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Thread: Ask a PT

  1. #31
    I thought this link gave excellent demos to treat prevent scapular dyskinesis, impingement and the whole gamut but I'm not a PT. What's your opinion?

    http://www.bidmc.org/CentersandDepar...pingement.ashx

  2. #32
    Can someone please point me to charts or other data sources on the web that indicate where electrodes should be placed in order to wake up nerves and stimulate increased blood flow? We have a comprehensive electrode set but lost the diagrams...

  3. #33
    HI
    Well where to start. I'm t-10 complete 6 years post. I've been using a pair of stance control kafo's for a couple of years but of course don't have the strength to use them as designed, just lock them when I get up to walk a bit. Just really frustrated that I can't free stand yet and must have a hold on something. What can I do to fight the hip extensor? contraction and get my hip to push forward. Also when standing in parallel bars with both hands on the bar, then if I lift my left hand my butt goes right and vise versa for the right hand. Are there some stabilizing exercises that would help with that.
    Thanks

  4. #34
    Avictoria - that is a good resource, thank you! It brought back memories of school - that is the orthopedic approach to shoulder impingement, and it applies to impingement after spinal injury just as it would for any other reason. Obviously, some of the exercises would need to be modified, and not just because they need to be done seated. If someone is doing the exercise or stretch without core/trunk strength, the muscle meant to be stretched may not stay in the correct position. Laying down may be a good alternative because the shoulder blade will stay where it is supposed to.

    The one difference about shoulder pain with the SCI population is that by the time treatment is being sought, the pain has usually reached the "chronic" phase, way past acute. That just plays a role in progression.

  5. #35
    cfcseo - you want to focus on one muscle group per pair of leads. Put them both on that muscle group, the distance depends on the size of the muscle group (wrist extensors are small, put them close together. Triceps are larger, put them a couple of inches apart)

    As for diagrams, here is a previous post:
    http://sci.rutgers.edu/forum/showthread.php?t=66374
    and another internet resource:
    http://www.everyway-medical.com/imag...pdf/body_c.pdf

    However, here are some IMPORTANT basics that I notice the diagram aren't following:
    1. Don't cross the spinal cord with electrodes! The reason they work in pairs is the current runs from the active lead to the ground lead. You don't want this current crossing your spinal cord.
    2. Stay away from your carotid arteries!
    3. Do not use estim if you have a pacemaker or have cancer!!

    Does that help?

  6. #36
    henrya - good for you for getting up on those braces!! It's really hard work!
    The way those braces were initially meant to be used is with forearm crutches, hopping your legs together. Obviously, balance is key for this because you have to pick the crutches up without falling over. So this is done by hanging out on the "Y" ligaments of the hips. This is a super strong ligament in the front of your hip, holding your femur to the pelvis. By thrusting your hips to this limit and bringing your shoulders back, this is that "free stand." Not only is this physically challenging, I would bet money that you have tight hip flexors.

    Important note for everyone - when you spend most of your time sitting, your hip flexors inevitably shorten. This shortening is even worse if you have flexor spasms. These muscles attach to your lumbar spine, so often when you try to stretch this muscle group, the path of least resistance is your spine increasing it's lordosis (think of how a gymnast stands) Some simple tests? Lay on your stomach - is your booty in the air? Did your lower back arch more? Tight hip flexors! Another test is also the best way to stretch (but tough...) Sit on the edge of your bed with knees bent, grab both knees and roll back. hold on to one knee, and let the other leg go down to the bed. If it doesn't touch the bed - tight hip flexors! Let it hang for a minute or so. Repeat with the other leg. This is much easier if you have someone help you.

    Back to hanging out on Y ligaments - you can't get to this position with tight hip flexors because your pelvis is being pulled in the opposite direction. This position is important even if you have strength to walk one foot in front of the other. This position also limits the pelvis' ability to sway side to side. You can also try putting your feet a little wider apart.

    Once you have this position, what can you do to get more stable? Strengthen your core as much as you can. At T10, you should have some abs. Laying on the floor, do crunches, toss a medicine ball, crunch side to side, med ball twists on the floor or in the chair... there's a bunch of exercises. I bet you'll feel muscles you haven't felt in 6 years!

    Hope that gives you somewhere to start! Good luck!! Let me know if you have any more questions.

  7. #37
    I'm doing extensive PT now, as I'm a little over 3 months into my injury. As of yesterday, i'm no longer wearing my back brace. I'm walking with a cane, without when in the house. Have an AFO for my right leg...foot dropped. I have little movement in the right ankle, just a small pull up, not even to flat foot yet. I have an electronic stimulation device at home and use it 4 days a week. Also do many weighted exercises. My doc said all nerves are intact, just it will take time to regenerate.

    Any advice/positive reinforcement/tips/comments u can provide??

  8. #38
    LIP26 - sounds like you are doing great! You're early in your recovery, so you'll certainly see more gains
    One thing about your foot drop - the estim is only effective if the weakness is due to an upper motor neuron injury. What level did you injure? The nerve root for dorsiflexion is L4 - this is part of the cauda equina, lower motor neuron area. This will just take time.
    Keep doing the exercises! And use caution to not fall - no one plans it, but it's common.

  9. #39
    thanks..
    I had a t12 fusion and a pin at t10,11,12, & L1.
    Please tell me more (positive words) about nerve root at L4 and possibility re: my foot drop situation.
    i have fallen quite a few times, or more than, since my injury. how can i tell what falls are serious vs. not as serious?
    i was very fit with muscles before injury...now most are soft...are those still muscles that need to be tightened?? will they come back..??

    Thanks again!!

  10. #40
    I really cannot tell you how much will or will not recover... that truly is something that you have to wait and work at. Again, it is still early in your recovery, and you will continue to see improvement.

    You injured your nervous system, so your muscles are not injured, they just aren't innervated the way they were before your injury. This is why they are soft. As you have continued neurorecovery, you'll see more muscle strength develop.

    Falls... yes, we can all handle the occasional spill, but falls can potentially hurt you. This would be a serious fall - one that results in an injury that prevents you from working on your rehab! I know you don't want this step back... I don't know if your PT has discussed bracing with you, but I would recommend an AFO for your foot drop. Here is what I previously wrote about AFOs:
    the rigid kind, usually plastic, are made to compensate for decreased strength, like drop foot. Since these are the cheapest, it's often what insurance covers. However, there are AFOs with ankle joints that allow your footplate to move, and this can be on plastic or metal braces. There are usually springs in the joints, and these allow for a couple of things - one is to assist muscles that are turning on but aren't strong enough for safe walking. They can be used by people who don't have sensation coming from their ankle - particularly proprioception that lets you know what your foot is doing without looking at it. Usually the metal ones work best for this, and I know they are not fashionable. But they add input to the brain, and can make walking safer and less effortful. The ankle joints on the braces are called DAAJ (double ankle adjustable joint)

    I recommend trying the jointed AFO. I know people don't like to wear braces, but they really do prevent falls, they help you walk faster, and they do not prevent recovery!! In fact, they could help you walk with a more normal gait pattern, promoting recovery and preventing injury from an abnormal gait pattern.

    Your PT should be able to have you trial one before committing to it so you have an idea of what you think, and decide if it is worth pursuing.

    Hope that helps

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