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Thread: Ask a PT

  1. #81
    I apologize - I haven't checked in for a little while, I didn't mean to leave anyone hanging.

    First, the AlterG. I do not have personal experience with this machine, but it seems useful for people who can ambulate. L3 incomplete seems like a good candidate, and if he can walk with crutches and AFOs, then he'll be able to walk on the treadmill. I would use it like any body weight support system - hook him up and check out a few things:
    - how much unweighting allows for optimal gait? Does 50% allow him to ambulate with a "normal" gait? Can he handle more weight, or need less?
    - can unweighting him allow him to walk without his AFOs?
    - research talks a lot about intensity. You want to increase intensity, so how fast can the treadmill get and your father still have a normal gait? The benefit of the system would be to get a great intensity than would be possible over ground.

    Do the PT's have the machine but not feel comfortable using it?? It seems like an expensive piece of equipment to not put to use...

  2. #82
    A basic machine that I use is the Intelect Digital NMES unit. It's $150, and I bring it to people's homes. It's a lot less machine than the one above, but it gets the job done. It can be set to TENS, but it's not also a TENS machine... There is a Biostim NMS-2 that is $175 that can do the NMES and TENS. Both machines are user friendly.

  3. #83
    Hi scitotalfitness, thanks again for the help that you provide to us. I had written in awhile ago about my feet twisting inwards when I step. You had diagnosed weak abductors, which makes sense. This has been a plague for me from the beginning. I've been putting more emphasis on working this area.

    When I started out walking, I was using AFOs on both feet. I was able to work out of them and now, I do pretty well. I'm wondering if using an AFO on my foot that twists the most would be helpful. I've been hesitant to do that because after all the work I put in to ditch the AFOs, I don't want to get lazy and depend on them again. However, when my left foot twists, it catches my knee. This side get tired so easily and my knee and hip start hollering after about a half-mile of walking. What would you recommend as far as the AFO? Try it or leave it off? Thanks for the help!

  4. #84
    Truly - you bring up an interesting question... I often hear people talk about AFOs (or any orthotic device) as a sign of laziness or weakness. I obviously don't know what it's like to rely on one, and I do get the frustration about appearance, comfort and footwear options. But the reason we look to orthotics for our patients is to maximize function. If an AFO is going to:
    a. allow a person to walk further
    b. walk with less or no pain
    c. decrease risk of falls
    d. protect joints
    then we look at finding the right one. It sounds like you fall under the category "d." When you are walking with any weakness, you are putting additional stress on your joints and your strong muscles. Unfortunately this is unavoidable, but we don't want you to wear down any quicker than you have to. A brace does not mean you are weak or lazy!

    If you are having pain in your knee and hip, that sounds like it can lead to nothing good in your future... I say wear the left AFO and see if it helps you walk with less pain, and walk further without the pain coming on. This doesn't mean you have to wear it all day, every day. If you can walk short distances without the brace and without pain, then choose when it's necessary.

    I have to be honest, I don't know if a basic AFO will completely fix that rotation. But it is worth a try. I want you to be able to walk for years to come, and not have to use a wheelchair because your joint pain is too severe. Also - keep up your exercises

  5. #85
    Thanks much! That's good advice. I think I'll give it a try for my distance walking and see if it makes a difference. For general walking about, I can probably leave it off. I'll let you know how it goes!

  6. #86
    I have a question regarding KAFO walking. It may seem silly but I am currently training w/KAFOs but I want to understand what I am using to make it possible for me to do this. I have no movements on my legs but if I am able to take a few steps w/the kafos, what muscles could I be using to make up for loss of function of my legs? Basically what is the minimal function needed to be able to use kafos?
    I do it but cannot figure out how. Sounds weird, I was told I use my hip flexors but where exactly are these muscles and how are they able to make up for lack of function on the whole leg? I know where my hips are, I just want to know internally what is going on?


  7. #87
    Great question! The answer can vary depending on how much motor control you have...

    If you have control over hip flexors, then these will do the majority of the work to swing a leg forward. They connect from your anterior lower spine to your anterior femur - this is why tight hip flexors cause low back pain, and can increase that curve in your lower back! Remember to stretch! One is part of the quadriceps and crosses the knee. They are deep muscles, difficult to palpate - to do so, you have to push really hard on the lower abdomen, off center at the middle of your thigh. But if you can pull your knee toward your chest, you have some hip flexors. You can try this on your side or on your back.

    How to explain how this works in simple terms? Hmm... walking is about moving forward, right? Hip flexors pull the leg forward, and the braces compensate for the rest of the leg muscles, as well as keep the leg from collapsing when you stand on it.

    If you don't have hip flexors, you abdominals can be used to advance a leg while also using some momentum. This is more difficult, but doable. This works because abdominals flex the body.

    If you have weak or no abdominals, KAFOs are generally used by hopping the two legs together rather than stepping one foot in front of the other. This is not only tough physically, but it requires those hip flexors to be stretched in order to balance.

    Is that enough of an explanation?

  8. #88
    Yes thanks, I have wondered since starting this training how this is possible. Thanks again!

  9. #89
    Hope everyone is doing well! I was hoping that I could get some help on a few things in my therapy. I am able to crawl which I do every day, and also walk in KAFO’s in walker but not good. Still working hard on balance. Any thoughts or advice would be great! I am a T10 incomplete Asia C injury date Jan 8 2011. Been a year and 5months since injury. Got a lot of signals back, have sensation to the toes but not good. This is a video of me crawling. Any help would be greatly appreciated!! I can take a step with my legs (hip flexors) but I can’t lock my knees. If I could lock my knees life would be great! I have 12 foot long Parallel bars in my living room. When I am standing in KAFO’s I have a hard time with balance. Taking steps is easy but balance is another story!! Thanks guys!!

    this is just one video there are alot more on the same youtube page.

  10. #90
    pbryant - First, I would like to tell you that you are doing a great job! It may not feel like you are strong, but you have good strength to have that much control when you crawl.
    Do you still get therapy sessions? My suggestion would be to strengthen your core and your hip flexors individually. You are getting a wonderful, complex exercise with the crawling, now isolate.
    Then for the quads, I would do estim.
    Strengthening will help balance a little, but then you have to practice simply balancing. I've mentioned this in previous posts, and the same is true with your KAFOs as it was with the AFOs. Work in the parallel bars to being able to stand still with one hand support and then no hands. Obviously, do this in a safe manner with someone close to you. Do not risk falling since that could set you way back! But getting a better understanding of your balance points standing still, will help you balance better with walking.
    Keep working hard

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