Showing posts with label physical therapy. Show all posts

Maybe it was around the time I started jumping, skipping, and running in my walker that my physical therapist decided to switch to crutches. Mind you it wasn't the kind of crutches that dig a deeper pit beneath your arms but the kind you slip your wrists through, and then grip. I'd had my red walker since I was in Kindergarten till the fifth grade, and very rarely did the arm rests need adjusting (maybe once every 3-4 years?). My red walker was like my own mini-fort of safety, confidence, and independence. There were four prongs, the front two were wheels and the rear prongs had rubber stoppers. There was a front piece to it that served to connect everything together, and in my mind also served to stop me from falling over or from otherwise getting hurt. I used to turn around and sit on that front piece (even though it wasn't really a seat, and even though my P.T. said it wasn't safe). I could put my entire weight on that walker! I was able to lift it just enough off the ground to be able to turn corners, or even do a full 360 turn-around. Suffice to say I felt safe in that walker, it was with that piece of equipment that I learned to take my first independent steps in.
So when all of the safety, comfort, and security was stripped away from me I got nervous. Immediately the first thing I noticed while wobbling in my crutches was: there is nothing in front of me. My face could see the immediate floor in front of me. I then noticed how much of my weight I had distributed throughout my forearms with the walker. In crutches all of my weight seemed to be leaning on to two metal extensions, resting on rubber stoppers that were never completely flat on the ground - but instead always at an odd tilt, this made me nervous. What if it slipped? All I could see in my head was the replay of me face planting onto the pavement, crutches flying with arms and legs pointed in every which direction - kind of like a cartoon dog slipping about on ice skates.What if I forgot which I was supposed to move first - my leg or my arm? With the walker everything seemed so basic, so intuitive, it seemed like I had to relearn and reteach my body how to walk again. Had I really taken steps towards my independence? Or was I now just re-inventing the wheel?

"Okay, so which do you want to use today?" My middle school physical therapist had both my red walker and my new silver crutches in front of me. Without hesitation I pointed at my red walker.
"Well let's do some walking with your crutches first okay? And then we can play soccer in your walker, does that sound good?" 
"Fiiiine-uhhh" I grumbled.
Slowly and with a lot of patience from my physical therapist my body became used to the crutches. I found that I was able to stand with a lot more ease, move quicker, and suddenly my movement seemed to flow a lot more naturally. I was no longer pushing and jerking myself forward. Everything seemed so intuitive after a few weeks: I knew just how much to put my crutch forward without over-extending myself, I could match where my foot stepped to with where my crutch was, I understood the cross-rotating pattern of left-right-left-right-crutch-foot-crutch-foot. The weight on the palm of my hands where I gripped loosened over time, I was no longer as nervous, I was no longer scared of my new boundary-less independence.

It became clear to me that I became comfortable in my crutches when I used them on my own, at home. I knew that I preferred my crutches when I chose them over my walker when my physical therapist asked. And most of all my crutches soon became a natural part of my school day when I felt comfortable enough to walk with them around my friends at school. I was no longer limiting my use of the crutches when everyone else was in study hall and the pathways were safe for me to exercise in. I'd use them to go to lunch, I used them during P.E. class, and sometimes during the day when I was tired of sitting in my wheelchair.

The decision to switch from a walker to crutches reminded me of how resilient my body is despite its genetic fragility. It still shocks me how adaptable we are and how with practice even the most challenging and daunting experiences can become second nature to all of us.

The one thing I dread most about being discharged from the hospital after an operation or after I get my cast off is the physical therapy that follows. If you are a Physical Therapist I'm sorry, but all the PTs before you ruined it for me. As I am laying on the plush blue mat, they are always kneeling besides me with the condescending smile frozen on their faces:

"Can you bend your knee aaallll the way up to your chest for me?" She says as she tries to collapse my freshly de-casted leg towards me as if it were an accordion. Then it always gets to a certain point where my finger tips are digging into the mat, my face contorts into a wince, and I am trying to wriggle free from her grasp. My body is confused because it isn't sure how to interpret the strange sensation in my leg: is that sharp pain that I am trying to resist really just a muscle that hasn't been used in 5 months? Or is what I'm feeling a fracture on the verge of happening? Because whenever a P.T. is flexing, bending, or stretching me I always assume that she will snap something in half. I start to sweat, my stomach tightens into a knot, and I am literally waiting for that snap and then the burning sensation.
No dammit, I can't bend my knee all the way up to my chest for you! In fact I don't want to do anything for you! But of course I am old enough to know better than to snap at her, have had too many experiences to know that she won't break anything; and yet there I am, my body always resisting what she is trying to get it to do. Instinct? A deep mistrust I have of anyone touching me? Maybe it's because it always feels like she is forcing my joints to break through the rust? And doesn't that just sound painful?
Part of it is also because my body has memorized and internalized a lot of painful incidents. So as the PT is handling the latest traumatized limb or area of my body, I imagine that it is freaking out as she drags it kicking and screaming to re-visit the motions of the injury - except this time to do it correctly, safely, and in a way that won't put me back in fiber glass for another 3 months.

Several weeks later it'll be completely different:
"Wow! Look at that! See? I knew you could do it all along! You've re-gained complete range of motion in your leg again!" They are always right in the end, in my experience anyway.

Every physical therapy session I have attended is always a test to see what my body is capable of. It's probably because of the nature of the OI that this in of itself sounds so terrifying. Because usually when I have inadvertently learned what my body is capable of, it results in an injury, some painful fracture. So as I'm laying on the blue mat for 45 min at a time, I am usually trying desperately to be as mentally positive as possible - anything to make the flexing and stretching easier on me.


On Physical Therapy:

• I have yet to meet anyone who looks forward to attending physical therapy sessions. It isn't supposed to be fun! Having more realistic expectations of what PT is meant to accomplish can make the struggle less challenging
• As I have gotten older (both in part from the lectures my PT/ortho gave me, and from personal experience) I have learned that the rehab time following an injury is just as important as getting a cast on in the healing process
• Regularly including PT in the fracture management process helps young kids understand that rehab and PT are not separate to fracture care. Just because your leg is no longer in three pieces, or just because you have the cast off and everything feels fine - doesn't mean that we are in the clear
• PT sessions are not just limited to regaining range of motion or strength. There have been many instances when my body has gotten stronger than I expected it to, when I came out of PT more physically independent than I thought was possible. 
• And you know what they say, no pain no gain!

I could name all the major bones in my lower limbs before learning how to walk. It was around pre-school that I had my first long-leg braces (KFO's) made. They are remembered with great disgust: the plastic was always sweaty against my skin so I would wear tights underneath, my sneakers always looked overly bloated as I tried to jam the foot piece in, and the clunky contraptions seemed to weigh about the same as a newborn elephant. My doctors and parents tried to make them more appealing: When I complained about how hot they always were they cut holes into the braces, then they printed cartoon characters on them - the left foot had Tweety bird and the right foot had Road Runner. Still I would dread putting them on once a day before school and rip off the velcro coverings the second I got home - relishing the feeling of carpet and the denim from my jeans against my skin.

Today I don't remember how many times a week I went to physical therapy at Children's Hospital in Boston, but I would guess at least twice a week. I don't remember much about the sessions except that I seemed to not mind having to put my leg braces on for my first P.T. After all how could I? Her name was Sandy too. Vaguely I remember taking my first steps, ever. She had showed my parents how to properly place my legs inside my braces, making sure my heel was firmly at the bottom of the foot plate. She showed them how the velcro straps were to be snug but not too tight, and the way the metal locks on the side of each brace worked. A little piece would slide up to lock the knee in place and back down when I needed to bend my knee freely.
Sandy the P.T. had dark brown shoulder length hair and it wasn't long after that I asked for the same haircut. I wanted to be exactly like her! It didn't matter how short of a period I would stand for, how high I could lift my leg up by myself, or how much I shook and hesitated in her hands when I made my first steps - her smile stretched a mile long and I knew that if I could I would want to walk every centimeter of it. For that first time, after putting the leg braces on, she picked me up and stood me between two low metal railings. Instinctively I knew I was supposed to grab onto the two sides and as I did so she nudged my back straighter, and positioned my feet so my toes would always "point like a compass!" She dropped the locks on each side of my legs down and held my waist in her hands.
I don't remember if she told me how to pick up my leg, how to crook my ankle just so, and then bend my knee, and roll the bottom of my foot from heel to toe. Something tells me she didn't. Even though I couldn't walk on my own, I knew how to. I had watched my friends, my brothers, my parents, everyone around me was doing it - all I had to do was mimic the motions. It took me a few tries to understand the rhythm of which foot to move when, and then which hand on which rail that I held onto was supposed to move next. Sometimes I would alternate left foot first, and then left hand, followed by right foot and right hand. But that didn't seem natural to me so I alternated between foot and hand, left and right. Sandy the P.T., never criticized the way I walked, the weird shift in body weight that I would do with each step, or how my shoulders were so tense I looked like I was in a permanent shrug. She just let me go for it, and over time would correct my positioning, encourage me to try this or that.

Sandy taught me that physical therapy is more than just rehabbing your body. It's more than recovering from an injury or re-learning how to perform a certain task. The motions are slow, steady, and progressed according to each person and muscle. There's an aspect of exploration to P.T. that I looked forward to as a much younger child, it was during these sessions I knew Sandy would never hurt me - that she'd catch me every time I was afraid or uncertain whether or not my body could handle something. The curiosity that every 3-5 year old has for their physical boundaries was finally something I could delve into without fear or shock of any pain.

Physical Therapy/Early Walkers Suggestions:

• I remember when my mom was instructed to practice the P.T. routines with me at home she became less my mother and more my physical therapist. It was always one of the few times when she would let herself allow me to try standing on my own or balancing on an exercise ball without resorting to "BE CAREFUL!!!!"
• Sometimes saying "I know you can do better" can be interpreted as not fulfilling mom or dad's physical expectations. Instead, saying, "do you think you can try again?" Puts the expectations back on the child, letting him or her choose the bar to reach for the day.
• When I reached elementary/middle school age I would do P.T. during school hours. Friends and teachers would see me practicing walking in the halls; for some kids this is okay and they don't mind the questions or the look of awe when classmates first see them walking, but for other kids it might be too startling or not the right environment.
• It seemed like the moment I had figured out how to walk with my walker, I had suddenly launched into leaping, skipping, and jumping with my walker. Though I was always having a boat load of fun doing these antics, the adults in my life were frozen with fear. Expect the child to figure out how to do things other than plain old boring "walking" !
• I remember in elementary school that some times friends would join me for P.T. sessions; this was a great way to inform other kids of what I was doing and also allow me to feel less isolated when I was pulled out of my regular routine in school.
• After leg injuries sometimes walking just won't feel the same again, or it will take awhile before getting back into that groove. There have been several fractures I've sustained that make bending my knee all the way too painful or the weight I put on one leg more painful than the other. Understand that just because fractures are totally healed doesn't mean that every other function has returned to normal again as well.