Learning how to walk

"So can she walk yet?"

I don't like that question.  I realize that when someone asks me if Anna can walk, they have the best of intentions.  But it certainly puts me in an uncomfortable position.  Most others don't have the perspective or knowledge that we have regarding Anna's brain trauma and her recovery.  Even those who have some of the information, still don't have the complete picture.  Nor do we, in fact; we keep learning more and more.

So when someone asks me "the question", I try to stay positive and give the short response about how Anna is continuing to make progress, but it will be awhile before she feels comfortable walking independently around lots of people.

Still, it seems like a bit of a cop out.  Shouldn't she be walking by now?  Babies learn how to walk within a year, why is it taking Anna so long?  No one ever asks me these questions, but sometimes I can just feel them.

I'd love to give people a glimpse into how much work it is to learn how to walk again after experiences like those Anna has had.  I like giving the long answer, but I don't think many people necessarily want the long answer when they ask "the question".

So I'm going to give the long answer here, for anyone who is interested.

Learning how to walk is very, very complicated.  The most intricate part, in my opinion, is our sense of balance.

Everyone's brain receives information from three main sources when it comes to balance.  First, your inner ear has special fluid-filled structures to give you a sense of where the ground is; second, your eyes will also be able to tell you which way is down; and third, whatever part of your body is touching the ground can feel the pressure of the touch.

If any one of those pieces isn't working properly, balancing gets more challenging.  For example, try standing on one foot while your eyes are closed.  It's trickier, isn't it?  And you are much more conscious of the changing pressures on the bottom of your foot, right?

All this information is routed through your brainstem up to your cerebral cortex (the thinking part, just in case some of the signals seem to be at odds with each other) before the signals are sent to the correct muscles.  Then, this information goes through the cerebellum, which is that wonderfully complex part of the brain that coordinates all of the correct muscle groups to fire at just the right time to make sure you don't fall over.

Now think about what happened to Anna's cerebellum.  First, there's still a big empty space in it where the tumor was.  Second, the cancer had spread throughout her cerebellum (among other places).  The cancer cells took over the healthy ones and fiddled with all of the connections that were there prior to cancer.

Think that's enough?  Nope.  Radiation came next, targeted very heavily on the cerebellum.  We know that the radiation was very effective on the cancer, but it also damaged the healthy cells.

As if that wasn't enough, at the end of the radiation therapy came that pesky shunt infection.  Just when everything on the inside was raw and vulnerable, the infection came.

Now, hopefully, you have a better picture of why Anna's neuro-muscular system was back to square one back in May of 2014.  Even though the rest of Anna's brain was (and is) still functioning well, all of that balance and muscle coordination had to begin again, and now with a less-than-perfect cerebellum.

At this point, it's helpful to think about how a baby's sense of balance develops.

First, parents and other caregivers play a huge role in helping a baby learn about where the ground is and how to keep from falling..  A child's life begins by being carried and rocked, a lot.  Then, as the baby gets stronger, they are bounced, spun around, turned upside down, etc.  All of these motions help a baby develop the visual part of their sense of balance as well as the inner ear aspect (collectively called the vestibular system).

It's a bit trickier to recreate those kinds of activities for someone who weighs more than 15 or 20 pounds, but therapists (and parents) do their best.

Another major benefit of learning your sense of balance as a baby comes with the idea of size.  When babies learn to crawl, they fall and don't get hurt.  When babies learn to stand, they fall and don't get hurt.  When babies learn to walk, they fall a lot, but have plenty of padding in all the right places so they don't get hurt, or at least not too badly.

Again, it's harder to simulate those kinds of learning experiences when you are farther away from the ground.  The taller you are, the harder you fall, and the more it hurts.  That's where therapists and equipment come in.

It's a miracle that any of us are able walk upright on two feet.  Think about that the next time you take a few steps.

And when Anna finally does learn how to walk again, now we will all know just how much of a miracle that will be.

So it is going to take time for Anna to learn all of these things again, and still ensure that she has a positive outlook on life.  She's getting there, but it will still take more time, and practice.  Her sense of balance is way better than it was a year ago, but certainly not where a toddler's is.


Maybe the next time someone asks me "the question", I should just refer them to this post :)  But that wouldn't be right; sometimes it takes too much time to give the long explanation and, honestly, not everyone wants to hear it.



Thank you, for taking the time to read and understand Anna's life a bit better.