20 March 2016

Martyn Ashton Is Soooooo Inspirational For Me! :: Bruce Snyder's Status



Imagine for just a moment, if you will, you are going through your day and everything is routine -- you take the kids to school, you collaborate with some co-workers, you eat some lunch and then you head outside for a bike ride. You are enjoying the weather, riding your bike and suddenly something goes terribly wrong. You don't understand, you hear someone screaming but you can't figure out what is happening. Then you realize... the screaming is you.

Blinding pain, you are bleeding, breathing is getting increasingly difficult, you are physically unable to move your legs, paramedics telling you things you don't understand, doctors and nurses running frantically and then blackness.

When you regain full consciousness in the hospital a couple of weeks later, you are confused and scared, still unable to fully comprehend the situation. Then reality sets in like a swift blow to the head as you become aware that the last two weeks were not a horrible, dark nightmare.

This is what I lived through from my cycling accident. Nearly two years later, I am now making it out the other side of my injuries and this video of Martyn Ashton back on his bike is the most inspirational thing that I have seen so far! Thank you, Martyn! I recommend watching it in full-screen mode with the volume turned up so you can hear the laughter of these friends as they help their buddy get back to the sport he loves.
'I am now making it out the other side of my injuries and this video of Martyn Ashton back on this bike is the most inspirational thing that I have seen so far!'
The joy on Martyn's face at getting to ride his bike again is amazing and seeing his friends set him up on his bike and careen down the mountainside together bowls me over every time I watch it. I dream of doing this again one day!

Martyn Ashton has been a professional mountain biker for over 20 years and in 2013 he experienced a spinal cord injury while on his bike. Martyn is now wheelchair bound, his life changed forever. To understand why this video has such a dramatic efffect on me, check how talented Martyn was on his bike before his accident in this wildly popular video of him (nearly 1.2 million hits!). This is truly inspirational for me and I wish Martyn continued success!

For an interview about the main video I posted above, check out this interview with Martyn.


28 February 2016

We Have Movement! :: Bruce Snyder's Status


After nearly two years of no movement below my knees, I was pretty surprised to discover recently that there is movement in the achilles tendons on both my legs!

Back in late January, I went back to Craig Hospital for the annual re-evaluation of my spinal cord injury. During the four days of poking and probing my body, just like last year, they told me again, 'According to your internal organs, we can't tell that you have had a spinal cord injury.' This does not mean that I am unaffected, it means that I do not have the deterioration of internal organ function that they commonly see in the kidneys, liver, etc., etc. after such an injury. Many paraplegics are in a very bad way internally due to a whole host of issues that arise as side effects to the nerve damage. For example, I still have to deal with bladder and bowel issues from the nerve damage. These issues have improved significantly from the time of the injury nearly two years ago, but I am also lucky enough that my injuries were not as bad as they could have been. (I could go on an on about the degrees of damage here but I will spare you the details.)

There were two really positive discoveries during my re-evaluation, improvement in sensation and some new movement. The first discovery that I have much more sensation in my hamstrings, lower legs and feet than I realized. Nerves heal at such a slow rate that it's difficult to gauge the level of improvement on any given day. But if you have a baseline against which you can measure, then you can quantify the amount of improvement. I knew that the sensation had improved, but it was difficult to tell how much it had improved. Additionally, if you know anything about nerve sensation then you know that there are different flavors of it -- basically soft/light touch to heavy touch to sharp touch (and everything in between). Interestingly, damaged nerve sensation can go from numb at one end of the spectrum to hypersensitive at the other end. So they tested much of my body for nerve sensation and compared my current results to the results from one year ago as well as against the initial injury. The result was that the improvements were rather significant.

If you look at the two images above of the nerve dermatomes, pay attention to those from the waist down related to anything L3/L4 or below (the vertebrae in the lower spine including L3, L4, L5, S1, S2, S3, S4 and S5). Right now I'm dealing with sensation issues in my feet, lower legs, hamstrings, tailbone and crotch areas. The great thing is that my body is still healing and nobody knows how far it will go over time.

The second discovery was that the achilles tendons in both legs have some movement! There was just barely movement there, but it's movement nonetheless. It is very similar to the way that my butt/glutes returned. This new movement in my achilles tendons was such a minor amount of movement that I did not believe it at first. However, as my glutes have recovered and rebuilt, I have also learned that even minor movement can snowball over time into much more movement as the muscles are rebuilt. My glutes have largely returned, but they are still not 100% and won't be for some time, so I continue to work on rebuilding them. The same will be true for my calves. Right now my calves are basically gone due to the muscle atrophy. But, over time, I will enlist my calf muscles more and more and they will rebuild. In fact, in the 30 days or so since the movement in my achilles tendons was discovered, I can now feel that my calves are just beginning to engage. But only just beginning. It's going to take a lot more work over a long period of time before I can visibly produce dorsi- or plantar-flexion of my feet (which is driven by the calf muscles and the tibialis muscles).

As I have been telling everyone for the last year, in addition to waiting for my nerves to heal more, the big focus of my physical therapy has been fighting back against the severe amount of muscle atrophy that occurred as a result of my injuries and immobilization. It took me a while to realize that the muscle atrophy was something from which I could recover (as long as there was movement). At first, I was so weak from the immobilization after the emergency surgery and spending nine months in a wheelchair that I just assumed that the weakness was caused by and part of the paralysis. To a certain degree this was true, but what I have learned over time is that if I have movement I can rebuild the muscle. There is such a thing as having the movement return but perhaps not having 100% of the sensation return. Another positive thing is that I have experience dealing with muscle atrophy. Having dealt with it way back in high school with my first couple of knee injuries, I understand the dedication and hard work required to recover from muscle atrophy. It takes a lot of consistent, deliberate, difficult work to rebuild muscles that have shrank away. As many people have asked me, 'Are you still going to PT?' and my response is, 'PT is a way of life for me, it won't stop for years.'


Anyway, because the movement is starting to return, I was fitted for a new kind of braces (this is the third type of braces now). The type of braces I need are called ankle-foot orthotics or AFOs. The first type of AFOs I had were rigid hybrids comprised of aluminum struts with plastic foot and calf beds. The second type of AFOs I had were rigid plastic with some carbon fiber reinforcement around the ankles -- rigid meaning no flexion whatsoever. I am now on the third type of AFOs and these are known as dynamic response AFOs and they are made of carbon fiber.

See the image to the right and notice that there is only a thin strip of carbon fiber along the back of the achilles tendon area. This strip is flexible for two reasons:
  1. To enlist the calf muscles in the stride
  2. To rebound or spring back once it is loaded from the ankle flexion providing a more natural stride 
Just like the switch to the previous AFOs, these new AFOs changed my stride again. It's much more natural and I don't need to pick up my feet as much because my ankles are flexing naturally. The downside is that I am pretty damn wobbly right now due to my lack of calf or foot muscles, but this will improve over time. Also, my feet and lower legs are pretty sore from the new material (carbon fiber is not very forgiving -- I know this from owning several carbon fiber bikes). I have already had a couple of adjustments to them and I will need more. But it is also a matter of your body getting used them, kinda like a new pair of shoes but much worse. This will all improve over time.

Someday I will post all of the videos that Janene has made of me walking at the different stages throughout my recovery. It's pretty amazing to see the progress so far and I'm not even done yet. As I tell myself quite often, never give up.