If you have recently purchased your first transfemoral leg prosthesis, you have perhaps begun the thrilling process of learning how to use it for descending stairs and slopes. This part can be kind of a white knuckler, no? But isn't it just the most fantastic thing in the world that the technology works and you can do this? I'm still not over that part. Every step I take -- even two and a half years out, even so skilled that I no longer look at the ground when I walk most of the time -- is like some kind of miracle for me.
It is my hope that you will experience this as a miracle, too, as the great, constantly evolving gift that countless other people's hard work and genius have made possible for us. First, as I did and as everyone else on this road must, you will have to take some awkward steps, lots and lots of them. It will get less awkward, though. The harder you work, and the better your team and equipment, the sooner it will happen.
The purpose of this post is to show you that even though it might seem very far away, it is possible to get very, very skilled at this descent stuff, to the point where you can even sidestep terrifying obstacles with much the same dexterity and confidence you always had with your original equipment.
Let's start with the basics. You have, no doubt, already been instructed to descend stairs by placing your prosthetic foot on the lower step first. This may seem counterintuitive, partly because you might not understand how to feel or control this leg yet, and partly because some of the people around you may occasionally refer to your living foot as your "good" foot. You may think of it that way yourself. Honey, they're both good. One is just different from the other.
As your extremely competent physical therapist and prosthetist have probably already told you, what really matters here happens in the knee. You work it from the foot -- from the heel, precisely -- but the not-falling-down part happens in the knee. What they may not have gotten around to telling you is that we start with stairs, not slopes, because they are ubiquitous in everyday life, because they are very visually and physically obvious, and because they usually have bannisters. However, the same mechanism you exercise and the same sensations and reflexes you develop using stairs will be the same ones you will use climbing or descending hills, going over rough and slippery ground or pavement, hiking in the woods, etc.
It all starts with the heel smack. Yes, go ahead and smack it, as hard as you feel like, back into the wall of the stair you are leaving and down onto the tread of the stair you are boarding. See how I do this in the photograph above (detail at right), as I descend the very steep stairs in my own home where the treads are so shallow they can't even accomodate the full length of my size-8 sandal. I've got my heel jammed right back into the corner of where one step meets the next, and you can see that my leg is straight, my knee locked erect. This means it's safe for me to take my other foot off the upper step and bring it down to meet the rubber one. I can feel this without looking because I can't pull my foot any farther back nor push it any farther down. There's no play in the knee at all.
As I have mentioned elsewhere, I am a huge klutz and always have been. With both my original legs firmly attached, I managed to fall down staircases at quite a few of the major monuments of the western world -- the Washington, Jefferson and Lincoln Memorials in Washington, D.C.; the Opéra de Paris, the Comédie-Française and the Hôtel Biron in Paris, France; etc. -- not to mention every hotel and office building in which I ever spent any significant amount of time. So actually, I learned this trick a long time ago. Rather than trust blindly that I know where the next step is -- 'cause I don't, I really, really don't -- I have learned to smack my heel into the wall of the stair I'm stepping off while placing my heel firmly down onto the next step. With practice, I've learned to do this less emphatically. However, while you are still unsure where things go, how far apart things are, and what it feels like to have your prosthetic knee snapped into a reliably upright position, this is a good technique to try. When you can't pull your leg back any further and you also can't push it down any farther, you are on the step and your knee is straight.
What you will eventually learn to do is incorporate this heel smacking into your stride downhill, on steeper and steeper hills, and then gradually not to spend a lot of energy on it and only do it very subtly. You will learn to catch yourself before you put weight on a prosthetic that has not been sufficiently smacked open and to shift your weight back onto the other foot really fast. You will. Sometime in the next month or so I hope to have a sunny enough day to photograph a demonstration of walking down a steep hill, and then to post it here. You'll see the similarities between that and this immediately. Meanwhile, this tin-soldier-ish heel-smackery -- swing and snap the leg forward, smack the heel down -- is how you start teaching yourself the limits, on flat land and on stairs. You can gradually go more gently. You will feel when it when it is time to ease up. You will feel your skills and senses build. It just takes time, and practice.
Now, some of us live more hazardous lives than others, and in certain situations it will always be necessary to watch where you put your feet. For example, although in many situations I can now go up and down stairs without a bannister and without even looking at my feet once, in my own home I cannot, for sometimes a dangerous obstacle lurks on the very next riser:
When you encounter an obstacle such as this one, see if there is a place where you can fit your prosthetic foot next to the obstacle. Think outside ordinary alignment. Remember, you don't have to descend facing forward at all times like a prom queen or a movie star. Remember, you can also just sit down and work your way carefully around the obstacle from a very stable butt base. If you choose to remain standing, though, keep in mind that your firmly placed organic leg and foot are keeping you stable, but that you can use the bannister, the steps above you, and any available walls to brace yourself further. Just make sure as much of your prosthetic foot is on the lower tread as possible, and that the leg, starting with the heel, is fitted firmly back against the wall of the upper step and down onto the lower tread so that your knee is straight and the whole apparatus has as much vertical support as possible. Less smacking and more careful, firm positioning will serve you best in this kind of situation, because when the obstacle is a living being who can be startled to move in ways which might prove disadvantageous to you both, it makes sense not to engage in sudden loud activities. In the photo above, you can see how I angled my rubber foot into a corner to ensure optimum positioning without startling the obstacle.
If the dangerous obstacle is not alive, of course, or at least not possessed of certain unpredictably wiggly characteristics, thus stabilized you may find you can simply bend over and pick the obstacle up or push it out of the way. This technique works well with things like grocery bags or carelessly abandoned accessories. It is not the best technique to employ with living obstacles, however, due to their often unpredictable reactions.
With living obstacles, you may have to employ powers of persuasion. Sometimes, all it will take to get the obstacle moving is the mere placement of your prosthetic foot next to the obstacle. Sometimes you may have to resort to cooing sweetly, bargaining, or even begging. Depending on the circumstances of your own life, perhaps a small water-filled squirt bottle or squirt gun will also prove a useful addtion to your toolbelt, hip pocket, or conveniently placed shelf. Just make sure you're well braced to withstand the results of whatever method happens to work.
In any event, if you are fortunate, extreme measures will not be necessary,...
...and you will soon be able to continue your descent uneventfully.
Very important: Note that even though it is quite possible that during the scenario I have illustrated here I am already late to work and on the verge of being fired (and I do hope I'm speaking strictly hypothetically), I have not brought my organic foot down to join my prosthetic foot on the stair below until my beloved little obstacle has cleared himself off. This is because, no matter what, when we are on stairs, especially when we know that a particular staircase tends to be haunted by dangerous obstacles, we are never in a hurry. Never. Understand? You can always make up time elsewhere -- or not. While you are on the stairs, though, your careful patience will keep you and your own beloved obstacles safe from violently unpleasant eventualities.
Now, if the obstacle is a living obstacle, even if you have not resorted to extreme measures, the obstacle might not be very happy with you after all this.
The obstacle might be downright peevish.
In order to be sure you will always (or even usually) obtain consistently positive results whenever you will wish in the future to clear this particular obstacle from your path, some sort of appeasement may be in order. At the very least, you should speak kindly, lovingly, and gratefully to the obstacle who has collaborated with you in your safe descent.
You know what you have to do. Don't be proud. Remember, although you are indeed entitled to go up and down the stairs in your own house whenever you wish, cooperation, like kindness, is not something we should ever take for granted. It costs nothing to say "thank you" every once in awhile.
This is
So wonderful.
So lovingly told and so *present*.
I've lately come to the conclusion that the secret of practically everything is never to be in a hurry, ever, about anything.
(By way of Patry. I had to come see who had such wonderful taste in books. Well, apart from the inexplicable liking for Balzac. Nobody's perfect, I guess :->)
Posted by: dale | July 10, 2006 at 02:29 PM
Thank you, Dale. It's lovely to see you here, and I'm glad you enjoyed this.
However, don't be badmouthing Balzac unless you've read Catherine de Medici. I love him and everything of his that I've ever read, even though I never picked up any of his work until well after I fell down the stairs at the Hôtel Biron, which was but shortly after viewing Rodin's sculpture series of him from bulgingly naked to cloaked and enigmatic; didn't even pick him up, in fact, until I spent a winter in Haines, Alaska, which was itself long after I'd also fallen down Mt. Roberts in Juneau, but I digress. Catherine de Medici was his breakthrough work, IMO. Very, very subtle and deep -- and sardonic, of course, as always. Read carefully and astutely and you will never think of Nostradamus the same way again.
Posted by: Sara | July 11, 2006 at 03:53 PM
Catherine de Medici? Okay. Maybe, maybe I'll give him one last go. I've never made it through one of his novels. The last time I tried Pere Goriot, really tried, because the same friend who turned me on to Milan Kundera insisted I read it, but after fifty pages I just couldn't take any more damp wallpaper and moldy furniture. I threw in the towel :-)
Posted by: dale | July 11, 2006 at 07:57 PM