Monday, April 17, 2006


Robb and his physical therapist Doreen went down to the beach in Alameda and spent their therapy session walking on sand. (Isn't this delightfully Californian? You're not completely healed until you can walk on the beach again...) Robb worked without his ankle braces, and the uneven and shifting surface of the soft sand "recruited" the weakened muscles in his ankles. And, yes, Robb's cane often sank deeply into the sand as he walked. When he told me about this tonight, he seemed pretty delighted by the whole thing. He and Doreen had gone down to Lake Merritt previously, but the stretches of sand aren't terribly long. The funny thing is that Doreen lived near the lake as a child and so her memories are of a huge, sandy stretch of beach. She also remembers there being monkeys on the bird sanctuary islands, but I'm still not entirely able to accept this story.

Other than one person who was strolling on an offshore sandbar, and looked apparently like he was walking on water, Robb and Doreen pretty much had the beach to themselves. Robb thinks this was a good thing, as they were doing some rather odd-looking exercises. For example, Doreen would hold Robb's cane in both hands and Robb would grab on in the middle of this bar, and they would do side-stepping lunges across the sand.

Robb also spent part of his afternoon educating himself on the subject of burst fractures. I'm going to quote extensively from one article he found online.

Robb's injury is what is described as in "incomplete" spinal cord injury, and hopefully the tests that he'll have on Friday will help us better understand the extent of the neurological impact of his injury.

What is a Burst Fracture?
A burst fracture is a descriptive term for an injury to the spine in which the vertebral body is severely compressed. They typically occur from severe trauma, such as a motor vehicle accident or a fall from a height. With a great deal of force vertically onto the spine, a vertebra may be crushed.

If it is only crushed in the front part of the spine, it becomes wedge shaped and is called a compression fracture. However, if the vertebral body is crushed in all directions it is called a burst fracture. The term burst implies that the margins of the vertebral body spread out in all directions. This is a much more severe injury than a compression fracture for two reasons. With the bony margins spreading out in all directions the spinal cord is liable to be injured. The bony fragment that is spread out toward the spinal cord can bruise the spinal cord causing paralysis or partial neurologic injury.


Also, by crushing the entire margin of the vertebral body the spine is much less stable than a compression fracture.

Nerve Injury
Neurologic injury from a burst fracture ranges from no injury at all to complete paralysis. The degree of neurologic injury is usually due to the amount of force that is present at the time of the injury and the amount of compromise of the spinal canal. With a greater amount of force, more bony fragments can be forced into the spinal canal causing greater loss of spinal cord function. This may cause loss of strength, sensation or reflexes below the level of the injury.


Typically, in a burst fracture that occurs at the junction of the thoracic and lumbar spines paralysis of the legs and loss of control of the bowel and bladder may result. In an incomplete spinal cord injury only partial paralysis or reflex loss is seen. With mild burst fractures only transient symptoms may be present or no neurologic injury may be present.

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