Phase IV

(Function and Coordination)

We call Phase IV the transition phase because the client is between worlds; they are no longer paralyzed and have the ability to move and control their legs and arms, but do not have the strength or coordination to walk with aids. The transition from Phase III to IV can be long and hard, and quite often very frustrating and can take anywhere from six months to over two years. And, it’s not guaranteed that every person will make the transition. Of those that do finally break through to Phase IV, the majority go on to walk with the help of aids.

Why does this happen? What we have learned, and what we teach our clients, is that movement creates more movement. Once tone and spasms are broken down, controlled movement occurs. The more one moves, the easier it becomes; and because it is easier, activity levels increase. Because activity levels increase, the client continues to improve. It’s like going downhill; as you gain momentum, the faster you go.

Phase IV, like the entire recovery process, doesn’t happen in distinct stages. Each stage overlaps with the next. Clients usually start to have coordinated movement in one area and plane of motion while they are unable to control other movements. For example, a client may have one leg that is good while the other one isn’t. Even though they may be mobile, they are still working on re-learning to use their nervous system.

The Dardzinski Method™ addresses nervous system discrepancies by working the nervous system as a whole. As the nervous system continues to mature, function slowly returns to more and more of the body. Because of this, we really pay attention to posture and biomechanics. Everyday, we train the body to work in a functional manner with a goal of alleviating a dysfunctional gait. Gait patterns are much easier to fix before you start walking and before compensation gets worse.

If you can move your legs, you should be able to walk if you have the right stimulation and the knowledge of a trained professional. Our combined background and experience in performance training gives us a totally different mindset when it comes to this process. We work and train our clients like athletes and teach them the skills they need to walk well. By mastering those skills, the body slowly regains coordination and momentum starts.

Training Guidelines

Appointments

Guidelines are set on an individual basis. At any time they can be changed as your body evolves. The biggest misconception out there is that you need to workout 6 to 8 hours a day. Our program focuses on the quality and intensity of a workout and the results that it produces. Each client has at least one Specialist at all times. Often two or more Specialists are used to help perform a particular movement or skill. We can not emphasize enough the importance of REST AND RECOVERY. The human body gets stronger when given the proper time between workouts to rest. Those that follow these guidelines get better; those that don’t allow for rest and recovery, struggle.

Workout Prescriptions

At this stage of your recovery, mental and nervous system fatigue is replaced with real muscle fatigue so you will begin to experience muscle soreness. Diet and rest become very important. Over training is now a real possibility and will only slow down your recovery.

Individual workouts become more specialized during this phase because now, more than ever, the wrong program will only produce more tone and spasms. Learning how to adapt to a client in this phase takes years of practice. Only our best skilled Specialists train Phase IV clients. It is not easy teaching a nervous system to walk again, so we rely only on our most experienced Specialists to supervise this transition. In the beginning, your daily workouts will focus on coordination. As you progress, you will spend more time working out in the vertical plane (standing up). This is where you will start taking steps.

You need to be close to 100% coordinated on the floor, controlling your legs through the full range of motion. Perfecting movement patterns on the floor will develop the coordination needed to walk.

Pushing your coordination is how you will recover. We will work on your weaknesses over and over until they become strengths. Our center is designed to stimulate and develop coordination, so we have many great tools to work with!

Suggested Additional Modalities

Pool Gait Training
This can be initiated at any time during Phase IV. The client can now take the dynamic movement patterns that they are doing at Project Walk® and begin to duplicate them in a standing posture. To add gravity, the client should use ankle weights to help with hip and knee flexion. Repetitions are what counts; as your balance improves, head to shallower water.

Massage
Sore, tired muscles can use a massage to aid with healing and recovery time. Massage isn’t a must but it will definitely help and it feels good. If you can treat yourself once in awhile, your body will thank you.

Acupuncture
Many of our clients get acupuncture treatments.

Cardiovascular Exercise
It’s good to get the heart rate up and the blood pumping. Try using a stationary bike, rowing machine, Versaclimber, or swimming. Get out and get moving. 

Real World Outside Activities
Since you have more function, use it! The more you use your nervous system, the faster it will learn. We have learned that clients who do more activities during this phase recover faster. So our advice is to go outside and play. Take advantage of the opportunities provided through the network at Project Walk®. In San Diego you have every activity you can think of, including: horseback riding, skiing, kayak surfing, hand cycle workouts and wheelchair sports. For more information.

Donate These Modalities

External Electric Stimulation/FES Bike
At this phase of your recovery, you don’t need it! Please donate it to someone that does. You will be riding a stationary bike or outside on a three-wheeler. One of our clients even put training wheels on her mountain bike.

Standing Frame
You don’t need it, so donate it. You will be working on perfecting the athletic position; weight on the balls of your feet; knees slightly bent; hips in flexion. Standing is something you can do without support.

Symptoms of Phase IV

You will be physically exhausted so you should sleep real well at night. You will also experience tired and sore muscles, and notice an increase in appetite.

Graduation from Phase IV to Phase V

This is a very nice transition. Slowly you will end up spending more and more time in the upright posture learning how to perfect taking steps. Phase V will be some of the same things you where doing in IV only at a higher level. Everything gets more complicated when you stand. For the first time since your injury, you are now bringing into the equation the inner ear (balance); you also have to connect your upper and lower bodies. Those with C injuries sometimes have great legs but the upper body is weaker, slowing down the progress. Think about a radio with a dial tuner—working out on the floor you can find the station that you want, but when you stand, you get static. With practice, the station comes in clearer. When you are spending more time standing during your workouts than on the floor, you have graduated to our gait program. Congratulations!