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Thread: New movement for a moment

  1. #1
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    New movement for a moment

    Hi, my wife told me that while relaxing in the recliner (she had a quilt over her) she thought "hey i can "feel" my right leg, she said she knew exactly where her leg was in relation to her body and could feel it, but when she tried to move she could no longer feel it. She is a T11 Complete, severed cord, after about a year post injury she got these shhoting pains in her leg that occur if she gets adjatated or suprised. Thoughts.

  2. #2
    IKU - Your wife sounds as if she has some sensory preservation that allows her intermittent feelings of knowing where her leg is along with occasional pain sensations. Often an SCI is categorized as complete when there is no motor (movement) recovery and little sensory recovery for function. In other words, it is not truly completely damaged in all cases. Some sensory pathways still get through every now and then but the motor pathways remain disrupted. Our spinal cord nerves control movement, feelings of hot/cold, pain, pressure, and perception (where our body parts are in space).

    Dr Wise Young has posted before on the controversy surrounding the definition of complete versus incomplete SCI and the use of American Spinal Injury Association (ASIA) scales (5 levels: A-complete loss to E-no loss of motor or sensory function) to describe motor/sensory loss and preservation. It may be a little more of a response than you expected but here it is for clarification.

    Original Quote from Dr Wise Young:
    posted Aug 28, 2003 01:22 PM
    "There continues to be, in my opinion, misunderstanding about what the ASIA categories mean and even how they should be applied. The categorization was set up so that it can be applied unambiguously. The problem with previous definitions of complete and incomplete spinal cord injury was ambiguity.

    Before the ASIA definition of A category was set up in 1991, clinicians were rating completeness of spinal cord injury without clear criteria. For example, suppose that somebody had a C4/5 injury with initially no motor or sensory function at C6 or below. Over time, suppose that person recovers sensation down to C8 and get some patches of touch sensation or deep pressure sensation in the abdomen and even legs but does not recover anal sensation or voluntary sphincter contraction. By the way, this is very common. A majority of people with so-called "complete" spinal cord injury recover some function below the injury level and often more than two segments below the original injury level.

    Some clinicians would rate such a person as "complete" while others would rate the person as "incomplete". This was an inappropriate situation for a supposedly objective clinical descriptor for spinal cord injury. One possibility was deciding on a given number of levels below the injury site that would be required for a person to be called "incomplete". The ASIA Committee looked at this issue carefully and realized that any criterion other than the bottom-most segment would be arbitrary. As long as a person has a segment level, below which there was no motor or sensory function, that person would be called complete. Thus, this was how the ASIA definition of "complete" was made.

    After that criterion was established, several papers were published concerning the extent to which a person with an ASIA A classification would recover. It turns out that there was a statistically high significant difference between a person with an ASIA A classification and those with all other classifications. This of course does not mean that all people who are ASIA A will not recover anything below the injury. But, we knew this already. A certain percentage of people with so-called "complete" spinal cord injuries do recover.

    Recently John Ditunno and his colleagues (Burns, et al. 2003) published a paper that evaluated the conditions under which the ASIA A classification was less predictive. They found that 6.2% of people who were classified ASIA A converted to ASIA B but none exhibited motor recovery (ASIA C or D) by one week after injury.

    They identified several factors that influenced exam reliability and found that those patients who had these factors (which included such things as concomitant head injury) had a higher incidence, i.e. 9.3% chance, of conversion to ASIA B by 1 week after injury.

    What is very interesting is the proportion of patients who had factors that potentially affected exam reliability. About a third of other patients had such factors.

    At a year, 17.4% of patients with factors that affected reliability of the initial examination converted to incomplete and 13% converting to ASIA C or D. Patients without such factors had only a 6.7% chance of conversion to incomplete injury by one year and none converted to ASIA C or D.

    They concluded that it is possible to identify a subset of patients who have a negligible chance of motor recovery at one year after injury. As I pointed out earlier, many patients continue to recover more function up to 2 or more years after injury. Thus, the above statistics are conservative. The likelihood of a person who is initially classified as ASIA A converting to incomplete status by one year is quite high".

    PLG

  3. #3
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    Ok, what if anything does this mean? Is it possible for sensory to return and stay or could it remain intermitant?

  4. #4
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    FYI; Supposedly her first neurosurgeon claimed that he physically saw her cord severed. Although it does not show that on an MRI.

  5. #5
    IKU -- It sounds as if it has returned and it is intermittent. Does she have an appointment soon with her SCI doc? You could discuss what she is experiencing with him/her as well. PLG

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