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    Advice / Question

    Can someone please explain the problem and remedy in how to get my legs to go straight all the way. I have not had therapy in 16 years and my legs don't bend back straight any more. I am hoping to get them straighted before trying to stand in one of those standing things. I suppose a bone density test would be a good idea first. Is this problem fixed with surgery or not. I also was wondering if anyone knows of any wheelchairs that stand you/me/us up?


    God Bless,


    David

    #2
    Hip and knee contractures result due to failure to do regular range of motion exercises, often combined with poor positioning and spasticity.

    You would need to consult with your SCI physician and a good PT to see if your contractures are the type that can be stretched out with range of motion exercises, splints and stretching with weights. Proning (laying on your stomach) is an excellent way to both prevent these and to stretch.

    If your contractures have calcified, then stretching may not be enough, and surgery might be indicated, although it can be difficult surgery for both hips and knees and the outcome is not always ideal (infections and hematomas are common). A DEXA scan is a good idea before you start a standing program, but you do need to get your contractures addressed first. You would also need to get your range of motion corrected in order to properly use a standing chair.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


      #3
      Thanks nurse,


      I doubt if my hips are contracted any. I would not do surgery on these anyways right now because I don't think I could tolerate it yet.

      How do you know if a contrature is "calcified" ? I would almost bet my legs (kness) are. But what about the feet. I know there are many bones there.

      I would really like to try standing but not sure how long a muscle might take to stretch if nothing is calcified.

      Comment


        #4
        SCI-nurse,

        We know that it is recommended to do ROM every day. Between standing, sitting up, lying prone (which he does do every night), and occasional ROM my husband probably gets about a quarter of that per week. Is it possible for that to be sufficient, or should we try harder to do it more often? He has only a very minimal amount of contracture since the accident 1 1/2 years ago, most of it occuring within the first three months or so - it does not seem to be getting any worse. He can still use his standing chair with no problems.

        *************
        AB wife of T8 complete para
        *************
        AB wife of T8 complete para

        Comment


          #5
          I've read when lying prone to have your feet hang off the end of the bed. Is this necessary? There is a board at the end of my bed so I can't do this. Will lying with them flat on the bed hurt them?

          Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash
          Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

          Comment


            #6
            I get ROM four times a week, sometimes three (depends how often the one aide who knows how to do range comes in a week.) My joints are all fine - no contractures or other problems. I'd like to get ranged more often, but that's not the way it is.

            Alan

            "Was it over when the Germans bombed Pearl Harbor?"
            Alan

            Proofread carefully to see if you any words out.

            Comment


              #7
              I am wondering still about how to rehabilitate my contractures. I am sure my legs are bent. Is there any hope that surgery and bone density drugs would allow me to stand. Also, is surgery for contractrures and rehab covered by medicare. Any experiences or advice is appreciated.



              David



              P.S. - I was skimming thru the topic of hip contracture and surgery. Is this a very effective operation. I am not sure yet if my hips are contracted some too? If surgery was done, then basically where is the muscle cut. I am not understanding this stuff too well yet. I was hoping a simple cut up front would release the tension. The main question is would a cast be necessary. Is the hip joint basically unsupported once the muscle is cut?

              [This message was edited by david65 on 02-24-05 at 09:06 PM.]

              Comment


                #8
                The standing wheelchair I have is made by The Standing Company in Bridgeport, MI. When I got mine a year ago the base price was $7,500 complete. It stands me up with very little effort in about 2 seconds. They have a series of pictures on the home page of their Web site that shows how easily it works. http://www.thestandingcompany.com/

                Mine is a folding chair so I can take it with me when my wife is along. It doesn't fold tight enough to fit behind the drivers seat in my Monte Carlo so I have to take my Quickie when I'm on my own.

                imnomis

                Comment


                  #9
                  David, have you been proning (laying on your stomach) to try to stretch out as suggested last year? Have you seen a good SCI experienced physiatrist and PT? You have to have this type of evaluation PRIOR to going for a surgical intervention.

                  As discussed here many times before, there is no indication that simply being on etidronate drugs is a successful way to increase bone density in people with SCI. Standing on bones that are very osteoporotic can cause fractures and slippage of the bone plate in some people. The advice of a good SCI trained physiatrist is essential prior to starting a standing program in someone who has not stood for many years.

                  Surgery should be a last resort. It is unlikely that surgery will allow you to stand, as the most common way to treat this in a person with a SCI is through a girdlestone procedure, which detaches the femur from the pelvis, leaving it attached only by muscles. A cast is not used, but standing is not possible afterwards. Infections due to hematomas (bleeding into the soft tissues) are very common in this surgery.

                  (KLD)
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                  Comment


                    #10
                    I have not tried to lay on my stomach but once and that was in rehab from the very beginning. I have an external catheter now and may get a colostomy. So the stomach will have to wait.

                    I will make an appointment to see if my hips are contracted and a bone density test. I was curious for now, if it is that important if the hips were contracted - could standing frames alot for an angle of posture. I would or could even modify something to lean forward more if necessary. The reason I am so adamant about gaining some standing, is that whenever I have a colostomy I get many uti's. My commode chair helped to flush my bladder during bowel programs and this kept uti's away. I don't heal well with constant uti's and the conmmode chair trick works to a point, when I have a colostomy.

                    I still have contractures of the knees and no bone strengthening program.

                    But, aside from the hip surgerey or not, would an operation on the knee flexons be too much to rehabilitate into a standing program like the hip. I sure hope it isn't as complicated.



                    David

                    [This message was edited by david65 on 02-24-05 at 10:02 PM.]

                    Comment


                      #11
                      As little as a 10 degree hip flexion contracture generally precludes standing (or ambulation if you were to get return or a cure).

                      Laying on your stomach is possible with both a colostomy and an external catheter by using foam blocks or pillows to "bridge" these areas so they have no pressure. We do it all the time where I work. To reduce contractures (if they are not yet fused or ossified) you can leave your foot off the side of the bed or table while proning and apply weights to the ankle. This helps to stretch out the knee and hip at the same time.

                      I am confused about your colostomy comments. Did you have a colostomy and then have it closed? And are now considering having it done again?

                      How are you managing your bladder? If you are using reflex voiding, it may be that your frequent UTIs are more related to a high pressure bladder and high residual than your bowel management. When did you last have urodynamics done?

                      (KLD)
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                      Comment


                        #12
                        Thanks SCI Nurse,



                        You've been a big help. I am not sure what you mean by "preclude". Is 10% hip contracture not great at standing then? I will inquire further from a SCI REHAB specialist as you first said. I will probably end up building a device to help rehabiltate (stretch & load bearing) in a safe and more controlled method than standing all at once.


                        I did have some urodynamics about 2 years ago. I also had the ostomy but had many uti's. I started to sit on the commode again so they went away. I didn't flush the bladder as well as I did during a rectal bm. I had the bladder sphincter cut in 1990 and drain (void) continually into a bag. There is a bit of residual left even after voiding and reflexive void doesn't kick in until round 650 - 700 cc's. Straight cathing still gave me many uti's and this commode bladder fluashing seems to be the only thing working. I will probably get more bladder tests again but things don't seem any different than in previous years. I may see if the bladder sphincter can be opened more or botoxed first to see if this helps flushing even more. I am not sure how the bladder sphincter works; so opening it more may cause more uti's. Seems like I once read this. I will ask what the Mayo urologist up here thinks first.

                        I will have to get another colostomy and hopefully this one will work out for me once it is done. The uti's seem to be a part of the problem. I am probably going to need to see a wound expert too. This skin is really not seeing the light very much and it has me in a bad place. Do you know if steriod shots is any help. I don't know.



                        David

                        Comment


                          #13
                          Preclude = prevent.

                          What are you wanting steroid shots for? What is wrong with your skin?

                          You do need to have urodynamics at least every 2 years; more often if you are having problems with your bladder such as frequent UTIs.

                          (KLD)
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment

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