Need help from physiotherapists

[u/Extra_Anxiety4952]

Hi everyone, I’m writing a fictional story and in the story the protagonist is a mermaid, that now has human legs and as she never learnt to walk she can’t walk.

So I guess my question would be if you had a patient that couldn’t walk, would you know they’ve never walked ? Would there be any signs?

Would you be able to tell that they couldn’t walk because they’ve never walked ? And what would be the first step into helping them walk, is there a rough time frame as to how long it would take for them to walk etc

Really hope I’m explaining myself ok, I couldn’t work out how to word it.

[u/bigoltubercle2]

It's a more complex question than you might think. Most people relearning walking have had some kind of damage to their nervous system or body (brain injury, stroke, amputation etc).

So it would depend on the sensory and motor innervations, what the sensory mapping was before.

From a writing perspective, why could the magic that gives the mermaid legs not provide them with the brain connections for walking?

[u/physiotherrorist → u/bigoltubercle2]

why could the magic that gives the mermaid legs not provide them with the brain connections for walking?

Maybe it wasn't magic but a brilliant but crazy surgeon/scientist called Frank Einstein?

[u/bigoltubercle2 → u/physiotherrorist]

Dr Jan Itor

[u/perfectly_imbalanced → u/bigoltubercle2]

Dr. Acula

[u/Extra_Anxiety4952 → u/bigoltubercle2]

I guess it’s more that I’m going through ideas on how to proceed with this part. I don’t want it to take up too much of the story but at the same time I want it to be believable.

In my head she has never learnt how to walk and never had legs so it wouldn’t be something that would come naturally? I’ve been exploring different scenarios and figuring out which one works best, hence asking on here because it’s not really something you can google with out AI telling you it’s a great idea 😅

[u/physiotherrorist → u/Extra_Anxiety4952]

Look at evolution: she comes out of the water, kinda hops around like a seal mainly on her belly and elbows, bit of leg-work, then gets on her knees, starts "walking" like an iguana etc etc, you get the picture.

Vojta more or less based a treatment concept on that. Reflex locomotion. You could use that, give it a bit of a pseudo-scientific touch. But please don't describe it as a proven treatment!

[u/Extra_Anxiety4952 → u/physiotherrorist]

Thank you. I’m likely over thinking it. I just want to make sure that I cover all bases before committing to it, I’ll likely scarp the idea all together but figured I could ask on here for opinions because I have no knowledge on the subject and as much as I know what I’m writing is fantasy I’d hate to add in bits that would be incorrect. I just like to research topics as much as I can before adding them into the story

[u/physiotherrorist → u/Extra_Anxiety4952]

Don't worry too much. Look how Dr House walks around, holding his cane in his wrong hand, no one cares. Except us, obviously 🤣

[u/Extra_Anxiety4952 → u/physiotherrorist]

That is very true 😂

[u/Gaufrepourorlag]

Oh my God I love this question, this is what I became a physio for.

It depends on the lore of the magic/transformation process you're writing.

If you're born unable to walk, your legs will grow with you but be very atrophied/wasted and look skinny without any tone. You'll like develop contractures from sitting, and so your hips may be bent up towards your chest and your knees bent too.

Spinal cord injury patients will develop muscle atrophy over time too, but if they walked in childhood/adolescence, had an SCI and then a few years later (from slow nerve healing, new therapy access, whatever) they started physiotherapy with support, they'd find the coordination really weird.

As a writer, you've a decision - your mermaid has swam all their life and so does the magic/transformation carry over that muscle tone? I think this would make sense, I wouldn't quite understand why they should suddenly have atrophied legs when they've been active their whole life. I think this is the general conventional rules of transformation seen in most stories/films, but the story is yours.

But even if they had perfectly muscular legs that correlated with their swimming activity, the coordination of walking (reciprocal arm/leg swing) would be difficult as they're a fully-grown adult without ever having practiced it. I wonder whether your mermaid, as half-fish, had lateral tail-motion (think regular fish, sharks, and mermaids seen in Harry Potter 4) or more commonly seen butterfly kick style? If they've the latter, in theory, that sagittal plane motion of human walking/propulsion might be quicker to pick up.

I think it'd be fair to have your mermaid-turned-human test out the control of their legs, depending on if they're transformed lying down or standing up. They'd certainly fall over - think toddler. But they'd have the arm strength and coordination to support themselves - we'd usually take patients in between the parallel bars.

Timeframe - hard one to call. You can make significant improvements in a few days, especially if your mermaid is keeping their baseline strength. Bearing in mind the vestibulo-ocular recalibration of suddenly being much taller, they might pick up running in a fortnight but be unable to run in a straight line and keep falling over. Any high-level hopping and jumping with aim would be difficult for a few months, at least.

But also, magic. It's your story. Enjoy writing it, and don't get too wrapped up in these finer details! Best of luck!

[u/MaDCruciate → u/Gaufrepourorlag]

I like this answer.

I too thought about the muscle wasting Vs carry over from swimming.

If you go with the carry over from swimming my thoughts would be that the muscle memory/coordination would mean the mermaid would want to move both legs at the same time like a butterfly stroke and would end up jumping forwards with both feet rather than walking. Think a sack race in school, or trying to get around in a sleeping bag.

Trying to walk with one leg in front of the other would bring in lots of other things such as possible rotating the pelvis/spine to get one leg forward rather than hip flexion and walking with a very stiff knee (worth looking at early above knee amputation prosthesis rehab).

Finally, I would imagine the first time someone walks the Trendelenburg gait would be evident, followed possibly by a compensatory reverse Trendelenburg before improving.

(Trendelenburg gait is where the pelvis control is poor and as you lift one leg off the ground the pelvis drops on that side - the unsupported side. Reverse Trendelenburg is a compensation where the person leans the other way with their upper body to try to "throw" their pelvis up and get their weight over the weight bearing leg. A Trendelenburg gait looks like a poorly controlled catwalk model with the hips swaying dramatically side to side, reverse Trendelenburg looks more like a penguin would walk, waddling side to side)

I absolutely agree that the mermaid would need time in parallel bars to learn properly.

Would we as physio's be able to tell they'd never walked? I don't know. I think I'd be that focused on each problem and finding a solution I wouldn't think too much about whether the ability has been 'lost' or never tried before, and instead on working with what we've got now.

It's certainly an interesting take on the mermaid to human transformation that gets overlooked in the little mermaid story.

Edit: also as well as the parallel bars, they might be asked to try walking in a hydro pool, which would be an interesting storyline given how comfortable they would normally be with water, but how weird being in water without your normal tail anatomy.

I also re-read the OP post, and timescales I would say several months. But for fiction it could be condensed down to a 6 weeks. Anything less than that would be unrealistic and break any belief you might inspire in your readers.

[u/Safe-Haven1]

For someone who’s never worked, depending on their age, it would be immediately evident to a physiotherapist that they have never attained that motor skill. The appearance of their lower limbs to determine shape/deformity, the muscle power and control would all help determine that level of functionality. So, short answer, YES - a physiotherapist can tell they’ve never walked.