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Thread: spinal cord infarct via a stroke

  1. #1

    spinal cord infarct via a stroke

    My father had a stroke in his spine (infarct) last year in the area of c4 or c5 (i think) in in his upper neck. There was no accident he just woke up and began to lose sensation in his arm. He was in the hospital for a week and when he came home he had another stroke and again in the hospital. His last stroke basically paralyzed him from the neck down. He has come back to the point where is he now in a wheelchair and can move his legs and his left arm. His right arm is not as good. Like I said he can move his legs and is learning to transfer from his electric wheelchair to be and vice versa. I don't understand why if he can move, feel when you touch him and we can see his muscles working why he can't stand up. The physical therapist is working with him to try and get him to stand up for longer than 30 seconds. I was wondering if any research has been done regarding acupuncture or hyper barci oxygen therapy?

  2. #2
    Fallon, I am sorry to hear about your father. An infarct of the cervical spinal cord is relatively rare. Chuck Close (the famous artist) may have had this.

    Standing and walking requires quite a lot of muscle power, balance, and control. First, he may have lost substantial muscle power and this may contribute to his inability to stand. Second, some of the spinal tracts are devoted to balance. For example, if you stand with your eyes closed, these spinal tracts are what keep you from tipping over. Third, loss of the blood flow to the spinal cord may cause demyelination which reduces the signals that can get across the injury site. I suspect that with sufficient therapy he may be able to stand and walk in a walker. But, he has to be careful about walking because he is at risk of falling and injuring himself.

    Regarding acupuncture and hyperbaric oxygen, there is no evidence that acupuncture will restore function in spinal cord injury. Even in China where they use acupuncture a lot for everything, this is not a goal of acupuncture therapy. Hyperbaric oxygenation (HBO) may have helped during the first hour or so while he was having the stroke but there is no evidence that HBO will restore function in chronic spinal cord injury. People still use it, however. I think that Carl Kao (a surgeon) use HBO after surgery to hasten healing and there is some evidence that this might be the case.

    Wise.

  3. #3
    DR YOUNG THANK YOU FOR YOUR RESPONSE. I THINK THE ROUTE WE SHOULD GO IS INTENSE PHYSICAL THERAPY TO TRY AND HELP MY FATHER STAND. ONE THING I FORGOT TO MENTION IS THAT MY FATHER DOES NOT HAVE ANY BOWEL CONTROL AND HAS A CATHATER (??). I THINK THIS ISSUE IS MORE IMPORTANT TO MY FATHER. DO YOU HAVE ANY THOUGHTS ON THIS ISSUE. ALSO DO YOU KNOW OF ANY DOCTORS AND/OR A PHYSICAL THERAPISTS WHO MAY HAVE WORKED WITH OTHER PATIENTS WITH THE SPINAL CORD INFARCT THAT ARE IN THE BOSTON AREA? THANK YOU

  4. #4

    Rehabilitation

    Fallon, was your father sent home from the hospital without going to a SCI rehabilitation program first? He should have been referred to such a program. Often this does not happen with older patients as they tend to be "written off" or not considered appropriate for acute rehabilitation. It is important that he work with a team than can address all these issues (mobility, strength, bowel, bladder, etc.) and is experienced and knowledgable.

    While often older patients are sent to "sub acute" (nursing home) rehabilitation program, they do not have expertise in this area. I would try to focus on a rehabiltation center that is CARF accredited for SCI rehabilitation. There is one in the Boston area:

    New England Rehabilitation Hospital
    Two Rehabilitation Way, Woburn, MA 01801
    tel. 617-935-5050

    Try to get an inpatient stay, but outpatient would be better than nothing.

    If your father is a military veteran, he may find it easier to get accepted into the SCI rehabilitation program at the Boston VA Medical Center (also CARF accredited):

    Brockton/West Roxbury VA Medical Center (128)
    1400 V.F.W Parkway
    West Roxbury, MA 02132
    tel. 617-323-7700 ext. 5128 or 6574

    (KLD)

  5. #5
    Super Moderator Sue Pendleton's Avatar
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    Hi Fallon,

    I also had a spinal stroke at about your Dad's level. It sounds like his was mild compared to mine. Mine was in the C3-4 area but I function as a C5-7 incomplete and can bear weight but not walk....yet. It's great that he has come so far so quickly. Even in older people I think physical therapy can help a lot. Is there a rehab place that has a therapy pool near you? They are wonderful for people who have the innervation but not the strength yet to stand and walk on land. Speak to a therapist about his incontinence problem and they should be able to work something out so he can do pool therapy. And I agree with the spinal nurse, inpatient is best!

    Was your Dad given heparin injections or given a blood thinner drug to avoid further strokes if his was caused by clotting or narrowing of the artery? If not he should really talk to his neurologist about the cause of his stroke and if his MRI shows anything that indicates the cause of both. I am curious about this as well because my stroke still comes under the "no known cause" heading.

  6. #6
    SUE - AS FAR AS I CAN TELL THE DOCTORS HAVE STILL NOT DETERMINED THE CAUSE OF HIS STROKE. I DO THINK THAT HE WAS TAKING MEDICATION TO THIN HIS BLOOD BUT I DON'T THINK HE IS TAKING AMYTHING FOR THAT RIGHT NOW.

    MY FATHER DID GO TO THE SCI UNIT AT THE VA IN WEST ROXBURY AND DID HAVE PHYSICAL THERAPY THERE. UNFORTUNATELY THEY FELT HE REACHED HIS PEAK (SIMILAR TO INSURANCE) FOR ACUTE PHYSICAL THERAPY SO WE HAD TO MAKE ARRANGEMENTS FOR HIM TO GO TO A SKILLED NURSING FACILITY (IE NURSING HOME). WE ALSO MADE ARRANGMENTS FOR HIM TO BE ON MEDICAID DUE TO THE LONG TERM NATURE OF HIS INJURY. BETWEEN BEING ON MEDICAID AND IN A NURSING HOME I FEEL HE ISN'T RECEIVING A GOOD AMOUNT OF PHYSICAL THERAPY EACH DAY. PERHAPS WE NEED TO GO THE ROUTE OF HAVING PRIVATE PAY PHYSICAL THERAPY. I REALLY WOULD LIKE FOR THEM TO CONCENTRATE ON HIM STANDING UP AND STRENGTHENIG HIS LEGS. UNFORTUANATELY HE CAN REALLY ONLY USE ONE ARM TO HELP HIM STAND UP. IF HE WAS ABLE TO TRANSFER HIMSELF THEN WE COULD MOVE HIM TO AN ASSISTED LIVING FACILITY AND PAY SOMEONE TO ATTEND TO THE INCONTINENCE ISSUES. ANY THOUGHTS??????

  7. #7

    VA care

    Even if your father is in a nursing home, he is still eligible for follow up care through the VA SCI Clinic. Ask for a re-evaluation appointment there, and then ask the physician for a therapy re-evaluation. If you are unable to get this, talk to your father's PVA National Service Officer. There job is to be sure that he is getting the services he is entitled to.

    (KLD)

  8. #8
    Fallon,

    It is difficult to predict the recovery that your father may get because he had a stroke of the spinal cord. However, your description of his condition suggests that he has what is sometimes called a central cord syndrome where the legs are less affected than the arms. Most people that I know with central cord syndrome eventually recover their sphincter control and bladder function, although it may take a long time.

    Are you saying that he has a foley catheter (i.e. a catheter that is inserted through the penis) that is left there? How often is it changed? Are there any plans to remove it? I would strongly suggest that he get into a situation where he can get the care and support to switch to intermittent catheterization for two reasons. First, I have known several older people with spinal cord injury who had the foley catheter placed and they didn't know that they could urinate when the catheter was removed and they were placed on intermittent catheterization. Second, urinary tract infections are more common with an indwelling foley catheter. Did anybody discuss the options with your father and family?

    As KLD suggests, something is not right. He has had spinal cord injury and he should have been evaluated and rehabilitated in a center that has experience with spinal cord injury. I agree with her that your father needs to be an inpatient to sort out the various problems.

    Wise.

  9. #9
    THANK YOU BOTH FOR YOUR RESPONSE REGARDING MY FATHER. WHEN MY FATHER WAS RELEASED FROM THE VA THEY INDICATED THAT IF HE BEGAN TO MAKE IMPROVEMENT THAT HE MAY BE ABLE TO COME BACK TO THE VA FOR MORE REHAB. RECENTLY I ASKED THEM WHAT CONSTITUTES IMPROVEMENT AND THEY INDICATED HE WILL HAVE TO BE ABLE TO HANDLE 3 HRS OF THERAPY EACH DAY (???). I DO MAKE SURE THAT MY FATHER STAYS WITHIN THE VA SYSTEM BUT IT IS VERY HARD ONCE THEY HAVE MADE THEIR DECISION. PERHAPS I WILL DISCUSS IT AGAIN WITH MY FATHER AND PERSUIT IT MORE WITH HIS DOCTOR FROM THE VA. I WILL DISCUSS THE INTERMITTENT CATHETER WITH MY FATHER. I KNOW BEFORE HE LEFT THE VA THEY DISCUSSED USING A DIFFERENT METHOD THAT INVOLVED A CONDOM BUT MY FATHER SAID NO. HE HAS BEEN PRETTY LUCKY WITH URINARY INFECTIONS IN THAT HE HAS ONLY HAD A COUPLE.

    I BELIEVE MY FATHER DOES HAVE A FOLEY CATHETER WHERE HE USES A SMALL BAG DURING THE DAY SO HE IS MORE MOBILE IN HIS WHEELCHAIR AND AT NIGHT HAS A BIGGER BAG. I GUESS THAT MAKES SENSE THAT IF HE HAS THIS IN ALL THE TIME HOW DOES HE KNOW IF HE IS GOING ON HIS OWN OR NOT. AS FAR AS THE BOWEL MOVEMENT THEY USE A SUPPSITORY IN THE MORNING AND HE PRETTY MUCH GOES AT THAT TIME. I HONESTLY DON'T KNOW ALL THE SPECIFICS BUT THE VA HAS BEEN VERY HELPFUL IN TEACHING THE NURSES/AIDES IN DOING THIS CORRECTLY. TO MY KNOWLEDGE HE DOESN'T HAVE THAT MANY ACCIDENTS ALTHOUGH HE HAS HAD THEM. I APPRECIATE YOUR HELP AND WILL TRY TO BE MORE AGGRESSIVE WITH THE VA. IT IS GOOD TO HEAR THAT POSSIBLY SOMETHING COULD BE DONE ABOUT BLADDER CONTROL. WHAT WOULD HAPPEN IF HE DID GET HIS BLADDER CONTROL BUT CAN'T STAND UP OR GET OUT OF HIS WHEELCHAIR? ARE THERE DIFFERENT DEVICES THAT HE MAY HAVE TO USE? THANKS AGAIN

  10. #10

    VA SCI Care

    According to VA regulations, veterans with SCI are to have access to ongoing lifetime outpatient primary care (regular SCI doctor clinic visits for managing all health care needs), sustaining care therapy as indicated, up to 4 weeks of inpatient respite care, durable medical equipment coverage, supplies, meds, etc. Depending on income there is a co-pay, but generally not if the veteran is Medicaid eligible.

    Your father should be followed regularly in the the SCI outpatient clinic and seen by an SCI physician. These visits should include re-evaluation as indicated of his bladder and bowel management as well as any new indication for needed therapy. While there are usually fairly strict criteria (such as this hospital's own 3 hour rule) for being admitted to the formal CARF SCI inpatient rehab program, generally this does not apply to outpatient therapy where there is potential for functional gain, esp. if there is a reasonable goal to return your father to a non-nursing home environment for his living situation.

    Again, if you have not discussed these concerns and access to the system with your father's PVA NSO I would urge you to do so. The NSO has a lot of power to push the VA to provide the services to your father to which he is entitled. Use the NSO...there is no cost to you or your father for their services.

    (KLD)

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