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Thread: Is 100% recovery possible?

  1. #1

    Is 100% recovery possible?

    I'm a C5/6 incomplete 4 months post injury. I have been extremely fortunate in my recovery to date. I have have finished all my therapy and still work very hard in the gym, etc. on my own. But I was wondering, does anyone ever fully recover? Are there any out there? Is 100% recovery a realistic goal?

    I know how lucky I am to have come this far, but I just would like to know if it is possible...

  2. #2

    Possible

    There are people who have a nearly normal recovery with full strength in all muscles, intact bowel, bladder and sexual function and full sensation. They are extremely lucky and unfortunately also fairly rare. Generally these people show very rapid improvement during their first week after injury and continue to improve at a rapid rate. There is even an ASIA category for this (Category E). Many people feel that they may not have had enough injury to actually kill spinal cord cells, but had something called a spinal cord "concussion" instead. Perhaps Dr. Young can expand upon this more.

    (KLD)

  3. #3
    I have known many people who have had incomplete cervical spinal cord injury with slight preservation of motor or sensory function and who recovered to the point that they behave, to all extents and purposes, normal. Many were paralyzed for many months and even years.

    My first encounter with such a patient was a man by the name of Carey Erickson. Carey was a well known choreographer in New York and had suffered a C4-5 injury in a swimming pool accident. When he came into the hospital, he had a small patch of sensation on his left leg and no movement in all four limbs. I did somatosensory evoked potential monitoring on him weekly for 72 days and saw the recovery of the responses from his legs and arms. After about 6 months, it became clear that he was a central cord syndrome where he had better preservation of function in the legs than in the arms.

    Over a period of 2 years, with a lot of hard work, he recovered to the point that most people could not tell that he had spinal cord injury. Carey told me that although he seemed normal, his coordination and stamina was only about 50% of normal. By the way, he was one of the first patients that we treated with methylprednisolone in 1981. We became friends and Carey worked for me for 7 years, during which he was our patient liaison for the NASCIS 2 study. Unfortunately, he developed AIDS and died in 1991, shortly after the NASCIS 2 paper was published.

    Another person is a young woman in Hong Kong who was thrown off a horse. She had a C4/5 injury. In the ambulance, her father said that she was able to feel her legs. However, the feeling was gone by the time she went to the hospital where she received methylprednisolone. She was unable to feel or move her arms or legs at all for several weeks after injury. Over 3 months, she gradually recovered function in her arms and legs. At 3 months, I met her. Her doctors and nurses described her recovery as nearly miraculous. She walked into the room and we walked up and down hills... It is interesting that she was not able to feel her leg position as well. In any case, she is now working at a high-powered job and I don't think that any body would be able to tell that she had spinal cord injury.

    The thrust of this story is that almost complete recovery can occur to people. In some cases, it takes a long years. In other cases, it occurs over several months. I think that their spinal cords were severely damaged in both cases. This is not just a matter of a "concussion" and some kind of spinal shock. Both of them had sustained very substantial losses of axons at the injury site but apparently had enough remaining and was able to learn how to use the remaining axons to the point that they are able to perform normally.

    I don't think that such cases are so rare. Dozens of people have approached me at meetings saying that they have recovered almost completely. Although I do not have systematic data, in 1992, I did an analysis of 400 patients who was seen at Bellevue Hospital in the 1980's. In this group, 17% of the patients walked out of the hospital. All of them (except for those who was in the placebo arm of the NASCIS group) had received methylprednisolone. Admittedly, most of them were "incomplete" but even amongst those who were "complete", I counted 14 patients who recovered to the point of having voluntary movement of their legs and arms.

    Of course, most clinicians would say that we simply did not examine the patient carefully enough, that we did not jab the pin into the perineal region to ensure that there was no sensation, etc. This may be true in some patients but I believe that substantial recovery does occur in some patients and much more frequently than most clinicians would admit or believe. The fact that such recoveries often occur late (many weeks or months after injury) strongly argues against a "concussion" or some kind of "spinal shock". Incidentally, I have not seen this kind of recovery in patients not treated with methylprednisolone but of course hesitate to suggest that it is due to methylprednisolone.

    gvinton, I think that you will continue to recover if you work hard on it. Most of the people who do recover have worked very hard on the recovery, including spending a lot of time walking and exercising in a disciplined way. I know some people who recovered one leg but did not really work on recovery and therefore remain wheelchair bound.

    Wise.

  4. #4
    Thank you for your responses, that's very encouraging. At the time of my injury I had no movement but some sensation from the neck down. My return began the next day and has been slow but consistent. I walked out of inpatient therapy with a cane a month after I was hurt. I went back to work a month later.

    I now walk normally but am not to the point where I can run normally. I can jog semi-mormally. My right side is much stronger than my left and was the first to return. I had to cath for a couple months but now have full bowel and bladder control. My left hand works but is slow - it is difficult to open and close my fist quickly and my pinky range of motion isn't great. I do full body workouts at the gym and am seeing real improvements in my strenght though it is nothing like pre-injury. I have always been an athelete and have done weight training for years.

    I am extremely fortunate to have had this kind of return. If it stopped today, I'd still feel extremely blessed. What I'm shooting for now though is getting back to what I enjoy. I'm 33 years old and still very involved in sports. I coach my son's hockey team and play as well. I play golf, snowboard, surf - you name it... Is that kind recovery still possible???

  5. #5
    gvinton, from your description, you have a central cord syndrome, similar to what Carey Erickson had.

    By the way, I want to point out that there have been at least three football players who had apparently severe injuries to the neck who have recovered substantially. For example, Dennis Byrd of the Jets walked out of the hospital and jogs although he apparently has neuropathic pain. Reggie Brown of the Detroit Lion likewise walked out of the hospital. More recently Adam Taliaferro from Penn State had cervical spinal cord injury on September 23 in Columbus Ohio. He is walking.

    Wise.

  6. #6
    Thank you again. I feel kind of dumb asking once more but it never really got answered directly. I am a fairly new injury and I've never really heard of a "complete" recovery. I know there are people who have recovered "substantially" and walk and live normal lives. I have had an amazing recovery and already live essentially normal.

    What drives me today is going for a "complete" or "100%" recovery. I strive to regain my strength, agility, stamina and speed. I dream to play the sports as I did pre-injury and with the same capability. Believe me, I know how lucky I am to have come this far but it helps keep me going in my rehab shooting for something. I'm not ungracious, I hope I don't sound it.

    The recovery I'm talking about would be these three football players playing ball again. I've never heard of that happening. Granted, with their injuries I'm sure they'd never get clearance but at least having the physical ability.

    Am I being unrealistic? Is that kind of recovery possible?

  7. #7
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    My buddy Mark who works for Schwinn bikes had an injury to his Lumbar cord...was RUN OVER by a van while biking. I do believe he was incomplete at the time....

    Anyway, he was told he'd never walk again (as they always tell us because of protocol.) He was in a wheelchair for two years. Now he is 5 years post. Anyway, he rides 27 mile an hour mile repeats with the Palm Beach Group. He did his first triathelon recently.... He still does lack dorsiflexion/plantarflexion in one leg. I loaned him my EMG unit to try and work on it.

    Anyway, I'm still wheelchair bound 95 % of the time when I'm unable to brace walk. But I was told I couldn't do that....

    I'm overwhelmed by how often the medical community can be wrong and still maintain a license to practice. I wonder if it is possible to sue for giving somebody an outcome prediction of less than what they actually accomplish??? Wouldn't the world be alot nicer place?

    Eric Texley

  8. #8
    Senior Member TD's Avatar
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    Originally posted by Eric Texley:



    Anyway, he was told he'd never walk again (as they always tell us because of protocol.)...

    I'm overwhelmed by how often the medical community can be wrong and still maintain a license to practice. I wonder if it is possible to sue for giving somebody an outcome prediction of less than what they actually accomplish??? Wouldn't the world be alot nicer place?

    Eric Texley
    My physiatrist now hesitates to use this protocol because of me. She continually told me in rehab I would never feel or use any portion of my body below my level of injury. I finally told her that if she would not encourage me to walk again then to stop discouraging me from walking again. Three months after discharge I rolled up to her and kicked her in the shins.

    I may not have been able to recover my ability to walk again but at least I gave one doctor pause to reconsider standard protocol. If it had not been for a lazy PT and an insurance company that would not listen I may have recovered even more than I did. As it is, I can stand on my left leg in the pool (water therapy is great) and can raise and lower my right leg at will. My biggest obstacle is the severe spasticity which I cannot seem to overcome.

    Any recovery is good so keep working at it, gvinton. Let's show all these doctors there is a reason they call it "practicing" medicine. They have to keep practicing until they get it right.

    "And so it begins."

  9. #9
    gvinton, there is such a thing as tempting fate too many times. I would advise a football player, and most people who have been injured in a contact sport, not engage in that sport again. We all know the consequence if the spinal cord were injured again. The person's margin for recovery will be smaller.

    TD, there is a very interesting situation in Brazil that some physical therapists (whose names I cannot divulge) told me about. There is apparently some very pessimistic doctors there. The therapists have all seen patients recover from spinal cord injury after having been told by their doctors that they would not recover. So, they gleefully usher walking quads back into the offices of these surgeons, just to see the look on the faces of both of their faces.

    Wise.

  10. #10
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    Recovery Predictions

    In the first gloomy days after my DD's injury we were given some bleak assessments from 'authorities'. I think it must be part of their training somewhere. Perhaps, as one PT pointed out, they spend all of their time with 'worst-case scenario' people, and those with good outcomes just seem to fade to the back of their memories.

    In our case, we were told that since she was an incomplete injury, she would walk...with equipment, but would likely use a wheelchair long-term because she wouldn't have the speed or stamina to make walking feasible outside our home. They were wrong. She isn't 100% recovered, like the original poster is looking for. (She'll never be a jock- hard to do when you can't run, and have sensory issues that make it hard to know just where your feet are) But we will definately take her current recovery over anything they told us in the first weeks.

    Cheer!

    M.Elston SCI Mom to 15YO incomplete L2-3

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