Thoughts on DBG's Recovery by a great friend

Nic Kanaan's insights on Daniel's ongoing rehab

FES Biking

Today Daniel did something quite remarkable.  When you see the video you probably will rub your eyes in disbelief.  I certainly did.  Today daniel was hooked up to a nerve stimulator, with patches that stimulate the quadriceps, hamstrings, and calf muscle groups.  He was then placed on a recumbent bicycle (Functional Electric Stimulation Bike). The electrical stimulators were then hooked to a computer that pulsated electrical signals to the muscle groups in quick succession allowing for a flow-like state of contractions that resulted in him not just riding a bike, but doing so fluidly for 4 miles.  The point of this exercise is to keep his lower extremity muscles engaged to reduce spasticity.  It is a bit magical to watch, and surreal.  And although it is not him powering his muscles through his spinal cord, it is a really amazing feat to view.  

Therapy every day

I can’t tell you how amazing it is to watch as Daniel continues to work hard and see the results of his efforts.  He is gaining more upper body strength on a daily basis.  With each PT/OT session he increases his abilities to lift and position his body without the use of his legs.  Watching has been quite a humbling experience, as you never think of how hard simple things in life can be when you can only use the upper ½ of your body.  Every transfer to and from his wheelchair is subsequently better than the previous.  His muscles still fatigue at the end of therapy, but every day is able to do more than the day before. He is actually getting "swolliosis" (i.e. Strengthening the hell outta his back and shoulders).  He is figuring out the physics, balance, and strength required to move himself around - and that is actually really exciting to see. His spirits are really high, and he doesn't seem to be sad or frustrated by any aspect of the injury or situation. He is smiling and laughing every day. He is giving the nurses a hard time as per usual, and giving constructive feedback and advice to the residents when they round. 

Trigonometry, levers, ergonomics, balance, and mechanical advantage 

These are the new realities that Daniel is becoming keenly aware of.  To sit up in bed without the use of abdominal or lower back muscles is incredibly difficult.  You realize that if you tilt your head just a few centimeters back and you can find a balanced position, but too far backwards and you’ll quickly and unintentionally be horizontal again.  For example, if you bend your knee in bed you can achieve extra leverage at the knee.  Get both legs square on the ground and you can translate your weight of your arms and shoulders down through them to the ground.  Move your legs wider apart and become more of a stable tripod position.  Lean too far backwards in your wheelchair and your arms become inefficient at wheeling forward.  Simply stated, the physics of movement have become ever present, and so much more necessary to understand and utilize in daily movements. This is Daniel’s new reality, and he will be the first to tell you that he is fascinated to be slowly learning how to take advantage and optimize all of this.

TLSO Brace 

The chest and back brace that Daniel is wearing is called a TLSO brace.  It is designed specifically for him and molded to his body.  Its utility is to protect his thoracic spine from damage or re-injury after his spine decompression and stabilization surgery (although there are screws fusing his spine where it was broken, the bone is not yet stable).  It acts similar to a cast for the spine.  He doesn’t have to wear it when he sleeps, but otherwise this chest piece is a piece of him until December when it can come off.  It makes a lot of movements a bit more difficult due to the inability to curve or bend about the spine.  Daniel keeps joking that he wants to get a sharpie and get “THUG LIFE” written in old english on his chestplate.  I think its a pretty damn good idea.

Hanging around.

This is where amusement park ride meets medical care.  Daniel has a motorized lift that connects to the webbing straps on a fabric chair.  With a hand-held controller he can raise it up and down, suspend himself in the air, and then glide along a series of tracks on the ceiling of his room that will take him anywhere he wants to go.  Its particularly helpful to get him to the bathroom and shower.  And as a bonus, when he cranks himself up as high as it gets - he and I are finally eye to eye.      

Standing room only.

Here is Daniel on the standing machine.  It blocks his legs from moving and then ratchets his hips up into standing position.  The idea is to get the body used to swings in blood volume from the upper body to the lower extremities, as well as stimulate the bones with his axial skeletal forces against gravity in order to promote bone strength. Due to his poor lower extremity autonomic regulation (vascular tone is maintained by sympathetic nerves which are disrupted in the injury, so his lower extremities do not modulate blood flow and pressure effectively anymore), this is also the machine that normally results in hypotension, tachycardia and seeing spots. But somehow today he had none of those symptoms, even after 30 minutes of standing!  So thats some pretty good news.

Another Day, Another Lesson.

Funny story here.  Today the nurse came in to give a flu shot and asked Daniel where he wanted the shot. Reflexively and without thinking he pointed to his non-dominant arm and said “left deltoid please”.  I interrupted him, “Are you sure Daniel?”, to which he replied, “yeah, that’s where I always get it”.  The nurse then pointed out that the thigh would probably be a more comfortable place to get the shot.  You see one of the small benefits of this situation is that now Daniel gets to have the benefit of the flu shot without feeling the needle or the sensation the next day like someone punched you. Cherish the small victories.