Tendo AB's Exoskeleton (Hand Unit)

This article in Health Europa describes an exoskeleton that could offer greater independence to people with high spinal cord injuries.  A modified space technology designed by Tendo AB, the new exoskeleton is a minimalist system for users with compromised hand strength or motor control.  The technology may be expanded to focus on other limbs, such as the elbow or knee.  Since the exoskeleton "(uses) the body’s signals as a source," it will be interesting to see what beneficial effects the device might have as a therapy tool.  There are many possibilities here; the hand technology alone has the potential to change many lives for the better.

Graduate Max Ahlquist's Recovery Story

 Max Ahlquist was paralyzed in a rafting accident, but he has had a miraculous recovery and continues to work hard in his physical therapy.  His positive story is one worth sharing, like the news that he has graduated as co-valedictorian and is now moving on to college.  Congratulations, Max! 

Using KAFOs and a Mobility Scooter (Video)

Today's video is posted in response to a question someone asked about mobility.  When starting to use KAFOs (knee-ankle-foot orthoses) and trying to navigate a college campus, I was blessed to be provided with a mobility scooter.  This video shows how well the KAFOs worked with the scooter, even when I was relatively new to long leg braces.  Between the two, I gained an immense amount of independence.  (This clip is also featured in my video "6 Years in 6 Minutes," where you can see how the scooter works similarly outside on different surfaces.)

Scooters are not always an option if you have a spinal cord injury.  I could not have used one in the first year post-SCI due to the extensive spinal damage caused by the original accident.  As time has passed, a scooter has been a great device for me.  It's especially nice to be able to swivel the seat and not have to avoid a footrest when standing.  The scooter is easier on the wrists and shoulders than a manual wheelchair is, and can go over more terrain without trouble.  Several types of scooters give increased accessibility because they are smaller, as well.  The prices of scooters vary widely and you may find foundations or other groups able to help with the cost.  

A scooter is not an option or best choice for everybody with an injury or neurological condition.  Obviously each user who does try a scooter will find disadvantages and advantages for the individual situation.  But for those who are curious about life with KAFOs and wondering about possibilities, maybe this video will be a help.  

Note: if you have a spinal cord injury and are considering a mobility scooter, make sure to research the size and padding of the scooter's seat and foot area.

Liam Wagner's Milestone Walk

 This is an encouraging story about Liam Wagner, recovering from a spinal cord injury four years ago.  He walks three times a week with forearm crutches and is working toward walking a mile on September 12th.  Now he is hoping to use "Liam's Milestone" to raise money for adaptive equipment for others. 

Prayers for Memphis H.

Six-year-old Memphis sustained a serious cervical SCI in June.  It's good to see that she is getting support and encouragement: she can look forward to having her own service dog in a year, thanks to some South Florida Foundations and Furry Friends adoption.  Memphis has a lot of rehabilitation ahead of her.  Please keep this little girl and her family in your thoughts and prayers.

Getting KAFOs/ Long Leg Braces after Spinal Cord Injury

Today I'd like to share information about the process of getting KAFOs (Knee-Ankle-Foot Orthoses).  As usual, nothing here reflects a medical recommendation, professional opinion, or endorsement.  Note also that I receive no money or compensation for any of the products named.  I write about my own experiences and hope that they encourage others to keep moving forward.  Please seek advice from medical professionals and physical therapists. 

With that disclaimer, if you want to know more about KAFOs, where to start?  If you're like me and you have a spinal cord injury or similar neurological condition, or if you know someone who does, you may already have passed time surfing the internet.  I spent hours doing general research about leg braces.  There are a lot different types of bracing to help with therapy and functional walking.  HKAFOs (Hip-Knee-Ankle-Foot Orthoses) extend up around the hips and include a belt or back bracing, KAFOs generally run from mid-thigh down, and AFOs (Ankle-Foot Orthoses) are used for bracing below the knees.  (To learn more about types of leg braces and to see pictures, click here.)  Within these categories, realize that braces provide varying levels of support.  They may be sturdier for users with very little muscle function, or be relatively lightweight, intended to offer supplemental support for toe droop or knee buckling.  Newer models of some of these braces are mechanically assistive with springs, or feature robotic stance control that responds to muscle movement. 

Over time, I've tried HKAFOs, KAFOs, and AFOs of multiple types (thank you, Hanger!), including stance control C-braces, polypropylene plastic and carbon fiber AFOs, thermoplastic heavy-duty KAFOs, modular KAFOs (my name for the Allards Combo brand), and (H)KAFOs with a hip belt and the Up and Go bracket system for gait stabilization.  I consider myself blessed to have had the opportunity to experiment with various kinds of bracing.  Sometimes braces have to be fitted directly for the user and cannot be used on a trial basis, or are too expensive and rare for clinics to have on-hand.

To schedule an appointment with an orthotist, I had to have a doctor's written approval (a scrip).  Insurance wants the document to show that braces are medically necessary or beneficial for your health.  I talked with my insurance provider directly and asking about leg braces as authorized Durable Medical Equipment.  I would suppose that spine centers or specialty clinics devoted to SCI rehab have standard ways of doing all of this. 

The first visit at the orthotics clinic was an assessment of the injury and its specific impact.  This stage was mostly answering questions.  What muscles were functioning?  What was my level of independence at different tasks, such as sitting up or leaning over?  Did I have any walking ability?  I was using a wheelchair for mobility at the time and had a little hip function.  When my knees were blocked or locked straight, I could take small steps.  Information like this helps determine what bracing is viable.

For me, the results were almost a disappointment.  My request for braces was nearly turned down because my walking ability was very poor.  Fortunately, I had a great advocate in my orthotist.  If it hadn't been for him, the braces would never have happened.  (If you know much about SCIs, you know that opportunities can easily be shut down.  Don't be discouraged and don't give up.  Be persistent and pursue all your options.)

Fitting for leg braces was a separate appointment.  All I had to do was show up.  The casting process was fairly straightforward.  It just involved having measurements taken and being still while the clinician created a mold of my legs.

 

The molds were used to fabricate custom braces for use at home.  I picked up the braces  about a month later, approximately two weeks after the one-year anniversary of my accident.  Since we had been able to keep my body used to being upright, I did not have to go through any stages of readjusting, such as worrying about blood pressure problems or potential blood clots.  Getting used to the braces mainly meant wearing them for longer periods of time each day: an hour one day, two hours the next day, four hours the next, and so on.  By July 4, I could walk down the local trail just enough to view fireworks while standing.  It was a long and triumphant way from the hospital bed where I had been exactly a year earlier.  Well worth it!

Obviously that isn't the whole story about long leg braces.  There is much more to say about adjusting to them and using them for daily function, but I hope that these short insights will help others who are looking into leg braces.  Please contact me or leave a comment below if you have any questions!

Classics Column: "Not Your Virgil's Sinon"

Guest Column:

Not Your Virgil’s Sinon: The Greeks and the Man Who Tricked the Trojans

Thank you to Alex!

Image: Detail from The Procession of the Trojan Horse in Troy by Domenico Tiepolo (1773).  Public Domain. 

Headset for Hand Function

"Gaming headset design" meets "3D printing" meets "EEG" meets "Functional E-Stim" meets "therapy at home."  Everything here meets to accomplish a single goal: building a headset to encourage improved hand function after spinal cord injury.  The brainchild of PhD student Nina Petric-Gray (University of Glasgow), this headset device is being developed for users to work with from home.  3D printing, FES, home therapy, and gaming headsets (for VR rehab) have all been themes of my previous posts, so the headset caught my attention for many reasons.  Petric-Gray's invention is a creative synthesis of a lot of technologies.  Incidentally, for readers who want to know more about the headset, it's currently under trial in Glasgow. 

Happy Independence Day!

Thank you to our veterans. 

Two Articles from June

From the busy month of June, there are two stories I'd like to share today.

First, the encouraging recovery of Jacques Matellus, who suffered a cervical spinal cord injury in 2019.  A year later, he is walking again, expecting far more progress ahead!  

Second, the recent injury of Officer Shay Mikalonis.  Officer Mikalonis was shot in the head June 1st and has been diagnosed as paralyzed from the neck down.  He is on a ventilator and soon to begin rehabilitation.  His injury is extremely serious; please remember him and his family.

Please keep both of these men and their families in your thoughts and prayers in the days ahead. 

Sensation and SCI

Sensation after spinal cord injury is complex.  Every SCI is different, and in many ways, feeling and sensation are a testimony to the amazing intricacy of the central nervous system.

What do you physically feel after SCI?  It truly varies from person to person.  Some people have no sensation and no movement or muscle function, others have complete sensation and no movement, and yet others have no sensation and full movement or at least some ability to stand or walk.  Personally, I have a mix of sensation and function.  It's relatively little of what anyone else might call "normal" sensation, and more of what you might call "deep" sensation: noticing pain, the discomfort of a big wrinkle in a pant leg, or pressure on a bony part of the knee, for instance. 

An interesting aspect of sensation is how much you notice it when it's gone.  I have a much harder time walking without seeing my feet.  This is because the body subconsciously relies so heavily on feeling.  (Proprioception is the term for your body's awareness of where it is and how it is positioned.)  But if you have ever heard people say that they knew what had happened as soon as they suffered a traumatic spinal cord injury, it's true that you can tell the difference before and after injury, and it can be in an instant. 

Questions or suggestions?  Please comment below!

Video: About KAFOs

If you'd like to know more about what knee-ankle-foot orthotics are, how they work, and how they are worn, this video is for you.  More to come about both KAFOs and AFOs.  Questions or suggestions?  Please comment below!

Video Update (May 2020)

My video update today shows my progress using AFOs (ankle-foot orthotics).  In years of working with orthotics, I've found the trickiest transition to be from KAFOs (long leg braces) to AFOs (braces below the knee).  As always, every spinal cord injury is different, so not everyone would find this to be the hardest change to make.  For me, regaining knee function has proven a challenge.  Plus, the last time I was closest to making the switch occurred right before the discovery that my leg was what the doctors called "impressively" broken.  The broken leg had nothing to do with using KAFOs or AFOs.  It had everything to do with osteoporosis, a side effect of spinal cord injuries.  But whenever AFOs come up, I worry that something else might happen — and that others, thinking it had to do with the orthotics, will miss out on the benefits of KAFOs/ AFOs!

In future posts, I'll be saying more about both KAFOs/ AFOs, including what they are and how to use them on a daily basis.  I'm also going to talk a little bit about osteoporosis.  These are some of my most requested topics.  If you have questions or comments about what would be helpful, or if there's something that you're curious about, please contact me or leave a comment below. 

Carrying the Rosetta Stone . . . and Other Exercise-at-Home Adventures

Health and fitness are always huge topics, but with the COVID-19 situation, a lot of people are asking questions about staying fit while staying put.  For some with disabilities and injuries, being out of physical therapy is not only mentally trying, but also physically difficult.  It can really set you back.  Today, I thought it might be helpful to talk about ideas for therapy at home.  Please remember that none of this information is intended to serve as medical advice.  It's based on personal experience and/ or research, and has nothing to do with a professional capacity or recommendation.  (I'm a doctor, but not that kind of doctor; please, consult with your medical professional and/ or physical therapist for their suggestions and ideas.)

Today's post touches on information for exercising both the upper and lower parts of the body, especially fingers, hands, and toes.  My past videos and posts have primarily focused on exercises for the lower body, and mostly for larger muscle groups.  This is because my spinal cord injury occurred at the thoracic level.  While it was catastrophic, there was no cervical spinal cord trauma or lasting neurological damage to my arms, hands, or fingers.  It was a close call.  In the accident that caused the SCI, I sustained very serious upper-body injuries, including a broken neck, broken ribs, and collapsed lungs.  After being in Intensive Care and Critical Care, I had to relearn how to breathe and move again.  Again, thankfully, the nervous system was intact to at least T10 despite many broken bones in the cervical area, so for me, respiratory therapy mainly involved using a spirometer (a topic for another post).  Physical and occupational therapy had to wait.  It never occurred to me how much muscle mass had vanished from my arms and hands until about the first day of being allowed to eat again.  Wow, was that an eye-opener.  I could hardly lift a small half-glass of water.  Before then, I wouldn't have begun to be in any shape to think about maintaining muscle tone.

That was where Occupational Therapy came in.  The routine with OT involved everything from stretching Therabands and lifting one-pound weights to measuring pinch strength of the thumb and index finger.  By the time I left in-patient therapy, I could lift two-pound weights.  Still, when I returned to school in August 2014 and was handed an iPad, that device alone felt impossibly heavy.  My backpack was a supported pack with lumbar straps, and all I could tolerate in it was that iPad.  Glasses of water were easier to lift than they had been, but books?  I could barely lift a paperback, much less a typical textbook.  Daily living became the best therapy.  Without help for tasks during the day, I learned how to do small dishes, carry lightweight bags with a walker, and sit while transferring books between locations.  By 2015, I was picking up huge books from the library and carrying them against a walker.  (The triumph came on the day I hauled a Demotic Egyptian reference book back home and unfolded its life-size replica of the Rosetta Stone.  I call that "The Day I carried the Rosetta Stone.")

Fortunately, with the exercises here, you don't have to be able to lift the Rosetta Stone (which is great, because even if you had access to it, the real thing weighs over 1600 pounds).  And I've tried to do some of the "heavy lifting" for you with these links by giving some extra information.

Questions or suggestions?  Please comment below!  You can also learn more by subscribing to my YouTube channel.

FlintRehab: Clever ideas for building hand strength after spinal cord injury: flipping light switches, sorting small items like candy, popping bubble wrap, turning the pages of a book, etc.  Using a yo-yo or scissors makes this list, and so do painting and sculpting.

CareFirstRehab: A resource for stretching and strengthening your hands after injuries, this page has ideas that don't require many props.

VeryWellFit: With everyday items like hand towels, rubber bands, and Silly Putty, you can find some pretty useful exercises here.

BeachBodyOnDemand: This link includes photos of foot, hand, and arm exercises, plus lower-body workout suggestions.

Athletico: A lot of interesting ideas here.  I haven't tried working with laundry detergent bottles, but in a pinch, being caught at home under the coronavirus conditions . . .

WholeBodyHealthPT: Including a nice list of items with approximate weight values (e.g., 5 pounds = 1 bag of rice).

Theraband Hand Exerciser: A product and not really an exercise website, this link includes a guide to hand exercises using the Theraband hand exerciser.  Take a look at the PDF image for suggestions like pinching, compressing, and finger-walking.  Note: I haven't used this product.

Cordical Release: AccessiRep 1.1!

Cordical Announces AccessiRep 1.1

Awesome Gang Feature

Ifscapes: Empires and Androids can now be viewed on Awesome Gang's book promotions page! Available on Amazon, the ebook is marked down to 0.99 through noon (PDT) on April 4 and then will be available for 1.99 until 11:59 p.m. (PDT) on April 7. Thanks to Awesome Gang for the feature! Click here to follow the link.

Video Update (April 2020)

At long last, a video update of walking forward with the Lifeglider!  This recording dates to earlier this year (February). 

As a general note, it's inevitable that the COVID-19 situation is affecting people's opportunities for physical therapy and recovery.  Unfortunately, some with spinal cord injuries are also having even more serious problems finding help with everyday tasks and maintaining routines essential to daily health.  Due to coronavirus, they may have caregivers who are ill or unable to come, for instance, and they have to take extra precautions from the contagion.  Many of the same people already suffer in silence from ongoing isolation.  Please keep them in your thoughts and prayers!

Ifscapes Markdown

On sale April 1 — April 8

Ifscapes: Empires and Androids

0.99, April 1 until noon on April 4
1.99, noon on April 4 until 11:59 p.m. on April 7

Enjoy!

Coronavirus, the COVID-19 Outbreak, and Science Fiction

A global pandemic sounds like, and occasionally has been, the stuff of science fiction.  Science fiction is all about asking questions and pushing boundaries, speculating and considering, positing and challenging, making social commentary, dreaming up worlds or taking them apart.  Suppose the already dangerous COVID-19 was even more dangerous and that it was unleashed on a society in the near future.  Then push the idea further.  What would happen if a massive plague were to spread across the world as an unstoppable force, causing destruction and chaos wherever it went, in a time when the world was the capitol of a galactic empire?  Or when humanity was busy colonizing other planets?  What if the disease was discovered in another system and accidentally — or intentionally — carried back to the homeworld?  And then expand on that: what if the pandemic lingered?  What if the virus mutated into something else altogether, not a flu or cold or respiratory attack, but something that altered the thought patterns or anatomy of its victims?

Science fiction tackles these types of questions head-on.  The genre compels us to journey through scenarios that actually can happen or those that seem much too far-fetched to be real.  Sometimes, reading SF (science fiction, not San Francisco) leads us to think completely differently.  Mind-bending twists and turns, feats of the imagination, amazing technology, virtually everything is possible in the narrative.  Of course, the science fiction story may be an overtly speculative story, and it might pose a situation just like the one we have happening in our world right now: a worldwide pandemic of unknown impact.  COVID-19 is going to shape generations and societies one way or another, like it or not.  How?  Science fiction is not afraid to ask the question and to explore a multitude of answers.

Maybe you're finding yourself wanting to escape the pandemic by exploring other questions and answers in science fiction.  Perhaps you're itching for some excitement and travel, and need a good book or short story to launch you on your way.  Or maybe you stumbled on this post by accident looking for more information on Isaac Asimov's Foundation Series, in pre-production for Apple TV+, or on Arthur C. Clarke's vision of the space elevator.  Whatever the case, here's a short list of some great classic science fiction titles to help you get started with the genre or pass the time while in  Coronavirus quarantine.  If you're a veteran of SF, this list has some classics you might have missed.  Murray Leinster and E. E. "Doc" Smith, anyone?

A Quarantine Short List of Science Fiction:

Against the Fall of Night, by Arthur C. Clarke
Citizen of the Galaxy, by Robert A. Heinlein
Foundation Trilogy, by Isaac Asimov
Lensman Series, by E. E. "Doc" Smith
Lest Darkness Fall, by L. Sprague de Camp
"The New Utopia," by Jerome K. Jerome
"Sidewise in Time," by Murray Leinster
"Slips Take Over," by Miriam Allen deFord
Space Trilogy, by C. S. Lewis
Time Patrol Series, by Poul Anderson

"Times Without Number," by John Brunner
"To Serve Man," by Damon Knight

COVID-19 and SCIs

With COVID-19 going around, it's an especially good idea to practice good hygiene and to be cautious about where you go and what you do.  But in the meantime, since people with spinal cord injuries are technically included in the "higher risk" groups for contracting Coronavirus, today's links lead to some resources specifically geared toward SCIs and COVID-19. 

Have you found other sites with really helpful information about SCI and COVID-19?
Please contact me or comment below!

https://news.shepherd.org/qa-coronavirus-disease-2019-covid-19/
https://www.christopherreeve.org/blog/life-after-paralysis/the-flu
https://www.spinal.co.uk/news/coronavirus-and-spinal-cord-injury/

Book Announcement: "Ifscapes: Empires and Androids" on Amazon

Happy Leap Day! To celebrate February 29 this year, I’m releasing my first short story collection, Ifscapes: Empires and Androids, featuring meta-myth, science fiction, and fantasy stories inspired by the ancient world. The book is exclusively available as a Kindle ebook on Amazon for $2.99. Please consider downloading a copy and leaving a review. Thank you to my readers and reviewers!

From the book description: "Alternate history, possible worlds, parallel universes, and counterfactuals/ contrafactuals come together in these speculative reimaginings of classical history, myths, and characters. Twelve stories feature a wide array of themes and translated excerpts from actual Greek and Roman texts, all injected into visionary future-pasts. This collection is for anybody with a taste for adventure, enthusiasm for the unknown, a penchant for science fiction or fantasy, or just a passing interest in antiquity or its literature and languages."

TruST Force Field

In this study from Columbia Engineering, researchers are designing a new rehabilitation device to help people who have limited trunk control. Trunk-Support Trainer, or TruST, is a unique idea: it's an assistive tool intended to increase users' sitting and balance abilities over time by retraining better postural control. Depending on the level of spinal cord injury (or on the severity of certain other neurological conditions or diseases), lack of torso control can represent a serious issue in everyday life. In response to the problem, TruST is supposed to help users improve their posture and regain more mobility. Researchers are calling it a "force field." Not quite the typical science fiction type of force field, but it's a clever concept, and I hope it turns out to be a useful one.

Video Update (January 2020): Using a Treadmill

One time several years ago, while we were walking in a grocery store, someone approached my family to ask about my injury.  When she heard that it was paralysis and then recovered from the shock of realizing how serious that was, she smiled encouragingly. 

"Keep it up," she said.  "That's some determination."

After she had walked away, my father laughed.  "There's a fine line between desperation and determination," he remarked.

The woman's kind words and my father's response have stuck with me.  It's true: life with a spinal cord injury can sometimes seem pretty desperate.  It's often a battle, which is one reason why setting goals and staying motivated are extremely important. 

At times, that line between desperation and determination does become very fine.  How to tell the two apart?  I don't take much time to think about it.  But I do have to laugh about the distinction again today.  This winter, after years of waiting, I've finally gotten to something that I have been determined to try: using a treadmill. 

As you can see in the video, it's not conventional.  Yet it's walking — and more importantly, it's working.  I don't think that I could have done this last year.  Almost seven years in, and seeing progress?  Yes, and I am thankful for it.  This newest exercise is another promising, hopeful step forward.

Still, there is a vital difference between desperation and determination.  The word "desperate" is derived from the Latin word desperatus, from the verb despero: "to despair," "to lose hope," "to give up," and "to be hopeless."  If you are desperate, you are in despair.  You have no hope.  Determination, on the other hand, comes from the Latin verb determino: "to bound" or "to limit."  To determine means to set a limit and to fix a boundary: metaphorically, to resolve on reaching a goal, or to be firmly decided about something.  Broadly, determination is about resolution and direction.  Desperation involves giving up and feeling like you have no hope.  Determination involves giving direction and keeping hope.  Personally, I find my hope in Jesus Christ, and that helps me move toward a bigger goal than what I can see. 

For now, I hope that this video update encourages you (and maybe gives you ideas for working out if you have the ability, especially if you, too, are constantly recovering or maintaining your health with physical therapy).  Reaching goals may not always look conventional, and might take time and creativity.  I don't know what the next day holds — and have had some huge setbacks along the way — but walking on a treadmill is a pretty big deal when you were told you would never be able to walk again at all.  Never give up.

A Witness

"With God, all things are possible." - Matthew 19:26

News Note on an Experimental Treatment

This is truly exciting.  I'll let the title speak for itself:
"Experimental spine treatment helping Lawrence man, paralyzed from the neck down, move again."

Happy New Year!

Six years ago, in January 2014, I began to use the kitchen sink and some pillows as a makeshift standing frame.  Having a place to work on standing was a turning point in regaining muscle function on a basic level.  My back had been so injured that on the first day it tolerated just four minutes of standing.  By the spring, I was leaning against the counter for fourteen hours a day, and not long after, I was able to start using leg braces to walk.

We often say that the beginning of the year is a time for new opportunities.  Every January, remembering the changes that started in 2014, I look ahead to what the next year brings.  Opportunities can come when and where you least expect them.  January happens to be an especially good reminder of that.

“The object of a New Year is not that we should have a new year.  It is that we should have a new soul and a new nose; new feet, a new backbone, new ears, and new eyes.  Unless a particular man made New Year resolutions, he would make no resolutions.  Unless a man starts afresh about things, he will certainly do nothing effective.” — G. K. Chesterton