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Thread: Ten frequently asked questions concerning cure of spinal cord injury

  1. #571
    Senior Member 0xSquidy's Avatar
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    Quote Originally Posted by Fly_Pelican_Fly View Post
    Hi Wise - rehabilitation costs of $50k for 6 weeks sounds like an awful lot. Even at a kingly sum of $200 an hour for 3 hours a day, 7 days a week for 6 weeks we are talking about $25k. Throw in accomodation and some care then maybe it gets closer to $35k.

    Also, 3 hours a day everyday is a LOT of training. From personal experience 2 hours a day 4 times a week is optimum for most people and there are many who dont have the physical stamina to do even that.

    Maybe it would be prudent to discuss tailoring a specific rehabilitation programme with the more cost-effective organisations such as Project Walk (and affiliates)? They have the experience and existing national coverage to allow you to outsource the physiotherapy at a far more competitive rate.

    PS I am not a sales representitive of PW. Im just throwing an idea out there.
    I agree 100% with you. I've been saying this since I knew the figures.

    There must be something that i'm missing, but those numbers just don't add up.

    There's an approved PW center here in Spain. They charge you 35€ (let's round up to 50$) per hour , the exercises sometimes are with 2 pt, but usually just one is enough.
    Let's say 2 hours per day 5 days per week for 6 months...this already requires balls of steel to the least.

    2 hours * 5 days * 4 weeks * 6 months = 240 hours
    240 hours * 50$ = 12.000$ all the pt for 6 month.

    What are we missing?
    Don't ask what clinical trials can do for you, ask what you can do for clinical trials.

    Fenexy: Proyecto Volver a Caminar

    http://www.fenexy.org (soon in english too)

  2. #572
    Quote Originally Posted by Fly_Pelican_Fly View Post
    Hi Wise - rehabilitation costs of $50k for 6 weeks sounds like an awful lot. Even at a kingly sum of $200 an hour for 3 hours a day, 7 days a week for 6 weeks we are talking about $25k. Throw in accomodation and some care then maybe it gets closer to $35k.

    Also, 3 hours a day everyday is a LOT of training. From personal experience 2 hours a day 4 times a week is optimum for most people and there are many who dont have the physical stamina to do even that.

    Maybe it would be prudent to discuss tailoring a specific rehabilitation programme with the more cost-effective organisations such as Project Walk (and affiliates)? They have the experience and existing national coverage to allow you to outsource the physiotherapy at a far more competitive rate.

    PS I am not a sales representitive of PW. Im just throwing an idea out there.
    Pelican,

    We have not yet come to a consensus concerning what is a suitable or best rehabilitation program. In one of our centers in ChinaSCINet, they are engaged in intensive locomotor training for 6 hours a day for 6 days a week. Many of our rehabilitation centers do not have the therapists to supervise such intensive training and have suggested 3 hours a day and 3 days a week. The length of time is also an open question. Most people feel that 3 months will be needed.

    Regarding places like Project Walk (and many others like them), please remember that this is a multicenter study that include many of the top spinal cord injury rehabilitation centers. The centers must not only follow a rehabilitation protocol but also evaluate the patients.

    Wise.

  3. #573
    Senior Member mcferguson's Avatar
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    Dr. Young,

    Do you think the exoskeletons such as eLEGS and ReWalk would be beneficial rehab tools? I can see where, provided they become cheap enough, a single therapist could oversee several patients at a time if they were all using an exoskeleton.
    T5/6, ASIA A, injured 30 Nov 08
    Future SCI Alumnus.
    I don't want to dance in the rain, I want to soar above the storm.

  4. #574
    Quote Originally Posted by mcferguson View Post
    Dr. Young,

    Do you think the exoskeletons such as eLEGS and ReWalk would be beneficial rehab tools? I can see where, provided they become cheap enough, a single therapist could oversee several patients at a time if they were all using an exoskeleton.
    mcferguson,

    There are basically three philosophies concerning rehabilitation. The first is the most common and that is no locomotor training. A majority of people with so-called "complete" spinal cord injury probably have received no significant locomotor training. The second philosophy is treadmill training with bracing and other devices. The third is practiced in China with intensive overground walking with a minimum of bracing, elastic bands for preventing footdrop, a family member walking in the back pulling on ropes tied to the legs to lock the knees.

    The U.S. and European rehabilitation groups are very device oriented. The Chinese do not favor bracing which reduce the degrees of freedom because they believe that these may result in bad habits. They prefer to train with the walking being as similar as possible to regular walking.

    Wise.

  5. #575

    t12 burst fracture 12 days old

    Dear Dr. Wise, I am recovering from a burst t12 at home in a brace. My neurosurgeon says I will recover and don't need surgery. I have no deficits. I am worried that he sent me home with a brace and walker but noreal instructions on how much I should get up, walk, sit in a chair etc. I am terrified of overdoing or underdoing. Can you advise? He said he would retake rads in 6weeks.
    Thank you for your kindness and time
    drkatysg

  6. #576
    Quote Originally Posted by drkatysg View Post
    Dear Dr. Wise, I am recovering from a burst t12 at home in a brace. My neurosurgeon says I will recover and don't need surgery. I have no deficits. I am worried that he sent me home with a brace and walker but noreal instructions on how much I should get up, walk, sit in a chair etc. I am terrified of overdoing or underdoing. Can you advise? He said he would retake rads in 6weeks.
    Thank you for your kindness and time
    drkatysg
    drkatysg,

    I think that you are very lucky to have no neurological deficits. Without more information about your burst T12, it is hard to advise concerning how much physical activity to do. Your doctor apparently does not think that the fracture is unstable and therefore sent sent you home with a brace and walker without instructions as to how much to do. This suggests that you can go ahead and walk as much as you want. The fact that you are intact neurologically means that you don't need to undergo intensive training. However, in order to maintain your function and prevent atrophy, you should probably stand and walk at least an hour a day.

    Wise.

  7. #577
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    Quote Originally Posted by Rollin Rick View Post
    Third-generation therapies 8 years from now, whoa!! That was a slap in the face.

    From what I see, we are moving in a much faster pace than that, how about 2 -3 years from now? This is a very exciting time, third-generation is right on second-generation backdoor. Time to push for clinical trials!!

    What one man can do another can do
    This is the real deal. As some one said "sooner or later, we will have to jump from animal and in vitro testing to the human being"

  8. #578
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    Quote Originally Posted by Wise Young View Post
    aten, good question. You would think that the answer is yes. The specific therapy that Dr. Huang is using may not be so easy to replicate in the United States because he is using fetal olfactory ensheathing glial cells. Dr. Lima's nasal mucosa transplant would be doable in the United States. Dr. McKay-Sims olfactory ensheathing glia cells cultured from the nose would be doable as well. I don't know. I am sorry to have to repeat myself but the reason may be lack of money for spinal cord injury clinical trials of therapies not supported by industry. Wise.
    This is a useful insight. However, I have always questioned the excuse of lack of money in SCI treatment. The fact remains that the actual cost of maintaining a growing population of SCIs is phenomenal. This just gets bigger when we add Alzheimer's, MS, Parkinson's and other neurological disorders.

  9. #579
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    Dr. Young,
    I apologize if you've answered these questions previously in the forum. I'm T-11 complete for 7 years now and had no idea that exercise below my injury is so important. I don't have access to a standing frame or any of the other 3 methods of exercise you mentioned. My legs are significantly smaller than they were prior to my injury. Since it's been 7 years, how do I know if my legs can support my weight (145 lbs)? What should I do to be ready for a cure? How much money should I expect to spend? Thanks.

  10. #580
    Quote Originally Posted by paracripdude View Post
    Dr. Young,
    I apologize if you've answered these questions previously in the forum. I'm T-11 complete for 7 years now and had no idea that exercise below my injury is so important. I don't have access to a standing frame or any of the other 3 methods of exercise you mentioned. My legs are significantly smaller than they were prior to my injury. Since it's been 7 years, how do I know if my legs can support my weight (145 lbs)? What should I do to be ready for a cure? How much money should I expect to spend? Thanks.
    paracripdude,

    I apologize for not having answered your questions earlier. When you start standing, you should do it for short periods of time. If you are in a hospital with equipment, if you have not been on your feet for 7 years, you probably should start with a tilt table that gradually tilts you towards an upright posture until you are no longer dizzy. Then increase the amount of time that you do weight-bearing on your feet from 5 minutes, 10 minutes, etc. until you are standding an hour a day.

    There are many devices for standing. One of the simplest that I have seen requires finding a place with wall-mounted handrails and using a sheet that is placed under your butt. Roll your wheelchair up against the wall with the handrail. Take the two ends of the sheet and insert them into the handrail and have somebody pull the sheets to lift you butt until you stand. Stand, facing the wall.

    Another simple device is a standing frame. A third device is the glider. You can look all these up on internet. I hope that other people might comment on the devices that they find to be the most useful.

    Wise.

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