New York Times article: Exercising Toward Repair of the Spinal Cord

[Wise Young]

The newspaper itself has a great picture of John McDonald sitting in front of the rat impactor.

http://www.nytimes.com/2002/09/22/national/22NEUR.html

Exercising Toward Repair of the Spinal Cord
By SANDRA BLAKESLEE


When Christopher Reeve went on national television last week to announce that he could wiggle his fingers and hips, the news seemed startling. Paralyzed from the neck down after a horseback riding accident in 1995, Mr. Reeve had been told repeatedly that he would never be able to move any part of his body below his shoulders.

But scientists who study the brain say Mr. Reeve's recovery is part of a quiet revolution in how intense physical exercise can help restore the brain and spinal cord after serious injury.

At academic research centers in the United States, Europe and Japan, paralyzed patients are hanging from harnesses, walking on treadmills and tying down limbs to force the use of paralyzed arms and legs. Some are being fit into robots designed to help move their bodies. Using such techniques, an estimated 500 paraplegics who had limited sensations in their lower bodies are now able to walk for short distances, unassisted or using walkers, scientists say.

The limits of what physical exercise can do for paralyzed patients is not known. While each person and each injury is unique, and some people recover spontaneously, an estimated 200,000 Americans are living with spinal cord injuries that have not improved, according to the National Spinal Cord Injury Statistical Center at the University of Alabama at Birmingham. Which therapy or combination of therapies will work for each person ó including the use of experimental drugs and stem cells ó is also not known.

However, the ordinary repetitive motions used in most rehabilitation centers, like squeezing a ball, are almost certainly not enough to revive badly injured adult brains and spinal cords, scientists say. Indeed, patients are usually told that after one year, two at the most, they will never make further progress in their abilities to move or feel sensation.

Mr. Reeve, the actor and director, was totally paralyzed for five years after his accident but stuck to an exercise regime because, he says, it kept his muscles strong and his mood elevated. Then one morning two years ago, he found that he could lift his left index finger on his own.

Thinking back on that day, he said: "My first reaction was to curb my enthusiasm. But inside, my hope and belief was that if my finger could suddenly move on command, I had to explore every other part of my body to see what was possible."

While still dependent on a wheelchair and respirator, Mr. Reeve, who will turn 50 on Wednesday, has recovered the ability to move all fingers on both hands, move each of his joints while floating in water and from a supine position push hard against a therapist's chest with each of his legs. This does not mean he can walk ó for one thing, he cannot support his upper body ó but he has regained enough muscle strength to carry out a pushing motion.

"Chris Reeve has called into question every assumption about the capacity of the human brain and spinal cord to recover after catastrophic injury," said Dr. Michael Merzenich, a pioneer in neuroplasticity research at the University of California San Francisco School of Medicine. "He has shown that intense exercise is not only good for the healthy nervous system, it can bring body and brain back from the oblivion of paralysis."

But the activity has to be specially designed to engage a mature nervous system, Dr. Merzenich said. The experience needs to be relevant and to have many components. It has to be broken down into very small steps and then pounded into the patient's body. Such therapy may have to go on for years before it will have an effect, he said. Because these therapies are still largely experimental, Medicare and most insurance companies will not cover their costs, which tend to be much higher than costs for conventional physical therapy. The weeks or months of rehabilitation typically paid for by insurance companies are rarely enough, scientists say.

These new ideas about adult plasticity have been slow to catch on because people are discouraged by what they see around them, said Dr. Bruce Dobkin, a rehabilitation expert at the University of California in Los Angeles. The fact is that most stroke and spinal cord patients reach a plateau after several months, he said. They are told to go home and live with their permanent disability.

The idea that the adult nervous system is set in stone began to change more than 20 years ago, said Dr. John W. McDonald, an assistant professor of neurology at the Washington University School of Medicine in St. Louis who is also Mr. Reeve's doctor. The synapses that help carry signals inside the brain turn over or renew themselves ó a person gets entirely new ones ó several times in adulthood, Dr. McDonald said. This means the adult brain is capable not only of learning but of repairing itself if challenged with the right kind of activity.

The brains of infants and children build all their complex circuitry in response to activity, Dr. McDonald said. This natural plasticity slows way down in adulthood but does not turn off. One way to drive plasticity in the adult brain is to break what has to be learned into smaller steps.

Adult Japanese speakers can easily be taught to hear and pronounce L's and R's ó sounds that they cannot usually distinguish ó if the sounds are stretched out by a computer. The activity also must matter to the individual, Dr. Merzenich said. If it is boring and mindless, the brain's plasticity mechanisms will not kick in. When a person focuses and pays attention, brain molecules turn on the reward circuitry that promotes plasticity.

These strategies for enhancing adult brain plasticity apply to damaged brains as well as to healthy ones. At research centers, including one at the University of Alabama in Birmingham, some stroke patients are making unexpected progress when their good arms are tied down and they are forced to use their bad arms for everyday tasks. The activity literally rewires damaged areas of their brains.

In spinal cord rehabilitation, patients in Los Angeles, Miami and Zurich are suspended in harnesses while their feet are put through walking movements on treadmills. Doctors at the University of California are building robots to help paralyzed patients practice walking.

Many spinal cord injuries leave some ascending and descending nerve tracts alive but stunned, Dr. McDonald said. Without activity, these fibers atrophy and the person ends up in a wheelchair. But when muscles are stimulated with electrodes and exercise, the nerve tracts sometimes partly revive.

Mr. Reeve is challenging the accepted limits of all such therapies based on exercise and plasticity. First, his injuries are more severe. Most patients who get on treadmills or tie down limbs have some spared movement and can breathe on their own. Second, he refuses to give up.

In a recent telephone interview, Mr. Reeve recalled his efforts to reawaken his body. After the accident he used electrical current to maintain his muscle mass and increase circulation. He lay on a table that tilted him vertically to increase bone density and enhance circulation. He hung in a harness over a treadmill. In 1999 he began an intense exercise program on a recumbent bicycle in which his muscles were electrically stimulated to move the pedals an hour at a time.

After a year on the bike, he could move a finger. "That's when I decided to exercise even more intensely," he said. "What I think happened, by exercising over such a long period of time, is that perhaps dormant pathways have been reawakened."

Mr. Reeve said brain scans show that 70 percent of his body is now actively represented in his brain, meaning sensory information is flowing into his cortex from the periphery. A study confirming this is to be published in the Journal of Neuroscience. Some motor functions also appear to be coming back. By artificially raising levels of carbon dioxide in his blood via his respirator, he is forcing nerves in his brain stem to reflexively move muscles in his diaphragm ó thus retraining his body to breathe on its own. The high level of carbon dioxide tells the brain it is suffocating and triggers the breathing reflex.

It may take many years of intense exercise to produce these effects, Mr. Reeve said. To people who must use wheelchairs, he gave this advice: "Do not give up. Go back to exercise. Even if not much happens right away, you've got to believe. Nothing is impossible."

[cheesecake]

I was in NY/NJ and picked up a copy of the Times today. The CR article was mentioned on the Front page and the article was Section A page 36 which for the Times is a great placement.

I thought the article was excellent and well done. Really pushes the rehab issue and pushing patients past plateau. The Insurance industry needs to hear this message. They can "PaY Now or Pay Later". In the long run this will benifit all with an SCI. There is now a scientifically proven Case study for longer rehab with positive health outcomes. Hopefully standing frames, FES and longer rehab will be the norm.

"Don't worry about the world coming to an end today.
It's already tomorrow in Australia!"----- Charles Schultz

[DA]

the same article was in the local paper. i got verbally beat
down today with the 'seeeeee, you can walk if only you try harder'.
'you dont need a doctor, do it yourself'
'try working harder since the brain can repair the spinal cord.'


thank you media, i wonder how much funding will we lose because
of this.

[antiquity]

Recovery is not going to happen overnight and if return does occur over time, it will be the result of customized and highly advanced rehab. techniques that just aren't available at most local rehab. centers.

DA, remind them of the following:

"He has shown that intense exercise is not only good for the healthy nervous system, it can bring body and brain back from the oblivion of paralysis."

But the activity has to be specially designed to engage a mature nervous system, Dr. Merzenich said. The experience needs to be relevant and to have many components. It has to be broken down into very small steps and then pounded into the patient's body. Such therapy may have to go on for years before it will have an effect, he said. Because these therapies are still largely experimental, Medicare and most insurance companies will not cover their costs, which tend to be much higher than costs for conventional physical therapy. The weeks or months of rehabilitation typically paid for by insurance companies are rarely enough, scientists say.

[This message was edited by seneca on Sep 22, 2002 at 10:44 PM.]

[alan]

"With half a million dollars a year, perhaps you, too, can experience some recovery from spinal cord injury." Where's that headline?

[Bareback Jack]

I have seen many high level quads and the experience I have tells me that CR probably had this capibility from the onset of his injury, but just didn't realize he had this ability. I think most of the ability he has with his very limited movements come mostly from concentrating on these movements and making it happen. I believe he has had the connections in his cord all along to perform the feats he showed us all on T.V. I also think that had his son not been the producer we would not have seen this documentary and that because of his previous claims that he would walk by his 50 th birthday, he needed to show the world something. I am not knocking CR or the documentary. I think it was great and I think what CR has done for SCI is tremendous and more and more doors are opening, because he is spinal cord injured. DA made a great point in that now people think exercise and our own will to walk is our answer. Wrong assumption for sure. We need the science and we need the research over anything. Yes, we can go on exercising until we die, but our cords will not be restored. Please, whoever reads this post, be assured we need the funding and we need speedy FDA approvals for human clinical trials in the USA. Over the years I have willed new muscle groups to move will limited exercise, but no matter if I exercise 20 hours a day, I still need my nerves that were injured to function properly. The media aggravates me, and the stupidity of the suggestions, without the first hand knowledge of what SCI is all about.

[Linda]

Exactly! I am grateful for all the attention SCI is getting because of CR and his tireless efforts, however, it is unfair that some people are only hearing "if you just try hard enough or want it bad enough....."

[Max]

After My Stroke, 27 Years Ago

o the Editor:

Christopher Reeve's regaining of sensation and limited motion has thrown into question decades of discouraging prognoses for victims of stroke and spinal cord injuries (news article, Sept. 22). I second his optimistic advice to people in wheelchairs.

I suffered a major stroke because of birth control pills in 1975 and was told that I might never get out of a wheelchair. Various specialists predicted that most recovery would take place in six months, with perhaps additional improvement up to two years after the stroke. I got out of the wheelchair, continued physical therapy at home and am still recovering after 27 years.

There were noticeable gains 15 years after the stroke, but I still had only partial use of my right hand. I recently adopted the two-handed Dvorak computer keyboard. I am developing new synapses and am thrilled by having greater use of my right hand in typing, piano playing and daily living.
NANCY KOVALEFF BAKER
Boston, Sept. 23, 2002



Copyright The New York Times Company | Permissions | Privacy Policy

==============================
"It was once written "To thine own self be true". But how do we know who we really are? Every man must confront the monster within himself, if he is ever to find peace without. .." Outer Limits(Monster)

[sinbad]

"Reeve and his physicians shocked the medical community last week when it was announced that the actor - best known for his movie portrayal of Superman in the '70s and '80s - regained sensation and movement of his fingers, wrist and toes."



I wonder ,why regained sensation and movement begin first fingers,wrist and toes.

WHAT IS THE MECHANISM THAT FIRST RECOVERY OCCURS HERE.FOR EXAMPLE WHY NOT FIRST BOWEL AND BLADDER

[none]

Can we wrap up the REEVE WORSHIP SERVICE. I can see the offering plate coming down the isle and I left all my solid Gold Bars at home.

Enough already.

meeker

jrm design art studio

[Chris Chappell]

Sure meek as soon as you stop worshiping and badgering everyone about Goldfinger and omentum.

People who live in glass houses...

Onward and Upward!

[dahliasinbloom]

After we're injured, muscle atrophy can set in very quickly. What if the muscles are not able to move for many years simply because of the muscle atrophy? If a long period of time goes by before the spine is stablized after being injured, is it possible the connections could still be intact but the muscles unable to move because of atrophy? If this is true for some, extensive physical therapy sounds like just what they need.... or electric stim.

I guess in Christopher Reeve's case, he had been using electric stim for a long time, probably not an issue. But could it be for some people with SCI? Is this a part of "learned non-use"?

[DA]

this has become the perfect excuse to footdrag the real cure.

i guess the power that be is laughing to tears at how stupid the sci
community can be.

[bill j.]

Jan, in answer to your question I am posting comments by Wise on another thread concerning atrophy. To read the discussion on the subject, go to:


Link Here (http://carecure.org/forum/showthread.php?t=8231)

posted Mar 28, 2002 03:53 PM
--------------------------------------------------------------------------------
Steve Oakes, yes, I was really quite excited about the restoration of atrophic muscles. Let me expand on that a little bit here and then hopefully cite some of the papers (unfortunately, the authors are mostly clinicians and have not been publishing their results and so this is word-of-mouth results).

• Dr. Ugo Carraro from Padova (Italy) is a pathologist who has been studying atrophy of the diaphragm. He denervated the phrenic nerve on one side of rats and then kept the rats from 1 year and, in some cases, longer. The denervated diaphragm was really quite thin and atrophic looking, compared to the innervated side which (from the pictures) were 5 times thicker. He talked about the microsatellite cells (these are cells in the muscle that generate new muscle cells that then fuse with the existing muscle fibers). He showed many pictures indicating that these microsatellite cells survive denervation for many years and appear to be still present even when the diaphragm is severely atrophic. In fact, he suggests that denervation initially causes a widespread dying of the muscle fibers but the microsatellite cells then will regenerate many of the muscle fibers. However, because the muscles were denervated, those regenerated muscle fibers really don't grow to be very big. He also pointed out that it was not necessary for innervation to be present for the muscle to grow, that passive stretching of the muscles will keep them alive. For example, he pointed out that the denervated side of the diaphragm continues to be moved by the innervated side. He also showed similar data for agonist and antagonist muscles, that if there is movement from a non-denervated antagonist muscle, the denervated agonist muscle will retain flexibility and muscle fibers. Finally, Dr Carraro pointed out that many of his colleagues believed that there are circulating stem cells that can move into the muscle but he was skeptical that this plays a major role in the maintainance of the muscles. Many of the doctors who discussed this issue clearly believed the functional electrical stimulation can and will maintain muscle bulk. To me the take-home lessons are that atrophic muscles can maintain themselves for long periods of time, so long as they are being stretched and stimulated.

• Dr. Helmut Kern from Wien (Vienna), Austria. He works in the same group as Milan Dimitrijevic. He used huge electrical currents, much much greater than those that are typically used for FES. This was because he found that one must use very intense trains of impulses from the surface of the skin to activate severely atrophic muscles. Please note that this is in humans with cauda equina lesions. He suggests that such stimulation can restore muscle in people as long as 25 years after injury although he did not present much data to support this statement. At the beginning of the symposium, I had asked Professor Giorgio Brunelli and the assembled clinicians whether a denervated muscle could be restored. Most of the people in the audience felt that a denervated muscle (that has undergone such severe atrophy that most of the muscle is connective tissue and fat) cannot be stimulated or restored. Dr. Kern therefore surprised everybody with his findings. On the other hand, I must point out the technical difficulties of the stimulator devices that he was using (he had to build the stimulators themselves). The amount of electrical energy that he used was truly enormous. Normal FES machines usually cannot deliver more thant 50-100 millijoules of electrical energy. Dr. Kern was using as much as 3 joules (30-100 times) more energy for his stimulus protocols, giving trains of stimuli. Many of the electrodes caused skin burns but he said that the electrical stimulation actually thickened the skin. By the way, such high currents would be very painful to people who have any preserved skin sensations and would cause tremendous spasms to people who have spinal cord injury. That is why the studies were done only in patients with peripheral nerve or cauda equina lesions. I discussed the issues with several of the people afterwards, including Reggie Edgarton (UCLA) and Michael Keith (Case Western) and they expressed some reservations about the safety parameters of such high currents. In order to reduce skin burns, the electrodes have cover a large surface area to minimize current density. The problem is that if the gel dries up a bit or the electrode does not get complete contact, it is very easy to get skin burns. I asked Dr. Kern whether he tried direct stimulation of the muscle, using implanted electrodes, which would cause less damage to the skin. However, he says that he tried direct muscle stimulation and found that the high currents can damage the muscles. We talked until 3 am one of the mornings trying to figure out a better way to stimulate the muscles. However, from the evidence that Dr. Kern shows (he had biopsies of the muscles before and after), it is possible to get completely atrophic muscles to regrow and bulk up again. Now that we know it can be done, it is time to work out the methods to do so safely.

Michaelm, the most painful sign of pessimism (at least for me) are the large numbers of procedures that are being carried out in patients assuming that they will never recover. So, for example, there were very large series of cases reported by several German, Italian, and Swiss units that placed the Brindley bladder stimulator after cutting the S2-S5 sacral dorsal roots. Likewise, there are still many doctors that were doing deltoid, biceps, triceps transfers to restore function to the hands, sometimes fairly early after injury. Lee Illis (a very good British neurologist) was the one who said that he did not think that there will be effective restorative therapies for spinal cord injury within his lifetime (although he then amended this by saying that he is older than most of the people in the room and that some of the younger people will see such treatments within their lifetimes. On the other hand, there were many people who are showing that FES, exercise, supported ambulation, and other therapies were restoring function in people long thought to be incapable of walking. One doctor, Giselher Schalow, from Nottwill, Switzerland, was incredibly enthusiastic and were using all sorts of innovative techniques to get the spinal cord "networks" activated. He has a machine that cranked both the hands and the legs at the same time. He put patients through creeping, crawling, standing, treadmill walking, springboard jumping, etc., a program that he called "coordination dynamic therapy". He does not believe in drugs and was very stalwart in his criticism of therapies that produced irreversible damage to the spinal cord.

Wise.

[This message was edited by mk99 on 10-06-04 at 07:38 PM.]

[Jeff]

Who, exactly, is footdragging?

FES is a great way to stay healthy. And activity-based recovery shouldn't be sneezed at either. No recovery should be.

We're getting closer to the Fall Neuroscience and Neurotrauma meetings. I'm sure we'll all get a boost from those.

~See you at the SCIWire-used-to-be-paralyzed Reunion http://www.stopstart.fsnet.co.uk/smilie/wavey.gif ~

[DA]

jeff dont you remember last year meeting. everyone was hyped
but it just fizzled.

[Chris Chappell]

bump.

[perda-10]

Dear. Mr. Wise
Did you get any information from any patient who participated in the stuy of dr. Kern? I mean the FES stimulation? Did anyone participating in this stuy sustained any injuries, burns, etc.

Kind regards,

Paraglider

Originally posted by Bill J.:

Jan, in answer to your question I am posting comments by Wise on another thread concerning atrophy. To read the discussion on the subject, go to:

Link Here (http://carecure.org/forum/showpost.php?p=73560)

posted Mar 28, 2002 03:53 PM
--------------------------------------------------------------------------------
Steve Oakes, yes, I was really quite excited about the restoration of atrophic muscles. Let me expand on that a little bit here and then hopefully cite some of the papers (unfortunately, the authors are mostly clinicians and have not been publishing their results and so this is word-of-mouth results).

• Dr. Ugo Carraro from Padova (Italy) is a pathologist who has been studying atrophy of the diaphragm. He denervated the phrenic nerve on one side of rats and then kept the rats from 1 year and, in some cases, longer. The denervated diaphragm was really quite thin and atrophic looking, compared to the innervated side which (from the pictures) were 5 times thicker. He talked about the microsatellite cells (these are cells in the muscle that generate new muscle cells that then fuse with the existing muscle fibers). He showed many pictures indicating that these microsatellite cells survive denervation for many years and appear to be still present even when the diaphragm is severely atrophic. In fact, he suggests that denervation initially causes a widespread dying of the muscle fibers but the microsatellite cells then will regenerate many of the muscle fibers. However, because the muscles were denervated, those regenerated muscle fibers really don't grow to be very big. He also pointed out that it was not necessary for innervation to be present for the muscle to grow, that passive stretching of the muscles will keep them alive. For example, he pointed out that the denervated side of the diaphragm continues to be moved by the innervated side. He also showed similar data for agonist and antagonist muscles, that if there is movement from a non-denervated antagonist muscle, the denervated agonist muscle will retain flexibility and muscle fibers. Finally, Dr Carraro pointed out that many of his colleagues believed that there are circulating stem cells that can move into the muscle but he was skeptical that this plays a major role in the maintainance of the muscles. Many of the doctors who discussed this issue clearly believed the functional electrical stimulation can and will maintain muscle bulk. To me the take-home lessons are that atrophic muscles can maintain themselves for long periods of time, so long as they are being stretched and stimulated.

• Dr. Helmut Kern from Wien (Vienna), Austria. He works in the same group as Milan Dimitrijevic. He used huge electrical currents, much much greater than those that are typically used for FES. This was because he found that one must use very intense trains of impulses from the surface of the skin to activate severely atrophic muscles. Please note that this is in humans with cauda equina lesions. He suggests that such stimulation can restore muscle in people as long as 25 years after injury although he did not present much data to support this statement. At the beginning of the symposium, I had asked Professor Giorgio Brunelli and the assembled clinicians whether a denervated muscle could be restored. Most of the people in the audience felt that a denervated muscle (that has undergone such severe atrophy that most of the muscle is connective tissue and fat) cannot be stimulated or restored. Dr. Kern therefore surprised everybody with his findings. On the other hand, I must point out the technical difficulties of the stimulator devices that he was using (he had to build the stimulators themselves). The amount of electrical energy that he used was truly enormous. Normal FES machines usually cannot deliver more thant 50-100 millijoules of electrical energy. Dr. Kern was using as much as 3 joules (30-100 times) more energy for his stimulus protocols, giving trains of stimuli. Many of the electrodes caused skin burns but he said that the electrical stimulation actually thickened the skin. By the way, such high currents would be very painful to people who have any preserved skin sensations and would cause tremendous spasms to people who have spinal cord injury. That is why the studies were done only in patients with peripheral nerve or cauda equina lesions. I discussed the issues with several of the people afterwards, including Reggie Edgarton (UCLA) and Michael Keith (Case Western) and they expressed some reservations about the safety parameters of such high currents. In order to reduce skin burns, the electrodes have cover a large surface area to minimize current density. The problem is that if the gel dries up a bit or the electrode does not get complete contact, it is very easy to get skin burns. I asked Dr. Kern whether he tried direct stimulation of the muscle, using implanted electrodes, which would cause less damage to the skin. However, he says that he tried direct muscle stimulation and found that the high currents can damage the muscles. We talked until 3 am one of the mornings trying to figure out a better way to stimulate the muscles. However, from the evidence that Dr. Kern shows (he had biopsies of the muscles before and after), it is possible to get completely atrophic muscles to regrow and bulk up again. Now that we know it can be done, it is time to work out the methods to do so safely.

Michaelm, the most painful sign of pessimism (at least for me) are the large numbers of procedures that are being carried out in patients assuming that they will never recover. So, for example, there were very large series of cases reported by several German, Italian, and Swiss units that placed the Brindley bladder stimulator after cutting the S2-S5 sacral dorsal roots. Likewise, there are still many doctors that were doing deltoid, biceps, triceps transfers to restore function to the hands, sometimes fairly early after injury. Lee Illis (a very good British neurologist) was the one who said that he did not think that there will be effective restorative therapies for spinal cord injury within his lifetime (although he then amended this by saying that he is older than most of the people in the room and that some of the younger people will see such treatments within their lifetimes. On the other hand, there were many people who are showing that FES, exercise, supported ambulation, and other therapies were restoring function in people long thought to be incapable of walking. One doctor, Giselher Schalow, from Nottwill, Switzerland, was incredibly enthusiastic and were using all sorts of innovative techniques to get the spinal cord "networks" activated. He has a machine that cranked both the hands and the legs at the same time. He put patients through creeping, crawling, standing, treadmill walking, springboard jumping, etc., a program that he called "coordination dynamic therapy". He does not believe in drugs and was very stalwart in his criticism of therapies that produced irreversible damage to the spinal cord.

Wise.

[This message was edited by mk99 on 10-06-04 at 07:39 PM.]

[Wise Young]

paraglider, I am sorry. I have not been to Italy or Switzerland for over a year and have no new information about the progress of the studies using high-current stimulation to activate muscles of people with lower motoneuronal damage. Their report at the time suggested that they were able to circumvent the damage by using very large surface electrodes (so that current density per area of skin is minimized) and they reported that they were able to increase the girth of muscles in the legs with such stimulation. I don't know of any other group that is trying this approach or whether the special stimulator they designed is being commercialized. Wise.

[perda-10]

Wise, I participate in the RISE study conducted by Dr. Kern (Wien) and his team. I have flaccid paraplegia, TH12 L1 complete since April 2003. I have the device at home and stimulate according to schedule I was given by Dr. Kern and Dr. Forstner. I had the first checkup after one month of using FES, the results were very good. (Power 10 Nm left thight (leg) and 11Nm (right leg), I stared with 200 ms and now I only need 120 ms for muscles to contract. I stimulate 5 times a week, I sustained no burns. The device is save, but you have to follow the instructions. I have the next checkup in November and as I was told,some weight will be put on my legs. In a sitting position I have lifted (the FES lifts them) my legs for about 75 degrees within the first month, now as I see, they are stretched out completely (second month). I also stimulate my calves (of the leg) and my posterior. The team in Vienna is absolutely wonderful. And I am happy to have "FES by Dr. Kern" at home.

Love

[Wise Young]

Paraglider, Thanks so very much for reporting. Wise.

[poonsuzanne]

Originally posted by PARAGLIDER:

Wise, I participate in the RISE study conducted by Dr. Kern (Wien) and his team. I have flaccid paraplegia, TH12 L1 complete since April 2003. I have the device at home and stimulate according to schedule I was given by Dr. Kern and Dr. Forstner. I had the first checkup after one month of using FES, the results were very good. (Power 10 Nm left thight (leg) and 11Nm (right leg), I stared with 200 ms and now I only need 120 ms for muscles to contract. I stimulate 5 times a week, I sustained no burns. The device is save, but you have to follow the instructions. I have the next checkup in November and as I was told,some weight will be put on my legs. In a sitting position I have lifted (the FES lifts them) my legs for about 75 degrees within the first month, now as I see, they are stretched out completely (second month). I also stimulate my calves (of the leg) and my posterior. The team in Vienna is absolutely wonderful. And I am happy to have "FES by Dr. Kern" at home.

Love

Dear Paraglider,

Thank you very much for posting your experience! My son, Richard, is also a complete flaccid T12 para. I am very interested in this "FES by Dr. Kern". Would you share with us the contact info of Dr. Kern? Are you going to Vienna for your next check up in November?

Suzanne

[perda-10]

Originally posted by Suzanne Poon:

Originally posted by PARAGLIDER:
Wise, I participate in the RISE study conducted by Dr. Kern (Wien) and his team. I have flaccid paraplegia, TH12 L1 complete since April 2003. I have the device at home and stimulate according to schedule I was given by Dr. Kern and Dr. Forstner. I had the first checkup after one month of using FES, the results were very good. (Power 10 Nm left thight (leg) and 11Nm (right leg), I stared with 200 ms and now I only need 120 ms for muscles to contract. I stimulate 5 times a week, I sustained no burns. The device is save, but you have to follow the instructions. I have the next checkup in November and as I was told,some weight will be put on my legs. In a sitting position I have lifted (the FES lifts them) my legs for about 75 degrees within the first month, now as I see, they are stretched out completely (second month). I also stimulate my calves (of the leg) and my posterior. The team in Vienna is absolutely wonderful. And I am happy to have "FES by Dr. Kern" at home.

Love

Dear Paraglider,

Thank you very much for posting your experience! My son, Richard, is also a complete flaccid T12 para. I am very interested in this "FES by Dr. Kern". Would you share with us the contact info of Dr. Kern? Are you going to Vienna for your next check up in November?

Dear Sussane,
Yes, I 've just just explained everything in a previous mail, sent it and it's gone. I just can't find it. So once again: Yes I am going to Vienna in November. The hospital is called Wilhelminnenspital, Abteilung (Department) 26, Physical Medicine Department (Abteilung für Physikalische Medizin), Vorstand (Head) Prim. Doc. Dr. Dr. Helmut Kern. I am not sure if any further candidates will be admitted in RISE study group. But there is another FES device also available in Vienna for flaccid paraplegia; it is calles Stimulex Cx, I was examined and my muscles contracted with Stimulex Cx as well. So I could have actually stimulated my muscles with Stimulex Cx as well. The price of Stimulex is about 2300 EUR, I believe you can rent it for about € 240 a month. The check up in Vienna is needed monthly, due to the condition and progress of muscles and the right programmes of the device. The programms are pre-set by the doctors and changed accordingly. You can not change the programms on you own. And FES by Dr. Kern is not available on the open market yet, as explained by Dr. Wise, this is an experimental RISE project. However I am delighted that also we " the flaccids" have a chance to stimulate our muscles. Hope that my answer will reach you.

Love

Suzanne

[jff23]

Paraglider,

I'm a faccid para as well. when you get a chance can you please provide some contact information for the stimulex cx. i have done a search on the internet and can't find any information on it.
thanks



Originally posted by PARAGLIDER:

Originally posted by Suzanne Poon:
Originally posted by PARAGLIDER:
Wise, I participate in the RISE study conducted by Dr. Kern (Wien) and his team. I have flaccid paraplegia, TH12 L1 complete since April 2003. I have the device at home and stimulate according to schedule I was given by Dr. Kern and Dr. Forstner. I had the first checkup after one month of using FES, the results were very good. (Power 10 Nm left thight (leg) and 11Nm (right leg), I stared with 200 ms and now I only need 120 ms for muscles to contract. I stimulate 5 times a week, I sustained no burns. The device is save, but you have to follow the instructions. I have the next checkup in November and as I was told,some weight will be put on my legs. In a sitting position I have lifted (the FES lifts them) my legs for about 75 degrees within the first month, now as I see, they are stretched out completely (second month). I also stimulate my calves (of the leg) and my posterior. The team in Vienna is absolutely wonderful. And I am happy to have "FES by Dr. Kern" at home.

Love

Dear Paraglider,

Thank you very much for posting your experience! My son, Richard, is also a complete flaccid T12 para. I am very interested in this "FES by Dr. Kern". Would you share with us the contact info of Dr. Kern? Are you going to Vienna for your next check up in November?

Dear Sussane,
Yes, I 've just just explained everything in a previous mail, sent it and it's gone. I just can't find it. So once again: Yes I am going to Vienna in November. The hospital is called Wilhelminnenspital, Abteilung (Department) 26, Physical Medicine Department (Abteilung für Physikalische Medizin), Vorstand (Head) Prim. Doc. Dr. Dr. Helmut Kern. I am not sure if any further candidates will be admitted in RISE study group. But there is another FES device also available in Vienna for flaccid paraplegia; it is calles Stimulex Cx, I was examined and my muscles contracted with Stimulex Cx as well. So I could have actually stimulated my muscles with Stimulex Cx as well. The price of Stimulex is about 2300 EUR, I believe you can rent it for about € 240 a month. The check up in Vienna is needed monthly, due to the condition and progress of muscles and the right programmes of the device. The programms are pre-set by the doctors and changed accordingly. You can not change the programms on you own. And FES by Dr. Kern is not available on the open market yet, as explained by Dr. Wise, this is an experimental RISE project. However I am delighted that also we " the flaccids" have a chance to stimulate our muscles. Hope that my answer will reach you.

Love

Suzanne

[antiquity]

This is good news for low para's. Thanks Paraglider, be sure to keep us abreast of your progress.

[perda-10]

[QUOTE]Originally posted by jimbo23:

Paraglider,

I'm a faccid para as well. when you get a chance can you please provide some contact information for the stimulex cx. i have done a search on the internet and can't find any information on it.
thanks



[DEAR JIMBO23, Stimulex Cx is available in Vienna, Dr. Schufried Medizintechnik Gmbh, a- 1090 Wien, van swieten - gasse 10, Tel: +43-1)405 42 06 Fax: (+43-1)405 4464, e mail: info@schuhfriedmed.at and you may find the description of Stimulex Cx on: www.schuhfriedmed.at (http://www.schuhfriedmed.at). I was examined at the Wilhelminnenspital in Wien, Abteilung 26, Institut für Physikalische Medizin, Tel: +43 1 491 50 3408.
For further information my e-mail: poizvedbe@hotmail.com
or
sksjug@hotmail.com.
Love,

[metronycguy]

i could not read the info on the stimulex cx,
i have no muscle conduction per EMG in a lot of my foot and i am a walker with a cauda equina injury
this has caused a neuropathic foot. i believe a lot of my weight bearing foot metatarsalgia pain may be from the flaccid muscles in my foot.
so i am interested in anything that will bring the atrophied foot muscle back

[perda-10]

I have just returned from Vienna. This was my third examination after I started with FES in August 2004. The results are very good, the strenghth in my muscles is rapidly increasing (in September it was 11 Nm and today 17 Nm). I have a new programme as from today, and I aslo have to put 1/2 kg weight on each leg.

Love

[poonsuzanne]

Originally posted by PARAGLIDER:

Dear Sussane,
Yes, I 've just just explained everything in a previous mail, sent it and it's gone. I just can't find it. So once again: Yes I am going to Vienna in November. The hospital is called Wilhelminnenspital, Abteilung (Department) 26, Physical Medicine Department (Abteilung für Physikalische Medizin), Vorstand (Head) Prim. Doc. Dr. Dr. Helmut Kern. I am not sure if any further candidates will be admitted in RISE study group. But there is another FES device also available in Vienna for flaccid paraplegia; it is calles Stimulex Cx, I was examined and my muscles contracted with Stimulex Cx as well. So I could have actually stimulated my muscles with Stimulex Cx as well. The price of Stimulex is about 2300 EUR, I believe you can rent it for about € 240 a month. The check up in Vienna is needed monthly, due to the condition and progress of muscles and the right programmes of the device. The programms are pre-set by the doctors and changed accordingly. You can not change the programms on you own. And FES by Dr. Kern is not available on the open market yet, as explained by Dr. Wise, this is an experimental RISE project. However I am delighted that also we " the flaccids" have a chance to stimulate our muscles. Hope that my answer will reach you.

Love


Hi Paraglider,

You're very nice! I am so sorry that I missed your post and did not reply in time...

Do you mean the 'device conducted by Dr. Kern' and 'Stimulex Cx' are same as good?

As a T12 para, do you display any spasms at all in your legs before entering the RISE study?

My son, Richard, is now studying in Vancouver. If we cannot find anything available in North America that could possibly stimulate his muscles, we need to fly 13 hours all the way to Vienna. http://sci.rutgers.edu/forum/images/smilies/frown.gif

Suzanne

[Wise Young]

paraglider, thanks so much for your post. Can you tell us how long you are stimulating, the size of the stimulator pads, and what effects it is having on the skin? Wise.

[perda-10]

Originally posted by Wise Young:

paraglider, thanks so much for your post. Can you tell us how long you are stimulating, the size of the stimulator pads, and what effects it is having on the skin? Wise.

Dear Dr. Wise,
I think I posted my experience with FES to the wrong forum. I think it would be better if it was on Exercise forum instead.
I started using FES as a member of RISE study on 8th August 2004. I have returned from Vienna an hour ago, so I can give you my latest results. I still use sponge in which the electrodes are placed. I have four electrodes, two on each leg (thigh). I also started putting some weight on each leg, now I have 1/2 kg on each ankle. I also stimulate my calves, and sole of the foot, as well as my buttocks. Each electrode is 12 cm wide and 15 cm long. I place two on each leg. Your next question was about the effect on my skin: I had no reactions at all on my skin, no skin burns ets. My skin is normal after every stimulation. I will use sponge or so called watex pads in which the electrodes are placed until the end of febraury and they I will only use electrodes with gel. The pad are use for some time in order to prevent skin burns, according to Prim. Dr. Kern the skin gets used to stimulation with time. So I started in August with a lighter and shorter programm and since the results of stimulation were very good, they added some exercesises every month. The power in the legs in measured at every examination and my power today was almost 20 Nm. I will stand up, as I was told today by the doctors, with the helf of FES in march or april 2005. The doctors also measure the angle, meaning how much the legs stretch in the sitting position. My angle is 90 degress, meaning, that my legs stretch as much as they possible can. However I still need to improve the fatigue of my muscles. From Nov 26th 2004 untill today I had the following programm: Program 1: warming up 2 minutes, Program 2: 4 times 5 minutes (I call it a long program, my muscles contract and stretch slowly and strongly, so that I reach the aforementioned angle and I change the sitting and lying position). Than I have the program 3, 3 x 5 minutes (I say am running, becouse my muscles stretch and contract very quickly and shortly). I did this exercises for two day and on third day the exercise for power followed. So on the third day I put 1/2 kg on each ankle and here the program was: warming up 2 minutes (without weight) and than with 1/2 kg on ankles 4 times 15 repetitions. Buttocks: 2 minutes warming up, progr. 5 = 2 times 6 minutes and Progr. 6= 2 x 6 minutes. And calves: 2 minutes warming up, and 2 different programs each 2 times 5 minutes. From today I have more repetitions untill the next examination. The power today was about 20 Nm and 19,5 Nm. Dr. Kern said I should be able to stand up in april 2004. As far as the power is concerned I could have allready started standing up(with the help of FES and not on my onw), but I should wait due to fatigue. It takes about 1 1/2 hour to 2 hours daily to do complete exercises. What is realy very very important is, to do exercises according to the plan, I you don't do it on regular basis, the results are poor. I will have CT in February.

The difference between Stimulex Cx and "FES by Dr, Kern" is that both deviced my be used for denervated /flaccid) paraplegia, but Stimulex device has fewer setting options than Fes and has only two and not four electrodes. However as I was told by the patients who use it (also flaccid) the results are also very good.
The team in Wilhelminenspital is realy great. The problem is the distance. I am four hours away and some of you 13 hrs by plane. However if anyone is interested, I suggest you call the doctors there and try to make an arrangement about ckeck-ups. As I understand some patiens from Germany and Italy come only once a year to Vienna and are examined by their own doctors in their countries. I appologise for mistakes, I am very tired, had more that 8 hours ride and 4 hrs examination.

Please don't hesitate to ask any further questions.

Kind regards,

[perda-10]

Originally posted by Suzanne Poon:

Originally posted by PARAGLIDER:
Dear Sussane,
Yes, I 've just just explained everything in a previous mail, sent it and it's gone. I just can't find it. So once again: Yes I am going to Vienna in November. The hospital is called Wilhelminnenspital, Abteilung (Department) 26, Physical Medicine Department (Abteilung für Physikalische Medizin), Vorstand (Head) Prim. Doc. Dr. Dr. Helmut Kern. I am not sure if any further candidates will be admitted in RISE study group. But there is another FES device also available in Vienna for flaccid paraplegia; it is calles Stimulex Cx, I was examined and my muscles contracted with Stimulex Cx as well. So I could have actually stimulated my muscles with Stimulex Cx as well. The price of Stimulex is about 2300 EUR, I believe you can rent it for about € 240 a month. The check up in Vienna is needed monthly, due to the condition and progress of muscles and the right programmes of the device. The programms are pre-set by the doctors and changed accordingly. You can not change the programms on you own. And FES by Dr. Kern is not available on the open market yet, as explained by Dr. Wise, this is an experimental RISE project. However I am delighted that also we " the flaccids" have a chance to stimulate our muscles. Hope that my answer will reach you.

Love


Hi Paraglider,

You're very nice! I am so sorry that I missed your post and did not reply in time...

Do you mean the 'device conducted by Dr. Kern' and 'Stimulex Cx' are same as good?

As a T12 para, do you display any spasms at all in your legs before entering the RISE study?

My son, Richard, is now studying in Vancouver. If we cannot find anything available in North America that could possibly stimulate his muscles, we need to fly 13 hours all the way to Vienna. http://sci.rutgers.edu/forum/images/smilies/frown.gif

Suzanne
Dear Susanne, I missed your question about spasms: No I did not have any spasms at all in my legs before enetering the RISE study, and I still don't have any. The RISE study is only for flaccid paralegia. For spastic paraplegia, Dr. Kern has other devices, Stimulex Cx my be used for both "groups". They also have very very good devices in the Republic of Slovenia, but not for flaccid paraplegia. If the stimulation works (this device stimulates the nerves, the impulse goes to the musles than, the patients walk with this device. I've seen it in Ljublana, Institute for Rehabilitation called SoÄ?a, but at the moment can't tell you much about this device, since it did not contracted my muscles and I was not really interested in it. But I was delighted to see patients making steps, they had higher injuries or paresis, if I am not mistaken. Prof. Dr. ÄŒrt MarinÄ?ek is an exellent doctor; he worked on this kind of FES ( if I am not mistaken together with Prof. Dimitrijevic, but I am not sure). I will talk to Institute in Ljubljana tomorrow morning and give you precise information, if anyone might be interested. I know that these devices are very effective and the price is also not high. More about it tomorrow.

I believe that FES is very important. If the cure comes in near future ( i.e.2-5 years) it is very important that the muscles and bones are prepared to do their job. That's why I am trying so hard to keep my muscles preserved as much as I can.

Please contact me for further questions.

[Wise Young]

Wow, paraglider, thank you so much for writing this just an hour back. That is really dedication. I had no idea that it was so far advanced and that you are getting no skin reactions. It will be fabulous when they publish these results. This will be the first device for those people who are currently not getting activation of their muscles from standard FES devices.

You are right about this probably being better in the exercise forum. I will move it there soon. Wise.

[poonsuzanne]

[QUOTE]Originally posted by PARAGLIDER:

I believe that FES is very important. If the cure comes in near future ( i.e.2-5 years) it is very important that the muscles and bones are prepared to do their job. That's why I am trying so hard to keep my muscles preserved as much as I can.
QUOTE]

Dear Paraglider, you have been more than helpful!!

You're absolutely right with the above statements. When you said you sustain good results from using the device from the RISE study, do you mean the device actually reverse muscle atrophy? Do you have any figures to share with us?

I am also looking forward very much to hearing more news from you from the Institute in Ljublijana. I really want to know if Pro. Crt Marincek works with Prof. Dimitrijevic as I have heard so much about Prof. Dimitrijevic from Dr. Wise Young.

However, I am a bit confused here. You said there are some very good devices in the Republic of Slovenia, but not for flaccid paras. What about the devices being used in Ljublana, Institute for Rehabilitation 'Soca'? If I understood you correctly, the devices being used in Ljublana, Institute for Rehabilitation 'Soca' are not for flaccid paras!?

BTW, I emailed info@schuhfriedmed.at yesterday but have not heard from them yet.

Many thanks!

Suzanne

[This message was edited by Suzanne Poon on 01-08-05 at 08:01 AM.]

[perda-10]

Originally posted by Suzanne Poon:

[QUOTE]Originally posted by PARAGLIDER:
I believe that FES is very important. If the cure comes in near future ( i.e.2-5 years) it is very important that the muscles and bones are prepared to do their job. That's why I am trying so hard to keep my muscles preserved as much as I can.
QUOTE]

Dear Paraglider, you have been more than helpful!!

You're absolutely right with the above statements. When you said you sustain good results from using the device from the RISE study, do you mean the device actually reverse muscle atrophy? Do you have any figures to share with us?

I am also looking forward very much to hearing more news from you from the Institute in Ljublijana. I really want to know if Pro. Crt Marincek works with Prof. Dimitrijevic as I have heard so much about Prof. Dimitrijevic from Dr. Wise Young.

However, I am a bit confused here. You said there are some very good devices in the Republic of Slovenia, but not for flaccid paras. What about the devices being used in Ljublana, Institute for Rehabilitation 'Soca'? If I understood you correctly, the devices being used in Ljublana, Institute for Rehabilitation 'Soca' are not for flaccid paras!?

BTW, I emailed info@schuhfriedmed.at yesterday but have not heard from them yet.

Many thanks!

Suzanne

Dear Sussane,

1. Muscle Atrophy: In my case the devise reverses muscle atrophy with certainty. Not only that this is measured by a speacially designed computer programme (I will try to describe the measurment procedure later), it is also evident from CT (made every 6 months) and muscle biopsy. And of course every one who knows how muscles of paraplegic, who has no spasm look after two years, can see it with his own eyes. My power as I said is almost 20Nn in my tights, what is enough to stand up. The power necessary to stand up with FES (RISE) is 20-25 Nm, so I achieved the necessary power within 5 months of stimulating my legs. I've done some measurments: left leg - perimeter of my left tight 10 cm below hip is 49 cm, on my left thigh 10 cm above knee is 41 cm and the perimeter of my left calf is 33,5 cm. I am 1.83 cm tall and slim and my legs look almost the same as they looked before the accident. I know that such measurments my vary from one person to another, but just to give you the idea. What I find relevant is the power measured in Wiena. How the power in muscles is measured:I am placed on a specially designed chair, they put the electrodes on my legs (the same as I use for electrostimulation) and connect them to the computer, that measures the power of my muscles. I will make some pictures of my legs tomorrow,I think it is the best way that you can get an idea how my legs look.

You say you are confused about the stimulation in Ljubljana and that in Vienna. The FES often does not work for those with lower injuries, as Dr, Wise also already described, so the FES in Vienna is designed for flaccid (denervated) and the one they use in Ljubljana works with those who have higher injuries and spastic paraplegia. I will talk to Prof. Dr. MarinÄ?ek on Monday, he is not availabe on Saturdays, what I forgot yesterday. So on Monday I will let you know where to get pictures of my legs and FES and also post more info about the FES from Ljubljana. Schufried also works from Monday - Friday, so I guess you will receive a reply on Monday.

Kind regards,
Paraglider

[This message was edited by Suzanne Poon on 01-08-05 at 08:01 AM.]

[jff23]

Paraglider,

Thanks for posting your progress. I am just wondering are you supplementing this training with any specific nutrition program -- you know higher protein intake for muscle growth etc.?

[perda-10]

Originally posted by jimbo23:

Paraglider,

Thanks for posting your progress. I am just wondering are you supplementing this training with any specific nutrition program -- you know higher protein intake for muscle growth etc.?

Jimbo 23,
No I have no special nutrition, no higher protein intake. The fact is, that I've never been thinking about it, but it sounds interesting. Do you have any experince with such nutrition, I have none. But I am angry, they also control my body weight in Vienna every month and a half and I put on some weight, namely 3 kg from November 26th until yesterday - January 7th. I don't like it, if I keep on going like this, I am afraid it will not be good for my legs when I will start standing up in March or April. (This is my idea, the doctors say it's just fine). So if you have any experience with proteins I'll be greatfull if you let me know what and how much should I take. I would try it, why not.

Kind regards,
Paraglider

[jff23]

Paraglider,

what is your email? and just another question -- has the fes program increased muscle on your buttocks? this would help immensely to prevent pressure sores.

[perda-10]

Originally posted by jimbo23:

Paraglider,

what is your email? and just another question -- has the fes program increased muscle on your buttocks? this would help immensely to prevent pressure sores.

My email: poizvedbe@hotmail.com
Yes the FES program helped me increased muscles on my buttocks, I have never had any pressure sores on my buttocks, and I spent sometimes several hours siting on my QUAD (ATV), without using ROHO or any other cushion, (I use it in my wheelchair), I sometimes sit on a wooden bank, and have no red spots or any other signs of sores on my buttocks or my legs. I stimulate my buttocks 20 minutes 5 times a week. My buttocks does not look as it used to, but if I compare it to buttocks of those who have the same injury and the same time after the accindent it looks great and it's still improving. What I have forgotten to mention before, my osteoporosis risk level is very high, and after 6 months of using FES I will have another examination for the osteoporosis as well. The experience of Dr. Kern is, that FES should also reduce osteoporosis, but I have no results yet, since I've been using it for five months only. I will know more in Febraury. I have not had any sores before I started using FES neither. But there is another friend of mine who has great problems with sores on his buttocks, he is C4-C7, sensation preserved, some motor fuction has returned, he is 3 years post -injury, and he started using Stimulex on January 4th 2005. Too soon to have any results, but I will be able to send some results in February after his first check-up in Wilhelminenspital. And the third friend of mine also goes to Wilhelminen in Febraury to get FES. She is T12-L1 complete as well, has very, very slight spasm in her left sole and is flaccid on her right leg. She is also 2 years after the injury and her skin is also very sensitive. I will post her first results in March or April.

Love,
Paraglider

Paraglider

[poonsuzanne]

Hii Paraglider,

I look forward to hearing more and more from you and info about your friends! Yes, please share with us pics of your legs and pics when you will start standing in March or April.

If I don't receive a reply from Dr. Schuhfried in the next two days, I will call him to start my enquiries. In the meantime, could you please find out if the RISE study still accept new candidates? If possible, perhaps you will let us know the contact info of Dr. Kern so that we can enquire directly from him.

According to what you have told us about the promises of the devices in Vienna, it's worthwhile for me to fly over there to look at them.

Thank you so much!

Suzanne

[poonsuzanne]

Hiii Paraglider,

Do you have a comparison of measurements of your left thigh and calf before and after using the device for five months?

I intend to invite Dr. Kern and his team coming to Vancouver to start a small study group here in North America, if it is not too costly!!!

Thank you for your patience, Glider!

Suzanne

[perda-10]

Originally posted by Suzanne Poon:

Hii Paraglider,

I look forward to hearing more and more from you and info about your friends! Yes, please share with us pics of your legs and pics when you will start standing in March or April.

If I don't receive a reply from Dr. Schuhfried in the next two days, I will call him to start my enquiries. In the meantime, could you please find out if the RISE study still accept new candidates? If possible, perhaps you will let us know the contact info of Dr. Kern so that we can enquire directly from him.

According to what you have told us about the promises of the devices in Vienna, it's worthwhile for me to fly over there to look at them.

Thank you so much!

Suzanne
Dear Susane, Mag. Scuhfried is Mrs. Gudrun Schuhfried and will answer your mail if she got it. She allways answered all of my questions. I will ask Dr, Kern about a possibility of accepting another canditate into study. Is your son completely flaccid and what is the level of his injury. Does he have any spasm, and when was he injured? If will call Dr. Kern as soon as you give me some more information abou your son. I will also talk to Mag. Schuhfried tomorrow for another candidate a friend of mine and I can also ask her to be carefull about your mail (spam filter) if you just let me know from which adress you wrote and your name. My mail is: poizvedbe@hotmail.com. Before flying to Vienna, discuss it with Dr. Kern or any other doctor in Wilhelminenspital, they work as a great team and Dr. Kern is informed about everything what is going on in his department. By the way, all the doctors in Vienna are fluent in English.

Kind regards,

Paraglider

Paraglider

Kind regards,

[perda-10]

Originally posted by PARAGLIDER:

Originally posted by Suzanne Poon:
Hii Paraglider,

I look forward to hearing more and more from you and info about your friends! Yes, please share with us pics of your legs and pics when you will start standing in March or April.

If I don't receive a reply from Dr. Schuhfried in the next two days, I will call him to start my enquiries. In the meantime, could you please find out if the RISE study still accept new candidates? If possible, perhaps you will let us know the contact info of Dr. Kern so that we can enquire directly from him.

According to what you have told us about the promises of the devices in Vienna, it's worthwhile for me to fly over there to look at them.

Thank you so much!

Suzanne
Dear Susane, Mag. Scuhfried is Mrs. Gudrun Schuhfried and will answer your mail if she got it. She allways answered all of my questions. I will ask Dr, Kern about a possibility of accepting another canditate into study. Is your son completely flaccid and what is the level of his injury. Does he have any spasm, and when was he injured? If will call Dr. Kern as soon as you give me some more information abou your son. I will also talk to Mag. Schuhfried tomorrow for another candidate a friend of mine and I can also ask her to be carefull about your mail (spam filter) if you just let me know from which adress you wrote and your name. My mail is: poizvedbe@hotmail.com. Before flying to Vienna, discuss it with Dr. Kern or any other doctor in Wilhelminenspital, they work as a great team and Dr. Kern is informed about everything what is going on in his department. By the way, all the doctors in Vienna are fluent in English.

Kind regards,

Paraglider

Paraglider

Kind regards,
Dear Susane, don't forget the time difference: it's 23.06 (11.06 pm) in Austria now.

Love

[poonsuzanne]

Dear Paraglider,

I will email you! Thank you for your kindness!!

Suzanne

[poonsuzanne]

Dear Paraglider,

Thank you very much for all your useful replies to me thru email.

I have just called Dr. Forstner of Wilhelminenspital requesting her to kindly investigate into the possibility of coming to Vancouver to test the device with my son and some other paras at the same time as well.

She said she will discuss this with Dr. Modin and asked me to contact her again next Tuesday at 1:00pm. They are concerned about the law restrictions on their practice in Canada/U.S..

Unfortunately, by next Tuesday I will be in Vancouver, 1:00pm in Vienna equivalent to 4:00am in Vancouver. Anyway, I will do whatever I can!

Suzanne