Improvement continued over the next few weeks of February of 2006 until my home physiotherapist thought all that could be accomplished at home had been. As I was still an employee of a local hospital, I was fast tracked into their ‘on-site’ physiotherapy department. Here I continue to receive a variety of therapies from stretching out the muscles that haven’t had a full range of movement for about a year. Some of the exercises are outlined below.
(1) Mat - I was taught to be able to transfer onto the low, dense mat on which various exercises could be administered. With my legs suspended in a sling, I was encouraged to move them in and out thereby exercising the muscles and stretching out the ligaments, tendons and muscles that had very little use in the last year. My legs could also be suspended in the slings with springs attached to the overhead latticework. In this configuration I would press my suspended heel down to the mat surface over and over again thereby exercising a different set of muscles. I was re-taught how to roll over and then stretch out on my hands and knees. Like a child learning to crawl again.
(2) Tilt table - is a full body length padded table on which you are strapped and then raised to an upright standing position. This table aids in diagnosing fainting and other disorders but in the case of a paraplegic, it is used to stretch out the Achilles’ tendons which have shortened over the months of non-use. Sessions for me have lasted for about 15 minutes each and while in the upright position I could work out further with weights or elastic “Therabands”.
(3) Standing Frame - the one I am using is somewhat different than the one pictured here. It is a metal frame with counterweights which through a sling that supports your butt, off-sets your weight and assists you to stand up from your wheel chair. The purpose of the frame is twofold. It stretches out the tendons as with the tilt table and exercises the quads and other muscle groups needed to stand and sit. I like the standing frame better than the tilt table as it is “active” in that I participate rather than letting the tilt table and gravity do the “passive” work. The tilt table makes me feel as I am always falling forward in spite of my actually tilting backwards. It is amazing how quickly this injury and extended bed rest can cause you to forget or be unable to feel comfortable doing such simple tasks as standing. I am improving but I wobble laterally and had some difficulty in standing straight when upright.
(4) MotoPed - is a set of bicycle pedals that I can drive my wheelchair up to and strap my feet into. There I can set a rotation speed as well as pressure or force required to turn the pedals. With the speed set the unit will passively rotate my feet in order to stimulate the muscles and get the blood and fluids moving. This keeps the muscles supple and perhaps assists in preventing thrombosis (blood clots). I set the unit to 60 rpm at which point it will engage and move my legs around in a circle. As I have regained mobility in my legs, I am not content to let the unit passively move my legs so I take over and pedal above the 60 rpm threshold taking the rpm’s to between 80 and 110 rpm. That is all my own work! In about 30 minutes, I can pedal the equivalent of 14 km (about 8.7 miles).
(5) Hand Cycle - again is a cycle unit that I can wheel up to and use to exercise and increase my metabolism by turning the arm pedals with my clenched hands. Tension can be dialled in to increase resistance. I generally add resistance (tension is rather subjective) and rotate the arms for about 20 minutes. Works up a sweat.
(6) Swimming Pool - this salt water pool is heated to above room temperature. A hydraulic lift with a seat or bed can raise the patient into the water. The salt inhibits many bacteria and makes the water more buoyant. This therapy is a real treat as for one hour per week I can get the pressure off of my butt. In it I can do exercises mimicking the tilt table and standing frame. Gripping a hand bar running along the edge of the pool I can find a suitable depth and do knee bends. Most other muscles can be exercised as well utilizing the resistance of the water. My years of canoeing has made me comfortable with water and I was able to swim the length of the pool under my own power with my legs fluttering in a kick stroke. An added treat is when the water jets are turned on. Turning my back to these water jets I can get an intense massage which feels particularly good on the area of my back where the surgical scars are as it still feels very tight.
(7) Quad & Hamstring Bench - This is a simple bench which is a bit of a challenge to get on to from the wheelchair simply because of the height difference between the wheelchair seat and the seat of the Quad & Ham apparatus. Once seated there are two "arms" on the side of the seat onto which weights can be placed. By placing ones leg calf against an extension on the arm you can press down against the weight to exercise the hamstring muscles or by placing your shin against the extension you can lift the weights thereby exercising the quad muscles. I found that I didn't use this apparatus for very long as my muscles had already strengthened to where other exercises were much more beneficial in progressing.
(8) The Biodex - Probably a trademark name. The apparatus consists of an adjustable seat which faces a mechanical post. This post has a variety of attachments which are chosen depending on the injury and exercise required. In my case, an arm was attached onto which my leg was strapped. I would move my leg my knee joints extremes (first straight out then bent at the knee over the edge of the seat). The limits are entered into the machine and these parameters become the range over which the leg motion will be measured. The apparatus has a second part which consists of a computer, monitor and printer. The computer is used to set the physical parameters of the exercise. The range of motion, the resistance etc. The program can vary within a session as I explain further.
Once seated and the parameters entered the machine beeps and I try to kick (straighten) and contract (bend at the knee) as hard as possible - up and down for 10 repetitions. There is a 20 second rest period and the sequence repeats, perhaps at a different resistance. Sometimes it is harder and other times it is lighter (easier). This is repeated for a pre-set number of times, often 10. The computer can measure the force exerted by the quad muscles and the hamstrings and can keep a record of the total work done. I did this exercise each of 4 days of the week for several months. Retested at that time my exertion and total work done could be compared to my initial results. A computer printout shows the percentage improvement and of which particular muscles. I was happy to find out I had improved 60-100% depending on the muscle group. It also calculated that there was less than 10% difference between left and right legs which means that both sides have, for all intents and purposes, the same strength and that my injury resulted in symmetrical damage. This machine was useful in both strength training and in evaluating progress made.
(9) Parallel Bars - I am about to progress to the parallel bars where I'll try to master the new custom made leg braces that I have obtained. More on those later. The parallel bars simply assist one to lift, stabilize and balance once standing from the wheelchair seat. It is here where one learns to walk again by taking steps.
(10) Watch this space - I’m sure other exercises and apparatus are in my future.