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Thread: New SCI. What to expect in Rehab?

  1. #1

    Question New SCI. What to expect in Rehab?

    Dear all,

    My brother just has SCI injury (T12/L1). 2 weeks after surgery, his doctor say he is ASIA-B, I am not sure it is complete or incomplete. He is now in Rehab center in Singapore. I looked around and only see manual equipment, nothing electronic. Can any body tell me what to expect in a standard SCI rehab center ? Would appreciate to get information a good SCI rehab center in Singapore or somewhere in Asia.

    It is now exactly 1 month post-injury. He has sensation on his legs. No sensation on his butt. Can move toes (left leg only). If sit up too long, his leg will turn red and then purple blue. What is going on ? His leg is now flaccid. I would like to know what is his chances to walk again.

    We are really confuse how to help him, what kind of treatment we should give to him. Traditional rehab or more aggresive treatment.

    Any comment would be helpful.

    Nett/Hendra

  2. #2
    I'm sorry to hear about your brother. SCI affects everybody differently. I believe ASIA B means he is incomplete, but only time will tell "how" incomplete he is. I believe it is a good sign that he can move the toes on his left leg.
    Daniel

  3. #3
    Senior Member queen's Avatar
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    hendra,,,,Welcome to CC...

    I'm so sorry to hear about your brother, I know it must be heart breaking for you and your family.

    Dan's right, we're all like snowflakes here even if we have the same injury level. It just depends on what nerves were damaged really. Just stay
    positive for your bro. My rehab here in the states didn't have equipment
    per se....just beds, parellel bars and hand weights. But we have others that are "state of the art" with everything imagineable.

    I'm just a burst L#1 with a birdcage where it used to be. I have no B/B
    yet and my legs are numb (on any given day) from the knees down but
    I can now walk with a cane. I lost a lot of weight and was weak as a
    kitten to begin with but it slowly comes back. I'm 60, so your bro will
    likely get his recovery much faster than I did. Stay strong, think positive
    and make him do as much exercise as he can every day.

    You've found a great "site" for any upcoming questions you might have
    about anything he has yet to overcome.

    Take care,
    Queen
    Your life is what you make it, and only you have that choice!

  4. #4
    I am not sure what type of electronic equipment you are looking for (it is rare to have FES available in an acute rehabilitation center), but most equipment in a good therapy gym will be there to facilitate exercise and strengthening (weight machines, therapy mats, hand cycles, etc.). There should be some equipment to facilitate suspended gait ambulation, but this can be a LiteGait or overhead track system.

    The SCI center in Singapore is the best in the region. Other options would be to move him to a center in Austrailia or the USA. A post-acute rehab program might be an option for him after he has learned the basics in this program, but I am not familiar with any programs like this in ASIA. He might have to come to the USA for that, and these programs are quite expensive (most are not covered by insurance).

    ASIA B means that he has some sensory sparing which must include the area around the anus, but not any significant motor sparing. You can read more about his in Dr. Young's article here:

    http://sci.rutgers.edu/index.php?pag...nalLevels.html

    He should be spending at least 3 hours daily in PT and OT, with additional time in recreation therapy, teaching from nursing staff and other team members, and counseling. This is his time to learn as much as he can about how to keep himself healthy and to get himself active in the community as well as learn how to do the functional activities he needs to do daily such as transfers, dressing, bathing, etc. and use of a wheelchair. You can help him the most by encouraging him in his program, and also learning as much as you can, both in the program and on-line at forums such as this.

    As others have said, it is too soon to tell how much return he will get. At this point there is nothing that can be done to increase that return, but he can maximize whatever return he does get with intensive therapy. At his level, walking with braces would be possible down the road even without return, but it is not generally functional for community use due to very high energy expenditure, and the time required. This has to wait until his back is completely healed.

    The change in color in his legs is normal. It looks scary, but as long as the color returns when he elevates his legs, it is not of concern. It is due to the autonomic changes caused by the SCI.

    (KLD)
    Last edited by SCI-Nurse; 08-14-2006 at 09:23 AM.

  5. #5
    I am not one to give false hope, but it sounds like your bro will get lots of function back. I´d bet with therapy as the nurse recommends, he will walk with or without assistive devices.
    Disclaimer: I don´t have a crystal ball.

  6. #6

    How to maximize return

    Dear all,

    Thank you for your reply and encouragement.

    Seems like some of Hendra front thigh muscle coming back, but still very very weak. Therapist put him to stand yesterday, but he could not feel he is standing. What sort of exercise or stimulation we can do to awake these sleeping nerves ?

    I really appreciate SCI Nurse feedback. They are very informative. You mentioned Post-acute rehab program, what sort of therapy given in this post-acute rehab as compare to basic rehab program ? What you mean "can maximize return with intensive therapy"? Hendra is doing 1.5 hour OT and 1.5 hours PT daily. What sort of exercise he can do on his own during idle time.

    Anybody know any rehab therapist in this forum ?

    Best regards,
    Nett

  7. #7
    Unfortunately there is nothing we can do currently to make return occur, or to speed up return that is occuring on its own. See if they have a glider standing frame and see if they can start to use that. There is evidence that reciprocol movement of the legs along with the arms may improve outcome, although it is not a guarantee, and should not replace (only supplement) the other therapy he is getting currently. He should be talking to his therapists now about what he can do in his free time that is safe with his orthopedic restrictions, as well as effective in acheiving the current goals. It is unlikely that they will allow him to use equipment in the gym unsupervised due to safety and liability issues.

    A post-acute rehab program builds on the basic skills learned in the rehab program. It does not replace it, but builds on it. Most do not include nursing services, counseling or education about wellness, or other non-therapy services that are found at the acute program, and nearly all are outpatient programs. He needs to learn how to take care of himself now.

    You mentioned that he has flaccid paralysis in one leg. In order to use FES he must have either spastic paralysis or some voluntary movement. The fact that he is getting some return in thigh muscles it encouraging this early. Only time will tell if this return continues.

    (KLD)

  8. #8

    flaccid muscle

    SCI Nurse,

    Hendra has flaccid muscle on both legs. Is it common to have flaccid muscle just one month post-injury ? Dr. Young posted in other thread that flaccid muscle require special stimulator. Please inform what kind and where to get them.

    we can contract his front thigh muscle (left leg), and a little just above his right knee. SCI nurse suggest to use glider standing frame but there is none in this rehab center. Any other alternative method ? They tried to plank him up today.

    Please advise.

    Nett/hendra

  9. #9
    They tried to plank him up today
    I don't know what you mean by this. Did they put him into a regular standing frame or tilt table?

    Hopefully Dr. Young can provide more information about the e-stim. You might post that question on the Exercise and Recovery forum.

    With a cauda equina or conus injury, leg paralysis may stay flaccid. This is due to the damage to the lower motor neurons on the cord or to the cauda equina nerves, both of which supply the lower legs.

    (KLD)

  10. #10

    cauda equina

    SCI Nurse,

    If he has cauda equina or conus injury, does it mean he has better chance to recover and walk ? Any cure for this ? He can make his thigh muscle to contract but the muscle on his calves are very soft. I am trying to get the sensory and key muscle test they did on him and let you review.

    Best regards,
    Nett/hendra

    PS. Hendra is 36 years old.

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