It's been hot lately. Once again I'm a title surprised at how much fitness impacts subtly on my life. Once upon a time, 25 degrees in my house was unbearable, but so far the hasn't impacted me this year. Which I attribute to the increased fitness that I've developed.
I've also been able to answer my own question around my heart rate jumping all over the place in activity. I noticed while on a treadmill, my heart evens at if I maintain a specific pace, so it is possible to even out my HR. I still have much to research however, I clearly don't like to run at an even pace and I still don't totally understand what differences there would be when I train in different zones. They say training in zone 3 fitness is for endurance while zone 4 is for increased oxygen exchange, yet it seems that I'm still developing endurance as I'm primarily training in zone 4.
I've also further realized how abstract fitness is. In working with adults with cognitive disabilities I ponder how we can make it more concrete. Research argues that this needs to be done via getting data and creating charts to help create visuals yet are visuals concrete enough? If it is, then I'm really excited because there's a lot of opportunity to take data with our clients. My big excitement is that of activity trackers that are available. If we allow our clients to wear trackers for a period of time, then they might be able to visible see how much activity they are doing and it should result in a better understanding that each step they make helps them become more fit.

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AuthorNeil Cutler
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From November 2011 to January 2013, I was part of a study from Queen Alexandra's looking at the effects of Botox, physiotherapy and leg bracing on spasticity.

What is Spasticity?

Spasticity occurs when the muscles are engaging more than they need. In my particular disABILITY, when I engage a muscle, the opposing muscles engage as well. This means that for almost every movement, I have twice as many muscles engaged than that of an able bodied person. Furthermore, with two muscles engaging, eventually one muscle will become stronger than the other. The weaker muscle becomes less and less able to function and the movement becomes more and more unusual. This is what happens with spasticity.

What does Botox do?

Botox is essentially food poisoning. It is one of the most toxic substances on earth. Botox paralyzes the muscles it is injected into. With lower dosages, it weakens the muscle. The idea is fairly simple. Inject it into the stronger muscle so that the opposing weaker muscle can be strengthened and be used to develop a more natural movement.

It has been used for roughly 15 years for people with spasticity and as such has many things that is still unknown. I was surprised through my experiences how much trial and error needs to be done for each person. Take for instance the knowledge I've developed about my body. We focused on my legs since my goal was to develop less fatigue over the summer months. At first, I had my Gastroc (calf muscles) botoxed to help increase the range of motion of my foot. This really didn't do that much for me. It wasn't until we botoxed my latissimus dorsi (Lats in the back) that I first felt a significant difference. From that, we decided to add Botox to my hamstrings, this didn't seem to make any noticeable difference. In fact, it almost felt worse - my hamstrings felt tighter. It was explained to me that when my hamstring muscles were loosened, my body began using other muscles to move. But it wasn't until I was describing the exact tightness to a friend that she explained there was 3 hamstrings and perhaps it was only one of them that was tighter than the rest. It took me to recognize this difference to be able to ask my doctor if this is what might be effecting my body.

Process of getting Botox

I did and continue to see my Botox doctor once every 6 weeks. Botox lasts on average in the body for spasticity for about 3 months but this has enormous individual differences between people. Thus, i rotate from a checkup visit to a Botox injection visit to the doctor. For myself, my maximum dosage is 600 mg for my whole body, but what I do with that is up to me. I can choose to put it into the same muscles and to slowly reduce until we find the right amount, or I can choose to put it in new muscles to try new combos. But what it does mean is that you have to be very aware of how your body feels and reacts to the Botox.

For the checkups, the doctor focuses on what what combination of muscles I should get botoxed. On Botox days, a very thin, long needle is used to inject the Botox. A 450mg amount costs approximately $1750 (it is covered by pharmacare for use in spasticity). Each muscle has a maximum dosage. For larger muscles, this can be over 200mg while for others it can be much less. To make sure that the Botox is going into the correct muscle, an Electromyography (EMG) machine is used, the needle has a wire attached to it and electrodes are placed on your body so when the needle goes in it creates a series of click sounds from the wires. When the clicks become continuous, the needle has entered the muscle. The needle is so thin, you do not notice it, but I have noticed that I can feel it when it enters a muscle that was tight. Another sensation I have felt is the injecting of the Botox itself, it feels as if the muscle is slightly being expanded. Neither of these feelings are painful, just different.

The most amount of needles I have received is 18, the fewest was 8. When I began this study, I was was very afraid of needles, my fear has since decreased significantly. I am now able to avoid anxiety until the doctor visibly starts to get the needles prepared. 

Results of the study

I have found that for me, the greatest impact have been from the botoxing of my latissimus dorsi and the psoas. The psoas is a muscle that is near the lower spine which is very deep. As such, this can only be botoxed by using ultrasound or by using a CT scanner. I have done this once at the hospital and it proved extremely effective. In fact, I was able to increase the angle of my hips by 4 degrees and increased my stride length as a result. According to some doctors, they don't believe that botoxing the psoas should have had as much of a reaction that I experienced. Because of this, I have stopped receiving Botox in the psoas so we can test for the effect to decrease and document it. Re-introduction of the Botox into the psoas can then be watched to be able to definitively say that it was this Botox that made the impact and not other confounding variables.

CT Scanner that is used to Botox the Psoas muscle

CT Scanner that is used to Botox the Psoas muscle

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AuthorNeil Cutler
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90 minutes of pickleball, notice how much my heart goes up and down.

90 minutes of pickleball, notice how much my heart goes up and down.

Ever since I have bought a heart rate monitor, I've noticed that my heart seems to be significantly different to what I would think others would be like. My resting heart rate averages 65 BPM, although as soon as I stand up, this jumps to 80s. When I exercise, my heart seems to jump up extremely quickly into 170s+. I've been trying to stabilize this, but it's proving to be very difficult. I know I tend to run fast, but in playing around, I have not been able to keep my heart beat low - as soon as I transition from walk to any speed of run, my heart beat jumps. I can't help but think that this is connected to the increased effort my body goes through as a result of my disABILITY.

Follow Neil's RunKeeper progress.

My last run. I would let myself get up to zone 5 then when I got tired, began walking and let my heart return to zone 3 then began running again. Notice that it took the elevation climb at the end to actually maintain my heart beat at a consistent rate - even though it was near V02 Max.

My last run. I would let myself get up to zone 5 then when I got tired, began walking and let my heart return to zone 3 then began running again. Notice that it took the elevation climb at the end to actually maintain my heart beat at a consistent rate - even though it was near V02 Max.

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AuthorNeil Cutler

April 26th, 2013 PCI Results:

  • At a pace of 12:43 mins/km (4.72 km/h): 0.6524 (comfortable walk)
  • At a pace of 9:36 mins/km (6.25 km/h): 0.8474 (fast walk)

I came across the Physiological Cost Index while researching fitness for people with disABILITIES. It became clear to me that this will likely be one of the best measures to track my progress since it's focussed on the efficiency of walking specifically.

Also known as the Energy Expenditure Index (EEI), this is a measurement taken for the efficiency of walking. It measures the heart rate over the speed at which a person travels. The equation is as follows:

PCI = (Heart Rate for walking - Resting Heart Rate) / Walking Speed (as meters/minute)

Using this formula, one can measure a rough estimate of how much energy the body is using in order to travel. For those with physical disABILITIES, this can often be significantly higher than for those without.

Studies looking at the normal population find that for the average healthy adult, This greatest efficiency is achieved at a medium pace, Efficiency decreases in both directions (as you go slower or faster). Also, Males are slightly more efficient than females at all speeds.

According to this study, the most efficient speed to walk for the average adult male is 64.37 meters/min (3.86 km/hour or 15:32 mins per km) = 0.40 PCI

At 104.61 meters/min (6.28 km/h or 9:34 min per km) PCI was 0.51.

Compare the results I have done at the top to see where my body fits with the average adult male.

Complete PCI measurement. Began test without moving to get resting heart rate, then walked around a running track for 2 laps, sped up and did another 2.

Complete PCI measurement. Began test without moving to get resting heart rate, then walked around a running track for 2 laps, sped up and did another 2.

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AuthorNeil Cutler
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Neil C was born with left hemi cerebral palsy. Throughout his childhood, he spent an hour every day doing physio in order to maximize his potential. Yet once he became an adult, he found himself doing less and less physio. Through working at NSL, he found that over the summer months, he began feeling increasingly fatigued from everyday activities such as walking. When an opportunity arose to join a study looking at the effects of Botox, physio and leg bracing on Spasticity in a Study came up, he decided that he ought to immerse himself into the spirit of physical improvement.

Having never had Botox in the past, Neil was very nervous of it, especially since he had a phobia of needles, but the potential of trying something new that could offer the same benefits as surgery that he had in the past over rode his fear and he has since completed the year long study with fascinating results.

Neil continues to receive Botox once every 3 months and is still experimenting with where and how much Botox he receives in various muscles. So far, he has been able to increase the step to step distance he takes when walking by increasing the angle to which his hip can extend by over 4 degrees. This allows him to cover the same distance with fewer strides thus reducing the energy required. He plans to track his improvements via observing changes in his heart beat as well as the Physiological Cost Index (also known as the Energy Expenditure Index).

This blog's mission is to help Neil track his improvements in walking efficiency and to educate others on the implications that disABILITY can have on the efficiency of movement for those with physical disABILITIES.

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AuthorNeil Cutler