|03-07-2002, 11:03 AM||#1|
Join Date: Sep 2001
How 'Perfect' Care Saved an Athlete
I realize that this is an older article - HOWEVER there is some GREAT ADVICE in here regarding treatment and care right from the get-go of a spinal cord injury!!!
I put smile faces by the GREAT ADVICE SECTIONS
How 'Perfect' Care Saved an Athlete
Reviewed by Dr. Craig H. Kliger
-- With less than two minutes left in the game, Ohio State's football team held a commanding 45-6 lead and was running out the clock. The ball was snapped and handed off to a 231-pound running back.
On the other side, freshman Penn State defensive back Adam Taliaferro, 18, saw that the play, an end sweep, was coming right at him.
"I knew he was a big back, so I decided that I was going to take his legs," Taliaferro remembers of the game last fall. "He was running at a slow pace, and then he sped up. My head was at the wrong place at the wrong time. His knee hit the top of my helmet, and snapped my head downward." And then, darkness.
At the stadium and on TV, tens of thousands of horrified fans watched the incident and its aftermath. Taliaferro awoke and opened his eyes, and saw doctors and trainers looming over him. He tried to get up, but his body didn't respond. He could move only his eyelids. As word spread that he might be paralyzed, people on the sidelines began to weep. But Taliaferro doesn't remember the collision. The last thing he recalls is locking the Buckeye bull in his crosshairs.
Every year, 10,000 Americans are partially or completely paralyzed by spinal cord injuries. An overwhelming majority (81%) are young men 15 to 33 years old injured in automobile crashes, acts of violence, or falls, according to the Spinal Cord Information Network. Sports accidents account for 7.1% of all spinal cord injuries.
There have been "miracle" recoveries, but the diagnosis of a spinal cord injury usually means life in a wheelchair. Fortunately for Taliaferro, doctors determined his spinal cord was bruised but not severed. Others aren't so lucky: For every Christopher Reeve, the actor who was paralyzed in a horseback riding accident and remains upbeat and sure that a cure is near (and has written twice to Taliaferro), thousands of others remain emotionally devastated by their injuries. But those who do spinal cord research -- work that was begun in earnest approximately two decades ago -- now say they see reason for hope.
"The whole system is doing better," says William E. Staas Jr., MD, president and medical director of Magee Rehabilitation Hospital in Philadelphia, where Taliaferro was treated after leaving Thomas Jefferson University Hospital. "The quality of recovery and life is much, much improved. And we will continue to make progress."
There is extensive research on therapies to help people with what are called "complete" injuries -- complete in that the person cannot function. Still, scientists like Naomi Kleitman, PhD, of the Miami Project To Cure Paralysis, say that while there is a lot of hope and even good preliminary results, nothing looks like a cure.
Some of the more intriguing research is on what are known as Schwann cells. These cells normally wrap around the individual nerve fibers of peripheral nerves that go out to innervate organs and muscles. They can regenerate but are not found in the spinal cord. Scientists are now experimenting with ways to place Schwann cells in damaged spinal cords so they might form a "bridge" over the injured site, possibly allowing the nerve fibers (long finger-like projections from nerve cells in the brain) to grow past the point of injury.
"There is a lot of promise there, but we are not doing it in people yet," Kleitman says. "This has to be done very carefully in the lab, to the point that we know we're ready to go to [human] use of it. We're discovering what our tools are, and trying as quickly as we can to bring it to clinical reality."
Most dramatic in the last decade has been the decreasing number of people suffering complete paralysis, and the parallel increase in those with "incomplete" injuries (resulting in some, but not all, loss of function). That shift, Kleitman says, in part reflects new thinking about how newly injured people should be treated.
"In 1980, people believed that the brain and spine were hopeless if injured," she says. "Since the early 1990s, the thinking has gone from, 'We can't do anything, so let's wait,' to 'If we stop the chain of injury, now they will do better.' Something we're doing is helping people get some [function] back."
What doctors have learned is that it's critical to immobilize the neck and reduce inflammation after an accident. The spinal cord -- a band of soft tissue running down the back, from the brain to above the buttocks, and about as thick as a thumb -- houses a network of nerve fibers that relays messages to and from the brain and peripheral structures. Protecting the cord are bones called vertebrae. A spinal cord injury occurs when these bones shift and crush the cord, damaging nerve fibers, or fracture and pierce the cord like shrapnel. The higher the injury (closer to the head), the more likely there may be loss of function. Immobilizing the neck at least ensures that an injury in that region -- which could result in quadriplegia -- won't get worse.
Once the neck is stabilized, the next step is to reduce inflammation. While inflammation is a normal part of the healing of tissues, unfortunately when it comes to the spinal cord, swelling does more initial damage than good, distorting the delicate and highly organized nerve tissue even further. In the early 1990s, doctors began using large doses of steroids to reduce such inflammation. Today, steroids are considered the standard of care.
"We've learned to meticulously care for the patient from the moment of injury," says Staas, who cared for Taliaferro. "With traumatic spinal cord injury, it's important to get steroids on board and stabilize the neck so that the partial [paralysis] doesn't become complete."
Lying on the field last Sept. 23, Taliaferro says he had no idea he was paralyzed. All he knew was that his body wasn't listening to him.
"I couldn't feel anything on my body," he says. "Everything was numb. I was trying to get up, and nothing was moving."
Taliaferro had fractured the fifth cervical vertebra near the base of the neck. Lucky for him, Wayne Sebastianelli, MD, Penn State's team doctor, knew exactly what to do. Within minutes of the accident, he immobilized Taliaferro's neck and body and got him into an ambulance, where the fallen football player immediately was given intravenous steroids.
"If we sat down and planned the perfect system of care, this man received it starting right on the football field," Staas tells WebMD. "Everything that should have happened in the ideal medical situation, he got and it worked."
Two days after the accident, Taliaferro had spinal fusion surgery. The prognosis was grim. One doctor told Taliaferro's father that the chance his son would walk again was 3 in 100. Taliaferro never heard those odds. He knew he was badly hurt, but never considered not walking again.
"I found out during rehabilitation that the prognosis was that I probably wasn't going to walk," he says. "Thank God that it worked out."
Weeks after the accident, Taliaferro was transferred to Magee. Although he couldn't move his limbs, Taliaferro could distinguish between sharp and dull, and knew which direction his toes were pointing. "That told us that certain parts of his spinal cord were working," Staas says. He put Taliaferro on a program to keep his joints from stiffening. When he regained movement, the program switched to muscle-strengthening exercises.
In January, four months after the harrowing accident, Taliaferro walked out of Magee on crutches. Today he walks without any aid, and spends four hours a day at Magee working on building his endurance and balance. He knows he will never play football again.
"I've recommended against it to him and his family," Staas says. "Emotionally, he's made that tradeoff of walking and not playing football."
Taliaferro hopes to return to the classroom this summer, and says his doctor has told him he might be driving soon. He plans his first visit back to Penn State on Feb. 23, to attend a basketball game. And while the football team's defensive coordinator already has promised him a role on the sidelines, Taliaferro has one more football-related goal.
"I'm working up to jogging so I can come up the tunnel for the first game," he says. "We play Miami that first game, and I'm looking forward to it."
Bob Calandra is a freelance writer whose work has appeared in several magazines, including People and Life. He lives in Glenside, Pa.