Southern California: Week 1 at Awakenings

beware: this is a long post. i'm going to try to break it up by day so that it doesn't quite seem like the novel it is becoming. each day of the week, i tried something new in addition to my regular routine, so if you want to skim to those sections, feel free!

I came out to San Diego to attend Awakenings Health Institute for three weeks, March 9 - March 30. I've been lucky enough to have great friends who have journeyed out here to go on this adventure with me (some still to come), and so far it has been an amazing experience. Awakenings is a rehabilitation center for people with neurological disorders, with a focus on those with spinal cord injuries (you can read all about it on their website, www.awakeningshealth.org). Beginning this trip, my goal was to learn everything I could from the people here and the work they do, then take that information and experience with me back to the East Coast, where I could continue personal training and other aspects of the program (like massage, acupuncture, etc.). Now that I'm here, I see that I am going to get much more out of this experience than just knowledge and a stepping stone to the next chapter in my life.

Monday
I showed up at Awakenings on Monday, Allison and Laura in tow, not really sure what to expect. I knew a decent amount about the general workings of the place from what I read on the website and learned from Kristin Beale and her family, but as far as the feel of it, I wasn't sure what I was getting into. Laura Karch greeted us and instantly made us feel comfortable. She went over the paperwork with me, asked me a few questions, then started my physical evaluation. (I should add that she made Laura and Allison feel at home immediately - offering them a place to put their purses and jackets and two exercise balls to use as seats while they observed.) She did some basic range of motion exercises with my legs and asked me some questions about my spasticity, then gave me some good news right away. As I was already aware (but unsure of the implications), the muscles in my legs still have a lot of tone. They resist movement involuntarily and spasm often when stimulated (by touch - as many of you who have helped me move around have experienced!) I had heard mixed things about the benefits of spasticity - some doctors (including my rehab doc, Dr. Alfano) have said that they understand spasticity to be inversely related to recovery, while other experts (like the trainers at Project Walk) maintain that spasms are a good sign and mean that there is still a connection between the brain and the muscles, albeit not a reliable one. Laura showed me that, in addition to still having good tone, my legs still "remember" how to walk. When she flexed my foot and ankle and stretched my calf muscle as far as it would go, my knee bent and my leg jumped up. This is the same reflexive action that your leg muscles take when you walk - once your weight moves from your heel to the ball of your foot and your ankle is as stretched as it can be, you pick up your foot and move it in front of you. Basically, my legs still want to do this, even though my brain isn't telling them to do it. Laura said that it takes some patients a long time to get to that point (lots of repetive walking motion is required to remind those legs what to do) and that it's a really good sign that my legs are already there. She was very excited about that, which made me excited too!

After working with my legs a bit (with me lying down on the exercise mat), she had me get down on the floor and sit with my back up against the wall and my legs out in front of me. She was testing my core strength and my ability to keep my pelvis neutral, which is not very good - I tend to either arch my back or slump over to steady myself, as opposed to being right in between. I did a few weights and other exercises to test various muscles in my core and in my back, then they put me on a stationary bike. With my feet strapped into the pedals and people keeping my legs steady on either side, I was able to push my legs down into the pedals with my hips and actually use the bike, which was certainly a good workout for my abdominals!

After this initial evaluation, we had a lot of free time, so Allison, Laura and I went to lunch in downtown Del Mar and then headed to the airport to drop Laura off (or so we thought) and pick up Carter. Laura planned to check out the possibillity of taking Tuesday off at work and taking a flight out Tuesday instead (Southern California really seems to do that to people...no one ever wants to leave. Or so I'm told...) When we got to the Continental counter, they told her that it would be $150 to change her flight. Bummer! Then more bad news - her flight (which was supposed to leave at 5) was delayed 30 minutes, meaning she would have only 10 minutes to make her connection in Houston. In order to make the flight, she would have to leave in 45 minutes, and miss seeing Carter for the hour or so that they would overlap in the airport (Carter's flight came in at 3:15 or so). The Continental rep then got this twinkle in his eye and looked at Laura and said "Well, since you're going to miss your connection, I could bump your flight to tomorrow at no extra charge..." and all was right again! So Laura got to stay for another whole day, and spend the evening with Carter after she arrived!

When I went back to Awakenings that afternoon, I had a pilates session with Andrea Plichta. It was much of the same type of exercises that I remember from pilates classes I took over the years, just slightly modified. We talked a lot about working on my low back and getting my pelvic alignment right, which seems like it is something I am going to be focusing on a lot. I really liked her method of teaching - she uses lots of helpful metaphors to explain the exercises and appreciated my dance background!

After pilates, I had my massage evaluation. I had never had a professional massage prior to this, so I was really excited...and a little nervous. Complete relaxation has never been my strong suit, so I was a little apprehensive of my ability to relax and experience it appropriately. Matt McCall is my massage therapist (I learned from the AHI website that almost every trainer is also a certified massage therapist) and he talked a lot about breaking up the scar tissue at the site of the injury to my spinal cord. He said he could feel a lot of it and explained that breaking it up if at all possible is an important step in making it possible for the nerves to reconnect. Needless to say, it was a pretty intense deep tissue massage, and he said that it will take a lot of work to break up the scar tissue - that's what the next two weeks are for! He also relieved a lot of tension in my neck and in my hands and fingers (an area that you don't usually think of as tense - unless your hands are what you propel you on a daily basis!).

Needless to say, I was pretty relaxed after the massage, but unfortunately that relaxation didn't last. I encountered some problems with some medical supplies that were supposed to be shipped to the hotel, and long story short, I was in a desperate search to find what I needed. CVS and other 24-hour pharmacies don't carry urological supplies, but luckily Laura (from Awakenings) was able to find a client of theirs who was generous enough to lend me what I needed. It wasn't the most fun way to spend our one evening together (Allison, Laura, Carter, and myself) as a foursome, but we definitely made the most of it.

Tuesday
Allison and Carter rented a car for themselves for the week, and on Tuesday Allison took the car to visit her grandmother near LA. Laura and Carter entertained themselves in the town of Solana Beach while I was at Awakenings, and were also able to see some of the other activities I participated in on Tuesday.

I had personal training again 9 am (Monday-Friday), this time with Andrew Braga - a JMU grad. Apparently there are an awful lot of East Coast transplants out here. He did some workouts with my legs, similar to what Laura had done, then had me work on my core and upper body strength on the floor on my hands and knees. He came up with a lot of creative exercises to work different muscles, and I was throughly wiped out at the end of it!

After a short break, I used the gait trainer. This is basically a treadmill with a harness hanging above it that is suspended from the ceiling. Once I am fitted in the harness, they wheel me up onto the treadmill and strap me in so that I'm secured from the ceiling and the sides of the treadmill. My weight is entered into the machine and a percentage is chosen of my body weight that I will be supporting myself. I started at 70% - meaning that the machine is still holding up 30% of my weight and I'm supporting the rest on my legs. As the conveyor belt starts to move, trainers seated on either side of the treadmill hold onto my feet and legs and facilitate the walking motion. This is where my muscles' natural walking reflex comes in handy. When my legs are completely extended, they pick up and want to kick forward on their own. The trainers just have to hold onto my feet and make sure they step in the right spot. I was on the gait trainer for about half an hour and it seemed to go really well. Laura and Carter were there to watch and they said that they could the muscles in my legs and my gluts really working as I was walking.

After a trip to the airport to drop off Laura, I had a Jin Shin session with Chris Capitelli. I have to confess that even after he explained it to me, I probably don't understand it as well as I should. This website can describe it better that I can, but Chris basically told me that it's a method of channeling energy in the body and "fine tuning" the energy. For people with spinal cord injuries, it's especially important to bring energy down into the limbs that are paralyzed - to balance out the body's energy so it isn't all concentrated in the head, but flows throughout the body. His method is to touch two different points on the body and feel the beats of the pulse in each point eventually sync with one another. He told me that people tend to get very relaxed and often fall into a state of quasi-sleep during the session, which definitely happened to me. I kept falling into these really intense through processes, only to "wake up" out of them and realize I was still in the massage room. It felt like I was in there for hours. Chris also said that people often notice very intense dreams in addition to a change in energy levels, which I haven't noticed too much. He is learning the technique of Jin Shin from a woman who has done work with people with spinal cord injuries, and he said that there have been some really good results for many people. I was more relaxed during that Jin Shin session that I have been in a long time.

Carter and I decided to order sushi Tuesday evening, since Allison got back late from her visit with her grandmother and had already eaten dinner. We had an entertaining experience trying to physically find the restaurant we had ordered from (that we found online) and eventually discovered that it had moved 30 minutes outside of Del Mar. Whoops! We found another restaurant that was luckily still open, and had our first taste of delicious California sushi.

Wednesday
I worked out with Matt Wednesday morning, followed by another gait training session and more pilates. Wednesday's new experience was acupuncture. I sat down with Adam Gries, the acupuncture director, before our session. He talked about the benefits of acupuncture, especially for people with SCIs, then asked me many questions about my accident and my goals. He told me that the high level of muscle tone in my legs is quite rare for a paraplegic 1 year post-injury, and that if I really want to pursue recovery, I'm already well on my way. That was uplifting and exciting for me to hear, and made me all the more interested in what acupuncture could contribute! I was definitely nervous about the acupuncture - the thought of something poking needles all over your body isn't exactly calming - but it was really very relaxing. Adam said that in addition to targeting the muscles in my legs, he was also going to target my bowel and bladder, because some people have seen improvements in sensation and function in those areas after acupuncture. After inserting the needles in my calves, quadraceps, abdominals and obliques, he attached a cord (that looked like a miniature jumper cable) that was hooked up to an electric current to each needle. Once all the cords were attached and the current was turned on, all the targeted muscles started to pulse together. It was surprisingly relaxing. Adam told me to visualize myself doing the movements that the targeted muscles would control, like flexing my ankles or pulling my legs up toward my chest (calves and quads). He left me there for about 20 or 30 minutes to visualize and feel the effects of the acupuncture, and I actually almost fell asleep a couple of times! It was very relaxing and just really cool to see all my muscles working in harmony.

Wednesday evening was Allison's last night here, so she, Carter and I went to an Italian restaurant with a beautiful plant-filled, twinkling patio for dinner.

Thursday
Thursday was a relatively short day, as far as workouts are concerned. I had personal training with Andrew in the morning, then another gait training session. In the afternoon I got on the stationary bike again for about half an hour. Carter and I had lunch at a great sandwich shop in Del Mar and just took it easy for the evening - napping and reading and such. We ate some Chinese for dinner and enjoyed Thursday night TV.

Friday
I had personal training again with Andrew on Friday, then pilates and gait training back-to-back. After gait training, I ate lunch with Matt, one of the trainers, and returned to Awakenings to find that the FES bike, which had been missing a part all week, was fixed! Angela, who is the nutritionist and is also a chiropractor, set me up on the bike. She attached electrode patches to my quads, hamstrings, and gluts. Laura programmed my information into the machine, so all we had to do was plug in my unique ID number and password and the machine logged my usage statistics as I exercised. Once the machine is turned on, it sends an electrical current to the muscles where the patches are, stimulating the muscles to fire. That firing, in conjunction with the pedals on the bike turning, causes the legs to start pedaling the bike. I don't have to get out of my wheelchair - I just wheel up to the bike and strap myself in. I used the bike for an hour and could definitely feel it when I was done. I also noticed that I could feel my glut muscle on my left side firing as my legs were working. I'm not sure if it was the actual internal muscle working that I could feel or the external patch on my skin, but either way that is an area that I don't usually have any sensation or control. I've been told that the FES bike is the single most important piece of equipment, other than a standing frame, that I should have at my home. Using the bike every day is the only way to give my leg muscles constant exercise and keep them from atrophying. After being told so much that the muscle tone in my legs is a great sign, I really want to keep that up by using the FES bike. Now that it's fixed, I'll be using the one here 4 times a week, and even more if I'd like to.

Friday night, Carter and I went to downtown San Diego and had a fabulous dinner at a beautiful restaurant. She left Saturday morning to return to Atlanta, and I spent the day running a few errands and just enjoying the time to myself. Kasey arrives on Tuesday, so I'll have a few more days alone before the last member of my entourage (as the people at AHI called it) arrives.

After my first week, I feel fantastic. I can't believe that I only have two more weeks to continue what I've started here. Awakenings is an amazing place, and that is 100% due to the incredible people who work here. Every person is genuinely invested in the recovery of every client, but they are all still personable, fun, and extremely inspiring. They are all also incredibly knowledgeable about what it is they do. They are able to come up with creative exercises on the fly to work specific areas of the body, and notice even the smallest details in muscle movement and control. As a former dancer, I really appreciate working with people who view and work with the body as intricately as I do. They all have given me the motivation and inspiration to work really hard while I'm here, and the positive feedback that I've gotten already gives me a kind of hope that I haven't really experienced since my accident.

The atmosphere at Awakenings is laid back but at the same time intense and focused. One gets the sense that every client, while still able to joke around and join in the general camaraderie, is on a mission to push his or her body as far as it will go. The same goes for the trainers. I really get the sense that they see each other as family - they share in each others' (and the clients') successes (and they bring their dogs to the gym!)

I have to say that I am going to have a really hard time going back to Virginia, and that's after only one week here. Aside from the great feeling I get from being at Awakenings, southern California is just an ideal location. Everything (and everyone!) is so wheelchair friendly, the weather and the land is absolutely gorgeous, and the atmosphere here is just different. I am very excited to see how things go over the next two weeks, because I can already notice a difference in my body. I don't think that the type of workout experience I get here is something that I can replicate when I return. So much of it, for me, is about the environment and the people that I am starting to wonder if this is the place for me!