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Steve Collins go ima i na klipovite posle 2 godini ABR.Tuka
A nadolu e tekstot za Iskustvoto na Steve so ABR vo izminatite 9 godini.
and the rebuilding of a spinally injured body
A Life of Disability
My name is Steve Collins and this is the story of my life through the years of disability and the slow but steady return from paraplegia to full, able bodied health.
Until the age of twenty I was travelling through life much as any young man does. Being academically bright, I had embarked upon a degree in Engineering Product Design and was looking set to soon be dressing up in a suit and tie to pursue a career in manufacturing industry. My life however was about to get a rude awakening. On 23 rd September 1988, while out cycling with friends, I was knocked off of my bicycle, left unconscious in the road and then run over by a following car. My right foot was totally dislocated with an open fracture at the ankle. My left knee was badly damaged and I suffered a fractured skull leaving me with a permanent loss of hearing in one ear. Life was never going to be the same again.
In the true British fashion of stiff upper lip and dogged determination, I was not going to let this beat me. I got out of hospital, got out of the wheelchair, got off of the crutches and only four months after the accident returned to college, full of enthusiasm to get on with life. I finished my degree, but by the end of it was a down trodden man. Despite my efforts, my injuries were getting the better of me. Walking was difficult and painful and my hearing loss was impairing my ability to interact socially. I was disillusioned with our world and had no desire to take up a career in Engineering Design; manufacturing industry symbolising much of what I had come to despise about our modern world. I returned to my home town and got a part time job as a gardener.
Through all of this I never lost my underlying thirst for living, but my ventures and adventures are stories for another time. The sad fact is that my health continued to decline until my twenty fifth birthday when I finally realised that I needed to take responsibility and that is exactly what I did. My doctor referred me to the leg class at my local physiotherapy unit and after attending there two mornings a week for the best part of a year, I joined a yoga class. I took a real interest in my posture and one day threw away my arm chair and proceeded, from then on, to sit cross legged on the floor. Next I dispensed with my shoes, at times, and walked for miles bare footed, learning to use feet in a way that is not possible with them cramped in shoes. I worked hard and slowly improved my level of fitness until three years later, although still having to cope with the damage to my legs, I felt I was ready to move on in life and put this episode behind me.
The trouble was, I didn’t know where to go next. In order to try and make ends meet I was labouring on a landscape construction project, a job that wasn’t really for me and with hindsight I should never have been doing, but nonetheless I was until fate intervened. On 1 st August 1996, at the age of 28, I was driving a dumper truck up a slope when I managed to turn it over, crushing my body underneath it. Roll cages were not yet fitted and so with the full weight of the dumper pressing down on me, my back was quite literally snapped in two. My head was in my lap where it had never been before, my lungs were crushed, I couldn’t breath, I thought I was dying and passed out. Only thanks to the swift actions of the friend I was working for did I survive. He freed me from underneath the dumper truck, got me breathing again and kept me alive until the ambulance arrived.
Later that day I was taken by Coast Guard helicopter to the specialist Spinal Unit at Salisbury District Hospital. I had serious crush fractures to T12 and L1 vertebrae (they had basically exploded on impact) and a broken collar bone. I will never forget the words of the consultant as I was admitted. Referring of course to my body, paralysed from the waist down he said, “…with the damage you have done, you shouldn’t even be able to feel anything. You will never move anything ever again!”.
The Way Ahead
While in hospital a friend came to see me and she spoke these words, “that first accident was just preparing you for this one”, and she was right. There was nothing easy about coming to terms with paralysis and it made my previous injuries look like a drop in the ocean, but my experience stood me in good stead. Seven months after breaking my back I left hospital and have never looked back. Whereas before I had to struggle to make ends meet with my injuries entitling me to no financial support, despite the fact that I was not fit enough to do a full week’s work, now, for the time being at least, I no longer had to think about work. I could concentrate on learning to live with a damaged body, something I was very good at. People rallied round me and I found a compassionate side to life that brought years of disillusionment to a close.
Slowly my body settled down into its new physical state and I had learned to deal well with getting around in a wheelchair. My collar bone, however, was troubling me badly. Despite my vain attempts to get it seen to whilst in hospital, I still essentially had a broken collar bone. The two halves were so overlapped that they had only joined fibrously and gave my shoulder little support. There is a strange attitude that prevails within the health profession, that because one is severely disabled it is acceptable for one to live with such further disabling injuries, when in reality my collar bone had never been more important to me. Someone who is otherwise fit and strong could live without too much trouble with a broken collar bone, but what many doctors seem to fail to comprehend is the dramatic increase in importance of the arms when paralysed from the waist down. I rely on my arms for every movement I make and it is inconceivable that I should be expected to live with a broken collar bone. Anyhow. Finally, after much persuasion, I manage to get a surgeon to agree to bolt the two halves back together for me, over two years after it had been broken!
The operation went well and it was while recuperating at a Cheshire Home that a new chapter of my life began. The founder, Leonard Cheshire, had died some years before, but I found in him a kindred spirit. His vision of communal living was something I had long yearned for and I realised that I had much to offer the home. A few months later, three years to the day after I broke my back, I moved in to the Lodge at Heatherley Cheshire Home; a run down old cottage which my mother described as ‘virtually derelict and unfit for human habitation’. She didn’t worry though; I was in my element and she knew I’d survive. I’d struck up a deal that allowed me to live there cheaply in return for what I did around the place. Life had purpose once again and good use to which I could put my skills.
Slowly but surely I renovated the cottage, created a garden, managed the land with geese and sheep and did all I could to help others at the home. My projects have been numerous and each one is a story in itself, but we are not concerned here with the building of my life but with the rebuilding of my physical body.
Life in many ways was better than it had been for years, but trying to live an active life as a paraplegic was physically hard. As a relatively young man I could soldier on, but such an approach will inevitably catch up with you in the end, however good you are at using a damaged body. I was worried for my future health.
One day I volunteered to accompany a severely disabled resident to a centre in East Grinstead and it was there that I met Leonid Blyum. I watched him working with children with cerebral palsy, and their mothers, and saw that he somehow understood the workings of the body beyond the comprehension of the established medical profession. I knew then that he would be the man to guide me in my rehabilitation.
Advanced Bio-Mechanical Rehabilitation
ABR, as it is known, is the brain child of Leonid Blyum, a Russian gentleman, with whom I teamed up in 2001 and whose guidance I have been working under ever since, making enormous progress in improving the structure and function of my physical body and putting me well on the way to a full recovery from spinal injury. The therapy is based upon an understanding that represents a fundamental shift in the way that we view the bio-mechanics of the body.
The Threefold Aspect of the Physical Body
In comparison with the traditional view of the body that sees the hard, bony skeleton as being solely responsible for the body’s form and stability, ABR recognises the role of the smooth muscles, and other internal tissue structures that make up the core of the body, as the primary level of strength, providing stability. These tissues form the major cavities of the body, cranial, cervical , thoracic, upper and lower abdominal, together with the individual organs and smaller structures they contain, creating the multitude of compartments that each has a volume, density and pressure, combining to provide pneumatic capacity and therefore stability. It is not that these cavities contain air in quite the same way as, say, a balloon does, but that they act in such a manner as to give them the properties of being pneumatic. It is the pressures within the major cavities and the directions in which they act that give the body its curvaceous form and the structure as a whole that gives us our primary level of strength and the ability to effortlessly rise up against gravity.
It is around this primary, pneumatic structure that the skeleton is formed, but to see the strength of this level we must look at the joints. Each of these is a fluid capsule containing an hydraulic pressure. All the joints together make up our hydraulic skeleton which gives the body its fluidity of movement. The bones themselves are merely the sedimentary deposits along the force lines, indicating the manner in which the joints combine to create this structure. The bones are also the anchorage for the external skeletal muscles.
The skeletal muscles make up the third and final structure of the physical body, in terms of its bio-mechanics. Often considered the be all and end all of physical strength, they are, in reality, merely the superficial outer layer. They do, of course, provide the power for the actuation of movement, without which we would remain static.
Each of the three structures of the body, pneumatic, hydraulic and muscular, combine to give our physical body its threefold, bio-mechanical nature and are hierarchically dependent upon each other. Profound weakness in the primary, pneumatic structure will result in deformation of the hydraulic skeleton and spastic or flaccid paralysis of the skeletal muscles.
The Nature of Spinal Injury
When viewing the body in this light it is easy to see that there is far more to a spinal injury than nerve damage. Nerve damage will paralyse the muscles below the level of injury. This, in turn, will result in a depletion of hydraulic pressure and lapse of quality in the joints that are no longer being worked. Combined with the trauma of the accident and following bed rest, this will generally lead to catastrophic collapse of the primary, pneumatic structure, beyond the point to which it can naturally recover. Our bodies do of course have the capacity to recover from a certain amount of depletion of quality in both pneumatic and hydraulic structures and some people are lucky enough, particularly those paralysed through operations or poor osteopathic practice for example, to experience a spinal injury while still retaining sufficient quality within their core structure to naturally recover strength as a whole. This explains why some people manage to walk out of hospital. Most of us, unfortunately though, experience depletion in quality beyond the point of no return. Those that do recover physical function are said to have only bruised their spinal cord rather than actually damaged the nerve connections, but it is, in fact, the retention of intrinsic capacity that is the reason for their recovery, showing that the nerve damage can be overcome.
The damage to my spine was severe with shards of bone left imbedded in my spinal cord and yet by addressing the depletion in physical structure we are able to bring about functional improvements, indicating that even severe nerve damage is not necessarily a barrier to recovery. It is generally considered that in order to overcome spinal injury we must repair the nerve damage and reconnect the brain to the body, but, in reality, the body has depleted below functional capacity and if we improve this capacity, the body reminds the brain of its existence and re-establishes the connection. Just how those nerve pathways are re-established need be of no concern.
It must be understood that the pneumatic structure works as a whole and so it is impossible to retain full capacity in one half while being seriously depleted in the other. The notion, therefore, that a paraplegic can have a ‘strong upper body’ is false. He may develop a certain amount of muscle bulk through the increased use of the arms, but the foundation upon which the use of the arms is based will be depleted, resulting in deformation of the skeleton and muscular imbalance. A paraplegic will inevitably have the use of the arms and the ability to breathe impaired, but not to the same extent as a tetraplegic, who sustains direct paralysis of muscles in the upper body, but impairment nonetheless.
In order to bring about the recovery of functional ability, it is necessary to rebuild the core foundations of the body, ie. improve the structure of the smooth muscles and other deep level tissue that makes up our pneumatic capacity. This is impossible to achieve through conscious muscular effort. Due to the lack of foundation, conscious effort can only ever lead to poor use of the body and so further deplete and deform the structure.
ABR therapy uses techniques that directly address the smooth muscles by delivering an ‘external mechanical input’ into the system. This is done by hand in a series of repetitive motions. Using the compression of an air cushion placed on the surface of the body a wave is sent deep into the body, mirroring that compression within the smooth muscles, so working the tissue to improve its strength. The movements delivered are ‘quasi static’, ie. they create a resultant change in pressure with very little movement and must be delivered repeatedly over many hours to achieve results.
Improvements are seen over hundreds of hours of work and it is necessary to put in around a thousand hours a year to make good progress. The positive structural changes implemented by the therapy are predictable and, more importantly, permanent. When sufficient structural improvements are achieved, resultant functional improvements are noticed, leading to a slow but steady return of physical ability.
Although I have some ability to deliver the therapy upon myself, most applications must be delivered by another person and so someone to work upon me is essential. The necessary skills can be easily learnt, so no previous experience of therapy work is needed, just a desire to pursue such work with the dedication required to achieve a good level of skill. The importance of the team cannot be stressed enough; my progress depends upon their dedication and skill. The long term nature of my recovery means that it is almost inevitable that therapists come and go and I have had several during the course of my treatment. In order to ensure their long term commitment it is important to capture their interest by keeping them fully involved in all aspects of the therapy; the theoretical side and the assessment of changes in my body as well as practical side of delivering the therapy. I currently have two ladies working with me and between us we make a good team.
Due to severely depleted structural foundation, it is impossible to achieve any positive input through conscious muscular effort, but it is, however, possible to deliver a mechanical input into the system through active exercises, if done in the right manner. This is advantageous in that it is possible to do some work on my own.
By using an air mattress with layers of memory foam on top we build a platform upon which to work kneeling. The platform creates a floating element that eliminates muscular reaction at the knees. By then working in a bouncing motion we can deliver a mechanical input directly into the knee joints, addressing their hydraulic capacity. This will also work up into the hip joints and the pelvis.
Improvements to date
I embarked upon this therapy in the spring of 2001 having been injured for four and a half years. I was your average T12 paraplegic. At first glance I may have appeared fairly muscular in my shoulders and arms, but closer examination revealed obvious structural weaknesses that are common in all paraplegics. My body had very little depth to it, when viewed from the side it was little wider than my upper arm. It was possible to feel my spine through the front of my abdomen and to feel my shoulder blade by delving in just above my collar bone. My spine floated within my body and my shoulder blades were sunken deep in. The spinal valley was non existent with the spinal column protruding as the furthest back point of the body and exhibiting little of its curvaceous form. My rib cage was obviously deformed. Typical of a wheelchair user, it was splayed out at the bottom through the hinging of the body when pushing a wheelchair with no structural integrity to the trunk. My waist had disappeared with the lowest rib actually sitting below the top of my pelvis as my body had collapsed upon itself. My legs were nothing more than skin and bone with a slackness at all the joints. I had some feeling from the waist down, although this was not normal and faded out towards my feet, and only very limited movement that had no functional strength.
I pursued the therapy for a whole year before I began to notice any changes and now, after nine years, I bear little resemblance to the paraplegic I once was, having made dramatic improvement. I still cannot walk or even stand unaided, but live very comfortably with a body that has an intrinsic strength to it.
My trunk has filled out enormously with the various components attaining much more to their proper configuration. I have a spinal valley and shoulder blades that protrude out of my back, giving better anchorage to the shoulders. I have a waist once again and even a bum! I have far greater stability throughout my trunk allowing me to sit comfortably and hold my head high with ease, whereas before it was either constant muscular effort or extremely poor posture slumped in a chair. My pelvis has rotated back to its upright position so that I once again sit on my sitting bones to which the increase in flesh of the buttocks gives some cushion. My legs have filled out somewhat and I have much more controlled movement at the hips and knees. I still have no movement at the ankles but there is improved quality of both the ankle joints and all the joints in the feet, with better tone to the skin. Not only am I much more comfortable without all the aches and pains that go with a severely damaged body, but I move around with ease out of a wheelchair. I can crawl on all fours with power at the hips to propel me forward.
The Rocky Road to Recovery
Nothing in life is ever straightforward and it would be wrong to think that all my problems were immediately solved on embarking upon this therapy. It is true that the application of the therapy itself has brought nothing but positive improvements, but life has a habit of knocking you back and my path to recovery has been fraught with setbacks, some of which have been very serious indeed. True to form, these have generally been accidents due largely to my thirst for life and refusal to allow my disability to prevent me from pursuing my ambitions.
First of all was the ‘pressure sore’. This began as a nasty spot on my bum when returning from a week’s motorcycling holiday in the West Country. Having ridden a bike for years before my injury, I decided it now had to be with a sidecar for the wheelchair, not to mention for balance. Fantastic fun and the holiday went well. However I was still very weak and it took its toll upon the delicate flesh that I sat on, bouncing down the winding Cornish roads. The spot didn’t heal and eventually turned into a nasty pressure sore and I developed an infection which was quite literally eating into me. Much to the horror of the district nurse, I refused to take antibiotics or cover the wound. Antibiotics will kill the infection but will also further deplete the quality of the tissue making healing more difficult and covering the wound will prevent the air getting to it, which is necessary for healing. Luckily we had all the skills we needed to address this problem. With my therapists working on the sore, it healed in a relatively short time, much to the amazement of the same district nurse. I have to say, though, that this was more frightening than breaking my back. The potential to debilitate me was enormous and it is only thanks to the techniques of ABR therapy that I managed to avoid a year’s bed rest and plastic surgery.
Then there was the ‘burn’. The quad bike I had at the time, for doing jobs around the grounds, was not really suitable for paralysed legs. It had foot pegs rather than good flat plates, to sit my feet on, and no suitable guards to protect against the hot engine casings. I managed with it until one day I went to do my neighbour a favour in his field. While concentrating on the job I failed to realise, with little feeling in the lower extremities, that my right ankle was pressing against the engine. It wasn’t until I had finished that I realised I had burnt two nasty holes in my ankle. After the pressure sore experience I thankfully knew exactly how to heal the wound and being on my ankle I could work on it myself. Due to my embarrassment about making such a stupid mistake, I didn’t even inform Leonid Blyum and by the time I saw him, three weeks later, it was well on the way to healing, with all the work I had put in. It is worth bearing in mind, here, that paralysed parts of the body are of poor quality and do not have the same capacity to heal as a healthy body. Without the skills to heal such a wound, the flesh could easily have broken down leading to gangrene and the need to amputate.
The third serious setback was the ‘broken leg’. Dogs are a forte of mine and when my old collie died I decided to get myself a husky. What better dog to have when you live on a set of wheels. The only problem with harnessing a dog up to a wheelchair is that wheelchairs are inherently unstable at anything other than very slow speeds. The castors at the front catch easily on uneven surfaces, causing the chair to tip forward. In order to deal with this I tied the lead from the dogs harness around my waist so retaining the ability to wheelie the chair over any rough ground. This worked well but was very much a circus act and inevitably, I suppose, I goofed! While traversing an overgrown path I failed to maintain a wheelie, the castor caught and I knew I was going to be tipped out. What I didn’t expect was to get catapulted into the air. I rose to what seemed to be an incredible height. It all happened in slow motion and as I came down I landed as though standing on my left leg. The shock was taken through my leg and broke both the tibia and fibula clean across above the ankle. My left knee also took a battering. Yet again ABR techniques were a godsend and with all the work I undertook to my knee and ankle, healing was swift. I now run the husky harnessed up to my handcycle which is stable and much safer.
The future is bright with the prospect of walking on the horizon. So far my rehabilitation has followed a predictable, stage by stage recovery of structural integrity with resultant improvements in function. Provided I put in sufficient time and effort, there is no reason why this process of recovery should not continue until I am back to full able bodied health.
Bearing in mind that our strength is rooted in the head, we cannot expect too much from the legs until the higher structures are re-established. Once the chest is finalised then improvements lower down will increase rapidly, eventually gaining a momentum of their own.
I do not know how long this will take and nor have I ever asked Leonid Blyum, my consultant and teacher. Being the first spinally injured man in the world to follow this path, it would be a difficult question to answer. It is, however, of little importance. What is important is that I continue to improve, week by week, month by month and year by year as we constantly widen the boundaries of medical understanding.
I will heal my body and I hope that many others will learn from my experience and follow in my footsteps, creating a brighter future for the spinally injured.