Are you ‘unmovable’? Therapy seen as changing that

I like T-shirts. I especially like T-shirts that remind me of places I’ve been or things I’ve experienced. One of my T-shirts has Japanese characters on the front, and since I don’t speak or write Japanese I’ve had to trust what I have been told the characters mean: Perseverance and Determination. It turns out that what I was told is not entirely accurate.

Over the years more than a few Japanese strangers have commented positively on my shirt and have either struggled to translate what is idiomatic or struggled with their English skills. The last person I bumped into recently connected, in poetic fashion, all of the previously attempted dots. The best translation of the characters is: Someone with very deep roots who therefore cannot be easily moved or thwarted. Unmovable.

This translation is a beautiful irony, because the shirt comes from Project Walk, a paralysis recovery and fitness center in San Diego that just opened a center here in the Twin Cities.

To say that folks with paralysis are not easily moved is an understatement both literally and metaphorically, it typifies both the body and the spirit of the clients who roll into a Project Walk facility week after week.

Two weeks after my son was discharged from his three-month stay at Gillette Children’s Hospital in St. Paul, we flew from Minneapolis to California in order to attend Project Walk. The trip was not only a challenge, but even a bit scary. This was the first time we had travelled unaccompanied by any medical professional since he was paralyzed between the jaws of a wave and a sand bar 2,500 miles from home.

In 2008 it was one of the few if not only places you could go for what is most often referred to as activity-based therapy (ABT). This therapy initially grew up out of exercise science, not traditional physical therapy (PT). The fundamental difference being traditional PT has historically focused more attention upon a compensatory model of therapy: working on the functions you have left, at or above your level of injury so that you can best learn to compensate for your paralysis. ABT with its roots in exercise science, suggests that we work the areas above and below the injury and thereby place the demand back on the body that paralysis has taken away.

ABT is also an outgrowth of the relatively new understanding of brain science, referred to as neuroplasticity. Neuroplasticity has essentially replaced the formerly held notion that the brain (and central nervous system) was thought to be an organ that could not change after injury. In other words, once the brain and central nervous system fully develop, they are now hardwired. If the wires are damaged then the corresponding functions are lost. Neuroplasticity on the other hand suggests that the brain’s physical structure as well as its function have the capacity for change when given the proper stimulation and experience.

This is the heart of ABT: providing the proper, repetitive and challenging stimulation to the body creates the possibility to rewire spared nerve pathways, regrow some connections that have been lost as well as give an individual, who has lost the ability to independently ‘get a workout,’ the opportunity to improve and maintain some physical fitness. This is accomplished by a therapist or trainer actively assisting an individual with movements they are not capable of performing on their own. In addition, most of these activities are “load bearing,” meaning they are performed out of the wheelchair and with either the full or partial effects of gravity, such as body weight supported walking, standing, squats, elbows and knees, wrestling and more.

Even for those clients who may not find significant functional change, it is nonetheless incredibly important to continue exercising given the complications associated with paralysis. These are complications most akin to accelerated aging as a result of the body’s sedentary state. Exercise, especially exercises that engage the whole body like walking, help to mitigate complications like (but not limited to) pressure sores, urinary tract infections, respiratory ailments, spasticity and depression.

New developments in neuroscience such as the announcement of the four paralyzed gentlemen in Louisville moving lower extremities and recovering bowel, bladder and sexual function with the aide of epidural stimulation captured the attention of the world back in April 2014. It should specifically alert those with paralysis regarding the need to be physically prepared. The innovations that are being developed will not have the maximal benefit without the aggressive activity based exercise to battle or work back from bone loss, contracture, muscle atrophy and learned non-use. This is also true for other CNS disorders such as MS, cerebral palsy and stroke, which is why Project Walk is a paralysis recovery center, no longer specific to spinal cord injury.

In addition to the beautifully constructed characters on the front of my T-shirt is a quote from Confucius on the back: “It does not matter how slowly you go so long as you do not stop.” Are you unmovable?

Matthew Rodreick is the site manager for Project Walk Twin Cities. He can be reached at mrodreick@projectwalk.com