The prospects of treating teens and adults

By Natan Gendelman D.O.M.P  |  http://www.healthinmotionrehab.com  |  http://www.enabledkids.ca

Having worked with children for over 23 years, I’ve had many people come to me for information and advice on treatments that are suitable for teenagers and adults. It’s important to realize that if a loved one is diagnosed with a neurological condition, age can be a primary factor that influences how treatment may be approached as well as the number of treatment programs that are made available. This may be due to a person’s age and how others perceive his prospects for improvement and/or recovery. However, it is important to note that when treating an individual with a neurological condition, nothing is set in stone regarding his potential for improvement. Whether a person is a teen or an adult, his brain has the ability to form new neural pathways (also known as neuroplasticity) which can lead to great improvements in his function.

 For these reasons, it is crucial to understand your loved one’s condition and how that should influence what you should look for in treatment. In doing so, you will be better equipped with knowledge to help him on the road to independence.

 

Looking at bone formation in teens and adults up to 25-26 years of age

As the first step to understanding your loved one’s condition, it’s important to realize that up until the age of 25-26, the body is still in the process of growing. At this time the ossification and calcification of bones in the body has not yet finished, and you may be able to correct the positioning of joints to help the body gain and improve its function. Depending on a patient’s condition, during this time it is often possible to release the tissues around the joint and normalize its position for increased mobility.

 

Improving independence for adults 26 and over

Now, once a person passes the age of 26, the growing process has already finished. Since the ossification and calcification of the bones is done, unfortunately you cannot correct and completely normalize the bone’s position since it has already been set. However, at this stage it is still possible to treat a patient and improve the flexibility and mobility of his joints.

Of course, despite any differences between these two stages, the goal of treatment remains the same: to help a person walk away from what he has, and focus on improving his function and abilities so that he may become as independent as possible in his everyday life.

 

Final thoughts

With this in mind, please remember that these are only guidelines and that nothing regarding a person’s condition or prospects is set in stone. No matter what the prognosis may be, it doesn’t mean that you should give up on treatment or think that it is hopeless. Whether a patient is a child, teen, or adult, a therapist’s overall goal is the same: to improve a person’s way of life and function to the best of his abilities. Good luck, and I wish you and your family all the best with your loved one’s treatment.

If you have any questions, feel free to leave me a comment or email me at natan[at]enabledkids.ca. You can also read more about Fabio’s story here.

—
Key Terms
calcification: The accumulation of calcium or calcium salts in soft tissues, causing it to become inflexible or unchangeable
ossification: The natural process of bone formation

For More Information
http://www.nsbri.org/humanphysspace/focus6/ep_development.html
http://www.posna.org/education/StudyGuide/timingOfOssificationCenters.asp

Assistive devices, splinting and AFOs

By Natan Gendelman | http://www.enabledkids.ca | http://www.healthinmotionrehab.com

As we’ve indicated before, cerebral palsy is a neurological condition which results from damage to a certain area of the brain. When this occurs, a child’s ability to control specific parts of his body is affected, leading to impaired function and mobility. Since the brain is not sending the appropriate signals to parts of his body, a child will try to function in any way that he can and fight the condition that he is in. In turn, this will cause hyper tone, as we have written about before in our previous blogs.

In the case of a child, having hyper tone may cause certain patterns to occur during development. High tone in the trunk, for example, will lead to high tone in his hands, arms and legs, as well as to improper sensorial development. Now, what happens is that it becomes difficult for him to learn to walk properly, perform grabbing motions, or even bend his hands in the first place. For kids with cerebral palsy, this can result in the emergence of certain patterns like forming crab hands without bending them, or performing robot-like movements where the whole body is moved at once. When these methods of moving are left unchecked, they can have severe consequences on a child’s condition, and what he will be able to accomplish.

The effects of splinting and other devices

With this in mind, many people try to address these problems through the use of assistive devices, splints and AFOs (ankle-foot orthoses). Splints and other assistive devices are often used to maintain an appropriate range of movement in a child’s joint. However, it’s important to note that their usage may cause a chain reaction to occur in a child’s condition. When a child has a splint applied, his brain is not taught the appropriate function to go with the movement. Therefore, while his limb may be held in the correct position, his muscles will be stretched passively--that is, without the child’s active participation. This sends a message to the brain that the device is a foreign body, causing his body to try and fight it. As a result, that is why a lot of therapists find that a child’s tone will go up the moment a splint is taken off.

Making the decision

So, the question is: should we be using splints? Like I’ve said before, each situation has to be dealt with as a separate case which depends on the child’s condition, his ability to move and function, and--very importantly--his age. One key factor which will affect his need for these devices is his weight bearing and movement. A crucial part of joint development, weight bearing plays a necessary role in several movements which are part of a child’s function including sitting, crawling, standing, and walking. If a child places weight on his feet and hands in the process, he will not need a splint because his function will be corrected by his own weight. As he progresses from his knees to standing and then walking, the child then learns how to shift his weight properly. However, if a child is not moving at all, then--again, depending on the case--the use of a splint or other device may prove to be the most beneficial option.

For these reasons, it is important to understand and consider your child’s needs and condition before choosing and implementing splints, AFOs and other devices. Remember, their use will immediately limit certain movements for your child. As a result, it’s a good idea to think twice, do your research and learn how to use them safely and wisely.

If you have any questions or comments about this article, feel free to leave me a message down below or send an email to natan@enabledkids.ca. Thanks everyone, and I hope to hear from you soon!

So what’s the difference between cerebral palsy, brain injury and stroke?

By Natan Gendelman | http://www.enabledkids.ca

Cerebral palsy, traumatic brain injury and pediatric stroke are often brought together under the same treatment processes and types of rehabilitation. It is common knowledge for many people who work with kids that the approach to take is often quite similar between the three conditions. However, after working with and observing children who have cerebral palsy, brain injury or pediatric stroke, personally I would disagree with this method and viewpoint. In my opinion, there are many reasons why treatment for each condition should be distinct, and the first thing I would like to examine is what makes each condition different from the next.

Comparing terms

To start with, cerebral palsy can be generalized as a condition that a child is born with. The degree of severity of his condition will depend on how severely the brain is affected, and--by following a chain reaction--on the stages of development he has missed. This will lead to impairment as he grows older if the appropriate function is not gained. Children who have cerebral palsy cannot move through the stages of development because they are not acquiring skills in the normal developmental process. In most cases, a child is taken through his individual milestones by the nervous system. For a child with cerebral palsy however, this progression is absent and this normal development does not exist. Therefore, the skills have to be acquired first, and then repeated until they become automatic. This means that when we work with a child with CP, there is no re-gaining of skills, only learning from scratch. These are things that a child will then apply in his daily life, to become a part of his everyday function.

In contrast, traumatic brain injury and pediatric stroke can be seen as having totally different circumstances. Although it will depend on when these injuries occur, often a child with either one of these conditions would have already gone through at least some of the stages of development. This means that he would have already learned and acquired certain skills before the injury. When dealing with a child in one of these situations (and again, depending on his specific age, severity of condition and other factors), treatment will involve rehabilitation--that is, the re-gaining of movement and function which has been lost because of brain damage. This is what sets conditions such as TBI and pediatric stroke apart from cerebral palsy, and is something that should be accounted for in treatment.

Learning vs. regaining skills in treatment



When working with a child that has cerebral palsy, we need to remember that the child will not be regaining skills; he will be learning ones that he has never had before. Therefore, he has to be taught from A-Z what everything stands for, the individual body parts, the way they move, and how normal function should be. In contrast, a child with a brain injury or who has experienced pediatric stroke will need to focus on this idea of regaining skills, which means we are acquiring skills that take place before the injury has occurred. It is for these reasons that the approach to treatment will need to be completely different for a child with cerebral palsy. Rather than following the same steps that patients follow for the other conditions, the child will need to be shown how to turn, roll over, and be able to build on those skills before moving onto the next step.

As a result, a child’s treatment should differ according to how the child gains valuable life function. The methods of learning for kids with brain injury or stroke should not be the same as those for children with cerebral palsy. We take this approach in my clinic’s specialized treatment program called LIFE, and that is why we call our program an education / rehabilitation system rather than one or the other--the approach will change depending on the child’s needs. Here, we teach kids how to acquire these functions, how to do them, and why. If a child does not understand, we repeat them again and again and again under the child begins to follow. By paying attention to a child’s personality and characteristics as well as to his learning and specific condition, the treatment process becomes much more successful and fulfilling for those involved. It is for this reason that I think treatment for children under each category should be approached with regards to the condition itself.

Of course, whether dealing with kids that have cerebral palsy, pediatric stroke or brain injury, the bottom line is the same: the patient must be the one to work harder than the therapist. That’s the reason why at our clinic, we try have a child do everything he has been taught by himself. In the end, the ultimate goal of treatment is to have a child learn to do things independently. By distinguishing each of these conditions, I hope that more parents, caregivers and therapists will learn from and experience success with their child as he learns and discovers the joys, wonders and surprises held by the world around him.

If you have any questions or comments, feel free to leave a comment down below or email me at natan@enabledkids.ca. Thanks everyone!

Crying in therapy

By Natan Gendelman - http://www.enabledkids.ca

For many parents, family members and therapists, crying can be a big obstacle to overcome when teaching and working with a young child. While it may be difficult to manage this sort of behaviour, it is important to understand why a child is upset as well as the things you can do in order to see his way of thinking. In my opinion, the key to handling this issue is to try to figure out where the child is coming from and be willing to view things from his perspective. In doing so, you will be able to tell the difference between when he is simply protesting something new or if he is hurt and needs you to stop and assist him in his function.

Seeing from a child’s perspective

For this reason, it’s good to take a step back and observe your child. We often believe that since we are older and “wiser,” our primary goal is to teach a child the things that we know and understand. However, every child is different, and each has his own dreams, wishes and fears. In this respect our first response should be to learn as much from him as he learns from us. The ability to understand a child becomes really important especially when you are working with him to improve his function. In response to unfamiliar situations or tasks, a child will often cry because he does not want to do them. This makes it important to know the difference between crying as a response to new experiences or in response to actual injury. If he is really hurt, you will need to stop and find out what is happening. However, if this is not the case it is important to persist and continue with treatment.

Why is this the case, you may ask? If a child is only protesting, explaining things to him will be much more effective than stopping treatment every time he begins to cry. If you stop, he will automatically assume that crying will be the solution to stop you from making him do certain things. It is a self-defense mechanism, which is why you need to explain what, how and why he needs to do something in order for him to be able to understand. In this way, he will come to comprehend what is being taught and you will be able to continue with his treatment.

The effect of this approach

To demonstrate how effective approach this is, I’ll tell you about one of my experiences with a young girl that had cerebral palsy. As I worked with her, I made sure to explain every function and its purpose to her for each new activity we did together. During the girl’s treatment, her mother told me, “You are the first therapist that she didn’t cry with.” My question to her was: did anyone talk to the girl and explain what she was supposed to do? When the mom said no, it was easy to understand the differences she saw in her child’s learning and behaviour.

Whenever I encounter these situations, I ask myself: why do we have to assume things about a child and try to make him follow them, when we can simply ask a child what’s wrong and then explain what we are going to do? If a child is not willing to do the things which he should, then the approach to take is to explain, follow up, and repeat it again and again and again. This is how a child is able to learn and eventually follow. When we do everything for a child however, instead of simply assisting him as he learns to do things for himself, he starts to assume that everything can be done for him. If this were the case, then why should he have to follow instructions and strive to accomplish more? Without being given a reason for doing things, a child will continue to protest and cry whenever he comes across new situations.

So my final advice to parents, therapists and caregivers alike is this: communicate with your child. Explain why he has to perform certain functions and show him how to do them. It is important to be patient, persistent and understanding, for you are the one who will teach him what’s wrong, what’s right, what’s true and what’s false. As you help to introduce him to the world, remember: your child is bright, and it’s up to you to support and guide him as he continues along the path of development.

If you have any questions or comments, feel free to leave a comment down below or email me at natan@enabledkids.ca. Thanks everyone!

As we’ve already discussed, cerebral palsy is a designation which covers many symptoms. In medical terms, it is not attributed as a disease or genetic disorder, but characterized as a condition with several possible causes. Whether congenital or acquired, cerebral palsy occurs when certain parts of a child’s brain has been damaged, affecting his ability to function, communicate and control his movements. Since the brain acts as the control centre for the nervous system, this will also lead to changes in his cognitive and sensory development. For a child, this many first become evident from his clenched fists and hypertonic muscles affecting either the limbs, trunk, or one side of the body. He will throw himself backwards when touched on his back, instead of putting his head forward when raised up from his hands. Also, the child may not trace objects, roll to both sides, or he might use one side more than the other. Parents are often the ones who watch their child the most, and notice when something is wrong.

As parents continue learning about their child’s condition there are several things that they need answers to, and the prospects for their child’s development is one of the main issues that may arise. Having worked in rehabilitation for over 20 years, I’ve had many parents asking us: Is cerebral palsy curable? My answer to that question is that it really depends on each child’s specific development, stage of condition.

Now, I know that I am going to cause a lot of debate here, but it is not my goal to argue about this issue. Instead, I would just like to show everyone my standpoint on this issue based on my years of experience and practice in the field. First, to tackle this issue we need to determine that every case of CP is different and can vary from being really mild to severe. When dealing with extremely severe cases, then I agree: there is no cure. Can we improve their ability to function, and bring them as close to independence as possible? Yes we can, when we give them the right approach and treatment. However when we’re dealing with certain mild cases, then there is the possibility for the condition to be cured—if caught on time and dealt with in the right circumstances.

How is this possible? Well, until a child turns one year old his development is still in its early stages. He starts to learn how to roll, crawl and stand, which are huge first milestones in his progress. By doing this, the child is starting to discover the world and open himself to new experiences. When a child is diagnosed with CP during this time period, he will not have had time to form improper functions (movements, communication) to compensate for his condition. Since he has not begun the subsequent cycle of disability and loss of independence which often occur in children with neurological disorders, you have the opportunity to take the child and guide his learning. When given the appropriate methods and appropriate stimulation, his brain will form new functional pathways. This is something called: brain neuroplasticity, and since the pathways are in their developmental stages, it is very possible to develop your child and help him accomplish independence.

So how can we do this? If we get into the specifics and talk about spastic cerebral palsy, we need to consider how hyper tone develops in a child’s body. When a child’s muscle tone is increasing, this does not allow proper function to take place. Consequently, this leads to compensation in his movements and begins a vicious circle affecting his mobility. Once a child learns to move in the appropriate way, he can then progress on to the normalization of function. In my opinion, if a child can move, then he can learn. As a physiotherapist, I have seen many cases progress to a point where a child doesn’t even appear to have a condition after treatment has finished (watch Sean or Katerina’s treatment). So, if a child has achieved normal tone and normal function, why should he be aware of a condition that is no longer affecting his life? Again, I am highlighting that each child has to be seen as an individual with his own condition, and that not everyone can work out of it to such a degree. But for years, we have seen children brought out of their disorders, and today these certain individuals can run, interact and play without any signs of cerebral palsy.

We need to remember that, first and foremost, therapy is something that happens all the time. A child’s learning doesn’t just occur in the treatment room; parents play a key role in their his improvement. If there is a possibility for your child to become independent, what he can achieve will depend greatly on how you guide his development. Keep this in mind, stay optimistic, and believe in what your child can accomplish.

For more articles, visit www.enabledkids.ca.

Understanding hypertonic cerebral palsy

Cerebral palsy is a catchall term used to describe a wide variety of symptoms originating in the brain. The brain is the information centre of the nervous system, which governs the entire body. Therefore, once it is affected it ultimately impacts a person’s daily life functions.

When a child is diagnosed, please keep in mind that it does not set anything for your child’s future. The diagnosis involves just a general idea of what symptoms may arise. However, there are many factors which have to be taken into account for each individual. For example, even the most minor cerebral palsy can become severe if treated improperly or not at all. As well, a child’s personality has a great impact on his condition. Therefore, one child’s cerebral palsy will differ from another. The prognosis for a child with cerebral palsy will also depend on how early the disorder is detected. The younger the child is, the more likely he will be able to create alternative pathways in his brain. In some cases, with appropriate treatment, the child will be able to walk away from his cerebral palsy completely.

Hypertonic Cerebral Palsy is a condition where all the muscles in the body become tense. A child with this condition will appear “stiff.” Muscle tone is something that is present in every person. However, when a child’s nervous system is affected, it sends abnormal impulses to his muscles. As a result, the muscles contract / become spastic. The condition of a child’s hands and legs (extremities) usually follow the trunk. The trunk is king—or in other words, the center of the body. Once affected, it starts a snowballing effect on the rest of a child’s physique: if a child cannot roll from side to side, the tone in the trunk will increase (i.e. become hyper tone). This leads to increased tone in the hands and legs, which ultimately hinders a child’s daily function.

To reduce or normalize tone, a child has to be taught how to move and function in a proper way. This is learning and not rehabilitating. Rehabilitation involves regaining skills. The child never had these functions in first place—therefore, he is learning. You can compare this with learning how to drive a car. Do you remember the first time you drove? How tense you were, and how much you sweated? A child with cerebral palsy is not excluded from these feelings. The skills which he is learning are acquired skills. They were not given to him during the stages of his development. When a function becomes part of his daily interaction, he will begin to use his body and extremities in the appropriate manner. When learning to crawl for example, a child will start to put weight on his legs and hands. If he is taught to roll, he will begin to develop normal tone in his trunk. As he repeats these actions more and more, this normal, functional weight bearing will allow the tone to normalize. This will enable him to learn and perform a greater range of daily functions and movements.

Whether a child is learning to eat, use the washroom, or dress himself, these functions are necessities for daily living. They are not exercises, but practice for real-life activities. He needs to know how to do these tasks, and that is what we, as therapists, aim to achieve.

By understanding your child’s condition, his learning process and the chain reactions which occur, we will enable him to learn, grow and develop independence in his everyday life.

For more articles, visit www.enabledkids.ca.

Don't wait to treat your child

Elaine, the grandmother of 3-month-old Debbie, called me regarding her granddaughter’s condition. Concerned, she described to me that Debbie was not turning her head to the right side. She did not grab things with her right hand, and did not move her right leg. In addition, when picked up by her hands, she was pulling herself back, and did not try to hold her head in an upright position.
Her daughter-in-law consulted a paediatrician, and was promptly told, “There is nothing to worry about.” But Elaine, who grew up raising four children, knew that there was something wrong.
When the child was brought to me, I saw what Elaine had been talking about: Debbie had a “clenched fist” on her right side. She disregarded her right side as a whole: she did not want to turn her head, or move her right leg or arm. When she was pulled upwards from a lying down position, she did not tip her head forward.
All these are the first signs of cerebral palsy. Unfortunately not every paediatrician or physician is able to recognize them in their early stages. Thankfully for Elaine, she discovered it in time and we were able to reverse the effects of her granddaughter’s condition.
Development isn’t something that starts after a certain age. A child develops physically and mentally starting from pregnancy. This is why it is really important to talk to your child, and make him feel that he is a part of your life even before birth. Fresh foods (preferable organic fruits and vegetables) and fresh air are the best friends of your child. Remember that he deserves the best of what you can give him.
Once the child is born he begins to discover the world. His mental development is inseparable from his physical exploration. If a child moves—he learns. His discovery comes through touch (sensory development), speech and communication, and his daily function.
But if a child does not move, or is having difficulty reaching for an object, usually his parents are the first ones to do it for him. As a result of our “help,” he does not learn to do new things. In a way, we are discovering the world in his place, when it has to be opposite: he has to discover the world for himself, and by himself. We are here just to guide and assist his learning. This way we can teach a child to make his own decisions, and to discover the world on his own.
Life takes your child through the stages of development in a certain order with one goal in mind: to prepare him for the steps ahead. If you can see that your child is having difficulties achieving these milestones, this should ring an alarm for you.
Do not rely on the opinion of others. You are the ONLY person who really knows your child. Consult multiple child experts, and conduct as much research as possible. Look for a second or even third opinion. In some cases, look into therapies and additional services that may help your child.
The earlier you start up treatment, the easier it is to deal with the difficulties your child is facing. Stay positive. As a parent, you make all the difference in his development.

For more articles like this, visit www.enabledkids.ca.

Learning to walk again: Neurological rehabilitation overcomes paralysis

BY BRIAN PASSEY
bpassey@thespectrum.com

James Loris is walking again. The father of five who owned his own construction business was in a wheelchair, paralyzed from the chest down following an off-highway vehicle accident that fractured his C6 vertebrae.

"When I broke my neck, it pinched my spinal cord," Loris says, adding that the injury disrupted the brain's communication with his body, causing the paralysis. "He just turned the system back on."

Loris is referring to Steven Bennett, a physical therapist at Mountain Land's Southwest Neurological Rehabilitation Center in St. George. Bennett utilizes a neuromuscular training program to restore function to paralyzed or dysfunctional muscles resulting from a variety of medical conditions, including strokes, spinal cord injuries, brain injuries cerebral palsy and other neurological and orthopedic conditions.

The program utilizes electrodes placed on a patient's muscle group to read electrical signals transmitted from the brain to the muscle. An attached computer reads electrical impulses, displaying the signals on a monitor for the therapist and patient to see during treatments.

The therapist then uses a conditioning protocol to teach the brain to use alternate paths to communicate with the muscles. This conditioning is tracked by watching the signals on the monitor.

Once the brain learns to communicate with muscles through new paths it remembers the alternate paths for future use and, in effect, overcomes the paralysis.

That is how Loris came to walk again.

"You have to have determination," Loris says.

He's not quite back to his pre-accident mobility. Loris walks with a limp and has to concentrate on lifting his leg so he doesn't trip over his foot. Bennett says they have not yet been able to restore movement to the muscles in one of Loris' feet.

It's a long way from using a wheelchair because he didn't have any movement from the neck down.

"He'll come back in and we'll tune him up and smooth out that walk," Bennett says.

It's not an easy process. It's hard work. It requires strength. Yet Loris says he was driven because he had to provide for his family. He can even drive a vehicle with a standard transmission, clutch and all.

Bob Mower

The treatment is not just effective for accidents like what happened to Loris. Bob Mower, a retired Dixie State College chemistry professor, suffered a severe stroke in May and was unable to walk because he lost mobility on his entire left side.

"It was a long time before I could even move," Mower says.

Bennett says Mower was not supposed to be able to walk again. That was before he went through the neuromuscular training program.

"We had to turn on his whole left side," Bennett says.

Because Mower had the determination to move again, he checked out of both inpatient rehabilitation and home health before he was supposed to so he could begin working with Bennett.

Mower's wife, Susan, calls Bennett a "miracle worker" and says he's "perpetually optimistic and encouraging."

"Bob's in far better shape than anyone ever thought he would be," she says.

When he first visited the Southwest Neurological Rehabilitation Center, Mower couldn't walk or move his left hand. His goals were to overcome both of those obstacles and he has.

"Now I can walk from the parking lot into the therapy office, from the parking lot into the grocery store, and from the parking lot into church," he says. "I can move my hand and fingers well enough to hold onto things. I can hold the television remote so tightly my wife can't get it away from me."

Mower also likes how Bennett appreciates a good joke, because Mower is full of them.

Richard Cox

He still uses a wheelchair to get around but Richard Cox is much farther along in his recovery than he thought he would be after his injury more than three years ago.

"I had absolutely no movement," Cox says. "I couldn't type. I couldn't write my name. It's been a long 3 1/2 years."

Now he is slowly regaining movement. Although he still needs the wheelchair for everyday movement, he can walk short distances with the aid of a walker and knee brace.

Cox was riding in the back of a Jeep when he hit the roll bar and blood began to flood his spinal cord. Blood clots suffocated the spinal cord and peripheral nerves, leaving him paralyzed.

Then his aunt, who lives in St. George, mailed an article about Southwest Neurological Rehabilitation to Cox in Phoenix, where he lived at the time. About six months ago Cox moved to St. George to pursue treatment.

Like others who have sought Bennett's help, Cox has damage to the pathways normally used by the brain to communicate with his muscles. Because these pathways don't regenerate, Bennett has to work with Cox to teach his brain to follow different pathways.

To do this, Cox positions his wheelchair between two horizontal bars in Bennett's office. He uses his upper-body strength to pull himself up to a standing position. From there he slowly puts weight on one leg at a time to send signals to his brain. Through trial and error of placing the weight in different spots he can train his brain to find different communication pathways to the muscles.

"Once the brain sees it a couple of times it will repeat it and repeat it until it's locked into motor memory," Bennett says.

It's not easy.

As Cox puts weight on his leg he groans loudly, almost like he's bench-pressing weights in a gym. Because of his injury, his nerves are more sensitive than normal. Cox says everything is magnified by about 10 times. The process is both painful and exhausting.

Still he's determined to push through and regain mobility.

Cox meets his goal of sending a powerful signal to his brain as tracked on the computer monitor. Yet he wheezes, "One more."

He puts his weight on his left leg again, groaning under the effort once more. He meets another goal and Bennett asks Cox if he has enough energy to go again.

Without hesitation Cox replies: "Yeah."

Then he decides to show off. With Bennett blocking Cox's weaker left leg so it doesn't give out on him, he walks a few steps, using the horizontal bars for some support.

He pulls his hands from the bars, putting his entire weight on his stronger right leg for a few seconds. He is standing without assistance.

"I can, with my right leg, support my weight," Cox says with an optimistic smile.

For about three months after his injury, Cox was one of about 20 patients in the hospital with similar injuries. He got to know the other patients quite well during that time. Now he says they have all given up except one other and him.

That is why he wants to spread the word about this treatment.

"I figure this accident had to happen for a reason," he says.

He didn't know services like this were available until his aunt sent him the newspaper article. Only about a dozen locations around the country offer the neurological rehabilitation services.

Cox has been working with Bennett for less than six months and has seen many successes during that short time. Bennett says he's walked up and down the length of the center's gym with the walker.

Ever the determined optimist, Cox pats his sleek, black wheelchair and says: "I look forward to donating this to someone else."

For more information on Mountain Land's Southwest Neurological Rehabilitation Center, call 628-5194