? wise about rehab

jb · 03-04-2003, 04:31 PM

i do pt, aqua therapy, mat exercises, arm weight and standing. i want to know what other therapies or exercises i could possibly do other than this. if i can strengthen my knees enough i would only need afo's instead of kafo's. what do you think?

Christopher Paddon · 03-04-2003, 05:29 PM

Do you have access to a treadmill with a support harness so that your body can do a natural walking motion. This might teach your brain and spinal cord to walk smoothly again.

There have been several posts on this subject (ie, learned non-use).

Wise Young · 03-04-2003, 11:32 PM

jb, you are doing everything that I would. I would probably add FES biking and treadmill walking. Wise.

jb · 03-08-2003, 11:31 AM

magee rehab in phiadelphia is willing to let me have the treadmill as a treatment as an outpatient for about 2wks. i live approx 2 and 1/2 hrs away. they said i could get discounted hotel rooms, even so, it would still be expensive. they said if i don't show any improvement i have to stop. i'm not really sure what they mean. i'm complete, do you think completes would actually benefit from this? i don't think insurance will cover it. i'm confused.i have an order in for an emg because i wasn't showing anything from the fes units in rehab.

Wise Young · 03-08-2003, 12:31 PM

jb, at the present, most of the data regarding the benefits of weight-supported ambulation suggest that people with some motor or sensory function in the legs would show the most rapid and significant recovery from such exercise. The details concerning intensity (how long per day), frequency (how many times per week), and duration (how many sessions) are still not yet well-established and probably vary depending on the level and severity of injury.

As you can imagine, the therapy is very expensive when it is carried out at a rehabilitation center with manual manipulation of your legs. In the United States, the approach is usually to push the patients to faster walking speeds of 3 miles per hour because this is thought to be entrain the locomotor reflexes better. However, higher speeds require at least one person on each leg and one person to guide the pelvic rotation.

In Germany, as I understand it, most of the walking is done with only one physical therapist manipulating both legs. I also think that they are using the training for people who have significant sensation and motor control of their legs. In some of the rehabilitation centers (Kessler, for example), they are accepting patients who are ASIA B, i.e. people who have no motor control but sensation in the legs.

Several studies from Switzerland and Germany suggest that weight-supported ambulatory training will improve locomotor reflexes, posture control, and even allow autonomic locomotion in some patients. It does not lead, at least to date, in recovery of voluntary or independent locomotion. It depends on your definition of benefit. I think that even complete spinal cord injuries will benefit from such exercises but others probably define benefit as independent walking.

What level are you and how complete are you? Do you have atrophy of your legs and is that why you were unable to get a response from FES?

Wise.

jb · 03-08-2003, 01:14 PM

dr.young,
i'm t-11 complete w/sensation to just below one knee and motor return to i think l-3 on both,but not sure. i have both quads,hamstrings,glutes,adductors,abductors,hip flexors. i'm not sure if i missed anything. i don't think so.

Wise Young · 03-08-2003, 01:19 PM

Several groups are working on walking devices that can be used at home. I hope that these will be available next year. There is one device that you might be able to use: http://www.easystand.com/products/6000.html

Wise.

Snowman · 03-08-2003, 09:37 PM

JB

2 weeks on a treadmill is not going to do much good....

Speaking from experience at Project Walk

Eric Harness,CSCS
Project Walk

dogger · 03-08-2003, 10:55 PM

J.B. as a layman , i would consider you incomplete , but that is really immaterial to what you want to know . as a quad who has been walking since 3 month post i agree with snowman that 2 weeks on a treadmill is not likely to be of any great benefit , unless you were going to use it for a trial to evaluate whether to continue it long term . unlike snowman i won't just grin and leave it there . i will try to give a few suggestions from my rehab experience , which because that occurred in 1991 may be outdated . by the sounds of it your primary aim is to strengthen your quads so you can lock your knees ? i would firstly incorporate sitting on a table and doing repetitions of moving your leg from hanging down to out straight , if/when you are able strap weights to your ankle . you can do this exercise during the day if you are sitting around for a few minutes by crossing your legs and working on the upper one . i think bridging on the mat is a good exercise to do . stationary bike riding should also help . one word of caution , resist any urge to over extend your knees to lock them [ i started doing this on one leg due to a knee injury and it is now a habit , which i am finding very difficult to change ] .
i would be surprised if the above is not already in your PT programme but i hope some of it helps .

thank you
dogger

every day i wake up is a good one .

03-04-2003, 04:31 PM	#1
jb Senior Member Join Date: Jan 2002 Location: USA Posts: 315	? wise about rehab i do pt, aqua therapy, mat exercises, arm weight and standing. i want to know what other therapies or exercises i could possibly do other than this. if i can strengthen my knees enough i would only need afo's instead of kafo's. what do you think?

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03-04-2003, 05:29 PM	#2
Christopher Paddon Senior Member Join Date: Oct 2001 Location: New Zealand Posts: 3,207	Do you have access to a treadmill with a support harness so that your body can do a natural walking motion. This might teach your brain and spinal cord to walk smoothly again. There have been several posts on this subject (ie, learned non-use).

03-04-2003, 11:32 PM	#3
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	jb, you are doing everything that I would. I would probably add FES biking and treadmill walking. Wise.

03-08-2003, 11:31 AM	#4
jb Senior Member Join Date: Jan 2002 Location: USA Posts: 315	magee rehab in phiadelphia is willing to let me have the treadmill as a treatment as an outpatient for about 2wks. i live approx 2 and 1/2 hrs away. they said i could get discounted hotel rooms, even so, it would still be expensive. they said if i don't show any improvement i have to stop. i'm not really sure what they mean. i'm complete, do you think completes would actually benefit from this? i don't think insurance will cover it. i'm confused.i have an order in for an emg because i wasn't showing anything from the fes units in rehab.

03-08-2003, 12:31 PM	#5
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	jb, at the present, most of the data regarding the benefits of weight-supported ambulation suggest that people with some motor or sensory function in the legs would show the most rapid and significant recovery from such exercise. The details concerning intensity (how long per day), frequency (how many times per week), and duration (how many sessions) are still not yet well-established and probably vary depending on the level and severity of injury. As you can imagine, the therapy is very expensive when it is carried out at a rehabilitation center with manual manipulation of your legs. In the United States, the approach is usually to push the patients to faster walking speeds of 3 miles per hour because this is thought to be entrain the locomotor reflexes better. However, higher speeds require at least one person on each leg and one person to guide the pelvic rotation. In Germany, as I understand it, most of the walking is done with only one physical therapist manipulating both legs. I also think that they are using the training for people who have significant sensation and motor control of their legs. In some of the rehabilitation centers (Kessler, for example), they are accepting patients who are ASIA B, i.e. people who have no motor control but sensation in the legs. Several studies from Switzerland and Germany suggest that weight-supported ambulatory training will improve locomotor reflexes, posture control, and even allow autonomic locomotion in some patients. It does not lead, at least to date, in recovery of voluntary or independent locomotion. It depends on your definition of benefit. I think that even complete spinal cord injuries will benefit from such exercises but others probably define benefit as independent walking. What level are you and how complete are you? Do you have atrophy of your legs and is that why you were unable to get a response from FES? Wise.

03-08-2003, 01:14 PM	#6
jb Senior Member Join Date: Jan 2002 Location: USA Posts: 315	dr.young, i'm t-11 complete w/sensation to just below one knee and motor return to i think l-3 on both,but not sure. i have both quads,hamstrings,glutes,adductors,abductors,hip flexors. i'm not sure if i missed anything. i don't think so.

03-08-2003, 01:19 PM	#7
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	Several groups are working on walking devices that can be used at home. I hope that these will be available next year. There is one device that you might be able to use: http://www.easystand.com/products/6000.html Wise.

03-08-2003, 09:37 PM	#8
Snowman Senior Member Join Date: Jan 2002 Location: Carlsbad, Ca USA Posts: 928	JB 2 weeks on a treadmill is not going to do much good.... Speaking from experience at Project Walk Eric Harness,CSCS Project Walk

03-08-2003, 10:55 PM	#9
dogger Senior Member Join Date: Jun 2002 Location: Mitchell , Qld. Australia Posts: 2,239	J.B. as a layman , i would consider you incomplete , but that is really immaterial to what you want to know . as a quad who has been walking since 3 month post i agree with snowman that 2 weeks on a treadmill is not likely to be of any great benefit , unless you were going to use it for a trial to evaluate whether to continue it long term . unlike snowman i won't just grin and leave it there . i will try to give a few suggestions from my rehab experience , which because that occurred in 1991 may be outdated . by the sounds of it your primary aim is to strengthen your quads so you can lock your knees ? i would firstly incorporate sitting on a table and doing repetitions of moving your leg from hanging down to out straight , if/when you are able strap weights to your ankle . you can do this exercise during the day if you are sitting around for a few minutes by crossing your legs and working on the upper one . i think bridging on the mat is a good exercise to do . stationary bike riding should also help . one word of caution , resist any urge to over extend your knees to lock them [ i started doing this on one leg due to a knee injury and it is now a habit , which i am finding very difficult to change ] . i would be surprised if the above is not already in your PT programme but i hope some of it helps . thank you dogger every day i wake up is a good one .