Adventures in Neurorehab – Day 2: Gait, and Stairs, and Therapy Monkeys – Oh My!

Today was Day 2 of my 2 weeks at the Kennedy Krieger Institute in Baltimore, and I have to say, I felt a lot better about what we did today than what we did yesterday. Yesterday was a lot of measurements. Today, was a lot of work.

Since I want to keep this as part of a personal diary so I can go back and remember everything I did, here’s how the day went.

1.  First, Alison (PT) sent me to the Galileo (oscillating vibration plate) to try to tire out my calf muscles and relieve some of the spasticity in them (which is always worse in the morning). I did two 3-minute sets standing on it – one of calf raises and one of just standing.

2. Next up, Alison hooked me up to a sling (it looks quite a lot like a rock climbing harness) because I was going to do a lot of exercises on the treadmill, and to help make it a little easier for me, she hoisted me up a bit by hooking the sling to an attachment on the ceiling, so that I was 30 percent lighter than I actually am. I can’t say that I felt much lighter… because Alison also strapped an ankle weight to my leg that always has a harder time. I walked “normally” (as much as that is possible in this scenario), with her holding onto the back of the harness to help stabilize my hips. Usually, I don’t have any issues stabilizing my hips, but the harness is lifting you up slightly, which makes your pelvis want to rotate. After regular walking, I did side steps (both sides), and then a horrible set where I had to step over a pool noodle with every step of my (weak dorsiflexor/hip flexor) left foot. This was very, very hard for me, as my foot doesn’t clear the ground easily. I may have crushed the pool noodle… Finally, I got to walk without the pool noodle, at a faster pace. My Fitbit tells me the totality of the walking was 2500 steps, but I think it might be off as I had to be reminded to swing my arms. Your arms are through straps in this setup, so natural arm movement doesn’t feel particularly natural.

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3. Next, we went to the stairs (just a regular staircase, nothing special). First, Alison wrapped a heavy theraband around my left ankle and I stepped my foot forward to tap the step, lifting  against the weight of the band. I actually teach this exercise in my Pilates for Neurological Conditions courses. It really does work much better if you have someone holding the theraband. When I do it myself, I just tie it to a heavy piece of furniture.

After that, I walked up the stairs without holding on (I usually hold on, since my weaker foot likes to catch the step, which makes me more likely to fall UP the stairs than down them. But because this is PT, and I want (they made me) to do hard things, I walked without holding anything and then with my arms above my head. I also did sideways walking up the steps, bringing one foot to a step and the other foot adjacent to it, and going up that way. It was only difficult on the left side, so I did more reps on that side.

4. Our next exercise actually combined two exercises that I teach in my workshop. One is picking up marbles with your toes and moving them into a container. This works the intrinsic foot muscles. I’m actually very good at it, which I credit less to practice and more to the fact that my mom wouldn’t let us wear shoes in the house, so my foot dexterity is good (as I wear shoes as infrequently as possible, so my feet are pretty flexible). I did this adding e-stim to my dorsiflexors as I was lifting my foot (which I do by itself as an exercise). I liked combining the two because it cuts down on time.

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5. Then we put stim on my calves with the setting to TENS, which doesn’t make a muscle contract, but can help tired out the muscle fibers to relax it. I did sets of jumps with the TENS on, again trying to wear out my calves to cut down on the spasticity. I really want to try that out on my jump board, because in general, I can’t do jump board because my leg goes into a kind of spasm called clonus when I land from a jump. Perhaps with the stim being used in that way, it won’t happen. I’ll try it when I get home this weekend.

6. That was it for regular PT, but my main PT Kristen had suggested I would really benefit from dry needling, which I used to do regularly, so I said sure. Now, I remember my strong love-hate relationship with dry needling. It does really help loosen tight muscles. If you have a knot in a muscle, especially one just caused by a muscle strain, get to a dry needler asap. It works amazingly well. It also hurts like a bitch. Excuse my language, but that is mild compared to what I muttered under my breath/in my mind. In dry needling, acupuncture needles are inserted into a muscle, usually at a trigger point, and then wiggled around until the muscle has a spasm. Sometimes, these are really violent spasms (I have bent needles before). Then, for some reason I don’t think scientists have completely figured out, the spasm makes the muscle relax. Not right away, though. First you are very, very sore for a day or two afterwards.

The dry needling PT (Liza) has an identical twin who also works at Kennedy Krieger, which is cool, but also messes with your head when you wonder why Liza keeps changing clothes until you realize there’s also a Vicky.

Coolest thing of the day? There is a woman here who has a THERAPY MONKEY!! You heard me right. There are plenty of dogs at Kennedy Krieger, as dogs are the go-to therapy assistant animal. And anyone who knows me knows I am obsessed with dogs. Dogs, though, are not monkeys. I’ll try to meet said monkey tomorrow. I feel like we’ll be great friends. (To learn more about monkeys for spinal cord patients, check out this link!).

In health,


Determining an ASIA Score and the Role of a Physiatrist in Neurorehabilitation

Goal: 0 Percent Dorsiflexion (Adventures in Neurorehabilitation)