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Thread: treatment for child with new SCI?

  1. #1

    treatment for child with new SCI?

    How is a child with a new SCI treated? For example...
    <UL TYPE=SQUARE>
    <LI>Would a ten-year-old boy be given methylprednisolone?
    <LI>Would he be treated at a regular hospital or a children's hospital?
    <LI>Where would he receive rehab?
    <LI>Should he receive psychological counseling?
    <LI>Are there any special considerations because his body is still growing?
    <LI>Are there any other differences?[/list]

    Thank you.

  2. #2
    I will attempt to answer your questions. First, if it is about a specific child Private Message me and I will give you pediatric resources.
    My understanding is that MP is given based on body weight. I know of several children with SCI and all received MP with the dosing adjusted by weight.
    There are very few pediatric rehab centers that have CARF accredidation. As a parent, I would look for a center that meets the needs of my child best. If it is accredited, all the better. I would want a Child life specialist on board to assist with the counseling and patient education. They insure that materials are presented in a developmentally appropriate manner. Next, I would look for a facility that has a school based program as well as a school reitergration program. Hospital to school teamwork is imperative in helping a child successfully return to their community.
    I would also want a pediatric physiatrist in charge of my childs care. Most "Children's Hospitals" have such a physician in the rehabilitation department.
    For kids, the bone, muscle, organ and brain maturity play an important role in rehabilitation. Preventive care is even more important when the child returns home. Contractures, bone brittleness, pressure sores all happen faster with kids. Make sure the treatment team is "UP" on the latest.
    Lastly, clinical trials do not include children generally because of "informed consent" This is frustrating to parents and often hard to understand. I believe the safe guards are there for a reason. I enrolled my son in a compassion drug clinical years ago only to find out it cause heart abnormalities. The drug has since been removed for both adults and kids and is used in VERY limited and specific situations. (9 1/2 years ago it was a God send for us but today we are left with the down side.)
    Finially, one thing I tell other parents is, "You can be disrupted now but traveling far to a good rehab center or you can be disrupted later by having a child who can not self care, has numerous secondary conditions, etc." Only a parent knows what their child really needs..look long hard and deep as you make the difficult decision of choosing a rehab center.

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

  3. #3
    Depending on your area, most children who have traumatic SCI will be initially treated at a trauma center (preferrably a pediatric trauma center) and then should be transferred to a pediatric rehabilitation program that has extensive experience with SCI. If that is not available locally, then I would also strongly endorse going out of town or even out of state for specialty care.

    There are a number of specialty pediatric rehabilitation programs around the country, some based in pediatric hospitals while others are separate units in large rehabilitation centers. I would also endorse looking specifically for a program that is CARF accredited in pediatric rehabilitation. You can search for such a program at www.carf.org

    Granted, there are more SCI rehab programs for adults, but adults have many more SCIs as well. Shriner's Hospitals offer 3-4 specialty SCI centers around the country which have especially good programs, and information can be obtained about eligibility from your local Shriner's organization.

    (KLD)

  4. #4
    Senior Member giambjj's Avatar
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    The age of the child will restrict where they can go. For instance Shepherds Clinic in Atlanta does not take anyone under 16 and the Miami Cure no one under 18. The Schriners Hospital in Philly will take anyone under 18 and they are free. They specialize in treating SCI.

  5. #5
    Senior Member LauraD's Avatar
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    My daughter who will be 11 in May was injured a month after her 8th birthday. She was treated in a children's hospital that is connected with a regular hospital. U.W Children's hospital in Madison, Wisconsin. She did outpatient rehab at a local clinic. Last year she did go to Shriner's in Chicago. They also specialize in SCI. She learned more in 2 weeks there than she did in her year of local rehab. She received counseling when she was in the hospital following the accident but none since. I think it depends on the child. Heather has dealt with this very well.

    If I can help you any more please feel free to email me.

    LauraD

  6. #6
    Thanks cheesecake and LauraD.

    Although methylprednisolone's effect on pediatric spinal cord injury has not been formally tested in clinical trial, I believe that many emergency rooms have been giving the standard high-dose methylprednisolone to children. There have been relatively few published reports of the use of the drug to treat children but here are some. Pollina & Li (1999) described a case of a 3-year old boy that received the standard 24-hour course of the drug. Faillace (2002) from the University of Florida at Jacksonville reviewed the approach towards neurotrauma and indicates that adult protocols, including methylprednisolone, should be used in children as young as 1 year old. High dose methylprednisolone has been used to treat children for optic nerve trauma (Alford, et al. 2001). Graber & Kathol (2001) from the University of Iowa recommends that methylprednisolone be given immediately to children with suspected spinal cord injury even when the radiological examination does not show a fracture site.

    Wise.

    Literature cited

    • Pollina J and Li V (1999). Tandem spinal cord injuries without radiographic abnormalities in a young child. Pediatr Neurosurg 30:263-6. Summary: Anatomic features unique to the pediatric spine render this population susceptible to spinal cord injuries without radiographic abnormalities (SCIWORA). To date, published descriptions of SCIWORA have been limited to a single region of the spinal column. We describe a case of a 3-year-old boy in whom, after a motor vehicle accident, tandem SCIWORA lesions involving the lower cervical spinal cord and thoracolumbar junction resulted in severe quadraparesis. The child was initially treated with 24 h of methylprednisolone followed by 3 months of external orthoses of both the cervical and thoracic spine. We include in this article a brief review of the literature and treatment guidelines for SCIWORA and postulate the mechanism of these tandem spinal cord injuries. Department of Neurosurgery, Children's Hospital of Buffalo, University of Buffalo School of Medicine, Buffalo, NY 14222, USA.

    • Faillace WJ (2002). Management of childhood neurotrauma. Surg Clin North Am 82:349-63, vii. Summary: A summary of some of the more important aspects of brain, spinal, peripheral nerve and sport injuries of childhood is presented. Guidelines for the treatment of severe brain injury have been developed for adults, are currently employed with success to treat children, but much information still needs to be acquired about childhood brain injury so that better age specific treatment modalities could be implemented. The unique anatomy of the spine during childhood predisposes to cervical spinal injury without radiographic abnormality; immobilization is the primary treatment and a minority of cases require surgery. Peripheral nerve injuries are uncommon, often missed, and require skillful evaluation and early treatment by physical therapy and oftentimes surgery. Appreciation of the sequelae of cerebral concussion, education on proper sport techniques, body conditioning, and equipment upkeep are the mainstay of vigilant sport injury treatment and prevention. University of Florida/Jacksonville, Department of Neurosurgery, 32209, USA. Walter.Faillace@jax.ufl.edu

    • Alford MA, Nerad JA and Carter KD (2001). Predictive value of the initial quantified relative afferent pupillary defect in 19 consecutive patients with traumatic optic neuropathy. Ophthal Plast Reconstr Surg 17:323-7. Summary: PURPOSE: To study the predictive value of the initial quantified relative afferent pupillary defect (RAPD) in patients with indirect traumatic neuropathy as it relates to final visual outcome. METHODS: The RAPD was measured and quantified by neutral density filters in patients with unilateral indirect traumatic neuropathy. All patients were treated with megadose methylprednisolone by of the protocol established by the Second National Acute Spinal Cord Injury Study. Patients were followed twice daily during treatment and then at 3-month intervals. RESULTS: Nineteen patients were enrolled over a 23-month period. Patients ranged in age from 12 to 78 years old; 18 of the 19 patients were male. No patient with an RAPD of 2.1 log units or greater had visual recovery to better than hand motion vision. The 7 patients with an initial RAPD of less than 2.1 log units showed improvement in their RAPD and were found to have vision of 20/30 or better during the follow-up period. CONCLUSIONS: In patients treated with megadose methylprednisolone with an initial RAPD of less than 2.1 log units, visual acuity improved to 20/30 or better; however, patients with an initial RAPD of 2.1 or greater showed little visual improvement. The initial quantified RAPD appears to have a predictive value related to final visual outcome. Ophthalmology Associates, Fort Worth, Texas, USA.

    [This message was edited by Wise Young on 04-25-03 at 05:59 AM.]

  7. #7
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    MY SON DID REHAB AT THE REHABILITION INSTITUE OF CHICAGO. IT WAS 400 MILES AWAY BUT WELL WORTH IT.THEY MET EVERY ONE OF HIS NEEDS AND THEN SOME.HE WENT BACK FOR A SECOND VISIT 2 YRS LATER. I HIGHLY RECOMEND IT. THEY WERE A GODSEND!!!!

  8. #8
    rtr, I was just reading your questions and realized that I only addressed the first one relating to methylprednisolone. Let me try to answer the other questons.

    1. Would children be treated in a pediatric or adult hospital? Most hospitals have both pediatric and adult facilities. There are of course hospitals that are only for children.

    2. Where should he receive rehab? Most adult rehabilitation facilities will not take people under 17 because they do not have the specialized personnel and facilities for children. There are relatively few pediatric spinal cord injury facilities. One of the best that I know of are the Shriner Hospitals, particularly the one in Philadelphia. There is great interest in setting up a pediatric spinal cord injury unit in the Boston Shriner's hospital as well, because many families there had to go with their children out of town for rehabilitation. The advantages of having such a hospital close to home are obvious.

    3. Should he receive psychological counseling? The answer is yes, particularly if there is a good person at the facility. Children may not understand or understand better than we think but their concerns and fears are sometimes differently expressed than in adults.

    4. Are there any special considerations because his body is growing? Yes. Spinal cord injury may cause scoliosis (curvature of the spine) in children who are still growing. So, this is something that needs to be assessed regularly throughout the growth period. I have known a number of people who were injured during their growing years and find that their legs and arms continue to grow at the expected pace. In very young children who have not yet developed all their motor skills, spinal cord injury may prevent the development of some reflexes and functions. I worry about that.

    5. Are there other differences? Yes, I think so but I would really welcome the comments of our SCI-Nurses.
    • Treatment of spasticity and pain should be carefully planned and considered. A number of these therapies have central nervous system side-effects that may affect a child's learning or performance in school. I think that medication should be carefully titrated to minimize these effects.
    • Treatment of bladder problems may also differ. At the present, sterile intermittent catheterization is the standard. However, a young child may not be able to carry out the catheterization properly and may become dependent on an adult to do this every 4-6 hours. To encourage independence, one may want to consider a mitrafanoff or other suprapubic procedure that may allow greater independence.
    • Appearances. Several studies have shown that appearances are very important to kids. They often will choose not to use devices or other things that indicate their disability. This needs to be carefully considered.

    There are other differences but this should be enough to continue the discussion.

    Wise.

  9. #9
    Thank you for the responses. I'm writing a fictional story in which a child has a SCI. Because I have a C5/6 SCI, I felt comfortable having a character with SCI. However, when I started writing, I realized that there are major differences in how I handled SCI as an adult versus how SCI is handled by a child and the treatment and rehab provided for a child. I appreciate all of your help and insight.

    Thank you.

  10. #10
    Banned Acid's Avatar
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    Hmm ...

    I guess generally directly after such, as soon as the stomach is sort of ready for food again, aminoacids.
    (Amounts over the next days or a longer time being self-regulated by the person.)

    But apart from that, maybe not much messing around there and first letting primary damages healing settle naturally.

    Not sure how long, maybe between a bunch of weeks and 4 months or so.

    (And I don't think the rates of much smaller mammal persons of differing kinds, for how long it is better to not mess around with some stuff there, and first let primary healings take place, is necessarily an indicator for timings of members of our ape mammal kind there.)


    With a psychologist I don't wish to rate this straight.
    Some might just get a person to sort of dig up problems, then not offer advice, as this might be regarded against their branch's politics, and expect the person to find internal solutions.
    However if the person does not find internal solutions, the person is left with the dug up problems, and maybe higher emotional strains than before.

    With various mental problems it might be far more effective, if someone is wishing to talk about these with someone, to find a person who had similar problems, and managed to inside handle these well enough.
    As this way it is not just some stranger to the problems issues, who learned a bit from some book(s) or other ways from the outside, but someone internally well familiar with such problems directly.


    With differences, at least for me there are some.

    Within magic so far I am more against magical interlinks between an adult and someone who did not reach adult hormonal (& other) settings yet.

    With a child I might also wonder, if recovery chances might not be much better than with for example an old person.


    With general treatments I assume individual aspects are quite relevant.
    That it is more relevant to regard individual aspects, than to generalize too far around there.
    And within an individual there might be quite some sides differences.

    (For example when I played around here with C.R. pics, a bunch I tuned aimed for the right "stronger" side there, for the left "weaker" I found wrong.
    So already within one person there being differences, that what for one side I still regarded O.K. as a potential treatment, for the other I did not.)


    With drugs I think the person should be asked.

    There are drugs that are bad for the kidneys. Some are bad for the liver.
    Various effect the heart.
    I also heard of a drug able to reduce growth of a child, the number of white and red blood cells, hightening cancer and epilepsy risk, etc.

    Quite a number of drugs also influence emotions, and are on a level a chemical rape of natural emotions.


    Many drugs also cause like a too much or too little of transmitters in a synapse.
    With that receptor molecules on the other side can alter numbers in the other direction to correct the error.

    So after that the receptor molecule levels are no longer correct.
    (Which with a number of drugs can also cause addiction.)


    A ten year old, for example, might be bright enough to understand about various, if explained well, too, and to take decisions.
    The person is not the possession of others.
    And should be involved in decisions.

    As a drug might do harm to the kidneys, receptor molecule levels, or/and various other systems, the person thought about to give the drug should be asked. And honestly informed about the harms this drug can do. Which might be found also under "side" effects, that might be potential main effects.

    (Also with a drug, if for example it writes there, that problems with this or that organ might be possible, this does not mean, that if the damages don't go high enough with someone to be noticed, that there are no damages whatsoever with this drug done there.)

    With a person at the end of childhood additionally might come in, that the presettings for leaving childhood and heading for adult settings might be running.

    Females for example might get the period between the age of 10 to 15, a lot between 12-14. Childhood might be left around 2-3 years before, and the breasts starting to develop, etc.
    To mess around with drugs in this major change of systems from childhood to adult settings, while the preparations for the adult hormonal levels are starting, and lots of systems changes being running, seems not generally the wisest idea under the sky.


    So my question might be more is this drug avoidable.
    Does it really cure primary problems?


    (Another question might be the length. For example with a pain killer, if it is taken just once or sporadically when it hurts too bad, or every day.
    Taking a drug once seems less likely to cause receptor molecule numbers warps, than day after day.

    After it started to effect receptor molecule levels, even taking more of the drug might have less of the effects that one is after.

    However to organ and cells balances health, the bad effects, with higher dosages or longer time messing around with chemistry not belonging so into natural systems, might increase.

    By the time of noticing the problems, it might be already so late, that serious damages were already done. As with the kidneys.)

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