Walking w/braces at a T6 complete level?

[Andy]

My physical therapist suggested that walking with braces could be an additional goal that we could do in my therapy. I asked her if this would be possible with no hip flexion at my level (T6 complete), and she said sure. I asked if this would be more like hopping than walking and she said kind of. So...anyone here try something like this? I kind of remember thinking of 'walking' like this when first injured (did not want a wheelchair at all), but the rehab dr. said it would take tons of energy expenditure...and would require hip flexion to do. But now I think this would be pretty cool to tripod around rather than sit in a chair, at least for short distances. Anyone here with an injury somewhere around a T6 level try walking with braces, and could you give me a preview of what this was like?

[priotti]

andy how do you know you are a "complete"it is rare to be a complete leassion. do you have the anal wink if so you are an incomplete

[Andy]

Well, I guess I am not totally complete, there is a muscle somewhere on one side of my back that I can twitch and feel it twitch, my gf says it is below my level, but with rods down to T12 it wont do me any good. What do you mean by the anal wink?

[KLD]

An anal wink or a bulbocavernosus reflex (BC reflex) can persist, and often does, in a complete injury. All it indicates is that there is an intact reflex arc from the perianal or genital area to the S2-4 cord and back. It has nothing to do with a complete injury above that level.

An anal wink reflex test is done by pricking the skin around the anus with a pin and watching to see if the anal sphincter contracts ("winks"). A bulbocavernosus reflex is done by inserting a gloved finger into the anus, then either squeezing the glans penis or the clitoris, or tugging on the indwelling catheter balloon. A BC reflex is present when this action causes the anal sphincter to tighten around the finger.

[SWEETIEheart]

I was told when I checked out of rehab (injury date was April 21, 2000) that I was complete. I'm also T6. I struggled to understand complete vs incomplete and with everything I've found and read online I still say I'm Incomplete. If someone flexes my toes or feet up or down I can tell them if theyre pointed up or down. I was never sexually active before injury and recently had that experience. I was astonished in discovering I could feel him enter me, his pace, and almost everything it seems like. So not ever having sex prior to SCI and not till now(3years post) I could never find the words to describe what I feel when I do digital stim during bowel program to my doc.
He'd just ask me what do you feel? I had/still have no idea how to really describe it. I feel something but defintly not tempertures or actual skin to skin touch there. I feel the stimulus of the dig.stim hmmmmm I'm struggling to think or come up with a way of explaining it. So if you feel something there maybe describe your description to give me some thought of if mine is the same....not just the "anal wink" but a type of actual feeling.

[SWEETIEheart]

Oh and by the way I've never been asked to or attempted to stand with braces. I've had people try to pick me up in a standing postion and theyre basically supporting me under my butt cheeks or trying to hold me up under my arms and it seems it's all the can do to keep my up. My legs are like spaghetti and fold since theyre paralyzed, of course and I'll fall over at my hips/torso area without being "sandwiched" between something(example:standing frame..front and back support)

[berny]

HI ANDY!
I HAD AN L1 INJURY IN DECEMBER 2001, BUT DON´T KNOW HOW, THE INJURY "WALKS" TO T6, SO I´M ACTUALLY T6. SINCE THE FIRST TIME, I WANTED TO USE BRACES AND CRUTCHES, BUT I STARTED WITH A WALKER. I LEARNED TO DO RECIPROC GAIT, BUT WITH THE TIME I LIKED MORE TO "HOP" LIKE YOU CALLED THAT, AND I DID THAT TILL FOUR MONTHS AGO, THAT I STARTED TO UES THE GAIT AGAIN, AND NOW I "WALK" LIKE THAT.
I DON´T MOVE MY LEGS, THEY COME AND GO WITH SOMETHING IN MY BACK AND HIPS, AND GRAVITY...BUT THEY DO, AND I WALK.
IN THE BEGGINING IT WAS HARD, I SWEATED LIKE A HORSE, AND GET TIRED VERY FAST, BUT WITH TIME AND PRACTICE, NOW I USE MY WALKER AND BRACES ALLA TUE TIME, I ONLY USE THE WC FOR VERY LONG DISTANCES..... IF YOU WANTO MORE INFO ABOUT MY REHAB, FEEL FREE TO ASK....

berny.

[priotti]

KLD member you need to check on your research. and talk to your doctors. if you have an anal wink you are considered to be incomplete. done stop trying to give wrong answers to things you are not to educated on. I am in constante contact with research dr's in Gainesville FL. I think they know a lot more than you would . So check again before you discourage others. it is a very low % of people that end up being complete. About 10 % injuries.

[priotti]

Andy,

not during bowel program but sometime take your finger,stick it in your butt hole about an inch then squeez your penis. If your anus contracts on your finger then your an "incomplete" what that other person is talking about pricking your butt is crazy.

[Chris Chappell]

Andy,

It's also called "swing through" gaiting.

My experience; Legs are in full braces and locked at the knee as well as hooked at the ankle - think tripod as your two legs become one leg of the tripod while your arms are the other two.

With a walker to start you must use shoulders, back, chest and arms to lift your full body weight to a standing position from a seated position completely straight legged (think olympic gymnast on the rings doing an iron cross). Once standing and balanced you slide the walker or arm crutches (advanced) about 6 inches in front of you. Then you lean forwardinto the walker pressing down enough (strength with upper body) to lift your feet off the ground a couple of inches so that they 'swing through' forward to the next step.

Rinse and repeat. http://sci.rutgers.edu/forum/images/smilies/smile.gif

I did it as a C6-7 for about 6weeks. Got really strong and it felt great to be upright but it was terribly inefficient.

I do think, after my hand surgeries, that I may re-try the program using arm crutches. Previously my left side was pretty weak and I could only use the walker.

Overall though, unfortunately, the inefficiency and slowness involved (150 yds in 20 mins) in this type of gaiting was nowhere near as fast as the wc.

Oh, and getting in and out of the leg braces takes about 10mins. And you must use full leg braces if you are motor complete.

Try e-mailing Eric Texley. I think he's used them as well???

Good luck.

[KLD]

danp, sorry, but you are incorrect.

All a bulbocavernosus reflex or anal wink test does it tell if the reflex arc from the genitals to the spinal cord and back are intact (S2-4). They do NOT indicate if there is an intact pathway from the brain down the spinal cord to the genitals (an incomplete injury). They are used mostly to determine 1) when spinal shock is over and 2) whether the person is likely to have a reflexive or areflexive bladder and bowel and erections/lubrication after injury. You can have an intact BC reflex with complete or incomplete spinal cord injuries.

Here are some references:

Bulbocavernosus reflex: Squeezing the glans penis or clitoris (or applying traction on an indwelling catheter) results in palpable rectal contraction. This reflex is normally present in most patients. The reflex is brisk with upper motor neuron lesions and is absent in lower motor neuron lesions or spinal shock. http://www.emedicine.com/pmr/topic230.htm

return of the bulbocaverosus reflex (anal sphincter contraction in
response to squeezing the glans penis or tugging on the Foley)
signifies the end of spinal shock, and for complete injuries,
further neurologic improvement will be minimal;
- bulbocavernosus reflex involves the S1, S2, S3 neurve roots and is
spinal cord mediated reflex;
- its presence signals the end of spinal shock, and rarely will spinal
shock last beyond 48 hrs;
- complete absence of distal motor function (EHL - S1) or perirectal
sensation, together with recovery of the bulbocavernosus reflex,
indicates a complete cord injury, and in such cases it is highly
unlikely that significant neurologic damage will return;
- period of spinal shock usually resolves within 48 hours;
- if bulbocavernous reflex is present 48 hours following injury, it can
be assumed that the patient is out of spinal cord shockhttp://wheeless.orthoweb.be/o16/43.htm

A patient who sustains paralysis with no sign of distal sparing may have a complete and irreversible cord lesion. When the period of spinal shock is over, which is heralded by the return of the bulbocavernosus reflex (elicited by pulling on the glans penis, tapping the clitoris, or tugging on an indwelling urinary catheter and obtaining a rectal sphincter response), a definitive diagnosis can be made. If the reflex has returned and complete paralysis continues, there will be no neural recovery. http://www.trauma.org/anaesthesia/cspineanaes.html

While the percentage of complete injuries is less than incomplete injuries, the ratio is more like 40% complete and 60% incomplete than the 10% you quoted (using ASIA criteria for completeness). Obviously many people who are ASIA A have some spared nerves, but these are not enough to be detected in any neurologic tests such as the ASIA uses or for reflex testing.

I do not have a SCI myself, I have been caring for people with SCI and doing BC reflex tests on people with SCI since 1975, and have done hundreds in that time, so I do think I know what I am talking about. If you don't want to believe me, ask Dr. Young.

[This message was edited by KLD on 06-23-03 at 02:11 AM.]

[lway2002]

Andy

Phebus' discription is bang on.

You will have to use full leg braces but, you can get the knees to articulate up to 15 degrees. This is more realistic than trying to "walk" with locked knees. I'm not sure if it takes less energy or not. My son practices forward and backward walking daily on a set of parallel bars.

He was taught how to do this at Bohbot's clinic in France. Albert suggests starting with 5 degree offset in the knee joint at first then, as it gets easier, increase to 10 degrees then finally to 15 degrees.

The benefits of doing this, from what I can see, are weight bearing, giving hamstrings and achilles tendon a very good stretch, some cardio benifits, bowel program is better. There are other benefits I'm sure I've either missed or don't know about. (We were afterall designed to be upright)

Eric Texley has been doing this longer than my son and I'm sure will be able to fill in the blanks. All the best.

lway

[priotti]

KLD what you aare saying is very negitive. Ii am in constant contact with doctor's and research scientist in Ggaineville Fl. The Dr there and also my nuerosurgeon has told me that me having an anal wink is due to me being an "incomplete" Call and ask who ever you want.
When II am working with the right doctors and researchers in UF that have severed cat's spines and had them walking again right in front of my eyes, Thats who are the dr's that know what they are talking about. Ii was considered having a completely severed spine. How is it than that Ii have inner sensation. I can feel the difference in blood flow in each leg explain that? since Iim a complete with an anal wink. It does not happen period. So please check with top researchers before giving wrong answers. And usyng a needle to prick the outside of you ass. Yoour thinking needs to be corrected.

[Chris Chappell]

danP, let's try and stay on topic.

If you'd like to talk/debate to/with KLD why not start a private topic?


Andy, where are your thoughts/comments on the gaiting program? Are the descriptions helpful?

[Andy]

Great descriptions, I have a good idea what this will entail now. I did ask to try this last week, but they were out of braces at that time to try it out...and we are working on the dragging my butt into the chair from the floor now anyway, which is more important, maybe in a few weeks I will get to try the hopping along thing. Until then the standing frame satisfies the desire to stand/walk...really need to buy one of them for myself, great machine http://sci.rutgers.edu/forum/images/smilies/wink.gif

[Wise Young]

DanP, bearing in mind that classification systems are just that (just a bunch of people getting together and agreeing to give names to different conditions), I am somewhat hesitant to get into the debate.

The definition of ASIA A is absence of conscious perception of pinprick or touch in the S5 dermatome (the lowest level of the spinal cord) and the absence of voluntary contraction of the anal sphincter.

An anal wink can occur in a person with a complete spinal cord injury because it is a reflex that depends solely on circuits present in the sacral spinal cord. It is, however, a positive sign because it indicates that your sacral spinal cord is intact.

Andy, regarding walking without hip flexors, it would indeed take a lot of energy because what you have to do is to use your pelvis to provide the swing phase of your legs. You should be careful not to overstress your shoulders when walking since your arms must bear so much of your weight.

You might want to consider doing some of your walking in a swimming pool. You can attach rubber straps to your knees and pull your legs into the swing phase. In the meantime, you would also benefit from the stance phase and can progressively increase your weight support by going to the shallower end of the pool. This causes less stress to your joints.

Wise.

[Andy]

Today we got some braces fitted and I got propped up between the parallel bars, interesting 'standing' without a stander after 11 months of sitting around. We ran out of time before I could hop forward or something, this should be interesting. Wise, I understand about the hip flexor issue, it sure would be nice to have some, we'll see what happens.

[etexley]

Andy,

The point is not if you can walk in braces with what you "have now" or what other people THINK you have.

The first thing I'd like to suggest is that everyone in the world stop using "complete" and "incomplete" and begin using ASIA classications. It's a much more accurate "rating" of spinal injury, and I believe that some research into recovery potential has actually been performed.

If you ASIA A you ARE NOT getting signal getting all the way through to the last segment (sacral) of the spinal cord.

ASIA B, and ASIA C are classifications for sensory and motor function preserved exclusively.

A medical practitioner can give you real numbers which characterize your potential for recovery.

My doctor told me that my chances of walking with a T5 complete injury were 1 %...period. OK...whatever...Im walking braces now, so I've beat this number.

The second thing you have to realize is that Western textbooks instructor medical and patients to NOT LOOK for recovery. Part of this is due to the fear of liability on basic scientists which causes them to be reluctant to create any ambition in patients to get better.

Unfortunately the activity that would prove them wrong is discouraged.

Believe in your body's ability to repair itself. You don't know what you can do until you do it. What I am finding that I need are very specific exercises which target the muscle groups which lost voluntary signal from my brain. Ask your physical therapist what you can do...at T6? how are your abs? your paraspinals? The exercise metnioed several posts up from here is an excellent place to begin.

GET ON YOUR FEET! I was up for about an hour a day before. My biofeedback therapists told me this was insufficient. So now, I wear the braces all day long, and I stand up whenever Im not doing anything else.

Remember that you may will have to build your tolerance for standing very slowly. Normally it's the muscles in the legs that push the blood back to the head. You may need to get in a standing frame and work with your physio to get your circulatory control back. You will feel faint.

Believe in God and believe in yourself.

[mikes4x4]

great job andy, weird wasn't it. im t-10,11 asia c. while i was in rehab i as well was fitted for KAFO's im 8 months post now. i have some good hip flexors abductors and adductors i walk a good distance on any given day. the more you walk in them, the more you will feel comfortable and the stronger you'll be. just dont over do it. keep working on the mucules you do have, but dont over do it.

[Andy]

Thanks guys! Last week I hopped down the parallel bars with the braces, it was kind of neat. Right now I need to get used to balance and pushing my body forward/getting my back arched so I dont have to use my arms so much to hold myself up at a 'rest' position. Stomach spasms kind of detract from this, but I figure doing a good stomach stretch and downing a baclofen prior to doing this should help with this when we do it again in the next weeks (I think we will be doing the walking thing from now on as I kind of plateau'ed for now on my other PT goals) I figure that I have a sort of hybrid form of hip flexors...not that I have any that work, but that I have rods from T2-12, and I figure I can use my shoulders to move my hips around. I just wish my PT sessions werent 45 min a day 3 days a week, but longer to figure out my technique. Oh well, I just started this, getting a little anxious to work on it more. We'll see how it goes. On the standing up every day issue, I am in full agreement on this topic. Every time I go to rehab I get myself propped up in the standing frame for at least 1/2 hour, it works wonders for stretching out the abs when leaning back, and I generally feel better after standing for a while. I am working on getting my insurance to pay up for one (I want the Easystand 5000 with the mobility option), if that doesnt work out I'll just buy one. It will be great having one of these at home.

[mattblan]

Hi Andy,

I am between T6 and T10. I started using leg braces about 6 months ago. They started me with regular 'broken foot' crutches, which i thought was ridiculous. Next they gave me a walker and I was able to get from my room to the living room in about 30-40 minutes. The distance is about 100-150 feet around a few corners and doorways. With a walker, I find that it is nearly impossible to get up/down by myself because the braces that I have will not lock into place without an extreme amount of force. They are also a real pain to get unlocked. Make them get you the forearm crutches right away. If they try to 'start you off' on the walker make it clear that that is unacceptable. Enjoy your new braces man.

[etexley]

If you have a bail lock as I do, you may find that adding articulation makes the joint considerably easier to lock.

I stand up with a walker, and I able able to snap the lock backwards, throwing it into place.

A step lock is another option. I wanted them, but my orthotist gave the the old "at your level" excuse.

Try a pair of braces before you get your locks. Try walkers of various kinds. I find that I like a standard walker MUCH better than one with wheels on it.

My braces are FINALLY (after 2 years) becoming FUNCTIONAL for me. Just in the last couple weeks, I carry my walker on my knees. I've been going places, and then standing up and walking around.

Im really thrilled to be in this transitional phase...I just keep praying and keep working out.

God speed and best of luck!

[Andy]

Well, here's another progress report. I dont know if this is a recovery based therapy or not, but here we go. Played around doing this for a few more times, but stomach spasms kind of get in the way of doing any weight bearing by standing for any length of time. Plus the 'walking' isnt remotely functional in my view. As far as this maybe helping with recovery, I doubt it will apply to me after seeing just how demolished my spinal column was from the CT's & X-rays from the night of my accident, with the associated spinal cord damage. Maybe it will work better with others at this level, for now I will just be happy with a standing frame for getting up on two feet. This does have good cardiovascular benefits doing this, so give it a shot if you are thinking of it.

[stephen212]

You can find some inspiration here.

vENeu_pbFzA

Oops! I meant here. ;)

9h1bFBdW6BM

[arod636]

Here is what I can do I am a COMPLETE T-9 ASIA A

ZNA3rF1z-yI

x3FXvoDqRCw

[AlexAgain]

Hey arod - that is really terrific. I have a problem with my right leg going inward in front of my left leg. I noticed your right leg does the same. How do you bring it back out? When mine ends up crossed in front of my left - I am kind of stuck.

[tmorris381]

nice arod, keep it up. how much control through your abs/lower back and hips you got? anything come back through your hip flexors? i'm a 4/5, haven't looked into what a 9 typically has, but i think i remember reading somewhere you were at pdub for a little while, so i don't know what you have gained/retained..

[arod636]

Hey arod - that is really terrific. I have a problem with my right leg going inward in front of my left leg. I noticed your right leg does the same. How do you bring it back out? When mine ends up crossed in front of my left - I am kind of stuck.


I just swing it out to where I want it. I have stopped walking though because my right hip is FUCKED up. I have arthritis in it and its dislocated. I have tremendous spasms an it just wants to be bent all the time so it makes it very hard for me to stand let alone walk. I cannot find a doctor that actually gives a shit about someones hip who is confined to a wheelchair... Hope this helps

[arod636]

nice arod, keep it up. how much control through your abs/lower back and hips you got? anything come back through your hip flexors? i'm a 4/5, haven't looked into what a 9 typically has, but i think i remember reading somewhere you were at pdub for a little while, so i don't know what you have gained/retained..

I have controls to about my mid-stomach area. My trainers at sci-step tell me I have some hip flexion. But I do not feel that so I can't tell you if I do or don't have control there. Pdub doesnt believe in kafos or any devices like that to help you stand an walk. At least when I was there they didn't. I go to sci-step in northern california they do great work there. I also have been to sci-step in ohio they do really good work too... I recommend either place...