A person with a SCI is placed under huge financial strain right from the get-go. For most it is impossible to pay privately for therapy at specialised centres (at rates of £60 per hour or upwards) for any sustained period of time. In the UK, there is barely any support from the national health service (NHS): on discharge from hospital, an SCI patient is only provided with a one-off block of 12 hours of therapy. And without long-term access to therapy, progress stops.
In our view, the only viable option is to continue therapy at home, but this generally requires buying equipment specially designed for neurological impairments. However, equipment of this sort is very expensive, costing anywhere up to £10K. Even assuming you can afford it (and unfortunately most people cannot), if you have never used the equipment before, your decision to buy or not boils down to how much you believe the marketing spiel of the company and your gut instinct. Pretty scary.
In our blog we hope to assist people with SCI to make informed decisions about equipment purchases. We will do so by providing honest reviews of equipment Irrum has used extensively. First on our list is the Giger MD.
The Giger MD is simple in form. At first glance you may believe it is nothing more than a bench with spindles for the hands and feet. But the simplicity of design belies its effectiveness as a long-term rehabilitation tool. In fact, we attribute a significant portion of Irrum’s initial progress to this device.
How to use
Lying down on the bench face up, you have to put your feet into the pedals above you:
Then you secure your legs into position using two sets of velcro straps:
This is to keep your legs in the correct position whilst cycling and to stop your legs knocking inwards against the horizontal bar or swinging outwards.
Once in position, the idea is to cycle using your leg power (if any) and to assist the movement with your arms. As your leg strength improves, you can do less with your arms. Here is a short video of Irrum doing the exercise.
The height of the horizontal bar can be adjusted at both ends. This puts the user in different positions on the bench (e.g., legs are more inclined) and allows different muscle parts to be targeted. The resistance of the spindles can be increased/decreased by tightening/loosening accordingly.
It is important to note that the exercise is not passive: no arm and no leg movement implies nothing happens!
does it differ from a spin bike or a recumbent bike?
This is a legitimate question, as on first sight you could be forgiven for thinking the Giger MD is an over-engineered bicycle. Our understanding is that, yes, it is very different.
To begin with, the positions on the Giger MD cannot be replicated on an upright bike. Why is that important? Because the alteration of positions targets different muscles. For example, you can strengthen the lower back muscles, an oft-forgotten set of muscles in SCI patients that become weak because of lack of use, even if the muscles are not affected neurologically by the injury. Furthermore, the fixing of legs in position via the straps is absolutely vital, as this ensures a consistent repetition; if the legs wobble about while you cycle, then there is less uniformity in movement, and this may inhibit progress.
What is the science?
It has long been established that the central nervous system is malleable and can establish new connections to restore lost function. It is an open question about how to induce plasticity to target specific sensorimotor function (e.g., how can someone regain knee flexion?), but most believe high-volume repetitions over a long period of time are key. It is on this assumption that all SCI equipment and therapy are currently based, and the Giger MD is no different.
The company behind the Giger MD claim that it is the equilibrium of movement between the four limbs that is key to relearning a normal walking pattern, because these movements, even in a supine position, mimic the way we walk. Some scientific studies with the Giger MD have been done, but as far as we are aware, these did not include SCI patients.
Where Is it used?
In the UK, we are aware of two centres that have purchased the Giger MD: Stoke Mandeville hospital and a physiotherapy centre in Essex. We have heard from word of mouth that it is available in the US and in places on the European mainland, but we are not sure.
Excellent. When Irrum started using this equipment, she could not turn the foot pedals, so she would spend between 1 and 3 hours per day just cranking the hand cycle, trying to reteach her body a normal walking pattern. After a few months of use, enough strength had returned in her right leg that she no longer needed to strap it to prevent swinging side to side during a revolution. A couple of months afterwards the left leg followed suit. (Note that she still uses the straps to ensure consistency in repetition, as recommended by the designers of the Giger MD.)
One day she had enough leg strength to do a single revolution with leg power only. The number of revolutions kept on increasing, to the point where Irrum can now do a full hour of cycling pretty easily in a flat position, although the inclined position (cycling upwards) is very challenging and needs help from the arms.
There are secondary benefits as well. As any person with a SCI will attest, the general lack of movement causes huge problems with stiffness and digestion. The Giger MD has significantly helped Irrum with both of these issues.
The biggest downside to the Giger MD is mounting and dismounting. In principle a person can do this alone, and the company provides several low-tech gadgets to assist. In our view, this is far too challenging, and it is impossible if you have a higher injury affecting your arms. However, once you are on, then you can pretty much keep going for as long as you can muster the energy. And we should state that the setup itself is not technically difficult — it takes all of 5 to 10 minutes once you and a helper are accustomed to the vagaries of the straps.
We believe that UK-based SCI persons should have home access to the Giger MD. It is pretty pointless having it in a hospital because a patient may use it for a couple of hours per week for a few months, when in reality the person needs to be using it for 3-4 hours per day over a very long period.