Sep. 15, 1998 LOS ANGELES (September 11, 1998) - "Learning to walk again is hard--the hardest thing I've ever had to do," says Howard Rutman, a film maker who was virtually paralyzed in a motorcycle accident last December. Rutman remembers little about the accident -- except excruciating pain. Nor does he remember much about the ambulance ride to Cedars-Sinai Medical Center's Emergency Department, where doctors determined that he had suffered an "open book" pelvic fracture, crushed lumbar vertebrae, bone shards imbedded in his spinal cord, and a ruptured bladder.
The prognosis at that time, says Michel Levesque, M.D., director of the Cedars-Sinai Neurofunctional Surgery Center, was about a year in a wheelchair at best, more likely a lifetime. "With these types of injuries -- the spinal cord was 70 percent compromised -- I would more typically expect the person to spend the rest of his or her life in a wheelchair," says Dr. Levesque.
Nevertheless, Rutman was determined to walk again, and he even imposed a deadline upon himself. "I had a movie I wanted to make," he says. "That was one of reasons I wanted to get going on rehab. I think you need a goal--a carrot put in front of you is real important. Whether you actually succeed or not, it (the goal) drives you." So he decided to take charge of his own recovery. "I decided that as long as I wasn't damaging anything, I would push myself to get back on my feet. I had things I needed to do."
Working with physical therapists in the Cedars-Sinai Rehabilitation Department, Rutman learned to roll over and get in and out of bed, maneuver himself into and out of a wheelchair and car, and -- using a transfer board -- a bathtub. He also had to learn to put on a special fiberglass shell, designed to keep his pelvis and spinal cord immobile while they healed. "I didn't have to wear it in bed, but I had to strap my 'turtle shell' on before I got out of bed. I had to learn to roll onto my side, get up on my hands, creep my feet over to the edge of the bed and ease my feet down slowly. If I went too fast, the jarring hurt my back and pelvis."
After two months on his back, the determined Rutman was mobile again, and he was released to a halfway house, really a minimum care facility, where he continued to push himself to the limit. "I came in to the Cedars Sinai Outpatient Rehab Clinic for treatments, where I worked on learning to walk again. I could stand up, but I couldn't walk because of my feet."
Finally, Rutman was ready to go home, but he faced a big challenge -- learning to manage the steps. "I live on the second story, and I knew I had to be able to get up and down, whether it was one step at a time or on my butt," says Rutman. Working out at home with his therapist twice a week, Rutman devised a routine of his own to follow on the days in between.
"Learning to walk was tough. I had no coordination in my left foot, and I was still pretty numb from the waist down," he remembers. I'd put a piece of paper in front of my foot and try to hit it with my toes."
After a few therapy sessions at home, Rutman decided his therapist wasn't making him work hard enough. "I sat him down and said, 'When you walk out of here I want to be puffing and sweating. My goal is to be able to walk down stairs in a week-and-a-half." And sure enough. Soon he could do it, using a four point cane. Then he started walking with a walker/chair around the block in agonizingly slow increments -- shuffling carefully and cautiously from driveway to tree to fence, etc. "When I got tired I sat in the chair," he says. "I tried crutches, but realized I could support myself just as well with the cane, and the crutches got in the way. I decided I'd just walk through the pain, as long as I wasn't hurting myself physically. I used the cane for two or three months until I realized I was spending all my time looking for it, and now I don't use it at all."
"Once I was out of the chair, I started going back to Cedars Sinai for outpatient rehab a couple times a week. They knew me when I walked ---or rather, rolled, through the door."
Howard's motivation hasn't flagged, according to his physical therapist Rob Naples, P.T. "He's very motivated," says Naples, "ready to get down and dirty while he's here. It's mostly a matter of making him aware of deficits-- he's willing to deal with them on his own."
So what's the prognosis? "The neurosurgeon originally thought it would take me a year to get back on my feet," says Rutman. "But I walked into his office in May -- that was about five months after the accident. It's all a matter of motivation, if you have any feeling at all below your waist," Rutman concludes.
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