New Developments In Ambulation

A few weeks ago I spoke to Dr. Carlos Lima who performed my olfacotry cell transplant surgery back in April 2005. I asked him what specific types of excercises his patients in Europe were doing therapy-wise in their quests to regain mobility. His recommendation as to how to get the greatest potential benefit out of the surgery is that body must re-learn the movements it lost from the paralyzing injury. For instance, if the legs don't move because they are paralyzed the best way to regain potential function is to get them moving in a walking motion. Sit and do nothing and nothing will happen. The theory is that even if the original neural pathway is damged, putting the legs through the walking motion may help the nervous system open up and develop new pathways to the brain: reverse engineering or kind of like creating a neural bypass. This can be accomplished in a varitey of ways, like unweighted treadmill training, riding FES bikes and the like. I have utilized KAFO braces for assisted walking and standing exercises for two years now, and although Dr. Lima is not against the benefits of incroporating braces into the therapy program he has stressed that many of his european patients do not use leg braces in their therapy routines. His contention is that the braces do all the work of bearing the body weight and thus the legs don't get used to supporting the body.
When I asked him to suggest excercises that his European patients were having success with I was relieved that, for the most part, my therpy sessions included similar activities. He reassurted me that I was doing the right things, but then he also sent me a video clip of a patient of his, a C4 level quadriplegic, assited walking without legs braces eight months after her transplant operation. After watching the clip, I determined that there was no reason for me not to try the same thing. So, for the past month I have been doing my assisted walking without the KAFO braces I used in the past.
Using the braces I was getting to the point where I would be able to cover a couple hundrd feet before my shoulders reached their point of fatige. I went from swinging both of my legs at the same time to alternating gait, which I demonstrated here. I also started to notice a real improvement in my balance through my hips and when standing still, while utilizing a platform walker for upper body support, I can control my balance to the point where I don't need anyone supporting my hips to help keep me upright.
Assisted walking without the braces is different though and more fatiguing because all of the support and rigidity that the braces provide is gone. The weight of the braces and the fact that the legs are fixed at full extension contributed to the swing part of the walking gait once I was able to get momentum headed in a forward direction. Without the leg braces and without any voluntary function the knees want to buckle under the body weight and so getting the leg to swing forward is much more strenuous and difficult. What I concentrate on doing when not wearing the braces is shifting my weight side to side and trying to create a hip turn with my abdominal muscles to pull my trailing leg forward. Right now though, the majority of the hip turn I'm getting is coming down from turning my shoulders. When I have significant spasticity in my legs the contractions of the muscle spasms help me to lock my knees out and straighten up my back and at those points I'm able to bear most of my body weight with my legs. The spasticity is sporadic though and so 90% of the time while I'm walking, my PT has to assist with not only swinging my legs forward, but locking out my knees as well. Because of the style of walker we are using with this type of exercise I'm also doing less in terms of controlling my balance at the hips as the walker has a strap that can be used to lock my hips in a secured position. In the long road though, I hope this will help me accomplish more as now my legs are being forced to support the majority of my body weight as I go through a more natural walking gait pattern.
This is what it looks like: