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Thread: Complete, Incomplete?

  1. #11
    Quote Originally Posted by DustinRogers
    Dr. Young,

    Thank you for the information, and you are right, it is about as cut and dry as tax law, but not too convoluted as not to help. I see that since I have no sensory/motor in the anal region, the sensory areas I have in my leg and foot do not contraindicate what ASIA classification I've been assigned. Also, you've let me know that I'm in that 100% of which 90% will never recover substantial motor function below my injury site, without restorative therapies. I ask this though, how long should I wait before seeking out such therapies, as I assuredly can and will not receive them here. I get the feeling that my progress is good, but not progressing to the end which we all with SCI seek, to walk again.
    Dustin
    Dustin,

    I just re-read my post and made a correction. The ASIA Classification system is meant to provide an objective and non-ambiguous classification of spinal cord injury but not necesarily a precise prediction of recovery. Several studies have suggested that The classification does predict recovery 90% of the time at the present but I want to emphasize that this will change with time. As better treatments become available, more and more patients will become exceptions of whatever rules that are established. In some ways, this is good because an increased number of people breaking rules is a good measure of the progress in the field.

    At about the same time when I co-chaired the ASIA Classication Committee (1989-1991), we had published the paper in the New England Journal of Medicine that high-dose methylprednisolone given within 8 hours after injury significantly improved the motor and sensory recovery compared to placebo-treated patients. It is entirely possible that since methylprednisolone is now being used to treat most patients with spinal cord injury, it increased the probability of patients who were classified as ASIA A shortly after injury to recover to ASIA B, C, or even D.

    A major study will soon be published by UCLA and other NIH-funded centers will be reporting that 80-90% of patients who were admitted to hospital with ASIA C injuries recovered walking. I am anxiously awaiting the publication of the paper to see the definition of "locomotion" they will use. If they mean independent locomotion, i.e. walking without aids or long-distance walking, it may be a lower percentage than 80-90%. However, if they refer to locomotion with prosthetic aids such as ankle-knee-orthoses, crutches, or walking sticks, I think that it is likely that 90% of patients with ASIA C will recover such walking.

    The study compared two groups of patients who had been randomized to either "standard" rehabilitiaton or weight-supported treadmill ambulation training. Analyses of data from the Model Systems database of over 30,000 people with spinal cord injury, collected since the 1970's, suggested that only 45% of patients with ASIA C will recover walking. They had hypothesized that patients that receive treadmill training would improve the rate of walking recovery. To everybody's surprise, 80-90% of both groups recovered walking. What this is due to is unclear but here are several possibilities:
    • Patient in both treatment groups were encouraged to walk. This alone may have resulted in better recovery. Until recently, most patients with ASIA C were told that they are unlikely to recover. Therefore, fewer people tried and recovered.
    • Over 90% of people in the study received methylprednisolone whereas a majority of the patients in the Model Systems Database did not receive methylprednisolone. The NASCIS II results indicate that methylprednisolone improves recovery in patients with both complete and incomplete spinal cord injury.
    • Both groups of patients were mobilized early after injury and strongly encouraged to stand and to take steps. This may have accounted for the improvement in both groups.

    For a long time, the central assumption of rehabilitation was that people do not recover from their spinal cord injury. Rather, they make better use of what is left. Now, more and more, the goal of rehabilitation is to improve recovery, not just to make better use of what is left. The effort to improve and maximize recovery should begin as soon as possible after injury, not just when you are feeling well and back home. I believe that rehabilitation should start as soon as possible. We should be finding therapies that facilitate recovery.

    It is also important to note that physical therapy and standard rehabilitation is necessary but not necessarily sufficient. For many people, exercise will bring them only to a certain level of function. Beyond that, other therapies such as regeneration, remyelination, or neuronal replacement will be needed. That is of course why we need clinical trials to test therapies that have been showed to improve recovery in animals after spinal cord injury. After such therapies, it is likely that additional rehabilitation will be necessary. The goal of "restorative" therapies is to make "complete" into
    "incomplete", and "incomplete" into more "incomplete".

    Wise.
    Last edited by Wise Young; 01-27-2006 at 03:41 AM.

  2. #12
    Dr. Young,

    Thank you again for the information, it is a great help. I have spoken with my family(my step-father is a General Practitioner), and they are open to seek out those "restorative therapies" unavailable in the United States. My step-father's question is that, "Is there a time period I should wait before stem cell therapy?" He made a comparison to the time allotted before a bone graft and had some concern. Also, I have seen some references to a few clinics abroad which specialize in said therapies and was wondering other than my own preference what specific category of therapy I should be seeking, and if you had any suggestions of possible places I could go.

    Dustin
    "For only the truth which edifies is truth for you."


    -Søren Kierkegaard

    http://www.myspace.com/zosoninjitsu

  3. #13
    Dustin, I would suggest you post on and read the multiple messages about this on the Cure forum here.

    (KLD)

  4. #14
    Thanks, and sorry if I was posting in the wrong forum. Feel free to move this to the cure forum.
    Dustin
    "For only the truth which edifies is truth for you."


    -Søren Kierkegaard

    http://www.myspace.com/zosoninjitsu

  5. #15
    Quote Originally Posted by DustinRogers
    Dr. Young,

    Thank you again for the information, it is a great help. I have spoken with my family(my step-father is a General Practitioner), and they are open to seek out those "restorative therapies" unavailable in the United States. My step-father's question is that, "Is there a time period I should wait before stem cell therapy?" He made a comparison to the time allotted before a bone graft and had some concern. Also, I have seen some references to a few clinics abroad which specialize in said therapies and was wondering other than my own preference what specific category of therapy I should be seeking, and if you had any suggestions of possible places I could go.

    Dustin
    Hey Dustin,
    If you're feeling something going on below, start working out your lower body/legs immedietely. If you can afford it, check out Project Walk, NextSteps, Sci-Step, whatever. Every single person that I talk to that is trying to recover, including myself, says the same thing: I wish I had done this sooner. Don't wait, it only gets harder once the body gets used to sitting.

    Darren
    -------7-23-04----------
    C5/6- Workin' on Recovery
    www.darrentempleton.com
    www.pushtowalknj.org

  6. #16
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    Last edited by hydr0skunk; 02-08-2006 at 04:49 PM.

  7. #17
    Hi DustinRogers, You sound a little like me, same age and simular accident wise too. Have a read of my story ..... never know, might be able to help each other now and again ?? I moved on a little since but nothing major.

    Best of luck to you and the missus !

    http://www.spinal.co.uk/community/de...d=351&catid=92
    C-5 incomplete , walking with crutches. In controlled pain. Respect to all SCI people.

  8. #18
    Now I know I've got to be ASIA B. I can feel pressure and temperature at the S-4/S-5 dermatome, and have voluntary motor control of my anal sphincter. I am to see my physiatrist Tuesday and will hopefully have my own diagnosis reiterated when I, forgive the expression, put my ass to work, for him. Also, I went to the Urologist today and the obligatory handshake was as far as he got. He reviewed my prior urinalyses, and my renal ultrasound, and told me to change my cathing schedule a bit, put me on Ditropan, and scheduled urinodynamics in about a month. Basically he said my bladder is just doing its job, and as my SCI heals a lot of things could change so he wasn't at all worried and said that bladder spasms are falsely blamed for almost every ailment he sees. Anyway, I just thought I'd put it on here, I know everyone wanted to hear it. And Schmecky says Vgraven is the king of the run-on sentence.
    "For only the truth which edifies is truth for you."


    -Søren Kierkegaard

    http://www.myspace.com/zosoninjitsu

  9. #19
    YAY!! That's a great update, Dustin.
    Daniel

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