the pool, and get in. Hold your breath...relax. You'll float.

If you have arms you can work with, getting out of the pool is lots easier than a floor to chair transfer.

Be sure to take somebody with you who's capable of pulling you out. Tell the lifeguard that you're new to it since you've been hurt.

you're not gonna melt. If you ask me, trying to pop curbs is lunacy compared to getting into and out of a pool.

[betheny]

I plan to go swimming tomorrow. First I have to shave my legs (a challenge w/ these fingers). Does anyone out there have an opinion re working out w/ AFO's? I don't see how I'll ever be able to ditch mine if I use it all of the time. But my leg and foot won't pick up without it. It's a conundrum. My last round of PT was nothing I couldn't have done on my own. The money would have been better spent on massage and accupuncture, IMO. If your PT has FES bikes or a harness treadmill, it would be worth it. Is anyone interested in starting an online group to encourage us in the gym? I crave support and encouragement, and would love to be able to offer some back. Thanks for all your ideas-Betheny

[Lshall82978@yahoo.com]

Originally posted by Eric Texley:

If you have arms you can work with, getting out of the pool is lots easier than a floor to chair transfer.

Be sure to take somebody with you who's capable of pulling you out. Tell the lifeguard that you're new to it since you've been hurt.

If you ask me, trying to pop curbs is lunacy compared to getting into and out of a pool.

Where are you people goinging to swim? I go the YMCA and they have a device that helps people in chairs get into the pool. If you need help transferring they will help you. No grunts or groans about it. One you are in it, the machine does the rest of the work.

[This message was edited by LindsayS on Jan 03, 2003 at 12:19 PM.]

[skier]

I am 2.5years post injury and am having a difficult time finding a pt person or home program that I feel is benefiting me. Money is also an issue as I supposedly do not qualify for disability. I was self employed working on our farm and even though we paid taxes, all SS benefits were assigned to my husband. Therefore, the 20 quarters of credits that I do have aren't recent enough. My insurance only paid for 2.5 months rehab and they seemed to think putting me in an electric chair was good enough. I am C5/6 but don't have tricepts or much wrist flexor. I have never been in a pool. What do you do with the catheter? My caregiver does some streching with me and I am have been in a research program for nearly 2 years. I go to Iowa City twice a month plus do home stimulation of my left calf muscle with electro pads. I hope to start a standing study soon. The local pt hasn't had any experience with sci and came out with a manual dated 1985.

[dogger]

i think Betheny's idea in this is that due to the diversity that is represented here we will be able to combine experience and knowledge to help each other design a program which suits them . this may take a bit of time to get up and running . economics are a big consideration in my ideas too . i too live on a farm so i don't have much access to PT's and equipment [ my nearest rehab facility for SCI is 350 miles away ] .
thank you
dogger

every day i wake up is a good one .

[kate]

Bruce has Brown-Sequard, (c-6) as do a few others on these boards. He's also weak on his right side, but (after almost 2 yrs of pt) has normal strength in a few muscles in his left leg, and is getting more all the time. He walks with a walker, can go up and down stairs, and uses the regular upright stationary bike at our local gym. His last pt session (he's down to about 1 or 2 a month now) was spent mostly trying to "walk" around on his knees while holding his body upright--something that would have been impossible even quite recently. That exercise is killer for all the trunk muscles, and requires both balance and good posture. He has to do it with a trainer in front and one behind in case he crashes.

Has your doctor told you that many people with Brown-Sequard eventually recover a lot of function, even on the weak side?

[reifers]

Even if you do find a place to do FES or gait training, what do you do when you get home to keep it up? Our PT told me most insurance companies will not pay for equipment that has not been medically proven (still in experimental phase). So, what do you do after you PT visits for the year are up?

[tbird3ts]

one game before beddybye?

[betheny]

The idea about walking around on your knees is exactly what I was hoping for. I'll try it tonight. And yeah, I regained a lot of function quickly, thank God. It's these later days that I can't figure out what to do with. It's time for an all-out physical assault. Thanks-Betheny

[SueB]

I wear AFOs just about every day, all day. Without them, I wouldn't be able to walk at all. I got them originally because I had serious foot drop, plus to help control tone when I stand. The foot drop is no longer an issue, but if I don't wear the AFOs, as soon as I stand up tone kicks in and I go right up on my toes. It's impossible for me to walk like that. They make my gait somewhat awkward, but not terrible. Mine are hinged at the sides at the ankle, and split in the back, so they limit plantar flexion, but allow dorsal flexion - if I had any.

Funny thing, on days when I don't wear the AFOs, by the end of the day my legs and feet really bother me. They ache like mad. On days when I wear them, I'm fine.

[Jal]

Sue,

I was telling my daughter about you walking with you AFO's and she was excited to hear about someone who is at the same level T12,l1 and walks around all day with her AFO's. Could you explain how you get around. My daughter was worried about the breaking down of the skin.
She walks with a walker and her afo's but not all day. Please explain. My daughter is heading to project walk in March and would like to know more about your program, and would love to talk with you.

Thank you.

jal

[SueB]

I'm sorry, I didn't mean that I walk around all day. I wear the AFOs all day, so of course also when I walk. My walking is still mostly therapeutic, not functional. During the week, I really only have time to walk in the evening. On the weekends, I walk at different times throughout the day. One thing I've just started to do recently is to occasionally pick a day where I use a walker as much as possible the whole day. This is forcing me to figure out ways to get in and out of chairs and the bathroom, plus how to make tight turns and back up, things I don't really push myself to do when I'm trying to walk for endurance.

I got my AFOs last June. I was really concerned at first about pressure sores. I started wearing them an hour a day, and gradually worked up to all day over about 5 or 6 weeks. I haven't had any skin problems yet.

Great news about your daughter going to Project Walk! I'd be happy to talk to your daughter. I don't really have a formal program, just kind of make it up as I go along, but it involves exercises, stationary biking, paralllel bars and treadmill and walker walking. I think I must be doing something right, because a year ago I couldn't even stand; now I'm up to a half mile on a treadmill with short breaks. Does your daughter have a program she follows?

[emmy]

SueB and Jal

I am also a t12, 5/18/01 was my injury date. I had Dr.Kao's surgery in June and went to project walk in Nov. and I am going back in Feb. Please email me so we can talk. boxtownboy@stargate.net

[SCI PILOT]

I wear my AFO's all day long, I don't use the wheelchair outside. I only use the chair when I have the braces off which is in the morning and before bed. I have had them since August. I use to use a walker with them now I am down to a cane outside and nothing inside.

Here is a picture of them, I picked the colors!

Jim

[betheny]

SCI pilot- those AFO's rock! I never got offered the psychedelic option. I wear one on my right foot. I'm practicing walking around the house without it just to see if I can build up strength in that ankle. Re the earlier suggestion of crawling-try it, it's amazing. It is so much harder than walking! I can feel my weak glut and quad work when I do this. Another question-my right knee caves inward, like I'm snowplowing. Anyone else? Any ideas? I think it puts quite a burden on that hip joint. Thanks-Betheny

[SCI PILOT]

I will give the crawling a try, do you test your leg strength on a cybex machine or something similar? I tested in Sept, Oct and just last week my right quad has increased 80%, left quad increased 59% and both hams increased 24%.

It is a really good way to boost your recovery by having charts to try and beat. I am going to do my next test in March.

Here is my improvement since Sept.

[SCI PILOT]

Here is what the test results look like from the Cybex machine.

[dogger]

Betheny , you should be able to get some sort of knee cage to stop this . maybe even an elastic knee guard like sportsmen [and women] use may help. another suggestion is to tape your knee . the method i used to use worked when i had a similar problem pre SCI . get 4 pieces of self adhesive elastic bandage , about 1 inch wide and 12 inches long . take 2 pieces and stick in a X shape so where they cross is the middle of the knee on the outside . do the same on the inside . then wrap another piece around the leg over the ends at the top of the 4 bits forming the X . do the same around the bottom ends . the leg must be out straight and the 2 pieces forming the X must be pulled tight and well stuck . this was the most non restrictive and strongest method i found .

hope this helps
dogger

every day i wake up is a good one .

[betheny]

Cool charts, sci pilot! I will definitely try to produce something similar to monitor my strength. Did you develop that idea? You've made massive progress since your injury. As new as your injury is and as hard as you work I think you'll make lots more. (Voice of experience). Gotta love that! Dogger, I'll try the tape. I'm also stretching that hip an extra lot. Thanks, y'all! Betheny

[Chris Chappell]

bump