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Thread: What can help improve recovery in a walking quad?

  1. #21
    Senior Member Imight's Avatar
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    Ive never heard of HP184. Is this like 4ap or has it been approved by the FDA?

    btw...I can vouch for 4AP, I haven't taken it in a week (order has been on back log) but I can def see the difference, I feel a lot better after taking 4ap and my legs feel a lot warmer....

  2. #22
    Senior Member mj23's Avatar
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    Dr. Wise, do you know where I can get Spinal Cord stimulation done in Chicago?
    C-5, 6 SCI. Took about 6 months to walk. Walking full time. Without any assistance since Nov. 2003 and will make a full recovery

  3. #23
    What worked for me was intensive physical therapy, just got a new return after almost 7 years. My last return was about 6 months ago, Before that it had been 2 or 3 years since I got back anything "new".Changed up my workout routine to start including different weightlifting styles since I walked full time (had the balance necessary to "push up" to another level of lifting.) If you are walking I def recommend weightliftng, esp with free weights.If you walk unassisteed look into olympic weightliftin. Since I started it I have gotten 2 "new" returns in just over 6 months.

  4. #24
    Senior Member mj23's Avatar
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    what kind of return did u get back? what kind of intense therapy did you do?
    Last edited by mj23; 01-10-2012 at 02:11 AM.
    C-5, 6 SCI. Took about 6 months to walk. Walking full time. Without any assistance since Nov. 2003 and will make a full recovery

  5. #25
    I can feel my glutes contracting and I can feel it when I step down, can feel my lower back when I bend. Intense pt 5-6 days week, 1 1/2- 2 hours every time I worked out. STarting benching, doing asisted pull ups and dips, went to girl pushup to reg push up to diamond pushup.Swimming, walking, yoga, pilates, elliptical, bike, rowing.Once I coulod bench my body weight, decided if I could do that, I should be able to do a pullup, now can do 25-30 pullups.Its taken almost 7 years of non-stop working out to get to this point.

  6. #26

    Dr Young: an update?

    Quote Originally Posted by Wise Young View Post
    I received this question several weeks ago. Sorry about not answering. I had to think about this a lot.

    Let me start by discussing what a "walking quad" means. A person who is walking after spinal cord injury has enough axons passing through the injury site to activate the locomotor pattern generator. Relatively few axons are needed for this purpose. Sensory feedback is necessary for maintaining balance and posture. Many muscles may be weak or atrophied through prolonged non-use. The recovery may be stronger on one side than the other, thereby resulting in abnormal stress of joints and muscles that are weak. Spasticity often interferes with the movement but at the same time is important for the movement to occur. People often take drugs for spasticity and the drugs interfere with movements.

    If your recovery seem to have plateaued, what can and should you to do restart the recovery process?

    1. Check your medication. If you are taking anti-spasticity drugs, such as baclofen or tizanidine, the drugs may be causing weakness. In addition to reducing spasticity, anti-spasticity drugs weaken the muscles. If you are taking anti-spasticity medication or have a baclofen pump, you should discuss the situation with your doctor and consider lowering the dose so that it still controls your spasticity but gives you additional strength. There is some controversy about this and relatively few good studies (Source). The same may be true for anti-pain medications such as gabapentiin (neurontin). One possibility is to adjust your schedule of medication so that you take more at night (when you don't need to move) and reduce the dose during the day. Another possibility is to use alternative approaches to reducing spasticity (see below).

    2. Consider functional electrical stimulation of muscle. Muscle stimulation, particularly against resistance, strengthens your muscles. FES may also reduce spasticity. I have heard many people tell me that their spasticity is less after they have had a period of FES stimulation.

    3. Consider spinal cord stimulation. Several credible studies have shown that epidural stimulation of the lumbar cord with low frequency waves will activate the locomotor pattern generator in the spinal cord and greatly reduce the effort required and the speed of walking overground. There are only a few places in the United States that offers this kind of stimulation. One place in in Arizona and the other is in Vienna (Austria). See
    http://sci.rutgers.edu/forum/showthread.php?t=17601
    http://sci.rutgers.edu/forum/showthread.php?t=23383
    http://sci.rutgers.edu/forum/showthread.php?t=15424

    4. Consider 4-aminopyridine. There are many many posts concerning 4-aminopyridine or fampridine on this site. This is a potassium channel blocker that not only may improve the conduction of demyelinated axons but also increases the amount of neurotransmitter released per impulse that gets through. There is a phase 2 study in MS that shows that fampridine will reduce fatigue, increased strength and walking speed of people with MS. Do a search for 4-AP and you will find a lot of information on this. The drug is available through doctor subscription and can be dispensed by compounding pharmacies. Many people on this site take 4-AP.

    5. There are several new drugs that may help. One is HP184. This is a drug that apparently blocks both sodium and potassium channels and may have effects that are similar to 4-aminopyridine. Another theoretical possibility is to take a serotonin uptake blocker; these are antidepressive drugs that reduce the uptake of serotonin and since serotonin is an important neurotransmitter for activating the locomotor pattern generator, it is possible that such drugs may help reduce fatigue and improve walking. There are some reports that fluoxetine and maparotiline improves motor function in people after stroke (Source).
    There is a recent report that a drug called quipazine (which is a serotonin receptor agonist) helps mice with transected spinal cords walk better (Source). I am not suggesting that you take these drugs but just pointing out that there may be some pharmaceutical approaches that may be coming.

    There are other possibilities but let me just start with these and see where the discussion leads us.

    Wise.
    Dear Dr Young,

    I am intrigued by your advice for walking quads and was wondering if, several years later, you would still recommend all of these things (4-aminopyridine, sodium and potassium channel blockers, implanted spinal stimulation units, etc.). The idea that SSRIs might be helpful is really interesting -- does your experience in the years since you wrote these recommendations still support a possible contribution by SSRIs? Do you now feel that any of the suggested methods might not be so helpful? Has anything else become available since?

    Thanks in advance for any updated advice you can give.

  7. #27
    Thanks PMR DOC. What are inertial based exercises?

  8. #28

    Steroids

    I started my injections of 1cc of test cyc 400 once a week.I'm 2 weeks into cycle and can feel legs getting stronger.I'm c/4-c/5 central cord incomplete.I do 3 sets of squats on edge of bed 5 days a week.Have lowered bed height considerably in 2 weeks.Upper excercises I use ankle wghts. on wrists.Istarted with 2.5lbs.up to 5 now.Most of my weakness is upper.I'm 5 yrs.out.I had theraphy for 8mos in patient and 2 out.Was walking w/walker over 900 ft .I gave up.I lost so much muscle.I'm gonna be a 1st time grandpa any day and want to be able to hold her.I'm 58.Anyone out there used steroids(dr.prescribed) out there?

  9. #29
    posted by mistake
    Last edited by myerstim; 02-16-2012 at 12:30 PM.

  10. #30
    Junior Member
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    Quote Originally Posted by Wise Young View Post
    I received this question several weeks ago. Sorry about not answering. I had to think about this a lot.

    Let me start by discussing what a "walking quad" means. A person who is walking after spinal cord injury has enough axons passing through the injury site to activate the locomotor pattern generator. Relatively few axons are needed for this purpose. Sensory feedback is necessary for maintaining balance and posture. Many muscles may be weak or atrophied through prolonged non-use. The recovery may be stronger on one side than the other, thereby resulting in abnormal stress of joints and muscles that are weak. Spasticity often interferes with the movement but at the same time is important for the movement to occur. People often take drugs for spasticity and the drugs interfere with movements.

    If your recovery seem to have plateaued, what can and should you to do restart the recovery process?

    1. Check your medication. If you are taking anti-spasticity drugs, such as baclofen or tizanidine, the drugs may be causing weakness. In addition to reducing spasticity, anti-spasticity drugs weaken the muscles. If you are taking anti-spasticity medication or have a baclofen pump, you should discuss the situation with your doctor and consider lowering the dose so that it still controls your spasticity but gives you additional strength. There is some controversy about this and relatively few good studies (Source). The same may be true for anti-pain medications such as gabapentiin (neurontin). One possibility is to adjust your schedule of medication so that you take more at night (when you don't need to move) and reduce the dose during the day. Another possibility is to use alternative approaches to reducing spasticity (see below).

    2. Consider functional electrical stimulation of muscle. Muscle stimulation, particularly against resistance, strengthens your muscles. FES may also reduce spasticity. I have heard many people tell me that their spasticity is less after they have had a period of FES stimulation.

    3. Consider spinal cord stimulation. Several credible studies have shown that epidural stimulation of the lumbar cord with low frequency waves will activate the locomotor pattern generator in the spinal cord and greatly reduce the effort required and the speed of walking overground. There are only a few places in the United States that offers this kind of stimulation. One place in in Arizona and the other is in Vienna (Austria). See
    http://sci.rutgers.edu/forum/showthread.php?t=17601
    http://sci.rutgers.edu/forum/showthread.php?t=23383
    http://sci.rutgers.edu/forum/showthread.php?t=15424

    4. Consider 4-aminopyridine. There are many many posts concerning 4-aminopyridine or fampridine on this site. This is a potassium channel blocker that not only may improve the conduction of demyelinated axons but also increases the amount of neurotransmitter released per impulse that gets through. There is a phase 2 study in MS that shows that fampridine will reduce fatigue, increased strength and walking speed of people with MS. Do a search for 4-AP and you will find a lot of information on this. The drug is available through doctor subscription and can be dispensed by compounding pharmacies. Many people on this site take 4-AP.

    5. There are several new drugs that may help. One is HP184. This is a drug that apparently blocks both sodium and potassium channels and may have effects that are similar to 4-aminopyridine. Another theoretical possibility is to take a serotonin uptake blocker; these are antidepressive drugs that reduce the uptake of serotonin and since serotonin is an important neurotransmitter for activating the locomotor pattern generator, it is possible that such drugs may help reduce fatigue and improve walking. There are some reports that fluoxetine and maparotiline improves motor function in people after stroke (Source).
    There is a recent report that a drug called quipazine (which is a serotonin receptor agonist) helps mice with transected spinal cords walk better (Source). I am not suggesting that you take these drugs but just pointing out that there may be some pharmaceutical approaches that may be coming.

    There are other possibilities but let me just start with these and see where the discussion leads us.

    Wise.
    Hi Wise
    I read this with great interest as my husband is a "walking quad" with a weak right side and a stronger but high tone left side. Almost 2 years post injury (stenosis C4-C7 which left him symptomatically worse after a laminectomy to decompress), he's improving very slowly. Spasticity and tone are his biggest problems as good movement is there under the tone. He has regular physio and hydrotherapy and at the end of a therapy session his movement is good and he is close to being able to walk unaided. Sadly, although he makes small gains the tone always comes back. He's slowly getting stronger and gaining a little control over the tone but his progress is uneven. He takes baclofen (70mg daily) plus diazepam and amitriptyline at bedtime. He also takes pregabalin (150 am and 200 pm) to help with severe (at times) nerve pain.
    We are considering whether taking less baclofen might be a good idea as this makes him tired and weak. However we are concerned that he will be able to do even less if his spasticity worsens.
    However I wondered if there are any updates on this 2006 posting? We have an appointment with his rehab consultant soon and if you have any ideas for the way forward, we would be very grateful for advice. Thanks so much for any advice/info you can offer.

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