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Thread: Advice Please

  1. #1

    Advice Please

    Hi All

    I hope this is the right forum for this post as there is a 'cure' aspect to it.

    I was hoping to get some advice from the posters here regarding my father in law. He was recently in a car accident in Egypt where his car was hit by a lorry. As you can imagine the medical facilities in Egypt are not the best and getting adequate answers and treatment over there is very difficult.

    My wife is Egyptian and she is with him at the moment and this is what she managed to get from the doctors so far.

    CT Report
    29-08-2009

    CT Scan of the cervical in the axial cuts with sagittal reconstruction revealed:

    - Comminuted fractures of the posterior neural arches of the 6th and 7th cervical vertebrae, seen completely seperated with their spinous processes and displaced backward and to the right

    - Some of the bone fragments are seen displaced inside the spinal canal markedly compromising the cervical spinal cord and suggesting its injury

    - No abnormal para vertebral shadows or blood collection seen

    - MRI study of the cerevco- dorsal junction is suggested top confirm the cord injury


    MRI Examination of the Cervico-dorsal Spine

    Technique:
    Sagittal T1, T2 W images
    Axial T2 W images

    Findings:
    - Known case of RTA with cervical fractures ar C6 and C7 as seen on the CT study done earlier the sameday

    - Secondary to the C6 and C7 posterior arch comminuted fractures seen on the CT study, the MRI sagittal W images shows siginificant anterolithesis of the C7 over T1 (grade IV) with thebody of C7 over seen lying anterior to T1 and nearly at its same levels

    - Secondary tothis displacement the spinalcanal is significantly narrowed with the joint seen beween the posterior arch of C5 posteriorly (which is anteriorlydisplaced secondary to the anterolithesis) and the posterior border of the bosy L1

    - The point of maximum narrowing the cord shows siginificant abnormal signal within and disruption of its anterior surface, it is at least partially, if not completely transected

    - Surrounding para vertebral edema is seen around the fractured levels

    - Moderate left side haemo thorax is noted

    Opinion:
    - Comminuted fractures of the posterior arches of the C6 and C7 with grade II antero-lithesis of C7 over T1 and siginificant spinalcord compromise and possibly complete cord transection as described



    Surgeon Report after operation (I couldnt read his handwriting sothere might be spelling mistakes)
    Polytraume 7 days duration
    - Pathology: cervirodosal fracture dislocation (C7, D1) operated upon to fixation (cervical laterlmass, cloisal turapedicular)

    - Clinically post traumatic:
    Grade 0 moter power both lower limbs
    Grade 0 handgrip
    Grade 4 shoulder elevation
    No sensation (severe level)



    The doctors arent really explaing what all this means to the family and are very short on advice regarding next steps. He has already developed a tumour in his leg due to supposedly been in the wrong position in his bed.

    The family are quite wealthy so do have the resources to pay for excellent treatment .. the problem is finding out where is best to get that treatment. They met with someone from the xcell centre in Germany who was quite eager for him to go to Germany to have treatment soon at the cost of €25,000. I told them not to go ahead with it yet as i was quite sceptical of their website and treatment .. I found this forum as I was trying to do some research on them. After reading the threads on here I'm not sure if my fears were confirmed .. there seems to be some indiviudal cases of improvement but little hard data to back up their claim to my wifes family that 60% of people regain some function (esp bladder/bowel) afterwards.

    They were also looking a stemcellchina.com but I have asked them to stop looking at stem cell therapies until he has had a proper assessment from a reputable consultant. I have been looking at the mayo clinic in minnesota but seeminlgly its quite difficult to get accepeted there. Through a friend I have also been told about Miami hospital medical centre, they have a programme called finding a cure for paralysis but I know little about it.

    I guess what I'm asking is for some advice re his medical report and what it means and what the families realistic expectation should be. I would also like some advice regarding clinical trials and stem cells and whether we should even be thinking about that at this stage. My wife and I are based in London so it would be convenient to have him in the Uk with us but we do want him to get the very best treatment and are willing to go wherever that requires. Somewhere in the middle east would be ideal as his family would have easier access though and would be there to help and support him through this instead of having to fly half way around the world to be with him. I'm aware that having psychological support from your family is crucial at a time like this so moving him to the US would be a concern to us.

    Thanks for taking the time to read.

    Michael

  2. #2
    Senior Member KIM's Avatar
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    Check he is turned around every 3 hours so he won´t develop bedsores.

  3. #3
    Michael,

    There are no credible "cures" at this time, unfortunately. The best thing to do, in my opinion, would be to get him involved in intense physical therapy (Project Walk, for example) as soon as he is stable.

    There are a few people here with C6 and C7 injuries that live independently, or mostly so. If the report is accurate, there's a good chance that your father-in-law will regain use of his arms and possibly the ability to move his wrists. The functioning of his hands and fingers will likely be somewhat compromised, but he can be independent.

    Right now, as Kim says, you want to make sure he avoids pressure sores. In addition, you want to try to minimize muscle atrophy (through physical therapy) and contractures (through stretching, range of motion).

    Good luck,

    Steven
    ...it's worse than we thought. it turns out the people at the white house are not secret muslims, they're nerds.

  4. #4
    Quote Originally Posted by mickhoran View Post
    The doctors arent really explaing what all this means to the family and are very short on advice regarding next steps. He has already developed a tumour in his leg due to supposedly been in the wrong position in his bed.

    The family are quite wealthy so do have the resources to pay for excellent treatment .. the problem is finding out where is best to get that treatment. They met with someone from the xcell centre in Germany who was quite eager for him to go to Germany to have treatment soon at the cost of €25,000. I told them not to go ahead with it yet as i was quite sceptical of their website and treatment .. I found this forum as I was trying to do some research on them. After reading the threads on here I'm not sure if my fears were confirmed .. there seems to be some indiviudal cases of improvement but little hard data to back up their claim to my wifes family that 60% of people regain some function (esp bladder/bowel) afterwards.

    They were also looking a stemcellchina.com but I have asked them to stop looking at stem cell therapies until he has had a proper assessment from a reputable consultant. I have been looking at the mayo clinic in minnesota but seeminlgly its quite difficult to get accepeted there. Through a friend I have also been told about Miami hospital medical centre, they have a programme called finding a cure for paralysis but I know little about it.

    I guess what I'm asking is for some advice re his medical report and what it means and what the families realistic expectation should be. I would also like some advice regarding clinical trials and stem cells and whether we should even be thinking about that at this stage. My wife and I are based in London so it would be convenient to have him in the Uk with us but we do want him to get the very best treatment and are willing to go wherever that requires. Somewhere in the middle east would be ideal as his family would have easier access though and would be there to help and support him through this instead of having to fly half way around the world to be with him. I'm aware that having psychological support from your family is crucial at a time like this so moving him to the US would be a concern to us.

    Thanks for taking the time to read.

    Michael
    This may help--


    http://www.getbodysmart.com/ap/nervo.../tutorial.html


    And this--
    Necrosis definition: http://en.wikipedia.org/wiki/Necrosis The premature death of cells and living tissue which is caused by external factors, such as infection, toxins, or trauma. Necrosis is almost always detrimental, and can be fatal.
    Cells which die due to necrosis do not usually send the same chemical signals to the immune system that cells undergoing apoptosis do. This prevents nearby phagocytes from locating and engulfing the dead cells, leading to a buildup of dead tissue and cell debris at or near the site of the cell death. Necrotic tissue does not undergo the same chemical reactions that "normally" dying apoptotic tissue does.
    The sudden failure of one part of the cell (Necrosis) triggers a cascade of events. In addition to the lack of chemical signals to the immune system, cells undergoing necrosis can release harmful chemicals into the surrounding tissue. In particular, cells contain small organelles called lysosomes, which are capable of digesting cellular material. Damage to the lysosome membrane can trigger release of the contained enzymes, destroying other parts of the cell. Worse, when these enzymes are released from the non-dead cell, they can trigger a chain reaction of further cell death. If a sufficient amount of contiguous tissue necrotizes, it is termed gangrene.
    Necrosis typically begins with cell swelling, chromatin digestion, disruption of the plasma membrane and organelle membranes. Late necrosis is characterized by extensive DNA hydrolysis, vacuolation of the endoplasmic reticulum, organelle breakdown, and cell lysis. The release of intracellular content after plasma membrane rupture is the cause of inflammation in necrosis.
    Spinal cord injuries cause myelopathy or damage to white matter or myelinated fiber tracts that carry signals to and from the brain. This type of traumatic injury could also damage the gray matter in the central part of the cord, causing segmental losses of interneurons and motorneurons. Spinal cord injury can occur from many causes, including:


  5. #5
    Project Walk has a Certified Provider in England if your interested. Its called Standing Start. You can go to Project Walk website for more details.

  6. #6
    There are really no legitimate studies for cure that he would be eligible for at this time. You can find a lot of information about these studies or programs, most of which are NOT appropriate for a newly injured person on the Cure forum.


    At this point, what is critical for your father-in-law is the following:
    1. Did he get a SCI methylprednisilone treatment protocol immediately upon his injury?
    2. Proper stabilization of his spine to prevent further damage to his cord.
    3. An accurate and complete ASIA exam to determine how complete his injury is, and his actual neurologic level of injury.
    4. Admission ASAP to a specialty SCI center for both acute and acute rehabilitation care and training. This should occur BEFORE he goes to a post-acute exercise program such as Project Walk.
    If you are looking at SCI centers in the USA, I personally would not recommend Mayo Clinic, or University of Miami (associated with the Miami Project to Cure Paralysis) but instead one of the 13 federally funded Model SCI System Centers. I would look particularly at the Shephard Center in Atlanta, GA, Kessler Institute in NJ, or Craig Hospital in Englewood, CO. All are very experienced at caring for international patients with SCI. Private pay for such care is not inexpensive, and generally requires a significant downpayment prior to admission. In addition, there is the significant costs of international air ambulance to transport him. I know of no good SCI center in the Middle East. In England, I can only recommend the National Spinal Cord Injuries Centre at Stoke Mandeville Hospital, but that would be somewhat less ideal. There is also an excellent unit in Sweden at the Spinalis unit at the Karolinska Hospital, and I believe some good programs in Switzerland (which I will ask Dr. Young to comment on).

    Is he currently on a ventilator?

    How old is he?

    How was his health prior to this accident?

    I would like to second everything said about taking every necessary measure to prevent pressure ulcers at this time. Even a small one could prevent his participation in an aggressive rehabilitation program.

    Please continue to post here and we will answer any questions you may have.

    (KLD)

  7. #7
    Thanks All for the great advice and kind words. We are going to start exploring our options with the different centres that were reccommended.


    SCI Nurse -

    1. He didnt get the injection as far as I'm aware but I have asked the fmaily to double check

    2. He isnt on a ventilator .. he had an operation a few days after the accident to help regulate his breathing but he is breathing on his own now.

    3. He is 50 years old

    4. His healt was ok .. he is a heavy smoker though - 40+ per day. He was also suffering from mild depression before the accident.


    Could i ask how long treatment at for instance the Kessler Institute would take and what are the approx costs for private care?

    Thanks again

  8. #8
    Quote Originally Posted by mickhoran View Post
    Hi All

    I hope this is the right forum for this post as there is a 'cure' aspect to it.

    I was hoping to get some advice from the posters here regarding my father in law. He was recently in a car accident in Egypt where his car was hit by a lorry. As you can imagine the medical facilities in Egypt are not the best and getting adequate answers and treatment over there is very difficult.

    My wife is Egyptian and she is with him at the moment and this is what she managed to get from the doctors so far.

    CT Report
    29-08-2009

    CT Scan of the cervical in the axial cuts with sagittal reconstruction revealed:

    - Comminuted fractures of the posterior neural arches of the 6th and 7th cervical vertebrae, seen completely seperated with their spinous processes and displaced backward and to the right

    - Some of the bone fragments are seen displaced inside the spinal canal markedly compromising the cervical spinal cord and suggesting its injury

    - No abnormal para vertebral shadows or blood collection seen

    - MRI study of the cerevco- dorsal junction is suggested top confirm the cord injury


    MRI Examination of the Cervico-dorsal Spine

    Technique:
    Sagittal T1, T2 W images
    Axial T2 W images

    Findings:
    - Known case of RTA with cervical fractures ar C6 and C7 as seen on the CT study done earlier the sameday

    - Secondary to the C6 and C7 posterior arch comminuted fractures seen on the CT study, the MRI sagittal W images shows siginificant anterolithesis of the C7 over T1 (grade IV) with thebody of C7 over seen lying anterior to T1 and nearly at its same levels

    - Secondary tothis displacement the spinalcanal is significantly narrowed with the joint seen beween the posterior arch of C5 posteriorly (which is anteriorlydisplaced secondary to the anterolithesis) and the posterior border of the bosy L1

    - The point of maximum narrowing the cord shows siginificant abnormal signal within and disruption of its anterior surface, it is at least partially, if not completely transected

    - Surrounding para vertebral edema is seen around the fractured levels

    - Moderate left side haemo thorax is noted

    Opinion:
    - Comminuted fractures of the posterior arches of the C6 and C7 with grade II antero-lithesis of C7 over T1 and siginificant spinalcord compromise and possibly complete cord transection as described



    Surgeon Report after operation (I couldnt read his handwriting sothere might be spelling mistakes)
    Polytraume 7 days duration
    - Pathology: cervirodosal fracture dislocation (C7, D1) operated upon to fixation (cervical laterlmass, cloisal turapedicular)

    - Clinically post traumatic:
    Grade 0 moter power both lower limbs
    Grade 0 handgrip
    Grade 4 shoulder elevation
    No sensation (severe level)



    The doctors arent really explaing what all this means to the family and are very short on advice regarding next steps. He has already developed a tumour in his leg due to supposedly been in the wrong position in his bed.

    The family are quite wealthy so do have the resources to pay for excellent treatment .. the problem is finding out where is best to get that treatment. They met with someone from the xcell centre in Germany who was quite eager for him to go to Germany to have treatment soon at the cost of €25,000. I told them not to go ahead with it yet as i was quite sceptical of their website and treatment .. I found this forum as I was trying to do some research on them. After reading the threads on here I'm not sure if my fears were confirmed .. there seems to be some indiviudal cases of improvement but little hard data to back up their claim to my wifes family that 60% of people regain some function (esp bladder/bowel) afterwards.

    They were also looking a stemcellchina.com but I have asked them to stop looking at stem cell therapies until he has had a proper assessment from a reputable consultant. I have been looking at the mayo clinic in minnesota but seeminlgly its quite difficult to get accepeted there. Through a friend I have also been told about Miami hospital medical centre, they have a programme called finding a cure for paralysis but I know little about it.

    I guess what I'm asking is for some advice re his medical report and what it means and what the families realistic expectation should be. I would also like some advice regarding clinical trials and stem cells and whether we should even be thinking about that at this stage. My wife and I are based in London so it would be convenient to have him in the Uk with us but we do want him to get the very best treatment and are willing to go wherever that requires. Somewhere in the middle east would be ideal as his family would have easier access though and would be there to help and support him through this instead of having to fly half way around the world to be with him. I'm aware that having psychological support from your family is crucial at a time like this so moving him to the US would be a concern to us.

    Thanks for taking the time to read.

    Michael
    Michael,

    From your description, your father-in-law had a C7/T1 injury that was decompressed and a probable C8 neurological level. He should be taken care of in the hospital where he is currently until he is ready to be moved to rehabilitation. The goal in the acute care hospital is to ensure that his spinal cord is adequately decompressed and his body is well-taken care of. Based on what you describe, he is likely to be a paraplegic and will regain use of his arms and hands. The only treatments that have been shown to be beneficial in spinal cord injury is early administration of a drug called methylprednisolone and surgical decompression of the spinal cord if it is compressed.

    Your father-in-law needs to learn basic care of his body, including how to catheterize his bladder and have bowel movements, to transfer from bed to wheelchair, to protect his skin and prevent pressure sores, to manage spasticity and other problems that often develop after spinal cord injury. There is a lot of learn and his house must be converted so that it is accessible. He can learn to drive again. With good rehabilitation, he is likely to be able to become independent.

    There are many therapies that are being considered for spinal cord injury clinical trials. Unfortunately, none of the therapies that are aimed at 1-2 weeks after injury are currently recruiting at the present. There is one trial that is ending (Source) and a phase 2 trial is being planned but I have not seen this trial announced yet. I do not recommend the therapies that are being discussed in the http://stemcellchina.com in China, X-cell in Germany, Geeta Shroff in Delhi.

    There is *no* therapy that has been shown to improve motor recovery in patients with "complete" (American Spinal Injury Association Category A) spinal cord injury during the first year after injury. There is some data that intensive locomotor training can accelerate recovery in people who have motor "incomplete" (American Spinal Injury Association Category C). Our group (chinascinet and scinetusa) is planning to start clinical trials of umbilical cord blood mononuclear cell transplants and lithium for chronic spinal cord injury (>1 year). Several groups are planning clinical trials to treat therapies aiming subacute spinal cord injury, within 2 weeks.

    Regarding rehabilitation centers in the Middle East, I know that Israel has good rehabilitation centers and, although I have not been to these countries, I recently met good rehabilitation doctors from Jordan and Lebanon. I know that there are several Egyptian rehabilitation centers that take care of people with spinal cord injury. I attach a 2005 report on rehabilitation in Egypt. I hope that this helpful.

    Wise.


    http://otegypt.blogspot.com/2007/06/...uary-2005.html
    REHABILITATION SERVICES IN EGYPTTarek S. Shafshak, MDProfessor of Physical Medicine & Rehabilitation, Faculty of Medicine,Alexandria University, Alexandria, Egypt.

    Introduction and general description:

    Physical medicine and rehabilitation (PMR) have been practiced in Egypt since the 1940's. Currently, there are at least 195 hospitals belonging to the Ministry of Health and about 18 university affiliated hospitals that have special departments for PMR (these departments may also be named rheumatology and rehabilitation, or physical medicine, rheumatology and rehabilitation in some hospitals). They are distributed all over the country, but mainly in large cities. In addition, there are departments for physical and/or rehabilitation medicine at the internal security hospitals in Cairo and in some military hospitals.

    The biggest rehabilitation center in Egypt is the Armed Forces Center for PMR at El-Agouza, Cairo. There are also several private PMR centers (which may be a separate center or a separate department in a private general hospital) in most of the Egyptian cities. Generally speaking, the departments of PMR are supervised and managed by specialists of PMR (i.e. physiatrists). Many physiatrists, physiotherapists and trained nurses work together in these departments as one team. They offer rehabilitation services mainly for neurological, orthopedic and rheumatic patients. These services usually include medical treatment, rehabilitation nursing and physiotherapy, in addition to prescribing assisted devices (e.g. walking aids, orthoses and/or prostheses) and train patients how to use it. Also, they offer general medical services for many rheumatologic disorders; and sometimes rehabilitation services for some pulmonary and cardiac patients. Usually, physiatrists work in collaboration with speech therapists, psychologists, psychiatrists, social workers, vocational therapists and/or other medical specialists (that are usually not available at the departments of PMR) to provide the necessary service for each patient.

    Some governmental hospitals provide the rehabilitation service free of charge, or at low economic prices. The national medical insurance, and other medical insurance companies, usually covers the expenses of rehabilitation services (including the assistive devices, orthoses and prostheses) for insured people. The cost of rehabilitation services is also reasonable in the private sector.Physiatrists in Egypt are medical doctors who have a diploma, master or doctoral degree (MD) in PMR. They should have at least 2 years of training, and pass a written, oral and a clinical examination to get the diploma or master degree in PMR. Those with a master degree are eligible to be enrolled in the doctoral degree program, in which they prepare a doctoral thesis in PMR (for at least 2 years), then they have to undergo an advanced written, oral and clinical examination in PMR including the management (clinical diagnosis, electrodiagnosis, physical treatment and medical treatment) and the rehabilitation of all musculoskeletal and locomotory disorders in addition to other disabilities.

    Physiotherapists or who practice physiotherapy in Egypt should have a bachelor degree in physiotherapy. However, trained nurses who are trained in physical rehabilitation and had a diploma in physical rehabilitation (or massage and electrotherapy) also practice physiotherapy (and sometimes they practice in addition occupational therapy) under physiatrist supervision, and most of them are doing a great job.

    There are also many orthotic and prosthetic centers. Some of these centers belong to the Ministry of Health (e.g. the largest center is in the Institute for Poliomyelitis in Cairo besides smaller centers in Alexandria, Minoufia, Giza and Baniswief governorates), while few are affiliated to military hospitals (e.g. the Armed Forces Center for PMR in Cairo). Also, other centers (sometimes called plants) are affiliated to either the Ministry of Social Affairs or some charities.

    The most important of these are Alwafaa Wa-alamal in Cairo, the rehabilitation center at Moharam-Beck in Alexandria and the center for PMR, Masjid Sidi-Gaber Charity, at Semouha, Alexandria). In addition, there are many other small private centers. In general, they assemble or manufacture orthoses and prostheses from Egyptian-made or imported materials. The imported materials are mainly the hydraulic, safety or polycentric knee components. Sometimes however, other components i.e. the foot component are also imported. If the orthoses and prostheses are made totally from Egyptian materials, their price would be reasonable. However, if they are made of imported materials, this makes the cost expensive.

    Furthermore, there are about 60 physiotherapy and rehabilitation centers affiliated to the Ministry of Social Affairs. They are distributed in most governorates. Few are now available in some rural areas. Each center has a doctor (a physiatrist, neurologist, orthopedic surgeon or a general practioner depending mainly on the availability) and at least one physiotherapist in addition to few nurses. They provide general medical services, physiotherapy and limited rehabilitation services (prescribing some assisted devices, and offering gait training).

    Several physiotherapy centers, mostly private (but some are separate departments in few hospitals affiliated to either a university or the Ministry of Health) are now available allover the country, but mainly in big cities. They are supposed to receive patients referred by a physician for physiotherapy. In this way, they might participate in providing a part of the rehabilitation program for those patients.

    Elderly homes appeared in Egypt in the early twentieth century. However, they are still few, and are available mainly in Cairo and Alexandria cities. Most of them are affiliated to charities (e.g. Egyptian Red Crescent, Alwafaa Wa-alamal, Greek Charity, Al-Hadaya Charity, some churches and others). Most of them are well furnished and equipped. They help elderly people (who needs assistance for the activity of daily living, which is not available at their homes) to live a comfortable life, and to cover their basic needs. Limited rehabilitation services (e.g. exercise therapy, rehabilitation nursing, hydrotherapy,…) became available in some of these elderly homes during the past 2 decades. Unfortunately, most of the available places are on a charge bases. The cost is equivalent to 10-150 dollars/month, according to the accommodation standard and the offered service.

    Spa therapy (warm mineral water and/or mud) has been in practice in Egypt for several years. They provide rehabilitation services for chronic painful arthritic or non-malignant musculoskeletal pains. The most important places are at Helwan (near Cairo), the Suez Gulf region, Safaga on the red sea, some parts of upper Egypt, Sewa oasis, and at Elwady Aljadid governorate (in the western desert).The rehabilitation practice problems:The practice of PMR in Egypt might be considered accepted if compared to the practice of this specialty in many African and Arab countries. However, we hope at improving it to avoid a big gap between its practice in Egypt and its practice in the developed countries (e.g. USA, Canada, European Union,..). Also, we are trying to follow the great progress that was made in the USA as regard to this specialty. The author has tried to summarize the problems that we are facing now in the following items:

    The number of physiatrists is still low compared to the size of the Egyptian population and our hopes for the future.

    Some physiatrists need regular training programs to improve their knowledge regarding the rapidly progressing recent advances in PMR.

    Only a few physiatrists have the experience of managing spasticity using phenol neurolysis (which is a cheap method for controlling localized spasticity).

    The cost of botulinum toxin injection which has been recently used in managing localized spasticity is high compared to the standard of living in Egypt.

    Occupational therapists are not generally available in Egypt. Therefore, some physiatrists (especially, the university staff), usually train some nurses to work as occupational therapists.

    The well trained orthotists and prosthetists are still few compared to the population needs.

    The number of social workers, vocational therapists and speech therapists who are experienced to work in the field of rehabilitation medicine is still not satisfactory.

    The cost of the proper prostheses and orthoses (that are made of imported materials) is high compared to the standard of living of many Egyptian patients.

    The cost of the recent computerized and/or motorized equipment that might be used in the patient's environment for his proper rehabilitation is expensive.

    The price of the physiotherapy equipment is rising.

    The newly used equipment in the patient's evaluation procedures is expensive (e.g. those used in gait analysis and for electrophysiological assessment of the neuromuscular system).

    The financial support for most of the PMR centers is limited.

    The social and/or financial support for the increasing number of patients enrolled in a rehabilitation program is limited.

    The number of elderly homes is still limited compared to the population size, especially the centers that are ready to admit disabled and handicapped persons. Also, they are still not available for any one unless he is able to afford it.

    Some physiotherapists refuse working under the supervision of trained physiatrists. This might interfere with quality control.

    Many of the spa therapy places need development.

    There are only a few PMR centers or departments that are equipped and ready to admit patients for a long term in-patients rehabilitation program. The available places are reserved for special or selected patients.

    Hopes, dreams and plans for the future:Our hopes and plans for the future according to the author's view point could be summarized in the following:

    Increasing the financial support for the departments of PMR to cover the expenses of the recent equipment used for the patient evaluation and treatment, and that needed for the continuous training of physiatrists and all workers in the field of rehabilitation medicine.

    Increasing the number of physiatrists.

    Creating a special institute for occupational therapy to graduate professional occupational therapists (a paramedical institution).

    Increasing the number of trained orthotists and prosthetists by establishing modern schools for graduating them.

    Training many social workers and speech therapist to work in the field of rehabilitation medicine and increasing the number of trained vocational therapists.

    Increasing financial support for disabled subjects and those enrolled in a rehabilitation program.

    The number of rehabilitation centers should increase to cover all areas of the country not covered now. Also, the size of each rehabilitation center and the number of the available physiotherapy and training equipment should increase to deal with the increasing number of referred patients. This would also suggest increasing the number of the available trained physiotherapists in each center. Also, the number of trained physiatrists should increase so that at least one physiatrist will be available in each rehabilitation center to ensure proper planning and supervision of the rehabilitation program.
    Establishing new rehabilitation centers that have all facilities for a long term in-patient rehabilitation program.

    The number of elderly homes should increase and cover all parts of the country. Also, there should be a better chance for patients that could be admitted to these homes free of charge and at the same time having a good service.

    Finally, it is our hope or dream to establish a special PMR educational and training institute that provide all rehabilitation facilities available now in the USA for our patients at a reasonable cost, and at the same time will be a training center for junior physiatrists, physiotherapists and all other rehabilitation personnel.

  9. #9

    hope this helps nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn

    you can try JacksonMemorial Hospital in Miami, Florida. My brother was flown ther from St.Thomas V.I. in 10-08 after being shot in the back. there trauma center was excellent the doctors and nurses were caring and kept us in the loop with all his treatments and and diagnosis. He was then transfered to their re-hab center which is located on the same campus. They are associated with the University of Miami and the Miami project to cure paralysis they have a huge research facility. I wish you and your family all the best.

    Quote Originally Posted by mickhoran View Post
    Hi All

    I hope this is the right forum for this post as there is a 'cure' aspect to it.

    I was hoping to get some advice from the posters here regarding my father in law. He was recently in a car accident in Egypt where his car was hit by a lorry. As you can imagine the medical facilities in Egypt are not the best and getting adequate answers and treatment over there is very difficult.

    My wife is Egyptian and she is with him at the moment and this is what she managed to get from the doctors so far.

    CT Report
    29-08-2009

    CT Scan of the cervical in the axial cuts with sagittal reconstruction revealed:

    - Comminuted fractures of the posterior neural arches of the 6th and 7th cervical vertebrae, seen completely seperated with their spinous processes and displaced backward and to the right

    - Some of the bone fragments are seen displaced inside the spinal canal markedly compromising the cervical spinal cord and suggesting its injury

    - No abnormal para vertebral shadows or blood collection seen

    - MRI study of the cerevco- dorsal junction is suggested top confirm the cord injury


    MRI Examination of the Cervico-dorsal Spine

    Technique:
    Sagittal T1, T2 W images
    Axial T2 W images

    Findings:
    - Known case of RTA with cervical fractures ar C6 and C7 as seen on the CT study done earlier the sameday

    - Secondary to the C6 and C7 posterior arch comminuted fractures seen on the CT study, the MRI sagittal W images shows siginificant anterolithesis of the C7 over T1 (grade IV) with thebody of C7 over seen lying anterior to T1 and nearly at its same levels

    - Secondary tothis displacement the spinalcanal is significantly narrowed with the joint seen beween the posterior arch of C5 posteriorly (which is anteriorlydisplaced secondary to the anterolithesis) and the posterior border of the bosy L1

    - The point of maximum narrowing the cord shows siginificant abnormal signal within and disruption of its anterior surface, it is at least partially, if not completely transected

    - Surrounding para vertebral edema is seen around the fractured levels

    - Moderate left side haemo thorax is noted

    Opinion:
    - Comminuted fractures of the posterior arches of the C6 and C7 with grade II antero-lithesis of C7 over T1 and siginificant spinalcord compromise and possibly complete cord transection as described



    Surgeon Report after operation (I couldnt read his handwriting sothere might be spelling mistakes)
    Polytraume 7 days duration
    - Pathology: cervirodosal fracture dislocation (C7, D1) operated upon to fixation (cervical laterlmass, cloisal turapedicular)

    - Clinically post traumatic:
    Grade 0 moter power both lower limbs
    Grade 0 handgrip
    Grade 4 shoulder elevation
    No sensation (severe level)


    The doctors arent really explaing what all this means to the family and are very short on advice regarding next steps. He has already developed a tumour in his leg due to supposedly been in the wrong position in his bed.

    The family are quite wealthy so do have the resources to pay for excellent treatment .. the problem is finding out where is best to get that treatment. They met with someone from the xcell centre in Germany who was quite eager for him to go to Germany to have treatment soon at the cost of €25,000. I told them not to go ahead with it yet as i was quite sceptical of their website and treatment .. I found this forum as I was trying to do some research on them. After reading the threads on here I'm not sure if my fears were confirmed .. there seems to be some indiviudal cases of improvement but little hard data to back up their claim to my wifes family that 60% of people regain some function (esp bladder/bowel) afterwards.

    They were also looking a stemcellchina.com but I have asked them to stop looking at stem cell therapies until he has had a proper assessment from a reputable consultant. I have been looking at the mayo clinic in minnesota but seeminlgly its quite difficult to get accepeted there. Through a friend I have also been told about Miami hospital medical centre, they have a programme called finding a cure for paralysis but I know little about it.

    I guess what I'm asking is for some advice re his medical report and what it means and what the families realistic expectation should be. I would also like some advice regarding clinical trials and stem cells and whether we should even be thinking about that at this stage. My wife and I are based in London so it would be convenient to have him in the Uk with us but we do want him to get the very best treatment and are willing to go wherever that requires. Somewhere in the middle east would be ideal as his family would have easier access though and would be there to help and support him through this instead of having to fly half way around the world to be with him. I'm aware that having psychological support from your family is crucial at a time like this so moving him to the US would be a concern to us.

    Thanks for taking the time to read.

    Michael

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